In the mid-1990s an anxious mother began a letter-writing campaign to persuade legislators of the need to amend the Mental Health Act in the Australian state of New South Wales. Describing herself as a medical doctor with experience in psychiatry, she wrote to newspapers and politicians about her twenty-year-old son who was behaving strangely. She said that he was suffering from psychosis but was refusing to be treated. Her problem was that the mental health laws then in force in New South Wales would not allow for his involuntary treatment. To be eligible for forced treatment, her son was required to be at risk of causing serious physical harm to himself or to other people. Being a peaceful sort of young man, he didn’t fit either of these criteria, and so he was allowed to remain free.
Out of frustration, she began lobbying to have the law changed. She wanted the criteria for dangerousness removed from the legislation, so that peaceful people such as her son could be forced into treatment if they were unwilling to go voluntarily. Her local member of state parliament, Dr Peter Macdonald, was a medical doctor himself, and he joined her campaign. In an effort to persuade his political colleagues to change the legislation, he read one of her letters into the parliamentary record:
Our twenty-year-old son developed a psychosis about three years ago. He was a top student at his school, a promising musician, well liked and respected by his peers. Our relationship with him was good, and we had hopes that he would be a well-adjusted adult, able to take his place in society. Today he is wandering the beaches and streets of Manly, to all intents and purposes a ‘homeless youth’.
His psychosis (diagnosed as schizo-affective disorder) takes the form that he believes he has to convert all to Christianity because all are doomed to go to hell. He cannot explain why he believes this and he seems to think that the world is going to end soon. He gives away all his belongings and money to people he believes God is directing him to save, e.g. he gave away $2000 at Christmas. This was his entire savings.
For a while he was bringing home vagrants and they would spend the night in his bed while he wandered the streets looking for more people to save. We lost various possessions to these people, some of whom were also obviously suffering from psychosis themselves. He deprives himself of sleep as he believes he has to be ‘working’ i.e. evangelising.
He has lost all his friends and his relationship with us is under great strain as he puts his ‘work’ before all other considerations. But he is not a danger to himself or to others so he cannot be taken to hospital under the present Mental Health Act.
The doctors involved say he would probably benefit from medication for his psychosis and they want to put him on the clozapine programme but their hands are tied until such time as he deteriorates further and does something to actively harm himself or others. Meanwhile his family suffers, his relationships with all his mates are lost, he loses all his money, he smells, he neglects all that he formerly held dear when he was well.
I think it is a disgrace that our society can let this happen, and I know it is not just my son to whom this is happening. It involves many other youths who are also wandering the streets in the grip of mental illness.
In 1997 the New South Wales Mental Health Act was in fact amended so that people who have unusual but peaceful habits can be forced into treatment. This change, however, was not entirely due to one person’s efforts. It was part of a widespread trend all over the world to weaken civil liberties protections, in order to make it easier to force involuntary psychiatric treatment on people diagnosed as being ‘psychotic’.
Psychosis, the term used to describe the young man’s condition, is psychiatric language for a state of altered consciousness. To observers, psychotic people appear to have lost the ability to control their own minds and behaviour.
In psychiatric classification systems, schizophrenia is the most serious sub-type of a spectrum of psychotic disorders. The principal symptoms of schizophrenia are mental activity such as hallucinations, delusions, and disordered thinking. The hallucinations are usually in the form of inner voices that sometimes pass judgement on the person experiencing them. The inner voices also frequently supply the person with esoteric knowledge about religious and political affairs, and reveal secret meanings behind everyday events that are hidden from normal people. Unusual beliefs are formed from these internal experiences, and disordered thinking accompanies attempts to communicate the beliefs to other people.
As well as these so-called ‘positive’ symptoms, psychiatrists also use an alternative range of ‘negative’ symptoms to indicate schizophrenia. These are the opposite of the positive symptoms, in that a lack of self-expression is taken to indicate a similar lack of inner mental activity. On top of these, degrees of social and occupational dysfunction are also used as diagnostic tools. There are no laboratory tests to verify the presence of schizophrenia, and identification of the condition relies on the subjective opinions of those making the diagnosis.
Despite all this apparent certainty about the condition, and after almost one hundred years of recognition as a valid and distinct mental illness by mainstream psychiatry, schizophrenia still remains controversial in many ways. There is controversy about the psychiatric classification system that identifies a diverse range of signs as symptoms of a distinct mental disorder; there is controversy over diagnosis for the condition; there is controversy over treatments, particularly when the treatment is given without informed consent; and there is controversy over the causes.
It is the linked issues of diagnosis, treatment and causes that are together the main focus of this book. On the one hand, I believe that the diagnostic criteria for schizophrenia are so broad that people are included who clearly do not have medical problems. There are some people, for instance, who are diagnosed when they are undergoing a spiritual/mystical emergency, and others who are only diagnosed for having problems of living arising from social or occupational dysfunctions. Many others are misdiagnosed with schizophrenia when they actually have drug- or substance-related disorders that have other diagnoses.
On the other hand, schizophrenia is almost always treated with drugs upon a diagnosis being made, whether the patient consents or not. In fact, more than half of all people treated for schizophrenia are involuntary patients. Unlike voluntary patients, people who have psychiatric treatment forced on them are not ‘consumers’; instead, their forced treatment is justified with what I think are often cynical interpretations of ‘the right to treatment’ and ‘informed consent’.
The drugs used to treat schizophrenia manage but do not cure the condition. They are also dangerous, and have a wide range of debilitating side effects. Even so, there are now insistent demands being made by mental health professionals and support groups for patients’ relatives that drug treatment be given at the earliest signs of schizophrenic symptoms. These demands are supported by an international lobbying campaign sponsored by drug companies to alter mental health legislation to make it easier for psychiatrists to force treatment on unwilling patients.
For all the above reasons, I have developed serious concerns about the human rights of people who receive psychiatric treatment for schizophrenia, whether voluntarily or involuntarily. My greatest concern is that when psychiatrists force treatment on people they bypass the normal doctor/patient contractual arrangements, and other human rights come into play that are not normally associated with medicine. People who are forced into treatment when they are undergoing a mystical experience, for instance, are entitled to feel that their ‘right to the freedom of thought and belief’ is being violated. This is a fundamental human right guaranteed in United Nations’ covenants and declarations.
Similarly, people who are incarcerated and forcibly treated for only having social or occupational problems can complain legitimately that their rights to ‘liberty’ and to protection against ‘torture, or cruel, inhuman or degrading treatment or punishment’ are being violated. These rights are also guaranteed by international law.
As things stand, psychiatrists deflect complaints such as these by claiming that all people who are diagnosed with schizophrenia are, by definition, mentally ill and therefore have a ‘right to treatment’. According to this way of thinking, forcing treatment on patients is merely a way of respecting this right. Any claims to the contrary by patients are simply further signs of their mental illness. To put it mildly, I disagree. The central objective of this book is to show that there are serious problems of truth and justice arising from these psychiatric beliefs and attitudes. I hope this book demonstrates that spiritual/mystical emergencies and social alienation are not medical problems, and that when people undergoing these experiences are diagnosed and forcibly treated for schizophrenia they clearly have valid complaints that their human rights are being violated.
The description of the young man above, who was the subject of his mother’s letter-writing and political campaign, raises many of the uncertainties that surround the mental disorder which psychiatrists call psychosis. Did he have a problem with his mind, or was his problem primarily one of social adjustment? If he had a mental problem, was it caused by an imbalance in his brain chemistry (which should have been rectified with medication) or was he undergoing a religious/spiritual emergency (which forced drug treatment would have suppressed but left unresolved)?
His mother’s opinion—that he was in desperate need of medical attention—wasn’t just that of an anxious parent. She was a medical doctor with experience in psychiatric problems. She had to be taken seriously. When she said her son was suffering from psychosis, she presumably knew what she was talking about. But can we be certain that she did? Ordinary lay people wouldn’t necessarily read signs, such as his apparent selfless generosity, as indications of mental illness. To some people, he might have been showing signs of a virtuous spirit. Some might even argue that he appeared to be acting under the influence of a perfectly legitimate religious inspiration. If he believed that he was acting under God’s direction, and he was doing more good than harm by helping homeless people, was it right for his mother and her psychiatric consultants to intervene? At twenty years of age, after all, he was a grown man.
Other people might see this particular young man as having been under the influence of something far less dramatic than either madness or sainthood. Like so many young people before him, perhaps he was simply rebelling against the middle-class values of his parents. But his mother didn’t think so. And, as she said, there are a great many young people like her son wandering around. The question is this: are differently minded people like her son in need of forced psychiatric intervention to alter the direction of their lives? If they remain untreated, are they at risk of harm greater than the risks of their treatment, and do they cause social problems that are more serious than the obvious disappointment and distress they bring to their loving parents?
 Peter Macdonald, ‘Mental Health Support and Counselling Services’.