#24. No One is Free Unless We're All Free

This is Day 24 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 24.

Principle 24 reads in full as follows:

We believe that so long as one individual's freedom is unjustly restricted no one is truly free.

Basic Rationale

This principle is a litmus test.  The test is about which paradigm - which worldview of human relations - we identify with the most.  If I'm in the self-interest, free market, business as usual paradigm, this Principle makes no sense.  In the business as usual paradigm, What does it matter if you're not free?  I'm free and that's what counts.  

In the business as usual paradigm, the only way it matters to me if you're not free is if what happened to you could happen to me.  So long as I can rationally distinguish you from me, I'm free to keep doing what I'm doing how I'm doing it.  No problem for me, too bad for you. My focus is self-interest, and under the business as usual paradigm I'm free to exploit that to my heart's content.  After all, that's what the free market, competition and capitalism are all about.

All good -- as long as I'm getting what I personally want & need.  All good -- as long as I'm pretty sure I can keep what happened to you from happening to me.  All good  -- as long as I can see you as different enough from me that I can keep your fate separate from my fate both mentally and materially.  All good -- as long as I don't have to worry that you'll drag me down or suck me into the vortex that sucked up you.

In this business as usual paradigm, we worship human successes and despise human failures.  We distance ourselves from misfortune and loss and the possibility that it could ever happen to us.  We shun vulnerability, align ourselves with the fortunate, compete for opportunities, and grade our own efforts and those of others based on our relative successes at achieving these aims.

If all of this seems pretty 'normal' and kind of like 'duhhh', then it just goes to show how much we've internalized the business model (think corporations and industry) of human relations.  In the business of human relations, our safety and survival - physical, emotional, social - all depend on how much power and privilege, relative to others, that we can secrete for ourselves and how securely we can maintain it.  We compete with each other, trying to get as much power and privilege as we can amass. We amass as much wealth, power and privilege as we are able to access.  We get to use our power and privilege in any lawful way we want (as well as a lot of unlawful ways so long as we have enough power and privilege to insulate ourselves from the consequences).

It's a high price to pay.  Unbearably high, when you really think about it.  

Human beings in this profit-centric relational paradigm have no affirmative obligation to each other. We're basically free to wheel and deal in any way that gets us the best deal. Beyond bare legal minimums, there is no requirement to think about the consequences of our actions on others.  If you get a good deal and I don't, that's your good fortune and my tough luck.  If you become a millionaire and I freeze to death in a cardboard box, that's still your good fortune & my tough luck.

The boundaries (rights) of this profit-centric world are basically set by power and privilege.  They protect the power and privilege that some have managed to amass or acquire - even when it means that the needs of massive numbers of human others will be thwarted or outright unmet.

The problem is, no one really wants to go home to that model.  It's actually not a way of thinking about human relationships that anyone ever feels safe with.  In the profiteering industry model, no one has your back.  The world is forever dog eat dog.  A momentary lapse of attention or performance, and - guess what? - you're toast...

The consequences of this way of social operating are a boatload of anxiety and insecurity all around. Everyone, everywhere, is naturally nervous about their fate and their future.

We should be.  

The fact of the matter is that life lived from this worldview is lonely, isolated, cut off from the best of what life has to offer - the consideration, kindness, authentic connection, generosity of spirit that potentially abound in our species. Instead, we devolve to our lowest common denominator.  Self-interest rules the day.  Beneath the rhetoric of social progress, it's basically just the same old the law of the wild and predator-prey.  Looking out for each other is the exception, the aberration, an unexpected grace.

I suspect this is not the world that most of us want to live in.   More than likely, the longing most of us have is for the possible world of grace and graciousness, rather than our current world where conniving, unscrupulosity and the ever present need to 'be on guard' rule the day.  A lot of us - perhaps all of us - would be more than willing to be there for others if only we knew, really knew, that others would have our backs too in meaningful significant ways.  But since, in modern society, this latter feels really out of the question, we mostly just keep slogging along in paradigm #1.

All in all, it's a quiet despair.  We mostly put it out of our minds and distract from the nagging, unacknowledged background noise that disturbs the surface certainty we would vastly prefer to gloss over.  

Despite the boatloads of propaganda telling us this is the only possible world, however, it really doesn't have to be this way.  In 1948, in the aftermath of World War II, the peoples of the world took a hard look at this way of operating. They concluded it was a dead end, and they proposed something radically different.  In the Universal Declaration of Human Rights, they proposed a new world order where we protect not power and privilege, but rather each other's access to basic human needs.

The basic concept of human 'rights' really is indistinguishable from what the mental health system calls 'boundaries'. The major difference is that, with human rights, you focus on protecting the universal human needs of the people you say you are serving, rather than the provider's privilege to go home and sleep at night while totally ignoring them. In other words, like boundaries, human rights are designed to protect human beings.  But unlike mental health boundaries, they're not primarily concerned with protecting human self interest.  Rather, they protect both individuals and communities from the fear, vulnerability and outright bad behavior that result when people anywhere get scared their basic needs won't be met.

Here are the core principles:

The Human Rights Model  

1. There are certain things (food, housing, freedom, fairness, material and emotional safety, respect, dignity, voice, the means to make a living and support a family) that every human being needs in order to live and be well. 

2. No one does well without these things. 

3. If we want a world where human beings treat each other well, then we must protect people's access to the basic things that every human being needs in order to live and be well. 

4. Protecting this access is the function of human rights. 

5. Human rights, in effect, establish a boundary that begins and ends with the personhood of every human being. 

6. These boundaries endeavor to protect everyone's access to basic human needs.

7. Such boundaries (rights) insure that no human being is deprived of access to the basic resources that all human beings need in order to live and be well.

8.  If we want to prevent social ills - including the mental distress, strained relationships, social ill-will that so often precede them - then we have to promote human rights. 

Accordingly, in a human rights informed world, protecting access to essential life supports is the obligation of everyone.  Thus, instead of prioritizing power, privilege and the rights of individuals to exclusive enjoyment irregardless of the harms or deprivations suffered by others, the human rights model protects access for all of us to the life essentials that none of us can live or do well without.

In the human rights model, these protections (rights) are shared by all.  They represent a common trust, a precious resource, a survival element that all of us require.  The capacity of our communities to ensure a fair and just allocation of these precious resources determines how we feel about each other.  This in turn, impacts the quality of the social relations and collective good will we collectively create.  When there is not enough to go around, the requisite access to resources is negotiated thoughtfully, respectfully, between human equals as a matters of fairness, principle and conscience.  It is not - as in the business/ corporation/ self-interest model - yanked unilaterally by moguls of might.

Thus, in the human rights paradigm, the freedom of the one is inextricably intertwined with the freedom of all.  The shared recognition is that our inherent nature, right, is to be dignified and free.   Instead of insulating ourselves with petty divisions, we align ourselves based on shared and universal needs. Protecting the freedom of one and all is a shared endeavor and responsibility.

In a human rights-informed world, it makes perfect sense that the unfreedom of one of us is a threat to all of us. None of us is free - or fed, or respected, or housed, or treated fairly, or heard, or valued, or believed - unless we all are.  We simply can't afford the ill will or the collective insecurity that sacrificing a single individual's needs on the alter of public expedience will create.   We rise and fall together.  Our social welfare and collective good will rises and falls together.  The future of our people and of our kind rises and falls together.

This is totally different from the business profit model.  Rather than being about self-promotion or self-interest, the human rights model is really about something in the nature of kith and kindred bonds.  It is about our legacy - our birthright - as members of a human family.  It is about being seen - and about seeing each other - as allies of worth, dignity, reason and conscience with whom we can learn, grow and make a life together.  

That is what we are allowing psychiatry - and all of conventional society with all of conventional business as usual - to rob us of each day.  Our birthright - as equal, valued members of a human family - is being stolen from us every minute that we continue to put up with it.

Suffice it to say, there are two basic choices to make these days. We can stand with each other in our ordinary, flawed, vulnerable humanity or we can stand with power and privilege and all the deniability and obfuscation of limitation that good PR marketing can buy. The former is about living into a vision of a human rights-informed world, where we all matter and are seen as having something worthwhile to contribute. The latter is about perpetuating the business of marketing exploitation as usual (people, the environment, whatever else is sale-able).

The major requirement for change is an investment of heart and will.  It is about deciding to do differently.  Deciding.  A simple decision, each day, that as much as possible we are in this together. As much as possible, we will stand with each other. As much as possible, we will have each other's backs and treat each other like family.   As much as possible, there will be no 'others' whom it is ok to treat as less than worthy of accessing the basic resources that every human being needs to live and be well.

Not today, not ever. Not on our watch.  As much as possible. Day by day.  One person, one interaction, one conversation at a time.

Questions for Reflection

We are building this work together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. How do you relate to this principle?

2.  How do you see it applying you life?

3. Have you ever been unfree when others around you were free?  

4. How did you want them as people of conscience to respond to the gap between your rights and theirs...?

Semptember 24, 2016:  Conference on Principle 24

We will talk about Principle 24, including your responses, on September 24 from 9-11  PM EST.  Call-in details to be announced soon. 

#23. Criminal Psychiatry: Medicine By & For Social Predators

This is Day 23 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 23.

Principle 23 reads in full as follows:

We believe that there should be no involuntary psychiatric interventions in prisons and that the prison system should be reformed and humanized.

You could hardly find a better fit if you looked for it.  By all appearances, the psychiatric industry was ready made for prisons.  Medicine without conscience commissioned to control citizens presumed to be without conscience.  Licensed psychological predators supervising alleged misanthropic predators.  Socially approved opportunists engaged to neutralize socially disapproved opportunists.  The psychopaths of science assigned to chaperone the psychopaths of culture.

Yep, the ironies never cease to abound.

Here's what I believe is the definitive paper on these issues thus far:

A Discussion Paper on Policy Issues at the Intersection of the Mental Health System and the Prison System 

-by Daniel Hazen and Tina Minkowitz, Center for the Human Rights of Users and Survivors of Psychiatry

(originally published at https://wgwnusp2013.wordpress.com/prison-system/)

1. Debunking the Myth: Prevalence of Psychosocial Disability in Prison – What Does It Mean?

It has become a commonplace of mental health advocates and criminal justice advocates, often without lived experience of incarceration in either system, to point to high numbers of people with mental health problems in prison, and argue for increasing transfer of direct control and supervision of such individuals to the mental health system.

We contest the implied assumption that the presence of people with mental health problems in prison is inherently shocking or problematic, as well as the recommendation of greater involvement of the medical-psychiatric system in social control as a response to this situation.

Given the traumatic backgrounds of people who end up in prison and the relationship of trauma to mental health problems, the prevalence of mental health problems by any measures should not be surprising. Trauma may be common among prisoners for reasons including discrimination in access to justice, discrimination in the definition of crime and in the establishment of penalties for
different crimes, as well as factors influencing the commission of criminal acts.

The gathering of information on mental health problems, whether by self-reporting or diagnosis, may change over time for reasons unrelated to people’s experience of distress. Diagnostic trends in particular change with the fluctuation of DSM/ ICD categories, and with the attention placed on mental health issues by authorities.

Given the traumatizing nature of prison – deprivation of freedom, toxic environment, bad food, strip searches, etc. – people inevitably experience distress and altered consciousness that can be labeled as mental health problems. The traumatizing nature of prison can been encapsulated in the degrading entry procedure, described from experience of a U.S. prison:

“Walking into a system where you are being given a number that becomes
your identification. A barber shaves your head, they have you strip your
clothes off and de-lice you, dropping this powder. There are 50 men in
this line. It has a humiliating, degrading, punishing effect immediately.
How trauma-insensitive that is, the anxiety that drives through your body is
incredible. It reminded me of the concentration camps. They say that
Germany was so bad but we’re doing the same thing. They call it
rehabilitation – they break you and rebuild you.”

The number of people labeled with mental health problems in prison is sometimes compared with declining numbers in psychiatric institutions, as if to argue that the psychiatric system by failing to confine people with psychosocial disabilities is creating the conditions for these individuals to commit crimes and be incarcerated in the prison system. It is a tautology that incarceration of any
demographic would stop those individuals from committing crimes. Human rights principles do not permit profiling and preventive detention based on psychosocial disability, any more than they would permit profiling and preventive detention based on race, gender or age. To the extent that the mental health system has been placed in the role of public safety official, with legal duties to confine individuals based on risk assessment of any kind, this is incompatible with the duty to serve the individual client and must be removed in order that the mental health profession may be able to comply with its human rights obligations.

Moreover, mental health treatment is far from being foolproof, reliable or safe. Expansion of mental health treatment, even when community-based, has not resulted in decrease of mental health problems, but rather in an upsurge, iatrogenic problems in both physical health and mental health, and enforced dependency on mental health providers for services that maintain individuals in
poverty and segregation.

2. Mental Health System is Coerced Compliance – Not a True Alternative to Prison

A. Diversion into Coerced Medical Disablement is Not a Viable Alternative to Incarceration

Diversion from the court system to coerced mental health treatment is also proceeding apace. “Mental health courts” in the U.S., although participation in them is voluntary at the outset, induct individuals into coerced compliance with treatment, in exchange for suspension of prison sentence. A guilty plea is required, and compliance with treatment is supervised by the court, with the possibility of a prison/ jail sentence being imposed if compliance is not deemed adequate.

In Japan, a preventive detention law for people with mental disabilities went into effect in 2005. Under this law, a person accused of a crime and deemed by the court to have a mental disability can be diverted from a trial of their guilt or innocence, to a hearing before a mental health tribunal to determine whether civil commitment should be imposed. This means that a person labeled with mental disability is denied the right to be considered innocent until proven guilty, and unlike all other criminal suspects can have detention imposed without proof of having committed the crime. Unlike the U.S. mental health courts, this diversion is not voluntary but is decided by the court.

The use of diversion schemes has been promoted as an alternative to the punitive sentences imposed by the “criminal justice” system, however we cannot consider it in any way an acceptable alternative, particularly when there are penalties for noncompliance with the prescribed treatment. Mental health treatment appears to many people to be beneficial to all concerned, to society as well as to the person accused of crime. But when the mental health system is made to do the duty of public safety official, it promotes neither public safety nor mental health. Irreparable harm is done by the coerced ingestion of mind-numbing drugs (the main modality of forced treatment), and by the narrative of incapability that removes a person from responsibility for, and confidence in, making deliberate choices to shape his/her own life.

Proponents of restorative justice, and of any theory of justice that supports re-integration, need to consider the implications of the social model of disability for their work, and to go deeper in imagining systems of accountability that respect human dignity. Coerced mental health treatment of people accused or convicted of crime is not restorative, and it does not contribute to meaningful re-integration.

It is furthermore a form of discriminatory violence that fits the criteria for torture and ill-treatment.

B. Double Discrimination Against People with Psychosocial Disabilities in Prison. 

People with psychosocial disabilities in prison experience double discrimination.

In some U.S. jurisdictions a person who has been given a psychiatric diagnosis is not eligible for programs with early leave such as work release and military style or modeled shock camps – 6 months of military style discipline and training after which the remainder is served on parole. (This blatant discrimination extends also to people with physical disabilities, for example if a person is unable to run with their legs.) Men and women with psychiatric diagnoses who have physical illnesses such as cancer or diabetes are often not treated for the physical illness which is explained as a psychiatric symptom.

In addition, state systems have access to past records. Due to having received a psychiatric label/diagnosis in the past, upon entry into the prison/penal system, a person can be placed in solitary confinement until being “seen” or evaluated by a mental health professional. This takes place in a segregated part of the prison, not the general population.

Forced drugging and confinement in a psychiatric unit within a prison can be similar to the way it’s done in psychiatric institutions, but double discrimination emphasizes a person’s status as being under the control of others.

“I felt, here I am a prisoner and mental patient. Those two things together left me with no liberty. I felt if I was captured by one, I could escape. Why would a judge listen to me not to medicate me, here I am a prisoner found guilty by judge and jury, there’s no way I’m going to win a medication hearing or a retention hearing. The hearing was very short, about a minute. The psychiatrist said, “You need to take this,” and that was it, bye, they send you back.

“There’s no access to a lawyer in the penal system for psychiatric things. No access to a phone. The culture inside prison is often controlled by gang activity, underground crime. There are a lot less phones in the psychiatric piece than in regular prison – 120 prisoners inside the psych hospital in prison, and two phones. You can’t get to the phone. And you have to be in programs all day.

“In the hospital they call you by name and not a number. You think you’re a person again in the psych ward and not in prison. My thing was, you’re getting out of one cage to be in another. This one’s shinier, more buttons… but that doesn’t make it not a cage.”

3. Accountability

A. Insanity Defense is Counter-Productive

Behind the schemes to divert people from courts and prisons into the mental health system lies a belief that people with psychosocial disabilities do not belong in a penal system, but instead need medical treatment in order to not re-offend. The traditional penal system objectives of retribution and deterrence are seen as inapplicable to people with psychosocial disabilities, who are considered uniquely unable to control their actions. The remaining objectives of incapacitation and rehabilitation (primarily in the form of compulsory medication and other incapacitating treatments) are intensified.

This is seen most clearly in the operation of the insanity defense and its equivalents in every legal system. This defense – that a person is not guilty, or cannot have responsibility imputed for a crime, because of his/her mental state at the time the crime was committed – is considered a pillar of our legal systems and a sacred right of defendants. At some times and in some places, where the objectives of retribution and deterrence were primary, it may have operated to allow people to avoid punishment that was seen as unfair given the circumstances.

However, ordinarily a verdict of insanity results in psychiatric rather than penal incarceration (and the Standard Minimum Rules on the Treatment of Prisoners so provide, in Rule 82). Whether it is labeled as punishment or treatment, the deprivation of liberty, lack of privacy, having one’s daily life controlled by authorities, assaults on personal dignity and integrity from strip searches to forced medication have substantially similar effects on people in both institutions. Both institutions promote a negative self-image and submitting to authorities rather than seeking internal self-justification and conscience.

There is, furthermore, an overlap between the two systems that discloses their underlying unity. Despite the label of “treatment,” the mental health system administers a wide range of punitive measures. These include “steps” or “levels” of increasing control, “privileges”, and the imposition of coercive regimes in response to “failure to comply with prescribed treatment”. Rehabilitation in prison, when imposed coercively, is substantially similar to forced mental health treatment (e.g. programs like “DARK”, psychological intervention, coercion to attend self-help groups, and programs to “correct the personality”).

The CRPD takes an opposite approach to responsibility of persons with disabilities for their own actions. Article 12, Equal Recognition Before the Law, provides that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life. Legal capacity implies both rights and responsibilities, and “all aspects of life” can encompass criminal as well as civil matters. As the Office of the High Commissioner for Human Rights has said, this requires abolition of the insanity defense and its replacement by disability-neutral concepts such as the subjective element of a crime (mens rea).

B. Community Responsibility and Support

Article 12 also provides that States Parties must provide access to the support needed by persons with disabilities in exercising their legal capacity. The Committee on the Rights of Persons with Disabilities has clarified that support “respects the autonomy, will and preferences of the person,” and that States Parties must replace all substituted decision-making schemes with support.

What might support look like in relation to crime and punishment?

It could start with community members taking responsibility to help avoid the commission of a crime and defuse conflict situations. Two examples:

“I was in the Apple Store and saw a kid bend down and took some
hardware or software for IPad, he ripped open the box and put it in his
sleeve. I had two choices – I could tell the staff, assumed he was going to
steal, maybe he was testing the staff. I said to him, ‘What you got there?’
He put it back and didn’t take it.”

“One gentleman was camped out in his parents’ backyard. The county
mental health director called me [as head of a peer advocacy center],
didn’t want to call police, didn’t want to go through routine, asked if we
would go over. The guy didn’t want respite, didn’t want any government
thing. He didn’t get locked up that I know of, and moved off his parents’
porch.”

These examples might also be understood in a restorative justice framework, and there is a great deal of congruency between the values of restorative justice and the social model of disability as enunciated in the CRPD. Both promote intersubjective and relational .
processes for arriving at decisions, respect for individual dignity and the equality of persons, autonomy, and reliance on community members rather than the state. Both encourage personal accountability and responsibility as a manifestation of mutual respect. Both encourage a holistic and big picture approach to justice, which is simultaneously grounded in lived experience: what do participants need, what is lacking (or over-present) in our social and economic system that impacts on the current situation, what is crime and what should be criminalized?

The prison reform and abolition movement, particularly including current and former prisoners, have a significant role to play in developing guidance and policy and in sharing their experience and wisdom with the community. Prisoners with psychosocial  disabilities especially need to be consulted. This is a part of “re-integration” that is often overlooked.

The CRPD framework, restorative approaches to justice, and prison reform/abolition need to inform each other so as to transform our communities to promote social and individual healing, self-determination and mutual respect and accountability, for all people including people with disabilities. We need to reject one-sided approaches that either fail to address disability, or that address it from
a medical model rather than social model perspective leading to increased discrimination. We need to fundamentally change both the legal framework for civil and criminal responsibility, and the relationship of responsibility to the law itself. We need to simultaneously build the capabilities of communities and ensure that the law reflects and enforces values of fairness, equality, freedom
from torture and de-escalation of violence. The scope of the task should not overwhelm us, but inspire us to begin.

References:

Kay Pranis, Restorative values, in Gerry Johnstone and Daniel W. Van Ness,
eds., Handbook of Restorative Justice (2007).

Wanda D. McCaslin, ed., Justice as Healing: Indigenous Ways (2005).

James J. R. Guest, Aboriginal Legal Theory and Restorative Justice, in Wanda
D. McCaslin, ed., Justice as Healing: Indigenous Ways (2005).

Tina Minkowitz, The Paradigm of Supported Decision-Making, presented at
Eötvos Loránd University, Bárczi Gustáv Faculty of Special Education, Budapest,
November 30, 2006.

Intentional Peer Support, http://www.mentalhealthpeers.com.

Center for the Human Rights of Users and Survivors of Psychiatry,
http://www.chrusp.org

Questions for Reflection

We are building this work together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. Have you ever experienced prison psychiatry?   

2. What would you like people of conscience to know about your experience?  

3. What do you see as the connection, if any, between legal and mental health concerns?

4. How could a society of conscience address these connections in an effective, principled manner?

5. If we were more interested in prevention than punishment, what would we be doing differently?

August 23, 2016:  Conference on Principle 23 

We will talk about Principle 23, including your responses, on September 23 from 9-11  PM EST.  (Call-in number/ contact information to be announced shortly.)

#22. 'Expert' Witlesses - Psychiatric Perversion of Justice and Due Process

This is Day 22 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 22.

Principle 22 reads in full as follows:

We believe that persons charged with crimes should be tried for their alleged criminal acts with due  process of law, and that psychiatric professionals should not be given expert-witness status in criminal proceedings or courts of law. 

Basic Rationale

Psychiatric perversion of the legal system must end. Psychiatry confounds rather than advances the cause of justice.  Mental health professionals are no better at predicting dangerousness to self or others than a toss of a coin. They are no better at judging intentions or motivations than anyone else. Their processes and methods are inherently subjective, power-imbalanced, self-indulgent and self-serving.

In actuality, the opinions of psychiatry carry weight not because of the factual accuracy, but because of the social power of their position.  At most, their function is to let the decision makers with real responsibility off the hook. They function as a socially-approved Nuremberg defense for judges and jurors to pass the buck and rely on a socially designated ‘expert’ authority.  Psychiatry should not be letting the proper socially-designated decision-makers off the hook, nor should it be usurping or undermining their rightful power.

This is a travesty of justice that must be ended. There is no reason that judges, law enforcement and ordinary citizens cannot do as well on their own.  These issues are necessarily difficult.  No human being - however experienced - is flawless at predicting the future.  Some things simply cannot be known in advance by human beings.  This, in fact, is the basic point of the protection against preemptive detention that is written into the bulk of our law.

Indeed, everywhere but psychiatry, people have to actually commit a crime - or engage in substantial preparation to do so - before they can be charged, arrested or detained.  Everywhere else but psychiatry, someone else's say so that you scare them or that they are afraid for you - without more - is not enough.  You have to actually do stuff or seriously threaten it - not just think or talk about it.  

Moreover, the stuff you do - and the way you go about it - has to violate an existing law that is already out there in the codes.  Even then, if the authorities want to keep you, they actually have to write up charges - listing exactly what you did and why it was wrong.  You also get a right to stay silent, to bail, to a timely hearing, to confront your accusers, to call witnesses on your behalf, to have an attorney help you with your defense.  All of this you get in regular court, but not in the farcical psychiatry-infested parallel proceedings that only apply to people who psychiatry has gotten to first and labeled 'mentally ill'. 

Here is another point to consider:  Analytically speaking, the proper party to investigate and evaluate public safety concerns (if any) is law enforcement, not psychiatry.  Law enforcement holds the societally-designated public safety role.  Public safety is the defined responsibility of law enforcement, as well as the specific role for which law enforcement has been employed.  As such, law enforcement is far better positioned - and potentially far more experienced and reliable - than psychiatry for getting at objective truth about safety or danger.  Thus, law enforcement can and should be trained to effectively assess and skillfully respond to public safety concerns, thereby obviating any perceived need for psychiatric opinion or involvement.

Once these roles are clearly distinguished, the irony of psychiatric involvement in the court system becomes clear.  It would be unthinkable to let a police officer get up on the witness stand an render an opinion that basically says, "I did my homework and can tell you from my experience with a zillion criminals that Joe Smith here is really dangerous so you should lock him up as a preventive measure."  That clearly would not pass Constitutional muster and the officer would basically be laughed out of court.  Yet we basically let psychiatrists - who have far less experience with real danger than law enforcement and far more of a personal investment (guild interests, organizational interests, liability concerns, professional pride) in being seen as 'right' about their perception of the threat a person poses -- to render these kinds of irresponsible, prejudicial, self-serving opinions all the time.

No less important, ethically speaking, psychiatry has no business entering the public safety role.  The first duty of psychiatry, medicine and any so-called helping professional is to the person who has been entrusted to their care.  Any attempt to divide the responsibility inherently destroys not only the helping function, but also the possibility of any meaningful information resulting from the so-called therapeutic interaction.   In a word:

1. The only way to get good information from the person about their real status is by establishing trust.  (Otherwise it is just an interrogation - which law enforcement can do just as well.) 
2. In the absence of genuine trust, there can be no good information.  
3. In the absence of good information, there is no expertise to offer.  
4. In the absence of expertise, there is no basis for psychiatric court involvement.  

On the other hand, if trust actually is established, and the information actually is good, then there is no way for psychiatry to nonconsentually report to a court on the information that was entrusted.  The moment it does so, the professional obligation to the client, along with the trust that was created, is violated.

No less important, the moment trust is violated, the treatment relationship - not only with the psychiatrist in question but with the entire profession they represent - ends in the person's mind.  This means that once the professional obligation of duty to the client has been violated, there is no point in continuing to 'treat' the person. The treatment relationship itself has been so contaminated by the professional violation that no court or other rational decision-maker could reasonably expect anything therapeutic or helpful to occur.  

The clinical relationship - from that point forward - is by definition coercive.  The nature of the power imbalance and the inherent coerciveness are imprinted indelibly in the memory of the person entrusted to clinical care.  There is no way to unring the bell - for either the 'treater' or the 'treated.' 

It's over. 

This is really important to get.   The purpose of holding the person is for 'treatment'.  But the psychiatric testimony - in and of itself - has killed the possibility of legitimate 'treatment'.  Ergo, there is no rational legal basis for continuing to hold the person for 'treatment' - because at that point there is no reasonable expectation that anything resembling 'treatment' will ever again result. The only thing that will result is in the nature of master-servant, wherein  I do what you tell me to do, because I now know of the incredible power you hold over me, including the power you have to hurt me if I don't do it your way.  

You would think someone in the 'helping' professions - or the court system - would have figured this out.  The implications are pretty obvious to anyone sincerely interested in seeing them.  That alone shows how truly witless the so-called psychiatric experts are - as well as how self-serving the little courtroom dog and pony show the profession is operating really is.    

Stay tuned!

There is a lot more to come on this Principle.  We are delighted to announce that Ingrid Johanne Vaalund of Norway will be talking about this principle in relation to the Breivik case.  The Breivik case is an incredibly important case that came up in Norway after Anders Behring Breivik killed 77 persons, many of them children and youths, in two separate events in 2011. Prior to sentencing, Breivik went through two separate forensic evaluations - where so-called experts came to radically different conclusions.  The first evaluation determined that Breivik had a psychotic disorder, thus being legally unaccountable.  The second concluded that he had a personality disorder, thus being legally accountable.  Ms. Vaalund will discuss the implications of the Breivik case in relation to this Principle.   

Questions for Reflection

We are building this work together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. Has psychiatry ever been allowed to testify against you in a court of law?   

2.  What would you like people of conscience to know about your experience?

3. What was the impact of that experience on your relationship with the psychiatrist in question? The treating facility?  The mental health profession in general?   

4. In your experience, how helpful, useful or accurate was the psychiatric opinion?

5. How helpful was the entire process in reducing the dangerousness or risk you were alleged to represent?

6.  Do you recommend this process to anyone who is sincere in their intent to address concerns about someone's dangerousness or risk? 

7.  What better alternatives are there?

8. How could we make them real?

August 22, 2016:  Conference on Principle 22 

We will talk about Principle 22, including your responses, on August 22 from 9-11  PM EST.  Details for listening or calling in will be announced shortly.

#21. Dangerous Deprivations - Preemptive Detention of "The Mentally Ill"

Today we resume 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.)  We take up where we left off - at Principle 21.

Principle 21 reads in full as follows:

We believe that alleged dangerousness, whether to one­ self or others, should not be considered grounds for denying personal liberty, and that only proven criminal acts should be the basis for such denial.

Today's Blog

Our blogger today is Karlijn Roex, a PhD-fellow residing in Cologne, Germany.  Her essay was first published as part of the Campaign to Support Absolute Prohibition of Forced Treatment and Commitment.  The Campaign represents an international effort to protect the integrity of the Convention of the Rights with Persons with Disabilities from infiltration and degradation by psychiatric guild interests.  

The Contested Freedom of the ‘Scary’: the use of coercion in psychiatry violates basic human rights - Karlijn Roex

Detention, solitary confinement, forced drugging; throughout history, societies have had the tendency to aggressively constrain people with psycho-social disabilities and preferred an security-obsessed instrumentalism above universal human rights. But recently, the use of coercion in psychiatry is a highly debated practice in human rights circles; witness the latest report of Human Rights Watch[1] on shackling. This increased interest has gotten a great impulse by the recent release of the UN Convention on the Rights of Persons with Disabilities. Drawing upon scientific work, ‘user’ narratives and moral principles, I support the call made by the Committee on the Rights of Persons with Disabilities (CRPD) to abandon the use of coercion in psychiatry.

According to authoritative documents of the Convention[2], the use of coercion in psychiatry is a form of discrimination of people with psycho-social disabilities, and violates the right of these people to enjoy autonomy and personal integrity. These principles are to be respected, regardless of any instrumental benefits that may result from applying coercive psychiatric interventions. But the perceived instrumental benefits are exactly why the use of coercion in psychiatry has long gone uncontested. And these benefits have moral significance too. People have the right to be protected against themselves, or against dangerous fellow-humans. In fact, many proponents of coercion in psychiatry follow this ethical ‘lesser evil’ reasoning. According to them, it is allowed to introduce an evil when a greater evil is prevented by this. Thus, such a lesser evil argument justifies the abandonment of some key fundamental human rights. This is dangerous, because human rights are typically abandoned during the times in which they are most needed[3]. In fact, these human rights are meant to protect our scapegoated minorities from being oppressed during times of public fear. In times of public fear, some human rights become a privilege of the non-scary, or if one prefers, of the ‘respectable section of society’[4]. In the context here, the lucky ones are the people without psycho-social disabilities. The scary, by contrast, have to deal with a contested freedom.

Coercive psychiatric interventions are decisions or actions imposed on the individual, without his/ her informed consent, based on psycho-social disability. In this regard, the CRPD has also come out against the use of this danger standard, or any other criteria, as a way of legitimizing psychiatric detention[5]. To be clear, the coercive interventions that are discussed here are not taken because of a criminal suspicion or criminal conviction. Today, most countries allow coercive psychiatric interventions only when an individual is considered dangerous to him-/herself or to others. However, the initial assessment of dangerousness is taken by psychiatrists only. A court is not yet involved in this initial decision to psychiatrically detain an individual. This is highly problematic, because the psychiatric perspective and security-obsessed instrumentalism are clearly dominating the process of key decision making, at the cost of the human rights perspective. At the moment where the psychiatrists’ initial decision is critically reviewed, marks of shame have already been added to the affected individual. Not only has this mark of shame been added through the unfavourable initial psychiatric guess, which gains much epistemological authority in our societies, but also because of the very stigmatizing practice of the detention itself[6]. It is then much harder for the affected individual to win credibility.

We therefore see that the conditions for coercive psychiatric interventions have become stricter over time, but that they fail to seriously challenge the practice of arbitrary detention. This may explain why the ‘stricter’ danger standard has not led to a decrease in the number of psychiatric detentions[7]. Probably, the innovation has rather served to silence any critical voices from the human rights corner. This silencing has been achieved by incorporating insignificant parts of the critical demands into the existing policy, without meaningfully changing any inherently oppressive and discriminatory principles[8]. Apparently, there is a high demand in society to confine people with psycho-social disabilities, and one of the main drivers behind this demand is a perceived danger.

Protecting people against themselves: the right not to be a false positive[9]

But what is wrong with this dangerous-criterion? Is it, for instance, not our moral duty to protect people from themselves when needed? Obviously, it is! But we should become reflect one more moment about our ability to assess mental states: when is someone to be considered a danger to him-/ herself? Let me take suicide as an example. As a researcher in this topic, the literature clearly shows me that assessing the risk of suicide in individuals is a very difficult task. Most people that disclosure suicidal thoughts do not commit suicide, especially women[10]. Secondly, psychiatric risk assessments are proven to be really unreliable[11], leading to many ‘false positives’: people who are considered a danger while they are actually not. The statement whether someone is a danger, is in fact a hypothesis about mental states and future behaviours. These are unobservable things that are hard to measure. Even when an individual has committed self-harming acts in the past, this does not necessarily make him dangerous for the present, or the future. Test results are likely to be biased and steered by common prejudices about people with psycho-social disabilities[12], ethnic minorities, and the poor[13]. Worse, the dangerousness claim is strictly not falsifiable, at least at a short term: how can one prove today that one will not kill himself soon? As a consequence of this, many individuals are subjected to coercive interventions because they were wrongly labelled as ‘dangerous’ and cannot easily escape this label. Escaping the dangerousness-label is made even more difficult by general mistrusting attitudes of hospital staff towards mental patients[14], and the fact that people tend to start behaving conform the stigma over time, due to its adverse effects on them[15]. The accumulation of humiliating interactions, which would frustrate every normal person, can lead to responses that can be termed as ‘aggressive’. How would you respond if you learn that you were wrongly informed about your legal status[16]concerning something as important as your freedom?

These ‘false positives’ are vulnerable people, just like people who are a real danger to themselves. But is it actually a wise strategy to expose such people to some of the very traumatic coercive psychiatric interventions? There are numerous accounts of patients or ‘ex-users’ of psychiatry that indicate how stressful and traumatic these interventions were to them. Indeed, some human rights advocates define some of these interventions as torture. There are even indications that exposure to such interventions can lead to post-traumatic stress symptoms and suicide[17]. There are user narratives that indicate that individuals without any previous suicidal tendencies became suicidal after being exposed to coercive interventions, such as solitary confinement. User narratives indicate how humiliating these experiences can be, with people losing their personal integrity, humanity and dignity. Affected individuals often carry along these feelings until long after the incidents.

Protecting people against their dangerous fellow-citizens: contesting the freedom of the ‘Other’

But what if a person is not a danger to him-/ herself, but to others? When we want to be protected against our dangerous fellow-citizens, then what is morally wrong with that? Well, nothing, but of course we have to come with reasonable grounds and evidence of this supposed danger. The mere existence of a psycho-social disorder, cannot point towards a certain danger. When an individual tells me that he is going to harm me, he can be prosecuted for threats. Most countries have also criminalized several public order disturbances. We can already prosecute anybody who has visibly undertaken preparations for committing a criminal offense, or who has clearly tried to commit a certain crime. Therefore: we already have a great law that protects us against dangerous fellow-citizens: the Criminal Law! Even greater, this law protects the citizen against the state and an over-feared community. We cannot just convict an individual because of a mere suspicion; instead, conviction requires that we have some tangible evidence against this individual.

With this great law in mind, why would we create another law especially for people with psycho-social disabilities? Because we are afraid of people with psycho-social disabilities. A mere suspicion of dangerousness in a person with mental illness is already terrifying enough, isn’t it? Why then bother about visible evidence for a criminal conviction? Mental health laws are the dubious innovation of a frightened society. These laws enable communities to incarcerate individuals with psycho-social disabilities when we suspect that they are dangerous. This suspicion is backed with test results from, again, very unreliable and biased psychiatric risk-assessments. As a consequence, we have created two types of citizenship: the ‘normal’ citizens and the scary semi-citizens. The latter group has found his freedom contested: it can be denied at any time, as soon as a suspicion of dangerousness arises. Whereas the majority of us can feel safe and count on the basic human rights principles that respect our freedom and integrity, there is a group in our society whose members can simply be detained without the regular battery of legal requirements.

This is an inconvenient leak in our modern democracies, and should concern every citizen. No citizen can find himself guaranteed at the ‘right’ side of the divide, because the boundaries between mental illness and normality are time-dependent and not nature-given. In the past, we have seen the ‘psychiatrization’ of homosexuality, political dissent, and poverty. This teaches us that mental health laws are a convenient way to subtly discipline certain categories of people; much more smoothly and subtly than explicitly prosecuting these deviants through criminal courts[18]. And although our societies are now to be considered ‘free-minded’, or ‘post-modern’, we should always be aware of the disciplinary potential of mental health laws. This disciplinary potential can be toxic in combination with the timeless fact that we are never aware of the oppressive ideas of our own time.

In all, let’s give it a shot and abandon the use of coercion in psychiatry towards history. Fear makes that we immediately grab towards the so-called ‘last resort’ of a coercive intervention, whereas there are instances in which a simple conversation would already help. Such a conversation would also help us, learning about the specific and different logics behind madness, and therefore render it a little bit less unpredictable and scary.

Karlijn Roex is a PhD-candidate in Sociology and human rights activist. She lives in Germany.

[1] Human Rights Watch (2016, March 20). Indonesia: Treating Mental Health With Shackles. Human Rights Watch. Retrieved 21 March 2016, from:https://www.hrw.org/news/2016/03/20/indonesia-treating-mental-health-shackles

[2] See for instance: CRPD. (2015). Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities – The right to liberty and security of persons with disabilities. New York: United Nations; CRPD. (2014). General Comment No. 1 (2014). Article 12: Equal Recognition Before the Law. New York: United Nations; United Nations Human Rights Committee (2015, October 10). Dignity must prevail – An appeal to do away with non-consensual psychiatric treatment World Mental Health Day. United Nations. Retrieved 10 March 2016, from: http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=16583&LangID=E

[3] Hudson, B. (2009). Justice in a Time of Terror. British journal of Criminology, Delinquency and Deviant Social Behaviour, 5(49), 702-717; Roex, K.L. A. & Riezen, Van. B. (2012). Counter-Terrorism in the Netherlands and the United Kingdom: A Comparative Literature Review Study. Social Cosmos, 3(1), 97-110.

[4] Berger, P.L. (1992). Sociology as a Form of Consciousness. In H. Robboy & C. Clark (edit.), Social Interaction. Readings in Sociology (pp. 6-22). Richmond: Worth Publishers.

[5] See for example CRPD. (2015). Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities – The right to liberty and security of persons with disabilities. New York: United Nations.

[6] Goffman, E. (1961). Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books; Becker, H. S. (1963). Outsiders. New York: The Free Press.

[7] At least in Europe. See: Salize, H. J., Dressing, H. & Peitz, M. (2002). Compulsory Admission and Involuntary Treatment of Mentally Ill Patients – Legislation and Practice in EU-Member States. Brussels: European Commission.

[8] This strategy to silence critics is widely analysed by the Foucaultian sociologist Mathiesen: Mathiesen, T. (2004). Silently Silenced. Essays on the Creation of Acquiescence in Modern Society. Winchester: Waterside Press. See also on this specific topic: Harding ,T.W. (2000): Human Rights Law in the Field of Mental Health: a Critical Review. Acta Psychiatrica Scandinavica, 101: 24-30

[9] Borrowed from Steadman, H. J. (1980). The Right Not to be A False Positive: Problems in the Application of the Dangerousness Standard. Psychiatric Quarterly, 2, 84-99.

[10] Cannetto, S. S. & Sakinosky, I. (1998). The Gender Paradox in Suicide. Suicide & Life Threatening Behavior, 28(1), 1-23 and Möller-Leimkühler, A. M. (2003). The Gender Gap in Suicide and Premature Death or: Why Are Men So Vulnerable? Eur Arch Psychiatry Clin Neurosc, 253: 1-8.

[11] Steadman, H. J. (1980). The Right Not to be A False Positive: Problems in the Application of the Dangerousness Standard. Psychiatric Quarterly, 2, 84-99; Madsen T, Agerbo E, Mortensen PB, Nordentoft M (2012) Predictors of psychiatric inpatient suicide: a national prospective register-based study. J Clin Psychiatry 73:144–151; Steeg S, Kapur N, Webb R, Applegate E, Stewart SL, Hawton K, Bergen H, Waters K, Cooper J (2012) The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT self-harm rule. Psychol Med 42:2383–2394; Ryan C, Nielssen O, Paton M, Large M (2010) Clinical decisions in psychiatry should not be based on risk assessment. Australas Psychiatry 18:398–403.

[12] Link et al., (1999).Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. American Journal of Public Health, 89(9), 1328-1333; Perscosolido, et al. (2013). The ‘Backbone’ of Stigma: Identifying the Global Core of Public Prejudice Associated With Mental Illness. American Journal of Public Health, 103(5), 853-860.

[13] The population of involuntarily hospitalized psychiatric patients contains an overrepresentation of low-income indiivduals, black people, and people of an ethnic minority. See for example: Salize, H. J., Dressing, H. & Peitz, M. (2002). Compulsory Admission and Involuntary Treatment of Mentally Ill Patients – Legislation and Practice in EU-Member States. Brussels: European Commission.

[14] Goffman, E. (1961). Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books.

[15] Becker, H. S. (1963). Outsiders. New York: The Free Press.

[16] Something that appears to happen quite often in EU countries: see Salize et al. (2002)

[17] For instance: Large, M. M. & Ryan, C. (2014). Disturbing Findings about the Risk of Suicide and Psychiatric Hospitals. Soc Psychiatr Epidemiol, 49, 1353-1355.

[18] See also the different works of Michèl Foucault on this

Questions for Reflection

We are building this work together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. Have you ever been preemptively detained by psychiatry?   

2. How did that affect you, your life, and your relationships with others in the relevant community where you lived?

3. What would you like others of conscience to know about your experience?

4. How do you recommend people of conscience respond if they are afraid for their safety or that of someone else?    

5. How can people protect both their own interests and those of others, while still respecting human rights...?

6. How do our systemic responses need to change in order to make potentially volatile situations safer for all concerned?   

7.  What factors, in your experience, lead up to situations becoming 'life or death'? 

8. If we were truly interested in prevention, what kinds of support would need to be available - and how would people access them - in order to prevent situations going from bad to worse?

August 21, 2016:  Conference on Principle 21

We will talk about Principle 21, including your responses, on September 21 from 9-11  PM EST. Karlijn will be our featured guest for that discussion.  The call-in number and details will be announced shortly.

Important Notice: Declaration of Principles Conference/ Blog - Postponed

As many know, there is a really important event in that has been called for tonight - Monday Aug. 1 @ 9 PM EST. Originally this was the start date & time for the Declaration of Principles Conference of Principle 1. Hopefully however, the forum below will generate a lot of energy and focus on racism, misogyny and violence. I will be attending this forum and encourage others of conscience to do the same.

A few days ago, I posted a request for feedback as to how to proceed with the Principles Conference that was scheduled to start today and continue daily throughout this month. The vast majority of support was for option #4:

4. Postpone the whole Declaration of Principles series until Sept 1 so that more energy and focus is available to address the pressing issues of racism, misogyny and violence that are front and center right now...

I appreciate so many people weighing in as to how to proceed with the seemingly conflicting needs present on our movement at this time. I also feel grateful for the thought and concern went into the feedback offered.

As a people we are having some necessary but also incredibly difficult conversations. To navigate them well will require the full energy and attention of everyone willing to offer this. My personal aspiration is to take the time and space needed to thoughtfully reflect and address my own culpability for social 'othering' in whatever ways that manifests for me. This includes internally (thoughts, assumptions, biases, preferences) and externally (actions, choices, words, deeds, tendencies to favor one group's way of thinking over another). It also include ways I may privilege some causes or concerns over others that has the effect of advancing the interests of some groups over others and thereby serves to reinforce white supremacy, misogyny, trans oppression, sanism - or some other kind of social exclusion mentality that I continue to hold (verbal/ academic privilege, ableism, classism, etc).

My hope is that, together, we can deepen our appreciation and understanding of the massive pain that exists among us - as well as generate ideas for moving forward together as intersectional allies dedicated to creating a truly human rights informed world for all people everywhere.

As always, the most important healing I need to do is in my own life and the relationships closest to me. For the time being, that has meant postponing this series to free up the energy and resources I need for meaningful self-reflection and personal change efforts.

If all goes well, I hope to pick up on Blog 21 on August 21 and then resume the Principles Conference starting with Principle 1 on or about September 1, 2016. The plan is to make the conference accessible by phone and internet, and as internationally as possible. Details will be updated in this blog, on facebook and in Google+, as they become available.

Thanks so much to all who have followed this series for your incredible enthusiasm, inspiration, dedication, participation and support.