Governing Madness: Coercion, Resistence and Agency in British Columbia's Mental Health Law Regime




Fraser, Gene

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Among the features that distinguish British Columbia’s mental health laws from those in other provinces in Canada is that they accord a high level of discretion to psychiatrists to impose involuntary treatment on patients who have the mental capacity to withhold consent to this treatment. In this research I examine the nature of the medico-legal regime in British Columbia that permits this coercive treatment, describe how it came into existence, and explore how it works in the lives of specific patients. Michel Foucault’s philosophy informs the historical, theoretical, and empirical dimensions of this research and provides a framework for a normative critique of British Columbia’s mental health law regime. In establishing the background to British Columbia’s current mental health laws, I give a historical account of the social forces that produced this province’s laws, which reflect a strong orientation toward neurobiological psychiatric ways of understanding and treating people diagnosed as having mental disorders. Foucault’s writings on governmentality, discourse and human agency provide the theoretical basis in this research for understanding the operation of psychiatric power in British Columbia. These writings also inform the methodology for the analysis of institutional discourse, which I use in the empirical component of this research. In order to conduct an empirical investigation of this British Columbia’s current mental health law regime, I gathered data from transcripts of three administrative tribunal hearings before the Mental Health Review Board of British Columbia and two other decisions from hearings before that board for which transcripts were not available. In these hearings, patients who had been subjected to involuntary psychiatric treatment orders under mental health legislation sought release from detention by challenging the psychiatrists who had issued the orders. The Review Board is legislatively empowered to affirm these orders or discharge the patients from involuntary psychiatric treatment. I use critical discourse analysis to analyze discursive exchanges between patients, psychiatrists and other participants at the hearings, exchanges that disclose power relations between the participants and have significant effects in shaping the outcomes for the patients. My critical discourse analysis of the transcript data and Review Board decisions discloses discriminatory and prejudicial psychiatric practices shaped by British Columbia’s mental health laws. This research lays the groundwork for a normative framework, based on Foucault’s writings on ethics and relational agency, for understanding patients’ rights to consensual medical treatment that overcomes problems associated with traditional liberal conceptions of individual rights and is a philosophically coherent basis for making recommendations to change British Columbia’s mental health law regime.



British Columbia, Mental Health Law, Discourse Analysis, Governmentality, Charter of Rights, Foucault