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
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
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 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.
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 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.
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 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 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 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 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 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.
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[36] (Joseph)
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