Earlier this year, the United Nations published a new report1 by Special Rapporteur Dainius Pūras. The report expands on a 2017 publication2 (also authored by Pūras), which called for ‘little short of a revolution in mental health care’3 to overturn the prevailing biomedical paradigm.
Pūras begins by summarising some of the major issues he raised previously:
Mental health systems worldwide are dominated by a reductionist biomedical model that uses medicalization to justify coercion as a systemic practice and qualifies the diverse human responses to harmful underlying and social determinants (such as inequalities, discrimination and violence) as “disorders” that need treatment.4
Addressing the consequences of medicalising misery (and other psychological experiences), the report goes on to state:
Medicalization deflects from the complexity of the context as humans in society, implying that there exists a concrete, mechanistic (and often paternalistic) solution. That reflects the unwillingness of the global community to confront human suffering meaningfully and embeds an intolerance towards the normal negative emotions everyone experiences in life.5
The report also highlights the dangers of medicalising children:
The tendency to medicalize children’s distress can lead to an approach whereby multiple medications are prescribed for various symptoms, where some symptoms are iatrogenic effects of the medications, despite the lack of evidence for poly-pharmacy in children. Children have a right to thrive, to develop in a holistic way to their full potential and enjoy good physical and mental health in a sustainable world. It is crucial that investments are made to provide the nutritional, educational and societal resources for healthy development, and that the effects of adverse childhood experiences are addressed. . . . It is important to train mental health professionals and educate broader society to understand that psychotropic medications are not effective first-choice treatment options in child and adolescent mental health care and that excessive use of psychotropic medications is not compliant with the right to health. A broad variety of other interventions, such as watchful waiting and other psychosocial interventions, must be available, accessible, acceptable and of sufficient quality.6 (Emphasis added)
Pūras later describes how coercive practices negatively impact relationships with clients:
Acceptable and high-quality therapeutic relationships between providers and users of services must be based on mutual respect and trust. However, trends persist in modern mental health legislation and clinical practices worldwide that still allow the proliferation of non-consensual measures. Coercion erodes trust in mental health services and cannot be viewed as aligned with a rights-based approach.7
A common tactic used by proponents of (and apologists for) the status quo is to dismiss these kinds of criticisms as ‘anti-psychiatry’. In defence of said critics, Pūras writes:
It is troubling to see such voices dismissed by the conventional (and dominant) psychiatric profession and its leadership. Those who speak against coercion and support the view that alternatives are safe are not unethical, negligent or derelict in their duty of care, neither do they represent “anti-psychiatry”.8
For more from Dainius Pūras, check out his Mad in America interview.
Read the extended version of this blog post here.
Footnotes
- United Nations General Assembly. (2020). Right of everyone to the enjoyment of the highest attainable standard of physical and mental health: Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Retrieved August 1, 2020, from https://undocs.org/A/HRC/44/48
- United Nations General Assembly. (2017). Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Retrieved from http://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspx
- United Nations. (2017, June 6). World needs “revolution” in mental health care – UN rights expert. Retrieved May 25, 2020, from OHCHR: http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689&LangID=E
- United Nations General Assembly, 2020, p. 4.
- United Nations General Assembly, 2020, p. 9.
- United Nations General Assembly, 2020, p. 12.
- United Nations General Assembly, 2020, p. 15.
- United Nations General Assembly, 2020, p. 6.
