Magazine of the INTERNATIONAL ASSOCIATION AGAINST PSYCHIATRIC ASSAULT No. 2 – September 2004

COERCIVE
PSYCHIATRY A TORTURE SYSTEM
[Translated from German]

By Alice Halmi Psychiatric coercive measures are a “cruel, inhuman, degrading” (CID) treatment, or rather torture and part of the mandate of human rights organizations

A plea for the acceptance
of coercive psychiatry as torture and thus as part of the mandate of human
rights organizations.

Preface:
With this text the attempt is undertaken
to interpret coercive psychiatry and/or psychiatric
coercive treatment and incarceration as torture and as a non-medical, (social/)political
problem.

I regard this as a first contribution to the discussion and wish to point
out that in
this article I have not dealt with the internal
discourse of human rights organizations regarding torture.

However
I would be pleased to
enter into discussion with other human rights
groups which concern themselves with the topic
of torture and CID treatment.
Firstly, that which applies internationally:

Universal Declaration of the Human Rights, Article 5 (prohibition of torture): No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Very important is
also the anti-torture convention of the UN with the definition of torture
contained in it:

The accepted definition of torture in the convention against torture and other cruel,
inhuman or degrading treatment or punishment (Anti-Torture Convention),
by the resolution of the General Assembly of the United Nations on 10 December
1984, effective from 1987:
Part 1, article 1, paragraph 1:

(1) For the purposes of this Convention, torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

The term “coercive psychiatry” (as well as legal incapacitation
and persecution) can be applied,
when a person is locked up in a psychiatric institution and diagnosed
against his will and with no “illness insight” or consent to a “treatment”
and is forcibly subjected to physical intervention with psychiatric drugs
(psychopharmacological drugs) and electroshocks.

Moreover psychiatric coercion can consist of being bound to the hospital bed
(“four point constraint”), being compelled to participate in activity therapies
and further legal incapacitation by the undesired order of an official custodian.

Also, being designated as “mentally ill” and/or being applied a psychiatric
“diagnosis” (e.g. “schizophrenia”) and the consequent evaluation as a
“not sensible” and “not legally competent” person is an element of coercive
psychiatry.

In addition, many previously psychiatrized persons, having once been “diagnosed”
and entered into the national psychiatric system, experience persecution for
many years by psychiatrists, public health authorities or social-psychiatric
institutions.

Psychiatric coercion fulfills the following criteria of the definition
of torture as taken from the Anti-Torture Convention of the UN:
1. Intense physical or mental pain or suffering is caused to a person.
2. The goal is a confession and/or a statement.
3. The purpose is to intimidate and coerce the person.
4. One acts on basis of discrimination.
5. The suffering has been arranged by and is expressly agreed to by members
of the public services.

As to #1)
Intense physical or mental pain or suffering is caused to a person:
Psychopharmacological drugs cause both physical and mental suffering.
They intervene in almost all bodily functions and with high probability cause
symptoms of most diverse physical illnesses (e.g. Parkinsons, blood circulation
illnesses, heart damage, eye diseases, motorial malfunctionings, suppression
of the libido, diseased changes of the blood and the bone marrow etc.).

On a psychological and mental level psychopharmacological drugs (in particular
neuroleptica) are strongly impairing, emotionally and mentally: they subdue
and restrain, cause cognitive disturbances, awarement and personality changes
and result in addiction.1

The so-called electrical convulsion therapy (electroshock) produces internal
head injuries: an artificial epileptic attack in the brain (brain cramps)
is caused, which destroys and/or changes parts of the brain. Brain haemmorage,
cognitive disturbances and memory loss, intellectual and emotional turbidity
etc. is the result. The tortured person leaves the “ECT treatment” scared
or apathetical.2

The experience of being deprived of one’s rights and liberty, violence and
a sense of powerlessness, being locked up, bound, being prevented from organizing
one’s own daily routine, legal incapacitation by an appointed custodian and
the often lifelong stigmatization of having a psychiatric “diagnosis”, being
deprived of one’s reason, the ability to make one’s own decisions and being
denied responsibility and the associated social descent likewise causes intense
suffering to the person concerned.

Moreover, arbitrary chicaneries by the hospital personnel such as insults,
being publicly exposed psychologically, not being taken seriously, being made
fun of and arbitrary prohibitions are all usual practices in psychiatric institutions.
A large power gap prevails between hospital personnel and “patients”,
in which those in power can act in a quasi lawless space, i.e. who are not
(or only with difficulty) called to account for their offences against human
rights. The reason being: First of all “crazy people” are not (or less) believed,
when they report having suffered humiliation. Secondly, arbitrary and incomprehensible
“measures” such as no visiting rights, solitary confinement (also
a standard torture method in prisons) or the banning of leave are presented
as therapeutic measures.3 There have
also been reports of repression within institutions, which take place against
events such as e.g. merrily singing in a group.

Physical and mental suffering as a result of psychiatric torture often extends
far beyond the period of the internment in a psychiatric institution: psychopharmacological
drugs and electroshocks in certain cases cause irreversible latent damage,
for example motorial disturbances like tardive dyskinesia or mental deficits.
The inmates leave the psychiatric institution with low self-esteem and as
disconcerted and scared persons and often experience a lifelong persecution.
Even among so-called medical and psychological experts one speaks of trauma
as a result of psychiatry.

From a societal viewpoint, the long-term consequence of psychiatric stigmatization
and coercion is often a drastic social descent: Loss of social acknowledgment,
vocational chances and also domicile. Some psychiatry victims out of despair
even commit suicide during or following a psychiatric stay.

As to #2) The
goal is a confession and/or a statement
The goal of this kind of torture is to extract a confession of “illness
insight” and thus “compliance”.
The “illness insight” of the tortured person makes the following
possible:
– to interpret and justify the abovementioned abuse by physicians and other
hospital personnel as being medical measures and assistance.
– to convincingly argue the necessity for the deprivation of liberty, to legitimize
this denial of one’s rights.
– to present the legal incapacitation as “supportive protection”
and as a measure for the alleged well-being of the concerned.
– to mask slandering and discrimination.
– to control people and, when possilble, to make them socially and economically
functionable.
– to guarantee the continuation of the so-called “treatment” outside a psychiatric
institution.
Above all, for the guarantee of the durable controllability of a psychiatrized
person, the confession of an “illness insight” is of the greatest
importance and has the most effect, if it is succeeded that by the torture
the broken person not only pretends “illness insight”, but in the
end actually also believes to be “ill”.

Torture – one example Excerpt, taken from the “Dossier Heilberufe”, (“Dossier of Welfare Occupations”), a publication by amnesty international and/or their “Aktionsnetz Heilberufe”, (“Action Net of Welfare Occupations”), 2nd Edition May 2000 (source: http://www.ai-aktionsnetz-heilberufe.de/docs/ai_aktionsnetz/dossier.pdf) Thus the “Amnesty Heilberufe” in Germany documents how they are able to interpret forced electroshocking as torture only in the cases where it is exercised far away and by certain regimes.

As to #3) It
happens in order to intimidate and coerce the person
It requires intimidation and compulsion
– to arrange the stay of the person in a psychiatric institution without friction
and resistance,
– to achieve the goal of extracting a confession of “illness insight”,
– to thus ensure the continued control of the person mentioned in point 2.

The abuses are a means to break the will and the resistance of the person
concerned. In this regard here is an exemplary quotation by the psychiatry-critical
psychiatrist Peter Breggin: “Electroshocking works also because it spreads
fear and terror. In this way, as one of my good friends, who was electricalshocked,
said to me yesterday: “After the first shock I would have done anything
in order to be dismissed from the clinic. After that I did everything that
they wanted from me.” 4

The effects of psychopharmacological drugs (in particular of neuroleptics)
and electroshocks, namely to psychologically and physically restrain and subdue
the persons concerned, are not – as often falsely assumed – just “side effects
of healing medicines”. They are deliberately caused by the physicians who
prescribed them, usually probably knowing or taking into account that the
person suffers from it and that the immobilizing serves the surrounding human
environment (and the psychiatrists themselves), but is not the solution to
the possible problems which lie at the cause the “crazy” behavior.

Beyond that, psychopharmacological
drugs and electroshocks are used in order to destroy socially unwanted and
disturbing emotions and thoughts (e.g. anger, loss of motivation, dejection).
It is doubtful whether these methods will succeed, points however to the fact
that thereby the attempt is undertaken to make persons socially functional.

Apart from the methods of abuse described in point 1), brain washing by psychiatric
ideology is a usual means of intimidation:
Psychiatrists (supported by their credibility and authority in society and
the scientific world) and hospital personnel, with the participation of the
authority-respecting relatives, urge the “patient” to be compliant, who, locked
up and confused by the effects of drugs, and in addition possibly in a life
crisis, finds himself in a powerless situation.
Here one commonly hears the stated lie that those who remain “untreated” will
remain chronically ill for the rest of their lives.
Brain washing and torture function in such a way that those involved become
instilled with a fear of lifelong stigmatization as being “mentally ill” and
an ever increasing feeling of being unable to cope with life and of a repetition
of the suffered torment or even worse agonies (for example being administered
injections or electroshocks in the event of refusing to take pills) and an
even longer stay in the institution.

In an explanation by rebellious psychiatry survivors, it is therefore concluded
that: “The end of the torture only at the price of so-called “illness insight”
leads – in connection with false promises of help – to a broad acceptance
of an individualized perception of oppression. At the same time a false hope
of regaining one’s own dignity is created by identification and precursory
obedience in relation to the colonizing system.5

As to #4) One
acts on the basis of discrimination
Discrimination consists of the labeling of persons as being “mentally ill”
and the assigning of appropriate diagnoses, such as “schizophrenic” or “manic
depressive”.

The concept of “mental illness” is however not based, as often assumed, on
medical-scientific facts, but on assumptions of alleged “illness”-related
causes for unwanted behavior.6 Lately psychiatric
diagnoses are increasingly biologically and genetically justified, so that
racist biological theories, such as “mental disorder as hereditary disease”,
are given an extra boost.

Hand in hand with the diagnoses is the denial of one’s ability of reasonable
judgement formation, insight and personal responsibility. Exemplary is the
definition of a “free will” as specified in the custodian law, which is characterized
by the descriptions “ability of discernment of the concerned person and his
ability to act accordingly”. According to this, “mentally disturbed” persons
possess no “free will”, as described in the custodian law.7

Psychiatric survivors due to this discrimination and treatment are denied
the right to be considered a rationable, responsible human being, capable
of self-determination and endowed with dignity.
Discrimination is the basis for defining torture as medical measures. Second
class humans are created, to whom special laws apply and these people’s dignity
is tarnished and their fundamental rights and/or human rights are allowed
to be reduced and/or nullified.

As to #5) The suffering is decided by and carried out with the express
agreement of members of the public service
Psychiatric coercive treatment and incarceration as well as the order of an
official custodian is legitimized in Germany through the “PsychKGs”
(laws for the “mentally ill”) and the laws concering official custodianship.

In order to approve an incarceration in a locked psychiatric ward and/or coercive
treatment in a specific case, it requires a medical opinion, on the basis
of which the court decides. If an official custodian is available in the applicable
field, he has the possibility of committal to a closed psychiatric ward.
Also the local public health authorities (the social psychiatric service)
and the police play a role: Employees of the public health authorities have
the authorization to visit psychiatrized persons in their own home without
their consent and, by the use of force by the police, if necessary arrange
for the prescribing of placement – against their will – in a closed psychiatric
ward by the government physician.
The persons concerned have the possibility of raising an objection against
the incarceration and coercive treatment and are assigned a defense lawyer
by the court, which however rarely leads to an annulment of the incarceratrion
or coercive treatment, since the courts generally follow the advice of the
physicians.

Psychiatric torture under the cloak of medicine
Psychiatrists, hospital personnel and legislators claim to act for the well-being
of the those concerned and to render help. In contrast to the medical treatment
for people with no psychiatric diagnosis, which requires the consent of the
patients, “treatment”, incarceration and “custodianship” in coercive
psychiatry occur also without the consent of those concerned and thus without
consideration as to whether they are of the opinion that it is for their well-being
or not.
The denial of liberty is frequently justified with attributing people as being
“a danger to themselves or to others”. This has nothing to do with the
result of any criminal offences having been committed – which would be grounds
for incarcerationg a “normal” offender-, but rather a subjective
assumption of the potential future behavior of a person, who is denied his
own responsibility. The internment in psychiatric institutions thus turns
out to be a kind of protective custody.
Due to the absence of the consent of a “patient” to psychiatric treatment,
this can neither be interpreted as medical nor as therapeutic assistance,
but must rather be considered to be an extreme violation of human rights and
an authoritarian and paternalistic act.

Pychiatric torture and psychiatric ideology in the service of social control
and domination
Edward Peters, who, in his book “Torture. The History of an Embarrassing
Enquiry”8
dealt with the subject of the nature and purpose of torture, comes to the
conclusion that “a special element of torture [… ]” is
“the torment”, “which someone ostensibly out of public interest
is subjected by a state authority” (page 23). Torture is therefore to
be seen as an “expression of the view of a government over the state order”
(page 10). A goal of the torture can also be to “break the will
of the victim”, so that he is subjected to a system and an ideology (page
208). In doing this “Each ideology [… ] presupposes an image of a human
being, a conception of that, which human creatures are and how they should
be treated, in order to be able to develop the society, which the respective
ideology demands” (page 210).
Also behind psychiatric torture are certain conceptions about a social order
and political goals, an ideology and an image of human beings on which it
is based:
On the one hand, we have the picture of a typically ideal, reasonable and
rationally thinking person and a socially designed standard for a “healthy”
and “normal” person, who is adapted to the social and economic conditions.

In contrast to this we have on the other hand the senseless, irrational “mentally
il” person, who is a nuissance, disconcerts, is non-functioning and less usable
and useful for society and economics.
Also US-American psychiatry critics and psychiatrist Ron Leifer proceed from
the existence of a psychiatric ideology:9
“The medical model pretends to be scientific but functions as an ideology.
It is an ideology because it emphasizes the similarities between medical disease
and mental illness, namely, that both involve suffering and disability. And
it represses their differences, namely, that the suffering and disability
of medical illness is caused by demonstrable changes in the body, while the
suffering and disability of mental illness have no demonstrable cause in the
body and refer instead to speech, feelings, and social conduct.”

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