The Liberals’ Assisted Dying Bill: Reflections on a Cop-Out

When it comes to the issue of assisted dying, there is fresh pain and understandable outrage in the country right now because, as most readers are aware, a bill was recently tabled in parliament that, as it were, pulls the proverbial rug out from under the feet of a huge constituency who have been counting on something better. "It’s mean," states Linda Jarrett. "There’s going to be a lot of unnecessary suffering," objects Rachel Phan (http://www.dyingwithdignity.ca/advocates_speak_out_against_new_legislation). Correspondingly, a huge anti-bill lobbying effort has mobilized.

What in a nutshell has happened? The prelude is—and a highly welcome prelude it was—after years of activist struggle—the Supreme Court declared Canada’s criminalization of assisted suicide unconstitutional and it unequivocally stipulated that legislation must be passed whereby people with severe and irreversible agony, should they competently so choose, could receive assistance from doctors to end their lives (Carter vs. Canada). Enter the Liberal government, who sounded like they would comply. Now to their credit, they indeed did introduce assisted dying legislation. However, what they have tabled -- Bill C-14 -- falls seriously short of the Supreme Court ruling. Ergo, the stunned outrage.

What is wrong with the bill? And what can we do about about it?

The problems largely arise from the restrictive nature of the conditions that have to be satisfied. The most worrisome of these is spelt out in section 241.2  (2d).  Earlier sections specify that the person must be capable, have requested the service, have given informed consent (all unproblematic), be at least 18 (please put a marker here), be eligible for Canadian health services, and have "a grievous and irremediable medical condition". [241. 2 (2c)] Then comes 241.2 (2d), which stipulates that the condition must be so advanced that "their natural death has become reasonably foreseeable."

Note the vagueness in the stipulation above. Just what is meant by "reasonably foreseeable"?  And exactly how advanced and close to "natural death" must a person be? Question: Would an ALS sufferer who is told that she probably has only 6 months to live qualify? Would the stalwart Sue Rodriguez qualify -- the woman, after all, most responsible for helping Canadians begin to seriously grapple with these issues? And if not, should that not worry us? And if no one knows for sure whether or not they would qualify, should not that likewise worry us?

Worse than the lack of clarity, much like American legislation in this area (for an overview of relevant American legislation, see Stefan, 2016), the bill is intrinsically connected to the concept of imminent death. To qualify for assisted suicide, according to this bill, the person must be close to death—this, despite a Supreme Court ruling that made no such stipulation.

Herein we find a blatant contravention of the Supreme Court ruling for the assistance available was not to be restricted to people whose death is imminent or even those whose malady is terminal -- no minor difference. In the very process of veering from the Supreme Court ruling, moreover, the bill disqualifies a huge number of people, leaving them without the assistance which they may desperately need. Note in this regard, not all horrid suffering is connected with imminent death or indeed with terminal conditions at all -- a reality which does not make the suffering in question an iota less severe or the person less in need of relief.  

On top of which, the bill in essence makes the relief unavailable at any time for people with certain conditions, given the double binds created by the combination of restrictions.

Take the person in early stage dementia. At this early juncture, they would not qualify (despite having a serious and grievously deteriorating condition) for they are not yet near death.  And so they must wait. Eventually they will indeed satisfy condition "d"—for death will be "foreseeable". However, by the time they satisfied that criterion, they would no longer be able to satisfy the competence criterion. Which in short means: People suffering from one of the most humiliatingly debilitating conditions with which anyone is ever afflicted -- a condition that may rob them fundamentally of who they are -- are in effect totally excluded from exercising even the highly limited rights which that statute makes available to other Canadians. Which makes the bill inherently discriminatory, and indeed, frighteningly so.

This is not equality. This is not adequate. This is not the compassion and the dignity that we owe Canadians in difficulty. Ergo, the Liberals should seriously amend the bill, which amendments should include but not be limited to removing both the "foreseeable death" and the terminal criteria and allowing for advanced directives.

My invitation to Canadians is to urgently push the Liberals to do just that. Sign petitions; contact your member of parliament; talk to senators; let them know that we expect more from them; and urge them to vote against the bill unless the necessary changes are made. And if all this fails, gear up for a Supreme Court challenge.

That noted, to date, I have focused on problems with this bill that have already received considerable attention. Well and good. However, I cannot in good conscience end this article without drawing attention to various other problematic features -- ones of special significance to people who are likewise being shortchanged by this bill yet who are but seldom mentioned by commentators. The point here is that there is a not-so-hidden dividing line between people that the average Canadian is comfortable seeing included in such legislation and ones that the average Canadian is not -- and unless we actively grapple with the latter, fairness is unlikely to prevail. 

To begin with psychiatric survivors, here we see yet another very clear violation, for the Supreme Court stipulated that mental anguish was to qualify. Moreover, the parliamentary committee established to advise on this bill specifically stated that "mental illness" should qualify. The recognition evident here is that this suffering too can be grievous and it too can prove to be irremediable.

Question: Why has this deviation not been taken up by the public with equal fervor that others have? Quite simply because the average citizen is uncomfortable with psychiatric survivors and their misery qualifying. Understandable, perhaps, but let us look at the issue more carefully.

Now it goes without saying that like everyone else, there are psychiatric survivors leading lives of meaning to them -- and thankfully, this is the vast majority. And like everyone else, there are survivors who do not.  Of the latter, some opt to kill themselves, and as with everyone else, in many of these instances, such a decision seems premature to most, and regardless, the condition in question fails to meets the threshold of irremediable. There are survivors, nonetheless, who have struggled for decades, who have tried one measure after another, and whose agony has only grown worse -- in some cases exponentially so -- survivors, moreover, who have made a clear and measured decision to die. Are they to remain either trapped or forced to die alone? Moreover, in response to readers who are certain that exclusion is in order, whether because they believe that a termination-of-life decision by a member of this population is likely to be a product of their "mental disorder" (a concept and a conviction, note, unsupported by the evidence) or for any other reason, I would ask this: Given that the identical safeguards would apply, given, for instance, that psychiatric survivors seeking physician-assisted dying would also have to be competent to make the decision in question, given they too would have to wait the requisite period of time to ensure that the decision is not in any way impulsive, and given that the condition would have to be seen as advanced and irremediable, is not denying this population what we allow other Canadians tantamount to discrimination? And is that truly what we want this country to stand for? 

Herein, let me suggest, our biases get in our way. Moreover, our sense of compassion and responsibility toward people we see as vulnerable badly skews our judgment. The point is that while vulnerability is a reason for making extra help available, it is not a reason to deprive people of their rights (albeit we habitually act as if it is). And robbing people of their rights is ultimately neither the compassionate nor the responsible thing to do.

Finally, to end with the age restriction, the Supreme Court was clear that "mature minors" should also have access to assisted dying services -- and yet this bill manifestly excludes them. Now I doubt that anyone would disagree that extra safeguards are in order here. For example, there may be reason to look into issues of neglect or of undue influence. That is different, however, than the across-the-board exclusion found in this bill. Once again, irrespective of intention, this smacks of discrimination. And here once again, paradoxically, our desire to protect the vulnerable gets in our way and in effect leads us to shortchange and to violate.

In ending, I invite readers to grapple with these issues. While without question, we need safeguards and criteria -- and most of the ones already stipulated make perfect sense -- and while without question, we must ensure that such measures are never used as an excuse for cutting back on services for people who in any way want help to live, cannot we not be less restrictive? More compassionate? More respectful? And what better time than now when legislation is on the table and the Supreme Court has provided the requisite signal?

References

Stefan, S. (2016). Rational suicide, irrational laws. New York: Oxford University Press.

A “Hot-Potato” Topic and a “Rational” Book: Burstow Reviews: Rational Suicide, Irrational Laws

This year Oxford University Press and renowned scholar Susan Stefan (2016) released a very thoughtful book on one of the most controversial subjects with which any tome could ever deal—the question of suicide and the laws and public policies surrounding it. A long book of 540 pages, it is called Rational Suicide, Irrational Laws.

This is without question an excellent book. It is highly comprehensive, including an examination of a vast number of related laws and issues. While focusing on the US, it has international scope and provides a critical overview, for example, of assisted suicide laws throughout the world. It explores the criminalization and decriminalization of suicide. It analyzes laws by which “mental health” professionals and organizations are held accountable or “liable”. It exposes horrific contradictions in how laws are applied, particularly problematizing the assumption that people who kill themselves are suffering from a “mental illness” which makes them “legally incapable”, also the legal contradiction of mental health professionals deeming people capable when they go along with the professionals’ wishes while assessing these very same people as incapable otherwise. It weaves throughout real cases and the plight of very real people. Moreover, the underlying research includes at once depth analyses of statutes and legal journeys, and personal interviews with a large number of different folk, including health professionals, and what is especially gratifying, including people who have tried to kill themselves—a group arguably with the most relevant expertize and yet one which recognized “experts” on the topic characteristically sideline.

Finally, it is at once a compassionate and an intelligent book, written by a researcher who listens intently and who is trying to do justice to a complex issue about which she deeply cares. All of which is obvious right from the introductory remarks.

As the title of the book suggests, the story which Stefan tells and the analysis proffered is largely one of “rational” suicide and “irrational” laws and processes. Positions arrived at/articulated include: The state has an interest in preserving life and as such, a balance between the interests of the state and those of the person need to be struck. The vast majority of people who opt to end their life, including psychiatric survivors, have the legal capacity to make this choice and should be treated accordingly. The state should be getting rid of suicide magnets such a bridges with no barriers and should require the safe lockup of personal firearms. We should be moving away from an emphasis on detection and the immediate stopping of suicide to addressing the systemic issues that incline people toward suicide. A full range of help options should be made available to people, including safe houses, peer counseling, even long term 24 hour wrap-around services. While there are some who are “suicidal” for whom short term involuntary confinement is necessary given their lack of capacity, contends Stefan, in most cases, this is not so. It is critical that people who are considering killing themselves be able to talk about it freely—without the threat of being apprehended (an outcome traumatizing in itself and which increases the likelihood of suicide). What goes along with, so that professionals are not predisposed to avoid the topic of suicide or call 911, laws should be changed making “mental health professionals” not liable for the suicide of their non-committed clients.

Assisted suicide should be legal, Stefan goes on to state, but only if a number of stringent conditions are met, including the existence of capacity, the fact of having no more than 6 months to live, and having considered one’s options carefully. Correspondingly, she makes a sharp distinction between “assisted suicide” and “euthanasia” and regardless of whether or not euthanasia is actively solicited by the capable person themselves, wants it utterly prohibited and treated like ‘homicide”. And optimally, neither strangers nor family members should be allowed to “assist”.

Do I agree with all of the above? Decidedly not. However, before I touch on disagreements and what I see as problems (some of them major), let me say, there is much in this book that makes me want to stand up and cheer. The deep awareness of problems caused by trying to control people would top that list. Stefan is understandably horrified by the ease with which police are summoned, with vulnerable people concomitantly cuffed and dragged to “hospital” simply because they have mentioned suicide. As part of countering this expectable reaction, correspondingly, Stefan recommends legal, policy, and educational changes so that therapists, for example, stop focusing on control and start focusing on connection. Correspondingly, she is crystal clear that the status quo generally makes the suicidal person’s plight worse. Consider in this regard this thrilling passage:

People who are struggling with a reason to stay alive don’t want to be “assessed”. They don’t want to be asked endlessly if they have a plan, if they have the means, if they will contract for safety.  They want to talk about someone who cares, about hope, about solving the problems that seem insolvable, about how to get through the night (309).

Or consider this one:

The most skilled mental health professionals doing their best work must necessarily take risks that their patients will commit suicide. The journey to a life that a suicidal person considers meaningful and worthwhile must carry some risk. To increase the quality of life and the absolute number of lives saved, we have to be prepared to tolerate the reality that some people may kill themselves, We cannot continue creating unnecessary misery, increasing costs, and reducing both the availability and the quality of treatment to nurture the myth that all suicides are preventable. They never have been and never will be. (277)

She opines, correspondingly, that there would be considerably less suicide if we put less emphasis on controlling people and more on connecting with them.

In this last regard, while our opinions are far from identical on this issue for I place greater emphasis on freedom and personal autonomy than Stefan, let me share a bit of my own professional history for it solidly supports Stefan’s point: As a therapist, for well over three decades my specialties have been adult clients who: a) self-injure; b) are psychiatric survivors; c) have been profoundly traumatized; d) live with alternate realities; and e) want to kill themselves. As a matter of principle, I am clear with clients right from the start that I will not prevent them from killing themselves, will not call 911, so they have no need to censor themselves. Bottom line positions for me are that people desperately need to be safe to talk about “suicidal” thoughts, that we should not presume to know what is best for others, nor make decisions for them, moreover, that people in dire distress need to connect, and to deny them the possibility to do so safely is ultimately to make counseling and therapy unavailable to those in the most dire distress. What is significant in this regard, while no doubt some degree of luck has been involved, in all these decades, despite my having a specialization that makes the suicide of my clients a statistically strong possibility, not a single client of mine has ever killed themselves. As such, I am highly aware that there is wisdom in what Stefan is alleging and recommending here.

More generally, what this book does well is introduce us bit by bit to the legal territory, and the place of culture in determining what conceptualizations are viable. Praiseworthy and major contributions similarly are the author’s insistence that whatever laws are created, psychiatric survivors must not be discriminated against, must be treated like everyone else; the sharp distinction that she draws between adults and children; the argument that we should prioritize addressing the systemic problems that commonly underlie people’s desire to kill themselves (e.g., in the case of children, bullying); the push toward less control and more connection/compassion; the highlighting of psychiatric contradictions; the unmasking of so many current practices in this area as illegal and/or irrational; the downplaying of medical solutions as well as the recognition of how causal they can be in suicide; the recommendation that society consider the different types of suicide and find ways of providing the various types of help needed; and finally, what goes along with this, the caution against the advent of assisted suicide becoming just another way of letting society “off the hook”.

Which brings me to the problems.

From my perspective—and I suspect most people would critique Stefan from the opposite perspective—the author seriously understates the problems caused by psychiatry, and in no way touches on the invalidity or the inherently damaging nature of all its biological “treatments”. As such, while she wants to protect people’s rights as far as they are “legally capable” and while she remains very critical of psychiatry, she still sees a place and a privileged place for psychiatry. More generally, while she would greatly reduce it, she ultimately accepts the “need” for involuntary psychiatric detention—and no, I do not.

What relates to this, while once again being critical, Stefan accepts a view of incapacity that would still have a huge number of people declared incapable (albeit far less than are so deemed today). For example, she sees as obviously incapable people who are “floridly psychotic” and as such, would have no compunction over 911 being called on them, if, for example, they are actively suicidal. What this position invisibilizes is that there are people with such different ways of processing that they are automatically seen as lacking reason. As demonstrated in Burstow (2015, Chapter Nine), this failure to comprehend is largely a limitation of the “sane”, as well as a deficit—and indeed correctable deficit—in our education systems. Correspondingly, society’s failure to understand people whose minds work differently does not per se make such people “incapable”.

An example pertinent to the issue at hand: A client of mine that at once dwelt in an alternate reality, was “suicidal”, and who would certainly have been seen by most as ‘incapable” announced one day she was going to kill herself forthwith in order to join the trees. To the average person, it would look as if she had lost her power of reasoning and so could not conceivably be competent. An understandable reaction, sure, but what this view leaves out is that she was literalizing a metaphor. What she was saying, in “sane parlance”, is that she wanted to return to nature, to dust, as it were. That is, finding life meaningless, she wanted to rid herself of the existential burden of being a separate and cognizant being. Now I can well understand why a situation like this gives us and indeed must give us pause. Nonetheless, is not a variant of this position held by most people considering ending their lives—including those, I would add, that the average person would “recognize” as “capable”? Indeed, to step totally outside pathologizing frameworks (always a good thing), is not her question a variant of the ultimate existential question that philosopher Albert Camus (1975) sees facing all of us? To be clear, I am not suggesting that anyone “support” her decision. However, how in good conscience can we uphold a framework which would not only thoroughly invalidate it but would inevitably lead to her apprehension?

Less obviously but more fundamentally problematic is the statist framework which Stefan uncritically employs. Note, while I well understand the need to balance community rights with individual rights, weighing the needs of the individual against “the interests of the state” (in this case in “preserving life”) which the author is advocating, is a different matter altogether. To be clear, while I am decidedly “on board” with wanting to improve society and people’s situation for a variety of reasons, including so that fewer end up feeling that they have no recourse but to kill themselves, not one of those reasons is that the “state” “has an interest in preserving life”. By the same token I see as inherently problematic concepts like “suicide prevention” so rampant in this book and indeed, the very conceptualization of people “committing suicide”. Note, in this regard, “committing suicide” is a concept tied to the state. And as institutional ethnographer Dorothy Smith (1983) so astutely put it decades ago, while people indeed end their lives, “no one commits suicide.” While shifting a framework this hegemonic is hard, I appreciate, and runs directly counter to legal training, attempts to bring about a more humane approach, I would suggest—are minimally jeopardized by statist ways of thinking and statist problem-solving. By the same token, while I applaud the author for wanting and pushing for better services, I question the degree of improvement possible in our current statist arrangements, for states have their own interests, as do their representatives—note, the very people in whose hands lies the state’s parens patriae powers—ergo, the power (and responsibility) to commit and to intrude (see Burstow, 2015).

Finally, we come to Stefan’s positions on assisted suicide and euthanasia (issues with which, I would agree that as things currently stand, we need to involve the state).

To put this simply, people in dire distress and who rationally choose to end their lives often need more than either decriminalization or assistance to live, significant though both are. As a society, of course we need safeguards and of course we need standards, and of course, contrary to how we currently act, we need to prioritize doing whatever we as a community can to help improve the quality of everyone’s lives. And of course, having the right to end one’s lives does not automatically translate into having the right to assistance with this—far from it. Nonetheless, let me suggest such assistance is often in order. 

On a simple level, no one wants to die alone; most people would greatly prefer having the peace of mind that comes from knowing that the procedure will not be botched.  Correspondingly, allowing assistance of this ilk only in those cases where the person has but six months to live (one of Stefan’s provisos) is woefully inadequate. What for example, about the person who is not in the least terminally ill but is in terrible pain that cannot be stopped, that in essence cannot be “made comfortable”. Take the person who has advanced arthritis, together with exceptionally severe gastro-intestinal problems along with such a dire case of multiple chemical sensitivity, along with a body with such low intolerance that no pills will alleviate her suffering, for no medication whatever, however introduced, can be tolerated. Imagine further that she has spastic conditions that will not allow her to tolerate even seemingly non-intrusive measures like acupuncture or mindfulness or indeed any of the other options in the medical repertoire. Do we as a society really want to say to such a person that while we will not stop her from ending her life, unless she has but six months to live, we will neither help her nor allow others to?

Enter the author’s recommendation for how assisted suicide might work. Understandably worried about the involvement of doctors, Stefan recommends that persons with six months only to live enter a hospice, whose operator in turn gives them a voucher which allows them to receive a fatal dose of medication from a pharmacy. To go back to the previous example, which as it happens is not a hypothetical but a real situation with which I am highly familiar, besides that the person in question would not be eligible—for she has way more than six months to live—she is unlikely to be able to enter a hospice for the presence of everything in it would instantly make her vilely ill. Moreover, the medication is highly unlikely to be something her body would tolerate. And it is hit-and-miss with injections or other like solutions. Nor would starvation (a method suggested in this book) be endurable for her body reacts even worse to food deprivation than to eating.

Which brings me to the question of euthanasia. Stefan unequivocally rules it out and equates it with homicide even where the person in question actively requests it, waits the required amount of time, carefully considers their options. To be clear, of course far more stringent oversight is needed if we allow direct second party involvement, and of course, we need to keep in mind what has been called “the slippery slope”, but at the bare minimum people’s peace of mind in dying can at times be greatly enhanced by making more direct assistance possible. Again, take the person referenced earlier.

With solutions that work with others habitually backfiring with this person, do we not want her to have a medical expert there to deal with physical reactions that might suddenly happen, that might make an otherwise seemingly uncomplicated procedure unworkable and/or tortuous? Or do we want to leave what happens to her to chance? Correspondingly, are we okay leaving as one of the only options that does not leave her trapped or feeling guilty (the latter because of a route that involves legal jeopardy for potential helpers), the lonely and indeed frightening option of crawling away and shooting herself?

The point is clear. Society has been moving to assisted suicide because we do not want people in agony stuck with such dilemmas. However, we cannot provide what is needed without considering the real dilemmas that real people in extremis face. Correspondingly, we cannot just accept models that might work for many. Any model that places anyone in such dilemmas is unacceptable. 

Time for greater clarity on the example at hand: In short, what I have done here is draw on several of my own conditions, while leaving out the vast majority of disabling but nonterminal physical conditions I have (e.g., inability to sit, to eat more than 4 specific foods, to travel at all, to see anything without significant distortion, to treat a single ailment, to be around sounds louder than a hush, etc.). Factor in all of these and the need for active help to be available is even more apparent.

To be clear, I am 71 years old. I have a wonderful life, continue to be highly productive, work with awesome students and fellow activists, am a professor at a leading university, have just become head of my program; and I have no intention whatever of retiring any time soon, never mind killing myself soon—if ever.  However, if things got so bad that life was no longer tolerable irrespective of the help offered, a society that could only push “solutions” at me that would make my plight worse and/or would in any way penalize anyone who helped me bring my life to a peaceful conclusion would surely be failing me—not to mention the helpee. And mine is just one set of circumstances.

Who knows what worse circumstances others and indeed younger individuals might be facing? Bottom line, the criteria for qualifying for assisted suicide stipulated in this book, together with the dismissal of more active help, seriously “misses the mark”.

Two final observations: While there are unquestionably people, including doctors, whose “help” in this area qualifies as undue influence and/or borders on criminal negligence, moreover, others where it is downright murder—both of which are “beyond unacceptable”—at this point in history, that is hardly typical; and processes and laws that operate as if it is are themselves sadly wanting. Moreover, often people, including doctors and including family members who go “the extra mile” do so because individuals who are by conventional standards demonstrably “capable” want them to—are clear that they urgently need them to. Question: Can we not find better processes and ways of distinguishing what is happening? And cannot we not respond accordingly? As for bone fide helpers who cross the still-to-be-negotiated line, let us deal with that for sure, but in a way that factors in their predicament and society’s inevitable role in this.

And finally: Like Stefan, like virtually all disability activists, I too consider “beyond unacceptable” any slippage whereby states start using assisted suicide as the ultimate solution to their “problems”, as a cost-effective and convenient way of ridding themselves of whatever or whoever they see as burdensome. Correspondingly, as I too see a danger here and as I want better, not worse services, I personally would favour a policy whereby for every penny that a state spends on the combination of assisted suicide and requested euthanasia, an equal amount has to be added to the coffers supporting programs intended to help people in difficult circumstances live—that is, to help them lead lives of meaning to them.

Closing Remarks

As I stated at the outset—and I would reiterate it at this juncture—Rational Suicide, Irrational Laws is a ground-breaking, brilliant, indeed courageous book; and I encourage people to read it. There is information, analyses, wisdom to be gleaned from it. What is also important, it is written by someone who is clearly highly ethical. And reading the reflections and considered opinion of those who are guided by a strong sense of decency is in itself good for the soul.

My invitation? Pick up the book, engage with it, where you find yourself agreeing, ask yourself why, similarly for when you find yourself disagreeing, and continue thinking about the issues raised. Through the lens of suicide and societal responses to it, it implicitly asks what kind of society we want, and as such, it holds significance for all of us, addressing in the detail it does issues that cannot but touch each of our lives. At the same time, it holds special significance for psychiatric survivors, for survivors of childhood trauma, for lawmakers, for therapists, for educators, for people who are sick or dying, for anyone who has themselves or whose loved ones has ever seriously entertained killing themselves—hence my particularly drawing your attention to it.

In ending, additionally, I would say this to the author: I hope that some of what I have written holds meaning for you, including where we agree, including where we disagree.

And regardless, Susan, thank you for penning this book.

References

Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave.

Camus, A. (1975). The myth of Sisyphus. New York: Penguin.

Smith, D. (1983). No one commits suicide. Human Studies, 6, 309-359.

Stefan, S. (2016). Rational suicide, irrational laws: Examining the current approaches to suicide in policy and in law. New York: Oxford University Press.

The CHRUSP Call to Action and Its Significance

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.

Setting the Record Straight: The Psychiatric Legacy of Robert Spitzer

On December 25, 2015, renowned psychiatrist Robert Spitzer died. Spitzer was a giant in world psychiatry, best known as the architect of the third edition of the psychiatry’s diagnostic bible -- The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) -- the edition that effected a turnaround and became the template for how psychiatric diagnosing has proceeded ever after. As such, this death has hardly gone unnoticed, with stories about him proliferating. Most of what is written is highly laudatory. We are told, for instance, that he placed psychiatric diagnosis on a scientific foundation, that he introduced rigor (see, for instance, http://www.nytimes.com/2015/12/27/us/robert-spitzer-psychiatrist-who-set-rigorous-standards-for-diagnosis-dies-at-83.html), that he was a “pro-gay psychiatrist” who “campaigned to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders.” (Newsmax, http://www.newsmax.com/Health/Health-News/robert-spitzer/2015/12/29/id/707468/ This article takes serious issue with the most significant of the claims.

To be clear, it is always sad when someone dies -- and I in no way wish to detract from the personal tragedy. Nor do I intend to make any pronouncement about Spitzer the individual. What concerns me in this article is one thing only—how to understand his “psychiatric contribution” to society. Now no one denies that Spitzer was enormously influential. However, it is precisely because his legacy endures and because vulnerable people are forced to live with what was set in motion that I felt compelled to write this article.

So what are we to make of the claims? And what in fact is Spitzer’s legacy?

Claim: Spitzer Was Enlightened and Opposed the Pathologizing of Gays

It is claimed that Spitzer was largely responsible for removing “Homosexuality” as a disorder from the DSM. This claim has some merit —nonetheless, the situation is not as straight forward as appears. The American Psychiatric Association (APA) was in difficulty at the time. Gay rights activists were skillfully protesting the inclusion of said disorder, interrupting meeting after meeting of the APA (see Teal, 1971). Spitzer was called in to help. His actions eventually culminates in a postal vote and the concomitant removal of the offending diagnosis from the DSM. That this is an important legacy is without question. At the same time, Spitzer was hardly the great liberator suggested by most who tell this story. What is significant in this regard, he went on to introduce another disorder which also pathologized gay life -- ego-dystonic homosexuality. This was a particular worrisome diagnosis for it pathologized discomfort with being gay -- a reaction totally expectable in a homophobic world. Herein we find an unfortunate default mode which characterized Spitzer and those who followed him -- totally ignoring context. As for the question of gay existence per se, for most of his professional career, Spitzer flip-flopped on it, in the early 2000s, for example, mounting a study in support of a therapy to “cure” people of being gay, in 2012 retracting said study -- albeit only after it was exposed as shoddy scholarship (see https://www.washingtonpost.com/national/health-science/robert-spitzer-psychiatrist-of-transformative-influence-dies-at-83/2015/12/26/b6851764-ac46-11e5-bff5-905b92f5f94b_story.html).

The Major Claim: With the DSM-III, Spitzer Introduced Rigorous Science and Thereby Made Diagnostic Psychiatry Credible

This brings us to the main claims and without question the central “contribution” for which Spitzer is known –the revolution that constitutes DSM-III. On this “contribution” clarity is critical -- for to misunderstand it is precisely to misunderstand the nature of the psychiatric quagmire that we as a society are facing to this day.

The claim put forward by almost all psychiatrists, including those of a reformist bent, is that Spitzer placed psychiatric assessment on a more or less solid scientific foundation. States psychiatric reformer Dr. Allen Frances in this regard, “He [Spitzer] saved the field…from a crisis of credibility, raising its scientific standards (see http://www.nytimes.com/2015/12/27/us/robert-spitzer-psychiatrist-who-set-rigorous-standards-for-diagnosis-dies-at-83.html).

There are two sets of claims involved. The first is that psychiatry was suffering a crisis of credibility, that Spitzer introduced a new approach to diagnoses with DSM-III, and that in the process, he shepherded psychiatry through the crisis. To start at the beginning, there was indeed a crisis at the time: Psychiatric diagnoses had been shown to have extremely low inter-rater reliability. That is, the chances of different psychiatrists assigning the identical diagnostic category to the same patient was low -- little more than chance. Moreover, a major experiment by Rosenhan (1973) had exposed psychiatry on an even more basic level.

The experiment involved Professor Rosenhan sending students pretending to be disturbed into hospitals. While the students proceeded to act “normal” except for initially telling staff that they had heard a voice saying, “hollow,” “thud,” and “empty,” all were kept a sizeable time and all were assigned major diagnoses. When the results of the experiment became known, the public’s reaction was that psychiatrists could not even distinguish between “real patients” and “pseudo-patients” -- never mind between different “disorders.” And as such, the credibility of the diagnoses, and by extension, psychiatry itself, was at an all-time low.

Did the reputation of each improve after the introduction of DSM-III (1980)? Yes, it very much did. And was this because of how DSM-III was constructed? To a significant degree, yes. And was this because, as claimed, psychiatric diagnosing had finally been placed on a sound scientific footing? In a word, no.

By way of explanation, Spitzer for sure created discrete diagnoses. Correspondingly, unlike in the past, they came complete with explicit sets of criteria, superficially at least reflecting how physical disorders are delineated. And for sure, tests were conducted and validity thereby “claimed” for each of the included disorders. The point is, however, mirroring the trappings of medicine, that is, using medical-sounding language has no bearing on validity.

Aside from the inherent persuasiveness of medicalized language, what exactly was Spitzer’s claim to validity? Quite simply, that the research conducted by his team had established high inter-rater reliability. The problem here is that high inter-rater reliability similarly has nothing to do with validity. To quote a passage from Burstow (2015) in this regard:

The fact that people can be trained to apply a label in a consistent way, note, does not mean that the label points to anything real. To use an extreme example, let us say that we want doctors to be able to identify people walking about who secretly hail from Mars. We might provide clear criteria for such people and so carefully train the doctors that they achieved a high level of agreement when making their determinations. None of this gets around the problem that there are in all likelihood no people from Mars walking the earth. (p. 78)

A still further problem enters in with Spitzer’s very claim to high inter-rater reliability. At their most successful, there was miniscule difference between the reliability ratings for DSM-III diagnoses and the rating for previous “disorders.” Often there was no difference at all; and at times the DSM-III scores were lower, this despite the fact, as Kirk and Kutchins (1997, p. 52 ff.) demonstrate, experiments were rigged so as to create superior results, including providing the DSM-III raters with extensive training so that their scores would be bolstered. Additionally, different criteria were used when re-evaluating the DSM-II studies than when interpreting the DSM-III studies -- thereby creating the impression/misimpression that the DSM-III categories yielded superior results. One obvious example is the very same level of agreement that was deemed “only satisfactory” in the reevaluation studies (e.g., 7) was deemed “high” or “very high” in the studies involving the DSM-III categories.

This is not medicine; this is not science; and this is not rigor.

So if the claim to high scientific standards will not hold—and as you can see, it will not-- exactly what was the revolution that constituted DSM-III?

What was introduced was a classification schema that was avowedly neo-Kraepelian (see Kraepelin, 1907 and Burstow, 2014) -- that is, an etiology-free schema which has little tie-in with the realities of people’s actual lives and as such, is largely classification for classification’s sake. In the DSM as it emerged, there is no thought to why people are acting as they are. The not-so-hidden benefit to psychiatry is that the new schema put an end to most internal squabbles, for it is precisely when it comes to issues of cause and what something is “about” that arguments break out. The ramification of such a system, correspondingly, is that the label or diagnosis itself ends up treated as causal. The circularity thereby engendered is visible in this comment which I made in a recent interview:

[The DSM) sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they’re going to be honing on questions that follow the logic of the DSM, or to use their vocabulary, the “symptoms” for any given “disease” they’re considering. In the process it rips people out of their lives. And so now there’s no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed. In essence, the DSM decontextualizes people’s problems, then re-contextualizes them in terms of an invented concept called a “disorder.” Let me give you an example. “Selective Mutism” is a diagnosis given to people who elect not speak in certain situations. So, if I were…trying to get a handle on what’s going on with somebody—I would try to figure out what situations they aren’t speaking in, try to find out if there’s some kind of common denominator, to ascertain whether there’s something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example,  a person of color going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, “Selective Mutism” is a discrete disease. So, according to psychiatry, what causes these “symptoms” of not speaking? Well, “Selective Mutism” does. (Burstow’s response in Spring and Burstow, 2015)

Combine this vacuousness and this circularity with medicalized language, such is the revolution that was DSM-III. 

Concluding Remarks

I began this article by taking issue with claims about Spitzer’s legacy. Clearly Spitzer’s most formidable contribution to psychiatry is his overall contribution to diagnostic psychiatry via introducing a whole new way of constructing diagnoses, as spearheaded in DSM-III. On this, everyone agrees. However, what is it that Spitzer -- and his colleagues -- set in motion? Contrary to the claims being made, through the use of scrupulously medicalized terms and through the pretense of carefully conducted research they created “the appearance” of science, medicine, and rigor. That is, they set psychiatric diagnosing decisively on a path where it would look scientifically rigorous, where it could claim the authority of medicine on the basis of appearance, while in point of fact, being vacuous. Correspondingly, subsequent DSMs have continued in the same vein -- hence the difficulty combating psychiatry.

In ending, I would remind readers once again that a human life has been snuffed out. At the same time, I invite readers not to lose sight of the real legacy of Spitzer and his brainchild -- DSM-III.

Otherwise, how are we to keep our bearings in the struggle ahead?

References

Burstow, B. (2014). Neo-Kraepelinian Psychiatry. In Cultural Sociology of Mental Illness (Andrew Scull, Ed.). (pp. 575-576). Thousand Oaks, California: Sage.

Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave Macmillan.

Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.

Kraepelin, E. (1907). Clinical psychiatry. (Ross Diefendorf, Trans. and Ed.). New York: Macmillan.

Kutchins, H. and Kirk, S. (1997). Making us crazy. New York: The Free Press.

Spring, L. and Burstow, B. (2015). Probing Psychiatry and the business of madness. Retrieved January 5, 2016 from http://rabble.ca/books/reviews/2015/07/probing-psychiatry-and-business-madness

Teal, D. (1971). The gay militants. New York: Steiner and Day.

Good News on the Publishing Front: BizOMadness and Antipsychiatry, Full Speed Ahead

As the holidays approach, I am just posting a very short blog article to let people know that there has been terrific news on the publishing front.  But a day ago, Palgrave Macmillan  signed a contract with me for the publication of my book Psychiatry Interrogated--an anthology of institutional ethnography investigations into psychiatry--featuring stellar researchers/authors from Canada, the US, the UK, and Poland. About a month and a half before that, Inanna Press signed a contract to publish my second novel--The Other Mrs. Smith, whose fictional narrator is an ECT survivor, struggling to make sense of her life.

And and all, a very good year!

Could Life Be Sweeter?: Signing a Contact for "The Other Mrs Smith"

 Just when I thought life could get much sweeter for those of us in the antipsychiatry world, the Canadian feminist publisher Inanna sent me a contract to to publish my blatantly antipsychiatry novel "The Others Mrs Smith."

Why am I so excited about this novel?  But it conveys the reality of ECT in the way only a novel can, and yet almost no novel really does.

 There is a vast array of different characters in this novel, many of them very colourful.  For example, there is Gerald, a very kind transman with a flair for research and a dim view of the world; Earl Smith, the overbearing Newfoundland husband and an avid environmentalist; Rose Cohan who is Naomi¹s  twin, a bisexual, a twin with a keen telepathic ability; Ruth, Naomi¹s angry daughter; Ida Cohan, Naomi¹s mother, a clever and witty woman, who has the unfortunate habit of creating lifelong feuds at the drop of a hat. And then there is Jack, fondly known as the indomitable Jackman--an extremely helpful fellow patient, an Aboriginal man who is the admiration of most all the patients at St. Pukes, for among other things, as Naomi puts it, he rolls "the meanest cigarette in Turtle Island.  That said, the novel revolves around one character, in whose head we frequently find ourselves mired--narrator and north end Winnipeg Jew Naomi Cohan Smith. Critical to her circumstances is having been subjected to ECT (electroconvulsive therapy), and as a result suffering enormous memory loss, additionally an estrangement from her family of origin that she has no way to wrap her mind around. From the moment that we come across this confused woman wandering the corridor of St. Patricks-St Andrews Mental Health Centre (referred to by the inmates as "St. Pukes"), not knowing who she is or even what species she belongs to, Naomi's  plight becomes our world--what has happened to her, what will happen to her. Just as the protagonist slowly comes to terms with the damage as well as the hidden details of her life, so do the readers.

Via the device of flashback chapters, the novel moves back and forth in space and time, between a relatively happy childhood in the legendary Jewish north-end Winnipeg of the mid 1900s and her post-ECT adulthood in Toronto. In this regard the structure of the novel itself may be seen as a metaphor for Naomi¹s mind. While the movement in space continues, the foray through the past comes to an abrupt halt when we come to the limits of Naomi¹s memory.


The novel per se  begins a few years after of what is called Chapter One, with the kindly figure of Gerald as he goes about the unusual task of cleaning someone else¹s house. The introduction of Gerald sets the stage for a query that haunts the novel. Putting Naomi¹s binders back in order, he stops to re-read Back Binder Number Three. He ends it, feeling certain that there is something more to this binder that meets the eye.

What follows is what Naomi calls her memoir (in three books).  Other character breath life into this memoir and this novel.  Examples are It begins with her in the hospital. An uncompromisingly unsentimental novel, every time an easy or cliché solution appears to be offered, it is refused. The novel culminates in Naomi making something important of her life, of her creating meaning and purpose despite the very real damage, indeed, out of it and along side it. The final vision with which it leaves us is one of wisdom. Critical events which transpire along the way include: fleeing Toronto and indeed her controlling husband,  building a new foundation with the twin from whom she has been estranged,  establishing dual residence so as to connect up with her daughter. It ends with Naomi, her sister, and Gerald taking aim at the very institution which is her nemesis and in the process uncovering the hidden truth which lurks in the pages of Black Binder Number Three.

The novel, as circumstances will have it, will not be coming out till 2017, but already I am looking forward to it.  And already book launches in two different countries are being planned.

Check this blog and check Facebook for updates.

Why Did 158 People Plus Attend An Antipsychiatry Book Launch?: A Reflection

Two weeks ago, on Friday September 18 2015, people assembled at Ontario Institute for Education of the University of Toronto for the last of the three international book launches for Psychiatry and the Business of Madness, preceded that same day by a press conference. While others also spoke, major scheduled speakers included the author (me), Member of the Provincial Parliament (MPP) Cheri DiNovo, and leading Canadian mental health lawyer Anita Szigeti. There were many wonderful highlights of the evening. Ones that immediately come to mind are: the articulation of the findings of the research, all leading to the inescapable conclusion that psychiatry has no foundation and should be phased out (and while admittedly, it would be difficult under the circumstances, not a soul raised an objection). Member of Parliament Cheri DiNovo’s thrilling statement that while it was virtually impossible to move on “reining in psychiatry” before, “now we have the facts -- and now there is no excuse.” Leading mental health lawyer Anita Szigeti declaring Psychiatry and the Business of Madness a must-read for  lawyers and professionals everywhere. ECT survivor Connie Neil bearing witness to the atrocity to which she was subjected. All good. All riveting.

That said, there are several astounding facts about the Toronto book launch that are not captured in this description. Half an hour into the launch, according to the official count, there were 158 people in attendance. I kid you not! 158! And an hour later, there were at least 15 additional people. This is an amazing turnout for the launch of any book, never mind something as far from the mainstream as antipsychiatry. And what adds to the triumph, well before the launch began, there was standing room only, with the Nexus Lounge at OISE (room where the launch was held) virtually packed to the rafters. “Bonnie, never in its history has any event in the Nexus Lounge drawn so many,” observed one excited OISE staff member in amazement. Moreover, people remained the full two hours, including the people who were standing. Which leads me to ask these questions:

How is it that such a huge crowd showed up? And how is it that so many people, who after all were only able to stand, remained without budging a full two hours?

Something of an enigma, though there are a number of possible answers. To touch on a few of these:

Answer One: All of the speakers were well known. Absolutely true. And without question, the reputation of the speakers was a factor. That said, reputation is clearly not the whole of it for we have had a number of  these speakers together on a stage before, with nothing like such a stellar result.

Answer Two:  The organizers did a great job publicizing. Again, true—and much thanks to everyone for the hard work. However, despite doing what was ostensibly a first rate job of publicizing before—at one point several years ago, note, we even had a professional publicist helping us—never have we drawn an audience of this proportion.

Answer Three: The book was known to be controversial: This is the least compelling of the answers for everything critical of psychiatry is controversial. And again, historically, such events have not tended to deliver anything close to this turnout.

Which brings me to a final answer—one that I am suggesting has considerable explanatory value: There is a hunger out there for a foundational critique of psychiatry—something that pulls no punches, minces no words. That is, there is a hunger for a reasoned antipsychiatry position. Something that explains how we ended up here, provides solid evidence that psychiatry should be abandoned, and begins theorizing what we might do instead. Moreover—and here we connect up with the first answer—people were acutely aware that this is exactly what this book and this launch were all about.

Elsewhere I have written that the tide is turning against psychiatry (see http://www.madinamerica.com/2015/09/yes-the-tide-is-turning-against-psychiatry/). May I suggest that the turnout on September 18^th is yet another indicator that this is so.

What is, as it were, an accompanying indicator, besides that the audience were hanging on the various presenters' every word, who was present was not just “the usual suspects.” In attendance was a clear cross section of society, from youth to the elderly, from survivors to professionals, from the mainstream to the counter culture, from the poor to the ostensibly well off. Again, all of which would have been unthinkable but a few years ago.

There is a change in the air. People have come to strongly suspect that the emperor “has no clothes.” A minority for sure, but a healthy minority are ready to start entertaining modes of living together and of approaching human distress in profoundly different ways. And indeed, the people in attendance could sense that change, additionally could sense that everyone around them could sense it too. Hence the high spirits.

The point here is, while social change agents often declare events historical moments which prove not to be, and oftentimes we are simply hoping that our words will be self-fulfilling, there was a palpable feeling in the room that we had genuinely arrived at one such moment. Only time will tell whether rightly or wrongly.

Was there any downside to the day? There was, and fellow old-timers in the movement may well be able to guess what–-the conspicuous absence of the media.

How many “regular” members of “The Fifth Estate” turned up? Despite a major effort on the part of the organizers, including reaching out to over 300 media people, in a word, none. But in this very conundrum or rather in our response to it lay part of the beauty and the brilliance of that day. We responded in the only way that made sense—proactively. Having been “around the block” enough times that we had more than an inkling that this would happen, we met four days prior to the event to strategize. We proceeded to create our own press—“The Peoples' Press”—and that press turned up in full force at both events, asked insightful questions, and covered and indeed covered brilliantly several of the more stirring highlights of the day—of the press conference in particular (for highlights of the press conference, see https://www.youtube.com/watch?v=pjtJvjDG4uM).

So the bad news is, the mainstream media is still ignoring this book (Burstow, 2015). They are likewise ignoring Whitaker's and Cosgrove's (2015) book and indeed, all the leading antipsychiatry and critical psychiatry publications that have come out this year (for a discussion of why and for a number of suggestions about what to do about it, see http://www.madinamerica.com/2015/04/getting-anticritical-psychiatry-authors-read-case-book-activism/). The good news is the organizers did not rely on the traditional media (a default mode which ill serves us). We were proactive. And thanks to a combined effort, both the book and the event are literally “all over” the social media—and note, as long as this is the case, sooner or later the mainstream press will be forced to take note.

The power of the social media—herein lay the new reality. Albeit hardly everything—and we ignore its limitations to our detriment—it substantially alters the “playing field.” Moreover and more to the point, it works to the advantage of those of us involved in counterhegemonic struggle.

To end this article with one final highlight of that memorable day, that evening Member of Parliament Cheri DiNovo spoke confidently of our winning this fight—a note that we had not heard struck by a legislator heretofore. Correspondingly, she reminded us of the famous Gandhi quote: “First they ignore you. Then they ridicule you. Then they fight you. And then you win.” (see http://philosiblog.com/2011/05/25/first-they-ignore-you/).

I would add, while we are still in the “ignoring” stage, there are distinct signs of fighting here and there (e.g., the special issue of Acta Psychiatrica Scandinavica; see http://onlinelibrary.wiley.com/doi/10.1111/acps.2014.131.issue-1/issuetoc).

Moreover, 158 people plus from all walks of life turning up at a launch of this ilk is hardly being ignored!

References

Burstow, B. (2015). Psychiatry and the business of madness. New York; Palgrave.

Whitaker, R. and Cosgrove, L. (2015). Psychiatry under the influence. New York: Palgrave.