萝莉视频

Dr Lade Smith CBE, President of the 萝莉视频, spoke with Jade Wright, Special Committee on Human Rights (SCHR) member, about her perspective on human rights, and how they are at the very core of the work we do as psychiatrists.

Click the links below to jump to each question.

1. Can you tell us a bit about yourself and your journey into psychiatry and human rights?
2. Do you have a favorite book or film that relates to the topic of human rights? 
3. In the current world, what are the key human rights challenges for psychiatrists and how can we support people facing these challenges who may be unable to advocate for themselves? 
4. What progress, or lack of, have you seen in upholding human rights in mental health from the time you started practicing as a psychiatrist?
5. What advice would you offer a College member who considers any discussion on human rights to be theoretical, impractical and idealistic? 
6. What is your vision for the role of the SCHR within the College?

1. Can you tell us a bit about yourself and your journey into psychiatry and human rights?

When you say your journey into psychiatry and human rights, that's an odd question for me. The reason being that everyone has human rights. 

When I was little, I was really into horoscopes and matchmaking people. I then quickly realised this is all about psychology. So I decided I'll go and do medicine, even though it was a hard thing to do at the time, and I thought I can go and be a psychiatrist.

So then I started doing medicine and realised there were loads of other parts of medicine I was really interested in; surgery, obstetrics and gynaecology. Then I did my psychiatry rotation and I just thought- I have arrived. This is for me. And it was clearly the thing that I was always going to do. I was very good at it and I got prizes in it and things like that. 

I love that you get to do medicine, you get to look after people, make them better. It's incredibly rewarding. As a psychiatrist, you look after people's physical health but also look after their mental health.  I think that makes psychiatrists the ultimate in being a doctor. You can do it all, being holistic.

I think that it's an enormous privilege and in what other branch of medicine does your job involve getting to know someone so intimately that, you talk to people about stuff that they won't even talk to their closest life partner about. That's an incredible gift and it's very precious. 

Also it's fascinating. I'm amazed at not just people's stories, but I'm amazed at also the psychopathology.  I work in South London, which is a very morbid area. There's lots of deprivation, lots of substance use, violence, crime, etc. That's just in the general population. Then you get people who are unwell, because of all the trauma that they've suffered throughout their lives. So there's huge amounts of psychopathology. It is just fascinating.  

My journey into human rights; well everyone has human rights. We take these for granted. 

Part of what happens in life is when we are children, the first thing our parents and caregivers do is teach us right from wrong. We learn that in loads of different ways. And the reason we need to know about right from wrong is because we live in communities with other people.

As a child we are taught that's a good thing, that's a bad thing. Then as we grow up and  get older and we go through adolescence, we start to learn that life is not like a fairy tale, where there's just good people and bad people. Actually good people do bad things. Bad people do good things. Life is much greater than that. There is nuance and part of our maturation and part of becoming an adult is learning about the ambivalence of life.

We are living in the UK, which is supposedly a country that's got great human rights. But there are people sleeping on the streets and we walk past them and we may or may not give them anything.  That's the ambivalence of life, isn't it? And we live with that, actually. And we get used to it.

We all have our morals, our red lines. My red lines as an individual might be quite different to someone else's red lines, as an individual, they might have a completely different moral compass to me. 

So we've got to have some basic agreement about what can, and what should, everyone have? This is where human rights come in. I have taught on an MSc for many years, and we did an exercise where we asked students to think about what basic human rights should everyone have. And what people came up with aligned with the ECHR. 

2. Do you have a favourite book or film that relates to the topic of human rights? 

I love feminist dystopian fiction and it relates to human rights. So there is Margaret Atwood who is well known, but also Octavia Butler. 

Octavia Butler was born in California and in the 70s she wrote these books about a kind of post-apocalyptic world. She started a trilogy but she died, unfortunately, so didn’t finish them all. The first book in the trilogy is Parable of the Sower, and there is Parable of the Talents. Those books are really brilliant in helping people to understand how our human rights can be so quickly eroded. 

It’s incredible because I could see it happening when I was in Los Angeles, I noticed you've got some of the richest people living in their estates, then down the road 80,000 people living homeless in a place called Skid Row. When I walked down Skid Row with the Dean, we saw people not just homeless, but people catatonic on the street. We saw one guy who was really ill in the street, his trousers were halfway down, there was diarrhoea down his leg, the buses were beeping at him. I was thinking, what shall we do, shall we call the police? I spoke to a friend who lives in LA and asked them what shall we do, in the UK someone would have contacted the emergency services, the police would have picked him up, as he was obviously ill. My friend said that it is different in California, there is a big thing about choice and autonomy. I said that it is not his choice, he is unwell, he cannot help it and he needs someone to help him.

3. In the current world, what are the key human rights challenges for psychiatrists and how can we support people facing these challenges who may be unable to advocate for themselves? 

As psychiatrists, we need to really understand the science behind everything as best as we can, and we know it's always evolving and improving, but we need to know the science and keep up to date so that we can educate not only ourselves, not only other people, but our patients as well. More than anything, that will help to counter the stigma.

The human rights of psychiatric patients have been problematic for years. The history of the illustrates this. The term hospital came from the Latin hospes, to do with hospitality. Initially the Bethlehem was a place where monks treated travellers with hospitality, giving them food, drink and a place to rest. However, after a few hundred years there is record that it became a place where people ‘of the lunatic persuasion’ came to be kept and looked after. Then it progressed to being a place where people who had done something criminal were kept. By this stage people could pay a penny to come to view the ‘mad and wild’ people, and it became about keeping them incarcerated. 

There was an idea that if you were ‘mental’ it is because there is something inherently wrong with you and there is nothing to be done. All that can be done is you lock these people up and hope they don’t hurt themselves or anyone else too much.

However, then young men started going off to war, these were lovely young men from good families, yet they ended up with shell shock, PTSD. It was only at this point that therapy started to be introduced and for the first time ever, it was shown that you could treat mental illness. That was in 1916.

But back to people paying a penny to view the ‘lunatics’. It was a form of moral instruction, to show that if you did not behave properly, this is what would happen to you. It was the idea that bad people become unwell in some way. The idea that mentally unwell people are inherently degenerate, or they have done something really bad in their lives and caused it to themselves, and that all you can do is lock them away. 

We have to remember that not only are our patients viewed with suspicion and negativity, but also those who look after them. People’s understanding of mental illness is so limited, that they still see mental illness in the same way it was understood in the 1500s. The big human rights issue for psychiatrists is basically that our patients are still subject to the same understanding, morals and values as they were 1000 years ago, which is why it's absolutely incumbent upon psychiatrists to really understand the science behind everything as best as we can. We know it's always evolving and improving, but we need to keep up to date so that we can educate not only ourselves, not only other people, but our patients as well. More than anything, that will help to counter the stigma.

4. What progress, or lack of, have you seen in upholding human rights in mental health from the time you started practicing as a psychiatrist?

There is now much more talk about health inequality and health inequity. There is a lot more recognition about how important it is. That is a major, major step forwards I think. 

The evidence is clear. There is now much more understanding about the fact that undermining people’s human rights can lead to mental illness in a way that people didn’t really understand before. 

There is an understanding that women’s rights are human rights and how undermining them has affected them. Rights about people’s ethnicity and how that affects them. 

People have asked why am I still focusing on specific groups of people; women, people from minority ethnic backgrounds, people with disabilities, LGBTQ+. I have said that because that is where the evidence leads. It is not a personal preference. 

Challenges are thinking about how we work with people and areas that have different values to the UK. We have to think about as a College, are we going to accept the ambivalence and complexity of things and are we going to continue working with psychiatrists and doctors who work in different value systems and regimes. That is the approach we have at the moment at the College. If we as a College penalise different values, then things start to improve in one area and one area stays the same, the disparity gets worse.

If we continue working in the way we do, by retaining our values and working to them, we can quietly hope to have an influence on societal values. 

5. What advice would you offer a College member who considers any discussion on human rights to be theoretical, impractical and idealistic? 

Human rights are basic stuff. I think people don’t understand human rights as well as they need to. For psychiatrists, our patients are subject to all kinds of problems and they don’t get given the same rights as others. 

When people are marginalised and discriminated against, basically it is saying ‘you are not worthy, you are not worth as much as I am.’ Our patients are particularly subjected to that. It affects us as well.

6. What is your vision for the role of the SCHR within the College?

I would like people to have a better understanding of human rights, particularly the human rights law. I think that everyone has an idea about it, and when you think about it thoughtfully and carefully, you realise human rights are limited. You know that you can’t just go around doing what you like. You’ve got to think about everybody else. How do you ensure that everybody gets to exercise their human rights without harming other people? 

I would like the SCHR to be more embedded within the College, and to provide more guidance. For example, making sure you are supporting the curriculum is very important, helping with maintaining standards. If human rights are embedded in the day-to-day, then it becomes part of what you do.