Monday, August 29, 2016

#29. We Demand Liberty and Justice For All

This is Day 29 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982.  (More info here.)  Today we are talking about Principle 29.

Principle 29 reads in full as follows:

We demand individual liberty and social justice for everyone.

The following paper was written to explain the connection between human rights and mental well-being to the public at large.  It makes clear the truth of this Principle:

No rights, no well being.  End of story.  

Human Rights and Mental Well-Being - Making the Connection  

"It's not just that human rights are important in mental health.  They are mental health.  People talk as if these are different concepts.  But in practice, principle and ultimate impact, they are one and the same. "

    --Sarah Knutson, Organizer, Wellness Recovery Human Rights Campaign

Most people have heard about the need for mental health recovery.  Very few have considered the need for ‘human rights recovery.’  Yet, they are inextricably intertwined.

Missing human rights can cause a lot of distress.  Think about what it’s like to be treated unfairly, go hungry, be thirsty, have nowhere safe to sleep at night or no meaningful way to make a living.   Think about what it’s like to be disrespected, hurt, called names, beaten up, pushed around, held somewhere you don’t want to be, or forced to do something you think is bad for you.

These kinds of things are highly distressing for most of us.  When human rights are violated or insecure, nobody does well.  We don’t have what we need to live and feel well.  Our survival is at risk in some important way – physically, emotionally, spiritually, socially…  We may even be literally fighting for our lives.

Our normal response when our rights feel threatened is anxiety and concern.  If nothing changes, this can grow into full-blown mental distress. A lot of time this is what people are talking about when they say “I have an anxiety disorder” or “I’m depressed.”

Intense, prolonged mental distress can lead to even more extreme states.   We can end up totally disconnected from ourselves, others and the communities we live in.  We can stop feeling like a part of things.  We can stop feeling human.  We can even stop feeling like living or being alive.
We may also stop caring how our actions affect others.  We may look for anything we can that deadens the pain. We may become so physically or emotionally reactive that we lose our capacity to think or be aware.  Once these things get set in motion, they may stay that way for a very long time.  We may get called “suicidal”, “borderline”, “addict”, “chronic”, “unmotivated”, “help-seeking”, “anti-social”  - or even “psychotic”, “psychopathic”, “delusional” or “schizophrenic.”

If that happens to us, it is important to look beyond the labels.  We need to remember that the root cause is not our “mental illness.” It is not our “addict nature.”  These are merely the predictable effects of pain and our subsequent attempt to cope.

The root cause is the insult to our humanity.  Something we needed was missing, disrespected, or threatened.  Yet, no one was there to help us.  Or maybe they tried, but things got worse instead of better.  Either way, we were on our own and continuing to fall.  Before long, we were in so deep that we didn’t know if we’d ever get out.  True, every so often a passerby might come along and poke their nose in our hole.  But, as soon as they saw how deep it was, they’d turn up  their nose and high-tail it on their way.

This kind of disconnection – both from things we need, as well as human beings -- undermines our confidence in life itself.  Neither the Universe nor those in it feel benevolent or worthy of trust.

Human Rights Recovery - Recovering Our Humanity

In Human Rights Recovery, we deliberately set out to reverse the injury to our humanity.  Since ignorance and ignoring human rights created the problem, we raise consciousness and respect for human rights as the solution.

We pay attention to the human rights quality of our relationships.  We support each other’s access to the opportunities that everyone needs to live, feel and be well. We reclaim our birthright as free and equal members of the human family.  We treat each other as people of reason and conscience, worthy of the same respect, dignity and rights as  everyone else.

We offer this freely.  We hold space for each other. We address issues as they come up instead of lowering our standards.  We don’t marginalize people who disagree with us.  We experience feeling seen and heard.  We experience seeing and hearing others.  We hold the same standards with the people we’re more and less fond of.

Everything else follows from there.  It’s about that simple.

  • It doesn’t cost a nickel.  
  • There is no higher law.  
  • No profession can license it. 
  • No corporation can patent, bottle or sell it.  
  • No Government can withdraw our funding.   
  • It only exists if we create it.  
  • We are never off the hook to ignore it.

Welcome to the human family.
Welcome home.

The human rights framework versus mental health treatment as usual

A lot of people mistakenly assume that 'good mental healthcare' and 'good human rights practice' are one in the same.  However, the human rights framework is radically different from mental health treatment as usual.

Mental health recovery is understood to be an individual issue:  A private problem develops.  The identified patient is expected to address it.  The obligation is on the individual to make progress and stop imposing their presumed pathology on unwilling others.

Human rights recovery challenges this worldview.  It argues that mental health, fundamentally, is a shared responsibility.  It stems from the quality of respect and support for human rights in the important relationships (e.g. family, school, work, neighborhood) that affect our lives.  When a human community fails to address these needs, injuries continue to mount. The first person to break down is only a harbinger of more wreckage to follow.

The human rights paradigm was articulated in 1948 to end this collective insanity.  Universal Declaration of Human Rights,   It arose in the wake of Nazi Germany,  with a global commitment to ‘never again.’ It is intended not only for nations, but for people everywhere.  It represents the consensus of the peoples of the world as to what human beings need in order to live and be well.  It helps us understand who we are - and how we need to treat each other - to create health and wellbeing instead of distress and disability.  It shows us how to recover our humanity as individuals, families, neighbors, co-workers and communities who affect each other deeply.

A Deeper Look at Human Rights 

“Human rights”, essentially, are socially agreed upon “human needs.” People worldwide have agreed that certain things are so important that human beings can’t, don’t and won’t usually function well without them. We call these things “human rights.”

Human rights include things as basic as access to clean water, breathable air, shelter, food, clothing, physical safety, healthcare, the means to make a living and support a family.  Human rights also acknowledge that human existence is more than material things.  We need to belong, form relationships and feel like a part of things.  We also need the freedom to be ourselves.  We want to explore, learn, develop and express our ideas, convictions, creativity and potential.

What Does This Have to do With ‘Recovery’ and Mental Health…? 

Almost everything! Human beings everywhere do best – physically, mentally, socially, spiritually - when we can count on certain basic needs being met. That’s why the human community has decided to recognize these needs as “human rights.”  No one does well without them.

When human rights are denied or overlooked, it’s bad for everyone.  We don’t have what we need to live well - or sometimes at all.  This triggers concern and anxiety in most of us.  If not addressed, it can grow into full-blown mental distress – like anxiety or depression.  It can also lead to mental and behavioral extremes.  This includes intense, prolonged ‘fight-flight-freeze’ responses that can disconnect us from ourselves, each other and the communities we live in.

When that happens, we definitely need to work on recovery.  But, not from an illness, brain disease or clinical diagnosis..  We need to recover our human rights!

The Human Rights Approach to Mental Health 

The human rights framework takes a deep and thoughtful look at human experiences that many people find difficult, confusing or troubling.  This includes phenomena that are currently labeled “mental illness” – things like mental distress, intensity, extreme feelings or moods, unique ideas or beliefs, loss of memory or awareness, and private realities, images, visions, voices, and tastes, smells or touch that others don't seem to experience.

Instead of labeling people as sick or ill, we take to human rights values to heart.  We see everyone as worthy of respect and dignity.  We see everyone as capable of reason and conscience.  We honor people’s right to think, see, believe and express themselves in ways that may seem strange or irrational to us.  Together, we ask:

  • How might such experiences make sense in terms of the physical, mental, social or moral human rights deprivations a person has endured? 
  • How can these deprivations be repaired? 
  • How might "illness" and "symptoms" change once human rights are restored and made secure? 

This approach is very different from jumping to judgment.  Instead of assuming we ‘know’ better, we ask what we can learn.  We engage in honest inquiry around areas of human difference.  We work to make sense of experiences rather than acting to suppress or exclude what we don’t understand.

Rinse, Repeat for Behavioral Health

We apply this same basic human rights approach to the difficult or confusing things that human beings sometimes do.  This includes behaviors that are commonly labelled "addictive", "self-harming" "unhealthy" or "anti-social."  Even if something is against the law – like drug use, violence, sexual trafficking or theft – we don’t simply stop at the conventional thinking that calls something  as ‘abusive’ or ‘criminal.’  Rather, we seek to understand the underlying human needs, concerns and social dynamics that have shaped its expression.

The human rights paradigm thus seeks to place important social concerns in a larger context of human experience.  It provides a straightforward, reasoned, ecumenical framework to understand much of what is happening in human hearts and minds.  It offers a way to orient ourselves, reflect deeply, and mine the information value of human differences.

The more we approach people in this way, the more we learn -- not only about others, but also about ourselves as human beings. We also discover - and come to deeply appreciate - the value of what we might otherwise have rejected or thrown away.  Much to our surprise, many of the rocks we used to trip on start to look like "gems in the rough."  it may take a long time, and some of us will choose to keep our edges.  But polished or unpolished, if you know what to look for, precious treasures we most certainly are.

But, It Can’t All Be Human Rights  …Right? 

If you’re asking this question,  you’re in good company.   In fact, there are a lot of questions we need to be asking.  For years now, we’ve been hearing that there is a ‘brain disease’ called ‘mental illness’ which results from a ‘chemical imbalance’ that only medication can help.  We’ve also been told that poverty, addiction, violence, and crime are primarily individual rather than community responsibilities. We frequently hear arguments, some of them ‘scientific’, that certain groups of people are irresponsible, anti-social or just plain ‘bad.’

So where do we draw the line?  How much can we explain in terms of personal, biological or moral short-comings?  How much can we attribute to the human rights quality of the communities we live in?

The problem is that we don’t really know…  Mental health professionals mostly focus on signs and symptoms.  But, these could easily be after-effects of human rights deprivations.

As a case in point, we now know that pre-existing childhood trauma (e.g., violence, sexual abuse, neglect, conflict, bullying, discrimination, poverty, homelessness, hunger) is a fact of life for as high as ninety (90!) percent of public mental health clients.  National Council Magazine (2011:2): Breaking the Silence: Trauma-Informed Behavioral Healthcare.  The same (90!) is true for those in substance use, criminal justice and hard to house contexts.  (Ibid.) Human rights deprivations like these can cause a lot of distress, which the body then expresses physically through the nervous system as ‘fight-flight-freeze.

So how do we tell if someone is ‘mentally ill’ versus being understandably traumatized by insecure or violated human rights?  For example:

  1. We currently call a lot of people manic, oppositional, defiant, borderline and antisocial - especially if the person is angry, intense or expressing something strongly.   But what if many of us are just fighting back or hanging on the best way we know how?  
  2. We often pathologize common expressions of fear and sadness, e.g., paranoia, panic, anxiety, depression, obsession, compulsion, addiction, avoidance.  But a lot of us actually have painful, terrifying, overwhelming problems that no one would want to face. 
  3. As a society, we have labeled and marginalized a lot of people as schizophrenic, psychotic, catatonic, dissociative,  disorganized...  But what if freezing off awareness - or creating a different one - is just what humans do sometimes in order to protect ourselves from further hurt?   

How many people is this?  No one has a clue.   The possible impact of human rights deprivation has been almost entirely overlooked!  People are still being treated and labeled as having primary ‘mental illness.’ Virtually no effort at all is made at all to assess for contributing human rights factors and assist people to resolve them.  

This is bad, irresponsible science.  It is also bad, irresponsible healthcare.  It needs to change.
Human rights concerns could be playing a huge role.  We need to find this out.  You can’t expect people to engage in treatment designed for illnesses they do not have.  You can’t expect people to progress when the system of ‘care’ ignores their real problems.

Reputable behavioral health researchers have an ethical duty to ask -- and answer -- these questions. So do providers of mental health services.

In the interim, we should seriously question our continued funding of diagnostic mental illness.  The existing research shows a high prevalence of  trauma among recipients of public mental health services.  Yet, at present we know very little about what this group wants and needs in the way of personally meaningful change.  This is not because they won’t tell us.  It is because no one has been asking.

A human rights approach would suggest that we start here.   There is good reason to believe that our public health funds would be much better spent in pursuing this inquiry, than on continuing the current mental illness course.  Society has been listening to providers for years, with little substantial gains to show for anyone’s efforts or public health dollars.  We therefore clearly have much to learn.  This includes not only what didn’t work, but also, moving  forward, with what might, could or would, from a service recipient’s point of view, be reparative or helpful.

Some might call this unscientific.  They favor a science of experts that studies people as objects and reports about us without us.

In the human rights view, this is not science.  It is a violation.  It denies rights and dignity.  It ignores the principles of equality, autonomy, voice, and self-determination.  It causes the same kind of social injuries that many of us are trying to recover from.

It represents a mental illness of societal proportion.  It defers the responsibility of personal reason and conscience to experts.  It legitimates the few to substitute their judgement for the many.  It sits back and complains and sulks when they get it wrong (they inevitably do).

Mistaking this abdication of human responsibility for science is delusion.  Allowing it to continue to the detriment of all is madness.  

Human Rights Assessment

How do we put these principles into practice? Here are some concrete suggestions:

Study the situation (evaluation):   

There is a good chance our distress is coming from somewhere.  Human rights and mental distress are closely connected. Nobody feels well when their human rights are at ignored, violated or at risk.

Ask the right questions (assessment). 

  • How are we and others being treated?  
  • Are everyone’s human rights present and accounted for? 
  • Do all important needs feel safe and secure - to  us?  to others?
  • Have they always felt safe and secure - to  us?  to others?
  • If not, what impact has this had  - on self? on others?
  • How are human rights concerns affecting what is happening right now?
  • Is something needed to restore human rights?

If anyone’s human rights are missing, the situation is not ‘well’.

Clarify the problem (diagnosis).  

Get to the heart of the matter.

  • What rights are missing? List the rights. 
  • What ways are people being harmed by this.  List the harms.
  • Make a plan to fix it (treatment).  
  • How can rights be restored?  List possible solutions.
  • How can harms be repaired?  List amends needed.

Notice that the plan is not about “fixing ourselves”.  The plan is about fixing the situation.  The thing we are “fixing” is human rights.

Take action to recover rights (recovery).  

  • List the actions that need to be taken.
  • Steps to restore or recover rights that were missing (list them): _____________________________

  • Steps to repair any damage or injuries -- physical, emotional, spiritual, social, etc. (list them):  _________________________________________________________________________ The reparations need to fit the person, the injury and the meaning of the injury in the context in which it occurred.  Sometimes a sincere apology is all that is required.  Sometimes mere apology is unthinkably inadequate. It just depends...

Remember, this is not mental health recovery. The focus is not on ‘fixing’ our heads.  This is human rights recovery.  The focus is changing the situation.  Any changes we make should respect each other’s human rights.  This is how we recover human rights.

September 29, 2016:  Conference on Principle 29 

We will talk about Principle 29, including your responses, on September 29 from 9-11 PM EST.  Call in number TBA.

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