Monday, August 11, 2008

PSYCHIATRY AS A TOOL OF POLITICAL REPRESSION: A Review

Rael Jean Isaac and Virginia C. Armat's 1990 book, Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill, is not what its title suggests. It is not about the reduction of government funding for mental health services, a legitimate matter of concern. It is about the struggle of psychiatric patients and ex-patients to free themselves from the forced treatments which the authors favor, and the efforts of psychiatrists to continue to administer them. Under the guise of concern for the mentally ill, the authors advocate a policy of involuntary commitment and forced administration of anti-psychotic drugs and ECT, or electroconvulsive treatment (I take the "T" as referring to "treatment", not "therapy", as the former is more objective-- a "treatment" can be anything, including torture, whereas "therapy" is intended to help).

We know three things for certain about ECT. First, it was invented in fascist Italy (Mussolini became dictator in 1925; the first ECT was administered by Ugo Cerletti to a subject who had been arrested by the police-- not a mental patient-- over his own objections in 1938). Secondly, it causes brain damage, above all amnesia. We know that because the CIA funded experiments with it for precisely the purpose of destroying memory (Colin Ross, M.D., The CIA Doctors, pp. 48, 52, 121-130, 168-74). And some advocates of the procedure have maintained that it works for this very reason: for instance, ECT advocate Max Fink has said that brain dysfunction is not a side effect but the sine qua non of the mode of action (Peter Breggin, M.D., Toxic Psychiatry, p. 198). Thirdly, it has been opposed not only by mental patients who have undergone it but by a number of reputable psychiatrists and neurologists, above all Peter Breggin, John Friedberg, and Thomas Szasz. If it has not been opposed by more physicians, that may be because medical students who oppose and resist giving the treatment are systematically persecuted (Breggin, p. 211). To be sure, some patients who have undergone the treatment, such as Kitty Dukakis, swear by it. That is why I do not advocate banning it entirely. What is at issue is its involuntary administration, and administration to people who have not given informed consent.

What do Isaac and Armat have to say about ECT? First of all, the campaign against it "affects hundreds of thousands of lives". As, indeed did the Civil Rights Movement-- for the better. They admit that bilateral ECT, in which the current passes through both sides of the brain-- can lead to memory loss, but maintain that this can be reduced by passing the current only through one side (unilateral ECT-- p. 199). The problem with this is that the side that the current is passed through in unilateral ECT is the nondominant and nonverbal side, so that the patient may be unable to verbalize his or her suffering, conveying a false reassurance and confidence to the psychiatrist. Furthermore, damage to the nondominant side of the brain is similar to that of damage to the frontal lobes, so that unilateral ECT is more lobotomy-like (Breggin, pp. 209-210). I can't think of anything worse than having an affliction which one cannot verbalize! As the opinion of those who have actually experienced ECT matters most, it is important to note that those who oppose it oppose all forms of it. Likewise with the so-called "new ECT" which is administered to heavily sedated patients so that they do not appear to have a grand mal convulsion, again conveying a false reassurance to the administrators-- as Breggin says, this requires a higher voltage current and can thus do more damage. The authors seize upon the undeniable defects of the film version of One Flew Over the Cuckoo's Nest, which emphasizes the immediate effect of the old way of administering ECT, but the visceral reaction against the sight of MacMurphy in seizure has long since ceased to be an important element of the campaign against ECT. And as we shall see, Ken Kesey is not the only famous novelist who has shown how ECT can be used for coercive purposes. Citing the replacement of an anti-ECT law passed in California in 1974 in favor of one which was less restrictive, the authors maintain that it still had the disadvantage that it "discriminated" against those "too sick" to give informed consent (p. 202). Thus they introduce the very dangerous idea that there may be people "too sick" to exercise the rights of the citizen of a free society.

The implications of this are fully set forth in another chapter, "The Specter of Violence". While noting that most mentally ill patients are not violent, the authors maintain that "there is a segment of the mentally ill-- particularly when untreated-- at risk of committing violent acts against themselves or others, often both." And "The more the right to refuse treatment is recognized, even in hospital settings, the more such Bedlamite violence can be expected to occur." (p. 271) Thus the patients must be forced to endure procedures which the authors themselves admit can cause brain damage not only for their own good but for the good of society. They deny that mental illness is a civil liberties issue: "All the principles taken from criminal law are simply inapplicable when you're talking about a person who is ill and in need of medication." (p. p.282) How similar to our government's reasoning with respect to the treatment of terrorist suspects, who are similarly "committed" to prisons without hope of release! In fact, the forced administration of procedures such as ECT is a flaming violation of civil liberties, because when the rights of one citizen or one group of citizens are infringed, the rights of all are threatened. President Bush is calling for nation-wide screening for mental illness, and one can well imagine why. What will be taken as an indication of mental health-- support for the War in the Middle East? Support for the Administration? How we not learned enough from the way that psychiatry was misused to persecute political dissidents in the Soviet Union? ECT and anti-psychotic drugs-- especially the neuroleptics-- are among the most potentially dangerous weapons of political oppression, and as I have suggested, may already be being used against detainees in the so-called "War on Terror" to elicit false confessions.

Where ECT is concerned, you do not have to take my word for it. A much more convincing argument against it than One Flew Over the Cuckoo's Nest achieved Nest achieved immortality before Kesey's work was ever written. In George Orwell's 1984, when O'Brien is torturing the protagonist, Winston, he tells him, "You know perfectly well what is wrong with you. You have known it for years, though you fought against the knowledge. You are mentally deranged... fortunately [your illness] is curable. You have never cured yourself because you did not choose to... Shall I tell you why we have brought you here? To cure you! To make you sane! Will you understand, Winston, that no one whom we bring to this place ever leaves our hands uncured?" And then he proceeds to direct "the man in a white coat" to inflict upon Winston the ultimate weapon of totalitarians everywhere-- ECT. (p. 212, Signet edition, 265 in the Harcourt Brace Centennial edition).

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