Forced Psychiatric Commitments

By Valérie Dole, member of CICNS

The spiritual minorities are often perceived as the refuges of cranks and of the “mentally ill”, of so-called “fragile” persons in general whose capacity to make healthy choices is supposedly diminished.

This perception, made popular by the media and a few political figures, prompted CICNS to make an inquiry into forced psychiatric commitments in France.

CICNS denounces in passing the convenient amalgam which leads to anyone taking an interest in the excesses of psychiatry in France being associated with Scientology.

See on this subject the letter of Philippe Bernardet, research fellow at the CNRS:

“For some ten years, in effect, no criticism of psychiatric practice can be formulated in France without one being immediately branded a Scientologist. (…) Why, moreover, should it be forbidden to talk with Scientologists denouncing certain practices in psychiatry? Besides the mad to be excluded and the delinquents to be locked up, are there new pariahs never to be frequented, on pain of risking the stake oneself? Is this how one envisages fighting the cults and the churches, to leave standing only the republicans of the Jacobin club?” (1)

Facts not without echoes of the famous Paris “map of the cults”

“In a recent report, the Court of Accounts was alarmed at the explosion of the number of forced psychiatric hospitalisations (in 2000, the Court recorded 52,000 forced hospitalisations, an increase of 45% over 1988). Because in France the administration decides commitments, one can, on the occasion of a quarrel between neighbours, a divorce or a difficult inheritance, a work dispute, or for political reasons, find oneself locked up in a psychiatric hospital, ‘treated’ against one’s will, indeed ill-treated… France is the only European country to practise administrative confinement, that implacable machinery made possible by the administration’s manipulation of psychiatry, but also their connivance. Veritable zones of lawlessness exist, like the psychiatric Infirmary of the Paris Prefecture of police (I3P).” (Enfermez-les tous!, by Philippe Bernardet and Catherine Derivery, Robert Laffont).

“France, in the matter of psychiatric commitment, remains one of the last countries in Europe to involve the police. In Paris, the latter has every power: from that of judging that someone is ‘insane’ to that of having him locked up, the compulsory placement being signed by… the Prefect of police himself. But if a policeman’s training includes learning the use of force, it has never provided - and so much the better - for transforming constables into psychiatrists. Yet here they are apprehending, confining, filling in certificates, indeed injecting drugs, at a frightful rhythm: 3,000 people on average each year for Paris and its suburbs! As a result, the abuses are innumerable.”

Concerning compulsory hospitalisations (HO): “The signature of the prefect of police, who is moreover responsible for the management and direction of the psychiatric infirmary of the Paris prefecture of police, will validate this decision impossible to contest, and which forbids the person struck by it to oppose his ‘treatment’. Without the assessment of a judge, and on the sole faith of the medical certificate delivered by the doctor carrying out the ‘hearing’, the police can deprive someone of his liberty without further form of trial, and force him to accept a treatment whose first objective is to break all his resistance.” (Les Asiles de la Honte, Pascal Colombani, éd. Carnot)

“The motives of daily life which allow someone to instrumentalise psychiatry and to use commitment as a weapon to settle a conflict opposing him to a third party are: divorce, inheritance, neighbourhood conflict, school conflict, professional conflict… But beyond the circumstantial and conjunctural elements (malevolence of some, imbalance of others, complaisance, indeed medical complicity), there exist structural causes (legislation, the current exercise of psychiatry, judicial and police practices…) which make such medical imprisonments possible. Among others, a particularly important space of incarceration is the psychiatric infirmary of the Paris prefecture of police (I3P). This singular structure goes back to 1845, the date of the creation of a medical post at the prefecture of police. It has functioned since then in complete illegality!!! Not only because it has no legal existence, but because the rules governing it are derogatory and contravene numerous legislative and regulatory provisions: absence of control, diversion of public and individual guarantees, publicity of passage through this infirmary in violation of medical secrecy… Yet it is nearly 3,000 people who each year are brought to spend from several hours to several days behind these bars.” (1)

“In 2002, the Society of psychiatrists of the sector hospitals of Paris (Somepsy) revealed that in Paris, ‘between 1989 and 2000, the rate of compulsory hospitalisations (HO) went from 10 to 20% of hospitalised patients, which is an absolutely enormous figure compared with the other French departments (of the order of 1 to 3%)’.”(2)

“In the current movement of continuous increase of incarcerations of every order (delinquency, trade-union activities, the residence of foreigners…), psychiatric commitment constitutes an additional worry when one knows the manner in which despotic regimes, notably the so-called popular democracies, were able to use it to organise the repression of their opponents. It is indeed another face of the carceral reality of our society that these practices unveil, aiming to conceal, behind the medical domain, a police activity. Certain slips of the tongue do not deceive: one has thus come to speak of ‘psychiatric police custody’. The risk, already realised in certain circumstances, of generalising situations where the doctor intervenes as an agent of police is real. And yet it seems to preoccupy general opinion only feebly, including within the medical profession!”

“While waiting for an end to be put to commitments, the framing of these practices urgently requires the reinforcement of the rights and legal guarantees of the committed, notably by the limitation of the powers of the police in favour of those of the judicial authorities, perhaps a little less inclined (let us hope) to free themselves from public and individual rights and liberties. French medicine has in effect this particularity of being the most condemned by the European Court of Human Rights for disputes relating to psychiatry (33 condemnations in the second half of 2000, for example).(1)

Everywhere in France, the inconvenient are locked up

“Nearly 2,800 Lyonnais were forcibly committed to a psychiatric hospital in 2003, against 1,600 in 1993, that is, an increase of more than 70% in ten years, and ten points more than the French average. An impressive figure which represents 18% of the 15,000 psychiatric hospitalisations in Lyon for 2003, against 13% at the national level.

“Hospitalisation under constraint at the request of a third party (HDT) represented 80% of commitments under constraint in Lyon last year. A letter from a relative and two medical certificates suffice to obtain the commitment of a patient.

At the origin of this phenomenon: social misery, unemployment, drugs, alcohol… And above all solitude.” (…)

“According to Georges Hron, regional delegate of the Groupe Information Asiles, ‘15 to 20% of hospitalisations under constraint are abusive.’ (GIA is an association of former patients who consider they were committed abusively.)

“It is very rare for the judge to consider that the patient’s state does not justify a measure of constraint and to demand the lifting of the measure: on average barely one case a year. ‘The judges take no risk. And if you have already been hospitalised, you are presumed ill,’ asserts Georges Hron.” (Lyon Mag, 1 December 2004) (1)

What does the law say?

“150 years after the law of 1838, the law of 27 June 1990, motivated by the search for a better guarantee of patients’ rights, begins by dispensing with their consent. It permits the imposition of two types of hospitalisation under constraint.

“Thus, a person suffering from mental disorders can be hospitalised at the request of a third party (HDT), if his disorders ‘make his consent impossible’ and if ‘his state requires immediate care accompanied by constant surveillance in a hospital milieu’. It is carried out on the basis of a request for admission presented by a person capable of acting in the interest of the patient (family or other) and of two medical certificates.

“Exceptionally, and in case of ‘imminent peril’ for the patient’s health, admission may be pronounced on the basis of a single medical certificate and the request for admission (this procedure was used in 23% of cases in 1995).

“Compulsory hospitalisations (HO) are for their part pronounced by order, in Paris, of the Prefect of police, and in the departments, of the Prefects, on the basis of a medical certificate, for ‘persons whose mental disorders compromise public order or the safety of persons’. This certificate may not emanate from a psychiatrist having a legal link with the receiving establishment; on the other hand it may be drafted and signed by a private doctor, by a doctor of another establishment or by a non-psychiatrist doctor of that establishment.

The doctor gives an opinion following what he has observed or heard concerning the ill person, when he has not been able to examine him.

“In case of imminent danger for the safety of persons, attested by a medical opinion or, failing that, by public notoriety, the Mayor and, in Paris, the police commissioners, order with regard to persons whose behaviour reveals manifest mental disorders all the necessary provisional measures, on condition of referring the matter within 24 hours to the Prefect, who rules without delay and issues, if there is cause, an order of compulsory hospitalisation.”

“The imprecision of the law brings out a risk of amalgam between mental disorder and irresponsibility. It exposes the persons to whom it applies to the arbitrary. In the two measures of hospitalisation under constraint, nothing in effect makes it possible to discriminate what arises from pathology from what arises from a conscious and responsible act.” (3)

“‘To commit someone without serious reason requires the complicity of a general practitioner and then of a psychiatrist, which is impossible,’ rules a psychiatrist of the Vinatier… According to Dr Ph. de Labriolle, hospital psychiatrist, Lyon: ‘This objection was, at least partially, receivable before 1990. It no longer is, for two principal reasons: the psychiatrist drafting the second admission certificate and the psychiatrist drafting the 24-hour certificate are work colleagues; there is no need for complicity, that is to say shared malevolent intention; it suffices to let the need for security generated by the interdependence between colleagues do its work, indeed simple passivity.’” (1)

“The law of 1990, whose concern was to improve the protection of persons receiving care and to limit recourse to commitment, remains a law of exception. The evaluation made of it today tends to demonstrate that it has not reached these objectives.

“Hospitalisations under constraint increased considerably between 1980 and 1995 (+94% for hospitalisations at the request of a third party and +48% for compulsory hospitalisations from 1980 to 1988, the date from which they diminished, only to increase again from 1992. They reach, in 1995, the figure of 1988). For the sociologist P. Bernardet, research fellow at the CNRS, the law of 1990 is more a ‘law of police of the insane’ than a law permitting access to care. The examination of the motives of the compulsory hospitalisations which he gives us makes one fear ‘a medicalisation of delinquency’, even more than the law of 30 June 1838.

“In the same sense, the tidying-up of article 64, replaced by 122-1 in the new penal Code, maintains the mentally ill person in the straitjacket of irresponsibility, which the notion of non-punishability would have avoided.

“One sees today that the mentally ill person remains an individual whom the legislator removes from ordinary law. For his own good or for the protection of others, the administrative and medical power continues to deny him certain fundamental rights. The increased sensitivity with regard to the status of hospitalised patients, the will to respect individual liberties, collide in practice with the institutional organisation. The principles of free choice of practitioner, of free movement, of the possibility of refusing a treatment, of communicating (…) do not apply to this population. These restrictions, justified by the search for the ‘good of the patient’, do not rest on clearly stated criteria, which still leaves a large place for the arbitrary and the subjective.

“The 20th century will not bury with it society’s ambivalence towards the mentally ill, which psychiatric praxis only reveals: it remains torn between indignation at confinement and the fear that madness inspires in it.” (3)

Proposed resolution No. 1459 registered at the Presidency of the National Assembly on 25 February 2004, tending to the creation of a commission of inquiry into the growth of the number of psychiatric commitments in France, presented by M. Georges HAGE, Deputy.

”(…) The study of the reports drawn up by the departmental Commissions on psychiatric hospitalisations (CDHP), created by the law of 27 June 1990, reveals numerous irregularities in the matter of commitment and constraint in psychiatry. Certain problems appear notably recurrent and pose serious questions with regard to the necessary respect for individual liberty. In certain departments, it is thus noted that there is ‘an increase in the number of hospitalisations at the request of a third party (HDT) as an emergency, when this measure ought to remain exceptional. For the CDHPs, this is an abusive banalisation.’ This recourse to the emergency procedure makes it possible in effect to dispense with gathering the opinion of a doctor from outside the hospital, a fundamental guarantee which the old law of 30 June 1838 had posed to avoid all abuse and arbitrariness in this domain. In some thirty departments, emergency admissions have thus become the majority of all admissions at the request of a third party, whereas they remained marginal before 1990 and the law of 1990 stipulates that they must be exceptional.

”(…) a last example, probably the most worrying for the future of the Nation: the CDHPs note that ‘behavioural and social difficulties of minors are too often transformed into hospitalisation under constraint when other solutions ought to exist’.

”(…) In recent years, the Courts of appeal of Paris and Douai have been led to order the State to pay indemnities of more than 45,000 to 190,000 euros to the victims of abusive commitments of some ten days to several months. By a Resolution DH (97) 394 of 17 September 1997, the Committee of Ministers of the Council of Europe found a violation of the European Convention for the protection of human rights and fundamental freedoms in the case of an arbitrary commitment of one year, and ordered the French Government to pay 230,000 F to the victim.

”(…) The General Directorate of Health is for its part still not in a position to provide the detailed statistical figures for the year 2000, having until now been able to process only those of 1999. The delay in processing the information thus now reaches 4 years, when the safeguarding of individual liberty is at stake. It seems there is a will to conceal a very worrying aspect of current psychiatry.” (2)

Mme Maryvonne BRIOT, deputy, reports the following answer of the National Assembly (circular No. 1598 registered at the Presidency of the National Assembly on 12 May 2004):

“One will however regret that the author of the proposed resolution retained the terms ‘hospitalisations under constraint’, and still more those of ‘psychiatric commitments’, which seem to hark back to darker times when psychiatry was powerless in the face of cases of deep psychosis and when the care of these persons was limited to an approach of assistance and security. Far from being a measure of confinement and sanction, hospitalisation without consent constitutes in reality a measure of restraint justified by the specificities of certain mental illnesses, namely denial of the illness and refusal of care, which justify that restrictions may be brought to the exercise of their individual liberties. Thus, as the report of the national group evaluating the law of 27 June 1990 rightly underlined, ‘hospitalisation without consent is totally different from commitment and placement. It is always first of all a health measure, ordered by a doctor’.

”(…) By a letter dated 7 May 2004, M. Dominique Perben, Keeper of the Seals, Minister of Justice, informed the President of the National Assembly that ‘judicial proceedings are regularly instituted following psychiatric commitments denounced as arbitrary’ (4)

On 14 July 2004, Philippe BERNARDET, Research Fellow at the C.N.R.S., answers Mme Briot:

“It is with consternation that I took cognisance of your report on the proposed resolution of M. Georges HAGE tending to the creation of a commission of inquiry into the growth of the number of psychiatric commitments in France, but also of the record of the debates which took place within the Commission for Cultural, Family and Social Affairs following your presentation. Such an absence of critical sense on the part of the Nation’s elected representatives on so delicate a subject frightens me, when what is at stake is the keystone of every democracy (individual liberty) and probably humanity’s most precious good (mental health).”

“It is nevertheless impossible, in 2004, to accept that the national representation should continue to ignore in this way the innumerable protests and cries of distress of the victims of abuse and of the arbitrary - in great part state-driven - including those suffered by persons afflicted with mental disorders who manage to access care only in a relation of violence and of negation of their rights, their dignity and respect for their person. The Groupe Information Asiles and the national Federation of associations of psychiatric patients (FNAPPsy) possess, in their archives, thousands of alarming letters and testimonies on the way their authors were treated. The courts now condemn, each year, several persons responsible for abusive psychiatric hospitalisations, where, before the 1980s, there was less than one condemnation every ten or twenty years.” (1)

According to the testimony of Ph. de Labriolle, psychiatrist of the Lyon hospitals:

“I come to the statement of my essential worry, shared by many:

The structural modifications of the public psychiatric hospital milieu tend towards the disappearance of medical ethics within it. The independence of the doctor is affirmed and concretely discouraged. Without the independence of the doctor from his employer, the supervisory authorities, and ‘collegial’ normativity, the user’s confidence is subject to the vagaries of the conscience of his interlocutor of the moment. Now, we have seen that everything leads the doctor to conformity with the expectations of those more powerful than he. The consented abandonment of ethics in favour of the concrete exercise of this conformity collides with the vigilance of no precise body. If this exercise is damaging, it can only be to the detriment of the user, who, in the matter, proves to be the weak link: applying to the courts has remained, for a century and a half, a marginal act.

”(…) Faced with a useless, illegal or arbitrary commitment, a hospital psychiatrist takes risks in refusing it. His interests of serenity, stability and career are at stake as soon as he ceases to be a cog or a clone, by challenging the authorities so that the law is applied. In doubt, keeping the patient is always more secure for oneself than giving him back his liberty and thwarting those who wanted the commitment. In its present state, the public psychiatric hospital illustrates André Gide’s aphorism in ‘Return from the USSR’ (1936): ‘To be happy, be conforming.’

”(…) It is essential to make users aware of their right of access to their hospital medical file, reaffirmed by the law of 4 March 2002, even for a hospitalisation without consent. A systematic claiming of files is a procedure which would contribute to having the law applied and the formal rights of patients respected.” (1)

“Following the double murder of Pau, in the night of 17 to 18 December 2004, when two women’s bodies were discovered terribly mutilated, Philippe Douste-Blazy, then Minister of Health, presented a ‘mental health plan for 2005 to 2008’, promising more than a billion euros in investment and operations to be devoted to this plan, a considerable effort by the community at the height of the stakes of mental health. ‘You see, both by the method, by the means released and by its objectives, it is not a simple plan I wish to build but a genuine policy of mental health.’” (5)

“A year on, public psychiatry is still waiting for the effects of the mental health plan.” (6)

“For years, the psychiatrists have been announcing that they are ‘on the edge of a great discovery’ in their understanding of the mental; or they announce the latest ‘miracle drug’ which will bring happiness to all. And each year, on the basis of these promises, billions come to be added to the billions already spent on research - to send new rats into mazes and test more chemical pills on new guinea pigs and new monkeys. For what result? The statistics of ‘mental health’ continue to worsen - according to the psychiatrists themselves.” (7)

But in what way do current psychiatric practices concern the spiritual minorities?

The Ministry of the Interior gives this advice, in case of conflict with a cult:

“If no direct action against the cult is possible, or if you do not wish to use it: try to dialogue with the person who belongs to it and who is close to you. If this person cannot be reasoned with, and if she makes a significant financial contribution to the cult, you can have her placed under guardianship, curatorship or judicial protection. (8) Judicial protection is a measure of provisional incapacity, of a duration not exceeding 3 to 6 months. It can be requested by a member of the family or a neighbour and be put in place very quickly (24 hours). The patient loses no legal capacity (apart from that of being designated a juror at a trial), nor any liberty: nobody can impose on him or forbid him anything whatever. This placing under judicial protection constitutes a sort of ‘framework of prudence’ while waiting for things to settle. At the patrimonial level, it presents the advantage of facilitating the annulment of an act which the dependent adult may have signed some time before, even though he was no longer perfectly master of his decision.” (9)

“If these measures are not applicable, you can have recourse to the protection of the adult of sound mind provided for by article 488 paragraph 3 of the civil code.” (8)

In a circular of the Keeper of the Seals of 29 February 1996 on the fight against attacks on persons and property committed within the framework of movements of a cult character:

Distribution to the prosecutors general, and, through the latter, to the public prosecutors

“The vigilant exercise of the civil attributions of the public prosecution service, outside the cases provided for in articles 375 and following of the civil code, should make it possible to ensure as well as possible the protection of persons, adult or minor, subjected to the hold of cult movements, as well as of their circle. In this regard, the procedures of placement under judicial protection, guardianship or curatorship can be an adequate response for adults. (10)

In a circular of 1 December 1998, the Minister of Justice addressed several recommendations to the prosecutors general, in order to reinforce the effectiveness of the fight against the cults:

”(…) The circular insists, like that of 29 February 1996, on the necessity of institutionalising, at the level of the prosecutors’ offices, coordination meetings involving all the services of the State confronted with dérives sectaires, in particular the police and gendarmerie services, the regional directorates of labour and employment, the departmental directorates of judicial protection of youth, the academy inspectors of national education and of youth and sports… (11)

The General Directorate of Social Action (DGAS)

Five sub-directorates compose the General Directorate; three of them carry the public policies of fighting exclusions, of responding to dependence and of aid to autonomy.

The sub-directorate of insertion policies and the fight against exclusions coordinates the interministerial policies of prevention of the risks of exclusion, of insertion and access, and of the fight against ill-treatment of vulnerable adults, the follow-up of the apparatus of legal protection of adults in relation with the Ministry of Justice, the management of the credits of State guardianship and curatorship as well as the follow-up of the policy of fighting against dérives sectaires. (12)

CICNS wishes to bring to the attention of the public and the authorities the current excess concerning psychiatric commitments. Must the designated enemies of the republic, often scapegoats or mirages generated by the ambient psychosis, undergo the waywardness of a democracy in search of stability?

Are we going to return to the dark ages of the inquisition, the concentration camps, the gulags, in order to control the populations who express the necessity of reforming our institutions? It is a serious question which deserves better than the pathetic reports of a few soulless officials.

Sources:

(1) http://www.groupeinfoasiles.org/

(2) http://www.assemblee-nationale.fr/12/propositions/pion1459.asp

(3) http://www.serpsy.org/piste_recherche/violence(s)/nelly4.html

(4) http://www.assemblee-nationale.fr/12/rapports/r1598.asp

(5) http://www.premier-ministre.gouv.fr/information

(6) http://psychiatriinfirmiere.free.fr/infirmiere/infirmier/presse/monde/sante-mentale.htm

(7) http://www.elysees-monceau.com/Therapie/PolitiqueSante/internements_abusifs.htm

(8) http://www.interieur.gouv.fr/rubriques/b/b2_vos_demarches/b21_fiches/Conflits_avec_les_sectes

(9) http://www.seniorplanet.fr/sp.fr.php?id=2286&action=article&id_cat=342&page=1

(10) http://www.justice.gouv.fr/actua/circulaire%20du%20011298.htm

(11) http://www.senat.fr/rap/l99-131/l99-1312.html

(12) http://www.travail.gouv.fr/ministere

See also http://www.breggin.com on the effects of neuroleptics and other medicines used in psychiatry (site in English)