Dialogue 1 | "Why are there so few rights-based institutions and alternatives to psychiatry in Germany? What does it take to change this?"

The first INTAR [International Network for Alternatives and Rights-based Supports] Dialogue took place on May 11th 2021.

Dialogue 1 | "Why are there so few rights-based institutions and alternatives to psychiatry in Germany? What does it take to change this?"

The following contributions are examples of the discussion at the event

Iris Hölling | : [Association for Protection against Psychiatric Violence, Board of Directors BOP&P e.V.]

"And I think there are also framework conditions in the survivors movement that make it difficult. So we are, I think not good in there to bundle our resources, but very well fragmented. This doesn't necessarily make it easier to find a really critical mass of people who say: We want to set up a new project now. I think many of ex-users and survivors have also decided to work more on the reform side or to try to change something in psychiatry, which from my point of view always carries the danger of appropriation and the risk that they are not radical, radical alternatives that are really based on a different model. And the dominance of the biomedical model is of course also a factor of the framework conditions that makes it difficult, because it is very powerful. And so from my point of view, really rights-based alternatives can also only emerge outside of the psychiatric system"

"It takes a group of people who have staying power, who also have the capacity to commit themselves unpaid, to develop such concepts and then work for a very long time to implement them. And then you need alliance partners at the political level and at the level of donors, who then also develop an interest in implementing such things themselves. And I think that's one of the big hurdles, so to speak, that it's not really wanted politically, because the dominant system is not interested in alternatives where people have a choice and can decide and alternatives that are based on other values, namely self-determination and self-definition, so to speak, to put one's own truth above one's own experience in a dominant way. In my view, these are central factors. But it takes forces to really be able to organize together. And for this, the conditions for many psychiatric patients are not optimal"

"So I believe that such projects can succeed and continue to exist. Do we need to be embedded in such a self-organized political space, where survivors have a strong voice? And I believe that this has become at least fragile, if not lost, along the way. And that's exactly where I think institutionalisation happens, which has also taken away some of the radicalism."

"I don't think that the public was different back then, because it was crazy hard. So there wasn't really any public support and I think actually the framework conditions, I would link to what Ute Kraemer said. The framework conditions with the UNCRPD have actually improved extremely, only because there are actually obligations to also implement such, I call it alternatives now, or we could also say human rights-based offers or whatever, because I actually think that is not possible to do that within the system that exists now."

"So I do believe that there is a need for spaces outside the system and for other allies who perhaps also represent these values from other movements.”

"But from my point of view, it's not really the job of the survivors to change this system, but to change that. So, no, I think that is also the task of the critical professionals. Personally, I'm no longer prepared to discuss this issue, I've been doing that for many years, and so far, my energy doesn't go there anymore, but rather to try to somehow build up other places for fellow sufferers."

"I didn't mean to say that I think the situation is better today, but I think the UNCRPD gives us an instrument. Which, if there were a serious political will to implement it, would mean a lot of obligations for."

Jann Schlimme [Specialist for Psychiatry and Psychotherapy, Board of Directors German Society for Social Psychiatry]:

"There are few people in the psychiatric field who represent real biomedical theses as exclusive theses, but I think it has a lot to do with the treatment paradigm. So this idea of intervention. That's already clear from the verb. The person we are talking about is already in the powerless position. He is accompanied. He is not supported. He is treated, but he does not act himself. He can't do much at all. He should leave himself to the intervention of the professionals. And then it all works itself out. We all know that it doesn't work that way."

"That may be true, but nevertheless it is not the case that these alternatives are somehow erupting here. On the contrary, I have the feeling that there is a much stronger concentration on more traditional institutions. In Berlin, more hospital beds are being built in psychiatric clinics rather than being cut back. Exactly. So I don't have the solution yet. So my feeling is really to create publicity. And I think that is central."

Inga Zimprich | Feminist Health Care Research Group:

"And my question to us is, As we build self-organised spaces, what work do we need to do to ensure that people are not harmed in our internalised dominant forms of oppression through rejectionism, through racism? And to what extent can we work to ensure that our access to alternative knowledge, to anti-psychiatry, to organised therapy or radical therapy is not just circulated among other elites, is not just accessible to, say, white leftists? What work do we need to be actively doing to look at? What do we practice, what do we take ourselves and what do we also pass on in these structures?"

"I think we need a lot of dialogue in the generations to pass on the knowledge that these initiatives have and also to open them up and to work in these initiatives so that they are more accessible and to learn a lot from what is happening in the Social Justice, Transformative Justice movement in the USA, from which we can learn a lot."

"And I think that especially when we network to strengthen ourselves, it's very important that we appreciate that these initiatives have lasted so long and can pass on and pass on this knowledge."

Following the event, we asked participants for feedback. Of 50 people contacted, 11 completed the survey.

The question "What is the most important thing you took away from this event?" was mainly answered with the new information about possibilities to work without pathologization and the insight into rights-based institutions already existing in Germany:

“Hearing a different national activist conversation. Of course some parallels to the U.S., but some different flavors, too.”

“Knowledge about criticism of pathologization and ways to do without it and that this has been implemented in projects for a very long time.”

“An overview of already existing alternatives to psychiatry in Germany.”

To the question "How could the event have been even more helpful?" wishes were expressed regarding a deeper discussion and more time for such. Breakout rooms were suggested as a possibility for a deeper discussion, or a full-day workshop. Likewise, more time for an open exchange was desired. In some cases there were technical difficulties in finding the button to activate the translation and the simultaneous translation was perceived as sometimes patchy and difficult to follow. The underrepresentation of BIPoC panelists and BIPoC centered initiatives on the panel was noted as a major shortcoming.

“I can also imagine (but probably wouldn't have the time myself) that the initiatives could have gone into more depth on individual topics in small workshops or breakout rooms in an all-day event. I briefly watched the online version of the video in English today and unfortunately I only got about 30% translated.”

“I never found the "Translate" button, so I had to try to understand the German. I don't know whether this is because I have Zoom on Linux, or maybe I needed to update to the latest version.”

“Perhaps it would be possible to go deeper into a topic with more specific discussion questions. The English translation was also a bit difficult to follow.”

“It would have been nice if BIPoC panelists had also participated and BIPoC-centered initiatives had been presented”

In further comments, the event was praised as very professional and well organized and the panelists as competent. The event itself was considered very interesting and having the translation was considered great.

“Very professional and well organized”

“It was a very interesting event. Thank you very much for letting me participate!”

“Thank you for organizing the event - competent panelists”

“Having translators was amazing.”

German video documentation:

English video documentation: