1 00:00:00,000 --> 00:00:14,000 What does it mean to be called crazy in a crazy world? 2 00:00:14,000 --> 00:00:29,520 Listen to Madness Radio, voices and visions from outside mental health. 3 00:00:29,520 --> 00:00:31,040 Welcome to Madness Radio. 4 00:00:31,040 --> 00:00:33,840 Today my guest is Tina Minkowitz. 5 00:00:33,840 --> 00:00:39,400 Tina is a survivor of psychiatric institutionalization and a human rights lawyer. 6 00:00:39,400 --> 00:00:44,400 She was a leading contributor to the drafting and negotiation of the United Nations Convention 7 00:00:44,400 --> 00:00:47,040 on the Rights of Persons with Disabilities. 8 00:00:47,040 --> 00:00:52,120 Tina is the founder and president of the Center for the Human Rights of Users and Survivors 9 00:00:52,120 --> 00:00:59,480 of Psychiatry and she is the author of Reimagining Crisis Support, Matrix, Roadmap and Policy. 10 00:00:59,480 --> 00:01:02,480 Welcome to Madness Radio, Tina Minkowitz. 11 00:01:02,480 --> 00:01:04,120 Thank you so much Bill. 12 00:01:04,120 --> 00:01:05,600 It's good to be here. 13 00:01:05,600 --> 00:01:12,680 Yeah, we've known each other for gosh more than maybe 15 years and in the world of survivor 14 00:01:12,680 --> 00:01:17,960 activism and human rights work, you are one of the most important leaders and you've 15 00:01:17,960 --> 00:01:23,480 done an incredible, incredible life's work and continue to do work in bringing this issue 16 00:01:23,480 --> 00:01:30,240 forward on a global stage around forced treatment, psychiatric violence, disability rights, psychiatric 17 00:01:30,240 --> 00:01:35,040 patients, people with a diagnosis in the context of disability rights and international 18 00:01:35,040 --> 00:01:36,040 law and human rights. 19 00:01:36,040 --> 00:01:40,800 So I just want to really thank you for the work that you do and have done and continue to 20 00:01:40,800 --> 00:01:43,880 do and tell you what an honor it is to have you on the show. 21 00:01:43,880 --> 00:01:46,040 So welcome to Madness Radio. 22 00:01:46,040 --> 00:01:47,040 Thank you so much. 23 00:01:47,040 --> 00:01:48,600 I appreciate that. 24 00:01:48,600 --> 00:01:54,160 So for people who don't know your work or even why is this even an issue, why do we even 25 00:01:54,160 --> 00:02:02,120 need to have psychiatric mental health as part of a United Nations International Law Convention? 26 00:02:02,120 --> 00:02:07,600 Like what's the scope of this issue for people who don't really understand how severely 27 00:02:07,600 --> 00:02:13,720 violated our basic human rights are on a very casual basis by psychiatry. 28 00:02:13,720 --> 00:02:20,960 Before this convention that I worked on, which I will abbreviate is the CRPD. 29 00:02:20,960 --> 00:02:29,440 So before the CRPD, the standard in the United Nations about forced psychiatry was pretty 30 00:02:29,440 --> 00:02:36,640 much the same as what we're familiar with in state mental health law. 31 00:02:36,640 --> 00:02:42,280 It was that you had to have standards, you had to have procedural so-called safeguards 32 00:02:42,280 --> 00:02:48,720 like that the person should be deemed a danger to themselves or others in order to be locked 33 00:02:48,720 --> 00:02:49,720 up. 34 00:02:49,720 --> 00:02:56,880 You know, they had to have capacity to make a decision in order to refuse treatment that 35 00:02:56,880 --> 00:03:01,680 they don't want and other things like that. 36 00:03:01,680 --> 00:03:08,640 And it was very clear to me and really to the movement, I think, that that just wasn't 37 00:03:08,640 --> 00:03:09,640 working. 38 00:03:09,640 --> 00:03:16,080 You know, like we always had an abolitionist aim. 39 00:03:16,080 --> 00:03:24,240 I know I go back to the principles of the 10th International Conference on Human Rights 40 00:03:24,240 --> 00:03:26,640 and Against Psychiatric Depression. 41 00:03:26,640 --> 00:03:27,640 Right on. 42 00:03:27,640 --> 00:03:32,040 I was just rereading that in Madness Network News a few days ago and I think that those principles 43 00:03:32,040 --> 00:03:34,760 absolutely still hold today. 44 00:03:34,760 --> 00:03:43,720 Exactly. So coming from the movement, you know, we always wanted total abolition of involuntary 45 00:03:43,720 --> 00:03:47,200 commitment and involuntary treatment. 46 00:03:47,200 --> 00:03:55,440 And shortly before I started working on the convention or a few couple of years before, 47 00:03:55,440 --> 00:04:03,640 in the year 2000, I don't know if you remember, but the US National Council on Disability issued 48 00:04:03,640 --> 00:04:07,760 a report called from privileges to rights. 49 00:04:07,760 --> 00:04:08,760 I remember that. 50 00:04:08,760 --> 00:04:12,920 I think Judy Chamberlain was one of the people involved with that and we got a hold of those 51 00:04:12,920 --> 00:04:17,760 at Freedom Center and we were so excited by at least it sounded a little bit like it 52 00:04:17,760 --> 00:04:21,960 was starting to validate our point of view that we got a bunch of copies and we were sharing 53 00:04:21,960 --> 00:04:24,920 it around because here we had some backup. 54 00:04:24,920 --> 00:04:29,320 We were connecting with the larger movement and all this testimony and this perspective. 55 00:04:29,320 --> 00:04:31,720 So I do, I remember that from 2000. 56 00:04:31,720 --> 00:04:40,200 Exactly. And, you know, from my perspective, it was the first document that I know of ever 57 00:04:40,200 --> 00:04:47,720 issued by a governmental agency, even though the National Council on Disability is only an advisory 58 00:04:47,720 --> 00:04:51,800 body, it was still a government body. 59 00:04:51,800 --> 00:04:58,760 And it said that policy should move in the direction of a totally voluntary mental health system. 60 00:04:58,760 --> 00:04:59,760 Yes. 61 00:04:59,760 --> 00:05:00,760 Yes. 62 00:05:00,760 --> 00:05:06,120 That was one of the things that was inspiring me at that time. 63 00:05:06,120 --> 00:05:07,920 I'm just, I'll link to that. 64 00:05:07,920 --> 00:05:11,040 We have a copy of that report on the Freedom Center website. 65 00:05:11,040 --> 00:05:12,120 We've had it for many, many years. 66 00:05:12,120 --> 00:05:13,800 I'll link to that. 67 00:05:13,800 --> 00:05:20,960 So making connections with the Disability Rights Movement with something that Judy Chamberlain 68 00:05:20,960 --> 00:05:29,480 and Ray Ansiker were particularly leading on in this country, internationally, Mary O'Hagen 69 00:05:29,480 --> 00:05:38,440 in New Zealand and many other people in Europe and I think in Latin America were also pursuing 70 00:05:38,440 --> 00:05:41,280 the same approach. 71 00:05:41,280 --> 00:05:45,200 And I think that was a really brilliant move. 72 00:05:45,200 --> 00:05:56,960 I came to understand the disability, non-discrimination framework as very important to articulating 73 00:05:56,960 --> 00:06:02,840 why we need to abolish forced treatment. 74 00:06:02,840 --> 00:06:07,280 Tell us more about that because I think that is the crucial piece, the non-discrimination 75 00:06:07,280 --> 00:06:12,040 because once you start discriminating rights, you start to say that they're second-class 76 00:06:12,040 --> 00:06:13,040 citizens. 77 00:06:13,040 --> 00:06:18,200 And that is the intuitive framework that I think people get if they see it explained in 78 00:06:18,200 --> 00:06:19,200 that way. 79 00:06:19,200 --> 00:06:20,200 So tell us a little bit more about that. 80 00:06:20,200 --> 00:06:22,400 I started to think about this. 81 00:06:22,400 --> 00:06:30,560 How to bring forward the core psychiatric survivor concerns in disability rights language. 82 00:06:30,560 --> 00:06:37,600 Because we don't have to translate into reasonable accommodation unless that's what we want. 83 00:06:37,600 --> 00:06:47,240 What we have to do is articulate our issues as core disability rights issues right alongside 84 00:06:47,240 --> 00:06:50,840 sign language ramps accessibility. 85 00:06:50,840 --> 00:06:51,840 Exactly. 86 00:06:51,840 --> 00:07:02,000 I was in law school and I was studying disability law and I was studying international human rights 87 00:07:02,000 --> 00:07:03,000 law. 88 00:07:03,000 --> 00:07:09,600 I had known of this document but I was researching the origins of it. 89 00:07:09,600 --> 00:07:18,640 A document in the UN called the principles for the protection of or principles on the protection 90 00:07:18,640 --> 00:07:23,800 of persons with mental illness and for the promotion of mental health care. 91 00:07:23,800 --> 00:07:30,880 Totally medical model document, totally about when they can do for a treatment as a list 92 00:07:30,880 --> 00:07:35,520 of millions of exceptions to the principle of uniform consent. 93 00:07:35,520 --> 00:07:39,480 The loophole that everything all the violence goes right through. 94 00:07:39,480 --> 00:07:40,480 Exactly. 95 00:07:40,480 --> 00:07:51,200 So I was inspired then in a class by a feminist professor named Drondik Copeland who was applying 96 00:07:51,200 --> 00:08:00,240 the principle of non-discrimination to the human rights framework to make visible core 97 00:08:00,240 --> 00:08:09,400 issues of the oppression of women that had not been made visible enough. 98 00:08:09,400 --> 00:08:16,600 In particular, work crime rape and sexual slavery, that was a project that I was working on 99 00:08:16,600 --> 00:08:19,520 with Ronda and some of the students. 100 00:08:19,520 --> 00:08:28,000 So I was thinking about how to do something similar for the core issues of psychiatric oppression, 101 00:08:28,000 --> 00:08:34,880 which I consider to be involuntary commitment and involuntary treatment. 102 00:08:34,880 --> 00:08:39,800 And kind of related to those, there's a whole host of issues. 103 00:08:39,800 --> 00:08:49,560 There's the economic issues, the way people are kept in situations of oppression by not 104 00:08:49,560 --> 00:08:55,560 having enough money, the discrimination in getting a job because you don't have the complete 105 00:08:55,560 --> 00:08:58,240 work history and all of that. 106 00:08:58,240 --> 00:09:04,080 And the way mental health housing works that it's kind of right there for people when 107 00:09:04,080 --> 00:09:11,800 the housing so-called market is excluding them in many ways. 108 00:09:11,800 --> 00:09:20,600 But the core issues of involuntary commitment and involuntary treatment, what came to me 109 00:09:20,600 --> 00:09:29,080 as how to frame that in terms of disability non-discrimination, involuntary commitment 110 00:09:29,080 --> 00:09:34,960 is a deprivation of liberty based on disability and it's discriminatory. 111 00:09:34,960 --> 00:09:38,280 It always is because- >> Always, that's right. 112 00:09:38,280 --> 00:09:44,840 >> The core, you can't have involuntary psychiatric commitment without a psychiatric diagnosis. 113 00:09:44,840 --> 00:09:46,000 >> Exactly. 114 00:09:46,000 --> 00:09:51,120 The fact that it's based on the diagnosis sets up this second-class citizenship. 115 00:09:51,120 --> 00:09:56,960 And basically it insurines discrimination and violation of civil rights into illegal 116 00:09:56,960 --> 00:10:01,800 framework, which we already know that we just have to get rid of for the case of women, 117 00:10:01,800 --> 00:10:05,480 for the case of people of color, for all these other categories. 118 00:10:05,480 --> 00:10:10,920 But we haven't quite realized it or seen it clearly enough around psychiatry because 119 00:10:10,920 --> 00:10:13,840 that's exactly what force treatment is based on. 120 00:10:13,840 --> 00:10:19,420 It's a legal support for the use of violence against people that fundamentally hinges on 121 00:10:19,420 --> 00:10:23,240 discriminating them as different because of their disability. 122 00:10:23,240 --> 00:10:24,240 >> Exactly. 123 00:10:24,240 --> 00:10:27,920 >> Which is why there has to be an abolitionist stand. 124 00:10:27,920 --> 00:10:32,880 It's like you can't say, well, we're discriminating against women because we need to, because we 125 00:10:32,880 --> 00:10:38,920 don't really want to put the money into doing this or like, no, you have to start from a position 126 00:10:38,920 --> 00:10:44,440 of the legal basis of discriminating by these categories is wrong. 127 00:10:44,440 --> 00:10:46,280 You have to have an abolitionist stand. 128 00:10:46,280 --> 00:10:51,560 And I think people intuitively have that until they get confused by the medical language, 129 00:10:51,560 --> 00:10:56,800 the disease model, sort of like the idea that force treatment is framed as benevolence. 130 00:10:56,800 --> 00:11:01,240 It's considered a service and it's access to service and all these things. 131 00:11:01,240 --> 00:11:01,920 >> Exactly. 132 00:11:01,920 --> 00:11:09,280 And I think that's why the disability, non-discrimination framework is important. 133 00:11:09,280 --> 00:11:10,280 >> Exactly. 134 00:11:10,280 --> 00:11:15,680 >> Like, we had always struggled with how to articulate our identity. 135 00:11:15,680 --> 00:11:18,880 And I mean, we didn't really struggle with it. 136 00:11:18,880 --> 00:11:24,560 We knew, we were survivors of psychiatric oppression and all of that. 137 00:11:24,560 --> 00:11:32,400 But that wasn't in itself an identity that you could say, I'm being discriminated against 138 00:11:32,400 --> 00:11:34,920 why, because you're a press. 139 00:11:34,920 --> 00:11:46,600 So to actually be able to understand madness as disability, I think was a genius of Judy 140 00:11:46,600 --> 00:11:54,080 and the others who really connected us with that movement that I think is really justified. 141 00:11:54,080 --> 00:11:59,400 And I've gone, like, this is something that we sometimes get a lot of questions about. 142 00:11:59,400 --> 00:12:03,200 >> Yeah, it can be controversial in some understandings, yes. 143 00:12:03,200 --> 00:12:06,480 >> And I'll say what I think about it. 144 00:12:06,480 --> 00:12:14,280 Number one, I take seriously the ADA Americans with Disabilities Act definition of disability 145 00:12:14,280 --> 00:12:20,560 that includes if you are regarded by the person who's discriminating against you. 146 00:12:20,560 --> 00:12:21,560 >> Exactly. 147 00:12:21,560 --> 00:12:23,080 If you're perceived as being disabled. 148 00:12:23,080 --> 00:12:24,080 >> Exactly. 149 00:12:24,080 --> 00:12:25,080 >> Exactly. 150 00:12:25,080 --> 00:12:30,080 So you may not embrace that identity yourself, but still the perception is the grounds for, 151 00:12:30,080 --> 00:12:36,080 because some people have a problem with the disability framework because they say, I'm 152 00:12:36,080 --> 00:12:37,960 not crazy, the world is crazy. 153 00:12:37,960 --> 00:12:39,560 Nothing's wrong with me. 154 00:12:39,560 --> 00:12:40,560 It's the world. 155 00:12:40,560 --> 00:12:46,280 You can have it both ways because it's about you're still being perceived as having a problem. 156 00:12:46,280 --> 00:12:51,640 So you have a right to non-discrimination on the basis of your perception of being 157 00:12:51,640 --> 00:12:52,960 disabled and being different. 158 00:12:52,960 --> 00:12:54,320 How they treat you, exactly. 159 00:12:54,320 --> 00:12:55,320 >> Exactly. 160 00:12:55,320 --> 00:13:01,840 Because discrimination, it can even in some situations work that way. 161 00:13:01,840 --> 00:13:05,200 Like let's say anti-gay discrimination. 162 00:13:05,200 --> 00:13:12,160 If a person is not gay but somebody perceives them as gay and beats them up because of it, 163 00:13:12,160 --> 00:13:16,400 they're still entitled to redress for that. 164 00:13:16,400 --> 00:13:20,440 And it would still have been an act of homophobic violence. 165 00:13:20,440 --> 00:13:27,120 And it's a little bit different because those of us who have been abused, oppressed, 166 00:13:27,120 --> 00:13:32,200 violated by psychiatry, we have an identity as a movement. 167 00:13:32,200 --> 00:13:36,520 So it's not just like, well, you're mistakenly perceived as something. 168 00:13:36,520 --> 00:13:41,800 >> The identity as a movement is itself contentious because some people identify as survivors. 169 00:13:41,800 --> 00:13:43,440 Some people identify as consumers. 170 00:13:43,440 --> 00:13:45,200 Some people identify as peers. 171 00:13:45,200 --> 00:13:47,840 People identify as being in recovery. 172 00:13:47,840 --> 00:13:54,160 And there are many people who have been severely oppressed by psychiatry who've never actually 173 00:13:54,160 --> 00:13:59,920 even received a diagnosis or been in the hospital because of their fear of going into that 174 00:13:59,920 --> 00:14:04,640 role and being caught by these sort of, these sort of, never, never been caught people. 175 00:14:04,640 --> 00:14:08,920 So I think that this is really important in conversation because we all can absolutely 176 00:14:08,920 --> 00:14:14,560 unite around the disability, justice, non-discrimination principle. 177 00:14:14,560 --> 00:14:20,240 We can all take an abolitionist stance, even if we have very different understandings of 178 00:14:20,240 --> 00:14:22,120 our own experience. 179 00:14:22,120 --> 00:14:26,720 Because regardless of our understanding and our self identification, the oppression and 180 00:14:26,720 --> 00:14:31,880 the discrimination based on othering as you are disabled, you are different, that still 181 00:14:31,880 --> 00:14:32,880 is there. 182 00:14:32,880 --> 00:14:33,880 >> Exactly. 183 00:14:33,880 --> 00:14:39,600 And I really do think the disability justice abolitionist overall framework is really 184 00:14:39,600 --> 00:14:40,600 helpful. 185 00:14:40,600 --> 00:14:44,160 It's a really helpful development in our movement. 186 00:14:44,160 --> 00:14:49,760 Because that was the piece about the involuntary commitment. 187 00:14:49,760 --> 00:14:54,240 Involuntary treatment also has to be dealt with. 188 00:14:54,240 --> 00:15:02,840 To me, involuntary so-called treatment for a struggling, non-consensual drugging was the 189 00:15:02,840 --> 00:15:07,280 worst violation which I experienced as torture. 190 00:15:07,280 --> 00:15:12,800 >> I experienced as torture to us kidnapping, assault, torture and an attempt to kill me. 191 00:15:12,800 --> 00:15:14,200 It was a murderous attempt. 192 00:15:14,200 --> 00:15:21,120 It was a murderous, and for so many people, and the chemical destruction of your mind is 193 00:15:21,120 --> 00:15:24,600 perhaps even worse than death for some people. 194 00:15:24,600 --> 00:15:26,800 It's a horrific act of violence. 195 00:15:26,800 --> 00:15:28,600 It absolutely is torture. 196 00:15:28,600 --> 00:15:32,800 That's something I wanted to ask you about is how that word and that definition has actually 197 00:15:32,800 --> 00:15:35,600 risen to United Nations recognition. 198 00:15:35,600 --> 00:15:38,400 We might want to go into that a little bit later or maybe you want to say something about 199 00:15:38,400 --> 00:15:39,400 it now. 200 00:15:39,400 --> 00:15:45,720 >> That was actually one of the pieces that I had in my initial way of thinking that forced 201 00:15:45,720 --> 00:15:50,880 psychiatric interventions should be recognized as torture. 202 00:15:50,880 --> 00:15:57,880 And the other piece of it that ended up coming to be important was something that hadn't 203 00:15:57,880 --> 00:16:04,600 been on my radar, which is the whole issue of legal capacity. 204 00:16:04,600 --> 00:16:11,840 So I had thought of legal capacity as related mostly to guardianship. 205 00:16:11,840 --> 00:16:18,560 And nobody I knew in this survivor movement was under guardianship or had been put under guardianship. 206 00:16:18,560 --> 00:16:25,680 And I think that in the US or at least in some of the states in the US, guardianship requires 207 00:16:25,680 --> 00:16:28,360 a lot of legal procedure. 208 00:16:28,360 --> 00:16:37,720 It's not something that's as common at least for people with the psych diagnosis as the 209 00:16:37,720 --> 00:16:40,120 being put into the psych system. 210 00:16:40,120 --> 00:16:46,600 But I also think that the people who are under guardianship are simply the most oppressed 211 00:16:46,600 --> 00:16:51,600 of our survivor community and don't get access to it. 212 00:16:51,600 --> 00:16:52,600 >> That's right. 213 00:16:52,600 --> 00:16:57,000 It's like the last resort of force by the system. 214 00:16:57,000 --> 00:17:01,600 They're depriving you of your liver either forcing you into care, they're forcing you into 215 00:17:01,600 --> 00:17:02,600 treatment. 216 00:17:02,600 --> 00:17:06,760 And then you cycle because your needs aren't being addressed, the issue isn't being addressed. 217 00:17:06,760 --> 00:17:10,520 Then you cycle in and out of the system and they escalate, escalate, escalate. 218 00:17:10,520 --> 00:17:13,640 And then finally they just say we're going to strip you of all your legal rights. 219 00:17:13,640 --> 00:17:18,520 We're going to substitute your judgment as if you had brain damage or as if you were a 220 00:17:18,520 --> 00:17:22,120 child or an elder who had lost their capacity. 221 00:17:22,120 --> 00:17:28,560 And it's a way of exerting the maximal control against someone when other interventions have 222 00:17:28,560 --> 00:17:30,400 failed to control the person. 223 00:17:30,400 --> 00:17:31,400 >> Right. 224 00:17:31,400 --> 00:17:37,640 So that hadn't been on my personal radar, but it was brought up by other people in the world 225 00:17:37,640 --> 00:17:43,360 network of uses and survivors of psychiatry. 226 00:17:43,360 --> 00:17:49,560 And their countries had had a lot more extensive use of guardianship against people with a psych 227 00:17:49,560 --> 00:17:51,840 diagnosis. 228 00:17:51,840 --> 00:17:59,640 And what I actually realized that we had to bring in, you can't really totally sidestep 229 00:17:59,640 --> 00:18:04,320 the issue of capacity in abolishing force treatment. 230 00:18:04,320 --> 00:18:08,920 Of course, yeah, just like you can't sidestep the issue of people's impairments, physical 231 00:18:08,920 --> 00:18:12,280 impairments, and other disabilities that we're talking about. 232 00:18:12,280 --> 00:18:18,160 These are real, it's not just about the kind of civil liberties of removing oppression. 233 00:18:18,160 --> 00:18:23,600 There also has to be a change that takes place in the social response to accommodate someone 234 00:18:23,600 --> 00:18:28,800 and meet their needs in a different way without force, without violating, without discriminating. 235 00:18:28,800 --> 00:18:33,120 That's part of it. 236 00:18:33,120 --> 00:18:38,800 The way I approached it was more that when they have a legal standard of saying you have 237 00:18:38,800 --> 00:18:47,760 to have the capacity to make a decision in order for your refusal of psychiatric drugs to 238 00:18:47,760 --> 00:18:52,680 be respected, it's a problem in the legal framework. 239 00:18:52,680 --> 00:18:55,800 It's something that perpetuates force treatment. 240 00:18:55,800 --> 00:18:58,120 Completely, it's a self rationalization. 241 00:18:58,120 --> 00:19:03,480 It's like a close logic loop there, it's just a complete totology that's used to people. 242 00:19:03,480 --> 00:19:07,920 Well, if you have capacity, you agree with us, and if you don't agree with us, well, 243 00:19:07,920 --> 00:19:10,040 it's a symptom of your lack of capacity. 244 00:19:10,040 --> 00:19:11,040 Exactly. 245 00:19:11,040 --> 00:19:21,160 And what we actually have done with the convention in the process of the drafting and negotiations, 246 00:19:21,160 --> 00:19:32,640 it became clear that we really all in the disability community working on it could agree that nobody 247 00:19:32,640 --> 00:19:40,640 should be deprived of the right to make decisions deprived of their legal capacity on the basis 248 00:19:40,640 --> 00:19:45,120 of disability or like any other finagling they want to do. 249 00:19:45,120 --> 00:19:48,640 So like not like disability plus something else. 250 00:19:48,640 --> 00:19:52,360 Like no, this shouldn't be happening to anybody. 251 00:19:52,360 --> 00:19:58,800 It's always a violation of the person's dignity, human rights, everything. 252 00:19:58,800 --> 00:20:06,080 So the concept and practice of supported decision making was introduced in the UN. 253 00:20:06,080 --> 00:20:12,560 There had been people working on that from the community of people with intellectual and 254 00:20:12,560 --> 00:20:16,600 developmental disabilities and their families. 255 00:20:16,600 --> 00:20:21,560 And so they had the most extensive practice with it, but we all were pretty, we're able to 256 00:20:21,560 --> 00:20:28,680 agree that, okay, so long as you don't take the decision away from the person, supporting 257 00:20:28,680 --> 00:20:34,800 the person, giving the person support that they can use to make their decisions, that's 258 00:20:34,800 --> 00:20:36,040 an okay thing. 259 00:20:36,040 --> 00:20:40,760 And so the framework from disability rights, if I'm, if I'm tracking this, is that people 260 00:20:40,760 --> 00:20:45,600 are put in institutions like historically, if you have a disability, you're an institution, 261 00:20:45,600 --> 00:20:49,640 you're in a wheelchair, you're blind, you're deaf, you're just, they're just pushed away 262 00:20:49,640 --> 00:20:51,000 from society. 263 00:20:51,000 --> 00:20:52,000 You're horribly violated. 264 00:20:52,000 --> 00:20:55,880 You're the abuses run ramp, but you have no security, you have no safety. 265 00:20:55,880 --> 00:20:57,760 You don't have your humanity. 266 00:20:57,760 --> 00:21:02,480 And the justification is like, well, you know, how are you going to manage your blind? 267 00:21:02,480 --> 00:21:05,120 How are you going to manage to live in, how you can't live in the community? 268 00:21:05,120 --> 00:21:09,960 We're doing this humane thing by force, by putting you in this asylum and concentrating 269 00:21:09,960 --> 00:21:15,920 you in this, in basically in a prison, because what you're going to just suffer in starve 270 00:21:15,920 --> 00:21:17,320 and you're not going to take care of yourself. 271 00:21:17,320 --> 00:21:22,360 And then the disability rights movement says, wait a second, give us some basic tools 272 00:21:22,360 --> 00:21:24,480 that we can live in the community. 273 00:21:24,480 --> 00:21:27,000 It's not that impossible, as you're saying. 274 00:21:27,000 --> 00:21:29,520 In fact, it doesn't matter because these are our fundamental rights. 275 00:21:29,520 --> 00:21:32,920 We have the right just as everyone else to live in the community. 276 00:21:32,920 --> 00:21:34,000 And now it's very common. 277 00:21:34,000 --> 00:21:36,720 Like, yes, of course, there have to be wheelchair ramps. 278 00:21:36,720 --> 00:21:40,640 We're not going to institutionalize someone because there's no wheelchair ramp for their housing. 279 00:21:40,640 --> 00:21:44,240 I mean, obviously this is imperfect and that it does happen. 280 00:21:44,240 --> 00:21:47,320 And there's still a long way to go with disability rights in general. 281 00:21:47,320 --> 00:21:52,080 But it's really crucial that we understand that this framework is very well established 282 00:21:52,080 --> 00:21:53,520 in disability rights. 283 00:21:53,520 --> 00:21:58,480 And so what you're saying is that what you brought you and colleagues brought to the United 284 00:21:58,480 --> 00:22:03,880 Nations discussion in developing the convention for the rights of persons with disabilities 285 00:22:03,880 --> 00:22:06,520 is to say, hey, what kinds of 286 00:22:06,520 --> 00:22:10,800 accommodations, what kind of access tools are needed. 287 00:22:10,800 --> 00:22:16,920 We need supported decision making so that we can be in the community and not have our rights 288 00:22:16,920 --> 00:22:22,040 taken away from us that we're not just put into hospitals and put into institutions. 289 00:22:22,040 --> 00:22:28,640 And then that's the conversation about how do we put the funding and commitment into making 290 00:22:28,640 --> 00:22:33,160 the abolition of forced treatment possible, just like we put the funding and commitment 291 00:22:33,160 --> 00:22:38,000 into wheelchair ramps and into supported housing and personal care attendants and all the things 292 00:22:38,000 --> 00:22:40,480 that we provide to people with other disabilities. 293 00:22:40,480 --> 00:22:49,760 I think that there is one difference, which is the whole element of coercion and the way 294 00:22:49,760 --> 00:22:58,880 capacity in the sense of what is sometimes called mental capacity or decision making capacity 295 00:22:58,880 --> 00:23:07,520 is used in a legal sense as a justification for either institutionalization or forced 296 00:23:07,520 --> 00:23:14,040 drugging or for removing the decision making's right from the person. 297 00:23:14,040 --> 00:23:21,960 So you will actually, or I don't know, maybe still some places, but we did use to hear 298 00:23:21,960 --> 00:23:28,520 a lot of in the mainstream disability movement, people would say, like, well, I may use 299 00:23:28,520 --> 00:23:34,600 a wheelchair, but I still have my capacity, like I still have my mental capacity. 300 00:23:34,600 --> 00:23:40,840 And people who use wheelchairs or who need wheelchairs are not being institutionalized by 301 00:23:40,840 --> 00:23:43,000 force of law. 302 00:23:43,000 --> 00:23:51,120 If they're being institutionalized, they're being institutionalized simply for lack of alternatives. 303 00:23:51,120 --> 00:23:56,680 And that's both like I don't want to minimize the impact of that. 304 00:23:56,680 --> 00:24:06,680 It's a huge impact because it has the same effect in the end in the sense of institutionalization, 305 00:24:06,680 --> 00:24:14,840 but it also, there's a way that what psychiatry does to us, it's like it negates, it's a kind 306 00:24:14,840 --> 00:24:24,000 of authoritative social negation of you as a person who actually has opinions, views, 307 00:24:24,000 --> 00:24:29,280 who has a subjectivity that deserves to be taken into account. 308 00:24:29,280 --> 00:24:34,480 Yeah, I'm thinking in someone who has a physical cerebral palsy, for example, sometimes people 309 00:24:34,480 --> 00:24:37,280 have a very hard time speaking. 310 00:24:37,280 --> 00:24:43,280 And so you could, from a certain authoritarian perspective, say, oh, this person can't express 311 00:24:43,280 --> 00:24:44,600 their opinion. 312 00:24:44,600 --> 00:24:49,840 But actually, if you sit and you listen and you learn how someone speaks and you maybe 313 00:24:49,840 --> 00:24:56,680 give them maybe an assistive technology like a touch screen that they can prod with a wand, 314 00:24:56,680 --> 00:24:59,440 then they actually have very clear. 315 00:24:59,440 --> 00:25:02,720 So there's a bridging that needs to, that needs to happen. 316 00:25:02,720 --> 00:25:09,360 And that is perhaps most confounding or most challenging and most systematically done around 317 00:25:09,360 --> 00:25:13,160 madness, extreme states, psychosis, what we want to call it. 318 00:25:13,160 --> 00:25:19,000 But it still exists within this larger disability rights framework of removing someone's 319 00:25:19,000 --> 00:25:23,320 capacity because they are in a different category. 320 00:25:23,320 --> 00:25:25,160 They're being discriminated against. 321 00:25:25,160 --> 00:25:28,720 There's a legal position that allows you to remove their capacity. 322 00:25:28,720 --> 00:25:30,240 And that's the abolitionist piece. 323 00:25:30,240 --> 00:25:31,800 That's what we want to get rid of. 324 00:25:31,800 --> 00:25:34,120 We want to not have that discrimination take place. 325 00:25:34,120 --> 00:25:35,120 Right. 326 00:25:35,120 --> 00:25:40,240 I mean, I think you're right to make it part of the bigger disability framework in that 327 00:25:40,240 --> 00:25:46,120 way because, you know, you're right that in the same way as what you mentioned with someone 328 00:25:46,120 --> 00:25:51,840 with cerebral palsy that you have to take a little more time and listen and pay very close 329 00:25:51,840 --> 00:25:52,840 attention. 330 00:25:52,840 --> 00:26:01,600 The same way, if someone is mad or you think they're mad or whatever, then the same way. 331 00:26:01,600 --> 00:26:09,840 I have experienced many situations where somebody is acting in a way that I'm sure could get 332 00:26:09,840 --> 00:26:16,080 them diagnosed and locked up, but you have a conversation and it gets real pretty quickly. 333 00:26:16,080 --> 00:26:17,080 Exactly. 334 00:26:17,080 --> 00:26:21,880 And so is the opportunity for that conversation given to the person? 335 00:26:21,880 --> 00:26:27,000 Sometimes it's as simple as listening or is it a bang on the door and there's the police 336 00:26:27,000 --> 00:26:31,320 and they open up the door and the person completely gets escalated and panicked and there's 337 00:26:31,320 --> 00:26:34,920 no actual opportunity to bridge with their communication. 338 00:26:34,920 --> 00:26:40,520 And this happens so often that there aren't the resources or the opportunities to create 339 00:26:40,520 --> 00:26:41,520 those bridges. 340 00:26:41,520 --> 00:26:48,480 Sometimes it is really as simple as taking the time to listen and sit with the person. 341 00:26:48,480 --> 00:26:52,760 Sometimes it's much, much more complicated and much, much more challenging and we should 342 00:26:52,760 --> 00:26:58,000 probably talk a little bit about that because there are situations I think where someone 343 00:26:58,000 --> 00:27:02,560 is acting in a way where maybe they're committing a crime, maybe they're, maybe they're trespassing 344 00:27:02,560 --> 00:27:04,720 or maybe they're causing a disturbance. 345 00:27:04,720 --> 00:27:08,920 And if mental health wasn't part of the picture, if they're altered state or they're 346 00:27:08,920 --> 00:27:13,280 extreme state, wasn't part of the picture, yeah, they would be grabbed and they would be 347 00:27:13,280 --> 00:27:19,680 forced into a jail, they would be given a ticket or they would end up being incarcerated. 348 00:27:19,680 --> 00:27:25,600 And so the question then sort of becomes how do you approach those situations in a way 349 00:27:25,600 --> 00:27:32,000 that doesn't mobilize this legal double standard of using the person's psychiatric diagnosis 350 00:27:32,000 --> 00:27:35,280 to deny them rights that someone would otherwise have? 351 00:27:35,280 --> 00:27:42,200 I actually really start from the point of view that the first thing we have to do is get rid 352 00:27:42,200 --> 00:27:44,000 of the separate legal framework. 353 00:27:44,000 --> 00:27:45,720 Yes, I know I'm absolutely with you. 354 00:27:45,720 --> 00:27:49,800 I'm not saying wait a second, again, we have to first put the alternatives into place. 355 00:27:49,800 --> 00:27:52,640 We need open dialogue and we need hearing voices movement. 356 00:27:52,640 --> 00:27:58,280 We need peer specialists and then we can realize that we have an alternative force treatment. 357 00:27:58,280 --> 00:27:59,280 I agree with you. 358 00:27:59,280 --> 00:28:00,280 I think it's the other way around. 359 00:28:00,280 --> 00:28:04,360 The first thing you do is you do, you get clear on the abolition and then you don't have 360 00:28:04,360 --> 00:28:06,560 that as an avenue anymore. 361 00:28:06,560 --> 00:28:13,200 You force society to provide these alternatives because it's absolutely unacceptable to do this 362 00:28:13,200 --> 00:28:14,960 legal discrimination. 363 00:28:14,960 --> 00:28:18,200 It's completely wrong to create a second class citizenship. 364 00:28:18,200 --> 00:28:22,000 And I think that actually is one of the pitfalls of promoting alternatives. 365 00:28:22,000 --> 00:28:27,080 I think it's also one of the reasons that alternatives get more attention than abolition 366 00:28:27,080 --> 00:28:31,560 because it's like a much easier road to travel. 367 00:28:31,560 --> 00:28:35,400 It's very attractive. 368 00:28:35,400 --> 00:28:36,400 It doesn't challenge people. 369 00:28:36,400 --> 00:28:38,040 It doesn't actually provide any kind of real confrontation with legal framework. 370 00:28:38,040 --> 00:28:43,640 But I absolutely I think we have to start with, we have to start with what's true and 371 00:28:43,640 --> 00:28:49,200 what's honest, which is that it's absolutely a moral evil to create a second class citizenship 372 00:28:49,200 --> 00:28:52,560 for people and then inflict this violence on them. 373 00:28:52,560 --> 00:28:57,560 We recognize that with so many other categories of people, let's recognize that for people 374 00:28:57,560 --> 00:28:58,800 with psychiatric diagnosis. 375 00:28:58,800 --> 00:28:59,800 Right. 376 00:28:59,800 --> 00:29:06,640 I mean, I think it makes a big difference to make that the starting point. 377 00:29:06,640 --> 00:29:12,400 And like one of the differences it can make is in terms of what kind of advocacy you're 378 00:29:12,400 --> 00:29:17,080 doing, is there any in the US? 379 00:29:17,080 --> 00:29:27,920 Are there any lawyers or activists who are actually trying to create campaigns to abolish 380 00:29:27,920 --> 00:29:31,880 the involuntary commitment and involuntary treatment laws? 381 00:29:31,880 --> 00:29:39,000 Now I don't have the expertise or the networks to organize that myself. 382 00:29:39,000 --> 00:29:46,240 I, I, like, I'll say it here as I've said in other places, I absolutely hold myself out 383 00:29:46,240 --> 00:29:53,720 willing to work with anybody in any state who wants to do that either through legislation 384 00:29:53,720 --> 00:29:54,920 or litigation. 385 00:29:54,920 --> 00:30:00,160 I don't think it's something that's beyond the realm. 386 00:30:00,160 --> 00:30:06,680 Very important to recognize is that the US is one of the few countries that hasn't ratified 387 00:30:06,680 --> 00:30:10,840 the conventions on the convention on the rights and persons with disabilities. 388 00:30:10,840 --> 00:30:13,160 Interesting coincidence there. 389 00:30:13,160 --> 00:30:21,760 So if we did ratify it, if the US did actually push this through, then would that be grounds 390 00:30:21,760 --> 00:30:24,680 for saying, okay, now we need to have a legislative framework. 391 00:30:24,680 --> 00:30:30,520 For abolishing all force treatment and creating equality under the law and establishing a different 392 00:30:30,520 --> 00:30:32,400 pathway for people. 393 00:30:32,400 --> 00:30:38,840 It may help, but the reason why I'm not like saying, oh yes, that's the main thing we need 394 00:30:38,840 --> 00:30:46,840 to do is because when the US ratifies human rights treaties, or they use all the technical 395 00:30:46,840 --> 00:30:56,160 means at their disposal to make it really impossible to just bring it into a US court, either federal 396 00:30:56,160 --> 00:31:03,840 or state court, and say, you know, hey, my rights are being violated under this treaty. 397 00:31:03,840 --> 00:31:05,120 I want redress. 398 00:31:05,120 --> 00:31:13,600 It has to be your claim in a US court has to be based on a federal or state statute. 399 00:31:13,600 --> 00:31:22,960 And they also use selective declarations, understandings and reservations on various provisions of 400 00:31:22,960 --> 00:31:29,400 the treaty to like to kind of carve out things they don't really want to do or don't want 401 00:31:29,400 --> 00:31:31,400 to take responsibility for. 402 00:31:31,400 --> 00:31:39,440 They've got some of those on the CRPD, even in the package that Obama sent to the Senate 403 00:31:39,440 --> 00:31:44,880 when he did sign the convention and then the Senate Foreign Relations Committee actually 404 00:31:44,880 --> 00:31:46,360 added more. 405 00:31:46,360 --> 00:31:53,280 So just one more thing is that in the current makeup of the Senate and the current makeup 406 00:31:53,280 --> 00:32:02,080 of US politics, I don't really see much possibility even forgetting the convention through in that 407 00:32:02,080 --> 00:32:05,280 kind of in the form that we have. 408 00:32:05,280 --> 00:32:12,880 If we did, the main value would be that it's there that we get to make reports to the committee 409 00:32:12,880 --> 00:32:19,120 of experts that sits in Geneva and we get to have them tell the US, hey, you have to abolish 410 00:32:19,120 --> 00:32:22,000 all those involuntary commitment laws. 411 00:32:22,000 --> 00:32:23,640 That's the main thing we get. 412 00:32:23,640 --> 00:32:25,120 And what is the main opposition? 413 00:32:25,120 --> 00:32:31,080 I mean, are there financial interests that are opposed to the CRPD because they feel like 414 00:32:31,080 --> 00:32:32,880 they would have changed their business model? 415 00:32:32,880 --> 00:32:37,400 What is the main argument against having an international disability? 416 00:32:37,400 --> 00:32:42,800 Or is it just part of the broader, well, the United States feels like it's this exceptional 417 00:32:42,800 --> 00:32:47,720 power and there's a lot of things that it hasn't ratified internationally? 418 00:32:47,720 --> 00:32:49,240 Is that part of it? 419 00:32:49,240 --> 00:32:50,800 It's mainly that. 420 00:32:50,800 --> 00:33:00,640 And the origins of that hostility to treaties were in, you know, I've had this summary 421 00:33:00,640 --> 00:33:07,920 of it in my mind that has to do with racist senators who were opposing our ratification 422 00:33:07,920 --> 00:33:09,720 of the genocide convention. 423 00:33:09,720 --> 00:33:16,680 I believe in the 1950s because they believed African Americans would use it in their civil 424 00:33:16,680 --> 00:33:19,240 rights, human rights struggles. 425 00:33:19,240 --> 00:33:25,160 And eventually that no longer was an obstacle to the genocide convention. 426 00:33:25,160 --> 00:33:28,920 I don't know all the, I don't have in my mind all the details. 427 00:33:28,920 --> 00:33:34,440 This is what I've learned from legal seminars on this stuff. 428 00:33:34,440 --> 00:33:42,080 But we have ratified the genocide convention, but there's still a lingering hostility to human 429 00:33:42,080 --> 00:33:45,120 rights treaties in general. 430 00:33:45,120 --> 00:33:54,000 And the current opposition is primarily from the religious right, the Christian nationalist 431 00:33:54,000 --> 00:34:02,160 right. They oppose mostly anything to do with women's human rights, especially if they 432 00:34:02,160 --> 00:34:08,000 will think it's going to lead to more women having the right to abortion. 433 00:34:08,000 --> 00:34:14,640 And anything related to children's rights, because they really think somehow that parents 434 00:34:14,640 --> 00:34:20,080 should have some kind of absolute authority over their children and the state can't say 435 00:34:20,080 --> 00:34:22,040 anything to parents. 436 00:34:22,040 --> 00:34:29,280 However, we already have a best interest of the child principle embedded throughout U.S. 437 00:34:29,280 --> 00:34:30,280 law. 438 00:34:30,280 --> 00:34:37,600 So they just don't want children to have human rights or women and pieces aspects of that 439 00:34:37,600 --> 00:34:40,600 are included in the CRPD. 440 00:34:40,600 --> 00:34:46,560 Yeah, there's definitely just a general right wing kind of push back against United Nations 441 00:34:46,560 --> 00:34:48,320 in general. 442 00:34:48,320 --> 00:34:54,920 And one of the things that is so powerful about the CRPD is that it recognizes the injustice 443 00:34:54,920 --> 00:34:55,920 of forced treatment. 444 00:34:55,920 --> 00:35:02,320 And it does acknowledge that when you kidnap someone, assault them and then hit them with 445 00:35:02,320 --> 00:35:07,760 lots of chemicals and punishment to change their way of thinking, which is inflicting pain 446 00:35:07,760 --> 00:35:10,120 on them, that's a form of torture. 447 00:35:10,120 --> 00:35:16,720 So tell us exactly what the CRPD does that kind of strengthens the abolitionist point 448 00:35:16,720 --> 00:35:22,440 of view of because I found it very empowering to read, first of all, the NCD report that you 449 00:35:22,440 --> 00:35:29,480 mentioned in 2000 and also very empowering to hear the validation of our perspective by 450 00:35:29,480 --> 00:35:35,360 international lawyers in the UN context because we get treated like we're crazy or irrational 451 00:35:35,360 --> 00:35:43,640 or off out of bounds when we take an abolitionist forced anti-force treatment stance. 452 00:35:43,640 --> 00:35:46,640 Absolutely. 453 00:35:46,640 --> 00:35:47,960 I'm glad you're asking that. 454 00:35:47,960 --> 00:35:51,760 There's a few different pieces of the answer. 455 00:35:51,760 --> 00:35:57,360 And again, this is for all people with disabilities, including people with a psychiatric diagnosis 456 00:35:57,360 --> 00:36:01,160 who were just perceived a certain way, regardless of their own self-definition. 457 00:36:01,160 --> 00:36:02,160 Exactly. 458 00:36:02,160 --> 00:36:08,840 So the principles of the present convention shall be and the first one is respect for inherent 459 00:36:08,840 --> 00:36:15,000 dignity, individual autonomy, including the freedom to make one's own choices and independence 460 00:36:15,000 --> 00:36:16,600 of persons. 461 00:36:16,600 --> 00:36:21,920 There's also one on respect for difference and acceptance of persons with disabilities 462 00:36:21,920 --> 00:36:26,200 as part of human diversity and humanity. 463 00:36:26,200 --> 00:36:27,200 Beautiful. 464 00:36:27,200 --> 00:36:34,440 So those are really beautiful and important as kind of the pillars of value that we're working 465 00:36:34,440 --> 00:36:35,960 with. 466 00:36:35,960 --> 00:36:44,480 In terms of what is the concrete legal language, on involuntary commitment, we have article 14 467 00:36:44,480 --> 00:36:51,840 on liberty and security of the person that says among other things that states parties, 468 00:36:51,840 --> 00:36:57,560 which means any country that ratifies the convention shall ensure that the existence of 469 00:36:57,560 --> 00:37:03,160 a disability shall in no case justify a deprivation of liberty. 470 00:37:03,160 --> 00:37:07,640 In no case shall in no case justify a deprivation of liberty. 471 00:37:07,640 --> 00:37:10,000 That is an abolitionist stance. 472 00:37:10,000 --> 00:37:11,160 Exactly. 473 00:37:11,160 --> 00:37:18,080 And it's funny because that language was really struggled over in the negotiations. 474 00:37:18,080 --> 00:37:25,400 The first draft said that there shall be no deprivation of liberty based on disability. 475 00:37:25,400 --> 00:37:31,720 And then some countries were saying they wanted to add in solely or exclusively. 476 00:37:31,720 --> 00:37:33,720 And you know what that would have done. 477 00:37:33,720 --> 00:37:34,720 Oh, right. 478 00:37:34,720 --> 00:37:35,720 There's the loophole. 479 00:37:35,720 --> 00:37:36,720 Yeah, there we go. 480 00:37:36,720 --> 00:37:37,720 Right. 481 00:37:37,720 --> 00:37:42,480 And then somebody came up with this language and I think they somehow thought they maybe 482 00:37:42,480 --> 00:37:44,480 had wiggle room. 483 00:37:44,480 --> 00:37:46,160 I don't know why, but. 484 00:37:46,160 --> 00:37:50,400 This is why it's so important to have you and other colleagues in their Tina to watch out 485 00:37:50,400 --> 00:37:52,200 for this backsliding. 486 00:37:52,200 --> 00:37:53,200 Exactly. 487 00:37:53,200 --> 00:37:57,560 And what actually made me feel comfortable with the language. 488 00:37:57,560 --> 00:38:09,680 And I mean, you know, I'm glad that you reading it. 489 00:38:09,680 --> 00:38:11,680 That's abolitionist language. 490 00:38:11,680 --> 00:38:14,560 The ambassador of New Zealand who is chairing the negotiations read out something that made it clear that at least his understanding in saying, OK, this is the article. 491 00:38:14,560 --> 00:38:15,560 This is what it means. 492 00:38:15,560 --> 00:38:26,560 We gaffled it close that it was really abolitionist that people with disabilities who do something that someone considers a danger to the community should be dealt with the same as others in that situation. 493 00:38:26,560 --> 00:38:32,560 It's not we're not going to, you know, lock people up based on their disability. 494 00:38:32,560 --> 00:38:34,560 So the torture piece. 495 00:38:34,560 --> 00:38:47,560 So we didn't manage to get the torture piece directly into the convention in terms of linking the issue of forced interventions with the right to be free from torture. 496 00:38:47,560 --> 00:38:48,560 We did try. 497 00:38:48,560 --> 00:38:50,560 We gave them language on that. 498 00:38:50,560 --> 00:38:55,560 But ultimately it didn't come into the text that was adopted. 499 00:38:55,560 --> 00:39:13,560 What we did get was in the health article, you know, it's language on free and informed consent require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by interal. 500 00:39:13,560 --> 00:39:20,560 Yeah, and then there's a lot of blah, blah, blah, but the free and informed consent is the important piece there. 501 00:39:20,560 --> 00:39:38,560 And we couple that with the article that has really been the most pivotal in terms of its of its global impact called article 12 equal recognition before the law that deals with legal capacity. 502 00:39:38,560 --> 00:39:51,560 It says among other things states parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life. 503 00:39:51,560 --> 00:40:04,560 There's a provision on that states parties shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity. 504 00:40:04,560 --> 00:40:27,560 That's the goal of the right to have access to the support we may require to exercise our legal capacity that basically puts into international law, the demand of the psychiatric survivor movement that we be listened to that people take time that they give us space that they create bridges with our madness or our extreme states. 505 00:40:27,560 --> 00:40:39,560 And then there's a lot of things to do with the legal capacity that we can do to make sure that we can have access to that. It's not just a nice benevolent thing that we have an absolute legal right to have that so that we can live freely in the community as the way that we want to equally with anyone else. 506 00:40:39,560 --> 00:40:54,560 So the important piece that is actually useful from an abolitionist perspective is that all measures relating to the exercise of legal capacity should respect the right will and preferences of the person. 507 00:40:54,560 --> 00:41:05,560 And so that does two things because one, you can't say I'm giving you support, but I'm coming you have to accept the support I'm giving you. 508 00:41:05,560 --> 00:41:18,560 It separates support from control coercion and violence and authoritarian. It makes it real support rather than this maddening we're going to control you violate you in the name of keeping you safe or helping you or treating you. 509 00:41:18,560 --> 00:41:32,560 Exactly. And then the fact that that pieces in there also is a good argument from a legal point of view as to why that paragraph can be taken as legitimizing any kind of control or coercion. 510 00:41:32,560 --> 00:41:41,560 Because anything that was doing control and coercion could not be, you know, respecting the right to the preferences of the person. 511 00:41:41,560 --> 00:41:50,560 So those are the important pieces in the CRPD itself in the text. And that's important for people to know about. 512 00:41:50,560 --> 00:42:02,560 You want special rapporteurs have many roles, but one of the things they can do is to put a spotlight on particular human rights issues of concern. 513 00:42:02,560 --> 00:42:14,560 So in 2008, the special rapporteur on torture at the time it was a man named Manfred Novak put out a report on torture and people with disabilities. 514 00:42:14,560 --> 00:42:31,560 And there had previously been an expert meeting to feed into his report that I participated in and it was, you know, definitely going to be and it was something that would deal pretty extensively with the psychiatric. 515 00:42:31,560 --> 00:43:00,560 You know forced interventions context. And so in that report, he actually adopted a version of the language that I had promoted for the convention itself, which was to say that medical treatment of an irreversible or intrusive nature when it is enforced or administered without the free and informed consent of the person concerned. 516 00:43:00,560 --> 00:43:07,560 And so that may amount to torture or other forms of ill treatment. 517 00:43:07,560 --> 00:43:25,560 And then he actually has some other paragraphs where he's where he's essentially showing that the kind of things he thinks about as being of an irreversible and intrusive nature are electro shock, 518 00:43:25,560 --> 00:43:44,560 and then there were a couple of other reports by torture rapporteurs. The most recent one from a torture rapporteur said that that forced psychiatric interventions likely amount to torture, not only torture or other kinds of ill treatment. 519 00:43:44,560 --> 00:44:01,560 He's equate, he's he's putting forth psychiatric interventions in the same category as political or religious reeducation camps and conversion therapy related to sexual orientation or gender. 520 00:44:01,560 --> 00:44:29,560 So what I really like about that, the most recent iteration of it is putting us very clearly in a class with all different kinds of groups that are discriminated against and saying that forced psychiatry, forced drugging, forced DCT is the same kind of absolute human evil undermining of the personality, 521 00:44:29,560 --> 00:44:41,560 and the violent discriminatory action as these other things. So I appreciate that putting it into that kind of perspective as well. 522 00:44:41,560 --> 00:44:58,560 Yeah, it's so validating to know that there is a larger international community that is just simply being honest and actually just looking at what our experience has been and listening to us because we've been saying this from the very, very early days that it's just so it's so clear. 523 00:44:58,560 --> 00:45:13,560 It's a form of religious coercion and conversion and trying to promote the doctor's point of view against your own perspective, which often is a religious perspective or does whatever, whatever you are believing the use of punishment and pain and and and 524 00:45:13,560 --> 00:45:36,560 and then it's an invasive painful destructive, disfiguring interventions to convince you or pressure you to change belief is absolutely what happens in torture to get someone infestive a crime they didn't commit or to change their belief or disclose information or cooperate or submit to authority under that punishment. 525 00:45:36,560 --> 00:45:48,560 Right, and really there doesn't always have to be in any kind of torture, but in psychiatry especially there's not always a clear aim that they want to achieve. 526 00:45:48,560 --> 00:45:56,560 Sometimes it's it is very clear they want to punish you, but often they want to punish you because you're resisting what they already want to do to you. 527 00:45:56,560 --> 00:46:00,560 They want you to agree and be cooperative and they want you to agree. 528 00:46:00,560 --> 00:46:05,560 Adopt their mindset. Right, and they want to agree to be tortured more. 529 00:46:05,560 --> 00:46:07,560 Yeah, yeah, exactly. 530 00:46:07,560 --> 00:46:28,560 I also bring in because sometimes people think when we say forced treatment that it means you know you fought and they held you down and overcame your resistance, but it's equally forced if they say here, take it. 531 00:46:28,560 --> 00:46:51,560 And there's you know what's going to happen if you don't and you put it in your own mouth or else that's right, you know that's equally forced and I think it's important for people to recognize that because all of us who have ever taken those drugs under conditions that we didn't want to. 532 00:46:51,560 --> 00:47:05,560 And we knew we took it because we knew what was going to happen if we didn't in terms of force that's all for us that's right that's that's forced treatment it's all for us and it's it's all for us as defined under international law. 533 00:47:05,560 --> 00:47:06,560 Right, exactly. 534 00:47:06,560 --> 00:47:09,560 Very clear. It's not just our opinion. It says this backup. 535 00:47:09,560 --> 00:47:27,560 So Tina, you have written a very powerful book that's available on your website reimagining crisis support matrix road map and policy and it really speaks directly to this pushback that we get, which is that well. 536 00:47:27,560 --> 00:47:52,560 And these are stereotypes if someone is running in traffic if someone is there about to hang themselves or they're going to they're going to set fire to the housing unit then of course we have to make them safe and we have to lock them up and we have to drug them and get them treatment because they they are in need of an intervention and they just are not capable of recognizing it. 537 00:47:52,560 --> 00:48:15,560 And what you're saying and what the abolition movement the movement and force treatment is saying and also international law in the context of CRPD is saying is no we need to rethink that because there's lots of things that we can do and also we're confusing the criminal justice system and its role with the medical system and its role. 538 00:48:15,560 --> 00:48:26,560 So let's talk about that because I want to really push back to this hesitation that so many people have to just for me what is obvious is to join the moral imperative to abolish force treatment. 539 00:48:26,560 --> 00:48:38,560 I mean, I think it's really key that there's a confusion between the medical system and its role with the criminal justice system and its role. 540 00:48:38,560 --> 00:48:58,560 And you know, I'll say like where I start out on this is that it's just never legitimate to have the psychiatric system medical system even any kind of social work system that's putting itself out as we're here to help you. 541 00:48:58,560 --> 00:49:19,560 We want to build a relation of confidence with you. You can't give a social control role to that same system. It's absolutely contradictory. It makes for it makes for really a crazy making situation for people who actually want to get services from any of those systems. 542 00:49:19,560 --> 00:49:32,560 It corrupts human relationships. It makes a mockery of trust. It makes an mockery of human connection to have it be in the context of violence and control and coercion in that way. 543 00:49:32,560 --> 00:49:36,560 They should be absolutely separated. They're clearly separated. 544 00:49:36,560 --> 00:49:52,560 I think that's still like that's still a hard stop. No involvement of psychiatry. No appeal to psychiatry. If somebody you think somebody's going to do an act of violence. It's not the job of psychiatry to stop it. 545 00:49:52,560 --> 00:50:10,560 It can't be the job of psychiatry to stop some it can't be really I think the job of the state or of anybody in an official capacity to stop anybody from committing suicide or harming themselves. 546 00:50:10,560 --> 00:50:23,560 You can justify that in the CRPD framework in the issue of legal capacity. I think in the US the survivor movement pretty much has a strong value of agreement with that. 547 00:50:23,560 --> 00:50:38,560 There's many places where it's very controversial to say that. We do have to look at suicide and self-injury in terms of what are the ways to support people. 548 00:50:38,560 --> 00:50:57,560 And mainly for that I feel we have to be honest as caring deeply and caring deeply about the person not about like simply the fact of whether or not this person actually takes their life. 549 00:50:57,560 --> 00:51:21,560 And that's what I think is really the way to do that is to focus on whether you're going to do this thing of committing suicide which then it really it becomes a focus of who's going to be responsible who's going to be for to be blamed who's going to possibly get a lawsuit to get into trouble and we should be honest most people who have suicidal feelings struggle with suicidal feelings because a part of them doesn't want to die. 550 00:51:21,560 --> 00:51:41,560 So there's a lot of people who are not feeling that they're in that conflict. If someone is 100% on board with killing themselves there's lots of ways to do it and you can be very secretive about it and accomplish it and actually there are a lot of people who do just kill themselves without any signal or sign or letter or warning signs or just out of the blue seemingly. 551 00:51:41,560 --> 00:52:10,560 So you just stood the whole role that society needs to be playing around suicidal feelings and then you add in the other aspect which is that once you start punishing people who have suicidal feelings or who attempt suicide you just drive those feelings in that experience underground so you make it harder for them to access the kind of trusting confidential supportive really supportive relationship that's going to be needed for them to go through whatever conflict that they're going through. 552 00:52:10,560 --> 00:52:39,560 Which is so often social context poverty trauma all the different pressures of life that the flirting of their dreams that the crushing isolation that people go to all go through all the different things that contribute to losing hope and losing a sense of empowerment for making changes in your life none of that is understood and then additionally we have enshrined pretty fundamentally in our criminal justice system and our sense of the world. 553 00:52:39,560 --> 00:53:06,560 And our sense of personal liberty and freedom that the prediction of a crime is not the basis to deprive someone of their liberty the police don't go around guessing that someone is going to commit a crime based on their future behavior and then we say okay we're going to lock that's that that's utterly totalitarian now if you're involved in in planning and you're right in the process of some kind of violence or imminent criminal act. 554 00:53:06,560 --> 00:53:25,560 Yes, that is something that's underway that can be interrupted and considered a crime but the idea that well we're going to predict that this person is going to be homicidal next week therefore we have to lock them up now is something that goes against all of our concepts of civil liberties and freedoms. 555 00:53:25,560 --> 00:53:54,560 Right and so in fact what we have is the psychiatric system being I don't know what the word is but being the thought police what I was going to say is we have them essentially roped in not again you know they're doing it very willingly but we have them put to the use of locking people up using deprivation of liberty as social control in conditions where the criminal justice system is so much more important than the crime. 556 00:53:54,560 --> 00:54:23,560 The system is supposed to not not do it right so that's I think that's all very clearly just you know out of bounds in in the terms of the convention I do think that even let's say we got rid of the psychiatric system the forced psychiatric system we get rid of the whole psychiatric system but get rid of all the involuntary commitment in voluntary treatment laws. 557 00:54:23,560 --> 00:54:51,560 We still have to think about is there a difference between somebody planning their own death and planning somebody else's death and doing that imminently which I think there is I don't think suicide can or should be made a crime or any kind of object for state intervention whereas you know if I've got a weapon I'm threatening somebody with it somebody should intervene you know so I don't actually do that. 558 00:54:51,560 --> 00:55:20,560 And that's very well established in you can be planning killing someone but if actually unless you have the actual process underway past a certain threshold you're free to think and imagine and and have it in your mind and and you have these feelings and want to do destructive criminal act and the police's job isn't to go around predicting who is going to actually act on those right or act on those thoughts I think where it gets more complicating. 559 00:55:20,560 --> 00:55:49,560 Complicating for people and people are hesitant to embrace an abolitionist view is when there's something going on where someone is in an altered state or in some kind of different state of mind they're doing something that may be criminal such as trespassing or harassing someone or being loud and creating a public disturbance and then the mentality starts to come in that actually it's more humane to send them to the psychiatric hospital. 560 00:55:49,560 --> 00:56:18,560 Then it is to the prison and in some cases that may be that may be true but often it's quite the opposite because you can get caught up in the psychiatric system for the rest of your life for doing something that would only get you maybe a ticket or maybe a couple of days in jail with a firm end date of when your punishment is over rather than what the mood of the psychiatrist is that day whether you're going to agree with them or not that you are going to take medication. 561 00:56:18,560 --> 00:56:47,560 So I think that's the the dilemma is that society often doesn't have a good response that's not either police or psychiatry and this is where I think the black lives matter movement and a lot of the discussion around defunding the police and because it's not about defunding communities it's about creating alternatives it may be helpful if somebody is causing a disturbance in your front yard and you're afraid of going out because you don't want to get punched or you feel vulnerable having someone to be in the back of the house. 562 00:56:47,560 --> 00:57:07,560 So I think that's the problem is that if you're a person who's in the back of the house and you're not going to be able to get a person who's in the back of the house and you're going to be able to get a person who's in the back of the house and you're going to be able to get a person who's in the back of the house. 563 00:57:07,560 --> 00:57:29,560 Then there may be a role for certain specialized responses, but I think this is the trap that often is set up either we can neglect someone or we can send the police after them or we can use forced psychiatry on them and that's I think where your book reimagining crisis support speaks to what do we do instead of these dead ends. 564 00:57:29,560 --> 00:57:58,560 Right, I had started out really just okay it's an equality perspective and so I think if you're going to reform the police there's also things you can do from a disability abolitionist disability justice perspective talk about like well the police need to actually deescalate be trained so they're actually not responding to everything. 565 00:57:58,560 --> 00:58:18,560 Just trigger happy but especially from a racial justice perspective, but I also think from a class and disability perspective, the police really institutionally keep on proving themselves incapable of an unwilling to change. 566 00:58:18,560 --> 00:58:47,560 So I really do think that that something like like violence interruption is really really the way to go and the way and things we need to develop more and more and more of and I think I really agree with the way you said it because this is sometimes something that comes up in a way that that people aren't so clear about, but I think that we do need to have people who are in the right way. 567 00:58:47,560 --> 00:59:15,560 We have people who are willing to step forward and take that role to put themselves out because it is a risk to go and confront somebody who's in the midst of preparing and threatening and doing violence or they're drunk and they're yelling and they're doing yeah and then it sort of then it raises the whole question of prevention and thinking about the root causes because the person who is out causing a disturbance or creating a threat. 568 00:59:15,560 --> 00:59:30,560 So I think that's the story. How did they get to that point? What's the build up? What are the needs that are maybe unmet and I think this is where a lot of the community alternatives to the police discussions are very helpful because it's so much that's about poverty. 569 00:59:30,560 --> 00:59:59,560 So I think that's about lack of a meaningful social role and employment. It's about the pressures of modern neoliberal capitalism and if we can start to think in a preventive framework, then people wouldn't be so neglected and left on their own until they reach these crisis points that need some kind of response and that conversation I think goes along with the abolition conversation around forced treatment but I absolutely 100% 570 00:59:59,560 --> 01:00:27,560 in first that's when you to focus on and then the rest will be pressured will have to come up with alternatives right now there's no real incentive or pressure because there's no legal rationale there's no legal support for it there's no financial incentives there's no industry that's going to be profiting off of it until we have that legal framework of basic human rights for abolition in place we're going to be giving the alternatives less emphasis than they need to have. 571 01:00:27,560 --> 01:00:53,560 I think it's something that happens when people talk in terms of restorative and transformative justice and we're focusing on somehow this person who did something wrong and what are we going to do to get that person to actually reform so we can trust them again as a member of the community. 572 01:00:53,560 --> 01:01:22,560 It's something I really struggle with because there's many situations including ones I've been in myself where there was simply a dispute about right and wrong about did you do something that violated my rights or are you actually violating my rights by accusing me and doing all these negative things. 573 01:01:22,560 --> 01:01:51,560 Towards me it responds to your feeling violated and you know in my experience when those things have happened you know that I felt was unjust towards me there's definitely been a gender dimension of them and I think that that gender issues and patriarchy is still something that needs a lot more attention in restorative and transformative justice than it actually is. 574 01:01:51,560 --> 01:02:11,560 I also really really do honor the people working in that area because I see them coming up with a lot of good kinds of practices that are some of what I think we need to build on. 575 01:02:11,560 --> 01:02:30,560 Well this speaks to how we've separated mental health concerns from all these other life concerns whereas actually in reality they're very deeply connected so so often what gets framed as a mental health issue is a conflict issue or or a question of that needs 576 01:02:30,560 --> 01:02:59,560 to have a lot of the same kind of communication and the importance of creating the opportunity for people in conflict in the community to have mediation available to them so they can resolve these two sides that are maybe seeing things very differently and I think if you talk to police and you talk to what they do on a day to day basis the vast majority of police don't ever draw their guns they're dealing with lots of community problems and they're dealing with a lot of people fighting and they're interrupting things they're trying to help deal with the problem. 577 01:02:59,560 --> 01:03:28,560 I think that's really a big help deal with these situations that really we need much more resources and much more support that it doesn't have to go to the police the police don't have a role to play in these issues but they're what is getting the resources and so ultimately I think that there's a larger conversation if we are going to respond to people's needs who are have a psychiatric disability have a label our scene as having a psychiatric disability. 578 01:03:28,560 --> 01:03:57,560 There needs to be large these larger social changes that resources are available to people and we have an incredible reservoir the psychiatric survivor movement we know we know what we need we've been talking about it for decades and decades and decades and it does work listening and spending time with someone and giving them space and giving them an alternative and waiting it out and meeting their basic needs and being with them works but we just don't have the infrastructure and the reason for that is that we have to be able to talk to people. 579 01:03:57,560 --> 01:04:07,560 We have to be able to talk to people about the infrastructure and the resources and then of course the housing crisis poverty all drive us away from those actual bridges to people. 580 01:04:07,560 --> 01:04:26,560 Yeah, I mean, I think that's that's all absolutely right. I think anything that you do to respond to conflict or try to resolve it or defuse it can also be used in a controlling and hierarchical way. 581 01:04:26,560 --> 01:04:45,560 So I think it's possible to have structures that we create that are somehow not that but in doing any kind of structures whether it's about conflict resolution violence and corruption or 582 01:04:45,560 --> 01:05:07,560 crisis support or other kinds of support there has to be a real openness to different perspectives different ways of being in the world conflicting ways of being in the world conflicting needs and thinking about how do we actually deal with that. 583 01:05:07,560 --> 01:05:29,560 I think that's really important and one of the ways that I sometimes think about you know interacting with the family member who has the diagnosis and who is seen as psychotic and is talking about the neighbors putting him under surveillance and there's poison in his food and I sometimes think about those conversations and that 584 01:05:29,560 --> 01:05:53,560 and that mediation as a cross cultural experience like if you're living with someone in your neighborhood who comes from a very different culture they don't even speak the same language that you do there's so much room for suspicion and conflict and escalation and so to bring that kind of sensibility because it is in a way it's like different realities in a react interacting and so someone may have a very strange 585 01:05:53,560 --> 01:06:21,560 strange fanciful dream like fantastic description that you think how is it possible that there's poison in the food and there's this micro beams that are coming in but then if you just set that aside you say your your reality is your reality and therefore it has equal standing and this other reality is a different reality and they're just different like different cultures no culture is better than any other but they just have a mutual need to find some 586 01:06:21,560 --> 01:06:49,560 middle ground to get along rather than arguing which person is more in touch with reality than than the other because they're fundamentally equal human beings and until we have that basic equality position from the disability justice movement and from the CRPD and from the abolitionist stance then we're going to go into that situation saying oh well your reality is less valid your reality is this your reality is this and they're 587 01:06:49,560 --> 01:07:17,560 for this going to be a bias and of course the transformative and restorative justice it gets very twisted in the criminal justice mediation is very suspect when there's coercion or there's a threat or you know family meetings have been part of psychiatric treatment since the sense for a long time and they are exactly unfair because of that hidden power and that hidden hierarchy that isn't recognized 588 01:07:17,560 --> 01:07:43,560 room for misuse of all these alternatives but one of the things i think is so powerful about your work is that you keep coming back to let's start with the abolitionist stance let's start with the principle of equality and then everything else starts to open up to an honest conversation exactly exactly and one thing i wanted to 589 01:07:43,560 --> 01:08:12,560 come back to a little bit is something that i have in my book it seems to me that just because of issues of kind of trust and accountability even that if i'm getting personal support from somebody i don't really want that person to be the one who's mediating a conflict between me and someone else 590 01:08:12,560 --> 01:08:41,560 yeah absolutely you know so i think that's kind of important and and i know like sometimes in the kinds of ways that people actually work in these community settings of providing on the street crisis support or violence and corruption it does often get mixed in together and i wonder about that because i can see that sometimes 591 01:08:41,560 --> 01:09:11,520 it might just kind of slide from one thing into the next the other this is an important criticism that came in immediately when open dialogue started to be introduced in the United States it's like wait a second i you know i don't feel supported enough to be having a conversation with my family and now my therapist is supposed to be listening to everybody equally no i need someone on my side i need someone who's taking my position who hears me because i've been so push 592 01:09:11,520 --> 01:09:40,520 down my power position and my parents power position is very very different we're facing very very different kinds of responses in the world i'm up against life threatening psychiatric incarceration and unless that is understood those that asymmetrical aspect to that so again we have to be vigilant about the subtle ways that the system can bring in coercion and 593 01:09:40,520 --> 01:10:09,520 control and the threat of violence and the hidden inequalities as a way of othering and making someone have less than full equal rights in a situation because one can imagine a very coercive very abusive very violent psychiatric system with kind of like an open dialogue style window dressing where there's a lot of the correct jargon and there's a lot of sort of referral to the idea open dialogue but it's at heart 594 01:10:09,520 --> 01:10:38,520 it doesn't have that democratic equality you know two things i would say about open dialogue one i don't know if the people in charge of it now actually do have an abolitionist stance but when i asked Jaco say kala back in 2010 or there about he didn't that's correct yeah that's correct yeah so to me that's really a tank on it to begin with and number two what's the 595 01:10:38,520 --> 01:11:07,520 purpose is the purpose to support me or is the purpose to resolve conflict in the family just even of the fact of asymmetrical power in asymmetrical situation it's like why are these people even supposed to be brought in and i think you can only do i think i don't know like i haven't talked to practitioners of it for a while but i think the only way you can do it 596 01:11:07,520 --> 01:11:35,520 is if you have first the conversation with the person who you think needs support and maybe it's not the person that a family member is identifying maybe it's the family member who needs support but you have to have a conversation with with the person you're talking to to ask what the person you want to talk to do you want this kind of support and do you think you could be helpful to bring in your family 597 01:11:35,520 --> 01:12:04,520 and i mean to me that's what the CRPD requires also that's like basic legal capacity free and informed consent to anything yeah i think that's an excellent point yes in in the way i approach open dialogue and in the training that we got that was a fundamental question is the participation in the dialogue voluntary and then what do you do if one person doesn't want to be part of the dialogue in there it absolutely is not something 598 01:12:04,520 --> 01:12:20,520 consistent with the open dialogue that there would be coercion or pressure but again you have to be very very sensitive that that coercion and pressure might be underground and so starting out by saying it's a voluntary process is key 599 01:12:20,520 --> 01:12:38,520 and i think that part of the appeal of open dialogue is that it kind of comes from this very clinical sort of angle of how do we improve outcomes and it sort of becomes safer for some clinicians and some policymakers to kind of take a step towards because it doesn't have that right space to abolitionist 600 01:12:38,520 --> 01:13:02,520 it's a clinical practice within a hospital setting but on the other side of it you can look at it and you can say well actually if we want to reduce forced treatment and we want to reduce medication use how is the way that we get there and open dialogue is very very promising from that standpoint because of the outcome measures in the way in which they've been able to achieve that and what i'm seeing in 601 01:13:02,520 --> 01:13:17,520 for example the parachute project in New York and other places that open dialogue has been used even in in private outpatient context you're getting people out of forced context you're getting people out of using so much 602 01:13:17,520 --> 01:13:38,520 medication so it is a step in the right direction but what i would like to see is a stronger emphasis as you're bringing on the abolitionist piece and then a very very strong understanding of open dialogue as one tool within a larger set of possible tools that's consistent with that disability justice standpoint 603 01:13:38,520 --> 01:13:59,520 I also actually wanted to say something first about just my book in terms of what's what's in it because number one i'm talking about the two changes in terms of approaching crisis that I think are necessary 604 01:13:59,520 --> 01:14:27,520 one is de-medicalization and the other in the book I call de-judicialization and I really mean not treating crisis as something not treating a personal crisis as something that the state needs to intervene in or society needs to intervene in if I'm experiencing a life crisis it's my perspective that's 605 01:14:27,520 --> 01:14:55,520 that defines it as a crisis not somebody else's if somebody else thinks that I'm experiencing a crisis and they want something to be done they can either find or for me support find a way to ask me if I need support and if I am wanting it to connect me with support or it becomes a conflict issue between me and that person 606 01:14:55,520 --> 01:15:23,520 and that's not something that requires support or they can get support for themselves maybe they need support exactly so for myself as a survivor of psychiatry and somebody who steers clear really of of almost anything that's even calling itself any kind of support I would not touch I cannot touch the mental health system I hear you 607 01:15:23,520 --> 01:15:52,520 I have like an allergy to it that's at a spiritual very deep level what would I actually think of as wanting for myself or being willing to accept if I if I needed something that's where I'm coming from and then also thinking about well what do we need what kind of society do we need to have to be welcoming to this kind of crisis 608 01:15:52,520 --> 01:16:21,520 kind of crisis support that I'm envisioning which is a crisis support that's not in a medical context at all it's in a community care like help people helping each other comes back to the fundamental question that I'm often raising is do we have the time to listen to each other and to care for each other voluntarily freely outside of commodities outside of marketplaces outside of job descriptions just taking the time to connect with each other 609 01:16:21,520 --> 01:16:47,520 and under a hyper pressurized neoliberal capitalist society that's being taken away from us more and more exactly so there's a few pieces in the book where I'm going into that context and connecting with the community justice alternatives movements black lives matter and the abolition of psychiatry arguments 610 01:16:47,520 --> 01:17:03,520 what I'm calling democratization of knowledge yeah I don't use psychiatry in any way shape or form I actually think diagnosis in any kind of any kind really has to be gotten rid of no kind of experts 611 01:17:03,520 --> 01:17:25,520 yeah having this position where they get to say what your reality is yeah in a more authoritative way than you do and the economic justice aspect and the core idea of demeticalization and digitalization of crisis actually makes it into the deinstitutionalization guidelines 612 01:17:25,520 --> 01:17:53,520 fantastic fantastic the deinstitutionalization guidelines is another one of these interpretive documents this one by the committee on the rights of persons with disabilities it doesn't have the same weight as the text of the convention itself but many countries take these interpretive materials seriously and so for instance in relation to legal capacity reform 613 01:17:53,520 --> 01:18:07,520 the interpretive document on on legal capacity that the committee issued was used and has been used by countries that really take an abolitionist approach on legal capacity 614 01:18:07,520 --> 01:18:11,520 just a but no what countries are at the forefront of an abolitionist approach 615 01:18:11,520 --> 01:18:31,520 well I say on legal capacity Columbia and Peru Peru in my in my view a little bit I like there's a little better than Columbia in terms of the legislation itself saying that everybody all adults have legal capacity without any kind of discrimination 616 01:18:31,520 --> 01:18:49,520 any adult can name a supporter to help them with understanding information making decisions communicating what we imagined even in the process of working on the convention was the extreme scenario of somebody who's in a coma 617 01:18:49,520 --> 01:19:01,520 okay because are you going to leave some kind of incapacity that you can declare someone incapable if they're in a coma and then other people make their medical decisions 618 01:19:01,520 --> 01:19:17,520 and what we said is well we really don't want there to be any formal declaration of legal capacity I want that if I'm in a coma if I suddenly come out of the coma and start again saying what I want I shouldn't have to go to court to get my legal capacity 619 01:19:17,520 --> 01:19:39,520 back so what we have in the framework of the convention is that if it's not possible to determine what a person's will and preferences are that there needs to be a best interpretation of that person's will and preferences 620 01:19:39,520 --> 01:19:55,520 and the way I understand that is best interpretation means best interpretation and you have to still keep checking it out with that individual and not trying to bully them 621 01:19:55,520 --> 01:20:08,520 and really it's meant to be used in a situation like coma it's really not meant to be used like if a person is saying a lot of inconsistent things 622 01:20:08,520 --> 01:20:19,520 you know we're entitled to our ambivalence also but that framework is included in the Peruvian and the Colombian legislation so 623 01:20:19,520 --> 01:20:36,520 and in Peru still a lot of people remain locked up in psychiatric institutions who are essentially what is what they say abandoned people who have been locked up for a long time and don't have connections 624 01:20:36,520 --> 01:20:57,520 so the guidelines on liberty and security of the person had already done quite a lot to say you know to kind of dot the eyes and cross the tees about all the different ways and all the different reasons why involuntary commitment is prohibited and involuntary treatment is prohibited 625 01:20:57,520 --> 01:21:09,520 and endorsing the view that involuntary treatment is part of the kinds of practices that amount to torture or other ill treatment 626 01:21:09,520 --> 01:21:26,520 you know the psychiatric system is in it is a whole regime that includes long term big institutions it includes little psych wards where you can be locked up against your will in a general hospital 627 01:21:26,520 --> 01:21:42,520 it includes involuntary outpatient commitment all of that and we wanted all of that to somehow be encompassed and not just be set aside as oh those are just particular issues 628 01:21:42,520 --> 01:21:49,520 we wanted our reality to be front and center equal with everybody else's reality 629 01:21:49,520 --> 01:22:06,520 this is not you know this is not the 1970s deinstitutionalization you know this is it whatever we in the US with that history think of when we hear the word this goes a lot farther 630 01:22:06,520 --> 01:22:14,520 and it really is abolitionist in terms of abolishing disability based incarceration 631 01:22:14,520 --> 01:22:27,520 and there's quite a lot that's pretty revolutionary in it so I want to say a few of those things first as I said about the crisis support issue 632 01:22:27,520 --> 01:22:38,520 I'll read this paragraph paragraph 10 persons with disabilities experiencing individual crises should never be subjected to institutionalization 633 01:22:38,520 --> 01:22:50,520 individual crisis should not be treated as a medical problem requiring treatment or as a social problem requiring state intervention force medication or force treatment 634 01:22:50,520 --> 01:23:07,520 that's a little repetitive but it captures very strong yeah and the thing that I want to say about any of this in what it's what what's in this document is it's all about whether advocates use it 635 01:23:07,520 --> 01:23:21,520 it's all about whether advocates pull up these pieces and say okay you know we're advocating for abolition and here's the way the UN supports us 636 01:23:21,520 --> 01:23:32,520 so that's why like I really want to talk about this stuff so I'll read a few more pieces states parties should immediately provide individuals with opportunities 637 01:23:32,520 --> 01:23:42,520 to leave institutions revoke any detention authorized by legislative provisions that are not in compliance with the convention 638 01:23:42,520 --> 01:23:46,520 whether under mental health act or otherwise etc. 639 01:23:46,520 --> 01:23:57,520 so the revoking of detention as something that they should do immediately then in a paragraph where it talks about forms of institutionalization 640 01:23:57,520 --> 01:24:12,520 it says institutionalization of persons with disabilities refers to any detention based on disability alone or in conjunction with other grounds such as quote unquote care or quote unquote treatment 641 01:24:12,520 --> 01:24:21,520 and they mention among other kinds of institutions psychiatric institutions they mentioned forensic psychiatric settings 642 01:24:21,520 --> 01:24:36,520 halfway homes group homes and many other things and then it says mental health settings where a person can be deprived of their liberty for purposes such as observation care or treatment and or preventive detention 643 01:24:36,520 --> 01:24:46,520 or a form of institutionalization and to me a setting where people can be deprived of their liberty 644 01:24:46,520 --> 01:25:03,520 even if you actually are on a voluntary status I want our advocates to be able to take that phrase and go around to places where people may be on voluntary status 645 01:25:03,520 --> 01:25:09,520 but they're there they're on voluntary status under a threat of involuntary 646 01:25:09,520 --> 01:25:16,520 under a threat exactly that I mean that's that happened to me a Langley Porter psychiatric institute at UCSF 647 01:25:16,520 --> 01:25:26,520 Medical Center I was allowed to be on the voluntary ward because they would put me back up on the locked ward if I misbehaved or I tried to leave 648 01:25:26,520 --> 01:25:32,520 they told me if I tried to leave I would be put in the locked ward exactly so it's not wasn't voluntary at all 649 01:25:32,520 --> 01:25:43,520 right so that can be important to make sure that you're reaching everybody in any kind of a psych setting where you can be deprived of your liberty 650 01:25:43,520 --> 01:25:56,520 another piece that I think is important related to the demeticalization because the mental health system is still in control of policy 651 01:25:56,520 --> 01:26:07,520 and so long as they're in control of policy who's the government going to look to for what we need what kind of sports and services we want 652 01:26:07,520 --> 01:26:17,520 so there are things in a few other places that say those who perpetrated institutionalization can't be in charge of new services 653 01:26:17,520 --> 01:26:30,520 nice but how narrowed you are widely that's interpreted you know and but here we have states parties shouldn't sure that options outside the health care system 654 01:26:30,520 --> 01:26:45,520 that fully respect the individual self-knowledge will and preferences are made available as primary services without the need for mental health diagnosis or treatment in the individual's own community 655 01:26:45,520 --> 01:27:08,520 exactly it's not such a strange idea I mean we provide homelessness services we provide domestic violence services that are just based on needs and voluntary participation when the resources are there we're not requiring a diagnosis or a medicalization of persistent domicile deficit disorder or 656 01:27:08,520 --> 01:27:25,520 or a massacistic personality disorder which actually was there was a push in the in the APA to get that into the DSM and link it to to so called battered wives syndrome and all this very completely misogynist patriarchal violence that's being medicalized 657 01:27:25,520 --> 01:27:37,520 fortunately there was a big pushback against that but why not provide services and options for people completely outside of a medical context which we already do for these other other areas 658 01:27:37,520 --> 01:27:54,520 exactly and housing should be neither under the control of the mental health services or other service providers that have managed institutions nor conditioned on the acceptance of medical treatment or specific support services 659 01:27:54,520 --> 01:28:13,520 don't hand them that power these guidelines and anything else that I've ever seen really does not define what what amounts to an institution and I think in these guidelines and also in the US 660 01:28:13,520 --> 01:28:31,520 and in something in legislation that's proposed in the US but hasn't passed Congress yet called the Disability Integration Act there's a strong push against any kind of any kind of housing that's like managed by some kind of staff 661 01:28:31,520 --> 01:28:36,520 that's like where the staff is not about managing the housing but managing the people in the housing 662 01:28:36,520 --> 01:28:49,520 yeah who would want your therapist and your landlord to be the same person exactly and the last thing I'm going to mention is the issue of reparations for any kind of institutionalization 663 01:28:49,520 --> 01:29:03,520 they're talking about survivors of institutionalization throughout this document and saying survivors are entitled to effective redress and reparations 664 01:29:03,520 --> 01:29:24,520 reparations is not just compensation it's not just a personal apology it includes a lot of systemic measures it includes that the violations actually have to be stopped and there has to be guarantees that the violations won't be repeated 665 01:29:24,520 --> 01:29:45,520 which actually could encompass both changes in legislation and whatever social and economic measures we can argue are actually needed to make sure that institutionalization doesn't happen again that these forms of coercion and violence don't happen again 666 01:29:45,520 --> 01:30:01,520 so I think there's a lot for advocates to potentially work with but then it's a big discussion of so okay if governments aren't really even going to abolish for psychiatry are they going to give us reparations 667 01:30:01,520 --> 01:30:22,520 but for me I think using a reparations framework is a way to stand on a ground that says very clearly this is a human rights violation it reinforces an abolitionist standpoint and says this never should have been done in the first place 668 01:30:22,520 --> 01:30:38,520 exactly exactly and because of the ways it has impacted us I know all the ways that it impacted me in my life you know over the years you know that didn't just end when I got out 669 01:30:38,520 --> 01:30:45,520 absolutely you know I think there's a lot that that we can work with in those terms 670 01:30:45,520 --> 01:31:13,520 I think we desperately need a legislative champion in congress we need somebody who really understands our issues and will push them in an uncompromising way I don't think it's too much to ask that at least one or two representatives in the house actually get it there's so much pharma funding there's so much health industry and insurance industry funding that I don't feel that we have that voice and it's uphill 671 01:31:13,520 --> 01:31:42,520 but we really need someone who's pushing our issues in the national political limelight so Tina let people know how they can get in touch with you and where they can go to find out more about your work you can certainly go to the website for my book which is reimagining crisis support dot org I have a page on academia dot e.d.u with a lot of my writings there's the cross website chr us p dot org 672 01:31:42,520 --> 01:31:56,520 I also have a blog on mad in america and that's one of the ways you can contact me I'm pretty available and I'm on social media so this I'm pretty easy to find 673 01:31:56,520 --> 01:32:03,520 Tina minkowitz thank you for joining us today on madness radio thanks so much for having me will 674 01:32:03,520 --> 01:32:32,520 you've been listening to an interview with Tina minkowitz Tina is a survivor of psychiatric institutionalization and human rights lawyer she was a leading contributor to the drafting and negotiation of the United Nations convention on the rights of persons with disabilities she's the founder and president of the center for the human rights of users and survivors of psychiatry and is the author of reimagining crisis support matrix road map and policy 675 01:32:32,520 --> 01:32:50,520 what does it mean to be called crazy in a crazy world listen to madness radio voices and visions from outside mental health 676 01:32:50,520 --> 01:32:59,520 music