The term psychiatric violence, or psychiatric abuse, describes the mishandling of power and authority health care professionals in psychiatry, or entire institutions, can expose their patients to. It comprises all sorts of aggression – active or passive. Psychiatric violence can occur on all levels of interaction between treating professionals and patients: social, psychological, chemical or physical.
Progressive thought currents in psychiatry advocate equality between the treating and the treated. More and more often, the right of patients to make choices and utter demands is recognized and respected. However, the outdated model of an authoritative doctor and his dependent and subdued patient is still very much alive.
Psychiatric violence occurs wherever doctors and nurses assume that someone who has been diagnosed with a mental illness is a person of diminished worth and respectability, and where psychiatric institutions consider it their main purpose to keep the mentally ill our of society’s way, as opposed to helping them reintegrate. Violent psychiatry robs distressed individuals of their humanity and punishes them for being dysfunctional. Humane psychiatry, on the other hand, dedicates to them attention, support and empathy – in short, authentic interest. I have experienced both models in action and guess what: humane psychiatry is the one producing positive results.
I’ve mentioned here on my blog that I was hospitalized a bunch of times during my psychotic break, in three different clinics over the course of nine months. The first two institutions operated quite a lot through psychiatric violence, which ranged from physical restraint to psychological abuse. Ironically, one of those two clinics had posters in its hallways, inviting patients and the general public to talks on psychiatric violence! It was the first time I ever heard of the concept.
Violent psychiatry will attempt to coax patients into compliance. In fact, their definition of mental illness hinges on the degree of compliance (or non-compliance, for that matter) an individual under examination displays. The discourse used reminds of the twisted logic of medieval inquisition trials: if you admit to being mentally ill, well then you of course are. And if you insist you’re just fine, that belief in itself will be considered a symptom of your craziness. Catch twenty-two! The same goes for the acceptance of psychiatric medication. If you are docile and willing to take your pills, that’s recognizing you are ill. If you refuse, it means you’re mentally deranged, too, because your fail to admit you need them, so your perception of reality must be distorted! In other words, if you come across the wrong sort of psychiatrist, you are destined for disaster the moment you set foot in their office. One way or the other, you will be diagnosed with something – accurately or not.
On occasions, psychiatric violence can get rather blatant and bizarre. During my second hospitalization, a doctor yelled in my face in front of a group of fellow patients that I was sick to my head. An arts therapist at the same facility communicated to the prescribing doctors that I had “distorted vision” – she was convinced that every time I looked in another direction but hers, I was actually looking at her! In retrospect, I think it might have been nice of me to offer her some of my antipsychotic. Unfortunately, the prescribing doctors and higher ranking staff believed her without subjecting me to any kind of exam. They had no interest in finding out if I really had “distorted vision”. After all, the arts therapist was a qualified health care professional and I was just a nutcase whose words were not to be trusted, and who had been caught displaying yet another weird symptom of craziness.
Another genius of a psychiatrist asked me a handful of questions to find out if I showed any symptoms of schizophrenia. I answered all but one or two with “no”. His diagnosis after barely 10 minutes: “You’re schizophrenic. But that I already knew when I saw you sitting in the waiting-room.” And then, he added: “Oh, by the way, you’ll have to take pills for the rest of your life. I assume that’s clear to you.” I may have been psychotic at that time, but that made me neither stupid nor insensitive to inappropriate behavior. Fuck you very much, Doc! Or, yet a bit more blunt: during my first hospitalization in a “renowned” private clinic, I got physically restrained by one guy (who was a favorite patient and watchdog to the psychiatrist in command of the place), another man forced my jaw open and the doctor himself poured a medication cocktail into my mouth in order to knock me out. Again, I may have been psychotic, but I could still feel dread and I also remember the scene perfectly. That same doctor also had the unsettling habit of interviewing patients in his office with the blinds closed and sunglasses on. Even for someone perfectly stable, this setup would have been disconcerting.
Psychiatric violence goes far beyond treatment. In fact, critics of the psychiatric discipline accuse not only specific institutions, but the entire legal system of allowing for psychiatric patients to be robbed of their autonomy, their dignity and their human rights. This, the argument goes, is the case even when healthy patients are wrongly diagnosed.
For example, in some countries, legally assigned caretakers look after psychiatric patients. They are usually social workers who are authorized to decide on the patient’s behalf (yet not always in their best interest). They control communication with the prescribing doctor, survey the medication plan, and are authorized to have their protégé hospitalized whenever they deem it necessary – or convenient because they are planning a vacation and therefore need to get rid of the ill person for a week or two. I know this sounds cynical and certainly does not do justice to the many social workers who actually do have sound work ethics. Yet, I have come across sad cases. Families can turn to the legal system to have their problematic relatives hospitalized by court order and forcefully kept there for quite long periods of time. If they succeed in legally establishing the “insanity” of their kin, they gain complete control over his or her possessions and decisions. Families may legally be the closest instance to an individual, but they aren’t necessarily protective and well-intended. In fact, dysfunctions within the family are suspected to be a major cause of mental illness. Yet, by default, the legal system considers them the first ones who are entitled to decide in the ill person’s name. Thereby, family members can become yet another source of psychiatric abuse. When a legal system is lenient towards psychiatric abuse, all sorts of parties can acquire power over the patient – psychiatrists, clinics, family.
The interface between psychiatry and the legal system acts very much like a fly-catcher: once someone gets stuck there, it will be very hard for them to ever free themselves and recover their autonomy. This is not an idea I have made up. Countless psychiatric patients spend years or their entire lives in and out of clinics, supported living facilities and under the “protection” of restrictive court orders. I need not go into detail about how that affects their chances of ever finishing an education, pursuing a career, or building a relationship and founding a family with a significant other. When I expressed my fear of ending up just like that to a nurse at an abusive clinic, she readily answered: “Well, the moment you set foot in here that became the track you’re bound to travel.”
Last but not least, another form of psychiatric violence is simple neglect. My second hospitalization was at a clinic where the prescribing doctor saw you for ten minutes once a week, if at all, and where the nursing staff refused talking to you if you had already addressed them with some kind of problem earlier in the day. Their therapeutic program was also utterly stimulating (yes, I am being ironical): the once weekly “gardening” activity consisted of grazing the parking lot for trash and discarded cigarettes for an hour or so. Hell is a place on earth.
Another feature of violent psychiatry is its propensity to sucking patients into a downward spiral of aggression and forced treatment. Whatever is done or said to you is supposedly all “for your own good”. How can psychological cruelty and neglect ever be for your own good? If your common sense is still functional enough to make you unappreciative of this kind of “help”, it is interpreted as another symptom of your desolate mental state. In short: if you allow psychiatric violence to be applied to you, you are being compliant and it is understood that you recognize you need it. If you speak up when feeling mistreated, guess what? You are deemed to be too ill to speak for yourself and the intensity of aggressions will likely be increased until you finally give in and shut up. Sounds familiar? I’ve talked about old school psychiatry’s witch hunt logic at the very beginning of this article.
The million dollar question is how to protect yourself or loved ones from psychiatric abuse. The keyword is “information”. Ignorance equals impotence. Gather information about your diagnosis and learn about your rights and treatment options. There is a lot of literature on psychiatry which is comprehensible and helpful for laymen (see the sources & reviews page). Luckily, mental health has gone from being a purely scientific matter to becoming a subject of general interest. If you are already caught in an abusive dynamic, your attempts of self-empowerment may be judged as paranoid, especially when you suspect your doctors or your family to be harmful to you. Even then, do not let anyone discourage you. Some doctors are in fact careless and some families are in fact harmful. As long as you are kept in the dark about your circumstances you will never be certain if you are as paranoid as they say or whether you are simply recognizing things for what they are. Do not let yourself be labeled as pathologically distrustful, ungrateful or obsessive. Seek information. You may eventually come across a piece that helps you find a new perspective, communicate more efficiently with your therapists and take informed decisions. In the end, it is irrelevant whether your inquisitiveness springs from paranoid ideation or healthy hunger for knowledge. It is your fundamental right as a human being to educate yourself about your condition. You are the one who is most deeply affected by it, so it is only fair if you know what is going on.
Psychiatric violence is a vast topic. I will stop here, at the boundaries of my personal experience with it. If you are interested in reading more, you can browse the internet or look for literature in online or local bookstores and libraries. If you Google search “psychiatric violence”, you will find that an overwhelming number of entries are about psychiatric patients developing violent behavior as a consequence of their illness or as a side effect of their medication regime. Searching for links on “psychiatric abuse” or “violent psychiatry” may yield better results. To save you some effort, I put together a small selection of links that offer information and are a good starting point for further research:
Webpage on psychiatric abuse in English: http://www.psychiatric-abuse.org.uk/
Website in English on human rights in mental health: http://www.mindfreedom.org/
Webpage on different types of abuse, including psychiatric abuse, in English language: http://we-are-survivors.webs.com/psychiatricabuse.htm
Website of the Citizens Commission on Human Rights in English. Apart from getting information, you can also report psychiatric abuse here: http://www.cchr.org/
Webpage in German, strongly biased against conventional psychiatry: http://www.zwangspsychiatrie.de/
Wikipedia entry on involuntary treatment in English: http://en.wikipedia.org/wiki/Involuntary_treatment
Wikipedia entry on the psychiatric survivors movement in English: http://en.wikipedia.org/wiki/Psychiatric_survivors_movement
Article in the Journal of Medical Ethics: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376496/
Article in English by The Guardian (British newspaper): http://www.theguardian.com/society/2011/mar/15/mental-health-patients-forced-detention
Article in German by the weekly magazine Spiegel (you can run it through a translation program): http://www.spiegel.de/gesundheit/psychologie/zwang-in-der-psychiatrie-das-letzte-mittel-a-836111.html
A British mother shares her experiences with psychiatric treatment in the UK: http://psychiatricabuseuk.com/
Personal experience of a former psychiatric patient in the USA: http://www.experienceproject.com/groups/Am-A-Psychiatric-Abuse-Survivor/239188
Interview with a survivor of psychiatric abuse by the Citizens Commission on Human Rights: http://www.youtube.com/watch?v=ve92-PFytAU