[원문]사회심리적 장애를 가진 사람들의 인권을 위하여 > 기획 연재

Thank you for giving me the opportunity to discuss the human rights abuses perpetrated against people with psychosocial disabilities.  In order to be very concrete, I will focus on the United States.  While there are some differences internationally – in particular there are some countries where western psychiatry has a very small presence – there are also many similarities, as we found this year in a strategic planning meeting of the World Network of Users and Survivors of Psychiatry (see reports at http://wgwnusp2013.wordpress.com/about/.) 

I was deprived of my liberty in a psychiatric facility in 1977, in the city of New York.  There was no recognition of any right to refuse drugs and all inmates were routinely forced to take neuroleptics such as thorazine (chlorpromazine) and haldol (haloperidol).  One woman was put in a straitjacket for refusing to take the drugs, and she was then also injected with them.  The institution served us a mixture of coffee and tea, demonstrating its disrespect for our dignity on a very basic level. 

Since that time, things have not changed much.  In 1986 New York State’s highest court ruled that involuntary inmates of psychiatric facilities had the right to refuse drugs so long as they could make a reasoned decision about treatment.  We all thought that this was great, and that of course our decisions would then be respected.  We were wrong.  In 1997 I conducted a court monitoring project, observing the hearings on commitment and forced treatment for six months in one particular court.  I chose to focus on forced drugging in the report that I wrote the following year, entitled “Do Psychiatric Inmates in New York Have the Right to Refuse Drugs? An Examination of Rivers Hearings in the Brooklyn, NY Court.”  In virtually every case, judges ruled in favor of forced treatment.  It did not matter whether the person presented reasons such as the adverse effects of poor concentration, dry mouth, etc., whether the person abstained from mind-altering drugs because she was in recovery from substance abuse, whether the person simply asserted a right to control what goes into her body and did not feel she had to give any reason.  It did not matter whether the person was a doctor or nurse by profession and thus had professional knowledge in addition to their personal reasons for refusing.  People who expressed the view that the drug was “poison” or “cyanide” and that the doctors were acting against them were labeled as paranoid, and this was used against them to justify forced drugging.  It was truly a nightmarish, Orwellian world in which everything you say is held against you because they seek to discredit you and establish total control.  It is a machine, an assembly line designed to process human beings into mental patients, and it almost always succeeds in one way or another.

Some things have changed:  When I was locked up, the myth of “chemical imbalance” was just beginning.  Some people believed in it but for the most part “mental illness” was understood as a metaphorical construct rather than a physical reality.  Now that is reversed.  The myth of “chemical imbalance” goes along with telling people that they have to take neuroleptics and other drugs for life.  More and more people are getting prescriptions of psychiatric drugs from their primary care physicians or from outpatient psychiatrists, rather than being forced in the hospital.  The drugs are being sold as a panacea for emotional distress, and people are not told about their serious adverse effects which imply that brain damage is occurring (see Peter Breggin, Brain Disabling Treatments in Psychiatry, 2008).  In addition, when I was locked up the community-based public mental health infrastructure was fairly new – the “adult homes,” “community residences” and “supportive housing” units where people’s housing is provided under the auspices of the mental health system, the day treatment centers, sheltered workshops and “clubhouses”– all of which replicate long-term institutionalization alongside the actual long-stay psychiatric institutions and many more locked units in general hospitals.  In 1977, it was possible to survive economically on public assistance or disability benefits; there were still SROs (single room occupancy housing) and low-rent affordable apartments.  That has not been the case now for many years, so that more people maintain a connection to the mental health system in order to obtain housing or meet other basic needs, for lack of better alternatives.  Staying connected with the mental health system can mean a greater likelihood of being locked up repeatedly, particularly since there are increasingly intrusive case management, “assertive community treatment” and outpatient commitment programs that aim to maintain people under perpetual scrutiny and control.  It is quite a punitive approach that is counterproductive to people getting past emotional distress and altered state experiences and going on with their lives: people who recover from the mental patient experience do so in spite of the mental health service system and not because of it.

The consumer/survivor movements in the United States have evolved a great deal since my experience in 1977.  I became involved with the movement in 1978, joining the New York City group Project Release.  Among the group’s accomplishments were helping people to be released from institutions and providing temporary housing for them with members, and producing a pamphlet on the effects of psychiatric drugs.  At that time there was almost no funding, we met in each other’s homes or in public spaces.  We referred to ourselves first as “ex-mental patients” and then more politically as “ex-psychiatric inmates.”  Similar groups existed in other North American cities, and each year we held an “International Conference on Human Rights and Against Psychiatric Oppression.”  In 1985, that phase of the movement came to an end, with the revelation that some groups had negotiated with the federal government to fund a movement that would cooperate with the mental health system as “consumers”.  There were ideological splits and even many of the more radical activists, who began calling themselves psychiatric survivors, ended up securing paid work as consultants to the mental health system.  Today there is a proliferation of “peer-run” agencies and organizations that receive mental health funding, as well as peer specialist positions with the public mental health system.  Most of what we consider the movement today is related to such organizations, which do individual advocacy, support, and awareness-raising activities but whose systemic advocacy has often been constrained by their funding sources.  Cooperation with the mental health system may have resulted in positive achievements in some places, but it is not something of which I have direct knowledge.  There are claims that some mental health services are adopting a more trauma-informed approach, or a “recovery-based approach,” but this takes place within a system that is dominated by the myth of “chemical imbalance” and the legal and institutional framework that allows force, coercion and deprivation of liberty, and that remains focused on medication compliance.

Some peer-run agencies are developing innovative programs such as peer-run respite houses (e.g. Afiya in Western Massachusetts, and Soteria Alaska), hearing voices groups (related to the Hearing Voices Network), and there is a great deal of interest in Open Dialogues from Finland and the Soteria model created in the 1970s by Loren Mosher.  Journalist Robert Whitaker has methodically exposed the myths and lies of biomedical psychiatry in his books Mad in America and Anatomy of an Epidemic.  He and a group of colleagues (including some survivors) have created the Mad in America website with relevant news, blogs and discussion forums, bringing together psychiatrists who question conventional practice with practitioners of alternatives including peer-run alternatives and human rights activists; I have a blog there where I mostly inform about the CRPD and related international law standards that offer hope for systemic social change.

As you know, the Convention on the Rights of Persons with Disabilities admits people with psychosocial disabilities to the human rights framework for the first time as equal persons and social citizens.  Earlier standards in international law, in particular the 1991 Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, incorporated uncritically the domestic law provisions of countries like the United States, which allowed for deprivation of legal capacity and guardianship, forced treatment and involuntary commitment.  The CRPD specifically disposes of each of these human rights violations.  Article 12 guarantees to persons with disabilities the enjoyment of legal capacity on an equal basis with others, including access to support in exercising legal capacity, which must respect the person’s autonomy, will and preferences.  Article 14 prohibits deprivation of liberty based on the existence of a disability – which according to the Committee on the Rights of Persons with Disabilities, prohibits all detention in mental health facilities, including based on laws that include criteria such as likelihood of harm to self or others, or need for care and treatment (see Concluding Observations on Austria, El Salvador and Australia, from the September 2013 session).  Article 25 requires that all health care and services be based on free and informed consent of the person concerned, including mental health services.  (See the Concluding Observations of the Committee with respect to each of these standards; my articulation of the standards includes interpretations made by the Committee.)  Utilizing the CRPD standards, two Special Rapporteurs on Torture have recognized that nonconsensual psychiatric interventions amount to ill-treatment or torture; most recently Juan E. Méndez, the current Rapporteur, called for an absolute ban on nonconsensual interventions including nonconsensual administration of electroshock or mind-altering drugs, as well as the use of restraint or seclusion for any period of time. 

The development of the CRPD and its application by the Committee to secure our rights and counter psychiatric oppression and abuse is a source of great satisfaction to me personally, since I both worked extensively on these standards and feel personally vindicated in relation to my own experience of human rights violations.  I believe it is valuable to think of our current human rights work as being a form of reparations for human rights violations that is being carried out and led by survivors ourselves.  In doing so, we confront and defeat the negative stereotypes about us that underlie the legal discrimination.  The CRPD is a comprehensive treaty that can be applied to all situations where people with psychosocial disabilities are discriminated against and deprived of their human rights – in the fields of employment and education, housing and adequate standard of living, as well as in relation to legalized discrimination such as the deprivation of legal capacity, institutional segregation, and violence and abuse in any setting including psychiatry, prisons, police stations, social care institutions, prayer camps, or the family home and community organizations.  I wish you success in your efforts to secure our human rights in Korea, and will continue to do the same in the United States, and to work at the global level to ensure proper application of the CRPD and underlying universal human rights norms.