Forensic Psychiatry in the Netherlands

I’m happy to hear that the speakers before me gave definitions. It’s always handy to know what we’re talking about. I’ll be giving you several definitions myself. To start with, forensic psychiatry. By this I mean all actions of so-called behavior experts on behalf of the ministry of justice. So also the Pieter Baan Center [for forensic psychiatric observation and diagnosis]. It surprises me that I haven’t heard anyone mention it yet, as without Pieter Baan there can be no forensic psychiatric treatment. Pieter Baan is also important for something else.

You see, the court has a difficult job. It has to determine who committed a certain crime. How can a judge know this when he wasn’t present at the scene and time of the crime?
 
Perhaps you’re familiar with the story of Silas Marner by George Elliot? It transpires in a small nineteenth century Christian village in England. One day a bag of money was discovered to be missing. They had an infallible method for determining the guilty party. They had God do it. God’s representative on earth, the minister, arranged for a drawing of lots. Marner drew the short lot, indicating that he was guilty.

Elsewhere in his time there was a social problem of witchcraft. How did the judge determine who is a witch? As everyone knows, a witch has been intimate with the devil. During the act, the devil pierces her skin with his tail. Therefore the judge orders a physician to examine the woman’s body for the place where the devil’s tail penetrated it.
 
These methods don’t work anymore because few people in the Netherlands believe in God and even fewer in the devil. Not that in those days all Christians held identical beliefs. It seems to me their beliefs were even more diverse that today’s.

What do we believe in today? Science --- with a capital S. The Dutch word for science is wetenschap (literally: knowledgeableness). That’s the point: you know, for certain, without doubt. Science makes no mistakes, like the god who incriminated Silas Marner. And the minister of Science is the doctor, the expert.

For instance Cees Borsboom and Lucia De Berk were convicted largely on grounds of reports by so-called behavior experts. Apparently judges think, “S/he’s crazy, so s/he must have done it.” Just as the physicians of yore always found the spot on the woman’s body where the devil’s tail penetrated, so psychiatrists and psychologists always “find” something wrong with someone’s personality.

By the way, I read in the newspaper that, commenting on the Lucia de Berk case, professor Hans Crombag joked that our criminal law should fall under the law for lotteries. I thought to myself, he is more right than he thinks. It’s the age-old lottery system, disguised as Science.

Judges have a lot of power. I don’t doubt that most of them try to handle it in a responsible way, but how do you do that? How do you punish someone? What is fair? How do you protect society? Especially when you’re not completely certain that the suspect is guilty?

What you do, is you hand the matter over to the minister, and in our time, that is the physician. You transform the suspect to a patient. The devil was exorcised from the witch, usually by burning. Similarly, disease is exorcised from the patient, usually by drugging. At least, that appears to be the judge's image of psychiatry.

Perhaps I have given you the impression that I believe that all the detainees in Dutch jails are innocent. No, I’m sure jail is a fine place for some people, for instance the young man who knifed down my night grocer. Not that I am blind for the tragedy behind this young man’s behavior, or that I don’t think he should be detained under humane circumstances, but people who rob other people of their lives cannot be allowed onto the streets.

What was the sentence given to him by the judge? Three years. Three years, for the life of my night grocer. Three years, but: with forensic psychiatry. So how long is that really? When will this young man be released?

We don’t know. Maybe he’ll remain locked up for the rest of his life. Maybe he’ll be released already after three years. Maybe even after one year, according to what one of the speakers before me said. The point is that it is not a decision made by the judge, nor by the public prosecutor, and nor by the legislator. It is decided by the doctor, the expert. In part due to this type of expertise innocent people languish in our jails while dangerous criminals roam free.

The judge turns the matter over to the clinic, and probably appeases his conscience with the thought that the young man will be receiving “help”. Even if it turns out he didn’t do it, who can object to help?

But what is help? Help by definition is something you ask for. Imagine, for instance, that you look in the mirror and notice that your nose is crooked. You can’t bear to look like that, or perhaps it interferes with your breathing. What do you do? You ask a plastic surgeon to straighten it out. When he does, you are receiving help with your problem.

But now imagine, not you but someone else decides that your nose is crooked, and you are dragged to the plastic surgeon in handcuffs. Or perhaps you go willingly, but it turns out the surgeon doesn’t have any instruments to straighten out your nose. Or he straightens it by pulling your eyes crooked. Then you are not helped. And so it is with psychiatry.

What is psychiatry? Psyche means soul (mind, personality) and -iatry means medicine (in Dutch, literally: healing). And medicine, it is assumed, is based on science. But the first requirement of science  is that the object under study is observable, and the human soul is not. I hear someone in the back row thinking, “We can observe human behavior.” But then we arrive at the second requirement of science: that the environment is controllable so that all variables can be ruled out. For instance, when animal behaviorists run experiments with mice, all the participating mice live in identical cages and consume identical diets. You can’t do that with people. There are too infinitely many variables.

There is also a third requirement for science: that the results are repeatable. An example from chemistry, at my level of knowledge on the subject, is what happens when you mix vinegar with baking soda. It fizzes. This will happen every time, regardless of who does the mixing, regardless of where it is mixed, regardless of who is looking on, and – very important – regardless of who paid for the vinegar and baking soda. You don’t achieve reliable results like that with human behavior.

Medicine means the art of healing, but nobody in psychiatry ever heals, nobody. Psychiatrists don’t even speak about healing or recovery, they speak about managing. The word has to be said all over the world in English to sound more learned. Managing (in English) means managing (in Dutch). So psychiatrists speak of managing mental illnesses, or disorders, or whatever they call them. Their favorite words are psychoses and schizophrenia.

However, they can’t demonstrate the existence of these disorders. They mumble about neurotransmitters, but it isn’t possible to test neurotransmitters in the human brain. That can only be done in mice (or rats). You kill the mouse and immediately dunk it’s head in ice water to cool it down, otherwise the neurotransmitters will disintegrate. Then you take out the brain, cut a thin slice from it, and put that in a centrifuge to spin out the neurotransmitters. But you can’t do it with a human, because, aside from ethical concerns, even the head of a child is too large to cool down fast enough to prevent the neurotransmitters from disintegrating by the time you get to the brain. So there is no proof whatsoever that neurotransmitters are involved in misbehavior. Not even the misbehavior of mice, not even in mice who hear voices or have personality disorders.

Now I’m not saying there’s no such thing as crazy people. Take, for instance, that creep in Austria with his daughter in a cellar, assuming what we read in the papers is true. Who would do such a thing? A madman of course, who else? The speaker before me gave a definition of crazy. He said it means strange. I agree with that. Crazy means bizarre, beyond understanding. Just as the word managing does not take on more meaning when said in English, the word crazy does not take on more meaning when said in medical pig Latin: psychotic, schizophrenic.

Psychiatry is not about managing psychoses and schizophrenia; these conditions cannot not even be demonstrated to exist. There are no objective tests for them, and the so called experts doesn’t even agree on what these words mean. The DSM – often called the psychiatric bible – doesn’t define the word psychoses, and the word schizophrenia is defined so broadly that that it can be and often is applied to people who have not one deviant characteristic (deceivingly called “symptom”) in common. And as if that isn’t vague enough already, many psychiatrists don’t bother with the criteria in the DSM.
 
What psychiatry is all about, is managing psychotics and schizophrenics, or rather, people so labeled. So psychiatry is about managing people. That’s why we have forensic psychiatry, but not forensic cardiology or forensic gynecology.

I already said that no one in psychiatry ever recovers, but people do become worse, and then I’m not even referring to the awful physical deformities, trembling, involuntary movements, and so forth. I’m talking about behavior. An earlier speaker discussed the issue of crimes committed while on leave from the forensic psychiatric clinic. There are even cases of people convicted of, say, setting fires, or self-exposure, who, while on leave from the forensic psychiatric clinic, commit murder for the first time in their lives. You go in as a nuisance and come out as a murderer. Why?

Shall I tell you? The first thing most detainees do as soon as they get the chance, is rid themselves of those horrid pills. Also in the cases we’ve had of people escaping, they did not say to the staff in advance, “Please prepare me a week’s supply of pills because I’m going to run away.” When you go off those pills cold turkey, you get withdrawal deliria. They’re not identical in everyone, but they are conspicuously often fits of rage, aggression.

The laboratory technician who explained to me about neurotransmitter research, also told me about experiments she did with neuroleptics. Nowadays they’re called antipsychotics for marketing convenience. It rhymes with antibiotics, a kind of wonder drug. I refuse to call them that because they aren’t. Neuroleptics is what the are, as their original inventors knew and named them. That literally means making the brain lethargic. Getting back to the laboratory technician, she was involved with testing neuroleptics on mice. She related that when the experiments were over, it was crucial to sacrifice the mice immediately, because if delayed, the withdrawal of the neuroleptics would kick in, and then those otherwise so tame little animals would become so extremely violent that it was impossible to catch them even wearing thick gloves.

The speaker [who was not able to attend, and whose speech was partly read out to us], listed recent news stories about people who suddenly and unexpectedly turned violent. She proposes that early psychiatric intervention could have prevented these horrific acts. What she doesn’t tell you is that each of these people she mentioned were already in psychiatric treatment and on psychiatric drugs at the time the act was committed. Prevention would be wonderful if it were possible, but we don’t have any effective methods of prevention. On the contrary, it is likely that the pills and shots that she would like to see administered at an earlier stage are precisely the cause of these acts of violence.

Psychiatrists promptly label such deliria “psychoses”, and then what? Then they prescribe even more pills and shots. Psychiatric drugs are partly responsible for the fact that there keep being more and more crazy people, more and more people who cannot control their behavior, more and more homeless, more and more disabled people. Think of the vast proliferation of young adults receiving disability pensions as was widely reported in our news media last week. The explosive numbers are specifically linked to the frequent diagnosis of ADHD. Is it any wonder that there are now so many disabled young adults, when the previous decades so many children who didn’t sit still in school were drugged with Ritalin or Risperdal or what have you? Of course when you damage children’s central nervous systems they grow into unemployable adults. I continue with my list: more and more cases of family violence, more and more accidents, for instance in traffic, and we are less safe than ever on our streets.

Terrorism, that’s a huge problem in Bagdad. Here in the Netherlands your risk of becoming the victim of a terrorist attack is nil, in spite of the angst our government tries to inspire us with. Perhaps they do it to promote the sale of pills for anxiety. Here, the biggest threat to our freedom and safety is psychiatry. Psychiatry is always hiding in the shadows, ready to pounce on us. And most of all, psychiatry is everywhere where people are warehoused: in jails, youth detention centers, old folks’ homes, institutions for the intellectually disabled, schools, and so forth. Because psychiatry is all about managing people.

Forensic psychiatry serves, besides for storing people, to paper over the judge’s doubts and fill in the cracks of our criminal justice system. Not to mention to fill the pockets of all those phony physicians and bogus experts. They’re much better than me at talking, but then so are used car dealers. And don’t forget the bank accounts of the pharmaceutical industries, whose lobbyists write our laws.

Psychiatric victims know that we do not live in freedom. In many aspects we are better off than other places in the world, but that doesn’t make us free. We live in a dictatorship of doctors. And fitting to a dictatorship is a nationalistic anthem, with which I will end. To spare your ears, I won’t sing it, so you don’t have to rise.

Conclusion of the conference with speakers receiving flowers.
MeTZelf chairman Mira de Vries is at the extreme left.

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