‘playing’ as a way to ‘meaningful stuff’. Over the next weeks, I noted that despite enjoying playing and doing brilliantly well with scenes, word-associations, and developing themes and stories, his “comfort” lay in ‘talking’. After the initial self-surprising creative jumps, he would not allow the creativity to sustain. Infact, over a period of 5 weeks, Ramesh’s creative abilities or play did not increase in sustenance.
This had manifold reasons: During playtime he experienced an amount of wellness (because the sick Ramesh would temporarily disappear or get shadowed under this bright, joyful one!) that would make him feel stretched and long to retreat to the usual mode. Hence, after encouraging him a bit, I would press him no further. Another reason is that he too reflected the societal attitude and belief that puts-down playing and creativity as either ‘childish’ (and dismisses it) or as artistic (and puts it on a pedestal). Hence, we- ‘the commoners’- are absolved of practising or indulging in it, though ‘connecting’ to art forms, provides us life sustaining and strengthening power.

Two dramatherapeutic principles (as we practise it) were at play in our work:

>> Imaginative warm-ups loosened and freed ‘thinking-feeling’ energy. In making mini-sculpts or images, something ‘new’ ‘original’ ‘his own’ emerged without the fear of judgement or ridicule. We were using as if and ‘lets play’ to propel this.

>> Using some of the freed energy and focussing on “creation” – what is wanted - rather than analysis of what is. The focus is on the power to Create from nothing.

During his visits, the healing agenda worked as a powerful anchor and a safety net too. During one session, he asked me if I really understood his illness and proceeded to state that he thought I did not understand

his illness. A loop? A trap? How to respond…or not?? I decided to acknowledge that he was right, that I did not specialise in his illness. I specialised in wellness, and that I was interested in taking a journey with him towards the objectives we had formulated. I was simply not interested in discussing his ill-health (lots of discussion about it had happened in previous 8 years!). This destroyed the mental trap! He had agreed before that he wanted to feel well, to be conscious - and like a staunch mule I would push only towards that desired state of experience!!

The creative play of our sessions quickly yielded one concrete, undeniable output – that Ramesh was ‘thinking’ – clearly, logically, imaginatively, wonderfully! I adopted the roles of ‘trickster-healer’ but the stories, funny word association games (everything!) belonged to him. I just laughed and enjoyed his creations. Listened, praised- obliquely or directly - and at appropriate times, shrugged my shoulders and pointed out that all this was “his” creation. He made it. He owned it. And how good it was! In closures (where we mainly bridge the metaphor and play to make real life connections), we spoke about his abilities and his strengths as a person, as a young man.

I spoke to his mother on telephone and suggested that they stop treating him like an unwell person, that they need to slowly but surely realise that he is OK, that he is whole and relate to him so. That would be one of the powerful ways to help create and sustain a state of wellness in him.
Ramesh did encounter a fear of feeling OK again. He called half an hour before time, to report that he had fever and would not come to the session. The trickster in me almost threw a tantrum, and asserted that he would have to pay me anyways, because I had kept the appointment. That he should have told me earlier, and that I expected him to show-up

with a pill down his gullet. When he emerged (sharp on time!) I showed all sorts of concern and found out soon enough, that he was perfectly well – no fever! Well, drama for a dramatherapist! His parents later reported that they had refused to support his pretences. They decided that they would not bend this time to make fake calls to me on his behalf; instead they allowed him to choose and take responsibility – either ways. Ramesh tried this twice – and gave up…or shall we say, it just fell off….

Within sessions, he explored issues of ‘what was within his control’ and what was not. A significant outcome was his own agreement and exploration that ‘himself’ was his area of control. It was important to acknowledge his long period of suffering, lost opportunities of education, friendships, and other rites of passage a young person experiences from teenage to young adulthood. It was also very important for him to focus on his ‘now’ and ‘now on’; stop grieving about the lost time and start dreaming. This was then followed-up by the story of two frogs –one is ‘deaf’ to the catcalls of negative voices – so he can come out of the pit in which he is fallen. Other one dies, listening to ‘others’. Ramesh said after the story “ I want to be the one who lives”.

We journeyed through the most crucial question - ‘what does being conscious mean?’. As Ramesh talked about it, he kind of defined it as ‘awareness’ of things, deliberately being and doing. We ventured to apply this by doing a ‘reality check’ – to life and people in general: traffic, roads, cities, population and such broad things first. It seemed (to him as well as to me) that many people were not really ‘conscious’ or aware of what is happening around. The words shuddhi – being conscious or aware of something, and shuddha – pure / clean, come from the same Sanskrit root. We deliberated on this – played

and sang old Marathi song about Shuddha – pure heart.

We used poetry and songs, but also invented conversations and dialogue (as noted before, Ramesh was more comfortable talking, than playing). We discussed, challenged, asked questions, sought answers, but even allowed the questions to be. One of my questions to Ramesh was about his “hero’s journey” – mission in his life. And of course, he knew it not. And wasn’t it an exciting journey ahead to go on and find – what was he meant to do – to create……?

Ramesh, for the first time said “I know I can and want to find life like this – but there are these voices that tell me not to”. That session we “saw” what dramatherapy techniques could show6, More than that, Ramesh (probably for the first time) directly confronted the ‘voices/they’, who he said, were controlling him. He juggled between ‘Ramesh- the victim’ and ‘Ramesh- the Creator’. He listened and explained what the ‘voices’ dictated, and responded as The Creator, as the original Ramesh by asking the voices to ‘shut-up’. He announced that he did not need them anymore, told them to “go away”, firm and loud. I paced him through a couple of ‘techniques’ meant to be used in responding to the negative voices, and to keep alert. We rehearsed the techniques. I also told him when not to use them, for example, when Mom is asking to wake-up, not to say “No. Thank you”!. It was a light closure of a serious dialogue.

Ramesh came willingly to the fourth session. We reinforced large-small insights and learning. He acknowledged that he could think, that consciousness is a continuous journey and he had ‘created’ the upper part of his brain. It was now important to close, feel whole and follow that up with practice, ensuring (in consultation with his therapist & family) that he does not slip back. His mother reported that he was doing much better at home; he was

more willing and regular at the small job they had found him, regular with medicines, exercise, and slightly more positive, connected to life in general. During this session he said, “I feel Ok, there are these moments of clarity when I feel absolutely myself. Then I am unwell again”. He lamented that these were few fleeting seconds during which he felt ‘free’. This was big news from him! He’d found a window - albeit a tiny sky-hatch of clarity - being and feeling himself totally. I exhorted him to hold on to these moments, to pull the veil apart, remain alert and expand the time of such clarity. That would be his road ahead.

Sensing that the short term we shared was nearing closure – we moved towards ‘reconnection to real’ and ‘grounding’ processes. Ramesh made a drawing of his family, drawing a thought cloud to one of the figures, he wrote a formula in it and on being asked, he explained “This is me. I want to become a scientist”. This was his lead. He was looking at possibilities – at dreams! In the last session he made a mandala7 - life’s beliefs, creative ability, life’s mission/direction, skills, and difficulties - a reflection of the whole in the moment. As yet, he could not see many skills on his list. His difficulty still was his ‘illness’, in the area of creativity he had his sense of humour listed out, and his mission/dream was to be a prize-winning scientist.

In this short span of 5 sessions, Ramesh touched new spots within – of creative power, of dreaming. He also ‘saw’ in practise that he could think, feel and be Ok. We had traversed a long way. The main task now was to create, repeat, practise, rehearse, and enable all this in real time and life. His family, therapist, support group, environment had a role to play in it. For this, I eventually met his family in a joint session with his therapist, and suggested new approaches and techniques. It would be a function of long-term follow-up to see what he sustains. The hope

is that he will strengthen the process of integrating his self and abilities into one flow that will hold the power to choose and make a life from that understanding and personal power.

Ramesh had moved away from the ‘wall’ he was at.

At my suggestion, and Ramesh’s choosing we brought our meetings to a halt. We’d had a journey where he saw what “driving himself” could mean. Hereon, Ramesh would have to prove that he could travel - by himself – and cross that bridge again.

Aanand Chabukswar is a drama-therapist and artist working in India and abroad for past 10 years.

Contact: 21 ‘Shrigeet’, Rajpath, RKP Nagar, Paud road, Pune 411038. India. Ph: ++91 - 20 - 25899533. E-mail: aanandc@vsnl.net

References:
1. Kashyap, Tripura. in My Body, My Wisdom - Drama and Music as Therapy in Pune, Penguin, 2005.
2. Landy, Robert. Persona and performance: the meaning of role in drama, therapy, and everyday life, Jessica Kinsley Publishers, 1993.
3. Name has been changed to preserve confidentiality and anonymity
4. Jennings, Sue. Introduction to Dramatherapy, Theatre and Healing, Jessica Kingsley Publishers, London, 1998
5. Chabukswar, Aanand. Birth of a Story: Story-circles for Healing and Change, The Prompt, The Magazine of British Association of Dramatherapists, Summer 2003.
6. Casson, John. Drama, Psychothe-rapy and Psychosis: Dramatherapy and Psychodrama with People Who Hear Voices, Brunner-Routledge, 2004
7. The Mandala method developed by Dr. Sue Jennings that examines the holistic image of life rather than just being problem focussed. See: Jennings, Sue. The Traveller: Healing Theatre in Magilligan Prison, Dramatherapy Vol 21 no. 2 Autumn 1999.

	Radhika Sharma

Plants and people in distress... does it strike any connection?

Most of us are aware of the relationship plants and people in general share, and the symbiotic liaison and their mutual interdependence could be discussed. But plants and people in distress?

These were my initial thoughts after hearing about Green/ horticulture therapy. But as I delved into my own experiences since childhood, and started reading up on Green therapy, I realized that I did not need to establish a connection between people in distress and plants, because it already existed, a connection that even I had very subconsciously utilized many a times for my own well-being.

Working with plants through gardening, horticulture has cons-tituted one of the oldest healing arts. But it has only recently been visible for the systematic, scientific and therapeutic value that it possesses. As of today, though more and more professionals are using it for its therapeutic value, we have growing research data to corroborate on the therapeutic experiences of the same. As horticulture is being widely used in various therapeutic settings, an understanding of it’s value and the mechanisms by which it works is also gradually widening.

To put it plainly, Green or horticulture therapy (HT) is a process in which plants and gardening activities are used to improve the body, mind and spirits of people.

The American Horticultural Therapy Association (AHTA) describes horticultural therapy as a method that uses plants, gardening activities, and the natural world in professional therapy and rehabilitation programs. Therapeutic benefits occur when people are exposed to plants, and when they take part in planning, planting, growing, and caring for plants.

At one end of the range, HT is used to mean any gardening activity that helps anyone in any way however, this approach implies that to receive horticultural therapy, all you need to do is plant a seed; and that to be a horticultural therapist, all you need to do is tell someone to plant a seed. While some are of the view that although horticulture is good preventative medicine to help overcome the stress and frustrations of daily life, it is an oversimplification to call any use of horticulture, horticultural therapy; just as going for a walk is not the same as physical therapy. The oversimplifications in their opinion make it difficult to truly understand the nature of this therapy, why it works, and how to implement it.

It is used worldwide in hospitals, rehabilitation and vocational facilities, nursing homes and senior centers, community gardens, botanic gardens, schools, farms, horticultural busin-esses and prisons. It can be an effective and beneficial treatment for people of all ages, backgrounds, and abilities.

In the 19th century, Dr. Benjamin Rush, who signed the Declaration of Independence and is also considered to be the “Father of American Psychiatry,” reported that garden settings held curative effects for people with mental illness.

As Charles Lewis of the Morton Arboretum puts it “The plant world is non-threatening and non-discrimi-natory.” It thus makes it extremely approachable to most people. According to Stamm and Barber, in the more severe emotional disturbances, such as schizophrenia, patients often have a long-standing fear of people that is believed to have developed at a point in their lives before words were used to communicate. They report that the “task orientation of horticultural therapy is ideal for such a patient, for it allows her / him to enter gently into a relationship with another person in a non-verbal way without the threat of being confronted with interpersonal

closeness too soon as may occur in a one-to-one verbal psychotherapy.”

At Melwood, mentally retarded young adults raise foliage plants in a modern greenhouse. These are taken to plant sales in the lobby of various federal buildings in Washington, D.C. While the public shops, they make positive comments about the high quality of the plants. These comments not only enhance the retarded person’s self-esteem, but also reinforce the public’s increasingly positive image of the abilities of disabled people.

A person who has paraplegia because of a car accident thinks of her/himself as a helpless cripple who “can’t even stand up.” In green therapy s/he learns to stroke the plants and comes to see concretely that s/he can also be a support along with being supported. The person can also review her/his attitudes towards seeking support and peoples intentions of providing support to them.

C. F. Menninger, in writing of his peonies, expressed many of the individual gains of the therapy. He stated- “There is a gratification of the sense of sight in color and color combinations, of the sense of smell in perfumes and odors, and to that inner aesthetic sense of beauty a charm that has, I believe, made a better physician of me. My whole nature was improved, my horizons wider and my appreciation increased in a way that aided me in my vocation.”

As a cognitive therapy, it helps clients learn new skills and regain the lost ones. It improves memory, initiation of tasks and attention to details. These are benefits of Green/ horticulture therapy.

Social growth occurs, as people caring for plants learn responsibility and experience hopeful and nurturing feelings. It can be constructively used in physical rehabilitation to retrain muscles and improve coordination, balance and strength.

In vocational settings (especially

vocational rehabilitation of differently abled), through this therapy, people learn to work independently, solve problems and also follow directions and instructions. It could be done by identifying objectives of the program and using it as a training medium.

World War I and II, veterans’ hospitals increasingly used gardening as therapy in the treatment and reeducation of disabled soldiers. Volunteers from garden clubs brought the delights and benefits of their hobby to thousands of men recovering from battle.

Gardening with individuals with disabilities has also shown surprising results in improving motor skills and in reducing stress. Even twenty minutes of watering and tending plants produces visible calm.

Tom Ogren says, “Plants are not judgmental. You take good care of them and they thrive. In the garden our minds are free to wander, to daydream, to relax. Good things happen in good gardens.”

The individualized therapeutic treatment goal in Green/ horticulture therapy is achieved through a series of treatment objectives that are clearly attainable and measurable. Each treatment objective is written to include: the desired behavior or response, the circumstances under which that behavior will occur and the minimum acceptable performance of the behavior.

Examples of horticulture treatment activities vary from greenhouse crop production to learning to make terrariums and bonsai, from harvesting flowers to dried flower arranging, and from pulling weeds to transplanting trees appropriately modified. The ultimate goal of these programs is the improved physical and mental health of the individual. The benefits may be seen in intellectual, social, emotional, and physical development or functioning.
Intellectual benefits could include; attainment of new skills, improved vocabulary and communication skills, aroused sense of curiosity, increased powers of observation, vocational and

prevocational training, stimulation of sensory perceptions. Social benefits would involve increased interaction within as well as outside of the any given group while parameters for increased emotional well-being would be improved confidence and self-esteem.

Friends Hospital, founded by Quakers in 1813, has used horticultural therapy from its beginning. Since Friends was originally designed to be self-sufficient, it included 30 cultivated acres of grass, corn, potatoes, and wheat. Meat and butter were supplied by dairy cows, and a kitchen garden produced the vegetables. Medicinal plants and “salutary” herbs were also cultivated. Large areas of grass and quiet forest paths were left for recreational use. Friends provided a serene atmosphere where patients could feel safe. Today, Friends Hospital uses horticultural therapy as an “active” treatment.

The therapists use plants of all stages to also represent the cycle of life, which can then be used for specific therapeutic objectives.

To a user, alternative therapies provide sensory and mental stimulation, along with therapeutic benefit—without the drudgery and frustration of being urged to “walk two more steps.” Instead, alternative therapies, such as puttering in the garden, enjoying the tactile stimulation of a massage or just sitting and absorbing sights, smells and sounds, can relieve them of their ennui. Green Therapy encourages many of the same goals as traditional therapies, by helping people perform the same exercises without their being perceived as “work.” For example, users for instance those with Alzheimer’s and dementia-related diseases can still retain hand functions by squeezing the soil instead of a rubber ball.

References:
DYNAMICS OF HORTICULTURE THERAPY by Diane Relf, Professor of Horticulture Originally published in Rehab. Lit. 42:147-150, 1981.
Menninger, C. F. Personal observations: Bul. Menninger Clinic. 1942. 6:3:65-67.

	By Tina Minkowitz

This presentation will address three levels of perspective on human rights issues affecting women who are users and survivors of psychiatry: first, my personal perspective as a woman and a survivor of psyc-hiatry; second, some themes that I have encountered among women users and survivors; and third, a human rights overview of our main areas of advocacy. 

A. Personal experience 

When I was a child, I thought that my role in life was to make things convenient for other people, to take care of myself and not ask for anything.  My mother was emotionally needy and not able to give me the kind of guidance and nurturing I wanted, although she loved me.  In my mind, I had become a woman already, and this self-abnegation was a mature woman’s role.  Then in my teenage years I saw that no one else was living this way, other girls were doing what they wanted, so I also became a little freer.  At this time I learned about women’s liberation and I affirmed my own belief that women should be able to do anything that a man can do.  When I was on the cusp of adulthood and trying to decide about my course in life, and also to come to terms with the lack of nurturing in my childhood,

I experienced an emotional breakdown.  I didn’t know where to go and felt that I was making irrevocable mistakes, no matter what I did.  It was at this time that my mother, influenced by her own psychotherapist, instigated putting me in a psychiatric institution against my will.

Imagine:   as a young woman, I was struggling with my self-determination in a world that was trying to accept women’s freedom.  Now, instead of making self-affirming choices, I was required to act passive again, to revert to my childhood role of giving others what they wanted from me.  Not only that but nothing I did could please those in authority or escape what they wanted to do to me, which was aggression:  they insisted that I take a drug that I knew would change my soul, split my personality and change me forever.  Something in me gave up and it would be a long, maybe lifelong process to heal that despair.   

I saw a woman put in a straitjacket for refusing to take the drugs. Somehow I had already known that this would be the consequence.  I was scared that I would die, and at one point I went into a short-term coma from an overdose of the drug.  When I got out of the institution, I quickly got my own apartment and tried to resume my life.  Whatever else I did, something in me remained empty and anguished.  I have succeeded in doing many things. Yet because of this experience it’s hard to measure my life from an internal perspective. Instead, I have to prove my worth by showing my external accomplishments.   

I am telling this story because I think it shows something about the intersecting discrimination related to gender and to disability.  It was oppression I faced as a girl and young woman that led to an emotional crisis, and oppression my mother faced as a woman that led to her putting me away so violently.

The psychiatric regime reinforced messages of oppression that affected me in ways related to my gender.  When I got out, I still had to face gender oppression. I often felt disempowered from dealing with it effectively.   

Women’s lives do not always tell a story of triumph. Sometimes our stories are of how to accept where we have been and still affirm life and possibility.  The ideal of individual triumph may be a reflection of, or desire for, privilege – male privilege, racial and class privilege.  Yet, self-determination, experiencing and seeking to fulfill one’s own aspirations, should not be a privilege, but a right for all.  This is the under-standing we have come to in the movement of users and survivors of psychiatry, advocating our human rights. 

B. Additional issues for women as users or survivors of psychiatry 

1. Women are twice as likely as men to receive electroshock. Electro-shock is an even greater assault than drugs, because it can cause irreversible memory loss and more extensive brain damage.  Electro-shock has been used by husbands and male psychiatrists to punish women for self-assertion and to brainwash a woman into being a more docile mate. It is especially ironic that women’s memories are being eradicated, when so many are struggling to recover memories of childhood sexual abuse.

2. Girls and women often hold inferior places in their families, making it easier for husbands,

parents, or adult children to accuse her of mental illness and have her institutionalized and deprived of civil rights.  In one situation I know of, an abusive husband who had friends in the police department told them that his wife was mentally ill because she was cutting down a tree with a chain saw.  The woman, a member of an organization that I also belonged to, knew how to use a chain saw and the tree was blocking her view.  The police came into her home while she was taking a shower, and male officers forced her to come out and dress as they watched, before taking her away.  This happened only a few years ago, in the United States.  I have also heard of male relatives putting women under guardianship because they want the woman’s property.  

3. Women who are mothers at the time they are put into a psychiatric institution risk losing their children.  I have known many women who lost their children in this way, and only one who succeeded in getting them back.   

4. Girls and women in any kind of institution are likely to be survivors of gender-related violence, accor-ding to Laura Prescott of Sister Witness International. Many women who were admitted voluntarily or against their will to psychiatric institutions have found solidarity with other women there who shared similar experiences of rape and incest.  This has led to “trauma initiatives” designed to minimize retraumatization of women entering the psychiatric system, by substituting non-violent interactions instead of violent repression of women’s pain and distress.  Women who self-injure as a way of coping with trauma have also challenged a one-sided view of this behavior as a psychiatric symptom, and should be listened to as the experts on their own lives.  

5. Forced psychiatric procedures can prevent women from defending

ourselves against violence.  The use of restraints that prevent women from fighting back or closing their legs (such as four point restraint in which each arm and leg is tied to a separate corner of the bed) facilitates rape.  Two electroshock survivors have told me that after the shock they were unable to resist rape but instead cooperated passively.  Neuroleptic drugs may have a similar effect since they are acknowledged to cause “psychic apathy and indifference.”  In locked wards where women are held together with men, this also enables rape. 

C. Analytical human rights perspective 

For women who are users and survivors of psychiatry, the exclusion we face as a matter of law, because of our disability status, is of the highest concern.  It is useful to look at the intersection of disability and gender discrimination, but our priority in human rights advocacy is to eliminate the disability-based exclusions. 

1. Legal capacity

Legal capacity is what a human being can do in the context of a legal system.  It includes such acts as testifying in court, voting, serving on a jury, entering into contracts, making financial and health care decisions.  Legal capacity can affect every aspect of a person’s life, yet it has historically excluded women and continues to exclude many people with disabilities. 

CEDAW Article 15 guarantees to women a legal capacity identical to that of men, and nullifies any private agreements to restrict women’s legal capacity.  This has been amplified by CEDAW General Recomm-endation No. 21, which emphasizes the importance of legal capacity for women’s autonomy within families and equality in society, as well as being able to provide for oneself and one’s children.

Autonomy is especially important for women with disabilities, since we face paternalism on both counts. 

At the same time, we recognize that some of us may need support in exercising legal capacity.  Some people may not be able to access information, come to a decision, or express their will and preferences independently.  In the UN Disability Convention we want to recognize the full legal capacity of people with disabilities to make our own decisions, and to ensure support for those who need it, so that everyone is included and can enjoy the self-authority that is so important to leading a full life.  Safeguards are provided for to ensure that support is not subverted to exploit a person or do something against his or her will.  This provision in the UN Disability Convention, if our text is accepted, will remedy the exclusion that women with disabilities have faced from our rights under CEDAW, and extend the same rights also to men with disabilities. 

2. Forced interventions are torture

Analysis of the international definition of torture shows that forced drugging and electroshock, and related assaults in psychiatry, should be considered torture.  While the distinction between torture and lesser forms of cruel, inhuman or degrading treatment or punishment does not always need to be emphasized, we believe that such practices meet the higher threshold for torture. 

In particular, forced psychiatric procedures are intentionally inflicted with the knowledge that they are likely to cause serious harm, ignoring the will of the victim.  Psychiatric professional literature is rife with information about the brain-damaging effects of neuroleptic drugs and electroshock, but these types of harm are either considered desirable for people labeled with mental illness, or they are

damaging effects of neuroleptic drugs and electroshock, but these types of harm are either considered desirable for people labeled with mental illness, or they are considered of less importance than the objective of curing the so-called illness – even if the person does not want to be “cured” in this way.  This amounts to dehumanization of the victim by seeing her entirely in terms of the disability she is perceived to have, which is given an exaggerated importance to the exclusion of all else, including her own will and desires.  Pursuing a harmful end against a person’s will, for reasons based on disability, constitutes discrimination, which is a relevant purpose of torture under the UN Convention Against Torture.  In addition, forced psychiatric procedures are inflicted for the purpose of coercion – enforcing a change in the person’s behavior or consciousness against her will, and by the use of methods that prevent her from resisting.  Coercion is also a relevant purpose of torture in the Convention Against Torture.  The definition also requires acquies-cence by a public official, which exists when forced procedures are done in a government-run institution, or when laws authorize or fail to protect against such practices. 

The Convention Against Torture can be used even now to advocate for an end to forced interventions and for reparations to victims, while also working for specific provisions in the UN Disability Convention.   

Nonconsensual medical interven-tions should be declared to be torture or cruel, inhuman or degrading treatment or punishment, similarly to nonconsensual medical experimentation.  There is also a specific provision prohibiting forced institutionalization or forced interventions related to an actual or perceived impairment.  It is crucial to delete provisions in the current text that would allow medical or psychiatric interventions against a

person’s will.  If those provisions remain, the Convention would be anti-human rights and should not be accepted by the disability community.   

3. Equal right to liberty  

Deprivation of liberty is degrading to the person and confers an inferior status.  Often it also entails restriction of legal capacity and civil rights.  While deprivation of liberty is not prohibited absolutely in international law, it is undeniably a harmful act without benefit to the incarcerated person.  Human rights law requires that deprivation of liberty not be arbitrary, unlawful or discriminate in any way.   
Mental health laws allowing forced institutionalization exist in most countries.  Such laws discriminate based on disability and do not serve any legitimate social purpose. People who commit crimes can be dealt with by law enforcement, with relevant rights and guarantees, and reasonable accommodation for disability.  People who are merely annoying to others, or who are harming themselves, should not be punished or deprived of rights.   
In some countries, there are no laws regulating deprivation of liberty in psychiatric institutions, but the practice exists without any legal regulation.  Often people are incarcerated based solely on the will of their families, and not released unless the family is willing to take them back. 

We want the Disability Convention to prohibit deprivation of liberty based on disability, to make sure that forced institutionalization is ended.

4. Include people with psycho-social disabilities in definition of “disability” or “person with a disability”  

Psychic distress or difficulty can be a disabling experience, especially within a social context where it is not well understood or accommo-

dated.  In addition, being labeled with mental illness, institutionalized, and victimized by forced interven-tions is a radical life experience that changes a person’s way of seeing the world.  World Network of Users and Survivors of Psychiatry brings together people with diverse first-hand experience of madness or mental health problems, or who have used or survived the mental health system.  We use the term “people with psychosocial disabilities” to identify ourselves in international disability and human rights work.   

It is important for people with psychosocial disabilities to be covered by the Disability Convention, and to be included in national disability legislations, and in umbrella coalitions of people with disabilities.  In many countries there is resistance to our inclusion, despite the fact that we are already covered by the Standard Rules and participate in the panel of experts advising the Special Rapporteur on Disability.  For this reason, we are advocating that there be a definition of “disability” or “person with a disability” in the Convention, which should include psychosocial disability within an overall social model of disability, and should also include imputed disability to cover those who are labeled by others. 

Conclusion 
This presentation has given an introduction to some issues facing women who are users and survivors of psychiatry.  I hope that we will have a chance to talk more as women with disabilities and explore our commonalities and our differences, and dialogue about our human rights. 

Jan Manasik Arogya Abhiyan, a people’s campaign in mental health in Maharashtra, co-ordinated by the Bapu Trust, is proposing to dedicate August 6th as the Erwadi Memorial Day and a human rights day for persons with psychiatric disabilities.

On August 6th, 2001, 25 people labelled as ‘mentally ill’ in the Badhusa mental home in Erwadi, Ramanathapuram, Madurai District, Tamil Nadu, perished in a fire. The Erwadi holocaust caused a lot of public outrage and became a tragedy of national scope. The tragedy highlighted the dire conditions under which many persons with psychiatric disabilities are treated in our country.

In the Indian history of human rights activism, this event stands as a landmark event. For the first time, newspapers, professionals, NGOs, the state government, the Supreme Court, the National Human Rights Commission, human rights activists and lawyers, all made immediate responses. For the first time, the Human Rights machinery in the country was activated in the interests of persons with psychiatric disabilities. The event brought national focus and set up a human rights and policy debate in the country, which still continues. The event has had its impact on Maharashtra also. This is why we are seeing this day as an eventful day, which must be commemorated.

In April, 2000, diarrhea deaths were reported at Erwadi. Recommendations made, following this, included provisions for a ward at the district hospitals in Tamil Nadu, training programmes for doctors, paramedical staff and for NGOs. On the 6th August, 2001, the hutments in which the inmates were housed, chained to their beds, caught fire.

11 women and 14 men died when the fire broke out early in the morning. In all, 43 persons were kept there. 3 persons died later in the hospital. “Compensation” was given to the family members, who had dumped their mentally ill relatives in these places. A swarm of brokers encamped in these places, soliciting customers who were willing to relieve themselves of their relatives for a meager fee. According to earlier investigations in this area, the conditions in the majority of the asylums were deplorable. No proper rehabilitation was offered. Mostly untrained workers were employed to take custody and the “treatment” always included physical torture. The government responded to this tragedy by starting more psychiatric hospitals in Tamil Nadu and establishing a district mental health program.

Following the Erwadi tragedy, the Supreme Court, in 2001, started a suo moto law suit against all the state governments of India for non-implementation of the Mental Health Act. In the meantime, an NGO filed a petition raising some pertinent human rights issues, such as solitary confinement, direct ECT, physical restraint, etc. The SC asked every state to comment on these issues.

Rs. 190 crores was released by the Health Government, GOI, to strengthen the mental health sector in the country, as part of the Tenth Five Year Plan. The monies are to be used mainly to improve the infrastructure, strengthen the psychiatry departments, including medical education. Very little resources have been allocated for community mental health work. Even though the SC case was a human rights petition, the government response has not addressed the rights issues at all.

The state of Maharashtra has also filed an affidavit before the supreme court, giving information about facilities available, use of ECT, traditional healing places, etc. Monies have been released to the GoM to strengthen the mental health sector.

There are two immediate and relevant issues for us in the context of Maharashtra.

1) What finances were released to the state of Maharashtra for strengthening the mental health sector, and how is this money being spent? Does the government of Maharashtra envisage a state level policy for strengthening the mental health sector? Or is the money going to be spent in an ad hoc manner, or diverted to other causes?

2) What information has been submitted by the state of Maharashtra, before the Supreme Court, and what is the authenticity of this information? For example, in Maharashtra, direct ECT is still being practiced, despite a High Court judgement restricting the procedure. What is the position of the GoM on the human rights of persons with psychiatric disabilities, and their rehabilitation?

Maharashtra has a total of 4 state run mental hospitals. The total bed strength is 5695 in the 4 mental hospitals, which is one fourth the entire bed strength of mental hospitals in India. Long stay patients (who have stayed for more than 2 years) is the greatest in Maharashtra, indicating that these facilities are perceived as dumping grounds by the communities.
In the Thane mental hospitals, the NHRC found that all the wards were locked wards. Most of the wards are overcrowded. Only 10% admissions

are voluntary admissions. All others are involuntary court ordered commitments. 26% of patients are “long stay”, who have been there for five or more years. Facilities for medical emergencies are poor. The hospital does not have a casualty and emergency service. There is no short stay ward or half way home. Patients reported that bathing facilities are not adequate and clothes are dehumanizing, as they are not changed as frequently as they would like. Although the quantity of food may be adequate, it is not sufficient in terms of nutritive value. Management of patients is mainly medical, with the use of drugs and modified ECTs. Solitary confinement is being used. Patients complained that they were not being able to contact family members. There is hardly any psychosocial intervention. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities.

The situation is more or less the same in the other hospitals as well- Pune, Nagpur and Ratnagiri. In the Pune mental hospital, both direct and modified ECT are being used. Physical restraint and solitary confinement are being used. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities. Newer drugs are not available. In Nagpur, only 14% are voluntary admissions, the rest being court ordered. Direct ECTs are administered in OPD. Modified ECT is being given only to the inpatients.

There is a huge deficit of human resources in Maharashtra, as in the rest of India. For a population of approx. 10 crores, with a case load of 1% severe cases and another 10% of common mental health problems, there are only 6073 beds in the government sector, and another meager 652 beds in the private sector. There are only 481 registered psychiatrists, 75% of

them being in the private sector. Only 33 clinical psychologists are available as against an ideal number of 484. So also, there is 90% deficit of psychiatric social workers.

In 1996, a blue print for the DMHP (District Mental Health Program) was made for India. The models developed in the state of Karnataka, by NIMHANS, were proposed to be replicated everywhere. In Maharashtra, there are 6 DMHP programs running, of which the one in Raigad district is the oldest. These programs have not been evaluated. The quality of services in these programs is very poor, being limited to drug dispensing at the community level. Psychosocial interventions are absent in all of the DMHPs dotting the country, and also in Maharashtra. Over half of Maharashtra is not covered by the DMHP.

On Erwadi Day, we demand transparency and accountability from the state of Maharashtra Health department, on some of these concerns. We will debate about the need for a state level mental health policy document, in which all stake holders in the mental health sector will be consulted.

JMAA will also challenge the silence of the Disability department, Maharashtra, on the plight of persons with psychiatric disabilities. The PWDA promises the Rights to education, employment (sec 47), social security; rehabilitation, unemployment allowance, special concessions and other rights. The right to education under the Act includes, access to free education till 18 years, the integration of PWD in normal schools, setting up special schools for those who need them, schools with vocational training facilities, schemes for non-formal education, teachers’ training institutions, etc. Various employ-ment rights provisions have been made in the PWDA for persons with disabilities, including 3% reservation in jobs, flexible working conditions,

social security (insur-ance, unemp-loyment allowance), preferential allotment of land and job security.

Recently a Maharashtra High Court Bench headed by Justice AP Shah had given a judgement in which a nurse, Mrs Desai, was reinstated in service after being summarily dismissed following a diagnosis of schizophrenia.
This was a wake up call for the Maharashtra Disability Department. One more time, it was proved that the law has to come in for the bureaucracy to function in the mental health sector. The Disability Department of Maharashtra has not at all recognized the plight of persons with psychiatric disabilities. Schemes available to other disabilities have not been opened up for this constituency. Obtaining a disability certificate is an insurmountable task. The certificate format is not suited to persons with psychiatric disability. The disability office is even known for its corrupt practices. Complaints are not settled for years together. Mental health agencies are not represented in the State level co-ordinating committee of the state level disability commission.

On this day, a range of activities will be undertaken by the people’s forum, which will waken the state of Maharashtra to the plight of persons with psychiatric disabilities. A 2 day photo exhibition presented for the occasion by Anjali, Kolkatta, and panel discussions on the theme of “Status of mental health services in Maharashtra” is being planned. This will be held at the Balagandharv Kaladalan, Pune, on 6th & 7th of August. For details, contact baputrust.mumbai@gmail.com; wamhc@vsnl.net

The proposal to commemorate Erwadi Day every year needs to be considered nationally.

a unique interface between sensations provoked in the mind and other neurological events. Music can function to bypass other areas of the brain which may be damaged or make links to underdeveloped areas; it organizes many disparate events in a global way. Here research evidence is presented.

The efficacy of music therapy has been investigated with individuals with a wide range of disabilities, for example: autism (Wager, 2000), dementia (Korb, 1997), acute brain injury (Nayak et al., 2000), Parkinson’s disease (Pacchetti et al., 2000), Alzheimer’s disease (Aldridge, 1998), attachment disorder (Brotons & Pickett-Cooper, 1996; Burkhardt-Mramor, 1996), chronic schizophrenia (Zhang & Cuie, 1997), depression (Suzuki, 1998), and multiple sclerosis (Davis, 1998). The positive outcomes reported in the majority of these studies suggest that it is an efficacious treatment.

Clinical evidence shows that arts therapies reduce symptoms such as depression and anxiety (Odell-Miller 1995b; John 1992; Davies 1995)

Dr. Connie Tomaino, director of the Department of Music Therapy, Institute for Music and Neurological Function in Bronx, New York, discovered that when people with irregular or weak brain rhythms, such as individuals with Alzheimer’s disease, listened to music with strong rhythms, their brainwaves became more organized, pronounced and higher in frequency.

Trevarthen and Malloch (2000) shows how as the earliest parent-infant communications cannot rely upon linguistic meaning, communication takes place through the use of expressive sounds or ‘the prosody of the infant-directed

speech’, together with facial and gestural movements. Music therapists have adapted these intuitively improvised and non-verbal methods of communication for expressive and therapeutic ends.

Pacchetti et al., (2000) studied the impact of weekly choral singing, voice exercises, and rhythmic and free body movements were used with a group of 16 individuals diagnosed with Parkinson’s disease. Improvements were subsequently noted in their emotional functions, daily living and quality of life.

Other demonstrated benefits are in: social interactions, mood and participation rates of people with traumatic brain injury and stroke (Nayak et al., 2000); emotional states of persons with schizophrenia (Zhang & Cuie, 1997); agitation in Alzheimer’s clients (Brotons & Pickett-Cooper, 1996), and depression in elderly (Suzuki, 1998).

Meta-analysis of music therapy as an intervention with 335 dementia patients, demonstrated significant results (Koger, Chapin, & Brotons, 1999).

A review of clinical music therapy (see Tervo, 2001) showed that rock music can give adolescents “the possibility to express, be in contact with and share among themselves feelings of anger, rage, grief, longing and psychological disintegration”.

Burkhardt-Mramor (1996) reported that insight-oriented music psychotherapy addressed the attachment problems of an 11-year old male with a history of physical and emotional abuse.

Krueger (2000) incorporated the use of information technology with a 10th grade student with behavioural

corn was introduced into Europe for mass consumption, people suffered and even died of pellagra.

Nutritional cures offer many benefits over conventional psychiatric care for schizophrenia, as Edelman enlists.

a) The cure leads to overall nutritional correction and well being.
b) Nutritional correction does not cause harm. Overdosing with natural treatments is rare. Even when it occurs, it is reversible.
c) Research has shown that 90% of acute patients recover, and the chances of recovery are good for the remaining 10%. The 30% “life long” or “chronic” patients that psychiatry has produced do not hold for nutritional treatments, according to Edelman.
d) The quality of life of persons treated naturally is better. Particularly, their level of social participation is high.
e) The mode of treatment is co-operative, as natural treatments are not stigmatising and patient resistance is low.
f) Nutritional treatments may also help to enhance the effects or minimise the side effects of conventional psychiatric treatments.

Eva Edelman’s book also reviews a vast plethora of nutritional basis of medical and psychiatric diagnosis, along with physiology. The role of essential fatty acids (Omega-3 and Omega-6), vitamins (B, C and E) and micro-nutrients (such as selenium and sodium) are being studied, with good results. Interesting mental health information about various essential nutrients can be obtained from this book. For example, Vitamin C works as an anti-psychotic agent and is a natural tranquilliser. It is as powerful in action but it doesn’t cause the harmful side effects of drugs. Vitamin B12 helps in

producing neurotransmitters and its deficiency may cause permanent nerve damage. Vitamin E has been used as nutritional supplement in treating schizophrenia. Vitamin B2 deficiency has been associated with tremors, depression, fatigue, moodiness, irritability, compulsive eating, hysteria, nerve damage, and sometimes psychoses. It enhances brain circulation, increases concentration and memory span, lightens moods and depression. EFA (Essential Fatty Acids) deficiency is a condition present in 2 out of 3 cases of schizophrenia. EFA is essential for developing the cell membrane and other structures within the brain. EFAs are sometimes also known as Omega