Torture and Psychiatry

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The following is an essay I wrote at the end of last semester in my human rights class, in which I explore torture in psychiatric institutions. I do this by explaining how current psychiatric practices are breaking international law.

The essay is quite reflective on my own personal struggles with mental illness, many of which are highlighted on my blog @ http://manicquotes.blogspot.ca/

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Torture and Psychiatry

  1. 1. 1 Torture is a very controversial subject among international bodies and countries alike. Article 5 of the Universal Declaration of Human Rights explicitly bans torture worldwide. While the condemnation of torture is widespread, it appears as though the application of the term has been subject to interpretation based on the definition outlined by the Convention on Torture and other Cruel Inhuman or Degrading Treatment or Punishment. Situations that constitute torture require thorough investigation, as the situation must meet a certain criteria based on this definition. The widespread use of forced medications, electroconvulsive therapy (ECT), and restraints in North American psychiatric facilities is a violation of this Convention as it meets the specific definition of torture outlined in Article 1. In order to better understand this concept, it is important to consider how psychiatric practices have evolved historically, to evaluate the severity of these practices themselves, and to analyze how these practices specifically breach the Convention. Many people are not aware of the atrocities that gave birth to today’s modern psychiatric system. It is important to review the history of modern day psychiatry in order to better understand the ideological foundation of current practices. This history is filled with the maltreatment of people deemed mentally ill. The term mentally ill has remained very subjective throughout the years, and is evolving constantly. It has historically provided psychiatry means to provide diagnoses highlighting racist, homophobic and misogynistic views. In terms of racial prejudice, physician Samuel Cartwright claimed that “Drapetomania” was a mental illness that caused black slaves to constantly run away from captivity. The medical community adopted the diagnosis in 1851.1 “Homosexuality” is a term that is widely used in society today, but many people are not aware that this term was actually first used to describe a mental illness by 1 (Joseph)
  2. 2. 2 physician K.M. Benkert in 1869.2 In its first publication in 1952, The Diagnostic and Statistical Manual of Mental Disorders (DSM), the main tool psychiatrists use in order to diagnose mental illnesses, the term “Homosexuality” was catalogued as “a form of sexual deviation under the category of Sociopathethic Personality Disturbance.”3 The third publication of the DSM was released in 1980, which included the term Homosexual Conflict Disorder.4 “Hysteria” is a very old belief that certain psychiatric problems (or “madness”) in women are based on disturbances in the uterus. Specifically, that a lack of sexual intercourse was causing these disturbances.5 The most recent DSM (the DSM-IV) includes a diagnosis of Histrionic Personality Disorder that many argue is an extension of the term “Hysteria”. Histrionic Personality Disorder is comprised of characteristics a person must demonstrate in order to be diagnosed with the disorder, including that a person “consistently uses physical appearance to draw attention to self.”6 These three terms were once widely accepted by the psychiatric profession and opened the door for a flood of abuse based on discrimination. Sadly, some of their old outlooks are still reflected in modern psychiatric diagnoses. In order to understand how modern psychiatric practices have evolved, it is imperative to examine the history of psychiatric treatment itself. The history of psychiatric treatment includes the brutal treatment of those believed to have been mentally ill. There is substantial documentation indicating that patients underwent horrific treatments including a commonly used torture technique where the person is continuously submerged in ice water.7 More specifically, Dr. Henry Cotton, a psychiatrist in the early 1900s, would perform surgeries on mentally ill patients in order to prove his theory about 2 (Joseph) 3 (Joseph) 4 (Joseph) 5 (Joseph) 6 (Joseph) 7 (Burstow)
  3. 3. 3 mental illness. These surgeries would consist of the removal of body parts, including the colon in some cases.8 Insulin shock therapy was introduced in the 1930s by Dr. Mafred Sakel who believed that convulsions could benefit the mentally ill.9 Insulin shock therapy is exactly as it sounds. It involves injecting the patient with large levels of insulin in order to induce “violent convulsions, intense hunger pangs, perspiration, and coma.”10 The widespread belief about convulsions and the brain among the psychiatric community has given birth to modern day ECT. The lobotomy became a popular surgery from the 1930s to the 1950s, for those who were considered “mentally disturbed.”11 A lobotomy is a surgery in which a physician physically alters the patient’s brain.12 An employee who worked at New York’s Willard psychiatric hospital stated in an interview that some of the holes created during lobotomy procedures she had witnessed “were deep enough so you could put your fingers in them.”13 In an extreme case of sexism, at Stockton State Hospital in California in the early 1950s, women were lobotomized based on theories that female masturbation was a sign of mental illness requiring this type of procedure.14 Today, common psychiatric practices have adopted many of these concepts. Neuroleptic medications, also known as antipsychotic medications, have been referred to by some as “chemical lobotomies.”15 At virtually any dose, these powerful drugs cause a person to behave eerily as if they have been lobotomized.16 In addition, well known side effects of these medications are “death (neuroleptic malignant syndrome), blood disorders, liver and kidney 8 (Joseph) 9 (Joseph) 10 (Joseph) 11 (Joseph) 12 (Joseph) 13 (Bassman) 14 (Bassman) 15 (Bassman) 16 (Weitz)
  4. 4. 4 disease, neurological movement disorders, diabetes, obesity, sedation, loss of sexual desire, neo- parkinsonism, lethargy, depression, disruptions in memory, cognitive deficits and drug-induced psychoses.”17 Tadive dyskinesia and dystonia (TD) is also a potential side effect of these types of medications. TD is a crippling disorder that involves involuntary tremors and muscle spasms.18 It is not uncommon for psychiatrists to prescribe additional medications to combat these side- effects, as opposed to removing the medication from the patient’s treatment plan.19 In 2009, a man in India was reported to have died from a “single 5-mg dose of olanzapine”20 (a typical neuroleptic medication), which is a very common dosage used in North America to control psychiatric patients. Many psychiatrists in North America argue that these medications are beneficial in treating mental illnesses. However, The World Health Organization published an 8- year study in which they studied schizophrenic patients from India, Nigeria and Colombia. In these three countries, neuroleptics are not as readily available as they are in North America, and are therefore not prescribed nearly as much. At the end of the study, it was concluded that 64% of the patients in the foreign countries were showing an absence of symptoms compared to 18% of the patients in “the United States and developed countries.”21 Neuroleptics are just one type of many medications that psychiatrists are currently prescribing at a staggering pace. In 2000, the amount of money spent on psychiatric medication in the United States alone was $23 billion dollars. Furthermore, in the 1990s sales of neuroleptic medications in the US inflated by 600%.22 In addition to the increase in prescriptions of neuroleptic medications, ECT has made a staggering comeback in the current scope of psychiatry. 17 (Bassman) 18 (Bassman) 19 (Joseph) 20 (Joseph) 21 (Joseph) 22 (Joseph)
  5. 5. 5 ECT is a common tool in psychiatry used to treat patients struggling with mental illness. It involves passing electricity through the brain to induce grand mal seizures or convulsions.23 It is widespread knowledge among the psychiatric community that ECT causes retrograde amnesia (memory loss of prior events) as well as antegrade amnesia (failure to maintain events post- ECT). One specialist indicated that “ECT causes severe and irreversible brain neuropathology including cell death. It can wipe out cast amounts of retrograde memory while producing permanent cognitive dysfunction.”24 Neurologist Sidney Samant described patients who underwent ECT appeared to be “functioning at a subhuman level.” Samant went on to describe ECT as a “controlled type of brain damage produced by chemical means.”25 Abraham Myerson, a psychiatrist who was an early advocate for ECT, declared that the “reduction of intelligence is an important factor in the curative process.”26 Some of the countless side effects of ECT, in addition to frequent amnesia, include dementia, decreased emotion, changed personality, headaches, tremors, nightmares, and leg twitches.27 Many feminist groups have lobbied against ECT, claiming that it is used as a means to discriminate against women. In Canada and the US, the statistics tend to support that claim given that about 70% of ECT recipients are female, 45- 50% are senior citizens, including some of which are over the age of 80 years old.28 Additionally, feminist groups have highlighted the fact that roughly 95% of people who prescribe this procedure are male.29 Many women have reported the use of intimidation tactics. One woman in Eastern Ontario claimed that she was told that she would “never get out” unless 23 (Burstow) 24 (Burstow) 25 (Burstow) 26 (Burstow) 27 (Daalen-Smith) 28 (Daalen-Smith) 29 (Burstow)
  6. 6. 6 she took the treatment.30 Additionally, there have been numerous reports of families consenting for a patient to receive ECT after they made allegations of sexual assault within the family.31 Another deadly common practice within modern day psychiatry is the prolonged use of restraints on patients. It’s virtually impossible to find a psychiatric facility that does not have restraints readily available. In extreme circumstances, restraints may be used to protect individuals within the institution. However, since there are no regulations with regards to their use, severe human rights abuses have been being committed in the name of psychiatry using restraints. Numerous deaths have been recorded, but no action has been taken in order to regulate their usage. Traditionally, these restraints consist of thick leather straps attached to the patient’s bed. However, sometimes patients are physically restrained in dangerous positions. As was the case for David Bennett who died after being crushed by staff with his own hand held against his throat.32 In 2005, one of the most famous deaths by restraints in Canada was the death of Jeffrey James in Toronto, Ontario. Jeffrey James was traditionally restrained and placed in seclusion for 5 and a half days, where he suffered a “pulmonary thromboembolism”33 , which occurs when a blood clot travels up a main artery into the lungs. Other causes of death that can occur for prolonged restraint are “asphyxia, aspiration”, and “blunt trauma to the chest”.34 Modern psychiatric facilities claim that they use these procedures in the patient’s best interest and as a last resort. But what they fail to recognize is that there are other alternatives. 30 (Daalen-Smith) 31 (Burstow) 32 (Surabhi) 33 (Weitz) 34 (Surabhi)
  7. 7. 7 The Soteria House experiment attempted to address these alternatives. Led by Dr. Lauren Mosher, Soteria House was a treatment center where staff and patients were made to live together in a caring and compassionate environment. The staff were not allowed to use any type of forced treatment including forced medications or restraints. Some of the patients admitted to Soteria House were “what psychiatry would deem the most acutely psychotic patients.”35 The results of the experiment were astounding: “At 6 weeks, Soteria patients had improved to the same degree as medicated patients, and they stayed well longer. Relapse rates were lower after 1- year and 2-year follow-ups, and Soteria ‘patients’ were better able to maintain employment and attend school.”36 This type of success did not reflect the current psychiatric treatment standards, and as a result the funding was dramatically decreased over the following years.37 All this information suggests that there is serious abuse being committed in North American psychiatric institutions; however, these abuses must meet a certain criteria in order to be considered torture by international standards. The Convention of Torture and other Cruel Inhuman or Degrading Treatment or Punishment was adopted by the General Assembly of the United Nations on December 10th , 1984. Article 1 of the convention outlines the definition of torture: For the purpose of this Convention, the term ‘torture’ means any act which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him a confession, punishing him for an act he or a third person has committed or is suspected to have 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 35 (Joseph) 36 (Joseph) 37 (Joseph)
  8. 8. 8 consent or acquiescence of a public official or other person acting in an official capacity. 38 The abuses being committed in North American psychiatric institutions do in fact meet the criteria for almost every aspect of this definition. In order to fully understand the extent of how much these abuses fall under the official definition of torture, it is imperative to analyze all of the aspects of Article 1 of this Convention. Certain atrocities being committed in these institutions do in fact cause “severe pain or suffering” both physically and mentally, and in some instances are “intentionally inflicted on a person for such purposes as obtaining from him a confession”.39 Intimidation practices are rampant, they are committed based on discrimination, and they are in fact “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.”40 While Article 1 does require this many similarities to the definition in order for the act to be officially considered torture, these parallels speaks volumes to the severity of the abuses being committed in these intuitions. As previously mentioned, the use of neuroleptic medication, ECT, and restraints can cause numerous debilitating and painful side effects. In some extreme cases, even death. These side effects can cause extreme mental anguish as well as physical symptoms, which can continue well after the person is discharged from the institution. One woman who underwent ECT therapy against her consent described her experience in a two year study focusing on the effects of ECT: “They man-handled me, grabbed me, and forced me into the ECT room. The room was small, white, and there was a metal box with wires hanging out of it. There was a rubber head strap and 38 UN Doc A/RES/39/46 39 UN Doc A/RES/39/46 40 UN Doc A/RES/39/46
  9. 9. 9 a needle. I yelled, fought, and pleaded for help. No one came to my rescue.”41 In many instances, these treatments are intentionally forced upon patients in order to confess that they are in fact mentally ill and require treatment. In order to justify many of these practices, staff in psychiatric facilities rely on the extraction of this confession, and will not allow patients to be discharged until they hear it. Intimidation and fear tactics both play a very essential role in modern day psychiatry. Benjamin Rush, who many grant the title as “the father of modern day psychiatry”, wrote about this: “Terror acts powerfully on the body, through the medium of the mind, and can be employed in the cure of madness….FEAR, accompanied with pain, and a sense of SHAME, has sometimes cured this disease.”42 Furthermore, Psychiatrist Peter Breggin alluded to ECT’s effectiveness “via fear and punishment”.43 There are also many instances where patients in psychiatric institutions comply with whatever is asked of them, based on fear of what might happen to them if they don’t. Discrimination and state involvement are also a key factors outlined in Article 1 of the Convention. Psychiatry has historically been used as an official tool to discriminate against people based on many factors such as race, sexual identity, and gender. Currently, the obvious distinction between the amount of women receiving ECT versus the men is cause for concern, and a female ECT survivor even referred to the procedure as “a gentlemen’s way to beat up a woman.”44 In a famous statement made by Psychiatrist Peter Breggin, he equated ECT to a “mental spanking”.45 Clearly there is evidence to support a claim that women psychiatric patients are being discriminated against. It is a widely accepted fact that mental illness constitutes as a 41 (Daalen-Smith) 42 (Bassman) 43 (Burstow) 44 (Burstow) 45 (Burstow)
  10. 10. 10 disability. In a report made by the current Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in 2013, Mr. Juan E Mendéz made it clear that people with a “psychosocial disabilities” are “individuals who have been either neglected or detained in psychiatric and social care institutions, psychiatric wards, prayer camps, secular and religious-based therapeutic boarding schools, boot camps, private residential treatment centres or traditional healing centres.”46 In 2008, the Special Rapporteur on Torture at the time, Manfred Nowak, confirmed that there can be discrimination based on disability within the Convention against Torture. This discrimination can be based on “any distinction, exclusion or restriction on the basis of disability which has the purpose or effect of impairing or nullifying the recognition, enjoyment or exercise on an equal basis with others, of all human rights and fundamental freedoms”.47 A large amount of hospitals where these human rights abuses are committed are government funded operations; therefore, the state is directly involved in the abuses themselves. One woman who was hospitalized and given ECT in Canada stated that “All the therapy in the world is not going to erase the scars of being dragged into a room, having a band on your head, and having your brain fried. People say there’s no torture in Canada … There is torture being paid for by the Ministry of Health.”48 These allegations of psychiatric human rights abuse have been a point of discussion for the United Nations since 1987. In 1987, Mr. P. Kooijmans, the Special Rapporteur appointed by the United Nations addressed the issue of psychiatric human rights abuses. He highlighted the issues concerning medications: “the side-effects of the major tranquilizing and antidepressant drugs can be very severe; for example the administration of strong tranquilizing or antidepressant drugs over a long 46 UN Doc A/HRC/22/53 47 UN Doc A/63/175 48 (Burstow)
  11. 11. 11 period may be such as to cause unpredicted personality changes in the patient”. 49 He went on to state that “every patient shall have the right to refuse treatment.”50 In Mr. Juan E Mendéz’s 2013 report, he reiterated Mr. Kooijmans’ previous statements from 1987, and even elaborated further on abuses being committed against people deemed mentally ill. In his report, Mendéz highlighted the fact that it was “previously declared that there can be no therapeutic justification for the use of solitary confinement and prolonged restraint of persons with disabilities in psychiatric institutions; both prolonged seclusion and restraint may constitute torture and ill- treatment.”51 He goes on by stating that these types of environments “can lead to other non- consensual treatment, such as forced medication and electroshock procedures.”52 In a very controversial move, Mendéz calls for “an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind altering drugs such as neuroleptics, the use of restrain and solitary confinement for both long- and short-term application.”53 Many people argue that the majority of these treatments are for the “best interest” of the individual. Mendéz counters this argument by explaining that “the extent that they inflict severe pain and suffering, they violate the absolute prohibition of torture and cruel, inhuman and degrading treatment.”54 The report by Mendéz was met a few months later with a letter from the Secretary General of the World Medical Association, Inc., Dr. Otmar Kloiber. In this letter, Dr. Kloiber addresses the issues concerning the use of forced treatment, and how it is required in some circumstances. What Dr. Kloiber failed to acknowledge was that there is currently no system of any kind put him place to 49 UN Doc E/CN.4/1987/13 50 UN Doc E/CN.4/1987/13 51 UN Doc A/HRC/22/53 52 UN Doc A/HRC/22/53 53 UN Doc A/HRC/22/53 54 UN Doc A/HRC/22/53
  12. 12. 12 monitor these abuses being committed, and that the length of detention and treatment plan for individuals is purely subjective. In effect, the fate of the victims are left in the hands of the abusers themselves. In the letter, Dr.Kloiber blatantly states that the claims against modern psychiatric practices are “potentially very damaging to the wider human rights agenda.”55 Issues concerning torture are generally heavily disputed. There always seems to be a great deal of denial involved in the process of determining whether or not a situation constitutes as torture. Evidence is a very key component to this process, and the issue concerning North American psychiatric practices is filled with over a century of it. There is no doubt that the current use of neuroleptic medications, ECT, and restraints in North American psychiatric institutions is in direct violation of the convention on Torture and other Cruel Inhuman or Degrading Treatment or Punishment, as their use meets the definition outlined in Article 1 of the Convention. After considering the history of psychiatry itself, as well as reviewing the current psychiatric practices themselves, it is easy to conclude that there are violations of human rights occurring behind the closed doors of these institutions. These violations cross over into being considered torture, as they meet the definition within Article 1 of the Convention virtually flawlessly. Many of these practices cause a person to lose a sense of personal control over their body and their mind, and it is difficult to imagine anything more frightening than that. 55 (Kloiber)
  13. 13. 13 Bibliography Bassman, Ronald. "Mental Illness and the Freedom to Refuse Treatment: Privelege or Right." Professional Psychology: Research and Practice (2005): 488-497. Burstow, Bonnie. "Electroshock as a Form of Violence Against Women." Violence Against Women (2006): 372-392. Daalen-Smith, Cheryl Leslie van. "Waiting for Oblivion: Women's Experiences with Electroshock." Issues in Mental Health Nursing (2011): 457-472. Economic and Social Council. "Torture and other Cruel Inhuman or Degrading Treatment or Punishment." (1987) UN Doc E/CN.4/1987/13 Hirshbein, Laura. "Historical Essay: Electroconvulsive Therapy, Memory, and Self in America." Journal of the History of Neuroscience 21(2) (2012): 147-169. Joseph, Ameil J. "Empowering Alliances in Pursuit of Social Justice: Social Workers Supporting Psychiatric-Survivor Movements." Journal of Progressive Human Services (2013): 265-288. Kloiber, Dr. Otmar. "Letter to Juan E. Mendéz." The World Medical Association, Inc. Geneva, 3 May 2013. Surabhi, Kumble and McSherry, Bernadette. "Seclusion and Restraint: Rethinking from a Human Rights Perspective." Psychiatry, Psychology, and Law (2010): 551-561. United Nations General Assembly. "Convention of Torture and other Cruel Inhuman or Degrading Treatment or Punishment." (1984) UN Doc A/RES/39/46 United Nations General Assembly. "Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment Juan E. Mendéz." (2013) UN Doc A/HRC/22/53 United Nations General Assembly. "Torture and other Cruel Inhuman or Degrading Treatment or Punishment." (2008) UN Doc A/63/175 Weitz, Don. "An Antipsychiatry Perspective." Radical Psychology (2008).

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