From compliance to collaboration

Psychiatric violence, overmedication, and the failure of care ethics in Spain

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Summary: psychiatric care in Spain continues to be structurally anchored in coercion and excessive pharmacological treatment, where diagnoses often lack empirical rigor and interventions are imposed without valid consent, resulting in iatrogenic harm and chronicity. Drawing on five years of ethnographic fieldwork and three national surveys, my dissertation shows how legal safeguards and human rights frameworks are routinely circumvented. The dissertation presents the urgent need for structural reform, with shared decision-making, deprescription protocols, dialogical approaches, and participatory monitoring representing the minimum ethical baseline.

Link to the PhD dissertation: https://bit.ly/4mCUr8d

Diagnoses are imposed without empirical rigor, treatments are administered without valid consent, discomfort is decontextualized and medicalized, producing structural iatrogenic damage that prevents recovery.

My doctoral dissertation, based on five years of fieldwork and three surveys with over a thousand experts, demonstrates how psychiatric care in Spain is structurally anchored in coercion and normalized negligence. Despite legal safeguards and international human rights standards, forced medication, diagnostic overreach, and chronic polypharmacy remain routine, embedded in governance, institutional inertia, and a professional culture that equates compliance with care.

The persistence of this problem affects patients most directly, by eroding autonomy, producing iatrogenic harm, and reinforcing chronicity. It also burdens families, undermines professional integrity, and weakens public trust in health systems. Spain illustrates a broader European paradox where rights are enshrined in law yet circumvented in practice.

The way out requires structural reform. Shared decision-making, deprescription protocols, dialogical care, and participatory monitoring are demonstrated to improve recovery, safeguard rights, and reduce systemic harm. Recovery must be treated not as an exception but as the ethical baseline of psychiatric governance. Without this reconfiguration, coercion will persist as a hidden yet normalized form of violence.

From this point, I direct my full attention to education, one health, and doubling down all efforts in the path toward professorship. I am advancing new technologies within the framework of our EU BEACON One Health Education COST action, a network already bringing together more than half thousand specialists, funded until 2029 with a clear and urgent mandate for structural change. This month thousands more will be contacted, as we shape up a true excellence network. EU BEACON was and continues to be the central axis of my ongoing participatory action research.

Regretfully, the final revisions of my dissertation, together with years of enduring true physical and psychological torture that devastated much of my earlier work, prevented us from coordinating two Horizon proposals due today. I apologize to all consortia members affected by this failure and by my limited capacity in recent months. From here we move forward, strengthening the proposals and preparing to submit winning ones in the next call. From safer ground, soon to be a doctor, I am regaining all strength and momentum. Despite these setbacks and the persistent obstacles in enforcing the law, namely extortion, harassment, threats and retaliation to silence and further destroy, the work continues. In Yogyakarta, with the support of local scholars and funding from the Spanish Ministry of Education, I am initiating research on the abolition of pasung -the practice of shackling, a form of domestico-medical torture- in Indonesia. These first tasks of my postdoctoral career are both urgent and essential. As in my own experience, halting violence against all victims remains the first priority. Yet, too often, legal, health, social and family systems continue to fail, entrenched in corruption, impunity, and normalized severe abuses.