What is Critical Psychiatry?

The concept of a critical psychiatry is part of the movement sometimes known as Critical Analysis, or Critical Thinking. All this says is: Don't take anything at face value. Question everything, especially everything you and your society hold dear. The idea has a long history, certainly going back to Socrates, but its practitioners tend to have fairly short histories (e.g. Socrates) as the powers-that-be in society generally don't like being questioned. Critical analysis isn't just a matter of rejecting everything, any nitwit can do that, but it involves the difficult process of going through each and every belief to see which ones are justified.

One of the major figures in the history of critical analysis was the French polymath, René Descartes (1596-1650). Descartes was very well educated in the classics, in the original Latin and Greek. After graduating from the foremost high school in France, he trained as a lawyer and then as a military engineer so he could study maths. He lived a low-key and rather abstemious life, devoting himself to his favourite topics, mathematics and philosophy.

At about the age of twenty-three, he decided that reading the classics wasn't all it was cut up to be. For every opinion that he saw in one book, he said he could go to others and find exactly the opposite opinion. He therefore decided that henceforth, he would accept as true only what he could prove was true, or was inescapably the case. If he could entertain any doubt about something, no matter how small, he would reject it. This led him to the position that there were only two possible absolute truths in the universe: that God exists (he retained his faith throughout) and that he himself existed. He could doubt his senses, his memory, his beliefs, even doubt that he had an actual body or that the world existed. However, the one thing he couldn't doubt was the fact that if he could ask "Do I exist?" then he knew immediately that he did. If he didn't exist, he couldn't ask the question. Cogito, ergo sum. I think, therefore I am.

Skipping nearly 400 years of philosophy, we arrive at a society which claims to be secular and humane. Secular? As Ambrose Bierce commented a century ago:

He swore that all other religions were gammon,

but wore out his knees in the worship of mammon.

That leaves us with the idea of a humane society. But if you want to see the measure of a society, just look to how it treats its least members. Who are its least members? Most people would say "prisoners," but as a matter of legal rights, the least members of most societies on earth are the mentally-troubled. In one country after another, convicted prisoners have more rights, and a generally much easier time, than people detained under what is misleadingly termed "mental health legislation." This is certainly the case in the state of Queensland, where I live. The Qld Mental Health Act of 2016 is a weighty 639 pages (it may have grown since), eclipsing the Qld Criminal Code of 2021, a mere slip at 538 pages.

However, like most such acts, the Qld MHA is not an act about mental health at all. It is an act about incarcerating the mentally-disturbed. Sure, it is all done with a parade of portentous players and a forest of fiddly forms but it comes down to this: society thinks it is meet and proper to snatch the odd, the eccentric, the disturbed and the disturbing, from the streets and from their houses and, regardless of their wishes, to convey them, trussed and drugged, to a secure place and lock them away. For as long as it likes, under whatever conditions it likes, and to submit them to any "treatment" it likes for whatever reason it likes.

A person picked up by the police, interviewed and then charged and convicted before being locked up has many, many rights. Mentally-disturbed people, who mostly have broken no laws, have, essentially, none. That leads us to the very obvious question: Why? Why are "different" people treated differently? Descartes would have had a field day with this, but practically everybody in this secular and humane age simply accepts that that's how it's always been so that's how it shall remain. When my son was about eleven, he asked me a question about the government. I replied something like "That's how it's always been." He thought for a moment, then snapped back: "A time answer doesn't answer a why question." So if it's obvious to eleven year olds that "That's how it's always been" doesn't work, perhaps we should actually question this habit.

There's good reason to question why mentally-troubled people are locked up: the UN Convention on the Rights of Persons with Disabilities (CRPD) is perfectly explicit:

The Convention ... reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms. It clarifies ... areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and areas where their rights have been violated, and where protection of rights must be reinforced.

Human rights ... Fundamental freedoms ... I would say that snatching people off the street, locking them in solitary confinement, stripping their clothes, and wrestling them to the ground to inject them against their will is prima facie a violation of human rights. The burden of proving it's not rests with those who authorise and do it.

However, there's more to it. The UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT) exists to protect people against the crime of torture. It specifically applies to helpless people, which includes people held as involuntary patients in mental hospitals. Torture is always and in all ways a crime. Remember that torture is defined as how the recipient perceives it, not as the perpetrator intends. Torture is as torture does: there is no defence, including "Oh but we were doing it for his good." Australia signed UNCAT years ago.

In 2017, state signatories of UNCAT were invited to sign a further convention, known as the Optional Protocol (OPCAT) which was an undertaking that the state would enforce standards to protect people against torture. After an enquiry by the Human Rights Commission, Australia signed in December 2017 (my submission to the enquiry is here). Part of it was visits at short notice by the UN Subcommittee to Prevent Torture (SPT) to inspect facilities and to ensure that the state was complying with both the letter and the spirit of the UNCAT.

In October 2022, the SPT scheduled a visit to Australia. This was welcomed in a press release by the Attorney General, Mr Mark Dreyfus, on behalf of the recently-elected Labor Government:

I welcome the visit to Australia by a delegation of the United Nations Subcommittee on Prevention of Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. The delegation will spend the next week visiting Commonwealth, state and territory places of detention. Australia and the Subcommittee have a shared commitment to ensuring people who are held in places of detention are treated with dignity and are not subject to degrading treatment or punishment.

In the event, the SPT terminated its visit early due to lack of cooperation by two state governments, New South Wales and Queensland, who refused access to their facilities. In its report, the Committee noted this failure, especially relating to Australia's treatment of unauthorised immigrants, of Aboriginals and juveniles held in prisons, and the failure of any Australian government to comply with international law regarding people suffering mental disturbances.

Now international treaties have the force of law and over-ride state laws. Having seen a number of locked wards in Queensland mental health services, it is an indisputable fact that the treatment of mentally-disturbed people breaches both the Convention Against Torture and the Convention on Rights of Disabled. That was what the government was hiding.

But that's not good enough. Somebody, somewhere, has to justify why psychiatry has been given the immense social power to detain people indefinitely and subject them to treatment that they often regard as torture. It's not good enough to say "That's how it's always been," or "We're doing it for their benefit." Extreme measures demand extreme justification. Where is the scientific and moral justification? Where are the placebo-controlled multicentre double-blind crossover trials to show that involuntary treatment is better than alternative or even no treatment? Where is the cost-benefit analysis to show that suspending human rights to force involuntary treatment is morally better than doing nothing? In short, where is the science psychiatrists are always trumpeting? It's not enough to show that society benefits (although that has never been done, either), we need to show that the patients themselves are better off, otherwise they're not patients, they're victims. So I'll be lodging a Freedom of Information application to try to see what led the generally reasonable Queensland Labor government to tell the UN committee to piss off. Watch this space.

Just before this file was due to be loaded, I came across a notice of a book to be published in a few weeks: Ron Wipond, Your Consent Is Not Required; a study of involuntary treatment in the US and Canada. That looks very interesting, I'll review it when it becomes available.

As always, we do not offer any advice or comments on individual cases.