伊瑞特·希姆拉特-2022 年 6 月 13 日

編者註：這是一篇文章的第一部分，改編自 Irit Shimrat 在 2014 年全國權利保護和倡導協會會議上發表的主題演講。作者應 Jim Gottstein 的邀請在最近的一次虛擬活動中提供更新版本。
Editor’s Note: This is the first part of an essay adapted from Irit Shimrat’s keynote speech delivered at the 2014 conference of the National Association for Rights Protection and Advocacy. The author was invited by Jim Gottstein to give an updated version in a recent virtual event.

我將這次演講命名為“精神病患者開放季”。但我也可以稱之為“人性開放季”。沒有人可以安全地擺脫精神病學的醫學化和治療人類情緒和行為的幾乎每一種變化的項目。
I named this talk “Open Season on Mental Patients.” But I could just as well have called it “Open Season on Humanity.” No one is safe from psychiatry’s project of medicalizing and treating just about every variation of human emotion and behaviour.

像往常一樣，尤其處於危險之中的是那些被包括土著人民在內的有權勢者懷疑和蔑視的人；黑色、棕色、亞洲人和其他有色人種；任何種族的大而響亮的年輕人；移民；難民；身體殘疾的人；婦女和性少數群體；老人; 千禧一代；青少年，甚至是小孩。
Especially in danger, as always, are those viewed with suspicion and contempt by the powerful, including Indigenous people; Black, brown, Asian and other people of colour; big, loud young men of any race; immigrants; refugees; people with physical disabilities; women and sexual minorities; old people; millennials; teenagers, even small children.

精神病治療的細節——貼上標籤、監禁、單獨監禁、鐐銬、吸毒、電擊，以及對那些在社區治療令下過著沉默、恐懼生活的人施加的不太明顯的暴力——對太多的思想和身體造成了驚人的傷害，和靈魂。
The particulars of psychiatric treatment—labelling, incarceration, solitary confinement, shackles, drugging, electroshock, and the less obvious violence inflicted on those leading silent, terrified lives under community treatment orders—cause a staggering amount of damage to far too many minds, bodies, and souls.

各種媒體總是對我們大喊當前的“心理健康危機”。事實上，還有一場持續的危機。但這不是他們所暗示的。無法忍受的貧困、歧視、虐待、忽視以及困擾我們社會的所有其他弊病，正在驅使越來越多的人進入疏離、絕望和精神錯亂的狀態，然後將其歸因於所謂的醫療狀況，接受藥物治療。
Media of all kinds are always screaming at us about the current “mental health crisis.” And there is, in fact, an ongoing crisis. But it’s not what they imply. Unbearable conditions of poverty, discrimination, abuse, neglect, and all the other ills that plague our society are driving more and more people into states of alienation, despair and insanity, which are then attributed to supposed medical conditions, to be treated with drugs.

創造和維持一種絕望、焦慮和恐慌的氣氛會推動點擊，但這還不是全部。它還促進了各種個人和集體社會控製手段的營銷，從消除自己麻煩的情緒到讓麻煩的人閉嘴、關閉和收起。
Creating and maintaining an atmosphere of despair, anxiety and panic drives clicks, but that’s not all it does. It also facilitates the marketing of various means of individual and collective social control, from drugging away your own troublesome emotions to having troublesome humans shut up, shut down, and put away.

精神病學的聰明和不知情的奴才——包括處理被視為由精神疾病引起的情況的警察——通過他們對我們一些最優秀、最聰明、最敏感的公民和非公民的壓迫而產生了難以言喻的痛苦。
Psychiatry’s witting and unwitting minions—including police dealing with situations seen as being caused by mental illness—produce untold suffering through their oppression of some of our best, brightest and most sensitive citizens, and non-citizens too.

在我居住的不列顛哥倫比亞省，警察確實闖入了人們的家——不需要逮捕令——因為一些熟人報告了他們認為奇怪的行為。
In British Columbia, where I live, police have literally broken into people’s homes—no warrant required—because some acquaintance has reported what they perceive as strange behaviour.

不僅是醫生和家人，朋友、鄰居甚至是路人都可以觸發合法的入室盜竊行為——這可能以監禁和強迫吸毒而告終，僅僅是因為一個人被認為“無法理解她對治療的需要” 。”
Not only physicians and family members, but friends, neighbours and even random passers-by can trigger legally sanctioned home invasions—which may end in incarceration and forced drugging, simply on the grounds that a person is deemed “incapable of appreciating her need for treatment.”

太多的精神病患者最終被警察殺死。可以預見，此類謀殺案最常見的受害者是窮人，其中許多是土著人。我想起了 Chantel Moore，一位年僅 26 歲的原住民婦女，警察在 2020 年進入她的家中進行所謂的“健康檢查”，並最終開槍打死了她。還有許多其他這樣的謀殺案。
And way too many mental patients end up being killed by police. Predictably, the most common victims of such murders are poor, and many are Indigenous. I think of Chantel Moore, a First Nations woman who was just 26 years old when police officers entered her home to conduct something called a “wellness check,” in 2020, and ended up shooting her dead. And there have been many other such murders.

健康檢查只是精神病學強製或脅迫治療能力猛增的一個例子，不僅在醫院，甚至在社區，由自信的社區治療（或 ACT）團隊根據門診住院命令進行管理。
Wellness checks are just one example of the ferocious increase in psychiatry’s power to inflict forced or coerced treatment, not only in hospital but even in the community, where it is administered by Assertive Community Treatment (or ACT) Teams, under outpatient committal orders.

不列顛哥倫比亞省擁有加拿大最倒退的心理健康法案。非自願入院的標準包括規定您需要“在指定設施內或通過指定設施進行護理、監督和控制”，以防止您的“精神或身體嚴重惡化”，或保護您自己或保護他人。其他。
British Columbia boasts Canada’s most regressive mental health act. The criteria for involuntary admission include the stipulation that you require “care, supervision and control in, or through, a designated facility,” either in order to prevent your “substantial mental or physical deterioration,” or for your own protection or the protection of others.

這些標準是如此模糊和無所不包，從本質上講，任何人都可能因任何事情而被關起來。當然，一旦你變成了精神病患者，任何不尋常的行為，無論多麼無害，都更有可能引發精神病干預。
These criteria are so vague and all-encompassing that, in essence, anyone can be locked up for anything. And, of course, once you’ve been made into a mental patient, any unusual behaviour, however harmless, is way more likely to trigger psychiatric interventions.

“長假”是我省對門診住院的醜陋委婉說法。當您在休長假時，您在技術上是自由的。但是，從法律上講，您仍在醫院接受治療。在任何時候，都可以對您的逮捕和重新監禁發出逮捕令——或者，正如他們所說，“召回醫院”。
“Extended Leave” is my province’s ugly euphemism for outpatient committal. When you’re on Extended Leave, you are technically free. Legally, however, you’re still under hospital care. At any time, a warrant can be issued for your arrest and re-incarceration—or, as they put it, “recall to hospital.”

國家本質上是分裂的人。你在社區中逍遙法外，但與此同時，你被合法拘留。
The state is, in essence, splitting persons. You’re at large in the community, but, at the same time, you’re legally detained.

你不能逃跑。你無法隱藏。你不能去地下。你唯一的辦法就是離開不列顛哥倫比亞省——你怎麼能負擔得起，你會去哪裡？
You can’t run away. You can’t hide. You can’t go underground. Your only recourse is to leave British Columbia—and how could you afford that, and where would you go?

實際上，延長休假將整個省，特別是包括您自己的家，轉變為指定的設施。
In effect, Extended Leave transforms the entire province, notably including your own home, into a designated facility.

如果你沒有家怎麼辦？警察有權一個接一個地出現在一個緊急避難所，要求提供住在那裡的人的名單。如果現在是冬天，並且您要遠離街道，以免凍死，他們可以追踪您。
And what if you have no home? The cops are empowered to show up at one emergency shelter after another, demanding the list of names of people staying there. If it’s winter, and you’re staying off the street so you don’t freeze to death, they can track you down.

當您有義務“參加”您的 ACT 團隊時，您的日程安排就無關緊要了。他們安排了約會，然後告訴你。你要么出現，要么冒著被“召回”的風險。
When you are obliged to “attend” your ACT team, your schedule doesn’t matter. They set an appointment and then tell you about it. You either show up, or risk being “recalled.”

延長假被比作監獄假釋。但是假釋是有限的，而延長假可以持續一生。每次前一份表格到期時，一位醫生只需簽署一份新表格。
Extended Leave has been compared to prison parole. But parole is finite, whereas Extended Leave can last a lifetime. All it takes is for one doctor to sign a new form each time the previous one expires.

在我們的社會中沒有其他類似的東西——這種不受身體限制的人的狀態，但只要醫生的話，就可以隨時被重新監禁——即使她遵守條件。
There’s nothing else like this in our society—this status of a human being who is not physically confined, but who can be re-incarcerated at any time, on the word of a physician—and even if she’s adhering to conditions.

警察，通常是臥底，對 ACT 團隊至關重要。每個團隊還包括至少一名心理健康專家，有時還包括一名同行，他們提供個人支持。但即使有同伴，她也處於從屬地位，不太可能改變乾預的預期結果。
Police officers, often undercover, are essential to ACT teams. Each team also includes at least one mental health professional and, sometimes, a peer, who provides personal support. But even if there is a peer, she is in a subordinate position, and unlikely to be able to alter the intended outcome of an intervention.

被延長休假的朋友被官員闖入他們的家中感到震驚，他們的工作是監督他們的行為並確保治療依從性。即使您合規，該團隊也可能會訪問（沒有警告）以檢查您或您家的狀況。
Friends who have been subjected to Extended Leave have been devastated by the intrusion, into their homes, of officials whose job it is to monitor their behaviour and ensure treatment compliance. And even if you are compliant, the team may visit (with no warning) to check up on you, or on the state of your home.

凌亂的公寓可以作為你“處於惡化危險中”的證據。而且，和往常一樣，如果你不是白人，或者不是說英語，或者看起來不是“普通”等，威脅會更嚴重。
A messy apartment can be used as evidence that you’re “in danger of deterioration.” And, as always, the threat is much worse if you are not white, or not English-speaking, or not “ordinary”-looking, etc.

然後，如果你不遵守規定——比如說，你沒有出席團隊約會，或者你的血液檢查表明你沒有服用藥物——法律允許團隊強行進入你的家，抓住你，拉下你的褲子，然後進行肌肉注射。（我們這些接種過Covid疫苗的人都知道，人體還有其他可注射的肌肉，但精神病學更喜歡臀大肌。這更丟人。）
And then, if you’re not compliant—say, you’re not showing up for team appointments, or your blood tests show that you’re not taking your drugs—the team is legally allowed to enter your home by force, grab you, pull your pants down, and administer an intramuscular injection. (As those of us who have had been vaccinated against Covid know, there are other injectable muscles in the human body, but psychiatry prefers the gluteus maximus. It’s more humiliating.)

我知道有些人害怕在自己的家中度過，因為這可能會發生在他們身上。
I know of people who are afraid to spend time in their own homes because this might happen to them.

那麼這些藥物可以讓你違背自己的意願服用嗎？
And what about these drugs you can be made to take against your will?

最常通過蠻力施用的藥物是抗精神病藥，也稱為抗精神病藥。長期使用安定藥會粉碎你的夢想、希望、慾望，以及你認為會成為你未來的東西。它可以刪除或減少你認識的自我。幾乎所有的精神安定藥的使用都是長期的。哪個精神病患者沒有被告知她必須在餘生中繼續服用這些藥物？
The drugs most commonly administered by brute force are neuroleptics, also known as antipsychotics. Long-term use of neuroleptics can crush your dreams, your hopes, your desires, what you had thought was going to be your future. It can delete or diminish the self you knew. And virtually all neuroleptic use is long-term. What mental patient hasn’t been told she has to keep taking these drugs for the rest of her life?

讓我提醒你一些精神抑製藥的短期和長期身體影響：靜坐不能；肌張力障礙; 運動障礙; 頭暈; 脫水; 便秘; 性功能障礙；血管出血; 骨質疏鬆症; 糖尿病; 心臟、腎臟、肝臟、胰腺、腹部和其他器官損傷；神經損傷；癲癇發作；肥胖; 帕金森病；神經阻滯劑惡性綜合徵；預期壽命降低；猝死。
And let me remind you of some of the short- and long-term physical effects of neuroleptics: akathisia; dystonia; dyskinesia; dizziness; dehydration; constipation; sexual dysfunction; blood vessel hemorrhage; osteoporosis; diabetes; heart, kidney, liver, pancreas, abdominal, and other organ damage; neurological damage; seizures; obesity; parkinsonism; neuroleptic malignant syndrome; decreased life expectancy; sudden death.

至於認知影響，當你停藥時，這些藥物會引起戒斷性精神病是很常見的。而且它們通常也會引起混淆；記憶問題；注意力、注意力和思考問題；焦慮; 苦惱；和“偏執狂”。
As for cognitive effects, it’s very common for these drugs to cause withdrawal psychosis when you go off them. And they also commonly cause confusion; memory problems; problems with focus, concentration, and thinking; anxiety; distress; and “paranoia.”

讓我們談談妄想症。經典的模因是錯誤地認為他們被跟踪或監視的人。但應該認識到，精神病患者經常生活在可怕的實際監視之下。
Let’s talk about paranoia for a moment. The classic meme is of someone who mistakenly thinks they’re being followed or surveilled. But it should be recognized that mental patients often live under a terrifying level of actual surveillance.

我的朋友弗雷德曾經對我說：“隨著年齡的增長，我意識到，我並不偏執。好心的護士正試圖從我這裡得到信息。她同情地聽完後，走進護理站，把一切都寫下來。當我試圖離開時，這一切都被用來對付我。”
My friend Fred once said to me, “As I get older, I realize, I’m not paranoid. The nice, kind nurse, is trying to get information from me. After she finishes sympathetically listening, she goes into the nursing station and writes everything down. When I try to get out, it’s all used against me.”

那麼，弗雷德為什麼一直被關起來呢？一方面，像我一樣，他有一些不同尋常的看待世界的方式，而且並不總是隱藏這一點。和我一樣，他有時會對不公正感到憤怒，以至於他的行為會讓人們感到不安。作為一個白人精神病人，我受到了一點迫害。但原住民弗雷德因未能遵守白人規範而受到很多迫害。
So, why does Fred keep getting locked up? For one thing, like me, he has some unusual ways of looking at the world, and doesn’t always hide that. Also like me, he sometimes gets so angry about injustice that he behaves in ways that upset people. As a white mental patient, I have been persecuted a little bit. But Fred, who is Indigenous, has been persecuted a lot—in his case, for failing to conform to white norms.

但是，如果正常性被高估了怎麼辦？
But what if normality is overrated?

如果像精神病學聲稱但從未能夠證明的那樣，導致自己或他人不適或痛苦的“奇怪”行為不是大腦化學失衡的結果呢？如果你感知到的瘋狂實際上是對我們生活的世界的瘋狂的自然反應呢？而且，如果我們有幸避免或逃避精神病學，我們能為自己和彼此做些什麼？
And what if “bizarre” behaviour that causes discomfort or suffering to oneself or others is not, as psychiatry claims but has never been able to prove, the result of a chemical imbalance in your brain? What if your perceived craziness is actually a natural response to the craziness of the world we live in? And, what can we do for ourselves and each other, if and when we’re lucky enough to avoid, or escape, psychiatry?

支持系統和應對機制對這次討論至關重要——這些不僅對精神病患者有用，而且對那些有精神病危險的人也有用。當然，絕對是每個人。
Support systems and coping mechanisms are vital to this discussion—and these can be of use, not only to psychiatrized people, but also to those of those in danger of being psychiatrized. Which is, of course, absolutely everyone.

在我看來，所謂的精神病學替代品的數量是無限的，因為人們不斷地想出新的替代品。對我來說效果很好的有：
In my view, the number of so-called alternatives to psychiatry is infinite, because people keep coming up with new ones. Among the many that have worked well for me are:

• 中藥
  Traditional Chinese Medicine
• 芳香療法
  Aromatherapy
• 反射療法
  Reflexology
• 各種呼吸技巧
  Various breathing techniques
• Feldenkrais 和其他身體意識和綜合運動學科
  Feldenkrais and other body-awareness and integrated movement disciplines
• 體育活動，如瑜伽、太極、騎自行車、游泳和跳舞
  Physical activities, such as yoga, tai chi, bicycling, swimming and dancing
• 唱歌
  singing
• 聽或播放音樂
  Listening to, or playing, music
• 一般來說，在戶外，即使在城市裡
  In general, being outdoors, even in the city
• 寫作、繪畫——任何創造性活動；而且，最重要的是
  Writing, drawing—any creative activity; and, most importantly
• 人際接觸，以及與誰進行接觸的選擇。以及何時何地擁有它。
  Human contact, and the choice of who to have that contact with. And when, and where to have it.

啊，選擇。對宜居生活如此重要。因此，當您在醫院尋求或被迫接受專業幫助時，您將無法獲得專業幫助。

如果你是個好女孩，你自己簽到，直接去病房，吃藥，遵守所有規則。

但是，如果像我和其他許多人一樣，你被違背自己的意願被拖進垃圾箱並試圖與之抗爭，你得到的只是一個狹小的混凝土牢房，角落裡有一個鋼製馬桶和水槽裝置，可能工作也可能不工作，床墊上可能有也可能沒有床單。

當你到達那裡時，你已經脫光了所有的衣服，被迫穿上一件令人羞辱的醫院長袍，後面敞開。你的血管裡流淌著劇毒的藥物，被護士強行注射，而勤務人員則將你壓在身下。

然後，如果你更像我，並且碰巧對這些藥物產生矛盾的反應，它們會讓你比警察把你拖進來時的你瘋狂一百萬倍。

通常，您會通過身體束縛將您束縛在床墊上：手腕和腳踝將您束縛住的皮帶。

如果燈一直亮著，它們會發出熒光且刺眼。門是鎖著的。

在隔離牢房裡，沒有人能聽到你的尖叫聲。或者，至少，沒有人會回應。

你被憤怒、恐懼和荒涼所留下。

破壞意志的過程已經開始。

一旦你變得足夠順從，可以被釋放到普通人群中，如果你幸運的話，將會有一些體力和創造性的活動來打斷病房裡單調的生活。這些將被稱為“治療”。

但是，當這些活動以及所有活動不被視為治療時，它們總是更令人愉快。畢竟，這種潛在問題是醫學問題的想法仍未得到證實。

一個很好的實驗是提供一些已知的東西來幫助人們感覺更好，讓你選擇任何有吸引力的東西。一位值得信賴的朋友、家人或倡導者可以與您同在，提供友善、溫和的指導和建議。

請注意，當您“處於某種狀態”時，即使有幫助，您也可能無法從菜單中選擇項目。因此，最好在問題出現之前提前製定計劃。

但是，在恐懼的氣氛和幾乎普遍相信生物醫學解決情緒、社會和政治問題的情況下，甚至很難想像常識性的預防策略和解決方案。

如果每個人都能儘早了解極端情緒狀態，那將有很大幫助。在我的理想世界裡，小學生會被教導明白壞事會發生在每個人身上；任何人都可能難以應對；有些應對方式看起來很奇怪；這種差異可以用好奇、尊重甚至欣賞來迎接，而不是恐懼或懷疑。

然而，在現實世界中，我們至少可以強調滿足基本需求，例如良好的營養、體面的住房、足夠的生活費、有意義的工作和充足的醫療保健——這些都不應該與“心理健康服務。” 我很確定，如果加拿大的每個人都能毫無疑問地獲得這些基本人權，那麼所謂的精神疾病的發病率就會直線下降。

一個常識性的、移情的方法可以走很長的路。

文章來源:
https://www.madinamerica.com/2022/06/open-season-mental-patients/

Irit Shimrat 認定為逃跑的瘋子。她共同創立並協調了安大略省精神病倖存者聯盟，在 CBC 電台的Ideas節目中展示了兩場多部分抗精神病學節目，並編輯了國家雜誌Phoenix Rising: The Voice of the Psychiatrized。她的書《叫我瘋狂：瘋狂運動的故事》於 1997 年在溫哥華出版。Irit 的作品出現在各種雜誌和選集中，她繼續寫作、編輯、倡導和鼓動所有人都有權擺脫精神病學和其他偽科學的社會控製手段。請參閱她存檔的 Lunatics 解放陣線網站和Spotlight on Institutional Psychiatry。