Another article of human rights law that is of particular interest to critics of medical psychiatry is Article 7 of the ICCPR:
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation.[14]
The linkage in Article 7 between torture and unreasonable forms of punishment, on the one hand, and medical experimentation on the other, is noteworthy. For sceptics all medical treatment for mental illnesses is, and can only be, experimental. And further, since it is implausible that any illness underlies the symptoms of schizophrenia, the rationale for applying medical treatment can only be explained in terms of punishment. That is, punishment for allowing thoughts, beliefs and behaviour to have crossed a threshold of social tolerance.
Concerns about torture and unreasonable forms of punishment are so fundamental to human rights that a special United Nations convention is dedicated to their elimination, which is supplementary to Article 7. The Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment conveniently supplies a definition of torture as:
any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having 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. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.[15]
The exclusion described in the last sentence is concerned with the application of prescribed punishments for specific breaches of the law. In some countries, for instance, whipping is still used as a punishment for certain criminal offences, and the intention of the Convention is to exclude such ‘lawful sanctions’ from the definition of torture. However, if medical treatment for schizophrenia can be shown to fit the former part of the definition of torture, it is unlikely that it would be excluded merely because it has lawful sanction under mental health legislation. It can be assumed that the lawful sanction for the application of medical treatment for schizophrenia is only given on the assumption that it will benefit the patient, not that it will deliberately cause pain and suffering.
An argument can be easily made that medical treatment for schizophrenia fits the above definition of torture because it causes severe physical and mental suffering; it is intentionally inflicted on a person for the purpose of obtaining a confession in the form of a demonstration of ‘insight’; it intimidates and coerces the person to change his or her pattern of thinking and belief; and, in the case of involuntary treatment, the mental suffering is inflicted by a government-employed psychiatrist acting in an official capacity.
It is not difficult to establish that schizophrenia treatment causes physical and mental suffering in those who receive it. Medical treatments for madness, from the fifteenth century onwards, have almost always done so. Noteworthy were ‘stone operations—that is, pretending to remove stones from incisions made in the heads of patients thought to be mad’.[16] This European practice, which flourished between the fifteenth and seventeenth centuries, is thought to be the origin of the description of mad people as having ‘rocks in their heads’.
A seventeenth-century English medical text-book on madness relates ‘that the observations that sword wounds penetrating the skull sometimes produced a cure for insanity led to operations to let out the “fuliginous humours” by boring the skull’.[17] The nineteenth century saw the widespread use of treatments such as prolonged exposure in cold water, shock therapy by suddenly opening a trap-door and dropping a patient into cold water, and a rotating swing device in which the patient’s head was strapped into a position in which the centrifugal force pushed more blood into the brain.
There have also been various kinds of infection therapies whereby pustules and running sores have been deliberately induced on the scalp so that they could be incised to let ‘the black vapours escape’.[18] Early in the twentieth century, fever therapies were used by infecting psychiatric patients with tuberculin, typhoid, and malaria. The exponents of all these improbable treatments claimed success at the time they were applying them. If it is true that such applications can indeed eliminate the symptoms of schizophrenia then it is simply a demonstration that torture and punishment can persuade people to change their minds and behaviour.
It was not until well into the twentieth century, with the advent of more sophisticated medical treatments such as insulin coma treatment in the late 1920s, and in the 1930s metrazol convulsive treatment, psychosurgery and electro-convulsive treatment (ECT), that schizophrenic patients were introduced to modern medical practices.
Insulin and metrazol have long ago been phased out as schizophrenia treatments, but the record of their usage is quite relevant to the current discussion on torture. Early psychiatric pioneers of these treatments were often candid in their opinions about the usefulness of insulin and metrazol in ‘fear therapy’:
No reasonable explanation of the action of hypoglycaemic (insulin) shock or of epileptic fits in the cure of schizophrenia is forthcoming, and I would suggest as a possibility that as with the surprise bath and the swinging bed, the ‘modus operandi’ may be the bringing of the patient into touch with reality through the strong stimulation of the emotion of fear, (and) that the intense apprehension felt by the patient after an injection of cardiazol (metrazol), and so feared by the patient, may be akin to the apprehension of the patient threatened with the swinging bed. The exponents of the latter pointed out that fear of repetition was an important element in success.[19]
During insulin treatment a person experienced a range of symptoms beginning with clouding of consciousness and progressing to wild excitement, involuntary gasping and sucking, protrusion of the tongue, snarling, grimacing, twitching, convulsions, spasms and deep coma. It is reported to be a very unpleasant experience.
A point from the above observation that needs to be emphasised is the ‘bringing of the patient into touch with reality through the strong stimulation of the emotion of fear’. The reality presented to the patient was that if he or she was not prepared to cease manifesting schizophrenic symptoms, and make the required adjustments of thinking and belief, the patient would be made to suffer more insulin or metrazol treatments. This is a fairly concise description of torture, and the objective of torture—that is, compliance. One psychiatrist summed it up this way:
The patient is mentally sick, his behaviour is irrational; this ‘displeases’ the physician and, therefore, the patient is treated with injections of insulin which make him quite sick. In this extremely miserable condition he seeks help from anyone who can give it. Who can give help to a sick person, if not the physician who is constantly on the ward, near the patient, and watches over him as over a sick child?[20]
Don Weitz is a psychiatric survivor and an antipsychiatry activist based in Toronto, Canada. He is co-editor of a book, Shrink Resistant: the struggle against psychiatry in Canada. He also produces an antipsychiatry radio programme called Shrinkrap and is the co-founder of a Toronto-based organisation called People Against Coercive Treatment (PACT). A perception that the forced insulin treatment he received as a young man was a deliberate form of torture motivates his ongoing campaign against psychiatric coercion.
I was once tortured for six weeks 46 years ago—it happened in December 1951 and January 1952. I was forcibly subjected to a series of over 50 sub-coma insulin shocks which psychiatrist Douglas Sharpe prescribed as a treatment for ‘schizophrenia’. I never believed I was ‘schizophrenic’ or ‘mentally ill’—just a very confused college student struggling to find himself, a common identity crisis. I was an involuntary psychiatric patient in McLean Hospital (a teaching-research facility affiliated with Harvard Medical School and Massachusetts General Hospital).
Psychiatrist Douglas Sharpe prescribed a series of insulin shock treatments for me because I was openly angry and defiant. Here’s a telling excerpt by Dr. Sharpe in my medical records: ‘The patient was finally placed on sub-coma insulin and after a month of sub-coma insulin three times a day he showed tremendous improvement … There was no longer the outbursts of anger … He spends most of his time trying to figure out what the effect of insulin has on him … ’
The shock treatments terrorised and debilitated me. I once went into a coma and thought I was dying—a ‘side effect’ Dr. Sharpe and other psychiatrists never warned me about. When I frequently complained to Dr. Sharpe about the maddening hunger, profuse sweating and convulsions I was forced to experience everyday on insulin-shock and that it was torture, he dismissed my complaints and calmly replied, ‘I’m not torturing you. These complaints are just part of your problem.’ The usual blame-the-victim game. I was finally released in 1953 only after I promised to conform to the psychiatrists’ stereotype of a middle-class young student—study and go back to college.
It took me almost 20 years to understand my forced psychiatric incarceration and forced treatment in political terms, 20 years to realise that I was a political prisoner of psychiatry—locked up against my will, tortured, no right to a hearing or trial before losing my freedom, no right to appeal.[21]
Like insulin treatment, ECT has also earned a reputation as a ‘fear therapy’. Sylvia Plath described a personal experience of ECT in The Bell Jar.
‘Don’t worry,’ the nurse grinned down at me. ‘Their first time everybody’s scared to death.’
I tried to smile, but my skin had gone stiff, like parchment.
Doctor Gordon was fitting two metal plates on either side of my head. He buckled them into place with a strap that dented my forehead, and gave me a wire to bite.
I shut my eyes.
There was a brief silence, like an indrawn breath. Then something bent down, and took hold of me and shook me like the end of the world. Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant. I wondered what terrible thing it was that I had done.[22]
Unlike insulin and metrazol, ECT is still widely used as a psychiatric treatment although these days patients are anaesthetised first. Even so, fear of the experience has been well documented. One group of researchers exploring the role of fear in ECT elicited comments from patients who had undergone it:
Reaction ranged from strong denial of fear, such as ‘I’m glad to take it,’ to fear of total mental destruction or death, such as ‘Shock will destroy my mind,’ ‘My heart will stop,’ ‘I will die.’ Many subjects expressed fears of being electrocuted, such as one who said, ‘It’s like being burned to a crisp.’ Often the subject revealed under questioning a high degree of fear after first denying any fear, such as a depressed subject who admitted ‘I’m scared to death every time. I never know if I’m going to come out of it or not.’ A very psychotic subject described ECT as ‘like crossing a river.’[23]
In the past ECT was, for a time, the main treatment for schizophrenia. More recently it has been largely reserved for so-called drug-resistant cases of severe depression. However, ECT is still recommended for treating acute symptoms of schizophrenia ‘in certain patients who are in severe states of withdrawal (catatonia) or who present with significant affective symptoms such as uncontrolled mania’.[24]
The medical profession often seems to have a blind spot in its collective conscience concerning the difference between treatment and torture when electric shocks are involved. When electric shock is applied to the genitals it is unequivocally torture. However, when a person is imprisoned in a mental hospital, and subjected to toxic chemicals and electric shocks to the head, it is called treatment.
A recent report on the use of electric torture by Amnesty International doesn’t have the same trouble making the distinction between treatment and torture when ECT is involved. The report identifies ECT machines as being one of two electrical devices that are specifically suited, and routinely used, for torture: ‘the story of human torture cannot be conducted without the study of the torture of the insane … This is quite clearly illustrated in the story of the development of the ECT machine … ’ [25]
Psychosurgery is another psychiatric treatment that was widely used for schizophrenia in the past, but which contemporary psychiatrists now reserve for other mental illnesses, such as depression and obsessive-compulsive disorder.[26] Psychosurgery is a form of psychiatric treatment which ordinary people have little trouble understanding. Its conception is not much more sophisticated than an operation to cut a rotten spot out of an apple. It relies on crudely conceived brain-mapping which purports to locate specific forms of deviant mental activity in certain areas of the brain. The basic principle is that unwanted mental activity can be surgically removed. The effects of psychosurgery are irreversible.
Psychosurgery has been ‘practised in most countries with the necessary technical skills’ but it boomed in the United States in the late 1940s and early 1950s, shortly before the widespread adoption of antipsychotic drugs. In Britain between 1942 and 1954, 10,365 people were given leucotomy operations, two-thirds of them being performed on schizophrenics.[27] At this time insulin and metrazol were passing out of favour for schizophrenia treatment and mental hospitals were over-crowded with war veterans from World War II.
The popularisation of psychosurgery in the United States was largely attributable to neuropsychiatrist Walter Freeman and neurosurgeon James Watts, who jointly developed new techniques. In 1946 they performed the first operation using a new all-purpose technique called transorbital lobotomy: ‘The only instrument needed was a simple penetrating and cutting tool, which was forced through the bony orbit over the eye to enter the region of the frontal lobes’.[28]
This instrument, which Freeman referred to as resembling ‘an ice-pick’,[29] was called a leucotome, and, being a blunt instrument in both literal and metaphorical senses, was driven into the frontal lobe area with the aid of a mallet. Once in place it was rotated ‘so that the cutting edge would destroy fibres at the base of the frontal lobes’.[30] Estimates for the number of first-wave lobotomy operations performed in the United States using this method range up to 50,000.[31] One of the main reasons for this popularisation was that:
transorbital lobotomies were relatively easy to perform and electroconvulsive shock was frequently used in place of anaesthesia, the surgery was commonly performed by psychiatrists without the involvement of neurosurgeons, anaesthetists, and surgical amphitheatres. In some instances, the operation was performed as an office procedure and the patient was taken home by the family a few hours after the operation.[32]
What the family took home, however, was a very different person to the one they had taken in.
Typically the patient tends to become more inert, and shows less zest and intensity of emotion. His spontaneous activity tends to be reduced, and he becomes less capable of creative productivity, which is independent of the intelligence level . . . With these changes in initiative and control of behaviour, our patients resemble those with frontal lobe lesions.[33]
An extensive study undertaken by P. MacDonald Tow in 1955 of Personality Changes Following Frontal Leucotomy found very significant changes in intellectual functions including ‘impairment of the powers of abstraction and synthesis; of perception of relations and differences; of the ability to deal with complex situations, planning and thinking out of the next action and its consequences; and appreciation of one’s own mistakes … There is also impairment of the power of sustained attention and of the capacity for fine discrimination; and a dulled appreciation of the subject’s own level of success or failure’.[34]
Tow also examined journals written by patients before and after their psychosurgery. The post-surgery journals were particularly good indicators of the effects of the operation and showed that patients had deeply felt concerns about loss of creativity and self awareness; in particular they frequently had ‘a terrible fear of being harmed and controlled by scientific and psychiatric technology’.[35] Breggin describes having made similar observations in post-psychosurgery patients: ‘I have observed a florid paranoid schizophrenic with terror of being controlled by psychiatric technology following amygdalotomy’.[36]
There is little doubt that psychosurgery, chemical and electrical shock treatments, and the variety of crude treatments used in earlier centuries, can all be easily construed as forms of punishment and neatly fitted into the United Nations definition of torture. If the past history of medical treatment for schizophrenia is so clearly a tale of punishment and torture can the same be said of the current forms of drug treatment?
Next: Neuroleptics and Right to Liberty
[14] United Nations, ‘International Covenant on Civil and Political Rights’, Article 7, p. 29.
[15] United Nations, Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
[16] Elliot S. Valenstein, ‘Historical Perspective’, p. 15.
[17] Ibid.
[18] Ibid., p. 17.
[19] P. K. McCowan, 98th Annual Report for 1937 of the Crichton Royal Institution, Dumfries (Scotland). Quoted in L. C. Cook, ‘Has fear any therapeutic significance in convulsion therapy?’
[20] Marcus Schatner, ‘Some observations in the treatment of dementia praecox with hypoglycemia: part 2, psychological implication’, pp. 22–26.
[21] Don Weitz, ‘Cruel and Usual—A Human Rights Violation’.
[22] Sylvia Plath, The Bell Jar, pp. 117–18.
[23] Evelyn Crumpton et al., ‘The role of fear in electroconvulsive treatment’, pp. 29–33.
[24] Deborah Dauphinais, Medications for the treatment of schizophrenia: questions and answers.
[25] Darius Rejali, Electric Torture: a global history of a torture technology.
[26] Neuropsychiatric Institute, General Information, Neuropsychiatric Institute (NPI), Prince Henry Hospital, Sydney, Australia, available on-line at http://acsusun.acsu.unsw.edu.au/~s8700122/npiphh.html/#NPS
[27] F. A. Whitlock, ‘Psychosurgery’, in Erica M. Bates and Paul R. Wilson, eds., Mental Disorder or Madness, University of Queensland Press, St Lucia, 1979, p. 182.
[28] Valenstein, op. cit., p. 26.
[29] Ibid.
[30] Elliot S. Valenstein, ‘Rationale and Surgical Procedures’, Valenstein, ed., op. cit., p. 69.
[31] Valenstein, ‘Historical Perspective’, op. cit., p. 27.
[32] Ibid., p. 26.
[33] R. Anderson, ‘Differences in the course of learning as measured by various memory tasks after amygdalectomy in man’.
[34] P. MacDonald Tow, Personality Changes Following Frontal Leucotomy. Quoted in Breggin, in Valenstein, ed., op. cit., p. 489.
[35] Breggin, in Valenstein, ed., op. cit., p. 489.
[36] Ibid.