Variety instead of Stupidity: About the Different Positions within the Movement of (ex-) Users and Survivors of Psychiatry Translation by Pia Kempker "Take or abolish psychiatric drugs? Reform or abolish psychiatry? An insoluble contradiction?" About this topic the author held a key note speech at the congress of the German Organization of (ex-)Users and Survivors of Psychiatry on October 12, 1997 in Kassel (FRG). There he describes the different trends within the movement of (ex-)users and survivors of psychiatry and advocates the respectful exposition. He is convinced that the described problem is a universal one. "We want a different psychiatry" is said in a flyer of the German Organization of (ex-)Users and Survivors of Psychiatry, "we demand the development of efficient alternatives to the mentality in nursing and supervising of the conventional medical psychiatry". I'm talking about "our cooperation as partners with equal rights", and as one of the tasks of the union the "calling in of the duty of agreement for medical measures of treatment as for mentally ill people" is mentioned. In the chapter "More human conditions of life" "less psychiatric drugs and more psychotherapies" are asked for, and depression and psychoses were not to be suppressed by drugs but to be taken seriously in their meaning. Different ideas in the organization About 665 (ex-)users and survivors of psychiatry are members of the organization in 1997. As the opinion research poll about the improvement and/or introduction of quality of psychiatric treatment has shown, the differences in how the members imagine a different psychiatry are considerable. Some want a psychiatry without psychiatrists, that means the abolition of psychiatry and a non-psychiatric care system instead. The others want better psychiatrists, more money for psychiatry for that more staff can be engaged, hoping that then the pleasant and therapeutic talks, that are nowadays generally missed, can be held. Some want delimitation, a completely non-psychiatrically oriented self-help and securing of their civil rights and their human rights as protection against psychiatric encroachments. The others want the development of a psychiatry that is determined by psychiatrists, (ex-)users and survivors of psychiatry and relatives together. Similar differences appear in the valuation of psychiatric drugs, the most important treatment method in psychiatry: Some people take psychiatric drugs with the conviction of not being able to live without them, whereas the others decline them with the conviction that psychiatric drugs are pure poison for the nerves. These two principal conflicts always played a part in the past and led to conflicts. Representatives of radical positions of both sides did not become a member of the German Organization of (ex-)Users and Survivors of Psychiatry, or they left it again with the opinion that the organization was too antipsychiatric on the one hand or too reformist and believing too much in psychiatry on the other hand. What is in this controversy? Are the conflicts of such a fundamental meaning that further arguing is programmed, that the danger of more and more frustrated members leaving the organization is inevitable? What do (ex-)users and survivors of psychiatry want at all? By my experience I know that many generally tend to wish to enjoy their lives, to be let alone, to have contact to like-minded people and to live tolerable lives. A change of psychiatry is not on their order of the day, either because they think psychiatry is o.k. or because they are alone and do not see a chance for them. For the others there is generally an attitude of central importance, that can be described best as 'empowerment'. (Ex-) users and survivors of psychiatry want to preserve or win back the competence over their own lives. It is the criterion that is brought by many (ex-)users and survivors of psychiatry all over the world, when they characterize alternative or emancipatory psychosocial institutions, no matter if they are psychiatric institutions or self-help groups. Empowerment—so the definition—means:
In the opinion research poll in 1995, the members of the organization declared what a changed psychosocial area shall look like. Over 100 members participated in the poll. In their statements, psychiatry got an almost crushing refusal. Only ten per cent of the answering stated that they found help for solving their problems in psychiatry. Often (wo)man's dignity was injured. In spite of being prescribed by law, there was no extensive information about treatment risks. For being able to talk of a qualitatively acceptable psychiatry, the following fundamental criteria have to be fulfilled: Observance of the dignity of (wo)man, warmth and human bestowal, individual company, a relation full of confidence instead of fear. There are many useless things in psychiatry: for many (ex-)users and survivors of psychiatry the whole institution together with the psychiatrists is useless. In general, the following factors were found to be useless: violence, the use of psychiatric drugs, coercive measures, electroshocks, fixation. Medical (wo)men who believe that they know more about their patients than they themselves, are useless. Alternatives are important for giving options to choose on. Concerning the question what these alternatives shall be like, the following suggestions were made: alternative drugs, e.g. homeopathic remedies, self-help, runaway houses, alternatives according to Mosher and Laing, soft rooms à la Soteria (Peeck/von Seckendorff/Heinecke 1995). Suggestions of the European Network Wherever (ex-)users and survivors criticize psychiatry unaffectedly and freely, similar ideas are given. When the European Network of (ex-) Users and Survivors of Psychiatry was asked for a statement by the World Health Organization (WHO), it submitted a similar catalogue of demands as the German Organization of (ex-) Users and Survivors of Psychiatry. In between, organizations of (ex-)users and survivors of psychiatry of about 30 countries are represented in the Network, which was founded in 1991: from Finland to Italy, from the Faro Islands to Bulgaria, from Lithuania to Greece. This representative organization asked the WHO to include the following criteria into a new definition of the psychiatric quality control:
Alternatives of psychiatry Why do projects like Soteria which become or became practice always have to be abroad? The exception there is in Germany seems to confirm the rule that the institutional psychiatry in this country does not accept alternatives. The exception is the runaway house in Berlin, the first anti- and non-psychiatric project which managed to become an official institution, i.e. an institute with a formal authorized license and, a lot more important, with paid, on the wage scale of civil servants—even if on a low level—oriented jobs (Kempker 1998; Wehde 1991). The following German projects are still in the stage of planning:
I know that I picked out the institutions which comply with my preference. There are, too, imaginations of (ex-)users and survivors of psychiatry in direction of day and treatment centers, that are more or less near to psychiatry and foresee quick treatment possibilities, where the (ex-)users and survivors of psychiatry do not always and not unconditionally want psychiatric drugs—understandably. In general these institutions are rather likely to be called reform-psychiatric institutions because they have psychiatric employees and clear hierarchies, maybe they give a bit of a right of contribution (not everyone wants to decide on his or her own), practice the medical understanding of illness. The ones who prefer these institutions are represented in the German Organization of (ex-)Users and Survivors of Psychiatry. Abolition or reform: a conflict that devides? I come back to the question asked in the beginning: Reform or abolish psychiatry? An insoluble conflict? In practice, this controversy is still there, in theoretical and ideological discussions, in the kind of institution that each single one prefers. And in theoretical discussions the conflict "Reform or revolution and/or here abolition of psychiatry" is important for getting mental clearness of where oneself stands, where the others stand, to understand where the differences are and what the others want, even if it is not the same as oneself wants. But "Abolition of psychiatry and provide alternatives instead"—the one extreme—will ridicule itself if the corresponding positions do not relate to the interests of (ex-)users and survivors of psychiatry, and "reform attempts" will also ridicule themselves if it is only about improvement of psychiatry. When we see all the mentioned demands, projects and hopes, the different imaginations tending to "reform" or to "abolition and alternatives" are always noticeable—but why should a coexistence be impossible as long as there is no fighting? And why not also a reciprocal support? How conflicts are to be solved was shown in the controversial discussion about the at that time still so-called "treatment contract" and "the psychiatric testament". First it seemed as if the treatment agreement—as it is called now—would stand in aggressive competition to the psychiatric testament. Finally there was a respectful discussion, taking the arguments of the opposite side seriously, that now admits the (ex-)users and survivors of psychiatry a fair decision to choose the kind of beforehand instruction which they think is best in their situation. Some trust in psychiatrists, others mistrust them, some feel depending on them, others feel offended by them. Who of us wanted to command which feelings the individuals shall have? Take or decline psychiatric drugs? The valuation of the dispense and/or taking of psychiatric drugs is a very controversial topic. The taking of neuroleptics, antidepressants, lithium, anti-epileptic drugs (e.g. carbamazepine) and tranquilizers can lead to apathy, to emotional plate lining, depressions, suicidality, paradox phases of excitement or confusion, intellectual disorders, lacks of creativity, concentration or remembering, status epileptic, weakening of the immune system, hormone or sexual disorders, chromosome and pregnancy damages, damages in the blood, disorders in the regulation of the body temperature, heart problems, damages of liver and kidney, skin and eyes, Parkinson damages, hyperkinesia, muscle cramps, movement stereotypes and much more (Lehmann, 1996). On the other hand many (ex-)users and survivors of psychiatry made the experience that they cannot be without psychiatric drugs in the situation of life they are in at the moment, or that they shorten a mental crisis with a short-time taking of psychiatric drugs and so avoid to be brought into psychiatry, where would probably be given psychiatric drugs for a long time. There are very often irritations when people who decline psychiatric drugs meet those who take them. In fact it is the decision of each individual person if he or she wants to take these substances, for whatever reason. Indeed, there are arguments against the free reasoning and/or a liberal basic attitude:
As to all these reasons, the use of psychiatric drugs is to be judged with skepticism. Nevertheless the decisions of the users about taking psychiatric drugs are to be respected: especially if they achieve to overcome escapeless conflict situations, which would end in psychiatry, with a very short, very low-dosed, very low burden of risks by reflected and self-determinate taking of psychiatric drugs. Also to be respected is the decision of users to take psychiatric drugs, no matter of what reason, in what time period and with which grade of content with being informed or not informed about the risks. Special sympathy and solidarity are due to the (ex-)users and survivors of psychiatry who are forced by nerve damages caused by psychiatry or social conflict situations to take psychiatric drugs to be able to live in any way. Particularly people affected by addiction make clear that user-controlled institutions for crisis cases are to be made up, so that the first taking of psychiatric drugs can be prevented. Necessary reflection of the differences Therefore we have to be aware of the stress that exists between the individual needs of the (ex-)users and survivors of psychiatry, who have a right on defining their conflicts, needs and risk readiness, on the one hand the danger that comes from the power demand of psychiatry (the biological psychiatry and the social psychiatry), politicians without responsibility and the profit-oriented drug industry. This stress can only be long-time mitigated if the consumers of psychiatric drugs as well as the people who are forced to take these substances have guaranteed human rights not depending on the diagnosis, simple access to financial compensation in case of needs, a right on help without psychiatric drugs and an alternative offer of non-psychiatric help. If we want to change something and if we want understanding by psychiatrists, therapists, politicians or whomever, we can only demand this understanding authentically if we try to understand ourselves. What do all the structures that we want to build up help the solidarity among each other if we saw on their basic pillar day and night? The fact that we were in psychiatry, have a psychiatric stamp, may be something we have in common, but we are too different in origins, beliefs, political interests and personal preferences to let the psychiatric community—a community primary defined by the outside—solve all problems of being together. Moreover, if we want respect, no matter of whom, we have to respect ourselves and treat different-thinking persons with respect, even if we do not share or understand their opinion in some cases (see Kempker 1991). As well as we demand choice possibilities for the case that we need and search for help, we have to concede to each other the right to wish and work on the form of changed psychiatry and/or alternative that we choose to be the most reasonable one for us. If the basis a change in the direction of more humanity, sensible alternative, in the direction of legal coordination, better life conditions: why should different strengths lead to unbridgeable differences? Only together we can carry through our demands. Sources
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