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19. Alternative Report on Force Drugging, Forced Electroshock and Mental Health Screening for Children, ICCPR Coalition Report

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Submission of the Disability Working Group
To the Human Rights Committee
Prepared by Tina Minkowitz and Al Galves, with the assistance of Celia
Brown, Myra Kovary and Eve Remba
On behalf of:
New York Organization For Human Rights and Against Psychiatric Assault
Mind Freedom International
Law Project for Psychiatric Rights
Executive Summary
1. The United States has a double standard on the use of mind-altering
drugs. On the one hand, the U.S. understands the intentional infliction of
mental suffering by administration of mind-altering drugs on a person as
torture; yet on the other hand it condones the practice of force drugging
when the victim is a person with psychosocial disabilities.
2. A report by five UN special rapporteurs condemned the force drugging of
Guantánamo detainees as a violation of the right to free and informed
consent and its “logical corollary, the right to refuse treatment”.
3. Force drugging and forced electroshock violate article 7 and article 18 of
the Covenant; maintaining separate standards in relation to people with
psychosocial disabilities violates article 2. A standard of legal capacity
that disqualifies people with psychosocial disabilities from exercising free
and informed consent denies equal protection of the law in violation of
article 26.
4. Neuroleptic drugs1 and electroshock inflict severe mental suffering and
cause permanent neurological damage. Neuroleptics drugs can cause
paralysis of the will along with uncontrollable restlessness. Electroshock
leaves many people with irrevocable memory loss and cognitive disability.
5. Gender and racial disparities intersect with disability-based discrimination.
Electroshock is administered twice as often to women as it is to men, often
under circumstances that demonstrate a gender-related motive. Force


Neuroleptic drugs are a major category of drugs used in psychiatry and are among the most
severe in their disruptive effects on consciousness. However, the principles at issue apply to any
force drugging.

drugging in the community by court order is used in New York State
disproportionately against people of color, mostly African Americans.
6. A new model of legal capacity being developed by people with disabilities
would eliminate incapacity determinations and instead provide support to
all who need it to facilitate their decision-making. The support model is
based on choice in a context of interdependence, rather than selfsufficiency, as a paradigm for legal capacity. Since everyone has a will
and is capable of making choices, legal capacity is accessible to all on an
equal basis, with the applicable standard for children being articulated in
CRC article 12, a right to freely express their views, which are to be given
due weight in accordance with the child’s age and maturity.
7. Adoption of the support model of legal capacity is necessary to eliminate
discrimination in the right to free and informed consent, which underlies
protection against medical practices amounting to torture or cruel,
inhuman or degrading treatment or punishment.
8. Mass screening of children for mental illness with only passive consent by
their parents (i.e. parents can opt out but no affirmative consent is
required, and there is no requirement of consultation with the children at
all), with the result that children are drugged with psychotropics, violates
their rights under article 7.
1. The Committee’s concerns
1. In 1995, the Committee recommended increased efforts to eradicate
persistent discrimination in the United States based on race and gender. 2
Disability-based discrimination similarly impedes equal implementation of
the covenant, both alone and in combination with race and gender, as
documented in this report.
2. The Committee has expressed concern about non-therapeutic medical
experimentation on minors and people with impaired decision-making
capacity including “mentally ill persons”3 based on surrogate consent.4 In
a broad sense, the topics addressed by this report constitute nontherapeutic medical experimentation.
Little is known about the
relationship between the effects of electroshock and neuroleptic drugs on
the brain, and changes in consciousness and behavior. It is, however,
well established that these procedures cause serious neurological

Concluding Observations of the Human Rights Committee: United States of America.
03/10/95. U.N. Doc. CCPR/C/79/Add.50; A/50/40, paras 266-304 [hereafter Concluding
Observations] paragraphs 270, 295.
The preferred term is persons with psychosocial disabilities or users and survivors of psychiatry.
Concluding Observations, supra note 2, paragraphs 286, 300; List of issues to be taken up in
connection with the consideration of the second and third periodic reports of the United States of
America, U.N. Doc. CCPR/C/USA/Q/3, 30 March 2006, paragraph 20.

damage as well as psychological trauma.5 Use of these methods remains
experimental and users often comment that they feel like “guinea pigs”.
The question of whether they are therapeutic depends on context; in
coercive circumstances the decision to treat states of consciousness or
behavior as unhealthy and needing therapeutic treatment is essentially
punitive, while with free and informed consent it is a philosophically
controversial6 but nevertheless valid individual choice.
administration of neuroleptic drugs or electroshock in psychiatry could
therefore be treated as a type of nontherapeutic experimentation for which
surrogate consent cannot be legitimately given.
From a disability
perspective, the concept of impaired decision-making capacity as a legal
category justifying surrogate consent for adults is flawed because it
inherently discriminates based on disability with the effect of restricting
self-determination and impeding the equal exercise of rights.7 For adults,
therefore, free and informed consent is required; while for minors the
limited right of participation in decision-making is insufficient protection
and administration of psychotropic drugs should be prohibited.
2. Force drugging and electroshock of adults in psychiatry
a. Relevant ICCPR Articles
Article 2, guaranteeing non-discrimination in enjoyment of rights protected in the
Article 7, guaranteeing that no one will be tortured or subjected to cruel, inhuman
or degrading treatment or punishment
Article 18, guaranteeing freedom of thought and that no one will be subjected to
coercion that impairs the ability to have or adopt a religion or belief
Article 26, guaranteeing equal protection of the law
b. Double standard for torture
3. Force drugging and forced electroshock strike fear into the heart of
anyone placed at risk. The first Special Rapporteur on Torture mentioned
neuroleptic drugs (commonly used in psychiatric institutions) as an

Breggin, infra note 16 (iatrogenic neurological disorders created by the neuroleptic drugs are
evidence of brain damage); Robert Whitaker, The case against antipsychotic drugs: a 50-year
record of doing more harm than good, in Medical Hypotheses (2004) 62, 5-13. See for research cited in
Whittaker article, and for additional
See CEDAW General Comment No. 21, paragraphs 7-8 and discussion infra paragraphs 18-20
and 22-26.

example of physical torture8, and human rights organizations take up the
cause of political prisoners who are considered sane by independent
doctors but labeled mentally ill and drugged in their own countries.9
4. Five UN Special Rapporteurs investigating the situation at Guantánamo
condemned both force-feeding and force-drugging of detainees as a
violation of the right to free and informed consent and its logical corollary,
the right to refuse treatment.10 The report also noted that integration of
medicine into a system of coercion violates medical ethics. The report
does not distinguish between detainees based on disability.11
5. The United States maintains a double standard on forced psychotropic
drugging and related procedures. In its reservations deposited with
ratification of the Convention Against Torture, the United States included
an understanding of the Senate that “mental pain or suffering refers to
prolonged mental harm caused by or resulting from…. 2) the
administration or application, or threatened administration or application,
or mind altering substances or other procedures calculated to disrupt
profoundly the senses or personality… or 4) the threat that another person
will imminently be subjected to… the administration or application or mind
altering substances or other procedures calculated to disrupt profoundly
the senses or personality.”12 Yet, in cases involving people with
psychosocial disabilities, both federal and state law hold that an
individual’s liberty interest in refusing psychotropic drugs can be limited
based on a compelling government interest.13
c. Force Drugging with Neuroleptics
6. The United States uses neuroleptic drugs extensively in psychiatry, and
appears to have used them on detainees at Guantánamo. After Shah

Report by UN Special Rapporteur Mr. P. Kooijmans, 1985/33 E/CN.4/1986/15, 19 Feb. 1986,
para. 119,
For example, Human Rights Watch, Uzbekhistan: Psychiatric Punishment Used to Quash
Dissent (Tashkent, October 25, 2005).
Situation of detainees at Guantánamo Bay: Report of the Chairperson of the Working Group
on Arbitrary Detention, Ms. Leila Zerrougui; the Special Rapporteur on the independence of
judges and lawyers, Mr. Leandro Despouy; the Special Rapporteur on torture and other cruel,
inhuman or degrading treatment or punishment, Mr. Manfred Nowak; the Special Rapporteur on
freedom of religion or belief, Ms. Asma Jahangir and the Special Rapporteur on the right of
everyone to the enjoyment of the highest attainable standard of physical and mental health, Mr.
Paul Hunt, U.N. Doc. E/CN.4/2006/120, [hereafter UN Guantánamo Report] paragraphs 54, 7282.
From the news article referred to infra note 14, it is likely that some if not all of those who were
force drugged were labeled with mental illness.
Declarations and Reservations to the Convention Against Torture, United States of America,
Riggins v. Nevada, 504 U.S. 127 (1992); Rivers v. Katz, 495 N.E.2d 337 (1986). Rivers is a
leading state law case on the issue of right of involuntary psychiatric inmates to refuse treatment.

Mohammed attempted suicide, he was forcibly injected with an unknown
drug that left him feeling paralyzed and unable to “think or do anything” for
one month.14 Mohammed says that some people were being injected
every month. This description is consistent with the drug haloperidol
decanoate15, a long-acting neuroleptic delivered as monthly injections.
Subjective reports and research confirm the disorienting effects of
haloperidol and other neuroleptics, for example:
Your thoughts are broken, incoherent, you can't hold a train of thought
for even a minute. You're talking about one subject and suddenly
you're talking about another... Your mind is like a slot machine, every
wheel spinning a different thought.16
I was horrified to see how I deteriorated intellectually, morally and
emotionally from day to day. My interest in political problems quickly
disappeared, then my interest in scientific problems, and then my
interest in my wife and children.17
What we have found is that most people with schizophrenia dislike
taking the drugs they are being prescribed... [T]he negative parts [of
the side effects] are perceived as quite often worse than the illness
itself.... [I]n the anonymity of phone calls to SANELINE, even the most
deluded person is often extraordinarily articulate and lucid on the
subject of their medication…..Almost all of our callers report
sensations of being separated from the outside world by a glass
screen, that their senses are numbed, their willpower drained and their
lives meaningless. It is these insidious effects that appear to trouble
our callers much more than the dramatic physical ones, such as
muscular spasms.18
7. Besides disorientation and numbing, neuroleptics induce movement
disorders that can also have a psychic dimension.
Recognized today as the most frequent (5% to 76% incidence) and
distress EPS [extra-pyramidal syndrome, a type of adverse effect of
neuroleptic drugs], akathisia was relatively ignored by researchers
until recently. This may be partly because the problem is often
subjective, described differently by patients: inability to sit still, a
sense of gloom and anxiety originating in the abdomen, restless legs,

James Meek, “People the Law Forgot”, December 2, 2003, The Guardian. See also supra note
10, UN Guantánamo Report, paragraph 75.
See for the complete
Physicians Desk Reference information on haloperidol decanoate.
Peter R. Breggin, M.D., Psychiatric Drugs: Hazardous to the Brain, 1983 p. 23.
Id., p. 25. These statements were quoted from former political prisoner Leonid Plyushch.
David Cohen, “A Critique of the Use of Neuroleptic Drugs in Psychiatry,” in Fisher and
Greenberg, eds., From Placebo to Panacea: Putting Psychiatric Drugs to the Test, 1997, p. 202.

and so forth … Akathisia is frequently accompanied by a dysphoric
mental state, described by some normal subjects as a "paralysis of
will" … A medical student who received 1 mg of HPL [haloperidol; 1
mg is a fraction of the usual dose] described the sensation of an
external force forcing him to move.19 [Internal references omitted]
8. It may be impossible to obtain accurate information about how prevalent
force drugging is in the United States. The mass media promote the
misconception that neuroleptics treat an illness, when in reality these
drugs cause illness, brain damage and early death.20 Neuroleptics are the
primary drug used in institutions to numb people’s minds and make them
more manageable. There is no healing in psychiatric institutions except
that which happens accidentally, from human interactions among people
reaching out for mutual support. Coercion and control are the rule, and
fear is the main weapon.21 In this atmosphere, people will agree to take
drugs by mouth to avoid an injection; will fear going to court and risking
public humiliation; will believe what the doctors tell them because they are
supposed to help and there is no alternative. Neuroleptic drugs are said
to be “anti-psychotic” and are the raison-d’etre of most psychiatric
hospitalization; people who contest the label of “mental illness” or the
efficacy of drugs are further labeled as “paranoid” and “lacking insight”
thus justifying force drugging.22 A comparatively small number of people
go to court to refuse drugs, and only a handful of these succeed.23 Liberal
use is made of injections to supplement the regular dosing, justified on an
“emergency” basis.24 In addition to force drugging in institutions, 42 states

Id., p. 206.
Breggin, supra note 16 (iatrogenic neurological disorders created by the neuroleptic drugs are
evidence of brain damage); Joukamaa et al., Schizophrenia, neuroleptic medication and mortality,
British Journal of Psychiatry (2006), 188, 122-127 (increased mortality rate from natural causes
correlated with use of neuroleptics, increasing in relation to number of neuroleptics used); Bonelli
et al., The influence of psychotropic drugs on cerebral cell death: female neurovulnerability to
antipsychotics, in International Clinical Psychopharmacology 2005, 20:145-149 (both typical and
atypical neuroleptics were correlated with brain cell death in women); Straus et al., Antipsychotics
and the risk of sudden cardiac death, in Arch. Intern. Med. 2004, 164:1293-1297 (current use of
antipsychotics associated with increased risk of sudden cardiac death, even at low dosage);
Levin et al., Death from Clozapine-Induced Constipation, Psychosomatics 43:1, JanuaryFebruary 2002; Gary G. Kohls, Preventive Psychiatry E-Newsletter #93 ( Robert Whitaker, The
case against antipsychotic drugs: a 50-year record of doing more harm than good, in Medical
Hypotheses (2004) 62, 5-13.
The situation is similar to that observed by the five Special Rapporteurs at Guantánamo, where
access to medical attention is embedded in a coercive system, with the result that detainees
cannot trust medical professionals and may forgo health care. Supra note 10. In psychiatric
institutions, people who react naturally to coercion with avoidance and fear are penalized for
breaking with the dominant ideology that coercion is for the person’s own good.
Mental Hygiene Law Court Monitoring Project, Part 1 of Report: Do Psychiatric Inmates Have
the Right to Refuse Drugs? An Examination of Rivers Hearings in the Brooklyn Court, at [hereafter Court Monitoring
Rivers v. Katz, supra note 13 expressly permits force drugging on an emergency basis.

and the District of Columbia now have laws authorizing compulsory
treatment in the community25, the primary purpose of which is enforcing
long-term compliance with drugs and subjection to psychiatric control.
The public is misled to support these laws by campaigns equating mental
illness with violence, and promoting neuroleptics as a treatment that can
prevent violence.26 Thus what amounts to physical and mental torture is
justified as not only a public safety measure, but a humane medical
9. Discrimination27 is woven throughout this story. People experiencing
trauma and abuse, emotional distress or elation, have nowhere safe to go
to ask for support and healing, and nowhere safe to simply exist.
d. Forced Electroshock
10. Electroshock has a similar brain disabling effect to neuroleptic drugs, but
the damage is more extensive. Electroshock, a procedure that involves
applying sufficient electricity to the head to cause a grand mal seizure,
wipes out memory and knowledge of self, for periods ranging from the
period immediately after surgery, to permanently28. For some people
extensive chunks of life are lost, including relationships with spouse and
children, as well as creativity and professional skills.29
11. Electroshock is administered twice as often to women as to men30, and
there are aspects of the harm that are gendered. Women have reported
passivity or “ductility” after electroshock, being easily led and unable to


Chart compiled by Treatment Advocacy Center,
See!80!A2!2134BF518044/stigmanet/ARCHIVESInvoluntary/ for fear tactics used in
a nationwide campaign for outpatient commitment led by Treatment Advocacy Center, supra note
In addition to disability-based discrimination, racial disparities can be stark. African Americans,
representing 16% of the statewide population, account for 42% outpatient commitment court
orders in New York, while Latinos, 15% of the population, account for 21% of court orders and
whites, 62% of the population, account for 34% of court orders. The racial disparities are not
accounted for by other factors. According to New York Lawyers for the Public Interest, possible
reasons include: “conscious or unconscious bias on the part of some involved in referring and
selecting people to whom to apply the law, people being selected from already-biased pools,
unequal access to mental health treatment, Black or Hispanic people finding the treatment
available less suited to their needs, and some combination of the above.” New York Lawyers for
the Public Interest, Implementation of “Kendra’s Law” is Severely Biased (April 7, 2005).
Harold Robertson and Robin Pryor, Memory and Cognitive Effects of ECT: Informing and
Assessing Patients, Advances in Psychiatric Treatment (2006) 12: 228-238, p. 234.
Bonnie Burstow, Electroshock as a Form of Violence Against Women, Violence Against
Women12:4 (April 2006 Sage Publications); Survey on the Provision of Electroconvulsive
Therapy (ECT) at New York State Psychiatric Centers by the Commission on Quality of Care
(August 7, 2001) [hereafter CQC Survey].

resist rape.31 Women are more likely than men to have experienced rape
and other intra-familial violence, and to be struggling with these memories;
electroshock can destroy the memories forever, along with the woman’s
ability to confront past abusers.32 Electroshock has been used in many
instances to enforce domesticity and compliance with a subordinate
female role, and in collusion between psychiatrist and husband.33
12. A 2001 survey of New York State-run psychiatric institutions found that
38% of electroshock was done by court order, without free and informed
consent.34 The same survey revealed that electroshock is used on people
with a variety of diagnoses, the most common denominator being severe
adverse reaction to drugs, or inefficacy of drugs. It is noteworthy that no
options other than drugs and electroshock were mentioned. In over half
the anecdotes describing “typical” individuals undergoing electroshock,
elements of behavior control are present; in particular electroshock is said
to be justified to control assaultive or abusive behavior, as well as selfinjury or attempted suicide. While a single course of electroshock is 6-10
treatments, some people are being prescribed “maintenance electroshock”
weekly, with no foreseeable conclusion. In one instance, a man was
electroshocked 56 times before it was determined that the treatment had
no effect. The picture that emerges is one of institutional apathy and
neglect; long-term institutional inmates are losing more of themselves with
each electroshock, and there is virtually no one to care.
13. Survivors speak about electroshock:
During ECT [electroshock] you are made unconscious, heavily
sedated by tranquillizers. Since a muscle relaxant completely relaxes
your whole body, including your lungs, you cant breathe so you are
administered artificial respiration (oxygen), then you are subjected to
150-200 volts if electricity to your delicate brain. ECT produces a
nerve racking convulsion and leaves people brain damaged! You then
wake up 10-20 minutes later in a ''recovery room'' with severe
headaches and muscle pain, memory loss, jaw pain, confused,
disorientated, and frightened. This is supposed to make you feel better
or think straight!35
The attendant tells me I've been here 3 weeks. I know I'm getting more
and more shock treatments. That man or someone comes in early in
the morning. They wake me up and grab me and drag me to the same

Information from personal communications from electroshock survivors, who are not available
to give permission to use their identities.
Burstow, supre note 22.
Information in this paragraph is taken from CQC Survey, supra note 30.
Personal communication, Diane Blakemore, New Zealand.

room. People push down on my arms and legs. The doctor puts the
metal on my forehead on both sides. Now he always tells me to lift my
head up and then puts a strap thing around the back of my head and
in front over the metal things. It pulls on my hair. He says to open my
mouth. I think I'm going to die each time. It's OK. I open my mouth and
he sticks the black thing in it. Then I'm out. Nothing. Nothing till I wake
up in my bed in the same dark room. Someone must carry me back
from the other room each time. I hate to wake up. Most of the time I
sleep but when I wake up, I remember where I am now because I hear
the old ladies moaning, rocking, the same constant hum. When I look
in the mirror I get more upset and want to cry again. I don't even look
like me! My face is always red and broken out with pimples and
blackheads, all blotchy and terrible. I don't know if I even wash or
brush my teeth. I can't remember what I'm doing! I never wash my
hair. It's sticky and itchy. I'm so tired. They just keep coming back and
leading me to that room for more shocks. My arms have red blotches
on them like finger marks. Why? They hold me down so hard on that
black table. I guess that's why my back hurts. If I don't open my mouth
fast enough they grab my face and pull my mouth open. I can't help it
anymore. I cry and cry. I want to die. I can't think. I can't remember
I am currently undergoing forced electroshock treatment. But I would
not call this electroshock 'treatment.' It is not medical. The forced
electroshock is horrible. It is horrible. Maybe God himself or herself
allowed me to hold onto my faith. … I am strong. But no human being
is invincible…. I thank you a lot. I ask God to bless you in anticipation
of your helping me in my torture and traumatization. God bless you.
Do whatever is possible!37
14. The aftermath is equally traumatic, as survivors learn to live with a new
I only remember being told this would help me. I remember feeling
nauseous and disoriented. I forgot which way was left and right. I
forgot where all the silverware was. I got yelled at for not knowing what
to do when I got home….38
… My fear was due to bereavement (I lost my mother when only 6),
abuse, neglect, living in institutions etc. and not something that

Margo Bouer, After Shock – A Memoir: Lost Childhood, Xlibris Corp. (2001).
Paul Henri Thomas, Do Something Please! In Mind Freedom Alerts, February 13, 2001. After
losing his court hearing to refuse electroshock, in September 2001 Thomas secured a transfer
out of the facility that was shocking him.
Personal communication, Alma (last name withheld).

couldn't be explained. I needed help and love, not a barbaric form of
brain busting abuse. Sometimes I think that damage to my brain
restricts my progress that I could have otherwise made. At present I
am trying to get a much needed education and am finding this
extremely difficult. I have to read stuff over and over again and am
aware of a dull ache and heaviness in my head a lot of the time. I feel
stigmatised as I have to tell people I'm had ECT to try to explain why I
can't seem to grasp subjects that quickly. I am confused but
concerned about the possible damage done to my brain. I am looking
to some form of legal help for compensation of a wasted life if that is at
all possible.39
14. Electroshock is performed against the person’s will a significant proportion of
the time. However, even when the person has given consent, it is unlikely to
have been based on full and accurate information. Only two states, California40
and Texas41, require disclosure of the probability of irrevocable memory loss, and
the American Psychiatric Association’s model form claims, “most patients
actually report that their memory is improved with ECT.”42 Of the New York State
Psychiatric Institutions that disclosed informed consent information to the CQC
Survey, none provided full or accurate information.43 Survivors have organized
the Committee for Truth in Psychiatry to campaign for accurate disclosure in
informed consent to electroshock.44
e. Applicable Legal Standard
i. Article 7
15. All human beings have the right to not be subjected to torture or other
cruel, inhuman or degrading treatment or punishment. States have a
corresponding obligation to prevent such practices, which are more
egregious when government officials or official policy are involved.
Torture is defined with reference to the degree of severity of mental or
physical pain and suffering45 caused to victim, as well as the purposive

Personal communication, Pam (last name withheld).
California Welfare and Institutions Code, § 5326.2.
Texas Statutes, Health and Safety Code, § 578.003.
See Manhattan Psychiatric Center Electroshock Policy, Creedmoor Psychiatric Center
Electroshock Policy, Pilgrim Psychiatric Center Electroshock Policy, New York State Psychiatric
Institute Electroshock Policy, and Policy from Rockland Psychiatric Center, obtained through
Freedom of Information Law and posted at
Mental suffering caused by drugs that subvert individual will is addressed explicitly in the InterAmerican Convention to Prevent and Punish Torture, article 2, and as an application of the UN
Convention Against Torture in Andrew Byrnes, Torture and other offences involving the violation
of the physical or mental integrity of the human person, in Substantive and Procedural Aspects of
International Criminal Law, Gabrielle Kirk McDonald and Olivia Swaak-Goldman, eds. (The
Hague: Kluwer, 2000).

nature of the act. Discrimination is relevant as a purpose of torture and as
a factor rendering people more vulnerable to torture.
16. Force drugging and forced electroshock can be seen as a type of corporal
punishment, inflicting harm on the body to bring a person under social
discipline and control. Medical practices, like educational methods, may
constitute corporal punishment or a related violation prohibited under
article 7.46 Furthermore, nonconsensual administration of mind altering
drugs and procedures can constitute torture per se47, irrespective of other
purposes or social function.
17. Where medical treatment is concerned, free and informed consent is the
factor that distinguishes between lawful and unlawful procedures.48
Traditionally, free and informed consent includes the element of capacity.
However, a capacity standard excludes people with psychosocial or
intellectual disabilities from being able to decide for ourselves whether to
accept a given treatment.49 Psychiatric treatments in particular cause a
high degree of pain, suffering, and subsequent trauma and disability, and
are administered in an adversarial way, often with a purpose of coercion
and punishment. The capacity standard cannot be allowed to serve as a
cloak to legitimize torture and for the medical profession to escape human
rights scrutiny.
ii. Articles 2 and 26


Human Rights Committee General Comment No. 20, paragraph 5.
See references supra note 45.
UN Guantánamo Report, supra note 10, paragraphs 54, 72-82. The importance of this issue to
persons with disabilities has been addressed in the proposed Supplement to the Standard Rules
on the Equalization of Opportunities for Persons with Disabilities, which provides for an equal
right to self-determination including the right to accept and refuse treatment, and an obligation to
“prevent unwanted medical and related interventions… from being performed on persons with
disabilities.” See U.N. Doc. E/CN.5/2002/4, annex, paragraphs 27 and 33. The obligation of
prevention is consistent with requirements under Convention Against Torture articles 2 and 16.
The EU Charter of Fundamental Rights,,
article 3, does not differentiate between experimentation and interventions, but requires free and
informed consent to be respected in the medical and biological fields, as part of the right to
respect for integrity of the person (which is also the aim of ICCPR article 7, see Human Rights
Committee General Comment No. 20, paragraph 1). The Committee on Economic, Social and
Cultural Rights treats nonconsensual medical treatment and experimentation on a par, saying
that freedoms in the right to health include “the right to be free from torture, nonconsensual
medical treatment and experimentation,” see CESCR General Comment No. 14, paragraph 8.
Court Monitoring Report, supra note 22; CQC Survey (indicating 38% electroshock done by
court order), supra note 30; Anne Krauss, Justice Hall Reserves Judgement in Forced Shock
Case,; Linda Andre, How Do Psychiatrists Decide
to Use Forced Electroshock?

18. All people are ensured the rights guaranteed in the ICCPR without
distinction of any kind, including disability.50 This entails not only a facial
guarantee of formal equality, but an examination of deeper influences that
may have the effect of depriving people of human rights on a basis of
equality. Thus the capacity standard has to be scrutinized for its effect on
equal enjoyment of rights under article 7.
19. Discrimination is also manifested in targeting people for compulsory
change of socially devalued physical or mental characteristics51 in
violation of article 7. Giving such practices a medical imprimatur does not
change their fundamental nature as violence against the integrity of an
individual human being.
20. Even where a right is not explicitly recognized in the Covenant, States
have the obligation to prevent discrimination in their own laws. The many
laws that make distinctions in relation to legal capacity of adults52, where
disability is an explicit or implicit factor in determining the right of an
individual to represent him or herself, deny equal protection to people with
disabilities. CEDAW acknowledges legal capacity as fundamental to a
person’s autonomy and independence, necessary to establish oneself
economically and take action to assert one’s rights.53 These values are no
less important to women and men with disabilities, than to non-disabled
women and men.
iii. Article 18


See Committee on Economic, Social and Cultural Rights General Comment No. 5 (nondiscrimination obligation “based on certain specified grounds or ‘other status clearly applies to
discrimination based on disability”).
For the purpose it does not matter whether or not one accepts the premise of psychiatry that
certain characteristics are symptoms of a disease. Discrimination is based on the social
significance of psychiatric labeling. Generally, any disability has a social dimension consisting of
the extent to which environmental or attitudinal barriers impact on the person’s life. This is true
even for people with chronic health conditions like diabetes, who would qualify as persons with
disabilities under international definitions. See definitions in World Programme of Action
Concerning Disabled Persons, U.N. GAOR 37/52, 3 December 1982; Standard Rules on the
Equalization of Opportunities for Persons with Disabilities, U.N. GAOR 48/96, annex, 20
December 1993; Possible Definition of “Disability”: Discussion Text Suggested by Chair (in
negotiations of Convention on the Rights of Persons with Disabilities),
This includes mental health laws, which have an implicit or explicit dimension of incapacity.
The other major premise of mental health laws, prediction of dangerous behavior, is also a form
of discrimination. Dangerous behavior either constitutes a criminal offense, in which case there
already exists an adequate social response, or it is behavior that people are legally free to
engage in (leaving aside rules for civil liability or other types of government regulation which also
operate neutrally with respect to disability). When disability contributes to a violent crime, the
crime should be punished, not the disability.
CEDAW Article 15; CEDAW General Recommendation No. 21, paragraphs 7-8.

21. The freedom of thought, conscience and belief is guaranteed to all people,
along with the right to not be subjected to coercion that would impair the
ability to have or adopt a belief of the person’s own choice. Forced
drugging and electroshock can damage a person’s ability to maintain a
chosen belief, due to cognitive impairment and disruption of thought and
personality in general. There is also an element of proselytizing and
conversion in the attempt to induce people to abandon a belief in
themselves as capable actors living out difficult experiences, and adopt
the belief system of biopsychiatry that sees such crises as evidence of a
defective brain and need for externally-directed control.
f. An Inclusive Construction of Legal Capacity
22. Traditionally, legal capacity is constructed as a binary system that
distinguishes two classes of people. Those who possess legal capacity
are equal with each other in rights and responsibilities, and are entitled to
enforce their rights and accept responsibilities directly, without
intermediaries. Those who do not possess legal capacity may be
excluded from some rights and responsibilities, and must rely on a
surrogate decision-maker to enforce their rights or discharge
responsibilities on their behalf.
23. Women have successfully established that equal legal capacity with men
is a human right.54 Children now have an evolving right to participate in
decision-making concerning themselves.55
It is only people with
disabilities whose legal capacity is still questioned in human rights
discourse, although this may soon change with the finalization of an
International Convention on the Rights of Persons with Disabilities.56
24. Until recently, disability was understood as an individual problem,
characterized medically and requiring medical judgment to determine
matters of policy. However, with the development of the Convention,
people with disabilities have fully emerged as a human rights constituency
and disability as a prohibited ground of discrimination. Like physical
environments, products, websites and educational strategies, the legal
system needs to be made accessible to people with disabilities and others
whose needs were not taken into account in the original design. A support
model of legal capacity does just that.
25. The traditional model of legal capacity posits individuals as acting in
isolation, outside any matrix of social relationships.
The support


CEDAW Article 15.
CRC Article 12.
See working text at Draft article
12 provides that people with disabilities have legal capacity on an equal basis with others.

model57acknowledges that other people may be involved in our decisionmaking processes, and opens up legal capacity to people who need a
high degree of support to make important decisions. The role of a support
person is always secondary to the person receiving support, who is free to
make decisions on his or her own authority. Support provides resources
for decision-making according to each individual’s needs, to equalize
opportunities to exercise legal capacity. Support can go from very little to
a great deal, and can encompass the assistance needed to seek and
obtain support. The support model upholds the value of self-determination
and choice, in an interdependent social context.58 The support model of
legal capacity, like other systems designed to be accessible to people with
disabilities, is likely to benefit non-disabled people as well. A model of
legal capacity based on interdependence rather than self-sufficiency could
make it easier for other communities disadvantaged by the traditional
model to have alternative styles of decision-making formally
26. For people with psychosocial disabilities, a support model of legal capacity
removes the punitive consequences of seeking help or acknowledging
distress and limitations. States have both a positive obligation to equalize
resources for self-determination according to individual need, and a
negative obligation to refrain from imposing services against a person’s
will, which, in the case of interventions compromising physical or mental
integrity, can amount to torture.
3. Mental health screening and drugging of children
27. The MindFreedom USA Campaign is focusing its effort on opposing the
widespread use of mental health screening in schools that is being
sponsored by the Federal government.
28. Its plan is to work with the Freedom Center on developing a kit that can be
used by communities and human rights groups throughout the United
States to effectively oppose screening that is based on unreliable
assessment instruments, that does not require adequate informed consent
and that coerces young people into treatment that uses psychotropic
drugs as a primary modality.


See Amita Dhanda, Advocacy Note on Legal Capacity at and Canadian
Association for Community Living, Report of the C.A.C.L. Task Force on Alternatives to
Guardianship (August 1992) at
for theoretical background.
This not only equalizes opportunities for people with disabilities; it is also consistent with the
recognition that human rights and inter-related (Vienna Declaration on Human Rights), and that
realization of economic, social and cultural rights is necessary to the free and full development of
the personality (UDHR article 22).

29. The Committee is also working on mobilizing members to encourage their
Congresspeople to support Representative Paul's bill that prohibits the
use of Federal funds for screening in schools and requires active informed
consent in order for any school child to be screened or treated.
30. We consider this screening initiative to be a violation of human rights for
the following reasons.
31. The great majority of screening will use Teen Screen, an instrument that
was developed by Columbia University. Recent information found that
Teen Screen is being used in 460 communities in 42 states. Teen Screen
has been shown to be an invalid assessment instrument. It results in
unacceptably large numbers of false positives - more than 70 percent of
screenees being falsely identified as at risk for depression and suicide.59
Validity coefficients of at least 75 percent are required for an instrument to
be considered valid.
32. There is good reason to believe that the great majority of children who are
referred for treatment will be given psychotropic drugs (including
neuroleptics60). A recent article in the Journal of the American Academy
of Adolescent Psychiatrists found that nine of every ten children who sees
a recently trained child psychiatrist will be prescribed a psychotropic
33. The U.S. Food and Drug Administration (FDA) recently required the drug
companies to include a Black Box Warning on all anti-depressant
medicine because of evidence that the medicine causes increases in risk
of suicidal ideation, suicidal behavior, violent behavior, hallucinations,
psychosis, mania, akathisia (uncontrollable motor activity and anxiety),
diabetes, and heart failure. There is also clear evidence that use of the
psycho-stimulants that are used to treat ADHD causes increased risk of
addiction to amphetamines.62 In view of these facts, any prescription of
psychotropic drugs to a child is a violation of human rights.
34. As for informed consent, most of these screening initiatives are funded by
the Substance Abuse and Mental Health Services Administration of the
U.S. Department of Health and Human Services (SAMHSA). In its

U.S. Preventive Task Force. Screening for suicide risk. Washington, DC: Office of Disease
Prevention and Health Promotion, May, 2004.
A Tennessee study found that the use of neuroleptic drugs on low-income children doubled
between 1996 and 2001. Amanda Gardner, Use of Antipsychotics Doubles for Low-Income Kids,
Stubbe, D.W. & Thomas, W.J. (2002). A survey of early-career child and adolescent
psychiatrists: Professional activity perception. Journal of the American Academy of Adolescent
Psychiatry, 41 123-130.
Jennifer Corbett Dooren, "FDA urges stronger warning on ADHD.” Wall Street Journal. March
15, 2006.

funding of such efforts, SAMHSA does not require its grantees to provide
for active informed consent of parents and requires no provision of
informed consent for children.63
35. There is evidence that many schools are using passive consent in which
the child can be screened if the parent doesn't object. In some schools,
the screening is made part of the curriculum so that informed consent
requirements can be by-passed.64 And it is very unlikely that even the
active consent is truly informed consent, i.e. in which the parents are given
complete information about the screening instruments that are used and
the true facts about psychotropic drugs administered to children.
36. There is no evidence that children are provided an opportunity for any kind
of informed consent, in violation of their rights under Convention on the
Rights of the Child, article 12, which requires that children have the right to
freely express their views on matters concerning themselves, with those
views being given due weight according to the child’s age and maturity.
Since the CRC is the only human rights instrument to address this issue,
we would urge the Committee to adopt the standard used in CRC as
relevant with respect to all issues concerning informed consent by children
that arise in the context of the Covenant. We would further note that this
standard must be applied without any discrimination based on disability.
37. Neither does SAMHSA require the use of screening instruments that meet
a minimum standard of validity and reliability.
38. MindFreedom is not opposed to efforts to identify children who are having
difficulty managing their emotions and behavior and, therefore, are failing
in school. We understand that there are children who suffer both lifethreatening and development trauma early in their lives. Such children
grow up with severe handicaps. Due to the effects of trauma, they suffer
from elevated levels of anxiety. They overreact to stressful situations.
Such children are at tremendous risk because they will do poorly in
school, which will keep them from gaining the skills they need to succeed
in later life and negatively affect their self-concept. They will also have
trouble getting along with other children, which will inflict further damage.
We think it is a good idea to identify such children and make an effort to
help them. We believe the schools are an appropriate setting in which to
do that. But we don't think mandatory or widespread screening with
instruments based on the DSM and with referral to mainstream mental
health practitioners is the way to do it. We believe there are more safe,
humane and effective ways of doing it. For example:


Teleconference with Charles Curie, Administrator of the U.S. Substance Abuse and Mental
Health Services Administration, October 27, 2005.
Teen Screen Facts Page. Freeing the Beehive State.


Sitting down with a child and finding out what is going on that is
causing the difficulties. What is going on at home? What does the
child want to learn? How does the child want to learn it? What is
the child afraid of, troubled about, upset with? What changes
would the child like to see?


Providing the child with alternative environments in which the child
can become more comfortable, feel more safe, feel more affirmed,
in which the child can learn what the child wants to learn, how the
child wants to learn it and when the child wants to learn it, in which
the child can be helped to address issues like getting along with
other kids, feeling OK about himself or herself, learning how to
manage the strong emotions like anger, hatred, jealousy, fear,
sadness, etc.


Providing environments in which the child can develop his or her
unique talents, abilities, passions - even if they don't involve
learning how to read, write and do arithmetic. We understand that
at some point all children need to learn academic skills but how and
when they do it has to be designed for the individual child, not the
one-size-fits-all approach we use now.

39. It is important to acknowledge the degree to which the screening initiative
is a victim of the domination of America’s mental health system by
mainstream psychiatry. It is due to that domination that the screening
effort will result in millions of children being administered psychotropic
drugs which are not only ineffective but are also harmful to the brains and
entire organism.
40. As currently practiced in the United States, the mental health screening
and prescription of psychotropic drugs to children violates article 7.
Active, fully informed consent by parents, and provision for consultation
that takes account of the children’s views, would address part of the
concern. However, since children cannot refuse medical treatment on
their own authority, informed consent may not adequately protect their
rights. Psychotropic drugging of children should be prohibited, along with
similar violations of integrity that have irreversible effects (such as
sterilization), as a per se violation of article 7, which aims to protect the
physical and mental integrity of all human beings.
4. Conclusion
41. Force drugging and forced electroshock of disabled and non-disabled
people, adults and children, women and men, of all racial and ethnic
backgrounds, is an injury with often lifelong effects. Disability is no excuse
to give license to the medical profession to inflict pain and suffering

without free and informed consent. Since the legal capacity standard for
informed consent, as currently constructed, serves to perpetuate the
infliction of suffering and deprive people with disabilities of a remedy
against it, legal capacity must be redesigned in an inclusive model.
Psychotropic drugging of children, who still do not have full legal capacity,
must be prohibited.
Contact information:
Tina Minkowitz