Re: Abuse of psychiatry.
To the editor, British Medical Journal
In August 2006, a student (HM), was attacked on her way to a Hungarian language exam in college, in Nitra, Slovakia. Her attackers shouted Slovak nationalist slogans. Photographs of her injuries were taken by fellow students and staff before she went to hospital for treatment. Another slogan was found written on her blouse: "Hungarians go behind the Danube, Slovakia without parasites".
HM was questioned by police for some 6 hours after she reported the incident. A police investigation into the incident was terminated after two weeks with no outcome. The police claimed that her account was a fabrication, and tried to persuade her to drop the claim, and the then Prime Minister and the Interior Minister (both now again in office since 2012), held a press conference in which they publicly refuted HM’s claims. In November 2006 HM was charged with perjury, following an accusation by an individual whose identity was at first kept secret, and who then apparently committed suicide in May 2007 at the time the case was to be heard. The case has yet to come to court.
Following the attack, and as a result of her symptoms, HM was referred for treatment to a specialist service where she successfully underwent treatment for post-traumatic stress disorder (PTSD). She has since completed her studies, married and had two children.
The Public Prosecutor has persisted in seeking HM’s prosecution for perjury, in spite of strong evidence supporting HM’s account, a number of acknowledged errors and alleged wrongful practices on the part of the police, and incidents of further harassment of HM and her then fiancé, by persons unknown. HM took her case to the European Court of Human Rights (ECHR), following which, in early 2012, the Slovak Government apologised, and an agreement was made that neither she nor the Slovak government would pursue any further actions. However, the Public Prosecutor has continued to insist on HM’s prosecution, without though bringing the case to Court, and has attempted to force HM to undergo psychiatric evaluation, for which there is no current clinical indication. Since HM has declined to have such an evaluation, the Prosecutor has attempted to have her involuntarily admitted to hospital for such an evaluation, ostensibly to review the findings of her treating psychiatrist from 2006.
In March 2013, an International Colloquium comprising 13 experts from six countries, Slovakia, The Czech Republic, Germany, Austria, the UK and Hungary, was held in Piestany, Slovakia, to examine the reports of HM’s treating team, and to consider the circumstances in which she now finds herself, in particular the attempts to have her forcibly hospitalised. HM herself was available to answer questions from the panel, as was her treating psychiatrist and psychologist, and her legal representative. The Panel concluded that there was no reason to doubt HM’s account of the assault or her treatment afterwards at the hands of the police and the courts.
The Panel strongly endorsed the exemplary evaluation, diagnostic formulation and subsequent psychiatric treatment of HM by the clinicians involved, and found that there were no clinical reasons that would support any further evaluations, nor could hospital admission, several years after the incident, be justified on clinical grounds, nor was there any possible justification in terms of supporting any legal process. On the contrary, the panel considered that this would be, at best, disruptive to her personal, work and family life, and would be very likely to represent a serious risk of re-traumatisation. The panel was, unanimously, of the view that the ongoing actions of the state represent an abuse of psychiatry and that this should be condemned.
The findings of the Colloquium were summarised in the form of a statement by the panel members, and were sent to the World Psychiatric Association (WPA), and to the Slovak Psychiatric Association (SPA). The SPA has endorsed the clinical team’s management and recorded it’s disagreement with the attempted hospitalisation.
Since the Colloquium was held, further attempts to force HM to be evaluated by state psychiatrists have been made, and the case has still not been brought to court, almost 7 years after the incident.
Abuse of psychiatry, and indeed of medicine, must be condemned, and practitioners of any discipline should refuse to be complicit with such abuse.
Further details of the case are available from the authors on request.
Dr Tim Lambert, FRCPsych, Consultant Forensic Psychiatrist
Dr Peter Breier, MD., Consultant Psychiatrist
Dr Maja Turcan, Doc. Clin. Psychol., Consultant Forensic Clinical Psychologist
Competing interests: The costs of T.L., M.T. and P.B. attending the International Colloquium were met by the Colloquium organisers. No fee for attending was paid.