Academic journal article Ethical Human Psychology and Psychiatry

Human Rights Progress in Psychiatry: More Apparent Than Real (Observations and Reflections on Life in the Texas Mental Health Courts)

Academic journal article Ethical Human Psychology and Psychiatry

Human Rights Progress in Psychiatry: More Apparent Than Real (Observations and Reflections on Life in the Texas Mental Health Courts)

Article excerpt

The history of modern psychiatry includes a legacy of coercion and infamous physical and mechanical treatments, on the one hand, and progress in human rights, particularly patient rights, on the other. The purpose of this article is to remind readers that this modern progress in psychiatry is more apparent than real. The author's experience with recent cases in the mental health courts is discussed in order to demonstrate the ongoing abuse of human rights in psychiatry. A brief look at other aspects of the current mental health climate in the United States is also provided, along with considerations of informed consent.

Keywords: psychiatry; mental health; involuntary commitment; human rights abstract

Psychiatry has an infamous history of tragic judgments about "mental illness," and damaging, punitive treatments such as ice packs, fever therapies, tranquilizing chairs, insulin comas, and lobotomies. Terrible examples abound, from the "snake pits" of early-20th-century psychiatric asylums to the Soviet use of psychiatry to suppress dissidents. Scholarly evidence is abundant in historical works (e.g., Foucault, 1965), and Robert Whitaker's Mad in America (2002) is an excellent recent exposition of the history of the psychiatric treatment of mental illness.

The historical image of Philippe Pinel freeing the insane from their chains at the Salpêtrière in France stands as an icon of psychiatric progress in human rights. Americans can relate to freedom from bondage, and there are many other signs of apparent progress in psychiatric rights. The concept of informed consent has found a place in law, and there are laws regulating psychiatric commitment and treatment. Patient bills of rights and advocacy groups purporting to defend these rights are readily available. "Moral treatment" had its day in the history of the asylum, but it was eventually overwhelmed by issues of control and warehousing, and attendant inhumane treatment (Grob, 1973; Rothman, 1971). The purpose of this article is to point out to readers that modern progress in psychiatry is more apparent than real. Recent cases in the mental health courts are used to fulfill this purpose.

THE CASE OF SOHRAB HASSAN

Sohrab Hassan is a 31-year-old African-born American. I share his story below, previously reported elsewhere in greater detail (Breeding, 2006), and include personal thoughts and observations. For reasons of confidentiality, Hassan is a pseudonym, as are the names of his doctor and lawyer. Hassan migrated to the United States at age 21, obtained his degree in electrical engineering, and in 2000 took a job in the computer electronics industry with Motorola in Austin, Texas, where he worked for the next four years.

Up to age 30, Sohrab Hassan had no direct contact with psychiatry or with law enforcement. In September 2004, however, Sohrab was having difficulty, experiencing stress and dissatisfaction with the learning and advancement opportunities at Motorola. He was reeling from the recent deaths of two family members. He was having trouble sleeping, and a night of drinking beer and wine, from which he usually abstained, made matters worse. His brothers became concerned and they convinced Sohrab to admit himself to the state psychiatric hospital. They then connected him with a private psychiatrist, Dr. Patel, and Sohrab was transferred to a private hospital where he stayed for a week under Dr. Patel's care. Although the difficulties described above were more than sufficient to elicit and explain a temporary breakdown, the doctor attributed Sohrab's problems to the emergence of a serious mental illness.

Psychiatry today believes that problems in living are due to biologically or genetically based mental illness, requiring psychiatric drugs to keep them under control. This belief negates any model of psychological distress, implying that natural healing is impossible and irrelevant. Dr. Patel diagnosed Sohrab as having a psychotic disorder and began him on a drug regimen of the neuroleptic Risperdal, the mood stabilizer Depakote, and a sedative-hypnotic called Ambien. …

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