Thursday, April 11, 2013

UN Human Rights Committee asks US to defend forced drugging in psychiatric institutions; and, how our choices matter

Following up on the recent news about the UN Special Rapporteur on Torture calling for the banning on all coercive psychiatric interventions including forced drugging, Tina Minkowitz from the Center for the Human Rights of Users and Survivors of Psychiatry (CHRUSP) reports at Mad in America on more progress:
The United Nations Human Rights Committee has asked the U.S. government to clarify how the possibilities for nonconsensual medication in psychiatric institutions comply with their obligations under Article 7 of the International Covenant on Civil and Political Rights – i.e. the obligation to ensure that no one is subjected to torture and ill-treatment.
She describes some of the implications:
The question asked by the Human Rights Committee is significant in a few ways. First, the Committee appears to be opening up for debate the standards that should be applied to nonconsensual psychiatric medication. The Committee is considering the related question of psychiatric commitment and compulsory treatment as a violation of Article 9 of the Covenant, on the right to liberty and security of the person, as it works on drafting a General Comment on Article 9.
As one of the human rights advocates who’s been working on the issue in Geneva, Minkowitz also discusses some of the issues ahead and practical steps forward in advocacy:
We should urge the U.S. to provide information about federal and state law and to present its justifications for inflicting treatments on people that disrupt their consciousness, flatten their emotions, cause serious neurological impairments, and otherwise cause serious anguish and bodily harm, without the person’s free and informed consent and often over their active objection and refusal.
She also situates the development within recent history:
We should keep in mind that the Special Rapporteur on Torture has strengthened our position in human rights law, with his recent call for an absolute ban on forced psychiatric interventions including nonconsensual drugging and electroshock, as well as restraint and solitary confinement, and for repeal of legal provisions allowing confinement and compulsory treatment in mental health facilities. The U.S. government should remember the advice of the National Council on Disability which recommended in 2000 that mental health policy should move in the direction of a totally voluntary mental health system, and take the call to action by the Special Rapporteur as a stimulus to revive those recommendations and improve the human rights record of this country.
(I hadn’t been aware of the 2000 recommendation, but it should by all means be revived.) This is tremendous news, and I think marks a turning point.

A few thoughts on the meaning of these developments:

When I posted recently about the statement by the UN Special Rapporteur calling for a ban on all nonvoluntary psychiatric interventions, I feared that many people in the US and UK wouldn’t see the relevance in their countries. We often associate these coercive practices with the former Soviet Union and other extreme authoritarian regimes. But this question put to the US government should raise awareness of the problem of forced psychiatric interventions here.

This is very much a US issue. As I’ve discussed in the past, the US has a long history of forced psychiatric “treatment,” and this has never been far removed from politics. (In fact, the entire drug-based model of adjustment psychiatry revolves around the medicalization, marginalization, and containment of disruptive elements.)

Part of the problem is that our culture teaches and encourages us to view things through the narrow lens of personal choice. Due to this culture and our position of privilege, we’ve largely come to see psychiatry in terms of individual consumption rather than in a larger cultural or policy context. So we think that it’s a personal matter if we choose to embrace this model and these drugs for ourselves, as long as we think it’s helpful for us.

In this sense, it’s much like religion. People who believe they’re just making decisions about their own consolation and well-being are contributing to the cultural acceptance of this model and the corporations and institutions that profit from it. It’s a sort of epistemic recklessness in which those who are subjected to the model with less, little, or no choice in the matter are neglected.

Ben Goldacre’s recent book Bad Pharma suffers from this choiceitis. The problem, as he sees it, is that the corruption of medical research and medicine interferes with the ability of people and their doctors (who want the best for them) to make informed and responsible decisions. That’s true as far as it goes. But the people affected by psychiatry aren’t only those “freely” (on the basis of a warped and corrupted research base and decades of manipulation, that is) choosing to participate. Psychiatry is special amongst medical subfields in more than one sense, but most significant here is the longstanding use of coercive or involuntary interventions, often sanctioned by law.

For many, rejecting psychiatric “treatment” isn’t an option. People admitted to psychiatric institutions, elderly people in convalescent homes, children in and outside of youth facilities, prisoners,… Most recently, public attention has focused on the military, as in a recent opinion piece in the New York Times by Richard A. Friedman. Soldiers aren’t in the same position as some of the other groups just mentioned, but neither can their compliance with psychiatric interventions be assumed to be entirely voluntary.

Some figures Friedman provides:

• In 2012, there were more suicides amongst active-duty soldiers than deaths in battle.

• The number of psychoactive drugs prescribed to soldiers increased almost 700% between 2005 and 2011, even though troop levels have decreased since 2008.

• The number of prescriptions for anti-anxiety drugs increased more than 700% and the number of prescriptions for anticonvulsant drugs (not FDA-approved for psychiatric use) for soldiers jumped almost 1000% between 2005 and 2011.

[Friedman is a psychiatrist who buys the brain-disease-drug myth, and his analysis is therefore misguided at times (he deplores the declining use of “antidepressants” in the military in favor of prescribing antipsychotics, for example, not on the basis that the latter are even more harmful than the former but under the assumption that the former are actually effective).]

Meaningful discussions about psychiatry and psychiatric drugs can’t take place on the foundation of the comforting myth that our personal choices don’t have wider ramifications.

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