Blog des AK Psychiatriekritik der NFJ Berlin

Historic Moment for the Right to Legal Capacity

On Tuesday April 8, 2014, the UN Committee on the Rights of Persons with Disabilities adopted its first General Comment, on Article 12 which deals with the issue of legal capacity.  It was a moment that brought tears to my eyes and I turned and hugged another woman who was crying – Raquel Jelinek from the Mexican group CONFE, which advocates for the rights of people with intellectual disabilities.  I had not expected the adoption to happen so quickly and had not expected my tears.

As I listened just beforehand to the Committee read and discuss the finalized version of the General Comment, I found myself considering the text as I had done during the drafting and negotiation of the Convention itself: wow, this is good; this is not great but I can live with it . . .  there were no parts that I couldn’t live with.  The text of this General Comment is better than the Convention itself, in terms of the satisfying experience of hearing it made explicit that nonconsensual psychiatric interventions must be eliminated, and that the “controversial” concept of mental capacity can never be a basis for depriving anyone of legal capacity, including the capacity to perform legal acts, make one’s own decisions and create legal relationships. It is truly a watershed for users of survivors of psychiatry and people with psychosocial disabilities throughout the world, and for people with intellectual disabilities as well.

In short, with its adoption of General Comment No. 1, the Committee on the Rights of Persons with Disabilities has brought to fruition the work that was started way back in 2002 when the World Network of Users of Survivors of Psychiatry joined other organizations in starting to think about what rights we wanted to address in the new treaty.  The work is far from over, and the General Comment gives us a solid platform to push for changes in domestic laws throughout the world in countries that have ratified the CRPD.  But at the level of international law, the General Comment certifies that the CRPD establishes the fundamental shifts in perspective and principles that we advocated for, and that we believed as a matter of legal interpretation as well as social justice must be the correct understanding of the CRPD text.


Antidepressants Make Things Worse in the Long Term

So, since at least 1994 – twenty years ago – researchers and commentators have been adducing evidence and arguments that antidepressants, even though they may have been initially successful in altering feelings of depression, when taken for extended periods may actually lead to persistent, treatment-resistant depression. Discontinuation of the drug sometimes produces a slow and gradual lightening of the mood, but in some cases this does not occur, and the chronic depression can become more or less permanent.

Amazingly, or perhaps I should say predictably, organized psychiatry has not launched a major investigation into this matter, and I can find no indication that any such investigation is in the works.


Are Neuroleptics “Anti-Psychotic”? Harrow’s 20-Year Outcomes

Martin Harrow along with his colleagues T.H. Jobe and R. N. Faull has published another paper on the long-term outcome of people who experienced a psychotic episode.  Funded by a grant from the Foundation for Excellence in Mental Health Care, this paper adds to our knowledge of an extremely important and valuable study.

In this blog, I am going to first review some material that may be familiar to many of you. I will then talk about this latest paper.

In the late 1980′s Harrow began the Chicago Follow-up Study. A group of 139 individuals were assessed during a hospitalization for psychosis.  They were then assessed at 2, 4.5, 7.5, 10, 15 and 20 years.   The sample included 70 individuals who met the diagnostic criteria for schizophrenia spectrum disorders and 69 individuals diagnosed with mood disorders.  The sample was comprised of consecutively admitted patients to two Chicago hospitals who were considered in the early phase of their disorder; for 41% this was a first admission and for 25% it was the second admission.


Antidepressants and Preterm Birth: More Concerning Findings

An important new research paper was published this week on the topic of antidepressant use during pregnancy and preterm birth.  The issue is a crucial one as preterm birth (i.e. birth at less than 37 weeks gestational age) is one of the most challenging problems facing the obstetrical community today.  Rates of preterm birth have been increasing over the past two decades.  Babies born early have increased risks of morbidity and mortality.  At the same time, rates of antidepressant use during pregnancy have increased dramatically.  In the 1970s and 1980s rates of antidepressant use in pregnancy were less than 1%.  These rates have rapidly increased over the past 25 years and now around 10% of pregnant American women are on these medications.  So the following questions are crucial: what are the effects of antidepressant medications on pregnancy and the developing fetus?  Are these medications linked to the important problem of preterm birth?

In this new research study Krista Huybrechts, MS, PhD, and her co-authors (of which I was one) did a comprehensive search of studies on women taking antidepressants during pregnancy.  Of the many studies on the topic, we found 41 that had information comparing women on antidepressants to those not taking the medications, as well as information about when the patients delivered (i.e. whether they were preterm births or not.)  We then did a detailed meta-analysis and found that an overwhelming majority of the studies (39 of the 41) showed increased rates of preterm birth in the antidepressant group.   When all studies were combined there was roughly a doubling of preterm birth risk in women on these medications into the third trimester.


Self Help is no help for inequality

For all the howls of rage from plutocrats like Tom Perkins and Ken Langone over possible tax rate increases, there has been relatively little public anger about the increasing wealth disparity in the United States — especially compared to the past.

During the Progressive era in the early 20th century and the Great Depression, we saw violent strikes and marches on Washington. These days, we have an army of sometimes-intemperate bloggers and a labor movement so bereft the United Auto Workers union recently failed to mobilize workers in a Volkswagen factory in Chattanooga, Tennessee. Occupy Wall Street, meanwhile, is now a distant memory, even as more than half of all Americans say they believe the nation remains in an economic recession.



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