For me, the issue of force in psychiatry basically boils down this: In our deepest darkest hour, do we deserve the dignity of conscience?
To answer this question I think we have to decide what we believe, at core, is the nature of human nature. In other words, in our experience of ourselves and others, are human beings basically just selfish, self-interested, pleasure-seeking, profit-making machines…? Are we and others really mostly driven by material comfort, and quite happy to satisfy our own needs without regard to the cost to others?
If so, then force and coercion are probably our best bet. They’ll probably achieve the greatest good for the greatest number. They’ll make sure nobody steps too far out of line, and they’ll yank us back in when we do. They’ll communicate clear reward and clear consequences for the essential psychopathic nature in all of us.
Even better yet, if this is our true nature – if we really are nothing more than skin, bone and Pavlov’s estimation of his dogs – then force and coercion should work. We should get better rather than worse with such a rational, straight-forward, reward-punishment approach to our existence.
On the other hand, if we believe in the human spirit – in the beauty and dignity of every person … if we believe that we all have a conscience and deeply held beliefs and values and something to contribute of great value that is different from any other human being on this planet - then the damage we are doing to each other by force and coercion is beyond comprehension. In this latter context, these are the last things we would want to do to other human beings in the deepest, darkest hours that all of us will at some point face. Such approaches are the least helpful, most hurtful, most likely to make things worse rather than succeed – both short and long term -- than practically anything else we could come up with in good faith.
Here’s another thing to think about: The former view of humanity is really ideally suited to the modern business world. There, the values and priorities are for people who shut down their values, initiative and dreams. The most important task is to fit into the cog of the corporate wheel and conform your will to industry needs during the 8+ hour day.
The latter view of humanity is basically the human rights model: The human rights model goes to great lengths to protect the personhood of every one of us. It says we are all equal in dignity and rights. We are all endowed with reason and conscience. It holds space for us all as people with potential. It believes in and values the unique contributions that we were all born into this world in order to make. Universal Declaration of Human Rights, http://www.un.org/en/universal-declaration-human-rights/
The critical difference between the business model and the human rights model is how we respond when someone gets uncomfortable. In the face of human discomfort, conventional mental health basically operates on the business model of human beings. Whether the discomfort is our own or that of someone else, conventional mental health steps in and supports the expectations of the established social order. In effect, it says:
You might have had a right to dignity, to draw your own conclusions (reason), to make your own decisions, and to operate based on your own values (conscience) before, but now you have made other people uncomfortable. So, from here on out, we’re going to police that. When you stop making everyone so uncomfortable, we’ll give you back as much dignity and freedom as we feel you can safely handle. The choice is yours. You keep making us uncomfortable and we’ll keep your rights forever. You start acting in ways that reassure us that you're on board, we’ll dole your rights back incrementally and see how you do. Until then, however, we're the guardians of your personhood. If you want to exercise it, you need to come to us first.
In other words, the mental health system essentially operates on the assumption that rights are relative: Rights are conditionally allowed based on demonstrated ability to conform to established social norms. If the ability to do this comes into doubt, rights may be withdrawn by experts who presume to know what is best for the person and society at large.
The human rights view is very different. It fundamentally respects the dignity, perceptions, understandings and values of every human being on an equal basis with all others. In the face of discomfort or human differences, it tries to start an honest conversation: I feel uncomfortable. I’m not sure what is going on here. I’m not sure if it’s you, me or something different altogether. Can we talk..?
The human rights perspective assumes people are doing things -even very uncomfortable things - for some good reason that makes sense to them. It doesn’t automatically assume that one person’s reasoning is better than another. It doesn't automatically assume that the way things have always been done is the best way. It doesn’t automatically assume that there is a right way to think or act in a given situation.
Rather, the human rights perspective supports people to make sense of their differences and the human needs, values and perspectives that underlie them. Thus, it tries to understand why those involved are feeling what they are feeling and responding the way they are responding. It tries to understand the outcomes they value and the life experiences that make them seem important. It tries to understand logical connections and the reasons people believe in the choices they are making in the moment.
In other words, instead of stripping people of their right to dignity, reason and conscience, the human rights perspective affirms people’s dignity. It supports all concerned to express their concerns, maximize their rational capacities and to realize their deepest values. It helps those involved to make sense of what is happening, to get in touch with what they care about the most, and to find a way to proceed with due regard for the personhood of all concerned.
Instead of picking winners and losers or substituting the judgment of so-called experts, the human rights approach supports those involved to regard each other as persons and negotiate concerns in good faith. Instead of shutting down inquiry, the human rights approach supports people to create new knowledge. Instead of shutting down conflict and discomfort, the human rights approach supports people to navigate it and learn from it.
In other words, the human rights approach is about supporting us to develop our full potential - as individuals, family members, friends, neighbors and community members. The role of helpers is to support people to regard each other as valued members of a human community - and to reach a greater understanding and appreciation of the needs and experiences of all.
The conventional mental health approach is about shutting down discomfort and keeping business operating smoothly.
I don't know about you. But, in my world, there are far too many widgets and far too little humanity. I'd like to see a mental health system that - instead of rotely producing more and more of the same stuff nobody really needs - actually contributed to something that felt like human development.
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Join us for a free online series of conversations to explore and envision alternatives to the medical model and conventional mental health responses.
Monday 7-9 PM EST: Conscience, Not Coercion - Respecting self-determination when needs conflict and discomfort rises.
Tuesday 7-9 PM EST: Facing Life Instead of 'Treating' It - The high cost of psychiatry on our collective social development
Wednesday 7-9 PM EST: Adaptive vs. Broken Biology - How the human survival response explains away 'mental illness'
Thursday 7-9 PM EST: In Our Deepest Darkest Hours - Why authentic relationship must become part of the solution
Friday 7-9 PM EST: Conflict Revolution: Getting beyond shutting each other up and shouting each other down
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