This comment was written for Sarah Knutson’s Peerly Human blog, see quote below:
#6. Quackery and Torture Masquerading as Medicine
This is Day 6 of our 30-day blog on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression held in Toronto, May 14-18, 1982. (More info here.) Today we are talking about Principle 6.
Principle 6 reads in full as follows:
We oppose forced psychiatric procedures because they are at best quackery and at worst tortures, which can and do cause severe and permanent harm lo the total being of people subjected to them.
Today stepping into international human rights lawyer role to share technical information and resources.
The Special Rapporteur on Torture is a “Special Procedure” of the UN Human Rights Council. Different individuals have held that post over time.
The first SR, P. Kooijmans (in 1986) (http://ap.ohchr.org/documents/E/CHR/report/E-CN_4-1986-15.pdf) listed administration of neuroleptics and other drugs as one of the forms of physical torture done in psychiatric institutions and detention. (The UN, motivated by reports of psychiatric abuse of “sane” political prisoners, started work on a declaration that in earliest forms was quite good and general in condemning forced drugging and similar practices. Then psychiatrists persuaded them that some force was necessary against ordinary mental patients, with the resulting horror show of the 1991 Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care. I won’t link to it, look it up.)
In 2002 drafting and negotiations started for the Convention on the Rights of Persons with Disabilities (CRPD). Having been in the right place at the time, I had just finished law school where I researched human rights issues related to psychiatric oppression and found the 1991 MI Principles, in a human rights law class, and also put together disability non-discrimination law with core human rights including torture to apply to psychiatric oppression. This was inspired a similar approach taken to making visible rape and other misogynist violence against women as torture and other hr violations, by feminist law professor Rhonda Copelon and others. I had ideas about how to anchor the abolition of forced psychiatric interventions to prohibition of torture, prohibition of arbitrary detention (which includes any detention that is discriminatory, as psychiatric commitment always is), and eventually the right to equality before and under the law as including legal capacity to make one’s own decisions. You can read more about details of development in this paper, prepared for publication in a book on CRPD but withdrawn by me due to editors’ attempted censorship: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2326668. The prohibition of forced psychiatry as torture didn’t make it into treaty text, but legal capacity + free and informed consent on an equal basis with others in health care took care of it. The arguments about torture per se persuaded human rights experts at the UN enough to convene an expert seminar at which I presented along with others, which led to the first post-CRPD report by a SR on Torture, Manfred Nowak, in 2008 (http://www2.ohchr.org/english/issues/disability/docs/torture/seminartorturereportfinal.doc) see also (http://www2.ohchr.org/english/issues/disability/docs/torture/AnnexIII.ppt).
Nowak’s report was a real breakthrough in that he adopted the language and concepts that I had proposed, centering the fact of discrimination as why forced psychiatric interventions were being legitimized against people labeled as “mentally ill”. He also was one of the first UN officials to recognize that CRPD prohibited involuntary commitment and involuntary treatment, contrary to the MI principles which accepted it. His report didn’t say that forced psychiatry was torture per se, but that it “may constitute” torture or ill-treatment. Much good in the report, worth reading in full. Note some standards have been improved by the Committee on the Rights of Persons with Disabilities, but some issues Nowak dealt with in greater detail.
In 2013, after somewhat reluctantly being persuaded to advocate for the new SR to go further than Nowak, another expert meeting and report by SR Juan E. Méndez, which both advanced the positions and also was messier, getting a few points simply wrong (e.g. misstating what Nowak had said) and contradicting himself in succeeding paragraphs on psychiatric detention. He advanced the positions primarily by calling for an absolute ban on forced or non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptic, and implicitly including this in a general statement that all the practices discussed in the report were instances of torture or other ill-treatment, in respect of which states (countries) are obligated to make reparation. Here is the report (http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf) and you can also see here (http://antitorture.org/abusive-practice-in-healthcare-settings/) links to his statement to the Human Rights Council (which removes offending contradictions and calls for an end to disability-based detention as well as forced interventions), and in contrast his dialogue with the World and American Psychiatric Associations in which he backtracks and maintains that even the absolute ban is qualified by language that to me is frankly incomprehensible. (My desired interpretation of his report, which Méndez himself apparently rejects, is included in a compilation published by Méndez and his colleagues at American University, also linked on that page).
Méndez’s call for an absolute ban provoked the outrage of psychiatrists and despite his disclaimers the plain language was circulated and understood well enough to inspire survivors everywhere and increase support for our human rights by well-intentioned allies and experts.
Meanwhile the Committee on the Rights of Persons with Disabilities had started their work in 2009, and developed a body of interpretive practice (jurisprudence) in Concluding Observations on the reports of states parties (countries that ratified the treaty, now up to around 160). They made it clear quickly that psychiatric commitment and forced treatment were prohibited, and two general documents issued in 2014 and 2015 cemented that jurisprudence firmly in international law. The CRPD is binding on all 160+ states parties, and the CRPD Committee is generally accepted as the ultimate authority on the interpretation of the treaty, as a universal instrument that should have the same meaning in all countries. These documents are the General Comment on Article 12, Equal recognition before the law (http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD/C/GC/1&Lang=en) (dealing with legal capacity – see especially paragraph 42 dealing with prohibition of forced psychiatric interventions as torture/ill-treatment/violence, but worth reading the entire thing, also see paragraphs 13-15 saying that actual or perceived decision-making skills cannot be used to limit a person’s right to make decisions). The second is the Guidelines on Article 14, liberty and security of the person (http://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc) reaffirming absolute prohibition of disability-based detention including mental health commitment regimes based on “danger to self or others”, and for the first time acknowledging without qualification that forced treatment, as well as restraint practices, constitute acts of torture or other ill-treatment in violation of Article 15 of the CRPD which says that states must protect persons with disabilities from torture and other ill-treatment on an equal basis with others. (See paragraph 12 for this.)
Survivors should be aware that the CRPD Committee’s jurisprudence is now the most authoritative statement as to the illegality of forced psychiatric interventions as a form of torture or other ill-treatment under international law. The CRPD is binding on the vast majority of countries in the world (see https://treaties.un.org/Pages/ViewDetails.aspx?src=IND&mtdsg_no=IV-15&chapter=4&lang=en). A number of countries have also ratified CRPD’s Optional Protocol (https://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15-a&chapter=4&lang=en) that allows individual to bring complaints of violations to the CRPD Committee – provided the violations happened after the CRPD and OP entered into force for that country and that you have used all available domestic procedures that reasonably might give effective relief. You do not need a lawyer but it is a good idea to get advice from someone who knows and understands well this aspect of the CRPD and is in sympathy with the absolute prohibition. CHRUSP (in which I am the principal individual carrying out pro bono work, as well as President) is interested in supporting this work and preparing amicus briefs to bring out complementary legal points in appropriate cases.
For people in the United States and other countries that have not ratified CRPD, or in countries that haven’t ratified the Optional Protocol, there are other UN mechanisms that can bring attention to individual cases and systemic violations, including the Working Group on Arbitrary Detention and the Special Rapporteur on the Rights of Persons with Disabilities. The WGAD issued a set of Basic Principles and Guidelines also in 2015, see (http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session30/Documents/A_HRC_30_37_ENG.docx) but be aware of this version with footnotes some problematic (http://www.ohchr.org/Documents/Issues/Detention/DraftBasicPrinciples/March2015/WGAD.CRP.1.2015.pdf). It is Principle 20 and Guideline 20 specifically. The Special Rapporteur on the Rights of Persons with Disabilities issued a joint statement with the SR on the Right to Health, calling for an to forced psychiatric treatment (see http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=16583&LangID=E).
There are other UN bodies dealing with torture and ill-treatment that are still in the grip of psychiatric hegemony, in particular the Subcommittee on Prevention of Torture, which recently issued a position statement calling for forced psychiatric interventions as a positive measure to implement both the right to health and the right to freedom from torture (again I will not link to it but you can find it if you search). The Committee Against Torture, which monitors the Convention Against Torture, and the Human Rights Committee, which despite its arrogant-sounding name only monitors one treaty, the International Covenant on Civil and Political Rights, have grappled with CRPD standards but still maintain only a “general” prohibition of forced treatment subject to exceptions (which is no prohibition at all). There is hope for those two treaty bodies as our sisters and brothers in several countries keep bringing them reports (US has ratified those two treaties, and folks in US can participate too, personally I am burned out on that part of the advocacy). (Talking here about general reports on the country situation, shadow reports as part of the regular review process also available in CRPD Committee for countries that have ratified that treaty. Too long to explain further now, but look at the Committees’ websites for information if interested.)
Other treaty bodies have been more promising – Committee on Elimination of Discrimination Against Women (CEDAW), Committee on Economic, Social and Cultural Rights (CESCR), Committee on the Rights of the Child (CRC) and Committee on Elimination of Racial Discrimination (CERD). CERD is one that some of us in the US were first to approach from survivor movement, they did not make specific recommendation on our issue (forced and coercive mh interventions on people of color in the US) but asked for more information in next country report; survivors in the US will need to be ready to get involved in the next reporting cycle.
Bottom line: know your rights and know enough to counter arguments that try to discredit what you say. CRPD Committee’s GC1 para 42 and Guidelines on Article 14 para 12 are the highest authority to point to at the present time for the point that international community recognizes forced psychiatric interventions as torture. The SRT reports are good as background, but we now await the next SRT (to be appointed this year) and hope this individual will renew the mandate’s commitment to not only upholding CRPD as a standard legally binding on 160+ states parties but enthusiastically promoting it and taking it as the basis of the SRT’s own work in relation to prohibition of forced psychiatric interventions, which Méndez had questioned and diluted.
We as civil society, as survivors with the moral authority to name injustice and promote enforcement of human rights against violations, and to propose remedies, still have the primary role to play and there are many ways to get involved directly with human rights mechanisms. Being involved by telling your stories and giving perspectives through this blog (and see also https://absoluteprohibition.wordpress.com) also builds the momentum and public awareness for abolition of all forced and coercive psychiatric interventions everywhere.