But, It Can’t All Be Human Rights …Right?

If you’re asking this question, you’re in good company. In fact, there are a lot of questions we need to be asking. For years now, we’ve been hearing that there is a ‘brain disease’ called ‘mental illness’ which results from a ‘chemical imbalance’ that only psychotropics and neuroleptics can help. We’ve also been told that poverty, addiction, violence, and crime are primarily individual rather than community responsibilities. We frequently hear arguments, some of them ‘scientific,’ that certain groups of people are irresponsible, anti-social or just plain ‘bad.’

So where do we draw the line? How much can we explain in terms of personal, biological or moral short-comings? How much can we attribute to human rights - and the impoverished relational quality of the communities we live in?

We Don't Really Know  

The problem is that we don’t really know… Mental health professionals mostly focus on signs and symptoms. But, these could easily be after-effects of human rights deprivations.

As a case in point, we now know that pre-existing childhood trauma (violence, sexual abuse, neglect, conflict, bullying, discrimination, poverty, homelessness, hunger) is a fact of life for as high as ninety (90!) percent of public mental health clients.  The same (90!) is true for those in substance use, criminal justice and hard to house contexts. (1)

'Mentally Ill' or Just Scared? 

Human rights deprivations like these can cause a lot of distress.  But it doesn't just stop in the mind. The body takes that distress and expresses it physically. This plays out in the nervous system as the survival response of ‘fight-flight-freeze.’ (2) 

So how do we know if someone is ‘mentally ill’ or just getting really upset because important needs seem threatened? The following examples illustrate how hard it is to tell the difference: 

• We currently call a lot of people manic, oppositional, defiant, borderline and antisocial - especially if the person is angry, intense or expressing something strongly. But what if many of us are just fighting back or hanging on the best way we know how? 

• We often pathologize common expressions of fear, sadness - like 'paranoia', 'panic attacks', anxiety and depression. We also pathologize common ways that many people try to cope with uncomfortable feelings, including 'obsessions', 'compulsions', addiction and avoidance. But how does that square with the reality that a lot of us have painful, terrifying, overwhelming problems that no one would want to face?

• As a society, we have marginalized and shunned a huge number of people who we claim are 'schizophrenic', 'psychotic', 'catatonic', 'dissociative' or 'disorganized.'  But, what if freezing off awareness - or creating a different one - is just what humans do sometimes in order to protect ourselves from trauma of unbearably painful proportions? 

No one has a clue...

How many people could be misdiagnosed for reasons just like this? No one has a clue. The possible impact of human rights has been almost entirely overlooked! 

Years after research made clear that huge people are experiencing the effects of trauma, nearly everyone is still being treated and labeled as having primary ‘mental illness.’ To make matters worse, trauma is often a euphemism. It's healthcare lingo that obscures the social and relational nature of the violations that people experience.  The harsh underlying reality, all too often, is that someone human rights were violated - and not with good effect.  Yet, virtually no effort at all is made to assess for contributing human rights concerns or to assist people to resolve them. 

Science should be scientific

This is bad, irresponsible science. (3)   It is also bad, irresponsible healthcare. (4) 

This must change.

Human rights concerns could be playing a huge role. We need to find this out. You can’t expect people to engage in treatment designed for illnesses they do not have. You can’t expect people to progress when the system of ‘care' ignores their real problems.

Reputable behavioral health researchers have an ethical duty to ask -- and answer -- these questions. So do providers of mental and behavioral health services. So do politicians and our government.  So does everyone who says they care and means it.

It's time to move beyond a mediocre mental health system.  We have to get to causes and concerns.   We need to research the impact of community human rights deficiencies.  We need to understand how, why and to what extent, human rights concerns affect individual health and wellbeing.

We also need to research the effect on outcomes:

• What happens to 'mental illness' when we help people recover their human rights? 
• If people are supported to live and be well, does 'mental illness' occur at all?  
• If it occurs, does it stick?  For how many people, how much of the time?
• What are the relative short and long-term costs?  
• Does it pay to keep drugging people as a primary strategy?  
• Would we be better off in investing in resources  - like housing, transportation, wellness clubs, childcare, quality food and education - that remedy existing societal deficits?

It's time to start asking the right questions.  That means asking the 'rights' questions.

Resources:

(1) National Council Magazine (2011:2): Breaking the Silence: Trauma-Informed Behavioral Healthcare), http://www.integration.samhsa.gov/clinical-practice/NC_Mag_Trauma_Web-Email.pdf. 

(2) Fight or Flight Response, https://en.wikipedia.org/wiki/Fight-or-flight_response. 

(3) Whitaker, R. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown 2010) It is also bad, irresponsible healthcare. 

(4) Whitaker, R. & Cosgrove, L, Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform (Palgrave Macmillan 2015);