The UN Commission on Human Rights wasn’t the only official human rights body to be galvanised into action by the Soviet example, only to end up burying psychiatry’s darker side beneath a restatement of the ‘right to treatment’. The Australian Human Rights Commissioner, Brian Burdekin, in his opening address to the Sydney hearings of the 1991/92 Inquiry into Human Rights and Mental Illness, said that Soviet human rights abuses in this area had been the catalyst for his own Inquiry.[54]
Burdekin explained that human rights circles in the Western democracies had formed the view that investigations were required into the mental health systems of democratic countries, to ensure that they were beyond reproach, before a full human rights assault could be launched on the Soviet psychiatric system. He said that his own Inquiry had been conceived as part of this project, but that while preparations had been under way to commence his Inquiry the issue had gone off the boil because the Soviet Union had collapsed. This change of affairs might partly explain why the Inquiry failed to fulfil one of its key terms of reference.
The Inquiry’s first term of reference clearly listed the classes of people it had originally intended to deal with: ‘To inquire into the human rights and fundamental freedoms afforded to persons who are or have been or are alleged to be affected by mental illness, having due regard for the rights of their families and members of the general community’.[55] [my italics]
What is meant by ‘alleged to be’ affected by mental illness is not immediately apparent. An early usage of the term ‘alleged mental illness’ can be found in a published dialogue between US patient rights activist Leonard Roy Frank and American Civil Liberties Union attorney and mental patient advocate, Bruce Ennis. Ennis explained in the interview that he used ‘alleged mental illness’ because ‘I personally have seen no evidence at all that there is such a thing as mental illness’.[56] It is possible that the Inquiry, like Ennis, had originally intended to question the existence of all mental illnesses.
Alternatively the Inquiry might have only intended to indicate a level of uncertainty in the accuracy of diagnoses of mental illness. There are at least two ways the Inquiry could have utilised this distinction. The first would have been to examine the issue of false positive diagnosis. This is a perennial problem for psychiatry and arises from the subjective nature of psychiatric diagnostic techniques and the lack of laboratory tests to confirm diagnoses. The second would have been to review patients diagnosed with certain varieties of mental illness—like the Soviets’ sluggish schizophrenia—which are not generally recognised by international standards, but which some psychiatrists allege exist. Perhaps the Inquiry had originally planned to investigate both problems. There are well-established concerns in both areas.
Regardless of what the Inquiry’s original interpretation of ‘alleged’ mental illness might have been, it was certainly appropriate for an Inquiry into Human Rights and Mental Illness to investigate complaints from any person who had suffered the discomfort and humiliation of a psychiatric diagnosis, and possibly incarceration and imposed treatment, on the basis of a mere allegation. But despite the nomination of this category in the terms of reference, as it transpired, the Inquiry completely ignored these people. They were not mentioned in the Inquiry’s report at all outside of the terms of reference.
In fact the definitions that were eventually adopted by the Inquiry made it impossible to recognise people who are ‘alleged’ to be mentally ill. This is because the Inquiry chose to use the term ‘consumer’[57] to describe all of the people covered by the terms of reference, thereby implying that people who have been diagnosed with mental illnesses are all willing participants in a mental health service industry. This title of ‘consumer’ was a totally inappropriate description for people who are ‘alleged’ to be mentally ill. It is apparent that somewhere between the time when the terms of reference were drafted and the time when the hearings of witnesses began, a decision was made to prevent people who are ‘alleged’ to be mentally ill from influencing the outcome of the Inquiry.
The failure to pursue one of its key terms of reference is a disturbing outcome for the Human Rights Commission. It reflects a general relaxation of civil liberties vigilance towards psychiatry in the post-Soviet new world order. This is an unfortunate development because the same type of problem that overtook the Soviet system is now becoming apparent on a global scale. The problem arises because the natural boundaries of human diversity are far wider than the limited range of personality types needed by ideologically-driven cultural systems. This is just as true for the new global culture of the market-place as it was in the Soviet Union. Human rights advocates and civil libertarians who have not yet caught up with these developments may inadvertently be collaborating in repression by assisting in the expansion of psychiatric coercion.
Critics of psychiatry have long argued that a diagnosis of schizophrenia is the most frequent way of using psychiatry to control troublesome citizens. This is because it is considered a serious form of mental illness and people designated 'schizophrenics', therefore, are in urgent need of treatment and control. A further useful aspect of the schizophrenia label is that its symptoms are vaguely defined so that it can only be identified with authority by a psychiatric expert. This means that a diagnosis can't be refuted by a non-psychiatrist. It is not surprising that Soviet psychiatrists used diagnoses of schizophrenia to persecute political dissidents.
There is little doubt that some people sometimes display the symptoms of schizophrenia. What is in doubt is whether these symptoms are really caused by an underlying 'disease' of the mind or brain accessible to medical analysis and treatment. Psychiatrists claim that it is a disease and they have devised the medical model to explain schizophrenic symptoms.
Next: 2. The Medical Model: schizophrenia as a disease
[54] Brian Burdekin, Federal Human Rights Commissioner, opening address to Sydney hearings, National Inquiry into Human Rights and Mental Illness, 17 June 1991, personal observation.
[55] Human Rights and Equal Opportunity Commission, op. cit., p. 5.
[56] Leonard Roy Frank, ‘An Interview with Bruce Ennis’, in Sherry Hirsch, Joe Adams, Leonard Frank, Wade Hudson and David Richman (eds), Madness Network News Reader, p. 165.
[57] Human Rights and Equal Opportunity Commission, op. cit., p. 13.