TRANQUIL PRISONS: CHEMICAL INCARCERATION UNDER COMMUNITY TREATMENT ORDERS Under community treatment orders, antipsychotic medications are frequently imposed on psychiatric patients deemed dangerous to themselves or others. This practice is based on the assumption that the prescribed treatment is safe and effective and is medically necessary. Under recent mental health laws, patients may be required to remain on prescribed medications after leaving hospital. However, many psychiatric survivors attest that such treatment, often used for the purpose of restraint, can feel like a form of torture. The consequences of withdrawal can also be severe. In this unique academic study of psychiatric treatment, Erick Fabris, himself a former psychiatric patient, discusses the use of chemical agents for treatment of mental illness despite the availability of suitable alternatives. He observes that patients often become dependent on psychiatric drugs, many of which have serious side-effects such as restricted movement and impaired cognition and communication. Calling for greater professional accountability and more therapeutic choice for patients. Tranquil Prisons is a bold, in-depth examination of a largely neglected but important social issue. ERICK FABRIS is a lecturer in the School of Disability Studies at Ryerson University. Tranquil Prisons Chemical Incarceration under Community Treatment Orders ERICK FABRIS © University of Toronto Press Incorporated 2011 Toronto Buffalo London www.utppublishing.com Printed in Canada ISBN 978-1-4426-4376-5 (cloth) ISBN 978-1-4426-1229-7 (paper) Printed on acid-free, 100% post-consumer recycled paper with vegetable-based inks. Library and Archives Canada Cataloguing in Publication Fabris, Erick, 1968– Tranquil prisons : chemical incarceration under community treatment orders / Erick Fabris. Includes bibliographical references and index. ISBN 978-1-4426-4376-5 (bound). ISBN 978-1-4426-1229-7 (pbk.) 1. Involuntary treatment – Moral and ethical aspects. 2. Involuntary treatment – Law and legislation – Canada. 3. Psychotropic drugs – Physiological effects. 4. Mental Illness – Chemotheraphy. 5. Psychiatric ethics. I. Title. R727.35.F32 2011 174.2'9689 C2011-902182-X This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Aid to Scholarly Publications Program, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council. University of Toronto Press acknowledges the financial support of the Government of Canada through the Canada Book Fund for its publishing activities. Contents Acknowledgments 1 Chemical Incarceration 2 Mad Don’t ask. Do. Explanation is useless. Mental Illness Psychological Trauma Ø Madness Discourse as Sanism Mad People’s Thought 3 Restraints and Treatment Beyond Experience Restraints Violence The No Force Coalition 4 On the Ground Perceptions Experiences Contradictions Abuses Identity as Lack of Insight Reviewing Orders Literature on Community Treatment Orders 5 Authorization: Psychiatric History and Law Legal Capacity Informed Consent Forms Patient Detainees Decision Making 6 Biocarceration Subjecthood under Chemobotomy Medication and Education Segregation without Walls Isolation from Within 7 Transinstitutionalization Coercion Literature Comparing Methods of Institutionalization Cycling of Evidence, Biology, and Chemistry 8 Dreams of Escape Gender and Psychiatric Arrangements Choice and the ‘Harness’ The Right to Be ‘Ill’ Mad Polity in Context Lack of Insight and Violence The Consent and Capacity Board and Community Treatment Orders Finding Hope 9 In the Present A Look Back Action References Index Acknowledgments This book is written for people who have been imposed upon or sometimes feel disordered or disoriented, but also for families and friends and anyone concerned with ‘us.’ I invite you to share this book with a counsellor, doctor, family, and friends. Whatever mistakes you find in it are mine alone, and I welcome your helping me to find them. I also invite you to read any part of the book in any order, unless you want to thoroughly critique it in which case you might want to read it all in order. It took many years to complete this book, for various reasons, not least of which is the effect of my own incarceration and forced care. I am fortunate to have a family who loves me and friends who have nudged me through the pain of that experience. I need to acknowledge psychiatric survivors who have struggled together despite indifference to our issues, and people who resisted but did not survive. A dear friend of mine who committed suicide recently is still in my thoughts. I also think of others who have died over the years, and how they, too, had moments and hours of happiness despite their situation. I also need to acknowledge other people who struggle, especially the First Nations people here on Turtle Island, and other Indigenous and racialized people, and my Queer and disabled friends and activists. I also want to thank people who have helped me with my writing, especially Nancy Jackson, whose guidance made this book possible from the start. Bonnie Burstow and Tanya Titchkosky have helped me better define research and representation questions, though in very different ways. Several friends have given of their time. The University of Toronto Press gave me gracious support. Their wonderful senior editor, Virgil Duff, I cannot repay with mere thanks. I wish to thank a few friends also: Jeremiah Bach, Loredana Bruni, Lucy Costa, Marion de Vries, Loree Erickson, Lana Frado, Rachel Gorman, Aubrey Lake, Geoffrey Reaume, Lena Richardon, Rett Rossi, Tina Shapiro, Lauren Tenney, Jijian Voronka, and Andrea White. Thank you to my dear parents and brother for everything, and to our extended family, our respective families and relations for all their love. This book deals with difficult subject matter. Some content may be disturbing.