Peter R. Breggin MD is a lifelong reformer known as “The Conscience of Psychiatry” for his criticism of biological psychiatry and his promotion of more effective, empathic, and ethical forms of psychological, educational, and social approaches to people with emotional suffering and disability. He graduated from Harvard College with Honors and his psychiatric training included a Teaching Fellowship at Harvard Medical School. Following his training, he became a Full Time Consultant in the U.S. Public Health Service at NIH, assigned to the National Institute of Mental Health. Since then, he has taught at several universities, including Johns Hopkins, George Mason, and the University of Maryland, as well as at the Washington School of Psychiatry.
ECT works by damaging the brain. ECT (electroconvulsive therapy) involves the application of two electrodes to the head to pass electricity through the brain with the goal of causing an intense seizure or convulsion. The process always damages the brain, resulting each time in a temporary coma and often a flatlining of the brain waves, which is a sign of impending brain death.
After one, two or three ECTs, the trauma causes typical symptoms of severe head trauma or injury including headache, nausea, memory loss, disorientation, confusion, impaired judgment, loss of personality, and emotional instability. These harmful effects worsen and some become permanent as routine treatment progresses.
ECT originated in 1938. Modifications have been used since the 1960s and are not new or safer. These changes make it harder to cause a seizure. As a result, modern ECT requires even stronger and more damaging doses of electricity.
THE PURPOSE OF ECT IS TO CAUSE AN INTENSE SEIZURE OR CONVULSION. THE PROCESS ALWAYS DAMAGES THE BRAIN AND CAUSES MENTAL DYSFUNCTION.
ECT works by damaging the brain. The initial trauma can cause an artificial euphoria which ECT doctors mistakenly call an improvement. After several routine ECTs, the damaged person becomes increasingly apathetic, indifferent, unable to feel genuine emotions, and even robotic. Memory loss and confusion worsen. This helpless individual becomes unable to voice distress or complaints and becomes docile and manageable. ECT doctors mistakenly call this an improvement but it indicates severe and disabling brain injury.
ECT permanently impairs memory and causes other long-term signs of mental dysfunction such as difficulties with concentration and new learning. Memories of important past experiences are commonly impaired or eradicated, including weddings, birthdays, vacations, educational experiences, and housekeeping or professional skills. Sense of self or identity can be demolished, and family members often report that their loved one “was never the same again.” Follow-up studies show that ECT has been used to abuse women by making them docile and submissive.
Many animal studies show that clinical ECT causes small hemorrhages throughout the brain as well as patches of cell death. Newly discovered ECT induced neurogenesis (growth of new brain cells) is not a benefit but instead confirms brain injury. Neurogenesis is a response to brain damage from many causes, including Traumatic Brain Injury (TBI).
ECT is not a last resort because it does not work and can ruin recovery. ECT does not prevent suicide, but can cause it. Controlled clinical trials show that ECT has no more benefit than sham ECT (anesthesia with no shock).
ECT DOES NOT PREVENT SUICIDE, BUT CAN CAUSE ITPeter Breggin MD
ECT blunts emotional life during the acute phase of brain injury for about 4 weeks, after which the person remains depressed with the added affliction of brain damage. Abundant evidence indicates that ECT should be banned. Because ECT destroys the ability to protest, all ECT quickly becomes involuntary and thus inherently abusive and a human rights violation. Therefore, when ECT has already been started, concerned relatives or others should immediately intervene to stop it, if necessary with an attorney.
ECT DESTROYS THE ABILITY TO PROTEST. ALL ECT QUICKLY BECOMES INVOLUNTARY AND VIOLENTLY ABUSIVE.
In place of ECT, depressed and severely disturbed people need good individual, couples, or family therapy. Family members should participate actively in therapy with their overwhelmed loved ones.
Since psychiatric drugs commonly cause or worsen depression, anxiety and psychosis, always consider stopping all psychiatric drugs through a carefully supervised withdrawal.
Becoming free of psychiatric drugs is often the start of recovery. See Peter R. Breggin, MD, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families (2013).
Key Points To Remember
ECT is not a last resort because it does not work and can ruin any hope of future recovery.
After one or more ECTs, the brain-damaged individual becomes too docile and confused to protest or resist. Therefore family members, concerned individuals, advocates, or attorneys must intervene to prevent more extensive injury. No harm will come from stopping shock treatment, but increasing harm will inevitably occur from increasing numbers of ECTs.
Because it always becomes involuntary and because it causes severe damage to the brain and mind, ECT should be banned.
How to Access Resources
The facts in this report are confirmed by more than 125 scientific articles and other relevant materials at Dr. Peter Breggin’s “ECT Resources Center” which is available free of charge online at www.ectresources.org.
A table of contents is provided with extensive search terms such as “memory loss” and “brain damage.” For Dr. Breggin’s medical textbook chapter on ECT see his book, Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex, Second Edition, New York, Springer Publishing Company, 2008.
Permission is given to reprint and distribute this publication in hardcopy or digital form provided it is free and the copyright is included.
Electroshock – In February 2013, the United Nations Special Rapporteur on Torture, Mr Juan Méndez, when speaking amongst other things, ECT (electroconvulsive therapy o electroshock) recommended an
“absolute ban on forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, [and] the use of restraint and solitary confinement, for both long- and short-term application.” [i]
REPORT OF THE SPECIAL RAPPORTEUR ON TORTURE AND OTHER CRUEL,INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT
1 February 2013
39. …Medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement and specific intent, it is torture.
63. … It is essential that an absolute ban on all coercive and non-consensual measures, including restraint and solitary confinement of people with psychological or intellectual disabilities, should apply in all places of deprivation of liberty, including in psychiatric and social care institutions….
V. Conclusions and recommendations
Significance of categorizing abuses in health-care settings as torture and ill-treatment
82. The prohibition of torture is one of the few absolute and non-derogable human rights, a matter of jus cogens, a peremptory norm of customary international law. Examining abuses in health-care settings from a torture protection framework provides the opportunity to solidify an understanding of these violations and to highlight the positive obligations that States have to prevent, prosecute and redress such violations.
B. Recommendations
85. The Special Rapporteur calls upon all States to:
Enforce the prohibition of torture in all health-care institutions, both public and private, by, inter alia, declaring that abuses committed in the context of health-care can amount to torture or cruel, inhuman or degrading treatment or punishment; regulating health-care practices with a view to preventing mistreatment under any pretext; and integrating the provisions of prevention of torture and ill-treatment into health-care policies;
4. Persons with psychosocial disabilities
89. The UN Special Rapporteur calls upon all States to:
Impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, the use of restraint and solitary confinement, for both long- and short-term application. The obligation to end forced psychiatric interventions based solely on grounds of disability is of immediate application and scarce financial resources cannot justify postponement of its implementation
“(d) Revise the legal provisions that allow detention on mental health grounds or in mental health facilities, and any coercive interventions or treatments in the mental health setting without the free and informed consent by the person concerned. Legislation authorizing the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished.
14 May 2018: Statement by UN High Commissioner of the United Nations for Human Rights, Mr Zeid Ra’ad Al Hussein
“Psychiatric institutions, like all closed settings, generate exclusion and segregation, and being forced into one amounts to arbitrary deprivation of liberty. They are also, often, the locus of abusive and coercive practices, as well as violence potentially amounting to torture.”
“Forced treatment – including forced medication and forced electroconvulsive treatment, as well as forced institutionalisation and segregation – should no longer be practiced.”
Report of the United Nations High Commissioner for Human Rights United Nations (A/HRC/39/36) of 24 July 2018
Report of the United Nations High Commissioner for Human Rights
44. In light of the discussions, the following recommendations were proposed.
46. States should ensure that all health care and services, including all mental health care and services, are based on the free and informed consent of the individual concerned, and that legal provisions and policies permitting the use of coercion and forced interventions, including involuntary hospitalization and institutionalization, the use of restraints, psychosurgery, forced medication, and other forced measures aimed at correcting or fixing an actual or perceived impairment, including those allowing for consent or authorization by a third party, are repealed. States should reframe and recognize these practices as constituting torture or other cruel, inhuman or degrading treatment or punishment and as amounting to discrimination against users of mental health services, persons with mental health conditions and persons with psychosocial disabilities. States should ensure their enjoyment and exercise of legal capacity on an equal basis with others by repealing laws that provided for substituted decision-making, and should provide: a range of voluntary supported decision-making mechanisms, including peer support, respectful of their individual autonomy, will and preferences; safeguards against abuse and undue influence within support arrangements; and the allocation of resources to enable and ensure the availability of support.
14 September 2018: Presentation of the UN High Commissioner on Human Rights thematic report Mental Health and Human Rights by UN Deputy High Commissioner for Human Rights, Ms. Kate Gilmore.
“PRACTICES SUCH AS FORCED TREATMENT, FORCED STERILIZATION AND FORCED INSTITUTIONALIZATION VIOLATE HUMAN RIGHTS, AS DOES THE CRIMINALIZATION OF THOSE WITH MENTAL HEALTH CONDITIONS.”
June 10, 2021: The World Health Organization’s “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,”
The World Health Organization’s “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” condemns coercive psychiatric practices, which it says,
“are pervasive and are increasingly used in services in countries around the world, despite the lack of evidence that they offer any benefits, and the significant evidence that they lead to physical and psychological harm and even death.”[ii]
“Several other rights of the CRPD, including Freedom from torture or cruel, inhuman or degrading treatment or punishment and Freedom from exploitation, violence and abuse, also prohibit coercive practices such as forced admission and treatment, seclusion and restraint, as well as the administering of antipsychotic medication, electroconvulsive therapy (ECT) and psychosurgery without informed consent.”[iii]
Consultation on ways to harmonize laws, at the United Nations (A/HRC/49/29) of 2 February 2022
Summary of the outcome of the consultation on ways to harmonize laws, policies and practices relating to mental health with the norms of the Convention on the Rights of Persons with Disabilities and on how to implement them
Report of the United Nations High Commissioner for Human Rights
“40. In the light of the discussions, the United Nations High Commissioner for Human Rights makes the following observations and recommendations for States and all other relevant stakeholders, including health professionals, on ways to harmonize, as appropriate, laws, policies and practices relating to mental health with the provisions of the Convention on the Rights of Persons with Disabilities and on how to implement them:
“(c) Stemming from their obligations under the Convention, States should repeal provisions on forced institutionalization and substituted decision-making in law and in practice. States’ commitment to deinstitutionalization should include ending involuntary treatment practices,”
DRAFT GUIDANCE ON MENTAL HEALTH, HUMAN RIGHTS, AND LEGISLATION
June 2022
WHO/OHCHR
“Significant controversy surrounds the use of electroconvulsive therapy (ECT) and its associated risks (171). In Slovenia and Luxembourg, ECT is not available (172); and in many countries, there has been a dramatic decline in its use (173). Moreover, there are calls to consider banning ECT altogether (174, 175). If permitted, ECT must only be administered with the informed consent of the person concerned. International human rights standards are very clear that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment (77). People being offered ECT should also be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage (176, 177).”
Box 24. What the law can say
WHERE ELECTROCONVULSIVE THERAPY CONTINUES TO BE PRACTICED, ITS ADMINISTRATION WITHOUT A PERSON’S PRIOR WRITTEN INFORMED CONSENT IS PROHIBITED.
171. Read J, Cunliffe S, Jauhar S, McLoughlin DM. Should we stop using electroconvulsive therapy? BMJ. 2019;364:k5233. doi: 10.1136/bmj.k5233.
172. Gazdag G, Takács R, Ungvari GS, Sienaert P. The practice of consenting to electroconvulsive therapy in the european union. J ECT. 2012;28:4-6. doi: 10.1097/YCT.0b013e318223c63c.
173. Read J, Harrop C, Geekie J, Renton J, Cunliffe S. A second independent audit of electroconvulsive therapy in england, 2019: Usage, demographics, consent, and adherence to guidelines and legislation. Psychol Psychother Theory Res Pract. 2021;94:603-19. doi: 10.1111/papt.12335.
174. Read J, Cunliffe S, Jauhar S, McLoughlin DM. Should we stop using electroconvulsive therapy? . BMJ. 2019;364:k5233. doi: 10.1136/bmj.k5233.
176. Sackeim H, Prudic J, Fuller R, al. e. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacol. 2007;32:244–54. doi: 10.1038/sj.npp.1301180.
[i] “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez,” UN Human Rights Council, 1 Feb.2013, https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf
[ii] “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, https://www.who.int/publications/i/item/9789240025707 (to download report)
[iii] “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, p. 7.
“The wave of deadly violence sweeping through the occupied West Bank since the beginning of this year is the inexorable consequence of an acquisitive and repressive occupation with no end in sight, and the culture of lawlessness and impunity Israel has nurtured and enjoyed,” UN Special Rapporteur Francesca Albanese said in a statement.
Recent months have been marked by escalating unrest between Israelis and Palestinians. Israel’s new hardline government has also pledged to expand West Bank settlements and annex occupied territory.
She said Israeli violence – including the deadly raid in Jenin refugee camp on 26 January, in the old city of Nablus on 22 February, and in Jericho a week later – has left 80 Palestinians dead, and over 2,000 wounded, in less than 90 days.Thirteen Israelis also were killed by Palestinians during this period.
“Every loss of life, whether Palestinian or Israeli, is a tragic reminder of the price people pay for not addressing pervasive injustice and its root causes,” she said.
Repressive occupation, symbolic condemnation
The rights expert noted that over the past decades, the international community has witnessed record-high numbers of Palestinian deaths and injuries.
Meanwhile, Palestinians have also endured confinement, land confiscation, home demolitions, fragmentation, discriminatory law enforcement, mass incarceration and other countless abuses, indignities and humiliations.
“Israel, emboldened by a lack of meaningful intervention, has consolidated its acquisitive and repressive occupation, with Member States offering little more than symbolic condemnation, humanitarians providing band-aid aid, and legal scholars entangled in theoretical debates,” she said.
‘No equal parties’
Her statement urged the UN to “move beyond simply counting casualties and calling for restraint.”
The Organization “cannot indulge in the condescending acceptance of an irresolvable ‘conflict’ and the myth of conflicting narratives, and in urging the ‘parties’ to ‘de-escalate tensions’ and ‘resume negotiations,’” she said.
“In reality, there are no equal parties nor a proper ‘conflict,’ but rather an oppressive regime that threatens the right of an entire people to exist,” she insisted.
Furthermore, “tolerating annexation would legitimise aggression, bringing international law back almost a century: this is the reality the international community must stop immediately and reverse.”
Oppose annexation, support self-determination
Ms. Albanese urged the international community to recommit to the ideals of the UN Charter, in the interest of both Palestinians and Israelis.
“To maintain its credibility and purpose, the UN must acknowledge that conflicting narratives and historical facts must be resolved through the lens of legality and justice, and work effectively to oppose any forms of annexation of occupied territory, realise the right to self-determination of the Palestinian people and terminate the apartheid regime Israel is enforcing upon them.,” she advised.
About Special Rapporteurs
Special Rapporteurs are appointed by the UN Human Rights Council, which is based in Geneva.
These independent experts are mandated to monitor and report on specific thematic issues or country situations.
They are not UN staff and do not receive a salary for their work.
Mr. Türk’s warning comes amid the reported harassment and prosecution of justice officials involved with the UN-backed International Commission against Impunity (CICIG), including, most recently, former Commissioner Francisco Dall’Anese.
The UN rights chief called on the Guatemalan authorities “to ensure judges and lawyers can function freely and without fear of reprisals”. An independent judiciary is “vital” for a democratic society, he insisted.
The International Commission against Impunity was an independent body established by a UN-Guatemala agreement in 2007 to carry out corruption probes. Its work ceased in September 2019 when its mandate was not renewed amid attacks by then-President Jimmy Morales.
Mr. Türk also warned about potential violations of the right to participate in public affairs, as the candidacies of several presidential and vice-presidential candidates for the upcoming June elections were rejected by election authorities.
“I am also concerned that presidential and vice-presidential candidates from across the political spectrum, including Thelma Cabrera, Jordan Rodas and Roberto Arzú, have had their candidacies for the 25 June elections rejected by the Electoral Court on seemingly arbitrary grounds,” the High Commissioner said.
Thelma Cabrera was the only indigenous candidate running for president until the decision to disqualify her from the race. Appeals on all three cases are currently before the Supreme Court.
Judicial independence at risk
Mr. Türk stressed that “the right to participate in public affairs, including the right to vote and to stand for election, is an internationally recognized human right,” adding that judiciary authorities should “decide matters before them impartially, on the basis of facts and in accordance with the law, without any restrictions or improper influence”.
Earlier this year, the UN rights chief sounded the alarm on similar reprisals in Guatemala, as the country’s Special Prosecutor’s Office against impunity announced arrest warrants against three justice officials, including a former CICIG staffer.
Volker Türk, High Commissionner for Human Rights addresses a biennial high-level panel on the death penalty.
Surge in harassment
When presenting his report on Guatemala to the Human Rights Council in March, Mr. Türk pointed out that between 2021 and 2022, his office had documented a more than 70 per cent increase in the number of justice officials facing intimidation and criminal charges in the country.
The harassment was related to the officials’ work on corruption or human rights violations, particularly those that occurred in the context of the civil war from 1960 to 1996. Some had left the country, fearing for their safety.
Guatemala’s human rights record was examined in January 2023 under the Universal Periodic Review. A significant number of recommendations made as part of that process, by other Member States, were related to the need to guarantee the independence of the judiciary, protect justice officials, and strengthen anti-corruption measures and the rule.
The updated law will ensure that products in the EU, whether sold online or in traditional shops, comply with the highest safety requirements.
On Thursday, MEPs endorsed the revised rules on product safety of non-food consumer products with 569 votes in favour, 13 against and no abstentions. The new regulation aligns the existing General Product Safety Directive with the latest developments in digitalisation and the surge in online shopping.
Improving safety assessments
In order to guarantee that all products placed on the market are safe for consumers, the General Product Safety Regulation includes measures to guarantee that risks for the most vulnerable consumers (e.g. children), gender aspects and cybersecurity risks are also taken into account during safety assessments.
Market surveillance and online shops
The new regulation extends the obligations of economic operators (such as the manufacturer, importer, distributor), increases the powers of market surveillance authorities and introduces clear obligations for providers of online marketplaces. Online market places shall cooperate with market surveillance authorities to mitigate risks, who in turn can order online marketplaces to remove or disable access to offers of dangerous products without undue delay, and in any event within two working days.
Products coming from outside the EU can be placed on the market only if there is an economic operator established in the European Union, who is responsible for its safety.
Efficient recall procedures
The revamped legislation improves the product recall procedure, as currently return rates remain low, with an estimated third of EU consumers continuing to use recalled products.
If a product has to be recalled, consumers must be informed directly and offered a repair, replacement or refund. Consumers will also have the right to file complaints or launch collective actions. Information on products’ safety and remedy options must be available in clear and easily understandable language. The rapid alert system for dangerous products (“Safety Gate” portal) will be modernised to allow unsafe products to be detected more effectively and will be more accessible for persons with disabilities.
Quote
The rapporteur Dita Charanzová (Renew, CZ) said: “Thanks to this law we are protecting our most vulnerable consumers, particularly children. In 2020, 50% of products listed as dangerous came from China. With this law, we took a crucial step against those who do not sell safe products in Europe.
Every product sold must have someone who takes responsibility for it inside the EU. Unsafe products will be removed from websites in two days. Consumers will be informed directly via email if they have bought an unsafe product. In addition, they will have a right to a repair, replacement or refund if a product is recalled. Once this law is in place, there will be fewer dangerous products in Europe”.
Next steps
Council will need to formally endorse the text too, before its publication in the EU Official Journal and entry into force. The Regulation will apply 18 months after its entry into force.
The new rules are projected to save EU consumers around 1 billion euro in the first year and approximately 5.5 billion over the next decade. By reducing the number of unsafe products on the market, the new measures should reduce the harm caused to EU consumers due to preventable, product-related accidents (estimated today at 11.5 billion euro per year) and the cost of healthcare (estimated at 6.7 billion euro per year).
On Thursday, MEPs endorsed the revised rules on product safety of non-food consumer products with 569 votes in favour, 13 against and no abstentions. The new regulation aligns the existing General Product Safety Directive with the latest developments in digitalisation and the surge in online shopping.
Improving safety assessments
In order to guarantee that all products placed on the market are safe for consumers, the General Product Safety Regulation includes measures to guarantee that risks for the most vulnerable consumers (e.g. children), gender aspects and cybersecurity risks are also taken into account during safety assessments.
Market surveillance and online shops
The new regulation extends the obligations of economic operators (such as the manufacturer, importer, distributor), increases the powers of market surveillance authorities and introduces clear obligations for providers of online marketplaces. Online market places shall cooperate with market surveillance authorities to mitigate risks, who in turn can order online marketplaces to remove or disable access to offers of dangerous products without undue delay, and in any event within two working days.
Products coming from outside the EU can be placed on the market only if there is an economic operator established in the European Union, who is responsible for its safety.
Efficient recall procedures
The revamped legislation improves the product recall procedure, as currently return rates remain low, with an estimated third of EU consumers continuing to use recalled products.
If a product has to be recalled, consumers must be informed directly and offered a repair, replacement or refund. Consumers will also have the right to file complaints or launch collective actions. Information on products’ safety and remedy options must be available in clear and easily understandable language. The rapid alert system for dangerous products (“Safety Gate” portal) will be modernised to allow unsafe products to be detected more effectively and will be more accessible for persons with disabilities.
Quote
The rapporteur Dita Charanzová (Renew, CZ) said: “Thanks to this law we are protecting our most vulnerable consumers, particularly children. In 2020, 50% of products listed as dangerous came from China. With this law, we took a crucial step against those who do not sell safe products in Europe.
Every product sold must have someone who takes responsibility for it inside the EU. Unsafe products will be removed from websites in two days. Consumers will be informed directly via email if they have bought an unsafe product. In addition, they will have a right to a repair, replacement or refund if a product is recalled. Once this law is in place, there will be fewer dangerous products in Europe”.
Next steps
Council will need to formally endorse the text too, before its publication in the EU Official Journal and entry into force. The Regulation will apply 18 months after its entry into force.
The new rules are projected to save EU consumers around 1 billion euro in the first year and approximately 5.5 billion over the next decade. By reducing the number of unsafe products on the market, the new measures should reduce the harm caused to EU consumers due to preventable, product-related accidents (estimated today at 11.5 billion euro per year) and the cost of healthcare (estimated at 6.7 billion euro per year).
Reviewing the latest EU Council, MEPs called for EU action to enhance the industrial sector, support households and businesses and continue backing Ukraine.
“The world is more dangerous today”, acknowledged European Council President Charles Michel, stressing the EU’s support for multilateralism and a rules-based order and highlighting the need to “deal with China and not decouple” from it. He welcomed the leaders’ endorsement to send additional weapons and ammunitions to Ukraine, a major step towards a European defence system. Regarding long-term competitiveness, Mr Michel said that Europe must become “a powerhouse of innovation”, particularly on renewable energy and clean technologies.
European Commission President Ursula von der Leyen said that the EU, given its ambitious targets for the deployment of renewables, needs to create a better regulatory environment for European manufacturers of clean technologies, while highlighting the importance of critical raw materials to ensure the green and digital transitions.
Moving on to the war in Ukraine, she reiterated that the EU will keep supporting Kyiv whatever the cost and described the decision by the International Criminal Court to issue a warrant for the arrest of Russian President Vladimir Putin, as a “step forward”. Von der Leyen also stressed that the international community needs to do everything possible to bring home all the Ukrainian children illegally deported to Russia since the outbreak of the war.
Many MEPs focused on international industrial competitiveness and strategy, with some highlighting the need to stop the loss of industrial strength and jobs in Europe. Others called on the EU to speak with a single voice for example with regards to China, and to reduce dependence on third countries.
On migration, most speakers insisted that ambition and courage are needed to succeed in the negotiations on the migration and asylum pact, referencing key topics like the fair distribution of migrants and asylum-seekers among member states and tackling the root causes of migration.
Several MEPs argued that more international trade agreements are needed (with existing ones requiring updates), while others focused on security and foreign policy concerns, calling for transatlantic relations to be protected and strengthened. Many also highlighted the need to continue supporting Ukraine and make sure that Russia will be held accountable for its war of aggression.
Some speakers criticised the EU’s approach to handling recent crises and common policies like the European Green Deal, and called for more decisions to be taken at member state level. In contrast, many others demanded enhanced cooperation, an end to vetoes and no more time-wasting in the Council to support households and businesses from threats like surging inflation and energy bills.
The recent report published by the High Council for Family, Childhood and Age (HCFEA) warns of the psychological suffering of children and adolescents, as well as the chronic lack of resources allocated to care, education and social intervention in mental health in France. In our previous article we detailed the continuous and inappropriate increase in the consumption of psychotropic drugs in the paediatric population in France.
Here we analyse the old idea that a mental disorder can be caused by a brain abnormality. And that, being of biological origin, this dysfunction can be solved by chemical, electrical or mechanical treatment. This approach has been favoured for a long time, but the results remain limited. Because, in fact, anomalies are ‘associated’ with mental disorders… the problem is their causality.
These prescriptions, often outside of international scientific consensus and regulatory mechanisms (marketing authorizations and recommendations of health agencies), contradict the words of the WHO, which warned, as recently as 2022, that “all over the world […] current practices place psychotropic drugs at the center of the therapeutic response, whereas psychosocial and psychological interventions and peer support are also avenues to be explored and should be offered”.
The international organisation takes a strong stance on the subject, stating that “to succeed in defining an integrated, person-centred, recovery-oriented and rights-based approach to mental health, countries must change and open up mentalities, correct stigmatising attitudes and eliminate coercive practices”. For this to happen, she adds, “it is essential that mental health systems and services broaden their horizons beyond the biomedical model”.
Biological psychiatry’ is the direct transcription of this biomedical paradigm.
This approach is based on a biological conception of psychological suffering: it seeks markers (mainly neurobiological and genetic) likely to provide a basis for psychiatric diagnoses and to open the way to essentially medicinal treatments. The UN organisation recalls that it has “dominated mental health research […] in recent decades”. Research, but also French policies over the last twenty years.
If international health institutions deplore the invasion of biomedical approaches, particularly in children, and their consequences in terms of overprescription of psychotropic drugs, it is not because of dogmatism. It is because an updated review of the results of research shows, experimentally and empirically, the impasses of the models inspired by biological psychiatry.
Work on the neurobiology and genetics of mental disorders has increased exponentially over the last forty years, supported by improvements in brain imaging and genetic sequencing technologies. Two main directions have been explored: the search for an organic causality of mental disorders on the one hand, and the development of drug treatments on the other.
Unfortunately, their contributions to clinical psychiatry remain limited and contradictory.
Almost all research hypotheses on the neurological and genetic causes of mental disorders – a fortiori in children – have been refuted by the so-called princeps (reference) studies and subsequent meta-analyses. At best, various parameters may have been associated with marginal increases in the risk of developing one disorder or another, but under such conditions that they do not allow any firm conclusions. They are therefore of little interest to practitioners or patients.
Thus, despite decades of intensive research :
No marker or biological test has been validated to contribute to the diagnosis of mental disorders;
No new class of psychotropic drugs has been discovered in the last 50 years, so much so that the pharmaceutical industry has virtually ceased research in this area since 2010. The current drugs were discovered in the 1950s-1970s by serendipity1, or are derivatives obtained by trying to reduce their adverse effects. Their effectiveness is also considered low by the latest publications.
These results are now supported by such a large body of work that the idea of continuing with the same neurobiological hypotheses is questionable. The likelihood of discovering a biological cause of mental disorders that would support the pharmacological approach of biological psychiatry is diminishing as studies progress.
This change of perspective began to emerge in the course of the 2000-2010s and is now widely supported by the most renowned specialists at international level.
For example, Steven Hyman, former director of the National Institute of Mental Health ((NIMH, the American institute for mental health research), states that “although neuroscience has made progress in recent decades, the difficulties are such that the search for the biological causes of mental disorders has largely failed“. Similarly, Thomas Insel, who succeeded him as head of the prestigious institute, recently admitted that “neuroscience research has, for the most part, yet to benefit patients.”, and that “the issues raised by biological psychiatry research were not the problem facing patients with serious mental illness”.
The most prestigious scientific journals are increasingly taking the same line. Psychiatrist Caleb Gardner (Cambridge) and medical anthropologist Arthur Kleinman (Harvard) wrote in the New England Journal of Medicine in 2019:
“Although the limitations of biological treatments are widely recognized by experts in the field, the prevailing message to the general public and the rest of medicine is still that the solution to mental disorders is to match the right diagnosis to the right drug. As a result, psychiatric diagnoses and psychotropic drugs proliferate under the banner of scientific medicine, even though there is no thorough biological understanding of the causes of psychiatric disorders or their treatments.”
In general, the problems posed by the biomedical approach to mental health have been well documented for a long time in numerous works by authors from multiple disciplinary fields – neurosciences, psychiatry, human sciences, history, sociology and social sciences…
Stigmatisation effects
Contrary to the good intentions of de-stigmatisation campaigns, which thought that allowing people with mental disorders to say “it’s not me, it’s my brain” would be socially and therapeutically beneficial, several international studies have shown that it increased social rejection, perceived dangerousness and pessimism about the possibility of recovery. Caregivers adhering to this view also showed less empathy towards patients. Finally, patients were also more pessimistic about their symptoms and more likely to rely on medication.
With regard more specifically to children, biomedical conceptions have undoubtedly contributed to the increase in the prescription of psychotropic drugs. At the same time, they are generally unfavourable to psychotherapeutic, educational and social practices, which have been widely documented as effective and recommended as first-line treatment.
The example of hyperactivity and depression
In support of its analysis, the HCFEA was particularly interested in the issue of Attention Deficit Hyperactivity Disorder (ADHD), which is considered to be the most common diagnosis in school-age children, and in the issue of depression, which can be understood in terms of several mental health problems in children and adolescents.
ADHD cannot therefore be formally qualified as a neurological disease or disorder
No significant results for hyperactivity
Brain imaging studies published in the 1990s suggested that advances in neurobiology would soon allow diagnostic tools to be validated. Thirty years later, no test for ADHD has yet been recognised.
Hundreds of structural and functional brain imaging studies have shown differences correlated with ADHD, but none of them correspond to structural brain changes, and even less to lesions: ADHD cannot therefore be formally qualified as a neurological disease or disorder. Moreover, they are quantitatively minimal, contradictory, and of no interest from the point of view of diagnostic and therapeutic practices or health policies. Other work suggested a dopamine deficit or dysfunction of dopaminergic2 neurons as the cause of ADHD, but this perspective has been tested and refuted.
In general, the hypotheses concerning the neurological etiology of ADHD are now scientifically weak and dated.
Initial studies also suggested a strong genetic etiology3. These associations or their causal impact have been disproved. Currently, the best established and most significant genetic risk factor is the association of ADHD with an allele4 of the gene coding for the dopamine D4 receptor. According to a meta-analysis, the associated increase in risk is only 1.33. More precisely, this allele is present in 23% of children diagnosed with ADHD and only 17% of control children. This is of no clinical relevance.
A recent review of over 300 genetic studies concludes that “the results from genetic studies of ADHD are still incohérent and inconclusive”.
Depression: neither neurological nor genetic
In 2022, Joanna Moncrieff’s team of internationally recognised experts on depression and psychotropic drugs published a study that demonstrated the inconsistency of biomedical views and drug treatments for depression.
This publication, combining reviews and meta-analyses on a panel of very large numbers of patients, aimed to produce a synthesis of the main works that have studied the links between serotonin and depression over the last three decades. Their conclusion is clear: they found no convincing evidence that depression is related to lower serotonin levels or activity.
Most studies have found no evidence of reduced serotonin activity in people with depression compared to those without depression. In addition, high-quality genetic studies with good statistical power also rule out any association between genotypes associated with the serotonin system and depression.
What consequences on diagnostic and treatment practices and health policies?
In the current state of scientific knowledge, there is no established causal link between biological mechanisms, diagnosis and treatment in the field of psychiatry, a fortiori in children. A serotonin or dopamine deficiency should therefore no longer be used to support the prescription of antidepressants or psychostimulants for depression or ADHD. This is consistent with the low effectiveness of biological treatments observed.
The American Psychiatric Association has attempted to classify mental disorders in its Diagnostic and Statistical Manual of Mental Disorders (first edition, 1952; now DSM-5) – APA, CC BY
In the same way, one should be careful about the use of diagnostic categories inherited from large nomenclatures such as the DSM, the Diagnostic and Statistical Manual of the powerful American Psychiatric Association, an international reference. In the absence of a biological etiology, the diagnostic categories described in the DSM have no scientific validity: they do not denote any identifiable natural entity that could be interpreted as a disease. The same is true for the psychiatric diagnoses in the ICD-10, the International Classification of Diseases published by the WHO
This lack of validity is manifest in the variability of diagnoses according to the age of the child, the high proportion of co-morbidities, and the heterogeneity of clinical situations that the nomenclatures do not allow to grasp in detail – all the more so because, due to their naturalistic epistemology, they were constructed to be independent of the contexts of occurrence of the disorders.
Moreover, despite its evolutions, the DSM still suffers from reliability problems: the diagnostic decisions made by two doctors about the same patient are too often different, which limits their interest. Given its scientific weakness and considering that it “had been an obstacle to research”, the NIMH, the main funder of mental health research worldwide, disassociated itself from it.
The problem is not only epistemic but also political: since the 2000s, France has relied on the idea that these diagnoses could be the basis for standardized recommendations of good practice. The result is disappointing. Thirty years of mental health policies oriented by biomedical approaches have not prevented an increase in the psychological suffering of children and adolescents, an increase in suicide rates, a chronic deficit in the supply of care, a deterioration of institutions and care and education teams, a scissor effect between the demand for and the supply of care, unbearable waiting times, a continuous increase in the consumption of psychotropic drugs…
Taking into account the advances in research also means considering the absence of convincing results as an evolution of scientific knowledge in its own right, capable of reorienting public policies and research practices.
The current model of biological psychiatry has not lived up to its promise, in part because of the narrow and misguided application of the evidence-based approach to mental medicine, which seeks to apply research data to the clinical experience of the practitioner.
While we should not necessarily hold it against those who developed and supported it, we must now take this failure into account in order to rethink approaches, policies and systems of care, education and social intervention. In this respect, the the High Council for Family, Childhood and Age report does not limit itself to documenting the malaise and the reasons for it: it proposes new approaches and details the psychotherapeutic, educational and social strategies likely to contribute to the accompaniment and care of children, as well as the support of families.
This is where research and public policy efforts must now focus.
Serendipity: In the scientific world designates a form of intellectual availability, which makes it possible to draw rich lessons from an unexpected discovery or an error.
Dopaminergic: which works or reacts to dopamine. Dopamine is of many which is a chemical that serves as a neurotransmitter in the brain and is involved in “motor control, attention, pleasure and motivation, sleep, memory and cognition.
Etiology: study of the causes of diseases. By extension: All the causes of a disease.
An allele is a variable version of the same gene, that is to say a varied form. There are usually a few alleles for each gene, but some genes have several dozen alleles.
Authors
Sébastien Ponnou Psychoanalyst, Senior Lecturer in Educational Sciences at the University of Rouen Normandy – France
Xavier Briffault Researcher in social sciences and epistemology of mental health at the Medicine, Science, Health, Mental Health, Society Research Center (CERMES3), National Center for Scientific Research (CNRS)
Disclosure statement
Sébastien Ponnou is a qualified member of the HCFEA’s Council on Childhood and Adolescence. He directs several research projects for which the CIRNEF and the University of Rouen Normandie have received funding from public organizations and mutual foundations: Interdisciplinary Research Institute for Man and Society (IRIHS), Fondation EOVI – Fondation de l’Avenir, FEDER – Région Normandie.
Xavier Briffault is, as a sociologist and epistemologist of mental health, a qualified member of the HCFEA’s Council on Childhood and Adolescence.
Hundreds of thousands of workers in both countries have lost their livelihoods because of the earthquakes, preliminary findings showed in the new ILOassessments of the disaster’s impact on the labour market.
“Employment promotion is central to a successful and inclusive response to this disaster,” said ILO Director-General Gilbert Houngbo. “People can only begin to rebuild their lives if they have rebuilt their livelihoods. We owe it to those who have lost so much in the earthquake to ensure that the principles of social justice and decent work are firmly embedded in the recovery and reconstruction process.”
The earthquakes left more than 658,000 workers unable to earn their living, and more than 150,000 workplaces unusable, initial findings suggest.
In the face of steep income and job losses, ILO warned about increasing risks to occupational safety and health, as well as child labour.
Affected workers face average income losses of more than $230 per month each, for as long as the disruption continues. Overall, the crisis is likely to have reduced take-home payby around $150 million per month in the affected areas, ILO reported.
Lost work hours have rippled across the affected area. Estimates show that in Malatya, 58.8 per cent of work hours are estimated to have been lost, with comparable figures of 48.1 per cent in Adıyaman and 45.2 per cent in Hatay.
The affected provinces in Türkiye are home to more than four million workers, most employed in agriculture, manufacturing, trade, or other “low-value-added” services.
Syria: Soaring ‘disemployment’
In Syria, where 12 years of civil war had already taken a huge toll on the economy and labour market, ILO estimated that about 170,000 workers have lost their jobs as a result of the earthquakes. This has directly affected around 154,000 households and more than 725,000 people.
Around 35,000 micro, small and medium-sized enterprises have also been affected. This temporary “disemployment” has led to total labour income losses equivalent to at least $5.7 million a month.
The five worst-affected districts – Aleppo, Hama, Idleb, Lattakia and Tartous – were home to an estimated 42.4 per cent of the country’s total population. This includes around 7.1 million people of working age of 16 and up, 22.8 per cent of whom are women.
Post-quake assistance
Immediately after the earthquakes struck, ILO set to work covering the emergency needs of workers and their families.
In Türkiye: ILO is already planning and implementing labour market and enterprise recovery strategies.
Emergency labour-based enterprise programmes include engaging businesses to enable them to offer decent and sustainable jobs.
ILO helps business organizations and trade unions to function and provide critical services to their memberships.
Dedicated initiatives will focus on seasonal agricultural workers, child workers and refugees.
Support will be provided to social partners to ensure that they can continue to engage in recovery and reconstruction initiatives as key actors of national social dialogue.
In Syria: New and continuing efforts are reaching populations in quake-affected areas.
A series of training campaigns for engineers is improving occupational safety and health practices.
Ongoing employment-intensive works reach affected neighbourhoods in Aleppo.
Grants support ILO’s social partners to help them reach affected workers and businesses, as well as improving occupational safety and health practices.
Find out how the EU works to reduce emissions from greenhouse gases besides CO2.
As the EU works hard to reduce CO2 emissions, it is also making efforts to regulate other greenhouse gases heating up planet Earth, such as methane, fluorinated gases – also known as F-gases – and ozone-depleting substances. Although they are present in smaller volumes than CO2 in the atmosphere, they can have a significant warming effect.
MEPs from the environment committee call for ambitious emission reductions of fluorinated greenhouse gases and ozone-depleting substances. They support the European Commission’s proposals to encourage the use of alternatives to fluorinated greenhouse gases and ozone-depleting substances where possible or to put measures in place to reduce their leakage and emission during production or use. Members will vote on Parliament’s positions on reductions for fluorinated gas emission and ozone-depleting substances at the end of March 2023 ahead of launching negotiations with EU governments.
Cutting fluorinated greenhouse gases emissions
What are fluorinated gases?
Fluorinated gases are man-made and can be found in common appliances such as refrigerators, air conditioning or heat pumps, aerosols, solvents and foam blowing agents. They account for around 2.5% of EU’s greenhouse gas emissions.
Even though F-gases are found in smaller volumes in the atmosphere than CO2, they can capture more sun energy. The EU must reduce their emissions to achieve its 2050 goal of cutting down emissions to net zero.
As they do not damage the atmospheric ozone layer, F-gases are often used as substitutes for ozone-depleting substances.
What has the EU done so far?
F-gases are covered by the Paris Agreement together with CO2, methane and nitrous oxide as well as under international agreements on ozone-depleting substances.
To further reduce F-gases in the EU, MEPs want to:
Strengthen new requirements proposed by the Commission that prohibit the placing on the single market of products containing F-gases
Phase out hydrofluorocarbons (HFCs) – commonly used in air conditioning and refrigeration – placed on the EU market by 2050.
Have close monitoring to ensure the HFC phase-down does not endanger the RePowerEU heat pump deployment targets.
Increase enforcement to prevent illegal trade and non-compliance
The Commission estimates that its proposals for the F-gas Regulation would save 310 million tonnes of CO2 equivalent until 2050, which is the same as the total annual greenhouse gas emissions of Spain in 2019.
Phasing out ozone-depleting gases
What are ozone-depleting substances?
Found in similar appliances as F-gases, ozone-depleting substance are also man-made chemicals. When they reach the upper atmosphere, these substances may damage the ozone layer, which keeps the Earth from dangerous solar radiation.
In order to further cut emissions of ozone-depleting substances, MEPs support the Commission’s proposal for an update of the legislation, including a ban on the production, use or trade of such substances, except for strictly defined cases. They also call for better monitoring, improved enforcement and stricter penalties to avoid illegal activities.
According to the Commission, the proposed changes in the regulation on ozone-depleting substances would lead to savings of another 180 million tonnes of CO2 equivalent by 2050 – the same as the total annual greenhouse gas emissions of the Netherlands in 2019.
Reducing methane emissions
What is methane?
Methane occurs naturally in the atmosphere but is also generated through human activities, such as agriculture, industry and the combustion of fossil fuels. It accounted for 12% of the impact ofthe EU’s greenhouse gas emissions in 2021.
