Neurology

From Wikipedia, the free encyclopedia

Neurology

A network of dendrites from neurons in the hippocampus.
System	Nervous system
Significant diseases	Radiculopathy, neuropathy, visual snow, stroke, dementia, seizures and epilepsy, Alzheimer's disease, Attention deficit/hyperactivity disorder
Significant tests	Computed axial tomography, MRI scan, lumbar puncture
Specialist	Neurologist
Glossary	Glossary of medicine

Neurology (from Greek: νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems (and their subdivisions, the autonomic and somatic nervous systems), including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, which is the scientific study of the nervous system.

A neurologist is a physician specializing in neurology and trained to investigate, or diagnose and treat neurological disorders. Neurologists may also be involved in clinical research, clinical trials, and basic or translational research. While neurology is a nonsurgical specialty, its corresponding surgical specialty is neurosurgery.

Significant overlap occurs between the fields of neurology and psychiatry, with the boundary between the two disciplines and the conditions they treat being somewhat nebulous.

Scope

A large number of neurological disorders have been described as listed. These can affect the central nervous system (brain and spinal cord), the peripheral nervous system, the autonomic nervous system, and the muscular system.

History

The academic discipline began between the 16th and 19th centuries with the work and research of many neurologists such as Thomas Willis, Robert Whytt, Matthew Baillie, Charles Bell, Moritz Heinrich Romberg, Duchenne de Boulogne, William A. Hammond, Jean-Martin Charcot, and John Hughlings Jackson.

Training

Neurologist

Occupation
Names	Physician, Medical Practitioner
Occupation type	Profession
Activity sectors	Medicine
Description
Education required	MD or DO (US), M.B.B.S. (UK), M.B. B.Ch. B.A.O. (Republic of Ireland)
Fields of employment	Hospitals, Clinics

Polish neurologist Edward Flatau greatly influenced the developing field of neurology. He published a human brain atlas in 1894 and wrote a fundamental book on migraines in 1912.

 

Jean-Martin Charcot is considered one of the fathers of neurology.

 

Many neurologists also have additional training or interest in one area of neurology, such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, or movement disorders.

In the United States and Canada, neurologists are physicians having completed postgraduate training in neurology after graduation from medical school. Neurologists complete, on average, about 8 years of medical college education and clinical training,which includes obtaining a four-year undergraduate degree, a medical degree (DO or MD), which comprises an additional four years of study, then completing one year of basic clinical training and four years of residency. The four-year residency consists of one year of internal medicine internship training followed by three years of training in neurology.

Some neurologists receive additional subspecialty training focusing on a particular area of the field. These training programs are called fellowships, and are one to two years in duration. Subspecialties include brain injury medicine, clinical neurophysiology, epilepsy, hospice and palliative medicine, neurodevelopmental disabilities, neuromuscular medicine, pain medicine, sleep medicine, neurocritical care, vascular neurology (stroke), behavioral neurology, child neurology, headache, multiple sclerosis, neuroimaging, neurorehabilitation.

In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.
In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five to nine years of medical school and a year as a preregistration house officer (or two years on the Foundation Programme), a neurologist must pass the examination for Membership of the Royal College of Physicians (or the Irish equivalent) before completing two years of core medical training and then entering specialist training in neurology. A generation ago, some neurologists would have also spent a couple of years working in psychiatric units and obtain a diploma in psychological medicine. However, this requirement has become uncommon, and, now that a basic psychiatric qualification takes three years to obtain, the requirement is no longer practical. A period of research is essential, and obtaining a higher degree aids career progression. Many found it was eased after an attachment to the Institute of Neurology at Queen Square, London. Some neurologists enter the field of rehabilitation medicine (known as physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine, as well as brain injuries.

Physical examination

During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the cranial nerves (including vision), strength, coordination, reflexes, and sensation. This information helps the neurologist determine whether the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.

Clinical tasks

Neurologists examine patients who are referred to them by other physicians in both the inpatient and outpatient settings. Neurologists begin their interactions with patients by taking a comprehensive medical history, and then performing a physical examination focusing on evaluating the nervous system. Components of the neurological examination include assessment of the patient's cognitive function, cranial nerves, motor strength, sensation, reflexes, coordination, and gait.

In some instances, neurologists may order additional diagnostic tests as part of the evaluation. Commonly employed tests in neurology include imaging studies such as computed axial tomography (CAT) scans, magnetic resonance imaging (MRI), and ultrasound of major blood vessels of the head and neck. Neurophysiologic studies, including electroencephalography (EEG), needle electromyography (EMG), nerve conduction studies (NCSs) and evoked potentials are also commonly ordered. Neurologists frequently perform lumbar punctures to assess characteristics of a patient's cerebrospinal fluid. Advances in genetic testing have made genetic testing an important tool in the classification of inherited neuromuscular disease and diagnosis of many other neurogenetic diseases. The role of genetic influences on the development of acquired neurologic diseases is an active area of research.

Some of the commonly encountered conditions treated by neurologists include headaches, radiculopathy, neuropathy, stroke, dementia, seizures and epilepsy, Alzheimer's disease, attention deficit/hyperactivity disorder, Parkinson's disease, Tourette's syndrome, multiple sclerosis, head trauma, sleep disorders, neuromuscular diseases, and various infections and tumors of the nervous system. Neurologists are also asked to evaluate unresponsive patients on life support to confirm brain death.

Treatment options vary depending on the neurological problem. They can include referring the patient to a physiotherapist, prescribing medications, or recommending a surgical procedure.
Some neurologists specialize in certain parts of the nervous system or in specific procedures. For example, clinical neurophysiologists specialize in the use of EEG and intraoperative monitoring to diagnose certain neurological disorders. Other neurologists specialize in the use of electrodiagnostic medicine studies – needle EMG and NCSs. In the US, physicians do not typically specialize in all the aspects of clinical neurophysiology – i.e. sleep, EEG, EMG, and NCSs. The American Board of Clinical Neurophysiology certifies US physicians in general clinical neurophysiology, epilepsy, and intraoperative monitoring. The American Board of Electrodiagnostic Medicine certifies US physicians in electrodiagnostic medicine and certifies technologists in nerve-conduction studies. Sleep medicine is a subspecialty field in the US under several medical specialties including anesthesiology, internal medicine, family medicine, and neurology. Neurosurgery is a distinct specialty that involves a different training path, and emphasizes the surgical treatment of neurological disorders.

Also, many nonmedical doctors, those with doctoral degrees(usually PhDs) in subjects such as biology and chemistry, study and research the nervous system. Working in laboratories in universities, hospitals, and private companies, these neuroscientists perform clinical and laboratory experiments and tests to learn more about the nervous system and find cures or new treatments for diseases and disorders.

A great deal of overlap occurs between neuroscience and neurology. Many neurologists work in academic training hospitals, where they conduct research as neuroscientists in addition to treating patients and teaching neurology to medical students.

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the conditions mentioned above. When surgical or endovascular intervention is required, the neurologist may refer the patient to a neurosurgeon or an interventional neuroradiologist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient has died. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as stroke, dementia, movement disorders, neurointensive care, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.

Overlapping areas

Some overlap also occurs with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequelae of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and interventional neuroradiology has created a demand for stroke specialists. The establishment of Joint Commission-certified stroke centers has increased the role of neurologists in stroke care in many primary, as well as tertiary, hospitals. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Likewise, most cases of sciatica are treated by general practitioners, though they may be referred to neurologists or surgeons (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists and psychiatrists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age. Physical medicine and rehabilitation physicians also in the US diagnosis and treat patients with neuromuscular diseases through the use of electrodiagnostic studies (needle EMG and nerve-conduction studies) and other diagnostic tools. In the United Kingdom and other countries, many of the conditions encountered by older patients such as movement disorders, including Parkinson's disease, stroke, dementia, or gait disorders, are managed predominantly by specialists in geriatric medicine.

Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a dementia).

Relationship to clinical neurophysiology

In some countries, e.g. US and Germany, neurologists may subspecialize in clinical neurophysiology, the field responsible for EEG and intraoperative monitoring, or in electrodiagnostic medicine nerve conduction studies, EMG,and evoked potentials. In other countries, this is an autonomous specialty (e.g., United Kingdom, Sweden, Spain).

Overlap with psychiatry

Although mental illnesses are believed by many to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote, "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway".

Neurological disorders often have psychiatric manifestations, such as poststroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, and Huntington disease, to name a few. Hence, the sharp distinction between neurology and psychiatry is not always on a biological basis. The dominance of psychoanalytic theory in the first three-quarters of the 20th century has since then been largely replaced by a focus on pharmacology. Despite the shift to a medical model, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder.

Neurological enhancement

The emerging field of neurological enhancement highlights the potential of therapies to improve such things as workplace efficacy, attention in school, and overall happiness in personal lives. However, this field has also given rise to questions about neuroethics and the psychopharmacology of lifestyle drugs.

Psychiatric survivors movement

From Wikipedia, the free encyclopedia

The psychiatric survivors movement (more broadly peer/consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who are survivors of interventions by psychiatry, or who are ex-patients of mental health services.

The psychiatric survivors movement arose out of the civil rights movement of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients. The key text in the intellectual development of the survivor movement, at least in the USA, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System. Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front. Coalescing around the ex-patient newsletter Dendron, in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's first public action was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting. In 2005 the SCI changed its name to Mind Freedom International with David W. Oaks as its director.

Common themes are "talking back to the power of psychiatry", rights protection and advocacy, and self-determination. While activists in the movement may share a collective identity to some extent, views range along a continuum from conservative to radical in relation to psychiatric treatment and levels of resistance or patienthood.

History

Precursors

The modern self-help and advocacy movement in the field of mental health services developed in the 1970s, but former psychiatric patients have been campaigning for centuries to change laws, treatments, services and public policies. "The most persistent critics of psychiatry have always been former mental hospital patients", although few were able to tell their stories publicly or to openly confront the psychiatric establishment, and those who did so were commonly considered so extreme in their charges that they could seldom gain credibility. In 1620 in England, patients of the notoriously harsh Bethlem Hospital banded together and sent a "Petition of the Poor Distracted People in the House of Bedlam (concerned with conditions for inmates)" to the House of Lords. A number of ex-patients published pamphlets against the system in the 18th century, such as Samuel Bruckshaw (1774), on the "iniquitous abuse of private madhouses", and William Belcher (1796) with his "Address to humanity, Containing a letter to Dr Munro, a receipt to make a lunatic, and a sketch of a true smiling hyena". Such reformist efforts were generally opposed by madhouse keepers and medics.

In the late 18th century, moral treatment reforms developed which were originally based in part on the approach of French ex-patient turned hospital-superintendent Jean-Baptiste Pussin and his wife Margueritte. From 1848 in England, the Alleged Lunatics' Friend Society campaigned for sweeping reforms to the asylum system and abuses of the moral treatment approach. In the United States, The Opal (1851–1860) was a ten volume Journal produced by patients of Utica State Lunatic Asylum in New York, which has been viewed in part as an early liberation movement. Beginning in 1868, Elizabeth Packard, founder of the Anti-Insane Asylum Society, published a series of books and pamphlets describing her experiences in the Illinois insane asylum to which her husband had had her committed.

Early 20th century

A few decades later, another former psychiatric patient, Clifford W. Beers, founded the National Committee on Mental Hygiene, which eventually became the National Mental Health Association. Beers sought to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions. His book, A Mind that Found Itself (1908), described his experience with mental illness and the treatment he encountered in mental hospitals. Beers' work stimulated public interest in more responsible care and treatment. However, while Beers initially blamed psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by Adolf Meyer and the psychiatric establishment, and toned down his hostility as he needed their support for reforms. His reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped establish. In the UK, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients sick of their experiences and complaints being patronisingly discounted by the authorities who were using medical "window dressing" for essentially custodial and punitive practices. In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the system of neglect and abuse she had suffered by publishing "The Experiences of an Asylum Patient".

We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York (now the Rockland Psychiatric Center) in the mid to late 1940s, and continued to meet as an ex-patient group. Their goal was to provide support and advice and help others make the difficult transition from hospital to community. By the early 1950s WANA dissolved after it was taken over by mental health professionals who transformed it into Fountain House, a psychosocial rehabilitation service for people leaving state mental institutions. The founders of WANA found themselves pushed aside by professionals with money and influence, who made them "members" of the new organization. During that period, people who received psychiatric treatment identified themselves as patients, and this term was generally unchallenged as a self-description until the 1970s. A patronizing attitude by some health care workers led to resentment among some current and former patients, which eventually found expression in more militant groups beginning in the early 1970s.

Originated by crusaders in periods of liberal social change, and appealing not so much to other sufferers as to elite groups with power, when the early reformer's energy or influence waned, mental patients were again mostly friendless and forgotten.

1950s to 1970s

The 1950s saw the reduction in the use of lobotomy and shock therapy. These used to be associated with concerns and much opposition on grounds of basic morality, harmful effects, or misuse. Towards the 1960s, psychiatric medications came into widespread use and also caused controversy relating to adverse effects and misuse. There were also associated moves away from large psychiatric institutions to community-based services (later to become a full-scale deinstitutionalization), which sometimes empowered service users, although community-based services were often deficient.
Coming to the fore in the 1960s, an anti-psychiatry movement challenged the fundamental claims and practices of mainstream psychiatry. The ex-patient movement of this time contributed to, and derived much from, antipsychiatry ideology, but has also been described as having its own agenda, described as humanistic socialism. For a time, the movement shared aims and practices with "radical therapists", who tended to be Marxist. However, the consumer/survivor/ex-patients gradually felt that the radical therapists did not necessarily share the same goals and were taking over, and they broke away from them in order to maintain independence.

By the 1970s, the women's movement, gay rights movement, and disability rights movements had emerged. It was in this context that former mental patients began to organize groups with the common goals of fighting for patients' rights and against forced treatment, stigma and discrimination, and often to promote peer-run services as an alternative to the traditional mental health system. Unlike professional mental health services, which were usually based on the medical model, peer-run services were based on the principle that individuals who have shared similar experiences can help themselves and each other through self-help and mutual support. Many of the individuals who organized these early groups identified themselves as psychiatric survivors. Their groups had names such as Insane Liberation Front and the Network Against Psychiatric Assault.

In 1971 the Scottish Union of Mental Patients was founded. In 1973 some of those involved founded the Mental Patients' Union in London.

Dorothy Weiner and about 10 others, including Tom Wittick, established the Insane Liberation Front in the spring of 1970 in Portland, Oregon. Though it only lasted 6 months, it had a notable influence in the history of North American ex-patients groups. News that former inmates of mental institutions were organizing was carried to other parts of North America. Individuals such as Howard Geld, known as Howie the Harp for his harmonica playing, left Portland where he been involved in ILF to return to his native New York to help found the Mental Patients Liberation Project in 1971. During the early 1970s, groups spread to California, New York, and Boston, which were primarily antipsychiatry, opposed to forced treatment including forced drugging, shock treatment and involuntary committal. In 1972, the first organized group in Canada, the Mental Patients Association, started to publish In A Nutshell, while in the US the first edition of the first national publication by ex-mental patients, Madness Network News, was published in Oakland, continuing until 1986.

Some all-women groups developed around this time such as Women Against Psychiatric Assault, begun in 1975 in San Francisco.

In 1978 Judi Chamberlin's book On Our Own: Patient Controlled Alternatives to the Mental Health System was published. It became the standard text of the psychiatric survivors movement, and in it Chamberlin coined the word "mentalism."

The major spokespeople of the movement have been described in generalities as largely white, middle-class and well-educated. It has been suggested that other activists were often more anarchistic and anti-capitalist, felt more cut off from society and more like a minority with more in common with the poor, ethnic minorities, feminists, prisoners & gay rights than with the white middle classes. The leaders were sometimes considered to be merely reformist and, because of their "stratified position" within society, to be uncomprehending of the problems of the poor. The "radicals" saw no sense in seeking solutions within a capitalist system that creates mental problems. However, they were united in considering society and psychiatric domination to be the problem, rather than people designated mentally ill.

Some activists condemned psychiatry under any conditions, voluntary or involuntary, while others believed in the right of people to undergo psychiatric treatment on a voluntary basis. Voluntary psychotherapy, at the time mainly psychoanalysis, did not therefore come under the same severe attack as the somatic therapies. The ex-patients emphasized individual support from other patients; they espoused assertiveness, liberation, and equality; and they advocated user-controlled services as part of a totally voluntary continuum. However, although the movement espoused egalitarianism and opposed the concept of leadership, it is said to have developed a cadre of known, articulate, and literate men and women who did the writing, talking, organizing, and contacting. Very much the product of the rebellious, populist, anti-elitist mood of the 1960s, they strived above all for self-determination and self-reliance. In general, the work of some psychiatrists, as well as the lack of criticism by the psychiatric establishment, was interpreted as an abandonment of a moral commitment to do no harm. There was anger and resentment toward a profession that had the authority to label them as mentally disabled and was perceived as infantilizing them and disregarding their wishes.

1980s and 1990s

By the 1980s, individuals who considered themselves "consumers" of mental health services rather than passive "patients" had begun to organize self-help/advocacy groups and peer-run services. While sharing some of the goals of the earlier movement, consumer groups did not seek to abolish the traditional mental health system, which they believed was necessary. Instead, they wanted to reform it and have more choice. Consumer groups encouraged their members to learn as much as possible about the mental health system so that they could gain access to the best services and treatments available. In 1985, the National Mental Health Consumers' Association was formed in the United States.

A 1986 report on developments in the United States noted that "there are now three national organizations ... The ‘conservatives’ have created the National Mental Health Consumers' Association ... The ‘moderates’ have formed the National Alliance of Mental Patients ... The ‘radical’ group is called the Network to Abolish Psychiatry". Many, however, felt that they had survived the psychiatric system and its "treatments" and resented being called consumers. The National Association of Mental Patients in the United States became the National Association of Psychiatric Survivors. "Phoenix Rising: The Voice of the Psychiatrized" was published by ex-inmates (of psychiatric hospitals) in Toronto from 1980 to 1990, known across Canada for its antipsychiatry stance.

In late 1988, leaders from several of the main national and grassroots psychiatric survivor groups decided an independent coalition was needed, and Support Coalition International (SCI) was formed in 1988, later to become MindFreedom International. In addition, the World Network of Users and Survivors of Psychiatry (WNUSP), was founded in 1991 as the World Federation of Psychiatric Users (WFPU), an international organisation of recipients of mental health services.

An emphasis on voluntary involvement in services is said to have presented problems to the movement since, especially in the wake of deinstitutionalization, community services were fragmented and many individuals in distressed states of mind were being put in prisons or re-institutionalized in community services, or became homeless, often distrusting and resisting any help.

Science journalist Robert Whitaker has concluded that patients rights groups have been speaking out against psychiatric abuses for decades - the torturous treatments, the loss of freedom and dignity, the misuse of seclusion and restraints, the neurological damage caused by drugs - but have been condemned and dismissed by the psychiatric establishment and others. Reading about the experiences they suffered through has been described as comparable to reading the stories of Holocaust survivors. Recipients of mental health services demanded control over their own treatment and sought to influence the mental health system and society's views.

The movement today

In the United States, the number of mental health mutual support groups (MSG), self-help organizations (SHO) (run by and for mental health consumers and/or family members) and consumer-operated services (COS) was estimated in 2002 to be 7,467. In Canada, CSI's (Consumer Survivor Initiatives) are the preferred term. "In 1991 Ontario led the world in its formal recognition of CSI's as part of the core services offered within the mental health sector when it began to formally fund over CSI's across the province. Consumer Survivor Initiatives in Ontario Building an Equitable Future' (2009) pg 7. The movement may express a preference for the "survivor" label over the "consumer" label, with more than 60 percent of ex-patient groups reported to support anti-psychiatry beliefs and considering themselves to be "psychiatric survivors." There is some variation between the perspective on the consumer/survivor movement coming from psychiatry, anti-psychiatry or consumers/survivors themselves.

The most common terms in Germany are "Psychiatrie-Betroffene" (people afflicted by/confronted with psychiatry) and "Psychiatrie-Erfahrene" (people who have experienced psychiatry). Sometimes the terms are considered as synonymous but sometimes the former emphasizes the violence and negative aspects of psychiatry. The German national association of (ex-)users and survivors of psychiatry is called the Bundesverband Psychiatrie-Erfahrener (BPE).

There are many grassroots self-help groups of consumers/survivors, local and national, all over the world, which are an important cornerstone of empowerment. A considerable obstacle to realizing more consumer/survivor alternatives is lack of funding. Alternative consumer/survivor groups like the National Empowerment Center in the US which receive public funds but question orthodox psychiatric treatment, have often come under attack for receiving public funding and been subject to funding cuts.

As well as advocacy and reform campaigns, the development of self-help and user/survivor controlled services is a central issue. The Runaway-House in Berlin, Germany, is an example. Run by the Organisation for the Protection from Psychiatric Violence, it is an antipsychiatric crisis centre for homeless survivors of psychiatry where the residents can live for a limited amount of time and where half the staff members are survivors of psychiatry themselves. In Helsingborg, Sweden, the Hotel Magnus Stenbock is run by a user/survivor organization "RSMH" that gives users/survivors a possibility to live in their own apartments. It is financed by the Swedish government and run entirely by users. Voice of Soul is a user/survivor organization in Hungary. Creative Routes is a user/survivor organization in London, England, that among other support and advocacy activities puts on an annual "Bonkersfest".

WNUSP is a consultant organization for the United Nations. After a "long and difficult discussion", ENUSP and WNUSP (European and World Networks of Users and Survivors of Psychiatry) decided to employ the term (ex-)users and survivors of psychiatry in order to include the identities of the different groups and positions represented in these international NGOs. WNUSP contributed to the development of the UN's Convention on the Rights of Persons with Disabilities and produced a manual to help people use it entitled "Implementation Manual for the United Nations Convention on the Rights of Persons with Disabilities", edited by Myra Kovary. ENUSP is consulted by the European Union and World Health Organization.

In 2007 at a Conference held in Dresden on "Coercive Treatment in Psychiatry: A Comprehensive Review", the president and other leaders of the World Psychiatric Association met, following a formal request from the World Health Organization, with four representatives from leading consumer/survivor groups.

The National Coalition for Mental Health Recovery (formerly known as National Coalition for Mental Health Consumer/Survivor Organizations) campaigns in the United States to ensure that consumer/survivors have a major voice in the development and implementation of health care, mental health, and social policies at the state and national levels, empowering people to recover and lead a full life in the community.

The United States Massachusetts-based Freedom Center provides and promotes alternative and holistic approaches and takes a stand for greater choice and options in treatments and care. The center and the New York-based Icarus Project (which does not self-identify as a consumer/survivor organization but has participants that identify as such) have published a Harm Reduction Guide To Coming Off Psychiatric Drugs and were recently a featured charity in Forbes business magazine.

Mad pride events, organized by loosely connected groups in at least seven countries including Australia, South Africa, the United States, Canada, the United Kingdom and Ghana, draw thousands of participants. For some, the objective is to continue the destigmatization of mental illness. Another wing rejects the need to treat mental afflictions with psychotropic drugs and seeks alternatives to the "care" of the medical establishment. Many members of the movement say they are publicly discussing their own struggles to help those with similar conditions and to inform the general public.

Survivor David Oaks, Director of MindFreedom, hosted a monthly radio show and the Freedom Center initiated a weekly FM radio show now syndicated on the Pacifica Network, Madness Radio, hosted by Freedom Center co-founder Will Hall.

A new International Coalition of National Consumer/User Organizations was launched in Canada in 2007, called Interrelate.

Impact

Research into consumer/survivor initiatives (CSIs) suggests they can help with social support, empowerment, mental wellbeing, self-management and reduced service use, identity transformation and enhanced quality of life. However, studies have focused on the support and self-help aspects of CSIs, neglecting that many organizations locate the causes of members’ problems in political and social institutions and are involved in activities to address issues of social justice.

A recent series of studies in Canada compared individuals who participated in CSIs with those who did not. The two groups were comparable at baseline on a wide range of demographic variables, self-reported psychiatric diagnosis, service use, and outcome measures. After a year and a half, those who had participated in CSIs showed significant improvement in social support and quality of life (daily activities), less days of psychiatric hospitalization, and more were likely to have stayed in employment (paid or volunteer) and/or education. There was no significant difference on measures of community integration and personal empowerment, however. There were some limitations to the findings; although the active and nonactive groups did not differ significantly at baseline on measures of distress or hospitalization, the active group did have a higher mean score and there may have been a natural pattern of recovery over time for that group (regression to the mean). The authors noted that the apparent positive impacts of consumer-run organizations were achieved at a fraction of the cost of professional community programs.

Further qualitative studies indicated that CSIs can provide safe environments that are a positive, welcoming place to go; social arenas that provide opportunities to meet and talk with peers; an alternative worldview that provides opportunities for members to participate and contribute; and effective facilitators of community integration that provide opportunities to connect members to the community at large. System-level activism was perceived to result in changes in perceptions by the public and mental health professionals (about mental health or mental illness, the lived experience of consumer/survivors, the legitimacy of their opinions, and the perceived value of CSIs) and in concrete changes in service delivery practice, service planning, public policy, or funding allocations. The authors noted that the evidence indicated that the work benefits other consumers/survivors (present and future), other service providers, the general public, and communities. They also noted that there were various barriers to this, most notably lack of funding, and also that the range of views represented by the CSIs appeared less narrow and more nuanced and complex than previously, and that perhaps the consumer/survivor social movement is at a different place than it was 25 years ago.

A significant theme that has emerged from consumer/survivor work, as well as from some psychiatrists and other mental health professionals, has been a recovery model which seeks to overturn therapeutic pessimism and to support sufferers to forge their own personal journal towards the life they want to live; some argue however that it has been used as a cover to blame people for not recovering or to cut public services.

There has also been criticism of the movement. Organized psychiatry often views radical consumerist groups as extremist, as having little scientific foundation and no defined leadership, as "continually trying to restrict the work of psychiatrists and care for the seriously mentally ill", and as promoting disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults. However, opponents consistently argue that psychiatry is territorial and profit-driven and stigmatizes and undermines the self-determination of patients and ex-patients The movement has also argued against social stigma or mentalism by wider society.

Well-positioned forces in the USA, led by figures such as psychiatrists E. Fuller Torrey and Sally Satel, and some leaders of the National Alliance on Mental Illness, have lobbied against the funding of consumer/survivor groups that promote antipsychiatry views or promote social and experiential recovery rather than a biomedical model, or who protest against outpatient commitment. Torrey has said the term "psychiatric survivor" used by ex-patients to describe themselves is just political correctness and has blamed them, along with civil rights lawyers, for the deaths of half a million people due to suicides and deaths on the street. His accusations have been described as inflammatory and completely unsubstantiated, however, and issues of self-determination and self-identity said to be more complex than that.

Disability rights movement

From Wikipedia, the free encyclopedia

Play media

Alternative access to the subway in Japan

 

Floor marker for disabled people in Narita Airport, Japan

 

The disability rights movement is a global social movement to secure equal opportunities and equal rights for all people with disabilities.

It is made up of organizations of disability activists around the world working together with similar goals and demands, such as: accessibility and safety in architecture, transportation, and the physical environment; equal opportunities in independent living, employment equity, education, and housing; and freedom from discrimination, abuse, neglect, and from other rights violations. Disability activists are working to break institutional, physical, and societal barriers that prevent people with disabilities from living their lives like other citizens.

Disability barriers

The social model of disability suggests disability is caused by the way society is organized, rather than by a person’s impairment. This model suggests barriers in society are created by ableism. When barriers are removed, people with disabilities can be independent and equal in society.
There are three main types of barriers:

1. Attitudinal barriers: are created by people who see only disability when associating with people with disabilities in some way. These attitudinal barriers can be witnessed through bullying, discrimination, and fear. These barriers include low expectations of people with disabilities. These barriers contribute to all other barriers. Attitudes towards people with disabilities in low and middle-income countries can be even more extreme.
2. Environmental barriers: inaccessible environments, natural or built, create disability by creating barriers to inclusion.
3. Institutional barriers: include many laws, policies, practices, or strategies that discriminate against people with disabilities. For example, a study of five Southeast Asian countries found that electoral laws do not specially protect the political rights of persons with disabilities, while ‘some banks do not allow visually disabled people to open accounts, and HIV testing centers often refuse to accept sign language interpreters due to confidentiality policies’. Restrictive laws exist in some countries, particularly affecting people with intellectual or psychosocial disabilities.

Other barriers include: internalised barriers (low expectations of people with disabilities can undermine their confidence and aspirations), inadequate data and statistics, lack of participation and consultation of disabled people.

Issues

People with physical disabilities

Access to public areas such as city streets, public buildings, and restrooms are some of the more visible changes brought about in recent decades to remove physical barriers. A noticeable change in some parts of the world is the installation of elevators, automatic doors, wide doors and corridors, transit lifts, wheelchair ramps, curb cuts, and the elimination of unnecessary steps where ramps and elevators are not available, allowing people in wheelchairs and with other mobility disabilities to use public sidewalks and public transit more easily and safely.

People with visual disabilities

Code Signs for People with CVD

People with color vision deficiency (CVD) regularly deal with implicit discrimination due to their inability to distinguish certain colors. A system of geometrically shaped code signs known as Coloradd was developed by Professor Miguel Neiva of the University of Minho, Portugal in 2010 to indicate colours to people who have difficulty discerning them. It has been adopted rapidly by numerous businesses to boost sales.

People with developmental disabilities

Advocates for the rights of people with developmental disabilities focus their efforts on gaining acceptance in the workforce and in everyday activities and events from which they might have been excluded in the past. Unlike many of the leaders in the physical disability rights community, self-advocacy has been slow in developing for people with developmental disabilities. As a result, much of the work done by the Disability Rights Movement was completed by allies, or those without disabilities but with a strong connection to someone with disabilities. Parents, friends, and siblings fought for education and acceptance when their loved ones with cognitive disabilities could not. Public awareness of the civil rights movement for this population remains limited, and the stereotyping of people with developmental disabilities as non-contributing citizens who are dependent on others remains common. Today, the movement has a more social focus to increase this public awareness, as evidenced by the "R-Word" Campaign, in which they try to eliminate the colloquial use of the word "retard."

People with mental health issues

Advocates for the rights of people with mental health disabilities focus mainly on self-determination, and an individual’s ability to live independently.

The right to have an independent life, using paid assistant care instead of being institutionalized, if the individual wishes, is a major goal of the disability rights movement, and is the main goal of the similar independent living and self-advocacy movements, which are most strongly associated with people with intellectual disabilities and mental health disorders. These movements have supported people with disabilities to live as more active participants in society.

Access to education and employment

Access to education and employment have also been a major focus of the disability rights movement. Adaptive technologies, enabling people to work jobs they could not have previously, help create access to jobs and economic independence. Access in the classroom has helped improve education opportunities and independence for people with disabilities.

Freedom from discrimination and abuse

Freedom from abuse, neglect, and violations of a person's rights are also important goals of the disability rights movement. Abuse and neglect includes inappropriate seclusion and restraint, inappropriate use of force by staff and/or providers, threats, harassment and/or retaliation by staff or providers, failure to provide adequate nutrition, clothing, and/or medical and mental health care, and/or failure to provide a clean and safe living environment, as well as other issues which pose a serious threat to the physical and psychological well-being of a person with a disability. Violations of patients' rights include failure to obtain informed consent for treatment, failure to maintain the confidentiality of treatment records, and inappropriate restriction of the right to communicate and associate with others, as well as other restrictions of rights.

As a result of the work done through the disability rights movement, significant disability rights legislation was passed in the 1970s through the 1990s in the U.S.

History

In the UK

Disability rights activist outside Scottish Parliament, 30 March 2013

In the United Kingdom, following extensive activism by people with disabilities over several decades, the Disability Discrimination Act 1995 (DDA 1995) was passed. This made it unlawful in the United Kingdom to discriminate against people with disabilities in relation to employment, the provision of goods and services, education and transport. The Equality and Human Rights Commission provides support for this Act. Equivalent legislation exists in Northern Ireland, which is enforced by the Northern Ireland Equality Commission.

Following the introduction of the Bedroom Tax (officially the Under-occupancy penalty) in the Welfare Reform Act 2012, disability activists have played a significant role in the development of Bedroom Tax protests. A wide range of benefit changes are estimated to affect disabled people disproportionately and to compromise disabled people's right to independent living.

In the US

The disability rights movement began in the 1960s, encouraged by the examples of the Civil Rights Movement and women’s rights movements.

It was at this time that disability rights advocacy began to have a cross-disability focus. People with different kinds of disabilities (physical and mental disabilities, along with visual and hearing disabilities) and different essential needs came together to fight for a common cause.

In 1948, a watershed for the movement was the proof of the existence of physical and program barriers. The proof was provided as a specification for barrier free usable facilities for people with disabilities. The specifications provided the minimum requirements for barrier free physical and program access. An example of barriers are; providing only steps to enter buildings; lack of maintenance of walkways; locations not connected with public transit; lack of visual and hearing communications ends up segregating individuals with disabilities from independent, participation, and opportunities. The ANSI - Barrier Free Standard (phrase coined by Dr. Timothy J. Nugent, the lead investigator) called "ANSI A117.1, Making Buildings Accessible to and Usable by the Physically Handicapped", provides the indisputable proof that the barriers exist. It is based on disability ergonomic research conducted at the University of Illinois Urbana Champaign campus from 1946 to 1986. The research was codified in the ANSI A117.1 standard in 1961, 1971, 1980, and 1986. The standard is the outcome of physical therapists, bio-mechanical engineers, and individuals with disabilities who developed and participated in over 40 years of research. Easter Seals Education Committee Chairman Harold Wilke was tasked with assembling that diverse group in 1959. The standard provides the criteria for modifying programs and the physical site to provide independence. Applying the researched standards criteria presents reliable access and non-hazardous conditions. In October 2011 the standard turned 50 years old. The standard has been emulated globally since its introduction in Europe, Asia, Japan, Australia, and Canada, in the early 1960s.

One of the most important developments of the disability rights movement was the growth of the independent living movement, which emerged in California in the 1960s through the efforts of Edward Roberts and other wheelchair-using individuals. This movement, a subset of the disability rights movement, postulates that people with disabilities are the best experts on their needs, and therefore they must take the initiative, individually and collectively, in designing and promoting better solutions and must organize themselves for political power. Besides de-professionalization and self-representation, the independent living movement's ideology comprises de-medicalization of disability, de-institutionalization and cross-disability (i.e. inclusion in the independent living movement regardless of diagnoses).^[4] Similarly, The Architectural Barriers Act was passed in 1968, mandating that federally constructed buildings and facilities be accessible to people with physical disabilities. This act is generally considered to be the first ever-federal disability rights legislation. Unfortunately for those with cognitive disabilities, their disability made it more difficult to be the best expert of their own needs, hindering their ability to self-advocate as their wheelchair-using counterparts could. Self-representation was much more difficult for those who could not articulate their thoughts, leading to their dependence on others to carry on the movement.

In 1973 the (American) Rehabilitation Act became law; Sections 501, 503, and 504 prohibited discrimination in federal programs and services and all other programs or services receiving federal funds. Key language in the Rehabilitation Act, found in Section 504, states “No otherwise qualified handicapped [sic] individual in the United States, shall, solely by reason of his [sic] handicap [sic], be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.” This was the first civil rights law guaranteeing equal opportunity for people with disabilities.

Another crucial turning point was the 504 Sit-in in 1977 of government buildings operated by the United States Department of Health, Education, and Welfare (HEW), conceived by Frank Bowe and organized by the American Coalition of Citizens with Disabilities, that led to the release of regulations pursuant to Section 504 of the Rehabilitation Act of 1973. On April 5, 1977, activists began to demonstrate and some sat-in in the offices found in ten of the federal regions including New York City, Los Angeles, Boston, Denver, Chicago, Philadelphia, and Atlanta. The two most noteworthy protests occurred in San Francisco and Washington, D.C. The protesters demanded the signing of regulations for Section 504 of the Rehabilitation Act of 1973. There were about 300 people in Washington, D.C. who marched to and then demonstrated inside the HEW building where Secretary Joseph Califano’s office was. He was the person who was to sign the regulations, but was delaying the process. Although he met with a few protest representatives, including Frank Bowe, he still did not sign. This action led many protesters to continue their sit-in overnight, but they then left after 28 hours. The more successful sit-in occurred in San Francisco, led by Judith Heumann. The first day of protests marked the first of a 25-day sit-in. Close to 120 disability activists and protesters occupied the HEW building. Califano finally signed on April 28, 1977. This protest was significant not only because its goal was achieved, but also because it was the foremost concerted effort between people of different disabilities coming together in support of legislation that affected the overall disability population, rather than only specific groups. Prior to the 1990 enactment of the Americans with Disabilities Act, the Rehabilitation Act was the most important disability rights legislation in the United States.

In 1978 disability rights activists in Denver, Colorado, organized by the Atlantis Community, held a sit-in and blockade of the Denver Regional Transit Authority buses in 1978. They were protesting the fact that city’s transit system was completely inaccessible for the physically disabled. This action proved to be just the first in a series of civil disobedience demonstrations that lasted for a year until the Denver Transit Authority finally bought buses equipped with wheelchair lifts. In 1983, Americans Disabled for Accessible Public Transit (ADAPT) was responsible for another civil disobedience campaign also in Denver that lasted seven years. They targeted the American Public Transport Association in protest of inaccessible public transportation; this campaign ended in 1990 when bus lifts for people using wheelchairs were required nationwide by the Americans with Disabilities Act.

Another significant protest related to disability rights was the Deaf President Now protest by the Gallaudet University students in Washington, D.C. in March 1988. The 8-day (March 6 – March 13) demonstration and occupation and lock-out of the school began when the Board of Trustees appointed a new hearing President, Elisabeth Zinser, over two Deaf candidates. The students’ primary grievance was that the university, which was dedicated to the education of people who are Deaf, had never had a Deaf president, someone representative of them. Of the protesters’ four demands, the main one was the resignation of the current president and the appointment of a Deaf one. The demonstration consisted of about 2,000 student and nonstudent participants. The protests took place on campus, in government buildings, and in the streets. In the end, all the students’ demands were met and I. King Jordan was appointed the first Deaf President of the university.

In 1990, the Americans with Disabilities Act became law, and it provided comprehensive civil rights protection for people with disabilities. Closely modeled after the Civil Rights Act and Section 504, the law was the most sweeping disability rights legislation in American history. It mandated that local, state, and federal governments and programs be accessible, that employers with more than 15 employees make “reasonable accommodations” for workers with disabilities and not discriminate against otherwise qualified workers with disabilities, and that public accommodations such as restaurants and stores not discriminate against people with disabilities and that they make reasonable modifications to ensure access for disabled members of the public. The act also mandated access in public transportation, communication, and in other areas of public life.

The first Disability Pride March in the United States was held in Boston in 1990. A second Disability Pride March was held in Boston in 1991. There were no subsequent Disability Pride Marches/Parades for many years, until Chicago on Sunday, July 18, 2004. It was funded with $10,000 in seed money that Sarah Triano received in 2003 as part of the Paul G. Hearne Leadership award from the American Association of People with Disabilities. According to Triano, fifteen hundred people attended the parade. Yoshiko Dart was the parade marshal.

Exhibitions and collections

To mark the 10th anniversary of the Americans with Disabilities Act, the Smithsonian Institution National Museum of American History opened an exhibition that examined the history of activism by people with disabilities, their friends, and families to secure the civil rights guaranteed to all Americans. Objects on view included the pen President George H.W. Bush used to sign the Act and one of the first ultralight wheelchairs. The exhibition was designed for maximum accessibility. Web-based kiosks - prototypes for a version that will eventually be available to museums and other cultural institutions - provided alternate formats to experience the exhibition. The exhibition was open from July 6, 2000 to July 23, 2001.