[Article] The weaponization of MI, due process, and overstep of authority

[TAW122]

The weaponization of mental illness (I will refer to as 'MI' in this thread) is not only inhumane, unjust, a violation of human rights (especially civil rights), and also detrimental to people with ACTUAL mental illness(es). Before I continue, first off, what is mental illness? According to the American Psychiatric Association, one of the overseeing bodies of the psychiatric field itself, the definition of mental illness is "a health condition involving changes in emotion, thinking, or behavior (or a combination of these)." It can also be associated with distress and/or problems functioning in social, work, or family activities.

(Note: I'm not here to defend Psychiatry itself, nor offer an apologetic stance, but just using a reference in order to further make sense of what I'm going to discuss in this thread.)

Next, let's define due process. What is due process? In the legal term, due process is a fundamental principle of fairness in all legal matters, both civil and criminal, especially in the courts. (based on The People's Law Dictionary) In other words, it is interpreted as that no person shall be deprived of life, liberty, or property, without due process of law. (as per US Constitution)

And last but not least, an overstep of authority is where someone, the state (government), or institution(s) excessively impose their authority over an individual. So given the definition of due process and the fact that the laws (currently on the books) gives the state the right to override personal liberties even if someone isn't a danger to society or others. If done in other cases, this would be considered unconstitutional, illegal, and wrong, but somehow, when someone is considered mentally ill, unsound of mind, not competent, suddenly everything (awful and degrading) becomes fair game for the authorities, institutions, and people with power. It's almost like whenever one is deemed to have 'MI' or be ill, suddenly, all the legal protections, morals, ethics, and other rules and regulations in place suddenly vanish (temporary) and then people can get away with egregious violations of human rights and autonomy while leaving the individual with little recourse. Even the legal and medical system is designed in a way to sanction this kind of attitude which is disgusting.

With those points defined and established, I find it repulsive that the state (government) and other individuals, institutions (regularity bodies or organizations) have the authority and power to treat an individual(s) like a criminal despite the individual having committed no crimes, nor done anything illegal. This (on paper) would be considered a violation of civil rights IN (ALMOST) EVERY OTHER CONTEXT, yet it is somehow appropriate and legal for these actors to do this. Furthermore, this kind of treatment is criminal and inhumane if done in other contexts (the state would have committed: assault, kidnapping, false imprisonment, fraud (through sending a bill for unwanted services), stalking, to name a few). YET all of this is legal and even encouraged by prolifers. Therefore, the weaponization of MI, which is a pretext to overstepping, overriding an individual's personal freedoms, bodily autonomy not only sets a dangerous precedent for what the state can do (which in the long term can lead to overreach and overstepping of state authority), but also grossly violates an individuals rights without due process and weaponizing MI to cause harm to individuals.

Why is using 'MI' as an justification to violate another person's rights a fallacy?
The fallacy of using 'MI' as an justification, or pretext to (temporarily) violate another person's bodily autonomy under the guise of safety and 'help' is 'MI' is not something that is objectively established, but based on what society, the laws, and status quo is at a given, time, place, and culture. It is a fallacy because to use something subjective and not grounded in objective as a legal authority to regulate and dictate how others should live or go about their lives is not only an overstep of authority by the state, medical authority, entity, or individual(s) involved, but also immoral and unethical as it is a violation of an individual's civil rights. Furthermore, the fallacy itself is an insult to people who have ACTUAL mental illness(es) (which I have mentioned earlier in this thread), as it undermines and sidelines their ailments and suffering.

In the video (TRTNLE podcast #10) it shows that mental illness as a concept is flawed (21:21). Also, the dangers of the subjective criteria and what constitutes as "mental illness" can be twisted to fit an oppressor's (or in this case, society at large and the government, authority, status quo, etc.) agenda and narrative is a terrible precedent. Bertalan mentions this (at 36:45) during the podcast and how that sets up a very dangerous precedent just because one steps out of line in society and that society (as a whole) can effectively deprive an individual of one's liberty, civil rights, and personal freedom because said individual did not conform to the standards of society (despite having committed no crimes, nor done anything illegal).

In conclusion, the weaponization of MI not only sets a dangerous precedent towards liberty, human and civil rights (personal freedom), but also undermines people who are suffering from ACTUAL "MI". Furthermore, because it is based on subjective criteria, it can be abused and used as a way to dismiss, invalidate, and silence dissidents who do not agree with another's views or that of the status quo. This is really headed towards censorship, authoritarianism, and similar to that of a dictatorial state.

 

[TAW122]

Bumping this topic as I think it got buried among the other threads. Furthermore, I think this is an interesting take on the current mental health system (mostly US focused since I'm US based) all around the world. In general, the label of mental illness (or 'MI' as this article states) is ripe for abuse and inhumane treatment of others who don't fit the status quo.

 

[ConstantineXI]

I guess the question is "What would due process look like if applied here?" There are a hatful of places that have decided that a repeatedly-stated intention combined with an insufferable condition that's leading to death in the foreseeable future is enough. There are a few that have gone a bit further (generally by backing away from the need for the condition to be terminal but still excruciating and with no real prospect of improvement), but serious discussion outside of that context is still taboo...and so it's hard to imagine what it "should" look like once you get outside of a set of narrowly-constrained circumstances. [1]

This reminds me of some of the rhetoric surrounding drug addiction and politicians claiming "If we don't force people out of this condition, we're giving up on them". That's sticky because in some cases, an addiction (whether mental or physical) might be unbreakable, or the cost of doing so might not be worthwhile to the individual. The whole opiate affair comes to mind - there are folks who got addicted to e.g. Vicodin on (legitimate) prescriptions and who now simply can't break it, but somehow boxing folks into a corner where they have to track down stuff on the street (and potentially OD on undisclosed fentanyl) is the better policy prescription since that's "not giving up on them".

To be clear, there's a subset of mental illness - where one is likely to become a danger to others or has demonstrated that one likely will become such a danger/had become one - that probably mandates involuntary commitment. But boy should the bar for that - particularly on a continuing basis - be higher than it is now, especially if there's a clear lack of harm intended to others and one's situation isn't otherwise disruptive. [2]

The other jam in this general area of discussion is the simple fact that the risk of coercion/pressure is significant. Even setting aside "obvious" situations such as "I have a large life insurance policy that's about to go away", the risk of the elderly deciding on such a course could just as easily be motivated by "I've done what I want to/can do in life" versus pressure from relatives (or, so help us, the government) to reduce financial burdens going forward. This latter bit leads to its own bit of government overstepping (it's something how government overreach can happen at either end of a spectrum).

So...I'm not sure what a "reasonable" due process standard would look like here. But it's interesting to ponder, at least.

[1] This also gets tangled up in questions of methods - I'm a bit bothered by the idea that it's only "proper" if you want to take a certain set of drugs (or one of a set of fixed options) for your exit, but any other method is still "wrong" and anyone assisting them going about it the "wrong" way should be penalized. Even constraining the discussion to methods which aren't likely to cause a lot of heartburn, why should "drink this icky-tasting drug for a lethal OD" be acceptable but "OD on 100% N2O or 100% N2" not be?

[2] This gets into a strange corner with things like (voluntary) homelessness, and the interactions are almost inherently problematic.

 

[TAW122]

Indeed, the taboo of death outside of those contexts are still very much active, even in current present day (and likely to be for quite some time unless there is a sudden change in view and perception). A due process in this situation (non-terminal illness, but perpetual suffering whether it is physical, mental, or both) could include a waiting period, evaluation of whether the person understands the implications of death being permanent, and also making sure that the person repeatedly wishes to die and is unwavering. Also, during the whole process, even up until the final moment, the person is free to change his/her mind when it comes to it.

Of course, the risk of the pressure exists in these cases, but even in countries with voluntary assisted death, voluntary euthanasia, and similar laws on the books, there safeguards in place and penalties for bad actors (those who are caught for fraud, dishonesty, or even taking advantage of a vulnerable person). These safeguards greatly reduce the chances of abuse, harm, and misuse of the system and the penalties could include fines, repartitions, and even imprisonment for such actions.

Hope these answers your questions.

 

[ConstantineXI]

Indeed, the taboo of death outside of those contexts are still very much active, even in current present day (and likely to be for quite some time unless there is a sudden change in view and perception). A due process in this situation (non-terminal illness, but perpetual suffering whether it is physical, mental, or both) could include a waiting period, evaluation of whether the person understands the implications of death being permanent, and also making sure that the person repeatedly wishes to die and is unwavering. Also, during the whole process, even up until the final moment, the person is free to change his/her mind when it comes to it.

Of course, the risk of the pressure exists in these cases, but even in countries with voluntary assisted death, voluntary euthanasia, and similar laws on the books, there safeguards in place and penalties for bad actors (those who are caught for fraud, dishonesty, or even taking advantage of a vulnerable person). These safeguards greatly reduce the chances of abuse, harm, and misuse of the system and the penalties could include fines, repartitions, and even imprisonment for such actions.

Hope these answers your questions.

This seems reasonable. I might add some expectation (however variable/situational) that less extreme methods have been sought out first (this was the case in at least one Dutch case profiled on the BBC), or at least reviewed/considered. An example with physical suffering would be the use of painkillers - but those can have side-effects. Ditto with psychiatric medications (e.g. I know someone who remarked that they had anti-depressants which made them nauseous, so they had to take anti-nausea pills that made them depressed). In this case, "reviewed/considered" doesn't mean "tried for X amount of time"...to my mind it means a frank discussion and there being some reason for not trying/not continuing.

[Another example is that I have a friend with latent TB - he's tried to go through the course of antibiotics to clear his system several times, but the (mostly mental health) side-effects have been genuinely insufferable. I don't note that as him being somebody who would pursue this course, merely as an example of "There's an option but it might not work".]

For what it's worth, I think if safeguards against "prompting" were built in (pardon the analogy, but the best one I can come up with would be that you have to ask to join the Freemasons in order to join - you aren't supposed to be recruited), it would help avoid situations like that Canadian vet where a social worker suggested that they consider it for something relatively minor. The main exception(s) that come to mind would be if you're getting down an ugly terminal track...but even then, I think simply saying that the person has to be the one to initiate the discussion in some manner would make a lot of sense.

 

[Dying science gal]

So I've actually read up on this quite a bit, and something that really stood out to me was McCorkell v. Riverview Hospital, (1993), 81 BCLR (2d) 273, 8 WWR. 169, at p. 300, which straight up reads:

I am satisfied that there are adequate procedural safeguards in place in the current Act. The certification by two physicians, each independent of the other, is preferable to a hearing prior to committal because those who are certifiable are in urgent need of treatment. Applications to court are expensive and time consuming. The patient is informed, soon after admission, of the right to a review, and the service offered by CLAS (mentioned at the beginning of these reasons) provides ready advice and representation to the patient. The Act lays down time limits for the duration of involuntary status and a physician must recertify the patient or the patient will be released. The absence of any criteria for the Review Panel is inconsequential. It is unnecessary to repeat in the Act the committal criteria for the review process because a review necessarily implies the application of the same standards used in the decision of first instance.

Although seldom used, the Act provides access to the Supreme Court, under s. 27, giving the patient the advantage of a reverse onus on the hospital to justify detention, or by way of a habeas corpus application.

Having examined both substantive and procedural elements of the disputed portion of the Act, I find that a fair balance has been struck and that there is no violation of s. 7. It is, therefore, unnecessary for me to discuss the issues under s. 1.

What this basically says is that the current system where patients have to prove to a review board/tribunal that they are good to go, rather than the Director (the person/position that runs the institution) having to prove otherwise like in every other section and type of law, does not constitute any charter violations, since the Act (Mental Health Act, RSBC 1996, c 288) still allows you access to the courts where you can file a habeas corpus application, despite the significant costs and the fact that you need to hire a lawyer (since you physically can't leave). Also, unlike if you are arrested, you have to pay for your own lawyer and if you don't have money, oh well...

 

[ConstantineXI]

What this basically says is that the current system where patients have to prove to a review board/tribunal that they are good to go, rather than the Director (the person/position that runs the institution) having to prove otherwise like in every other section and type of law, does not constitute any charter violations, since the Act (Mental Health Act, RSBC 1996, c 288) still allows you access to the courts where you can file a habeas corpus application, despite the significant costs and the fact that you need to hire a lawyer (since you physically can't leave). Also, unlike if you are arrested, you have to pay for your own lawyer and if you don't have money, oh well...

I feel like there's a balance to be sought (e.g. being able to detain someone briefly pending a hearing/review, much as is the case in most criminal situations - you can usually be held for a few days without charge), but this ruling does not achieve such a balance.

I do wonder if it might not be possible to build an argument (with good lawyers and a solid test case) for the mental health detention being in essence penal/punitive - setting aside some things such as electroshock therapy, "The medication does not work and has nasty side-effects" comes to mind as a valid reason for not wanting to be treated (so long as you're not at risk for harming others). "Society's duty to care for the mentally ill" is also a mess in this context - the bloviating about "abandoning" opioid addicts rears its head, and it would seem that there should at least be some point where "society" would be reasonably permitted to agree with the person in question that some level of duty has been reached and was still insufficient. Setting aside questions of desire, some conditions (e.g. Alzheimer's) are ultimately both incurable and only able to be treated to some extent.

[The question of the costs of fighting are a mess as well, and I'd agree that the committed person should have similar rights to counsel as someone under arrest at some stage of the process. I'd also note the risk of conflicts of interest in some cases - I don't want to impugn various doctors, but I do look at the health care sector as a business, and therefore with a similarly cynical eye.]