Chapter Two: Statement of the Problem

Anecdotally, people, who are users or survivors of psychiatry in New York State and beyond who protest the use of forced psychiatric treatment do not feel as though we are adequately represented in the planning, implementation, and evaluation of State-sponsored psychiatric policy, services, evaluation, or research, which I refer to as State-Sponsored Organized Psychiatric Industries (SSOPI).

Additionally, when someone who identifies as a user or survivor of psychiatry who opposes the forced use of psychiatry wins a seat at the policy-making tables of an SSOPI, affording us the opportunity to be present in the discussion about organized psychiatry’s public service delivery system, we do not consistently feel that we are listened to, or heard. Further, when we do feel that we have been listened to and heard, we rarely feel like adequate actions are taken by those in positions of power to resolve our spotlighted concerns. Ultimately, and too often, we do not feel that our participation leads to actionable plans or actual consequences of change in the current delivery system.

Further, without resources to support public education on murder, slavery, torture, and abuse or neglect carried out by SSOPI, which I spotlight and discuss later in this dissertation, there is no public space for which to reach people in society about our dilemma. We want to reach people to educate the masses on what everyday people ought to know about the public delivery system of State-sponsored organized psychiatry, which they may be subjected to and which through taxpayer expenditures, they fund. We also want to educate and reach open-minded individuals within SSOPI to change the system and abolish forced psychiatry.

The coordinating committee of a recent conference, of the International Network Toward Alternatives and Recovery, “Rethinking Psychiatric Crisis: Alternative Responses to ‘First Breaks,’” held at New York University on November 23, 2009, will serve as a good example of this problem. The coordinating committee, of which I was a member, being a survivor of psychiatry was the source of my expertise. The coordinating committee was made up of people who were in vastly different roles in the psychiatric system including psychiatrists, researchers, and advocates, as well as activists who identified as users or survivors of psychiatry.

I want to be clear that this conference was not the problem—in fact—this particular conference was a huge success in educating hundreds of professionals about alternatives to psychiatry.

However, for many of the people who identified as users or survivors of psychiatry who were on the coordinating committee, when we collectively reflected on the planning process, our reflections centered on the fact that we need to shed light on the absence of our true voice in systems change, and in this case, conference planning.

Collectively, and despite all of our efforts—we do not have a true voice in the planning processes of SSOPI or the State-Sponsored, Planned, Owned, Organized, Funded, and Evaluated Services (SSPOOFES) which they deliver. We know this because if we did have a true voice, what we have been saying for decades in the modern Movement for Human Rights in psychiatry: that there ought to be an abolition of forced psychiatric practices, procedures, and products and the mandate to psychiatric places—would be accomplished by now—human rights violations would end. We could move on with our lives and other desired work.

Perhaps, a worse scenario than not having any voice at the table of the SSOPI is when people are involved in a limited way that does not include leadership roles. Under this scenario, programs can be touted as meeting unfunded mandates of user or survivor involvement that many of New York’s publicly funded systems require, without actually ever acting on input offered by those in these roles (read: tokenization).

This required involvement of people who are users or survivors of psychiatry in an advisory capacity is not geographically limited to New York State. Required input into SSOPI from people with psychiatric histories exists at all levels of local, state, federal, and international governments. In many areas (nationally and internationally), law, regulation, policy, or more typically strongly suggested recommendations, seek to have involvement of people with psychiatric histories involved in the planning, implementation, and evaluation of state-sponsored public mental health systems. For more than a century—and actively in the last five decades—people who identify as having a psychiatric history advocated that we must be represented at the policy-making tables of State-sponsored psychiatry and its resulting State-Sponsored Organized Psychiatric Industries (SSOPI). Of course, SSOPI prefers people who use and want services to people who want to see services abolished. SSOPI, after all, is a machine.

At the policy-making table, tokenism is a consequence of this required representation of people who have psychiatric histories, particularly when the requirement is made as an unfunded mandate. Tokenism often leaves many of us who work for a Movement with the goal of ending forced psychiatry feeling a sense of embarrassment for being involved in the planning processes as representatives of our Movement and communities. This is always accompanied by a strong sense of knowing we let down our sisters and brothers with out inability to gain a better position for our Movement’s goals within the SSOPI plans. The embarrassment we experience when we are in positions of people who have psychiatric histories who work toward changing psychiatric systems occurs in a different way then the mortification (Goffman, 1961) described which is discussed in this dissertation. The embarrassment for not being able to adequately have movement goals accomplished at the policy table is different than the mortification we faced because of our personal experiences of being people in receipt of psychiatric servicing. This personal, not professional involvement with psychiatry often occurred over our expressed objection.

(de)VOICED is inspired not by rhetoric, but by the true meanings of phrases such as, “Nothing about me without me,” and “I am not a case and I don’t need to be managed.” These calls for involvement in SSOPI and personhood which ruled the Rights Movement of people who had psychiatric histories in the early 1990s and turn of the twenty-first century in New York State and elsewhere in the world, were routinely printed on buttons, T-shirts, and bumper stickers, as a way of trying to spread the word about psychiatric torture and abuse, and get people involved in the human rights movement by changing the SSOPI. To this day, these methods of message dissemination are still utilized and have expanded significantly with greater access to the Internet.

Over the last decade, many of us have more strongly urged the re-adoption of a Human Rights framework utilized through the 1960s to 1980s, in our advocacy and activism to change SSOPI. Sadly and problematically our activism often goes un-noticed by the general public because of a real challenge we have of reaching the mainstream media. Within the public spaces of our actions, such as public demonstrations at named locations or pushing lines at a policy-making table or public event, we are often silently observed by some of the more lenient members of SSOPI, and even some people in ‘peer’ roles working as outed people, in the psychiatric system, afraid to stand with us, or not entirely convinced themselves as the legitimacy of our claims, as we call for an end of State-sponsored murder, slavery, and torture. As a note, I do not use these words lightly and understand the weight they carry. Murder, slavery and torture of people involved with psychiatry are explored further in all three volumes of this dissertation. These are all major human rights violations committed by SSOPI, but certainly not the only human rights violations committed by SSOPI.

Without doubt, some individuals within SSOPI and some individuals who work in ‘peer’ roles genuinely support us as loudly as they can—without risking their own positions and roles in the State or other organizations—they, themselves, (de)VOICED. Particularly in light of the greater global economic crises we currently face, fear of the loss of one’s job security for speaking out against one’s employer is a substantial factor which motivates the inaction of some public employees from speaking out against structural abuses of psychiatry. Such structural abuses include the use of restraints or seclusion, electroshock or forced drugging, and involuntary involvement with any type of psychiatry, all of which are routinely committed with the sanctions of State power through organized psychiatry and SSOPI.

This situation of the silencing of employees—public servants—ought to be of great concern to academics, practitioners, policy makers, and most importantly, everyday people—citizens of the world—who rely on public servants to do the right thing. If and when employees feel a threat of job security for openly challenging mandates of job duties that they see as problematic, our society is in grave danger. Remember the argument of the Nazis who were ‘following orders’ (Milgram 1963, 1973, 1974, 1981) and the dangers blind obedience cause.

The voicing I am talking about, which we later show has caused problems for those working in ‘peer’ roles, is that of challenging the status quo of the practices, rules, regulations or laws of an organization, business or government. It is a real fear that one has of losing one’s position of employment because one takes a moral and ethical position against that of the employing entity. I understand and appreciate the situation that coerced silence creates. Having worked within the State, and being moved first, from the first position for someone as a Children’s Recipient Affairs Specialist in the Bureau of Recipient Affairs to a position which might seem as if it were elevated, but was actually a demotion, called a Statewide Project Director directly in the Bureau of Children and Families at the New York State Office of Mental Health (1999 – 2003), I can say with certainty that this threat of loss of job is a regular occurrence for State workers—regardless of their position or psychiatric history. Silence was a generally accepted state within the larger psychological environment of the place where psychiatric places, “total institutions” (Goffman, 1961), experienced their Total Administration. For people who work in SSOPI, regardless of psychiatric history, if they spoke out publicly against SSOPI, they “courted professional suicide” (Scull, 2005, p. 289). In my own experience, despite some allies, it was a hostile environment, which ultimately caused me to leave my position in the Bureau of Children and Families, in 2003.

I am not alone in this forced removal. Over the years many have been removed from positions inside of SSOPIs for attempting to educate those involved about what many survivors call the ‘truth of psychiatry” for “truth in psychiatry” (Andre, 2009). Some of us (not me, yet) have been jailed for it. If I were not a woman possessing white skin privilege, I do not know if I would have been jailed for my civil disobedience, but I believe it would have increased the possibility of that occurring.

But, why is the censorship of our message of human rights and voluntary participation with full informed consent and informed choice standard in the psychological environment of SSOPI?

Through my participation in the conference’s planning committee, I learned something important: It is not only people who identify as having a psychiatric history who are discriminated against for contesting the biomedical model of psychiatry. Even professionals who believe in and promote alternatives to the biomedical model of psychiatry have had to censor their message to varying degrees, if they are to be heard, as well. The discriminatory response toward a person who challenges the biomedical model of psychiatry may not only be rooted in having been assigned ‘diseased,’ but extend to any one who questions the medical model, deeming them, somehow, as needing to be assigned mad, as well. This ought to be studied as part of a follow-up of this current work.

A clear fault of this research, then, if the above is true, is limiting the silencing of people with psychiatric histories who speak out against the industry to a problem simply of the fact that we have been assigned ‘diseased.’ As my access to get closer to the center of policy-making, planning, evaluation and research tables has grown exponentially over the course of twenty years, I have been able to gain keen insights into the obstacles that professionals face in their attempts at maintaining their positions within SSOPI, and ability to effect policy, themselves, lest they are thought to be too radical, too controversial, too much of a risk to fund or employ.

Indeed, as I finalize this work, Robert Whitaker (2002, 2005, 2007, 2010), who I reference throughout this dissertation for his groundbreaking work Anatomy of an Epidemic, was invited by NAMI (National Alliance on Mental Illness) to speak at its national conference. NAMI. Among other things, NAMI supports electroshock (ECT) during pregnancy for women labeled with bipolar disorder.

When speaking out about psychiatry, Whitaker was accused of having “blood on his hands” for his message at the NAMI conference, that anti-psychotics may cause more damage than good, especially for what is called first-break episodes of schizophrenia in young people.

I sent a letter of support to Whitaker thanking him for his work and told him that I was planning on including what happened to him in this dissertation. Of course this is not the first time this has happened to Whitaker. In 2008, he was asked to speak at the Substance Abuse and Mental Health Services Administration (SAMHSA)-funded Alternatives Conference. After a backlash from the psychiatric industry, the invitation for Whitaker to speak at Alternatives was revoked. People involved in the Movement bombarded the Federal government with charges of censorship. In the end of that scenario, Whitaker was allowed to speak as long as a psychiatrist of SAMHSA’s choice was allowed an immediate rebuttal. I was not there, but Lester, a Study Coordinator of (de)VOICED was. Lester reported that it was a scene, as I am sure, reader, you could imagine.

In my communication with Whitaker (28 July 2013) I offered him an opportunity to sound off about this in the form of a quote for this dissertation. He responded stating:

It is about silencing voices, and who knows this better than those who have—as you say—a ‘psychiatric history.’ That is how this power has been maintained, by silencing people. Actually, I think one of the reasons for the NAMI furor and saying I have blood on my hands is that Mad in America’s website is giving voice to this disenfranchised group, experiences, etc. It’s not just about silencing me, it’s about silencing a larger voice. (E-mail communication from Robert Whitaker, 28 July 2013)

This phenomenon of being cast out of the field of Psychology for making challenges to the structural system has been discussed to some degree in my previous work (Tenney, 2000, 2006, 2007, 2008; Tenney and MacCubbin, 2008), which led to this current work. In “Psychiatric Slave No More: Parallels to a Black Liberation Psychology” (2008a), I wrote about how Phyllis Chesler, who is an Emerita Professor of Psychology at the College of Staten Island, CUNY and has worked at multiple universities in psychology and Women’s Studies was rejected by the American Psychological Association in her claims that women suffered abuse while involved with psychiatry. Chesler is the author, among other works, of Women and Madness (1972). She bravely points to this cast-out in the preface of Women of the Asylum (Geller and Harris, 2004). I wrote:

Phyllis Chesler, in the forward to this compilation, described how she called for reparations of one million dollars at the American Psychological Association’s annual conference in 1970 on behalf of the Association for Women in Psychology, citing abuses women have been subjected to at the hands of the system and their use as ‘slave labor in state mental asylums’ and was not only unsupported but deemed ‘crazy’ suffering from ‘penis envy’ (p. xvi). (Tenney, 2008a)

Calls are being advanced for reparations for those who have experienced torture at the hands of the psychiatric industry. However, these calls are no longer limited to survivors of psychiatry, and include people like Juan Mendéz, the United Nations Special Rapporteur on the Convention Against Torture (CHRSUP, 2013; Mendéz Statement, 2013; United Nations Human Rights Council, 2013). Reparations, now, are more than theoretically attainable.

Despite this major advance, (Mendéz Statement, 2013), and even for people in the roles of researchers and psychiatrists who agree with the importance of SSOPI adopting a Human Rights framework, willingness to push back against or change conventional thinking is limited to language that is not considered radical . . . Throughout this dissertation, I often use the term written as if to remove its silent p, and have the resulting phonetic as “(p)Harmaceutical” or “(p)Harma” to indicate the harm that can come from the industry’s priority for profit over humanity. Issues of “bad science” which is detailed in various ways in the books mentioned above also can be found in Whitaker’s (2002) Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill and a host of other resources which will be utilized extensively in my future work.

In my lived work experience, people in ‘professional roles’ I was working with, often deterred my ability to make outright assaults on the medical model, (p)Harmaceutical industry, and/or The State. It was consistently made clear to me that any assault on SSOPI would not be tolerated, and my ability to sit at the SSOPI tables would be rescinded. Instead, there must be no perceived disapproval of The State to attack a specific policy, law, regulation, entity, or people. For example, receiving calls from people working inside the State, asking me to publicly protest pending legislation that would be damaging to their current efforts and any organizing efforts to accomplish such a protest would not jeopardize employment or funding for participation.

Further, I was expected to understand that even if the assault has perceived approval from The State, in terms of participants not being sanctioned for their involvement, there also needs to be reasonable assurances that the assault will not damage perspective funding of the particular effort at issue—or any future undertaking, policy, or funding. I was to know that this collateral damage to potential funding I was supposed to avoid in any organizing activities I engaged in, would include a resulting low attendance at a conference, or withdrawal of the participation of people whose worldview is limited to the medical model of biopsychiatry, or people who are merely skeptical of the ideas of recovery and/or alternatives to the medical model. The loss of attendance of these people as potential conference attendees, if so turned-off by the messages of human rights and an end to forced treatment, if it were allowed to be spotlighted by the conference, the decision-makers of the conference planning committee feared, would result in the amount of people who financially supported the conference through their attendance. The collateral damage I was to avoid creating by any organizing I did, would also routinely include concerns about loss of potential funding of projects, that potentially, may exist at some un-named future date.

This was all informal knowledge I was expected to possess. A common unwritten rule I constantly violated was, ‘in the building you can say anything, outside of the building, no disagreement with our plans.’ This statement was reiterated almost verbatim by one of the people who participated in (de)VOICED. For now, though, this insight might help us to understand why survivors of psychiatry do not feel adequately represented or listened to, when we are outside the House we are to agree with the Master. It took me a long time to understand that part of the reason those I was working with insisted on silencing me was that to a large degree, their freedom of speech was limited, as well.

If we can position the work of people who identify as having psychiatric histories along-side the realities that ‘authorities’ such as psychiatrists, researchers, and medical journalists are unable to loudly voice what they know to be true—maybe we can begin to gain insight into why those people who identify as users or survivors of psychiatry struggle making our voices heard. The problem remains that as people who identify as having a psychiatric history, we are not afforded the physical and psychological environments in which to create educational experiences that reflect what we find important.

Many of my suggestions for educational topics at this, again, really fabulous conference, such as “human rights” and “stop forced treatment”—even “stop calling 9-1-1”—were thought of as too controversial by people who were in Assignor roles (those with the final decision-making power) to promote as foci for the conference, even if they agreed, in principle, that these things ought to be the foci. But, other Psychiatric Assignors had to be won in, to take part in the conference, in part, because their admission fees would largely be funding the effort. The sentiments I offered were loosely tied onto the conference as an afterthought or buried deep within the programming.

The problem of the tensions that are felt by people who identify as survivors of psychiatry, who for decades have been working to have our voices heard and privileged, are real and need to be released. People who identify as survivors of psychiatry do not have a clear and distinct voice in New York State SSOPI. This is a problem that has at least two known causes. The third cause of the tension, I will discuss after I address some basic terminology.

First, no two people with psychiatric histories want to see exactly the same things happen within the current practices of psychiatry—and that causes internal problems when attempting to offer alternatives to forced psychiatric treatment.

Second, even when survivors of psychiatry agree amongst ourselves on what we want to see happen—or more often, stop happening—e.g., stopping forced treatment—we have deep differences in how to go about bringing the changes we want. Consequently, collective groups of individuals have historically parted ways and efforts over strategies and tactics, which has limited our collective power. Of course, many of us believe that working with people who are willing to compromise, wordsmith, or bargain, because they do not want to appear as if they ‘lost.’ is what really eliminates our power.

References

Center for Human Rights of Users and Survivors of Psychiatry (CHRUSP). (2013). A time to act. Special Rapporteur on Torture Calls for an Absolute Ban on Forced Psychiatric  Interventions. Website. Retrieved on July 27, 2013 from https://dk-media.s3.amazonaws.com/AA/AG/chrusp biz/downloads/281251/A_Time_to_Act.pdf.

Chesler, P. (1972). Women and madness. Garden City, NY: Doubleday.

Chesler, P. (1994). Introduction to Women of the Asylum: Voices from behind the walls, 1840 – 1945. In Geller, J. L. and Harris, M. (ed.), Women of the asylum: Voices from behind the walls, 1840 – 1945. New York, NY: Doubleday.

Geller, J., and Harris, M. (1994). Women of the asylum: Voices from  behind the walls, 1840 – 1945. New York: Doubleday.

Goffman, E. (1961). Asylums: Essays on the social situations of mental patients and other inmates. New York: Doubleday.

Mendéz. J. E. (2013). Statement by Mr. Juan E Mendéz, Special Rapporteur on Torture and Other cruel, inhuman or degrading treatment or punishment. 22nd session of the  Human Right Council, Agenda item 3. Geneva. Retrieved on February 14, 2013  from https://dk-media.s3.amazonaws.com/AA/AG/chruspbiz/downloads/277461/torture_english.pdf.

Milgram, S. (1981). This week’s citation classic. Citation Classics, 5, 114.

Milgram, S. (1974). Obedience to authority: An experimental view. New York: Harper and Row.

Milgram, S. (1973). Perils of obedience. Harper’s Magazine, 247, 62-77, December 6.

Milgram, S. (1963). Behavioral study of obedience. Journal of Abnormal Social Psychology. 67: 371-378.

Scull, A. (2005). Madhouse: A tragic tale of megalomania and modern medicine. New Haven, CT: Yale University Press.

Tenney, L. (2012). Boycott normal: APA protest. Video. Retrieved on February 21, 2014  from http://www.youtube.com/watch?v=WFWo_NESuQk.

Tenney, L. (2008). Psychiatric Slave No More: Parallels to a Black Liberation Psychology, Journal of Radical Psychology. Retrieved April 21, 2014 from http://www.radicalpsychology.org/vol7-1/tenney2008.html.

Tenney, L. (2007). 10e Autobio. Video. Retrieved on February 21, 2014 from  http://www.youtube.com/watch?v=CINNEf8V4lY.

Tenney, L. (2006). Who fancies to have a Revolution here? The Opal Revisited (1851- 1860).Journal of Radial Psychology, 5. Retrieved October 14, 2008, from http://www.radpsynet.org/journal/vol5/Tenney.html.

Tenney, L. (2000). It has to be about choice. Journal of Clinical Psychology, 56(11), pp. 1433-1445.

Tenney, L. and MacCubbin, P. (2008). When no one was watching: Human subject protections and videotaping, Take 1. In Downing, M. and Tenney, L. (Eds.). (2008). Video Vision: Changing the culture of social science research. UK: Cambridge Scholars Publishing. (pp. 14-79).

United Nations Human Rights Council (2013). Report of the Special Rapporteur on  torture and other cruel, inhuman or degrading treatment or punishment, 1 February 2013, A/HRC/22/53. Retrieved on February 14, 2014 from http://www.refworld.org/docid/51136ae62.html.

Whitaker (28 July 2013). Personal e-mail communication.

Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Crown Publishers.

Whitaker, R. (2007). Affidavit of Robert Whitaker. State of Massachusetts, Suffolk County. Retrieved on February 16, 2014 from  http://psychrights.org/litigation/WhitakerAffidavit.pdf.

Whitaker, R. (2005). Anatomy of an epidemic: Psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry. 7(1), 23-35. Retrieved on July 27, 2013 from http://freedom-center.org/pdf/anatomy_of_epidemic_whitaker_psych_drugs.pdf.

Whitaker, R. (2004). The case against anti-psychotic drugs: a 50-year history of doing  more harm than good. Medical Hypotheses, 62, 5-13.

Whitaker, R. (2002). Mad in America: bad science, bad medicine and the enduring  treatment of the mentally ill. Cambridge, MA: Perseus Books.