Monday, October 26, 2009

Political Abuse of Psychiatry

It's important to note that we are unlikely to see "political abuse of pediatrics", "political abuse of family medicine" or god forbid, "political abuse of surgery'. However all over the world and especially locally political abuse of psychiatry goes on. Psychiatry is a marvellous tool but it can be used like no other weapon. Not just homosexuals have been labelled deviant and subjected to all manner of re conditioning and 'treatment' but women, minority groups, geniuses, and anyone the state deems as a threat. We can hear about this in China or the Soviet Union whereas in a foreign country you are most likely to hear about this abuse in Canada. I have seen it and I have reported it and I've been frightened by the power of it.
Power corrupts and absolute power corrupts absolutely. I do believe though and am hopeful that whereas this is very common in some places it is less common here. Civil liberties movements have reached out to protect inpatients however the very 'diagnosis' of a mental illness can be a punitive action. Having seen a psychiatrist in Canada remains a reason to deny a person a firearms license however a history of violence, the surest likelihood of future violence, may not.
Where once seeing a psychiatrist was for a major psychiatric illness only, increasingly people see psychiatrists for minor illnesses such as variants of bipolar disorder which were once simply called 'mood swings' or 'pms' but now have this clinical term attached. Much of psychiatric diagnosis remains 'subjective' with limitted 'objective ' findings in contrast to a dermatological facial rash that all can see, a rash that may also have significant associated lab tests.
Conversely a person who is suicidal and homicidal may only tell their doctor and no one else might know. Yet this very issue means that a doctor, with a conflict of interest, may say that a patient said he was 'homicidal or suicidal' when he wasn't. Who do we believe? In forensic psychiatry and addiction psychiatry there is even more denial and frank lying.
There are people who become homicidal or suicidal when they drink and yet when they're sober are normal. Some even experience this in a black out so don't even know that drunk they're homicidal or suicidal. One patient I knew who had temporal lobe epilepsy still has difficulty accepting the grocery store video tape that showed him in a black out after two beer beating a man with a baseball bat.
That said, it's still a major concern that individuals civil liberties are protected. This can involve protecting people from 'false labelling' and 'punitive psychiatric labelling' and further it can involve the protection of the civil liberties of those who are mentally ill. Part of the problem of being labelled mentally ill is that the mentally ill are most open to abuse and misuse in society, marginalized, denied employment, disbelieved, 'self fulfilling prophecies' applied, etc. In the US the Americans with Disabilities laws have been very powerful in protecting the mentally ill from the kind of abuse that can still go on in Canada and other western countries where similiar legislation doesn't serve as well.
Legislation is part of the solution but awareness and education is an even more important part of the solution. Further, while in Canada, in most provinces lawyers are available to those 'certified' or 'committed' or subjected to 'compulsory psychiatric treatment' only after a period of time of incarceration. In contrast, I had the priviledge of working in a far more advanced American system in which a lawyer was assigned immediately to anyone who requested legal aid at the point of 'compulsory psychiatric care'. This system worked far better than our system here. Not ironically patients were more cooperative from the outset because they had met with counsel and judges in these situations and understood the reasons for the 'compulsory care' and saw it as a 'state' function rather than a 'medical' one. Their alliance to the psychiatrists and psychaitric system was maintained. Further abuses by families and by the state were nipped in the bud. Nothing like a good lawyer to protect a person who is being abused by their community especially given that psychiatrists in general have a very limitted understanding of civil liberties and sometimes tend to ridicule the likes of psychiatrist Thomas Szasz or find the patient's movements more a threat than an adjunct to the best quality of care. These legal precautions further ensure that those who aren't don't find themselves falsely labelled as such and if a mistake is made in maintaining a person's freedom it's a judicial decision given the weight this system routinely gives to considerations that can impact community safety.

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