Tuesday, June 21, 2016

Stop psychiatric abuse

Peter Breggin has a blog on Mad in America entitled "Forced 'treatment' is torture". His blog follows that by Peter Gøtzsche entitled "Abolishing forced treatment in psychiatry is an ethical imperative". I agree psychiatric abuse must be prevented.

For both Peters, as it did for Thomas Ssasz, psychiatric abuse includes detention in hospital. They want to abolish all forced intervention in psychiatry. Here I do not agree. Society does expect psychiatry to manage madness on its behalf. However much informal and voluntary interventions, including psychotherapy, may have developed since the origins of psychiatry with the asylums in the 19th century, they have not completely replaced the need for compulsory detention. From a position in private practice, Peter Breggin may well have never detained anyone against their will. As he says, "Someone in an out-of-control manic episode or someone threatening to do harm in a psychotic episode presents difficult problems to civil libertarians and to those of us who wish to help people in distress while protecting others from them." However, he can't use these situations to justify mental health legislation, whereas I think I can.

Where I do agree is about the need to improve safeguards for forced medication. In England, apart from the right of appeal to the Mental Health Tribunal and hospital managers, this is primarily about having access to a Second Opinion Approved Doctor (SOAD) but only after 3 months of receiving medication. Patients on a community treatment order (CTO) with the threat of recall to hospital may take medication and be considered to be consenting to medication and therefore not be referred to a SOAD. The Alaska Supreme Court case ruling, referred to by Peter Gøtzsche, needs to be enforced so that someone should not be given medication against their will without "first proving by clear and convincing evidence that it is in their best interests and there is no less intrusive alternative available". We do need to have much more of an open debate about whether there is any justification for the forcible injection of medication, and, therefore, I welcome the two Peters contribution to this debate. Coercion in psychiatry needs to be reduced.


Anonymous said...

You're a human rights abuser and you disgust me to my core. The 'two Peters' are a million times the man you are. May we one day be protected from the thuggery you both practice and are an apologist for. I wish there was a hell for coercive psychiatrists to go to.

Anonymous said...

Unlike Breggin and Gøtzsche, this post doesn't provide any references or substantiation for the opinions provided that would allow for a reasoned response. We have all heard, ad infinitum, the justification for forced intervention on the basis of the fact that a small percentage of people experiencing psychosis become violent. That's not enough to demonstrate that the harm prevented by forced intervention outweighs the harm caused by the systemic failures of the system, which Breggin and Gøtzsche describe in convincing detail.

The author seems to believe his opinion is reason enough. This approach is reminiscent of typical psychiatric arrogance. I am not surprised that this post triggered the emotional diatribe posted by Anonymous.

DBDouble said...

Perhaps a place to start with the literature is the most recent review of the Mental Health Act in England and Wales. The government set up a scoping group that produced a report. This led to a process which eventually led to the reform of the Act in 2007. The Critical Psychiatry Network was formed in this context and commented on the documents produced at each stage (see documents page). The Scottish executive also produced a review of the literature. for the reform of the Scottish Act.

There is no randomised control comparing detention with non-detention and probably never will be for practical and ethical reasons. In fact, trials comparing inpatient with home treatment excluded people requiring detention.

I do have some problems with some of the references in the two Peters' posts but we'll leave that debate for another time.

Anonymous said...

Well done on posting Anonymous abusive comments Dr Double. I reject the negative and abusive comments which come to my blog, also the comments advertising products, which are many.

Peter Jones said...

@ Dr Double. the zepharia post above is spam and click collecting scam. please remove it.

I learned something here many years ago: right is ceiling or floor? If they detain you they do not have time then to revise. power of open ended detention exists, specially, in CTO. that is easy to be abused. That scares people to seek help. Some who are scared might become dangerous then, later. If they do something harmful, then in retrospect, in aftermath of the event, the authority gets the idea that they should be more restrict, they should do more screening. And the vicious circle goes on and on.

If human understands that he cannot solve some problems then he might be able to be helpful in certain limited cases.