Magazine of the INTERNATIONAL ASSOCIATION AGAINST PSYCHIATRIC ASSAULT
No. 2 - September 2004
COERCIVE PSYCHIATRY A TORTURE SYSTEM
[Translated from German]
By Alice Halmi
Psychiatric coercive measures are
a "cruel, inhuman, degrading" (CID)
treatment, or rather torture and part of the
mandate of human rights organizations
A plea for the acceptance of coercive psychiatry as torture and thus as part of the mandate of human rights organizations.
With this text the attempt is undertaken to interpret coercive psychiatry and/or psychiatric coercive treatment and incarceration as torture and as a non-medical, (social/)political problem.
I regard this as a first contribution to the discussion and wish to point out that in this article I have not dealt with the internal discourse of human rights organizations regarding torture.
However I would be pleased to enter into discussion with other human rights groups which concern themselves with the topic of torture and CID treatment.
Firstly, that which applies internationally:
Universal Declaration of the Human Rights,
Article 5 (prohibition of torture):
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
Very important is also the anti-torture convention of the UN with the definition of torture contained in it:
The accepted definition of torture in the convention against torture and other cruel, inhuman or degrading treatment or punishment (Anti-Torture Convention), by the resolution of the General Assembly of the United Nations on 10 December 1984, effective from 1987:
Part 1, article 1, paragraph 1:
(1) For the purposes of this Convention, torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.
The term "coercive psychiatry" (as well as legal incapacitation and persecution) can be applied,
when a person is locked up in a psychiatric institution and diagnosed against his will and with no "illness insight" or consent to a "treatment" and is forcibly subjected to physical intervention with psychiatric drugs (psychopharmacological drugs) and electroshocks.
Moreover psychiatric coercion can consist of being bound to the hospital bed ("four point constraint"), being compelled to participate in activity therapies and further legal incapacitation by the undesired order of an official custodian.
Also, being designated as "mentally ill" and/or being applied a psychiatric "diagnosis" (e.g. "schizophrenia") and the consequent evaluation as a "not sensible" and "not legally competent" person is an element of coercive psychiatry.
In addition, many previously psychiatrized persons, having once been "diagnosed" and entered into the national psychiatric system, experience persecution for many years by psychiatrists, public health authorities or social-psychiatric institutions.
Psychiatric coercion fulfills the following criteria of the definition of torture as taken from the Anti-Torture Convention of the UN:
1. Intense physical or mental pain or suffering is caused to a person.
2. The goal is a confession and/or a statement.
3. The purpose is to intimidate and coerce the person.
4. One acts on basis of discrimination.
5. The suffering has been arranged by and is expressly agreed to by members of the public services.
As to #1) Intense physical or mental pain or suffering is caused to a person:
Psychopharmacological drugs cause both physical and mental suffering. They intervene in almost all bodily functions and with high probability cause symptoms of most diverse physical illnesses (e.g. Parkinsons, blood circulation illnesses, heart damage, eye diseases, motorial malfunctionings, suppression of the libido, diseased changes of the blood and the bone marrow etc.).
On a psychological and mental level psychopharmacological drugs (in particular neuroleptica) are strongly impairing, emotionally and mentally: they subdue and restrain, cause cognitive disturbances, awarement and personality changes and result in addiction.1
The so-called electrical convulsion therapy (electroshock) produces internal head injuries: an artificial epileptic attack in the brain (brain cramps) is caused, which destroys and/or changes parts of the brain. Brain haemmorage, cognitive disturbances and memory loss, intellectual and emotional turbidity etc. is the result. The tortured person leaves the "ECT treatment" scared or apathetical.2
The experience of being deprived of one's rights and liberty, violence and a sense of powerlessness, being locked up, bound, being prevented from organizing one's own daily routine, legal incapacitation by an appointed custodian and the often lifelong stigmatization of having a psychiatric "diagnosis", being deprived of one's reason, the ability to make one's own decisions and being denied responsibility and the associated social descent likewise causes intense suffering to the person concerned.
Moreover, arbitrary chicaneries by the hospital personnel such as insults, being publicly exposed psychologically, not being taken seriously, being made fun of and arbitrary prohibitions are all usual practices in psychiatric institutions. A large power gap prevails between hospital personnel and "patients", in which those in power can act in a quasi lawless space, i.e. who are not (or only with difficulty) called to account for their offences against human rights. The reason being: First of all "crazy people" are not (or less) believed, when they report having suffered humiliation. Secondly, arbitrary and incomprehensible "measures" such as no visiting rights, solitary confinement (also a standard torture method in prisons) or the banning of leave are presented as therapeutic measures.3 There have also been reports of repression within institutions, which take place against events such as e.g. merrily singing in a group.
Physical and mental suffering as a result of psychiatric torture often extends far beyond the period of the internment in a psychiatric institution: psychopharmacological drugs and electroshocks in certain cases cause irreversible latent damage, for example motorial disturbances like tardive dyskinesia or mental deficits. The inmates leave the psychiatric institution with low self-esteem and as disconcerted and scared persons and often experience a lifelong persecution. Even among so-called medical and psychological experts one speaks of trauma as a result of psychiatry.
From a societal viewpoint, the long-term consequence of psychiatric stigmatization and coercion is often a drastic social descent: Loss of social acknowledgment, vocational chances and also domicile. Some psychiatry victims out of despair even commit suicide during or following a psychiatric stay.
As to #2) The goal is a confession and/or a statement
The goal of this kind of torture is to extract a confession of "illness insight" and thus "compliance".
The "illness insight" of the tortured person makes the following possible:
- to interpret and justify the abovementioned abuse by physicians and other hospital personnel as being medical measures and assistance.
- to convincingly argue the necessity for the deprivation of liberty, to legitimize this denial of one's rights.
- to present the legal incapacitation as "supportive protection" and as a measure for the alleged well-being of the concerned.
- to mask slandering and discrimination.
- to control people and, when possilble, to make them socially and economically functionable.
- to guarantee the continuation of the so-called "treatment" outside a psychiatric institution.
Above all, for the guarantee of the durable controllability of a psychiatrized person, the confession of an "illness insight" is of the greatest importance and has the most effect, if it is succeeded that by the torture the broken person not only pretends "illness insight", but in the end actually also believes to be "ill".
taken from the "Dossier Heilberufe", ("Dossier of Welfare Occupations"),
a publication by amnesty international and/or their "Aktionsnetz
Heilberufe", ("Action Net of Welfare Occupations"),
As to #3) It happens in order to intimidate and coerce the person
It requires intimidation and compulsion
- to arrange the stay of the person in a psychiatric institution without friction and resistance,
- to achieve the goal of extracting a confession of "illness insight",
- to thus ensure the continued control of the person mentioned in point 2.
The abuses are a means to break the will and the resistance of the person concerned. In this regard here is an exemplary quotation by the psychiatry-critical psychiatrist Peter Breggin: "Electroshocking works also because it spreads fear and terror. In this way, as one of my good friends, who was electricalshocked, said to me yesterday: "After the first shock I would have done anything in order to be dismissed from the clinic. After that I did everything that they wanted from me." 4
The effects of psychopharmacological drugs (in particular of neuroleptics) and electroshocks, namely to psychologically and physically restrain and subdue the persons concerned, are not - as often falsely assumed - just "side effects of healing medicines". They are deliberately caused by the physicians who prescribed them, usually probably knowing or taking into account that the person suffers from it and that the immobilizing serves the surrounding human environment (and the psychiatrists themselves), but is not the solution to the possible problems which lie at the cause the "crazy" behavior.
Beyond that, psychopharmacological drugs and electroshocks are used in order to destroy socially unwanted and disturbing emotions and thoughts (e.g. anger, loss of motivation, dejection). It is doubtful whether these methods will succeed, points however to the fact that thereby the attempt is undertaken to make persons socially functional.
Apart from the methods of abuse described in point 1), brain washing by psychiatric ideology is a usual means of intimidation:
Psychiatrists (supported by their credibility and authority in society and the scientific world) and hospital personnel, with the participation of the authority-respecting relatives, urge the "patient" to be compliant, who, locked up and confused by the effects of drugs, and in addition possibly in a life crisis, finds himself in a powerless situation.
Here one commonly hears the stated lie that those who remain "untreated" will remain chronically ill for the rest of their lives.
Brain washing and torture function in such a way that those involved become instilled with a fear of lifelong stigmatization as being "mentally ill" and an ever increasing feeling of being unable to cope with life and of a repetition of the suffered torment or even worse agonies (for example being administered injections or electroshocks in the event of refusing to take pills) and an even longer stay in the institution.
In an explanation by rebellious psychiatry survivors, it is therefore concluded that: "The end of the torture only at the price of so-called "illness insight" leads - in connection with false promises of help - to a broad acceptance of an individualized perception of oppression. At the same time a false hope of regaining one's own dignity is created by identification and precursory obedience in relation to the colonizing system.5
As to #4) One acts on the basis of discrimination
Discrimination consists of the labeling of persons as being "mentally ill" and the assigning of appropriate diagnoses, such as "schizophrenic" or "manic depressive".
The concept of "mental illness" is however not based, as often assumed, on medical-scientific facts, but on assumptions of alleged "illness"-related causes for unwanted behavior.6 Lately psychiatric diagnoses are increasingly biologically and genetically justified, so that racist biological theories, such as "mental disorder as hereditary disease", are given an extra boost.
Hand in hand with the diagnoses is the denial of one's ability of reasonable judgement formation, insight and personal responsibility. Exemplary is the definition of a "free will" as specified in the custodian law, which is characterized by the descriptions "ability of discernment of the concerned person and his ability to act accordingly". According to this, "mentally disturbed" persons possess no "free will", as described in the custodian law.7
Psychiatric survivors due to this discrimination and treatment are denied the right to be considered a rationable, responsible human being, capable of self-determination and endowed with dignity.
Discrimination is the basis for defining torture as medical measures. Second class humans are created, to whom special laws apply and these people's dignity is tarnished and their fundamental rights and/or human rights are allowed to be reduced and/or nullified.
As to #5) The suffering is decided by and carried out with the express agreement of members of the public service
Psychiatric coercive treatment and incarceration as well as the order of an official custodian is legitimized in Germany through the "PsychKGs" (laws for the "mentally ill") and the laws concering official custodianship.
In order to approve an incarceration in a locked psychiatric ward and/or coercive treatment in a specific case, it requires a medical opinion, on the basis of which the court decides. If an official custodian is available in the applicable field, he has the possibility of committal to a closed psychiatric ward.
Also the local public health authorities (the social psychiatric service) and the police play a role: Employees of the public health authorities have the authorization to visit psychiatrized persons in their own home without their consent and, by the use of force by the police, if necessary arrange for the prescribing of placement - against their will - in a closed psychiatric ward by the government physician.
The persons concerned have the possibility of raising an objection against the incarceration and coercive treatment and are assigned a defense lawyer by the court, which however rarely leads to an annulment of the incarceratrion or coercive treatment, since the courts generally follow the advice of the physicians.
Psychiatric torture under the cloak of medicine
Psychiatrists, hospital personnel and legislators claim to act for the well-being of the those concerned and to render help. In contrast to the medical treatment for people with no psychiatric diagnosis, which requires the consent of the patients, "treatment", incarceration and "custodianship" in coercive psychiatry occur also without the consent of those concerned and thus without consideration as to whether they are of the opinion that it is for their well-being or not.
The denial of liberty is frequently justified with attributing people as being "a danger to themselves or to others". This has nothing to do with the result of any criminal offences having been committed - which would be grounds for incarcerationg a "normal" offender-, but rather a subjective assumption of the potential future behavior of a person, who is denied his own responsibility. The internment in psychiatric institutions thus turns out to be a kind of protective custody.
Due to the absence of the consent of a "patient" to psychiatric treatment, this can neither be interpreted as medical nor as therapeutic assistance, but must rather be considered to be an extreme violation of human rights and an authoritarian and paternalistic act.
Pychiatric torture and psychiatric ideology in the service of social control and domination
Edward Peters, who, in his book "Torture. The History of an Embarrassing Enquiry"8 dealt with the subject of the nature and purpose of torture, comes to the conclusion that "a special element of torture [... ]" is "the torment", "which someone ostensibly out of public interest is subjected by a state authority" (page 23). Torture is therefore to be seen as an "expression of the view of a government over the state order" (page 10). A goal of the torture can also be to "break the will of the victim", so that he is subjected to a system and an ideology (page 208). In doing this "Each ideology [... ] presupposes an image of a human being, a conception of that, which human creatures are and how they should be treated, in order to be able to develop the society, which the respective ideology demands" (page 210).
Also behind psychiatric torture are certain conceptions about a social order and political goals, an ideology and an image of human beings on which it is based:
On the one hand, we have the picture of a typically ideal, reasonable and rationally thinking person and a socially designed standard for a "healthy" and "normal" person, who is adapted to the social and economic conditions.
In contrast to this we have on the other hand the senseless, irrational "mentally il" person, who is a nuissance, disconcerts, is non-functioning and less usable and useful for society and economics.
Also US-American psychiatry critics and psychiatrist Ron Leifer proceed from the existence of a psychiatric ideology:9
"The medical model pretends to be scientific but functions as an ideology. It is an ideology because it emphasizes the similarities between medical disease and mental illness, namely, that both involve suffering and disability. And it represses their differences, namely, that the suffering and disability of medical illness is caused by demonstrable changes in the body, while the suffering and disability of mental illness have no demonstrable cause in the body and refer instead to speech, feelings, and social conduct."
"The social interest served by the medical model ideology is the public mandate for a greater degree of social control than can be provided under rule of law. By labeling certain behavior as medical illness, the medical model serves, enables and justifies an extra-legal, covert form of social control. Unlike persons who are diagnosed with physical illness, [ ], persons who are "diagnosed" with serious mental illness may be defined as not responsible, be deprived of freedom without indictment or trial, and be forced to take drugs and other "treatments" against their will. Viewed through the medical model, these violations of human rights appear and are justified as medical treatment." (Leifer)
"The medical model developed as an ideology in a historical and political context.", i.e. that of the European einlightenment. This is because the modern state of an enlightened society, which holds itself to be free, can no longer afford to rob people of their liberty by penal laws or arbitrary decrees even though they have committed no criminal offence but simply because they behave or think unusually or are a nuissance. That is why these societies need the medical model (the psychiatric ideology) in order to practice social control.
1. On the effects of psychopharmacological drugs see among others
Peter Lehmann: "Der chemische Knebel. Warum Psychiater Neuroleptika
verabreichen" ("The chemical toggle. Why psychiatrists administer
neuroleptics") Berlin: Peter Lehmann Antipsychiatrieverlag 1993. Auch
Note: For practical reasons this text was written using
gender neutral forms.
Amnesty's position on torture in psychiatry
Where, for example, does Amnesty International (AI), as one of the most well-known human rights organizations, stand on the question of the recognition of coercive psychiatry as torture? In 1991 in Yokohama the highest international committee of AI, the International Council, which meets every 2 years, convened under the title "Psychiatric Confinement" and passed a resolution. It reads: "The International Council decides that AI's mandates on cruel, inhuman or degrading treatment or punishment of prisoners applies fully to persons forcibly confined to psychiatric institutions, although AI does not enter the area of treatment which AI's itself regards as authentically medical."
Thus AI puts itself into the position of specifying the criteria of what "authentically medical" treatment is and how it differs from non-medical abuse which occurs through the use of coercion and violence. The problem here is: On the one hand almost any punitive act can also be exercised by mutual consent, e.g. during sexual play. On the other hand it must be excluded that the state simply uses medical institutions as a front for torture centers. To make an absolute distinction there remains therefore only the criterion of an agreement with the concerned person or his consent for treatment. Classically this is referred to as "informed consent" and is the basis for medical treatment, because without advance agreement not least the hippocratic oath i.e. to do no harm, is broken, because the expressed will of the person is violated. Therefore the result of the definition of "authentically medical" from a human rights point of view can only be: Coercive psychiatry is reconcilable with neither medicine nor morality, but rather motivated by political torture and humiliation.
Since the concrete definition of the term "authentically medical" is pending, AI is, since 1991 - figuratively speaking - pregnant with the classification of coercive psychiatry as torture, without being clearly conscious of the fact.