Citizens Commission on Human Rights St. Louis

[Condensed from Jan Eastgate, President, CCHR International]

The pop icon’s traumatic story of being held captive by a punitive guardianship law, with abusive psychiatric evaluations and forced mood-altering drugs, has prompted legislators to act. But proposed laws, while applaudable, fall short on needed protections.

Conservatorships, which place guardians over the control of a person’s life when deemed incompetent, are often based on a subjective psychiatric evaluation. As such, while it is very easy for someone to be placed under a conservatorship order because of a psychiatric diagnosis, it’s very hard to get out of one. The diagnosis is stigmatizing and is hard to disprove because of its subjectivity. It can also expand over the years, especially where there may be deterioration in the individual from powerful psychotropic drugs prescribed to them.

The late professor of psychiatry and co-founder of Citizens Commission on Human Rights (CCHR) Dr. Thomas Szasz, warned against state intervention that allows psychiatry to circumvent individual and constitutional rights. He called it “The Therapeutic State,” where the state gives psychiatry the power to be an institution of social control. “When I use the term therapeutic state, I use it ironically, it’s therapeutic for the people who are doing the locking up, who are doing the therapy, it’s not therapeutic for the victims, for the patients,” Szasz said. “The therapeutic state seeks to remedy personal and social problems defined as diseases; its beneficiaries are often ‘helped’ against their will; it is a totalitarian state, governed by the rule of therapeutic discretion.”

CCHR asks legislators to review the World Health Organization’s recent guideline for protections of people with mental health disabilities. WHO recommends countries “repeal guardianship and other substitute decision-making legislation and replace it with laws that recognize legal capacity and promote supported decision-making, including the use of advance plans [living wills] and best interpretation of will and preference.”

In Britney’s case, the conservatorship was put into place in 2008, while she struggled with her mental health, and gave her father broad control over her life and finances. Britney obtained a court order recently to reinforce her inherent right to obtain the legal counsel of her choice. Her new attorney must petition the court to have the current conservatorship removed.

Britney pleaded that the conservatorship over her affairs has made her feel “demoralized and enslaved.” She has been subjected to numerous psychiatric evaluations and medications, stating: “I want to end the conservatorship without being evaluated,” she said. The system in place is “abusive,” Britney said in court, accusing her conservators of forcing her to take mood-stabilizing drugs and perform against her will.

Britney also told the court that her previous psychiatrist (who died in 2019) was abusive in his treatment of her. She alleged that she was subjected to lengthy psychological evaluations, forced into a $60,000-a-month inpatient facility and told that she wouldn’t be able to see her children if she failed to comply. “To be totally honest with you, when [the doctor] passed away, I got on my knees and thanked God,” she said. She was then forced to see a therapist three days a week. Paparazzi humiliated her by taking photos of her crying after the emotional sessions. She asked the judge last month to be allowed to be part of her own care plan.

NBC News reported that allegations of abusive psychiatrists in conservatorships are not uncommon. Doctors are asked to file capacity declarations with the court which form about 75 percent of how judges base their decisions to keep someone under court-ordered guardianship.

The WHO’s “Guidance on community mental health services: Promoting person-centered and rights-based approaches” released in June 2021, is very clear about abuse in the mental health system: “Many people with mental health conditions and psychosocial disabilities are denied the right to exercise their legal capacity; that is, the right to make decisions for oneself and to have those decisions respected by others. Based on stigmatizing assumptions about their status – that their decisions are unreasonable or bring negative consequences, or that their decision-making skills are deficient, or that they cannot understand and make decisions for themselves or communicate their will and preferences – it has become acceptable in services in countries throughout the world, for others to step in and make decisions for people with mental health conditions and psychosocial disabilities. In many countries, this is implemented through schemes like guardianship, supervision and surrogacy, and is legitimized by laws and practices.”

As an organization that has exposed abuses in the mental health industry for more than fifty years, CCHR has definitely come across unscrupulous guardians that have been able to secure the help of psychiatrists to maintain control over an individual, especially their finances. The diagnostic aspect of conservatorship needs closer scrutiny.

State laws need to ensure that someone who is subject to a psychiatric evaluation also has freedom of choice and the right to obtain a second medical—as opposed to a psychiatric—opinion. Contact your state legislators and express your viewpoint about this.

The WHO guidelines are clear about protecting individual rights to choose. It also recommends people sign a Living Will to express their treatment and guardianship preferences should their liberty be threatened by competency issues.