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.

Canada -- A Human Rights Violator

In Canada, we pride ourselves on our human rights record. That noted, while this is hardly the only area where we badly slip up, there is one area where we habitually fall into the abuser category with almost no one noticing. Did you know that every single mental health law in Canada contravenes human rights as understood by the UN? Our practice in this area is likewise in contravention. Nor is there any discussion of this infraction. Correspondingly, not only are we doing nothing to remedy it, in the name of promoting "good mental health," we are constantly advancing changes which magnify the violation.  

More particularly, there are a number of instruments of the United Nations which have made rulings that we ignore. To focus in on the most significant, I would draw readers' attention to the Convention for the Rights of People with Disabilities (CRPD; see http://www.un.org/disabilities/convention/conventionfull.shtml), of which Canada is a signatory. We contravene a huge number of articles therein, but I would focus in on two -- articles 12 and 14 -- for their contravention is integral to how we approach what is called "mental health."  

Article 14 reads:

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.

Given this provision -- and note, we signed this Convention -- every single mental health act in Canada violates our convention obligations for indeed, enabling deprivation of liberty, facilitating involuntary lockup is the mainstay of our mental health legislation. Now people may think that what is happening here is okay because it is done under the auspices of carefully worded laws or because the "mentally illness" area is somehow exempt. The Committee responsible for monitoring compliance, however, is clear that is precisely these laws and the practices thereby authorized that are unacceptable. In this regard, it provides the following guidelines:

Involuntary commitment of disabled people based on health care grounds totally violates the absolute ban placed on deprivation of liberty on the basis of impairments ... The Committee has repeatedly stated that the State parties should repeal provisions which allow for involuntary commitment of persons with disabilities in mental health institutions based on actual or perceived impairment. see http://www.ohchr.org/Documents/HRBodies/CRPD/14thsession/GuidelinesOnArticle14.doc).

And to place this issue on an ethical rather than just a legal footing, even had we not signed such a provision, it minimally should worry us that our everyday practices constitute a human rights violation according to a human rights authority as credible as the United Nations.

Now the violation of Article 14 is cut and dry. Judging Canada's noncompliance with Article 12 is more complicated. Article 12 unequivocally bans all involuntary psychiatric "treatment." That is, it states, "State parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life." Enjoying legal capacity on an equal basis, to be clear, means being equally entitled to make one's own decisions, and again, it is precisely depriving people of the right to make their own decisions on matters like "treatment" on the basis of deemed incapacity which is core to our mental health legislation.

Now throughout Canada we have built in very minimalist approximations of human rights protection via a mechanism known as "substitute decision making." People are entitled to appoint a substitute decision-maker to make decisions for them in the event of being deemed "incapable." To be clear, in no way is this in keeping with the UN ruling, as the Canadian officials signing the Convention were well aware. Accordingly, Canada stipulated a reservation on article 12, stating that we understand it to mean that substitute decision-making is allowed. Which led to the Committee responsible for monitoring compliance to provide the following clarification: "The Committee shall ensure that the provision of health services, including mental health services are based on free and informed consent of the person concerned … States have an obligation not to permit substitute decision-makers to provide consent on behalf of persons with disabilities." (article 11)

With this clarification, Canada's reservation "kicked in." As a signatory, it in essence protected us from being forced to truly honour the human right in question. That said, the moral imperative remains. Nor, I would add, is the CRPD the only UN instrument whose rulings on issues like involuntary treatment we as Canadians are defying. In this regard, the U.N.'s Special Rapporteur on Torture, for example, declared the involuntary subjection of people to antipsychotics (major class of psychiatric drugs) a form of torture (see chapter by Tina Minkowitz, in Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond's Psychiatry Disrupted): And torture, note, is paradigmatic human rights violation.

The fact that we are so far from compliance with international standards should give us pause. Now I am aware that the United Nations determinations may be alarming to some. How can we protect ourselves if we do not lock people up when they are psychotic?, some might wonder. And how can those so "impaired" possibly have the wherewithal to make reasonable choices for themselves? While I cannot adequately address all such concerns in one short article, I would point out that research shows that people deemed mentally ill are no more dangerous than anyone else. Correspondingly, while of course looking out for people in emotional difficulty is a "must," given that the choices made on their behalf have them hooked on brain-damaging drugs, it is hard to believe that on average those deemed "mentally ill" would make any worse choices for themselves than are currently being made for them (not that enjoying basic human rights can ever be contingent on making "good decisions"). And lest people think the CRPD is licensing benign neglect, I would point out the CRPD explicitly specifies that if people need help making decisions, it behooves the state to assist them, much as one might assist a physically disabled person to gain entrance to a building. In other words, the UN is not being naïve or thoughtless here. While I personally would prefer that the state not be the help mechanism but the community itself, providing assistance as needed is transparently part of the Convention obligation.

That said, not only do we do nothing of this nature, we routinely drag people to "hospital" against their will, drug people against their will, and indeed control their every move. Correspondingly, we interpret all objections to such treatment as evidence of "incapacity." Nor are we as a country discussing such issues, never mind making plans on how to bring ourselves into compliance. In fact, quite the opposite, we keep looking for ever new ways to make it easier to violate people's rights. Nowhere is this more obvious than with Ontario's Bill 95.

A piece of legislation which has already received second reading, Bill 95 (http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=3316) would authorize a special committee to propose legislation that would further erode the already woefully inadequate rights that psychiatrized people currently enjoy. In the name of ensuring good mental health for everyone, it would make it easier to both commit and to treat involuntarily. For example a change is proposed to what is called the A criteria whereby even a "perceived" danger to self or other that is in no way physical in nature would be grounds for involuntary commitment. And instead of "involuntary treatment" being held in abeyance while the person was under initial observation, it would allow for immediate involuntary treatment (see http://www.ontla.on.ca/committee-proceedings/committee-reports/files_pdf/Select%20Report%20ENG.pdf) Moreover, parental consent for "treating" children would be unnecessary. Additionally, in the name of prevention, it would unleash armies of "mental health professionals" into our schools, all poised to swoop down on youth and deprive them of rights. In other words, it would be intensifying our human rights violation.

As such, it is time for the average citizen to take a long hard look at what is being done in our name. A good beginning is asking ourselves these questions:

How do we feel about Canada being in such profound violation? Why do our elected representatives not attend to the violation? How is it that we have become so comfortable with compulsion and detention that we have lost sight of the importance of basic human rights? Is it really okay to deprive folk of rights just because we are scared of them or for them? How is it that that the most esteemed international body in the world can not only conceive of but actually legislate what the Canadian state appears to find unthinkable?

As you ponder this, I ask you to avoid pat answers like it behooves us to ensure that everyone enjoys "good mental health" for besides that the underlying concepts lack validity, it is precisely such discourse which has landed us in the current untenable situation. 

In ending, I would touch once again on Bill 95. It is clearly promoting an agenda that is a danger to everyone -- but not equally. Who are especially targeted as needing extra help (read: extra intrusion)? Children. Seniors. The Aboriginal community. All of which should sound an alarm.

Which brings me to two final questions: Is the rampant and ever increasing violation of the human rights of vulnerable populations what we want our country to stand for? And do we really think that it is the only way?

(If your answer is no, please contact your elected representatives and make your objection known.)

Yes, the Tide is Turning Against Psychiatry

The suggestion embedded in this article’s title seems counter-intuitive. How could the tide be turning on psychiatry when the institution has never been so strong? And indeed indicators of its growing strength and tenacity are all around us. The exporting of its model to the global south via the World Bank, the emergence of outpatient committal, the explosion of funding for psychiatric research (see Burstow, 2015). Correspondingly, daily are there calls for most aggressive “detection” and “treatment”  (e.g., Jeffrey Lieberman, 2015). And the mainstream press has never been more closed to truly foundational critiques. That acknowledged, let me suggest that such intensification is common when an old system is in the early days of crumbling.

Of course, intensification itself is hardly an indicator that a reversal is at hand. So how would we know? Examples of possible indicators are: Ever growing critiques from inside and outside the profession, growing discomfort with “anomalies” (in essence, the indicators of a paradigm shift spelt out by Kuhn, 1962). Established moral authorities making unprecedented negative pronouncements about the current state of affairs. The surfacing of more and more tales of corruption and fraud. The rising up of those subjected to it. Each of these signs and more we are experiencing now with psychiatry -- hardly conclusive individually, but taken together, convincing portents of a societal shift.

While psychiatric anomalies have always been with us, note, never have they been so visible. Even as we hear calls for the early detention and treatment of “mental illness” to prevent school shootings, for instance, we discover that the majority of the shooters were on psychiatric drugs. Correspondingly, as the system pushes western ways of handling “schizophrenia” on the rest of the world, World Health Organization studies conclude that the countries with the highest rates of “recovery” are those without the “benefit” of  modern “treatment” (see Robert Whitaker, 2010). As for the dissatisfaction experienced by people in the psychiatric and related professions, just check out the speakers at the 2015 conference of the International Society for Ethical Psychiatry and Psychology (http://psychintegrity.org/plenary-talks/), and you will quickly get a sense of it. Telling likewise is what happened in the years leading up to the release of DSM-5. While their goal, of course, was not "changing” but rather “saving” the current paradigm, well in advance of DSM-5’s release, in what was a historically unprecedented move, the two previous taskforce chairs, Robert Spitzer (2009) and Allen Frances (2009), each came out with hard-hitting critiques of what their colleagues were doing, describing it as once bad science and an exercise in subterfuge—critiques echoed, I’d add, to an unparalleled degree by mainstream media. At the same time, a plethora of radical survivor groups have sprung up. And sites dedicated to deconstructing psychiatry are legion (e.g. madinamerica.com and endofshock.com).

By the same token, proofs of fraudulent trials and fraudulent claims of discoveries abound. Witness David Healey’s (2009) unearthing of the systematic “cooking” of drug trials. Witness the exposés on the Breggin site (http://www.breggin.com/). And note the publishing this year of a book which clearly establishes that the American Psychiatric Association has intentionally misled the public throughout its history -- about “mental illness” being a proven brain disease, for example, about the efficacy of the drugs (Whitaker and Cosgrove, 2015).

Even as these developments unfold, major international organizations have cast doubt on psychiatry both morally and scientifically. Take the aforementioned World Health Organization’s studies. And what is particularly suggestive, in its role as moral compass, two different instruments of the United Nations have declared involuntary neurolepticization a form of torture. Moreover, trace the practical implications of the recently minted Convention on the Rights of People with Disabilities and it becomes clear that it positions a key modus operandi of psychiatry everywhere -- involuntary treatment -- as a human rights violation (a victory, I might add, for which the vintage work of groups like the Center for the Human Rights of Users and Survivors of Psychiatry must largely be credited; for details, see Minkowitz, 2014). All of which, note, paves the way for the current survivor-led campaign to rescind involuntary committal laws throughout North America.

Another salient indicator comes from non-psychiatric medical practitioners and students, for quiet though they remain about it, cogent evidence suggests that their opinion of psychiatry has plummeted. A major study written up by H. Stuart et al. (2015) involving 1057 non-psychiatric medical teaching faculty in 15 countries, for example, shows that the vast majority hold a highly negative view of psychiatry. They find psychiatrists, for instance, too powerful, “unscientific,” and “illogical.” Correspondingly, there is currently a formidable decline in the percentage of medical residents open to specializing in psychiatry. In the UK, for example (once a psychiatric hotbed), less than 5% of medical students choose to enter psychiatry (see Read, 2015).

Indeed, psychiatrists are aware of their faltering reputation. And in what is an unprecedented move, in January of this year a major psychiatric journal (Acta Psychiatrica Scandinavica) devoted a special issue to psychiatry’s “image problem” (Vol. 131; see http://onlinelibrary.wiley.com/doi/10.1111/acps.2014.131.issue-1/issuetoc), with leading figures in psychiatry weighing in -- e.g., current and former presidents of the European Psychiatric Association and the current president of the World Psychiatric Association. What the very existence of this special issue seems to suggest is that so bad is the public image that the upper echelons of the industry are taking alarm. Correspondingly, their response is how regimes of ruling commonly respond when their seemingly unquestionable authority begins to slip away -- for example, portraying themselves as victims and blaming everyone else. Bhugra (2015), current president of the World Psychiatric Association, for instance, lays the blame on the “anti-psychiatry media” -- ironic, given the enormity of the media’s support.

That noted, if the tide is turning – and, as shown, it is -- the question is how far? And what form will the change take? At the moment, despite critiques which demonstrate psychiatry’s utter invalidity, the primary discourse is reformist. This news is worse than it appears, for throughout the centuries, in the long run, reform agendas have only served psychiatry. Temporarily, for sure, they create a modicum of improvement, like with “moral management.” Nonetheless, as shown by Burstow (2014), each and every tempering of psychiatry under a reform agenda has culminated in the return of biological psychiatry with a vengeance. As such, despite good intentions—and I am in no way doubting the intentions and hard work of most of the people involved -- all “reformism” ultimately succeeds in doing is losing the momentum.

That said, at this point, many movement people are keenly aware of this dynamic. Correspondingly, we are seeing a renewed interest in psychiatry abolition, especially versions committed to societal rebuilding. The reception which I have been receiving among psychiatric survivors – and survivors, after all, is where the resurgence of subjugated knowledge must come from -- is suggestive in this regard.

Significantly, up until a few years ago, there was but muted interest in psychiatry abolition within survivor circles. What I am seeing now, conversely, is an abundance of posts of the ilk “If antipsychiatry is what Bonnie says it as, then I am antipsychiatry.” Additionally, more and more antipsychiatry websites are popping up. The point is, antipsychiatry -- and not just any type but one of a visionary nature -- is markedly on the rise.

And indeed, a visionary antipsychiatry is precisely psychiatry’s worst nightmare—hence the current barring of foundational critiques by the mainstream media and hence psychiatry’s worried references to “antipsychiatry.” Simple reform, as history shows, is inevitably coopted. And critique alone can easily be dismissed. A true revolution -- one involving reclamation -- is a whole different matter.

In ending, let me invite those in the Toronto area interested in continuing this conversation to come to my book launch on September 18 (5:30, Floor 12, 252 Bloor West). And more generally, let me ask all readers: Is a coercive, invalid, and damaging “system” really the best we can do? What makes setting our sights on but tempering it and/or but adding “alternatives” the “practical” option?

And now that the tide is turning, what can the average citizen do so that this time round, we as a society do not “squander” the moment?

(for this and related articles, see http://bizomadness.blogspot.ca).

References

Bhugra, D. (2015). To be or not to be a psychiatrist? Acta Psychiatrica Scandinavica, 131, 4-5.

Burstow, B. (2014). Liberal “mental health” reform: A fail-proof way to fail. Mad In America. November 17 (http://www.madinamerica.com/2014/11/liberal-mental-health-reform-fail-proof-way-fail/)

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

Frances, Allen (2009). A warning sign on the road to DSM-V. Psychiatric Times. June 26 (http://www.psychiatrictimes.com/articles/warning-sign-road-dsm-v-beware-its-unintended-consequences).

Healey, D. (2009). Psychiatric drugs explained. London: Elsevier.

Kuhn, Thomas (1962). The structure of scientific revolutions. Chicago: University of Chicago Press.

Lieberman, J. (2015). How to halt the violence. The New York Times. August 28  (http://www.nytimes.com/2015/08/29/opinion/how-to-halt-the-violence-treat-mental-illness.html?smid=fb-share).

Minkowitz, T. (2014). Convention on the rights of people with disabilities and liberation from psychiatric oppression. In Bonnie Burstow, Brenda LeFrançois, and Shaindl Diamond (Eds.). Psychiatry disrupted (pp. 129-144). Montreal: McGill-Queen’s University Press.

Read, J. (2015). Saving psychiatry from itself. Acta Psychiatrica Scandinavica, 131, 11-12.

Spitzer, R. (2009). DSM transparency: Fact or rhetoric. Psychiatric Times. March 6 (http://www.psychiatrictimes.com/articles/dsm-v-transparency-fact-or-rhetoric).

Stewart, H. et al. (2015). Images of psychiatry and psychiatrists. Acta Psychiatrica Scandinavica, 131, 21-28.

Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperbacks.

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