Forced Treatment & MECFS

Why PsychiatRic Abolition and ME Activism Are Intertwined

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What Is Abolition?

Abolitionists believe that no person should be imprisoned against their will and envision a world where this is never the case. In the present, we fight for reform to carceral justice (ie. Prisons & jails) and carceral psychiatry (ie. Psychiatric hospitals).

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Your Right To Refuse Care

In almost all of medicine, you have a right to refuse medical care. Even if a treatment is life-saving, for example chemotherapy, blood transfusion, heart medication, you have a right to choose not to accept it.

The only time this does not apply is if a patient is deemed incapable. This may happen to disabled people, especially when relatives petition for guardianship which gives them control of the disabled person's finances, care, and freedom.

However, the bar for incapacity is relatively high, which makes the easiest way to pass it psychiatric evaluation.

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Forced Mental Health Treatment

By far the most common reason for being deemed incapable of medical autonomy is mental health. If someone is not deemed "rational" or "sane" then it is assumed they cannot put their own interests first.

The most common example is the 72-hour psych hold for those deemed "a danger to themselves or others."

Once within a psychiatric facility, patients may be pressured to remain, not informed of their rights, or legally compelled to remain. They are frequently prescribed strong psychiatric medications that can be difficult to withdraw from without the ability to consent.

Unlike the legal system, psychiatric patients do not have the right to an attorney, nor are they presumed "innocent until proven guilty" but rather are forcibly imprisoned until they prove their sanity.

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Mythbusting Round!

Psych Abolitionists

Psych Abolitionists Hate Meds:

We believe that like with any treatment patients should have a right to consent or refuse. Medication is only 1 part of mental health treatment.

Psych Abolitionists Hate Therapy:

Once again patients should have right to consent or refuse. Therapists should respect patient's worldviews and peer support therapy is another great option.

While inpatient non-consentual therapy is advocated against protocols like advanced directives can be used for consentual inpatient treatment during crisis.

Psych Abolitionists Don't Care If People Die of Suicide:

Risk of suicide goes up after psychiatric hospitalization. Fear of incarceration stops many people especially suicidal people from getting the mental health treatment that would actually save their lives.

Psych Abolitionists Are Anti-Science:

We believe that mental health is tied to the societies we live in and that individual treatment can only go so far. Mental health must be part of a larger societal conversation. However, psych medication and evidence-based therapy are still incredible tools produced by science to be used by those who desire them.

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Forced Mental Health Treatment & MECFS

While ME patients do not have a psychiatric illness (unless they have a comorbid one) many psychiatrists still believe MECFS to be a psychiatric disorder. Thus they may argue that being bedbound and avoid post-exertional malaise is behavior that is a "danger to oneself" or represents inability to care for oneself.

All of this has been used and continues to be used to incarcerate ME patients in psychiatric hospitals where they are generally forced to undergo now disproven therapies like graded exercise and curative CBT. These therapies as well as the trauma of incarceration and the gaslighting that ME is not a real biological illness can permanently harm patients.

For severe ME patients, psych wards can and have been deadly in multiple recorded and likely more unrecorded instances.

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Anti-depressant Overprescription

Evidence to support antidepressant use is strongest in the short term and long-term antidepressants can actually contribute to the development of chronic depression.

Prior to the invention of antidepressant medication, 85% of people with depression went into remission within a year. In contrast, the recent large STAR*D trial on the efficacy of antidepressants found only 3% of patients went into remission.

The prevalence of the 9pt questionnaire as a tool for GP prescription of antidepressants has lead to frequent overprescribing, especially in patients with prominent tachycardia or fatigue (both common in MECFS) which can artificially inflate scores.

Of course, depression is actually very common in MECFS due to the low quality of life and chronic illness grief. So this is certainly not to say that antidepressants have no use in MECFS, especially when used with synergistic benefits in pain reduction and/or sleep improvement. Antidepressants can be a very helpful symptom management tool and should be in the toolbox.

But patients have the right to be fully informed about the medications they are prescribed and should not be forced to take any drug and supported through withdrawal effects if they choose to go off of medications.

https://www.madinamerica.com/drug-info-antidepressants/

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Mythbusting Round!

ME Advocates & Psychiatry

ME Advocates & Mental Health:

Most ME advocates support mainstream psychiatry for mental health issues. All support ME patients getting mental health support for comorbid psychological distress.

ME Advocates do not want to be associated with mental illness due to stigma:

We simply support the science that says that ME is not a psychological disorder.

We do not want harmful and ineffective treatment.

ME Advocates are anti-therapy:

We do not believe therapy can cure MECFS because there is not evidence supporting this and attempting to cure biological illness with therapy amounts to gaslighting.

ME Advocates are anti-psych meds:

Many ME patients are highly sensitive to medications. ME advocates, like any patient's advocates, support patient choice in all treatments. Many ME patients benefit greatly from psychiatric medication for depression or various comorbidities or treating chronic pain by addressing neurotransmitters.

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Silencing & Neglect Of Mental Health Concerns In Severe MECFS

Because carceral psychiatry is so dangerous to severe MECFS patients, many avoid seeking mental health treatment out of fear of harm.

However, this in itself becomes a harm of carceral psychiatry.

Severe MECFS patients have one of the lowest qualities of life of any illness, so depression and anxiety about the future is a normal response. Suicidal ideation is common with approximately 1 in 5 MECFS patients dying of suicide, 10 times more than patients with depression alone.

Additionally, neuroinflammation and psychiatric manifestations of comorbidities like mast cell activation can cause severe psychological distress.

Patients deserve a safe and accommodating environment to receive treatment for mental health comorbidities.

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Alternatives: Anti-Carceral Psychiatry & Peer Support

Anti-carceral psychiatry refers to psychiatrists and psychologists trained in conventional mental health therapies who are committed to working with patients to reduce harm without resorting to violence in the form of police reports or forced psychiatric hospitalization.

I recommend all patients with MECFS seek out anti-carceral practicioners.

Peer support goes beyond the traditional psychiatric model and supposes that many "mental disorders" are in fact rational responses to systemic discrimination, injustice and opression and/or traumatic life events.

A peer suppport model encourages us all to seek support from peers aka others with simular life experiences and struggles. This support can be a more formalized theraputic experience, a formal support group, or prioritizing informal support from friends and family.

Peer support does not minimize or dismiss mental health. Rather it encourages us to see mental health not as seperate from society but as integral to a healthy society. Not everyone has mental illness. But everyone is part of a society.

We should support people with mental illness and see them as sources of wisdom on who our society fails rather than a problem to be hidden away.

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Patients with Myalgic Encephalomyelitis must care about Psychiatric Abolition because we are and have been the targets of Psychiatric Incarceration.

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MECFS is a severe neuroimmunological disease which has been and in many parts of the world continues to be seen as psychiatric.

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The reason ME Advocacy rejects the treatment of ME as psychiatric is not because psychological illness is less valid. It is because there is strong evidence like CPET and Tilt-Table testing, neuroinflammation, and post-exertional immunological changes that show ME to be physical.

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But being wrongfully grouped alongside people with mental illness should give us empathy for the blatant disregard of human rights in the mentally ill.

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The imprisonment of patients with ME / CFS whose disease is seen as psychological in psych wards is not only wrong because the disease is not psychiatric. It is wrong because the way that psych wards use violence to enforce behavioral change is never right.

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Psychiatric incarceration increases the risk of suicide after release. It frequently traumatizes survivors and it is not an effective way to deal with mental or physical illness.

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We rely on psych wards because we have no choice. For patients who are actively a danger to themselves or others we do not have systems of community care and people within our communities trained in de-escalation to deal with these issues.

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But neither do psych wards. These places do not de-escalate they use the removal of freedom and coercive violence to make patients behave.

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We need an alternative to psychiatric incarceration. We need the ability to support people with difficult mental and neurological disease within our communities. We need peer support and antiCarceral psychiatry and psychology.

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People with ME should understand better than anyone that locking someone away and pretending the problem doesn't exist is not a solution, certainly not a humane one.