A/HRC/44/48 30. There is a concerning tendency to use medicine as a means to diagnose and subsequently dismiss an individual’s dignity and autonomy within a range of social policy areas, many of which are viewed as popular reforms to outdated forms of punishment and incarceration. Medicalization deflects from the complexity of the context as humans in society, implying that there exists a concrete, mechanistic (and often paternalistic) solution. That reflects the unwillingness of the global community to confront human suffering meaningfully and embeds an intolerance towards the normal negative emotions everyone experiences in life. How “treatment” or “medical necessity” is used to justify discrimination and social injustice is troubling. 31. A dominant biomedical approach has led to States justifying their authority to intervene in ways that limit the rights of individuals. For example, medical rationales should never be used as a defence or justification for policies and practices that violate the dignity and rights of people who use drugs. While efforts to move responses to drug use away from criminalized models towards health-based ones are welcome in principle, it is important to raise a caution about the risk of medicalization further entrenching rights abuses against people who use drugs. Medicalized responses to address addiction (particularly when framed as a disease) can reflect parallel coercive practices, detention, stigmatization and the lack of consent found in criminalized approaches. Without human rights safeguards, these practices can flourish and can often disproportionately affect individuals who face social, economic or racial marginalization. 32. Forced interventions in mental health settings have been justified because of determinations of “dangerousness” or “medical necessity”. Those determinations are established by someone other than the individual in question. Because they are subjective, they require greater scrutiny from a human rights perspective. While people worldwide are fighting for the unshackling of people with serious emotional distress, the physical chains and locks are being replaced by chemical restraints and active surveillance. The gaze of the State and the investment of resources remain too narrowly focused on controlling the individual with “medical necessity”, commonly invoked as grounds to justify such control. 33. Despite the absence of biological markers for any mental health condition, 22 psychiatry has reinforced biomedical and acontextual understanding of emotional distress. Because of the lack of a comprehensive understanding of the aetiology of, and treatment for, mental health conditions, there is a growing trend that urges a transition away from medicalization.23 There are growing calls within psychiatry for a “fundamental rethinking of psychiatric knowledge creation and training” and a renewed emphasis on the importance of relational care and the interdependence of mental and social health. 24 The Special Rapporteur concurs but calls on organized psychiatry and its leaders to firmly establish human rights as core values when prioritizing mental health interventions. 34. When considering initiating treatment, the principle of primum non nocere, or “first do no harm”, must be the guiding one. Unfortunately, the burdensome side effects resulting from medical interventions are often overlooked, the harms associated with numerous psychotropic drugs have been downplayed and their benefits exaggerated in the published literature.25 The potential for overdiagnosis and overtreatment must therefore be considered as a potential iatrogenic effect of current global efforts to scale up access to treatment. Additionally, the broader human rights and social harms produced by medicalization, such as social exclusion, forced treatment, loss of custody of children and loss of autonomy, warrant greater attention. Medicalization affects every aspect of the lives of persons with psychosocial disabilities; it undermines their ability to vote, work, rent a home and be full citizens who participate in their communities. 22 23 24 25 See James Phillips and others, “The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis”, Philosophy, Ethics and Humanities in Medicine, vol. 7, No. 3 (January 2012). See Vincenzo Di Nicola. “‘A person is a person through other persons’: a social psychiatry manifesto for the 21st century”, World Social Psychiatry, vol. 1, No. 1 (2019). See Caleb Gardner and Arthur Kleinman, “Medicine and the mind - the consequences of psychiatry’s identity crisis”, The New England Journal of Medicine, vol. 381, No. 18 (October 2019). See Joanna Le Noury and others, “Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence”, The BMJ, vol. 351 (September 2015). 9