Showing posts with label Mental Disability. Show all posts
Showing posts with label Mental Disability. Show all posts

July 22, 2019

Three hundred years of legal incapacity in Russia

By Yana Litins’ka

The concept of legal capacity is one of the most important concepts related to the personal status in law. When a person loses legal capacity, it means that he or she is no longer allowed to make decisions for themselves. Instead, a guardian makes decisions for them about things such as what to buy, with whom to live, what treatment should one get. A common reason for depriving people of their legal capacity is, historically as well as today, intellectual or mental disability. But how has the law of a specific state developed to define when persons become unable to make some or all the decisions about themselves? Which criteria have been used? Have these criteria been transparent and non-arbitrary? Who should decide whether a person is incapable: medical professionals or lawyers? In this post, I will focus on the legislative history of Russia concerning the deprivation of legal capacity due to mental disability.

The legislation on the deprivation of legal capacity in Russia was next to non-existing before the reign of Peter the Great. The primary internal concerns of the monarch were related to building a modern, reliable and sustainable system of governance. In line with this aspiration, it was considered that persons unfit to represent the state must not carry out this function. The Decree on Examination of Fools in Senate of 1722 was therefore established. The legislation targeted the noblemen who had inherited their posts as public servants. The Decree made it possible to deprive noblemen of their right to work as officials or as scientists, inherit property, marry and receive an education if they were considered “fools”. A year later, the legislator also laid down the procedure for the capacity assessment. This procedure required that the members of the Senate question a person whose capacity was impugned on any topic. The person in question needed to answer as “a wise man answers” or they would be considered “fools”, and therefore deprived of the aforementioned rights. The criteria for assessment, formulated in terms of being a “wise” or a “fool”, and the possibility to ask about anything, inherently allowed the Senate to have a broad margin of discretion in making the decisions about incapacity.

Senate assembly during the reign of Peter the Great by Dmitry Kardovsky
Senate assembly during the reign of Peter the Great by Dmitry Kardovsky

Linguistically, “fools” in Russian legislation of the eighteenth century were not necessarily persons with mental disorders. The language of the act emphasised behaviour and intelligence, rather than the diagnosis. However, in practice, the Senate’s concerns were related to the differences between the real and fake mental disorders. In 1746 the Senate requested that the Medical Board clarified the scientifically proven methods of recognising mental disorders. The Medical Board’s report stated that a careful and consistent monitoring of the person, as well as a study of their medical records and external detriments of mental health was crucial. These accounts seem to emphasise that despite the fact that initially determination of legal incapacity was considered to be a legal procedure, the assessors – the Senate – struggled with this task and required additional competence.

In accordance with the Decree on Custody Due to Physical or Mental Disorders of 1809, all acts of mentally disordered persons were considered to be void. Assessment of mental disorders was then performed by the medical boards in the presence of those entrusted by the Government, e.g. the governors, prosecutors or nobility. If a person was determined to be insane, the boards were supposed to send the detailed report to the Senate. The Senate’s function was then to decide whether this person was legally capable or not, based on the report. These changes in the legal regulation signified transition of the Senate’s functions to the medical professionals, and a separation of the obligation: the Senate remained responsible for the legal consequences, but regarding insanity, which could potentially trigger incapacitation, was delegated to the medical experts. These amendments to the legislation did not focus on the specification of the criteria for legal incapacity. Mental disability as such could have led to legal incapacity.

Nikolai the First ordered systematisation of all laws of Russia. In the Complete Collection of Laws of the Russian Empire of 1832, the term legal capacity was neither defined nor explicitly regulated. In his monography of 1879, Slonimskii argued that the Russian courts were able to interpret the laws as requiring the recognition of the person’s incapacity only in the context of a specific transaction, rather than a “civil death” or incapacity in all legal relations. However, in practice the courts chose to follow a simpler approach: a person either had a legal capacity for all the legal transactions, or was fully legally incapable. The criteria for the legal incapacity were, similarly to the previous periods, not laid down in the legislation, which resulted in a broad of interpretation thereof. The project of the Digest of Laws of the Russian Empire called for a more detailed regulation of legal capacity, but because it never came into legal force, the regulation and the practice of the courts likely remained unchanged until the end of the Russian Empire in 1917.

In 1922, the first Civil Code of Russian Soviet Federative Socialist Republic laid down the provisions on legal capacity. The Code established that legal capacity was the ability to acquire and exercise civil rights, create civil obligations and execute them. This definition remains unchanged in the modern Civil Code of the Russian Federation. In accordance with Article 8 of the 1922 Civil Code, adults could be deprived of legal capacity because of mental disorders if they were not able to manage their own affairs wisely, and only courts could make decisions on incapacity. A more detailed clarification of the criteria for incapacity was not provided. The criteria were slightly modernised in the Civil Code of 1964: criteria for incapacity were formulated as inability to understand the content [significance] of one’s own actions or to manage them. The same definition is provided in the modern Civil Code of the Russian Federation.

This brief overview of the legislative history indicates that deprivation of legal capacity in Russia has been mostly regulated in broad terms, such as not being a ‘fool’, being ‘wise’, having the ability to understand and manage one’s own actions. The broad formulations of the criteria for incapacity are likely to be the reason for the deprivation of capacity resulting in an incapacitation in every aspect of life. While the deprivation of legal capacity was considered a legal matter, the struggle with the interpretation of the legal requisites can be traced back to the very early legislative history.

Where does Russia stand now in terms of criteria for the declaration of legal incapacity? Has the vagueness of the legislation been replaced by clearer definitions, at least in practice? In my doctoral thesis entitled “Assessing capacity to decide on medical treatment: On human rights and the use of medical knowledge in the laws of England, Russia and Sweden” published in 2018, I analysed the modern interpretation of the criteria for legal incapacity in Russia. These criteria are interpreted in a dramatically different manner depending on the case at hand. In some cases, having “a pretentious hairdo”, having too good or too bad relationships with relatives, being too religious, or not having enough knowledge about Immanuel Kant’s doctrine, can be considered a reason for being deprived of legal capacity. The cases studied suggest that almost any type of behaviour in conjunction with the diagnosed mental disorder may still fall within the ambiguous requirements of the legislation on legal incapacitation. This study serves as a reminder that the deprivation of rights has been based on vague criteria for approximately 300 years. It is time to move away from the approach that the legislator has taken finally to ensure foreseeability and non-arbitrariness for persons with mental disorders in capacity assessment process.

Yana Litins’ka is an associate lecturer in jurisprudence at Uppsala University, Sweden.
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Recommended citation
Yana Litins’ka (2019): Three hundred years of legal incapacity in Russia. In: Public Disability History 4 (2019) 8.

April 13, 2019

Goodbye "Crazy Ex-Girlfriend", the show that revolutionized popular depictions of mental illness

By Ylva Söderfeldt

The musical sitcom Crazy Ex-Girlfriend just finished its fourth and final season. Up until the end, fans were biting their nails and debating which of her three love interests the main character Rebecca would end up with. Throughout, we got to enjoy the creative, funny, and intelligent song and dance numbers the show has become known for. But there’s more than the musical element that sets Crazy Ex-Girlfriend apart from other sitcoms. In particular, it’s an unusual series in that it makes mental illness a central topic.

Of course, mental illness in not an uncommon theme for film or television. But characters with psychiatric illnesses are rarely the heroes, usually the villains. The idea we get from media about people with psychiatric disorders is that they’re either dangerous, ridiculous, or both. Even in a story set in a psychiatric clinic, such as One flew over the cuckoo’s nest, the patient-hero is not “truly” mentally ill. For all its criticism of oppressive system and practices in psychiatry, that narrative centers not on people who experience psychological suffering, but on someone who in “reality” does not belong in the clinic. The uniqueness of Crazy Ex-Girlfriend is therefore that it allows a person actually suffering from a psychiatric disorder to have agency and gain audience sympathies.

The series centres on Rebecca Bunch, who impulsively leaves a successful career as a lawyer in New York City to pursue Josh, who was her boyfriend during a youth summer camp. She moves to a small town in California and starts building a new life and tries to win Josh back. This, she believes, will make her “truly happy”. The way she goes about her mission, however, is extreme and manipulative – that’s how she fulfils the sexist and ableist stereotype of the “crazy ex-girlfriend”. She breaks in to apartments, sets fires, stalks, and plots murder. All the while, the series is asking: is Rebecca “just a girl in love”, is she a criminal, or “crazy”?


Still, while recognizing her lack of boundaries and often appalling behaviour, it’s easy to root for Rebecca. This sets her apart from arguably the most classic fictional “crazy ex-girlfriend”, Alex Forrest from Fatal Attraction (1987). While Alex is closer to a horror movie monster than an actual woman, Rebecca gets to be a complete character. Early on in the series, it becomes clear that her obsession with Josh has a deeper root than just a typical love story. Her involvement with him, and the other men she ends up dating in the series, is motivated by a profound lack in her sense of self-worth. Through flashbacks, we learn about her childhood in a dysfunctional family, with a self-centered mother and an absent father, and that she previously has been hospitalized in a psychiatric clinic after having a violent mental breakdown.

The series, thus, becomes a narrative of living with mental illness. We get to follow Rebecca through different coping- and treatment strategies: going on and off medication, individual and group therapy, building a supportive social network and reassessing her career choice. We see her sink into a deep depression, deal with intense anxiety, and even attempt suicide.


This sounds like harsh topics for a musical comedy, and they are. But we also get to know Rebecca as a talented, funny, and clever person – and this is what makes the character unique as a portrayal of a person with mental illness. Whereas the role of “the mentally ill” in popular culture – in particular “crazy” women – is usually stereotypical, one-dimensional, and negative, Rebecca is a full person, and someone to relate to and identify with. Her mental illness is neither over-emphasised, nor erased. Rather, the series relentlessly examines the ambiguities surrounding narratives about love and shows that there is a thin line between what, in our culture, is considered romantic and what pathological.


Late in the series, Rebecca gets diagnosed with Borderline Personality Disorder (BPD), one of the most stigmatized mental illnesses. The cultural stereotype around BPD is prevalent not only in the public but far into the community of mental health providers (Knaak 2015). The way that the disorder is often characterized reads like a catalogue of the most undesirable, even immoral, personality traits. BPD patients are described as manipulative, unlikeable, violent, attention-seeking, not possible to treat and unable to have healthy relationships. The destructive effects of this stigma become clear in the series when Rebecca falls into despair after she reads up online on her new diagnosis. And at the same time, the entire series destroys the stigma. It’s impossible to dehumanize Rebecca based on her diagnosis when we get to see her as the full person that she is. It’s also abundantly clear that the fact that she has a personality disorder does not disqualify her from meaningful relationships – here, it’s worth noting that the way that the series portrays female friendship is also particularly refreshing.
The series has been praised for its diverse cast and the way that it addresses and challenges stereotypes around mental illness, gender, sexuality, and race. However, it’s a shame that the series never took the opportunity to extend its clever take on these issues to other disabilities as well. A broader disability perspective is absent and actors with visible disabilities almost non-existent.

Nevertheless, there is a lot to be learned from the series about how to think about and present the social and medical aspects of disability. In the Crazy Ex-Girlfriend universe, mental illness is inseparable from the social and cultural context in which it emerges. At the same time, however, it does not write off emotional pain as “just a social construction”, but presents it as as a very real, tangible, and common type of suffering. Medicine does provide some answers to it, but not all.

This is a perspective that could be extended to disability in general: we don’t need to make a black-or-white choice between social construction and medicalization. Medical interventions and services are valuable, but cannot alone explain or remedy disabling experiences, physical or psychological.





Ylva Söderfeldt is associate senior lecturer at the Department of History of Science and Ideas at Uppsala University.
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References

Knaak, S. et al. (2015): Stigma towards borderline personality disorder: effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design. In: Borderline Personal Disord Emot Dysregul 2: 9.

Recommended citation

Ylva Söderfeldt (2019): Goodbye "Crazy Ex-Girlfriend", the show that revolutionized popular depictions of mental illness. In: Public Disability History 4 (2019) 5.

March 13, 2017

Old medical records as historical sources - an accessible film

By Bettina Alavi and Eva Franz

Located at the psychiatric clinic in Heidelberg is the internationally known Collection Prinzhorn, in which works of mentally ill artists are archived and exhibited.1 Its founder, psychiatrist Hans Prinzhorn (1866-1933), laid the foundations for the study of art and art therapy in psychiatric context. From 1910-1921 he was hired by the Heidelberg Psychiatric University Clinic to develop an existing small art collection made by mentally ill persons. His book, "Bildnerei der Geisteskranken" ("Sculpture of the Mentally Ill"), was received by artists such as Max Ernst. Today's scholarly discussion of Prinzhorn's artists, in addition to dealing with the artistic products, also applies to the biography of the patients. The reconstruction of their life stories is based on historical medical records.2

Historical medical records are sources that were primarily written about the patient: the doctor noted symptoms, diagnosis, and treatment. Sometimes there were also letters from relatives. A further part consisted of official documents such as instructions, invoices, etc. Only in exceptional cases were letters, drawings, or pictures by the patient included. Nevertheless, the course of the patient's life can at times be at least partly traced. In addition, they provide insights into the historical background such as the roles of patients and caregivers, as well as insurance issues and much more.

With the demand for inclusion in education and with the development of disability history, the question arises about the provision of adequately prepared knowledge about mental illnesses and their treatment in history. Accessibility for all is an important basic condition: both to the Collection Prinzhorn, and to the materials made for educational purposes in the museum. The accessible preparation of these materials is the focus of a project in history didactics. Teacher training students at the University of Education in Heidelberg created accessible film sequences,3 which elaborate aspects of the history of psychiatry around 1900 in the context of the Collection Prinzhorn for a diverse group.

A product of the project is the film sequence "Alte Krankenakten als Quellen" ("Old medical records as historical sources").4 In the section shown here, the notion of historical source is clarified using an example of a medical record. Accessibility is enhanced through linear narration. This narration consists of language and visualization, which additionally structures the section and explains the content. The language is based on an everyday comprehensible vocabulary and follows the rules of Leichte Sprache (German version of Simple English).5 The moderation is calm, the articulation is clear. The source work is equated with detective work; a detective is repeatedly used as stylistic means. This visualization loosens the content humorously but not ironically. The lack of background music is intended and mental breaks are built in.



Making a film accessible is more than just methodological adjustments. It demands a deliberate reduction of the complexity of content through didactic elementarization.6 This concept is based on theories originated in special education. Leading questions for the process of elementarization are: What are the basic structures of the subject? What do people experience? And what is important from a social perspective? The elaboration of these "elementary structures", "elementary experiences" and "elementary basic principles of life" serve to elucidate the core of the matter.7

In the context of history didactics, the film sequence corresponds to the method of inquiry-based learning, as the detective work provides a method of identifying a historical source and shows ways to use it: Asking questions to a historical source is explicated. This is regarded as an important competence on the path to historical awareness.8

Recommended Citation:
Bettina Alavi & Eva Franz (2017): Old medical records as historical sources - an accessible film. In: Public Disability History 2 (2017) 4.


Footnotes:
[1] www.prinzhorn.ukl-hd.de/index.php?id=84, visited 2/22/2017.
[2] Fuchs, Petra (2010): "Sei doch dich selbst". Krankenakten als historische Quellen von Subjektivität im Kontext der Disability History. In: Elsbeth Bösl, Anne Klein, Anne Waldschmidt (Hrsg.): Disability History. Konstruktion von Behinderung in der Geschichte. Eine Einführung. Bielefeld, 105-123
[3] Vision Kino gGmbh (Hrsg.) (2013): Praxisleitfaden Inklusion und Film. Methoden, Tipps und Informationen für eine inklusive Filmbildung. Berlin: www.visionkino.de/publikationen/leitfaeden/praxisleitfaden-inklusion-und-film, visited 2/22/2017.
[4] The film was made by Anna Güse and Alena Roberts in Alavi’s and Franz’ seminar "Disability History" in winter semester 2016/17.
[5] www.leichtesprache.org, visited 2/22/2017.
[6] Lamers, Wolfgang/Heinen, Norbert (2006): Bildung mit ForMat – Impulse für eine veränderte Unterrichtspraxis mit Schülerinnen und Schülern mit (schwerer) Behinderung. In: D. Laubenstein, W. Lamers, N. Heinen (Hrsg.): Basale Stimulation kritisch – konstruktiv. Düsseldorf, 141-205.
[7] Seitz, Simone (2006): Inklusive Didaktik: Die Frage nach dem Kern der Sache. Zeitschrift für Inklusion www.inklusion-online.net/index.php/inklusion-online/article/view/184, visited 2/22/2017.
[8] Reeken, Dietmar von (2014): Historisches Lehren und Lernen. In. A. Hartinger, K. Lange (Hrsg.): Sachunterrichtsdidaktik für die Grundschule. Berlin, 98-116.

October 17, 2016

Who belongs in the murder clinic? The trouble with Nebel im August

By Ylva Söderfeldt

Germany is obsessed with narratives – movies, TV-series, novels – about its 20th century history. The most successful exports in later years have dealt with Nazi crimes and GDR oppression, not to mention the many productions directed at national audiences. No doubt, several of these works have been both of an outstanding artistic quality as well as having contributed to public awareness about the past, not least also about the continuities into and effects on the present German society.

One of the current movies on this theme (in the theatre where I watched it, there were at least two other films about Nazi Germany currently on the program) is somewhat unusual in that it addresses the murdering of sick and disabled people during the Second World War. Based on a novel that was in turn based on an actual biography, Nebel im August (Gloom in August) tells the story of Ernst Lossa (Ivo Pietzcker), who was murdered at the age of fourteen in a clinic in Irsee on August 9, 1944.
Lossa was Yenish, a minority that suffered persecution under the Nazis, had lost his mother, and was furthermore considered to have behavioral problems, all factors contributing to his institutionalization. We encounter him in the movie as he is transferred to the clinic in Irsee after having been in a series of other facilities. The initial impression is twofold: Lossa appears relieved at the friendly attitude he encounters from the head clinician Walter Veithausen (Sebastian Koch), but reacts with fear and contempt when he meets his fellow inmates, protesting that he doesn’t belong among "idiots".

A young boy with shaved head Ernst Lossa (Ivo Pietzcker)  is being viewed by a doctor Dr. Werner Veithausen (Sebastian Koch) standing behind him. Courtesy of StudioCanal.
A young boy with shaved head Ernst Lossa (Ivo Pietzcker)  is being
viewed by a doctor Dr. Werner Veithausen (Sebastian Koch) standing behind him. Courtesy of StudioCanal.
Between working in the fields and daydreaming of emigration, Lossa however soon comes to witness what quietly goes on in the clinic: inmates are being killed. At first, they disappear in enigmatic transports, then given lethal doses of medicine or deliberately starved on the premises.
The story is told at a slow pace and offers the viewers an almost excessive amount of scenic footage. At the same time, it is packed with information. When the camera doesn’t sweep over a beautiful landscape or interiors reminiscent of Vermeer paintings, it follows the protagonists in dialogues that painfully incorporate as many facts as possible about the ‚euthanasia’ programs. The ideological backdrop, the bureaucratic particulars, the role of scientific research as well as the Catholic church: it’s all in there, represented in the clearest way possible. This makes the viewing tedious, and the experience more like reading a Wikipedia entry than following a story. It is thanks to the generally very good acting and in particular Pietzcker’s brilliant performance, as well as David Bennent in an outstanding supporting role, that the movie still manages to engage and touch the viewer beyond the mere telling of historical facts.

A nurse (Henriette Confurius) hands a drink to a boy in a hospital bed. Courtesy of StudioCanal.
A nurse (Henriette Confurius) hands a drink to a boy in a hospital bed. Courtesy of StudioCanal.

This tendency to be overly pedagogic is a common trait for the genre and for German film in general (in a German detective story, you always know who the killer is, no mystery is tolerated). But it might also be due to the specific topic. The makers cannot anticipate that the viewers bring much previous knowledge into the theatre, and obviously felt it necessary to clearly lay out the facts in order to tell the story.

More troubling is the message that follows Ernst Lossa’s story throughout, and is articulated by one of his caretakers – and possibly, his killer  – "but he is a healthy boy!" The idea that Lossa "does not belong there" never quite leaves us even though his alliance shifts away from the staff and to his fellow inmates as the plot unfolds. This trope is all too familiar in narratives about the Nazi crimes against the sick and disabled: outrage tends to be directed especially at the abuse and murder of those who ‘weren’t even actually sick’ but ‘just’ labelled antisocial and degenerate. That line of reasoning, of course, implies that some people did ‘belong there’ and that certain illnesses and disabilities were, if not rightful, at least understandable grounds for extermination. From a public disability history perspective this particular presupposition  is precisely what needs to be questioned, and it is unfortunate that this production does not take the opportunity to do so.

Two boys with shaved heads(Niklas Post and Ivo Pietzcker) and a man (David Bennent) sit outdoors by a pile of potatoes looking amused and shocked. Behind them, men are making baskets.  Courtesy of StudioCanal.
Two boys with shaved heads(Niklas Post and Ivo Pietzcker) and a man (David Bennent)
sit outdoors by a pile of potatoes looking amused and shocked. Behind them, men are making baskets.
Courtesy of StudioCanal.

Nebel im August
StudioCanal, Germany, 2016
Director: Kai Wessel
Screenplay: Holger Karsten Schmidt
Lead cast: Ivo Pietzcker, Sebastian Koch, Thomas Schubert, Fritzi Haberlandt, Henriette Confurius

Recommended Citation:
Ylva Södrfeldt (2016): Who belongs in the murder clinic? The trouble with Nebel im August. In: Public Disability History 1 (2016) 18.

June 20, 2016

Disability History Beyond Borders: The Story of Ryoichi Ishii and Takinogawa Gakuen in Japan

By Yoshiya Makita

In the countryside, an hour’s train ride away from the noisy central districts of Tokyo, the buildings of Takinogawa Gakuen stand in solitude, surrounded as they are by deep forest and tiny streams. As a social welfare center, Takinogawa Gakuen provides services to people with mental disabilities. The small institution has a long history. Visitors learn with a sense of surprise that this first institution of its kind, which was established in Japan more than a hundred years ago, continues its mission on the western outskirts of the metropolis.

In the past ten years, the field of disability history has been expanding hugely to include various areas of research from diverse perspectives. No historian can now ignore the critical importance of disability, which influences one’s social life, at the intersection with other social attributes such as race, gender, and class. To this current state of the field, the story of Takinogawa Gakuen and its founder Ryoichi Ishii will add another new viewpoint: a transnational perspective on the history of disabilities. What it means to be disabled varies with location. But historical inquiries reveal that different institutions of disability in various localities have often developed through transnational exchange of ideas and practices beyond borders.

Portrait of Ryoichi Ishii (Courtesy of Takinogawa Gakuen)
Portrait of Ryoichi Ishii (Courtesy of Takinogawa Gakuen)