As discussed in previous chapters, a group of drugs called neuroleptics, formerly known as major tranquillisers and antipsychotics, is the contemporary psychiatric treatment of first choice for schizophrenia. It is not difficult to demonstrate that forced treatment with neuroleptics violates both the right to liberty and the right to protection from torture.
An involuntary patient usually undergoes a loss of liberty in two different ways. The incarceration process physically removes the person from the community. The forced treatment with neuroleptic medication effectively restricts brain activity and thereby restrains the person’s ability to be physically and mentally active. Neuroleptic drugging is so efficient that earlier methods of physical restraint such as straitjackets are now rarely needed. In fact, neuroleptic treatment itself is sometimes referred to as a ‘chemical straitjacket’.
So efficient is this chemical straitjacket that incarcerated people, although they may be considered still in need of control, are now often released under community treatment orders which ensure their minds and bodies remain under restraint after release from hospital. In the United States this process is called outpatients’ commitment, and states are progressively passing legislation to enable it. People are subjected to a legally binding order under which mobile treatment teams have access to their homes in order to inject them with long-acting neuroleptics at the required intervals. There is usually a prescribed maximum period for which an order is effective, but successive orders can be made for an indefinite period.
Despite the misconceptions of medical psychiatrists neuroleptic treatment applied in this way can not possibly have a therapeutic benefit because there is no underlying illness on which to apply the therapy. The only possible justification is that it is done for social control reasons. As such, the people who are controlled in this way have their right to liberty violated because the medical assessment process that identifies them for forced drugging is fraudulent and arbitrary.
The same drugs which are given to schizophrenics as therapy to supposedly rebalance their brain chemistry are also used in many different institutional settings purely as restraining devices to control the behaviour of non-psychotic people. When they are used on non-psychotic people there is no pretence of a therapeutic purpose. This suggests that the only effective use of neuroleptics is for chemical restraint.
Neuroleptics are used widely for treating agitation in elderly people, and there are varying opinions within the psychiatric profession about the correctness of this procedure. While one text protests that ‘the use of antipsychotic drugs to control disturbed behaviour in elderly patients with dementia is a widespread practice that should be deplored’ and that ‘antipsychotic drugs should not be used in the routine treatment of non-psychotic patients,’[37] other texts and professional papers canvass a very different point of view.
The influential Synopsis of Psychiatry recommends that ‘[i]n addition to treating overt signs of psychosis, such as hallucinations and delusions, antipsychotics have also been used to deal effectively with violent, agitated, and abusive geriatric patients’.[38] This view is supported by another text which says that neuroleptics are in ‘widespread use for the control of behavioural complications’ in nursing homes and hostel settings where from 20 to 70 per cent of institutionalised patients with dementia are receiving the drugs.[39] (Dementia is not regarded as a psychosis but is a symptom of brain damage/brain atrophy arising from a variety of causes.)
Studies of neuroleptic use in nursing homes have found that informed consent is often not sought in advance but is usually ‘presumed’, and that treatment continues unless it becomes apparent that the patient no longer acquiesces.[40] Studies have also found that the neuroleptic drugging has a detrimental effect and hastens the decline of elderly people. One recent study found that the intellectual capabilities of elderly people receiving neuroleptics were only half those of untreated elderly people.[41] Another study implicated neuroleptics in an increased incidence of injurious falls in nursing homes.[42]
In its Federal Budget Submission for 1995, the Council on the Ageing (Australia) recommended that Commonwealth funds be allocated to specifically address a number of matters raised by the Inquiry into Human Rights and Mental Illness. One of these matters is referred to as ‘the use of chemical restraint in residential care for older people’.[43] The Human Rights Inquiry had been told that old people with dementia ‘get zonked out with medication or tied to their chairs’[44] in some nursing homes as a matter of course. And that ‘elderly patients are routinely sedated as a management technique —rather than for therapeutic purposes’.[45]
But there is no equivocation when it comes to prescribing neuroleptic drugs for mentally retarded people: ‘Treatment of behavioural disturbances in the mentally retarded has tended to rely heavily on medication resulting in up to 50% of retarded people in institutions and community residences being on psychotropic drugs’.[46] (Neuroleptics are a sub-set of the psychotropic group.) A second text-book confirms the 50 per cent figure as being normal and enthusiastically recommends the neuroleptics Mellaril and Haldol as being ‘useful in reducing unwanted behaviour, such as self-stimulation, aggression, and motor activity’.[47]
Neuroleptics are also routinely used by psychiatrists to treat children and adolescents who have had complaints laid against them for being disruptive. High strength neuroleptics such as Haldol, for instance, are routinely prescribed for conduct disorder.[48] Conduct disorder is specific to children and adolescents and is essentially a tendency towards disobedience. Conduct disorder is considered a non-psychotic condition and so, unlike the dopamine hypothesis for schizophrenia, there is no attempt at formulating an underlying therapeutic rationale for using neuroleptic medication to control it. This has left drug treatment for conduct disorder open to severe criticism. A recent study of children and adolescents receiving neuroleptics in New York found that one-third of them had developed symptoms of parkinsonism, and one eighth had developed tardive dyskinesia, as a result.[49]
When neuroleptic drugs are openly used in these ways to control troublesome behavioural patterns, without any pretence of a therapeutic purpose, it is obvious there is no truth in claims that they have a therapeutic effect on schizophrenics. It is apparent that the drugs are administered to schizophrenics for the same reason as they are given to disruptive non-psychotic people in institutions—primarily to control their behaviour. This means that all involuntary dosing with these drugs is a restriction of personal liberty and therefore a violation of Article 9.
Next: Neuroleptics: Treatment or Torture?
[37] G. Johnson, ‘The Biological Therapies’ in Pierre J. V. Beumont and R. B. Hampshire (eds.), Textbook of Psychiatry, p. 330.
[38] Harold I. Kaplan and Benjamin J. Sadock, Synopsis of Psychiatry, sixth edition, p. 816.
[39] S. Tichurst, ‘Dementia’, in Robert Kosky et al., (eds.), Mental Health and Illness: a textbook for students of health sciences, pp. 269–70.
[40] B. S. Gurian et al., ‘Informed Consent for Neuroleptics with Elderly Patients in Two Settings’, pp. 37–44.
[41] Alison Motluk, ‘Dementia drugs hasten mental decline’, p. 9.
[42] James W. Cooper, ‘Drugs that cause falls in the nursing home’, pp. 45–7.
[43] Council on the Ageing (Australia), Federal Budget Submission for 1995, p. 9.
[44] Human Rights and Equal Opportunity Commission, Report of the National Inquiry into the Human Rights of People with Mental Illness, p. 517.
[45] Ibid. p. 245.
[46] H. Molony, ‘Mental retardation’, in Beumont and Hampshire, (eds.), op. cit., pp. 277–8.
[47] Kaplan and Sadock, op. cit., p. 799.
[48] B. Bowers, ‘Antipsychotics Evoke Youthful Concerns’, p. 276.
[49] Ibid.