Various instruments of the United Nations have
commented on forced treatment, or involuntary confinement, or both (for
details, see Burstow, 2015a), and a number of truly critical additions to
international law have materialized. Arguably, the most significant of these is
the Convention on the Rights of Persons with Disabilities (see http://www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx).
What makes it so significant? For one thing, because this landmark convention puts
forward nothing less than a total ban on both involuntary treatment and the involuntary
confinement of people who have broken no laws.
To highlight a couple of relevant passages,
article 12 of the CRPD states, “State parties shall recognize that persons with
disabilities enjoy legal capacity on an equal basis with others in all aspects
of life." Correspondingly, article 14 states:
State parties shall ensure
that people with disabilities, on an equal basis with others:
a. Enjoy the right to liberty and security of the person
b. Are not deprived of their liberty unlawfully or arbitrarily
… and that the existence of a disability shall in no way justify a deprivation
of liberty.
What is likewise significant, the guidance
provided clarifies that the ban on forced treatment and on voluntary committal
is to be seen as absolute (see http://www.ohchr.org/Documents/HRBodies/CRPD/14thsession/GuidelinesOnArticle14.doc).
What we have here in other words is nothing
less than a colossal breakthrough.
In line with the CRPD breakthrough, CHRUSP
(Center for the Human Rights of Users and Survivors of Psychiatry) has issued a
call to action in support of the prohibition (see https://absoluteprohibition.wordpress.com/).
I strongly support this campaign both as a human being generally and as a
psychiatry abolitionist—hence this article.
First let me say that whether or not one is
a psychiatry abolitionist, or to put this another way, whether one sees some
value in psychiatry’s tenets and approaches or whether one regards them as both
totally foundationless and inherently damaging, there is an onus upon us simply
as human beings to find a way to support campaigns of this ilk. When basic
rights such as the right to decide what does or does not enter one’s own body
and the right not to be confined to a locked ward are at issue, we all of us
have a moral obligation to do something to set the situation right. How can it
be acceptable to override people’s right to make decisions for themselves? To stop people from walking about
freely—especially when they have broken no law? Nor can the deprivation of such
rights be warranted by claims (what follows are several of the standard ones) such
as the person lacks the capacity to make decisions for themselves or they are
of danger to self or others. As noted in Burstow (2015b), while for sure people
may need assistance in making decisions, incapacity per se is a circular
institutional construct; and besides that it is indefensible to deprive people
of freedom on the basis of prediction, the elites involved in such decisions
(read: psychiatric professionals) have virtually no ability to predict
dangerousness. Nor for that matter do others.
The long and the short is that the cause is
just, liberation from oppression is at issue, and irrespective of any
differences in our respective understandings of psychiatry, there is ample
reason for us all to place a priority on the current campaign. I am accordingly
enthusiastically joining with leaders like Tina Minkowitz (see http://www.madinamerica.com/2016/01/campaign-to-support-crpd-absolute-prohibition/)
in urging people to get involved.
That noted, while the campaign in question
places a very special onus on all of us, and my major purpose in this article
is to support that, I did additionally want to do what no other writer to date
has done—to tease out the special meaning that the CRPD and such campaigns uniquely
hold for those of us who are abolitionists, whether inadvertently or otherwise.
What is especially apropos here is the attrition model of psychiatry abolition. So what is the attrition model of psychiatry
abolition? And as an attrition model abolitionist, how do I understand the
current campaign?
Predicated on the understanding that
psychiatry abolition is a process and a direction as opposed to a goal which
can be quickly attained, the attrition model of psychiatry abolition, as
articulated in Burstow (2014) and adopted by Coalition Against Psychiatric
Assault (see https://coalitionagainstpsychiatricassault.wordpress.com/attrition-model/)
is a model for determining what actions and
campaigns to support and what to prioritize. An operant principle is that
active support be predicated on the capacity or tendency of the action or
campaign to move society in the direction of abolition. Pivotal to the model are
the following defining questions:
1)
If successful, will the action
or campaigns that we are contemplating move us closer to the long range goal of
psychiatry abolition?
2)
Are they likely to avoid
improving or adding legitimacy to the current system?
3)
Do they avoid widening
psychiatry's net? (Burstow, 2014, p. 39).
Now again, while supporting the CHRUSP call
to Action is urgent and necessary for the reasons already indicated, the degree
of prioritization for an attrition model abolitionist would depend on the
answers to such questions. So are there “yes answers” to the questions above?
Let me suggest that albeit to varying degrees, in all three cases, yes.
To tackle this one by one, beginning with
the first question, any measure which abolishes any integral aspect of
psychiatry without question moves society demonstrably in the direction of
abolition. Hence the prioritization by Coalition Against Psychiatric Assault,
for example, of the abolition of certain “treatments” (e.g., ECT). And does
this campaign target the abolition of anything integral to psychiatry? Obviously
yes—all use of force and coercion. As such, the first criterion is satisfied.
Which brings us to Question Two: Is the
campaign likely to avoid improving or adding legitimacy to the current system? This
is the most ticklish of the questions, for a case could be made that the psychiatric
system would be improved by becoming less coercive. This notwithstanding, my
sense is that eliminating the coerciveness in no way constitutes an endorsement
of psychiatry and could in fact function in the exact opposite way—that is, it
could lead people to ask themselves: What else should go? It could even in the
fullness of time, culminate in a more wholesale questioning of
psychiatry—especially once it is seen that eliminating coercion can be
accomplished without a plethora of horrid consequences following.
Finally, Question Three: Does the campaign
in question avoid widening psychiatry’s net (translation: Would the campaign,
if successful, avoid enabling psychiatry to scoop up ever more people?)? Here
the answer is a resounding yes. The point is that were this campaign successful,
not only would it not widen psychiatry’s net, it would demonstrably narrow it,
allowing all those who say “no” to escape psychiatry altogether.
What follows from this analysis, this
campaign is in line with abolitionist principles. And as such, prioritizing this campaign is a
natural move for abolitionist groups to consider.
Summarizing Remarks, Invitations,
Suggestions, and Warnings
A very important move has been taken by the
United Nations in the passing of the CRPD. For the first time in history, there
is an international legal clarification that psychiatric survivors must enjoy
the same rights as everyone else—that is, force is absolutely prohibited. This
is not just “any” organization taking this position, additionally—this is a
mammoth mainstream organization which wields both moral and legal clout. Correspondingly,
an important campaign is now under way to support the absolute prohibition that
is part and parcel of the CRPD. What has been shown in this article is that the
prioritization of this campaign makes sense both on a fundamental human rights
level and additionally, on a psychiatry abolition level. Given the prestige of
the United Nations and given that many countries have already signed and even
ratified the Convention, moreover, explicitly wedding this campaign to the
Convention itself is itself pragmatic.
My hope is, correspondingly, that many
embrace this campaign and join us in actively promoting it. Please consider
contributing articles and pictures to the CHRUSP website. Please talk to
others. Perhaps create educational events. If your country has not signed the
Convention, not ratified the Convention, has added a restriction, or is simply
in non-compliance, you or your group might want to take the lead in making the
problem known. We have a moment for change here—and my hope is that enough
people will face whatever fears stop them and reach out and grab it. Not that winning this fight will be easy, for
countries have a habit of ignoring/evading international law, including contractual
obligations which pertain by virtue of being signatories to a convention. All
the more reason to double and triple our efforts.
The biggest obstacle that we are likely to
encounter is people’s fear of dangerousness. Be prepared to address it. Arguably,
the second biggest is people’s sense that vulnerable folk are going to be
deserted. A point to be made when talking to others is that the CRPD is clear that
supports must be offered. And indeed,
if we go about this correctly, the era of the CRPD could well become the era when
an unprecedented number of new and exciting support options materialized for
people—and, of course, voluntary ones. In this regard, contrary to the common and
I would suggest duplicitous equation of psychiatry and services, and besides
that “service” and “coercion” are more or less mutually exclusive categories, is
not the stranglehold exercised by psychiatry itself one of the principal
factors responsible for the paucity of services?
In ending, to comment briefly on a snag. Were
this campaign successful—and yes, it is for sure an uphill battle—psychiatry’s
likely response will be to step up its misrepresentation of its “treatments.”
The point here is that the future of psychiatry would then be more dependent on
personal buy-in; and as we know, institutional psychiatry, alas, has virtually no
qualms about misrepresentation.
Now some may feel that this last point is a
“red herring” or minimally a minor issue since the CRPD explicitly specifies
that “informed” consent is necessary. To be clear, indeed it does, but so does
almost every piece of “mental health” legislation in the world and that has had
no impact whatever on the ongoing and ever expanding production and
dissemination of psychiatric misinformation. Ironic though this may seem, the
upshot is that in the event of success, stronger monitoring of and stronger reins
on psychiatry would be absolutely necessary.
A conundrum to be sure, but hardly one that
we have not encountered before.
References
Burstow, B. (2014). The
withering of psychiatry: An attrition model for antipsychiatry. In B.
Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted (pp. 34-51).
Montreal: McGill-Queen’s University Press.
Burstow, B. (2015a). Canada—A Human Rights Violator (see http://bizomadness.blogspot.ca/2015/09/canada-human-rights-violator.html)
Burstow, B. (2015b). Psychiatry
and the business of madness: An ethical and epistemological accounting. New
York: Palgrave.
