Issue 29 / 11 August 2014

PSYCHIATRIST Dr Peter Young last week defined torture as “the deliberate harming of people in order to coerce them into a desired outcome”.

That, he said, is what is happening in Australian-run detention centres — intentional creation of suffering with the aim of coercing asylum seekers to abandon their hopes of living in Australia.

We have been hearing about the psychological harms inflicted on asylum seekers in detention for more than a decade now, but Dr Young’s public statements to the media and to the Human Rights Commission inquiry into children in immigration detention take this to a new level.

Until recently, Dr Young was director of mental health for International Health and Medical Services (IHMS), the private contractor providing medical services to Australia’s onshore and offshore detention centres.

It takes courage to stand against a system that you have been part of, and the Royal Australian and New Zealand College of Psychiatrists has commended Dr Young for doing it.

Here is how he describes the camp on Papua New Guinea’s Manus Island to The Guardian: “When you go to Manus Island and you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience.

“You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”

IHMS figures cited by the company’s regional medical director, Dr Mark Parrish, when he appeared before the Human Rights Commission inquiry show the prevalence of mental illness in adult asylum seekers in detention is around 30%, a rate that increases in line with length of detention. Overseas research has also suggested prolonged immigration detention has a negative effect on mental health.

This puts doctors working within the system in an impossible position. How do you provide effective treatment for mental illness when the patient cannot be removed from the environment that is making them ill?

A decade ago, I was a regular visitor to Sydney’s Villawood Detention Centre, a place that was by all accounts relatively benign compared with today’s offshore camps.

Despite that, I watched the people I visited deteriorate as their detention dragged on with no end in sight. I am far from equipped to make a clinical diagnosis, but it was not hard to recognise the abandonment of hope in long-term detainees, or their growing loss of confidence in their ability to function in the outside world.

I saw them struggle to maintain a welcoming smile for visitors like me, and I never quite came to grips with the fact that these people we had imprisoned, in some cases for 5 years or more, tried so hard to be good hosts.

That was then. Over the intervening years, governments from both sides of politics have done their best to hide what goes on in immigration detention from public view.

Now, the desperate people who try to come here on boats are imprisoned in remote island hellholes that are largely inaccessible to the media, let alone the average Australian citizen who might want to know what is being done in their name.

Whatever you think about issues of border control, or of how immigration should be managed more generally, as a community we need to ask just how far we are prepared to go.

Do we accept the deliberate infliction of harm on children, for example, whether as a means of forcing their parents to accept repatriation or of deterring other families from attempting to get here?

There are around 1000 children in closed immigration detention, according to the Human Rights Commission, which has also heard evidence of 128 incidents of self-harm by children in detention in the past 14 months.

Is this really who we want to be?

Perhaps we need to follow Dr Young in “feeling the shame” — and then insist to politicians of all persuasions that all people in our care, however they come to be there, must be treated with compassion and humanity.

 

Jane McCredie is a Sydney-based science and medicine writer.

12 thoughts on “Jane McCredie: Feeling the shame

  1. Murray Williams AO says:

    Thanks for defining an appalling and shameful situation — we need statements like this from anyone able to speak or write in public media, and constant LOUD reminders to our so-called decision makers. What sort of a country are we becoming?

  2. rosemary o'brien says:

    thank you Dr Young . After my short stint in Manus I spoke with my senate representative and used the term torture – as there is no other way to describe keeping young men in indefinite detention for no convicted crime , in an area where they do not feel safe ( nor can Australia apparently assure them of safety) had no occupation or even diversionary activities and, most had poor oral health – causing constant pain and making eating difficult .

    Young men were often on several antipsychotics – when the system was causing their illness  – and being accused of drug seeking – when again , their pain was due to neglect of dental issues ( there had been no dental services for 12 months other than occassional visits to the sole dentist for a province of > 50 000 people)

    To then have it announced -” the Australian government recognises the increase in mental health issues with prolonged detention , so will be funding increased mental health nurses ”  – seemed somewhat like providing grave diggers as it was apparent that pushing people off a cliff increased deaths

    Surely we as a clever country can find better solutions

  3. Robert LOBLAY says:

    If Dr Young’s characterisation of what is going on in our detention centres is accurate — and there is every reason to believe it is — then all medical practitioners providing services in detention centres can be considered ‘collaborators’, betraying accepted standards of medical ethics.

    Abigail Seltzer wrote eloquently about this following release of the US Physicians for Human Rights report “Aiding Torture” (NEJM 2010;375:872).

    In 2009 the World Medical Association reaffirmed its previous declaration, which “…prohibits physicians from participating in, or even being present during, the practice of torture of other forms of cruel, inhuman or degrading procedures, and urges National Medical Associations fo inform physicians and governments of the Declaration and its contents.”

    http://www.wma.net/en/30publications/10policies/30council/cr_8/

    It’s time for our shameful treatment of detainees to end.  All medical professional bodies should declare provision of medical services in detention centres unethical, and medical practitioners should insist that they will only provide services to detainees in normal community settings. Remote and off-shore detention centres would then have to be closed. 

    Carpe diem!!

     

  4. m kennedy says:

    The observations made by visiting doctors are probably correct but it should be remembered that these people are illegal arrivals,paying for the trip,and without doubt the smugglers know that having children on board generates enormous sympathy in countries like Australia.

    Some have lived in India for years and were born in India from where they could have  applied  for refugee status.

    While all Australians are sympathetic to genuine refugees there are a lot of questions as to the veracity of the claims made.The number of refugees who have now criminal records since arriving in Australia is a matter of concern.  Medical professionals must ensure they are not being used by political and other parties to encourage changes in policies. 

     

  5. Shoba Krishnan says:

    We don’t torture convicted criminals so I find it hard to justify any of the conditions we subject refugees to. Nobody gets on a boat for the fun of it. They pay because they are desperate. Why do people always try to villify people looking for a better life? Is that so evil that we should condemn them to misery?

  6. David MacFarlane says:

    I thought long and hard about the value of responding to the post of Anonymous at 12.38. It made my blood boil. I found it patronising in the extreme for the writer to concede that the specialist Psychiatrist – and others who have actually been there and seen it for themselves –  were “probably” right. But that wasnt the only or even the least remark that made my blood boil

    What I will say is this: whatever these peoples reasons for being there, however they got there, whoever they bought with them or paid to get them out of a situation they perceived as so bad the horrendous risks were worth taking, however you want to label them – none of this is our concern. These people are our fellow human beings, they have not been convicted of any crime, they came to ask for help and we owe them the dignity of a caring and human response.

    Not labelling.Not judging. Not presuming to know. Not incarceration and  mental torture.

    Just compassion, respect, decency.

     

    I am ashamed.

  7. Frank New says:

    It is very disappointing that the definition of torture offerred (defined torture as “the deliberate harming of people in order to coerce them into a desired outcome”) is accepted at face value. This definition can ainclude many well accepted community activities (spot.rt) which are quite plainly not torture.This highlights the very poor quality of the consideration of the many important issues, with an attempt to force a resolution by using the same techniques which are the subject of the complaint, even though less severe – emotional force.

    It is highly desirable to have publications which are more balanced, unless the authors clearly identify their statements as personal opinion, which does not have the authority of their organization, unless more information and issues have been considered in the discussion. 

  8. Kate Myers says:

    Well said David.

    1238 has unfortunately succumbed  to Morrison’s brainwashing.

    Refugees may well have money – finances don’t factor in to one’s refugee status.

    I question his/her source regarding criminal records too.

    Great article.

    We must continue the fight to remain the wonderful nation that we are.

  9. Marcus Aylward says:

    No David McFarlane (13.21); once again the compassion of medical practitioners is being tried as a manoeuvre to subvert a legitimate policy goal, which is border integrity. These people – labelled as economic migrants by the last foreign minister Bob Carr – cannot pretend that they did not know the outcome that was in store for them; the suffering of their children was brought on not by the Australian government but by the choices the parents made for them. It is terrible that they chose this course of action, but we cannot be played for suckers because they effectively choose self-harm.

    By again confusing the personal with the policy, you lose sight of the bigger picture. Churchill, for example, allowed 780 of his own people to die ‘at his hand’ in Coventry because he could not pass a warning to the RAF which would give away the fact that the British had broken the German’s Enigma code. A terrible tragedy and burden for him, but the policy goal was ultimately achieved. So yes, you have to break a few eggs to make an omelet, but if medical practitioners wish to wade into the policy debate, they would as well acquaint themselves with some Realpolitik.

  10. Judith Rona says:

    I have to protest this attempt to dilute a term of horror. Defining “torture” belongs to the experts who study it, not to psychiatrists. If detention is torture, how do we describe electroshocking the genitals? And what else becomes “torture”? Prison is a type of detention; do we tear down the gaols next? The UNHCR camps?Immigrant detention is painful, but what else reduces deaths at sea and slows our migrant inflow to absorbable levels? (Quick-fix “Open the borders” solutions to world inequality are like sharing 3 buns between 100 people; either 97 starve or they all do.) The politics of shaming isn’t going to solve the problem. World peace isn’t within grasp either. But if we could unclog the UNHCR transfer of refugees to asylum-states, at least asylum-seekers could have somewhere safe to wait out the resettlement delay. 

  11. Barri Phatarfod says:

    Are they ‘genuine refugees’ or ‘economic migrants’? That seems to lie at the heart of which side one takes in this continuing debate. Yet it is completely irrelevant, and furthermore cannot be determined until the individual applications are considered and processed by the authorities we as a country have installed. What is relevant is the harm we are actively perpetuating which should not be meted out to anyone under our jurisdiction. Ever. Of further relevance to doctors is that out colleagues are being ordered to act contrary to their professional standards and ethics. This should concern all health professionals, regardless of their personal views on immigration.

  12. Clare Farmer says:

    Jane , I share the feelihg of shame about our treatment of asylum seekers. We reject them before they arrive and as you say imprison them for long periods. We are deliberating harming them and their children, psychologically and as you say the physical conditions are difficult to assess.

    I can think of no-one who would not be horrified about the treatment doled out in Nazi Germany   and have difficulty understanding how ordinary germans accepted this. – I think ordinary Germans themselves were under threat. At that time boats of jews circled the world looking fo someone to take them in.

    We, living in the land of plenty and not under the threat of war or dictatorship are turning away and mistreating people who have fled persecution. In the words of Richard Flanagan , we are dehumanising people in need of our help.

    I find the discussion of whether they are economic  or  genuine refugees  irrelevant, – it seems likely that people would bring themselves and their families in barely sea worthy vessels at significant cost were they not in desperate circumstances.

    I would value any  strategies which bring to the attention of government and opposition  my dismay and I think that of others at the way we are treating people in need of asylum. We need leadership which treats  all humanely .

    Thanks

    Clare

     

     

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