Monday 19 February 2018

Psychiatry can be abused in pursuit of power

Adolf Hitler
Adolf Hitler

It is natural to assume that all doctors are trustworthy and act honourably for the good of their patients. Regrettably this trust is not always honoured, and there have been well documented cases of individual psychiatrists abusing their position, such as Pascual Javier Ramon Mora, who fabricated psychiatric risk in order to facilitate late-term abortions in Spain - he was recently imprisoned for same.

While these "rotten apple" cases do occur, even more terrifying is the collusion of the psychiatric profession with the state for political purposes.

Here I am not referring to "structural violence" such as inequality, discrimination, stigma and so on. I am instead referring to the role of psychiatrists in diagnosing and detaining individuals for the express purpose, not of treating them, but of obstructing their fundamental human rights.

One man who has studied these systemic abuses is Robert van Voren of the Human Rights in Mental Health Federation, based in the Netherlands. He has recently written about this in the February issue of BJPsych Bulletin, published by the Royal College of Psychiatrists.

He points out that this is usually used for political or religious dissenters and other "bothersome citizens" for expedience or for ideological reasons. In some instances these long-term detentions have been ordered by the courts and this is particularly true of totalitarian regimes.

The starting point is the belief that the person's ideas, political or religious convictions, are evidence of a troubled mind. Quoting President Khrushchev in 1959, he says: "A crime is a deviation from the generally recognised standards of behaviour frequently caused by mental disorders… To those who might start calling for opposition to Communism on this basis, we can say that… clearly the mental state of such people is not normal".

Thus opposing the regime that nearly everybody supposedly supported amounted to mental illness. A group of psychiatrists shared this view and became known as the Moscow School of Psychiatry headed by professor Andrei Snezhnevsky. The majority of Soviet psychiatrists were excluded from contact with international psychiatry and this view percolated unopposed through the profession.

This justified the forcible detention of these people whom they diagnosed with "sluggish schizophrenia". This has of course now ended with the fall of Communism.

Psychiatry's greatest shame was their collusion with the Nazis. A terrifying book The Nazi Doctors details their role in the killing of the mentally ill. This idea first surfaced in 1920 in a publication by Karl Binding, a lawyer, and Alfred Hoche, a psychiatrist. Entitled Permission for the Destruction of Life Unworthy of Life, it posed the question: "Is there human life which has so far forfeited the character of something entitled to enjoy the protection of the law, that its prolongation represents a perpetual loss of value, both for its bearer and for society as a whole".

This idea continued to be discussed in private by Nazi officials and after Hitler came to power the result was a memorandum on "the destruction of life unworthy of life".

Selected professors of psychiatry and asylum directors who were known to be sympathetic agreed that such a programme was necessary. A law on this was passed on September 1 1939 that allowed for the killing of a person with mental illness requiring permanent institutional care.

Psychiatrists identified the patients who were to be included in the 'Aktion T4' programme as it came to be known, and by mid-1940 over 70,000 psychiatric patients had been gassed.

After horrors such as this, is it possible that psychiatrists are still abusing their position? There is concern about activities in China where some "petitioners" as they are known, (people who frequently complain about local officials) are hospitalised and "treatment" is used as a threat. Members of the Falun Gong organisation have also been subject to repression and forced hospitalisation for their religious beliefs.

There is a lesson in the sorry tale of psychiatry's shameful role in human rights abuses. And it is this: no specialty has the right to decide who should live and who's life is unworthy of life. The activities of psychiatrists during this period are a horrifying example of how good practice can be perverted by the misuse of science for ideological reasons.

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