Photo: Bruno Vincent / Getty Images
For the past dozen years, I’ve been into mental health, both as a reporter and as a person living in a head. One big, fundamental, and easily overlooked point about mental health – something I really got it – is that we are all just one very bad day away from becoming our own version of Britney Spears on this pulled out stretcher a mansion in front of the world.
If you had this very bad day, here’s what you would likely learn: Our mental health system is extremely broken. Where this brokenness comes from and how we can do better than what we have, I have filled a book to answer such questions, and am closing a second. But if you had to put it all together, the big problem is this: Right now, our mental health system is based on violence. Violence against the person who is considered incapable of acting, for example because they have been diagnosed with a “serious mental illness” such as bipolar disorder or schizophrenia. There is intense discussion as to whether such psychiatric diagnoses make medical sense. What Psychiatric Diagnoses Certainly Are: Legal Terms.
In the event that a court ruled that you are incapacitated after such a diagnosis, you may be deprived of a number of rights. Perhaps you have now been prevented from participating in your own medical decisions, including psychiatric and reproductive decisions. You may be prevented from making your own financial decisions. Maybe you’re banned with a driver’s license now Sign in your name, including just one credit card; it can go on and on. Sometimes a court will tell you that you are no longer allowed to see your own children. I’ve heard people who pay attention to this cross between disability and law refer to this event as a “civil death.”
It is difficult to estimate how many people get into such situations, both because of patient data protection and because data collection on human rights violations by “mentally ill” people is extremely poor in this country. There is no centralized database tracking involuntary obligations, one of the classic ways a person is relegated to this lesser legal status. Existing data suggests they are becoming more common: a study by UCLA last fall found that involuntary commitments outstripped population growth by three to one over the past decade. “This is the most controversial mental health intervention – one is deprived of freedom, can be traumatized, and then stigmatized – but no one could say how often this happens in the United States,” said David Cohen, social welfare professor who directed it the study said in a press release. According to a recent estimate, over a million Americans are committed involuntarily each year.
I have interviewed many self-identified psychiatric survivors over the past several years, attending the World Hearing Voices Congress, taking part in protests outside the annual meetings of the American Psychiatric Association, and traveling here and abroad to find better answers. Most psychiatric survivors have at some point learned the hard way how much can suddenly be withheld from them. You tend to know what it feels like to become someone who is considered to be no longer able to make their own decisions. Someone who has to consent instead. Often because a doctor or family member said this, or a court said this, or for some or all of the reasons listed above. Sometimes a person is placed under a “guardianship”, as Britney did, or a “guardianship”. Such agreements have received increased attention lately, but in reality this situation is much broader: What we are essentially talking about is the potential we all have to lose basic civil rights – as long as this paradigm of forced psychiatry persists.
Why and however it happens to you, the gist is this: when you are consumed by this system, your personality is apparently shrunk. And since you often cannot sign anything yourself, you cannot even hire a lawyer to help you. Britney Spears herself has to rely on a court-appointed attorney for this reason, as many were surprised when they saw the documentary Framing Britney Spears.
Here’s something that people who have not experienced such a scenario usually don’t know: there is no real way to prove that you have a mental illness or not. These diagnoses remain biologically unfounded, more a metaphor than medicine. This was even admitted by the then head of the National Institute of Mental Health in 2013. (“Contrary to our definitions of ischemic heart disease, lymphoma or AIDS, DSM diagnoses are based on consensus on clusters of clinical symptoms, not any objective laboratory measurement,” wrote Dr. Thomas Insel in a post on the NIMH website In the rest of medicine, it would be equivalent to making diagnostic systems based on the type of chest pain or the quality of the fever. “The medical mystery of psychiatric diagnoses creates a great deal of confusion on these issues, both among experts and the general public a maintenance of the status quo, which in practice tends to generate abuse of power, however it is constituted – be it brainwashing the American public for the profit of Big Pharma or the confiscation of Britney’s wealth and personality by those nominally entrusted with the Ensuring their care.
For every Britney Spears there are an innumerable number of extremely less famous Britneys trapped in their own private hells, perhaps controlled by the state or a family member. all stories sure as harrowing as Britney’s, if not more so. These are stories that we will continue to ignore until we see the full humanity of “insane” people. Our legal and medical system is designed to ignore such people. And for a long time the public had also been extremely hostile to the voices of the supposed “crazy people”. Maybe until last week.
For psychiatric survivors, what happened to Britney is commonplace, obvious, mundane. She is one of them. The press and public, however, were amazed when they heard the alleged details of Britney’s case last week: How she can’t own a smartphone. How she can’t ride in her boyfriend’s car, let alone marry him. How they won’t let an IUD be removed so they can have a baby.
All of this, in her opinion, has of course had a negative impact on her so-called mental health – “I cry every day,” she said, also begging not to have to undergo another psychiatric examination (so little is she wishing for such a thing) the offered psychiatric care ). It is a perfect distillation of the fallacy of our mental health system as it is constituted: it overruns a person in the name of “public safety”, often actively harming them in the process. It is a system based on curtailing a person’s rights so severely that, as Britney’s case aptly shows, all the money and fame in the world cannot free you.
This paradigm of compulsory psychiatry has been criticized for decades by psychiatric survivors and their allies (clinics, lawyers, journalists like me) as ineffective and expensive. The United Nations has also broken this psychiatric framework as a human rights violation. In 2013, this special report on torture called on Member States to “ban all forced and non-consensual medical interventions against people with disabilities, including the non-consensual administration of psychosurgery, electric shocks and mind-altering drugs such as medication [antipsychotics], the use of restraint and solitary confinement, for both long-term and short-term use. ”Just last month, WHO also called for the implementation of an entirely new mental health paradigm centered on human rights.
In America, however, the coercive approach is still everything we know and really everything we fund. We tend to overlook the promise of “alternatives” to mental health care (as they like to be called). These include non-judgmental support groups for people who hear voices and those who are contemplating suicide, as well as safe shelter for people in acute crisis. Such approaches tend to be comparatively cost-effective and utterly hopeful – and in my experience, few Americans have ever heard of them.
The day after Britney’s testimony in LA court last week, heard around the world, I called a psychiatric activist I met, Caroline Mazel-Carlton. Mazel-Carlton, who is also a rabbi in training, works for an organization called the Wildflower Alliance that is revolutionizing mental health care in western Massachusetts (and beyond). I asked her what she thought of so many people suddenly standing up for the civil rights of psychiatric patients – or at least the rights of a patient.
“It’s just a relief to me to be honest,” said Mazel-Carlton. “Sometimes I even cry when people finally say, ‘This is not right. That is not right.'”
As we spoke, Mazel-Carlton seemed more focused on the actual activism of the day: this week she and a few colleagues spoke out before the Massachusetts legislature, speaking out against a proposed law that would expand coercive psychiatry in their state. Euphemistically referred to as assisted outpatient care, or AOT, such laws have been passed by 47 states in the past two decades. Such laws expand the powers of the state to make medical decisions for a person who is considered incapable of acting because of insanity, for example beyond the timeframe of mandatory psychiatric hospitalization, which traditionally lasts around 72 hours. Instead, under such laws, a person who has been discharged from hospital, for example, is now controlled and monitored by the state, often indefinitely.
These AOT laws are almost ubiquitous and represent a duplication of this compulsory psychiatry paradigm; In other words, they are the opposite of any liberated mental health care vision supported, albeit fuzzy, by #FreeBritney activists. I was wondering if those who post #FreeBritney realize that there is already a robust movement for the civil rights of mental health patients that has been organizing for decades?
“I just want to say to people, welcome to this movement,” said Mazel-Carlton. “It’s one of the lesser-known liberation movements, but we’re so happy to have you if you want to fight by our side, not just Britney’s side.”