Deprivation of liberty and forced treatment are the two most serious human rights problems that arise for the socially-alienated class of schizophrenics. Article 9 of the International Covenant on Civil and Political Rights (ICCPR) guarantees: "Everyone has the right to liberty and security of person. No one shall be subjected to arbitrary arrest or detention. No one shall be deprived of his liberty except on such grounds and in accordance with procedure as are established by law."[10]
The key word here is ‘arbitrary’. If correct procedures are followed and there is good reason to arrest a person, because he or she has broken a law, the person no longer has a right to liberty. But on most occasions schizophrenics are involuntarily hospitalised only as a precautionary measure. Is this arbitrary? Assuming there is no disease underlying the symptoms, and medical treatment is therefore unnecessary, the answer concerns whether the people selected are still in need of control because they are dangerous to themselves or other people.
A great deal of research has been undertaken to determine whether people with the symptoms of schizophrenia, and other mental disorders, are more dangerous than other people. The results of this research vary: from not at all to marginally more dangerous. Some classes of people, such as young men between the ages of fifteen and twenty-five, and men consuming alcohol, are statistically far more dangerous to other people than schizophrenics. However, it is unthinkable that all young men, and all alcohol drinkers, should be incarcerated as a precautionary measure. This often raises a rhetorical question as to why it is thought to be just to incarcerate a statistically less dangerous group, such as people with the symptoms of schizophrenia, on the grounds of their supposed dangerousness.
The same holds for the supposedly high suicide rate of schizophrenics. A far higher suicide rate prevails amongst people who have already attempted to kill themselves, particularly when there is a background of childhood sexual abuse. This is a group on whom no precautionary incarceration is imposed. Nor is there any institutionalised intervention in the lives of people who pursue dangerous sports such as mountain climbing and car racing. On the contrary, such people are encouraged because they inspire normal people with their willingness to take risks.
There is an interesting statistic that relates to the practice of incarcerating schizophrenics to protect them from themselves. It seems that schizophrenics undergo a particularly high risk of suicide shortly after they are released from hospital.[11] This can be interpreted in a number of different ways. On the one hand it could be argued that hospitalisation protects a person from suicidal impulses, and that those who suicide after release should have been kept in longer. But on the other hand it can also be argued that it is the treatment, or the humiliation of the incarceration experience, that causes people to suicide as soon they get a chance.
The possibility that hospitalisation and the accompanying neuroleptic drug treatment might induce suicidal or violent reactions is very disturbing. Neuroleptic-induced akathisia is a side-effect of standard drug treatment for schizophrenia: ‘The individual is virtually tortured from inside his or her own body as feelings of irritability and anxiety compel the person into constant motion, sometimes to the point of continuous suffering’.[12] DSM-IV is unequivocal about the risks of suicide and violence associated with neuroleptic medication:
"Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts. Worsening of psychotic symptoms or behavioural dysfunction may lead to an increase in neuroleptic medication dose, which may exacerbate the problem. Akathisia can develop very rapidly after initiating or increasing neuroleptic medication. The development of akathisia appears to be dose dependent and to be more frequently associated with particular neuroleptic medications. Acute akathisia tends to persist for as long as neuroleptic medications are continued, although the intensity may fluctuate over time. The reported prevalence of akathisia among individuals receiving neuroleptic medication has varied widely (20%–75%)."[13]
DSM-IV is not a polemic written by critics of medical psychiatry. It is an officially-recognised manual and is perhaps the most important contemporary document supporting the medical view of mental disorders. When it says that up to 75 per cent of the people given drug treatment for schizophrenia are put at increased risk of suicide this is a consensus opinion of the psychiatric profession. In the face of this admission it seems quite bizarre that the same profession regularly claims there is a need to incarcerate schizophrenics to ensure they are given this treatment to protect them from suicide.
Next: Torture and Cruel Treatment
[10] United Nations, ‘International Covenant on Civil and Political Rights’, Article 9, p. 29.
[11] B. J. Carone et al., ‘Posthospital Course and Outcome in Schizophrenia’, pp. 247–53.
[12] Peter Breggin and David Cohen, Your Drug May Be Your Problem, p. 78.
[13] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM IV), fourth edition, p. 745.