Mental Health Monday–God Knows Where I Am

The New Yorker published an article in 2011 depicting what it would be like for someone with a serious mental illness to reject their diagnosis.

The case described went beyond a mere declaration of, “I don’t have mental illness.” Linda, who had been diagnosed with Schizoaffective Disorder (where the sufferer experiences a combination of psychosis and mood instability), did not believe she had mental illness. She lacked the insight into her symptoms. For her, it was reality, and as such, it created significant tension between her and her family and between her and her treatment providers. She would be hospitalized when she was decompensated to the point of being unable to care for herself, meet basic needs (hygiene, nutrition, etc), and when she presented as being a danger to herself.

At one point, she holed herself away in an abadoned house, ate apples she picked from nearby trees and drank water she collected from rain and icicles). She kept a diary and it quite poignantly documented her deterioration into starvation, and ultimately, her death.

Talk about heartbreaking.

The debate comes in when we are charged with determining what is “best for someone” versus “what they want.” We often hope those two things coincide. In some cases, like Linda, what she “needed” was medication, housing, therapy, and other supports to help her manage her symptoms, and what she “wanted” was entirely different. She viewed psychiatry as a means of control and she just wanted to be “free.” From her point of view, she didn’t have mental illness, so why would she take meds? It made no sense to her.

From her providers’ point of view, she lacked the insight to make that decision.

In New York state, if a provider feels a patient lacks the insight and judgment to make health care decisions, that provider can submit legal paperwork and bring the case to court. At that point, the provider is charged with proving the benefits of medication over objection or staying in the hospital outweighs any risks and that there are no other less restrictive treatments available.

The patient will have a chance, with legal representation if they choose, to argue the provider’s viewpoint.

It becomes the judge’s decision whether or not to support continued hospitalization or giving the patient medication even if they don’t want it.

There’s lots more to the story, but we’ve already covered a significant amount of information. What I’m curious about–and the reason I bring up this story–is your opinion.

What are your thoughts on this case? How do we skirt the line between “forcing” treatment and maintaining someone’s “freedom?” Is there a way to balance it?

I may be opening a can of worms here, ’cause there’s multiple sides of the equation…

Don’t forget to check out Lydia Kang’s Medical Mondays and Sarah Fine’s The Strangest Situation for more psychological related goodness.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical advice or treatment. 😉

24 comments on “Mental Health Monday–God Knows Where I Am

  1. Catherine Johnson says:

    Tough question. I’d want a second doctor’s opinion if it was something I wasn’t keen on.

  2. That is sad. Difficult to force someone to do what they don’t want to do. And as Catherine said, a second opinion would be a must. I could see it going bad both ways. Shame there weren’t family members to step in and help.

  3. roguemutt says:

    The problem is it can be difficult to prove you are sane. I doubt I would pass such a test.

  4. Linda Gray says:

    So tragic and difficult! When a person is clearly a danger to themselves I would have to support requiring medical care/institutionalization if necessary for them. Obviously the proof of that could be way more difficult in some cases than others, so yes, second and maybe third medical opinions needed. A judge is just a person who needs help to make tough decisions, like everyone else.

  5. Karen Lange says:

    Wow, what a tricky and heartbreaking situation. I don’t know where I stand on this exactly, except to know that some kind of intervention is necessary. Much would depend on the family and other situations too, I’d think.

  6. My mom rejects her diagnosis that she has dementia. She says that there are people living in the basement and has tea with them, etc. Of course, no one is there. But it’s really weird seeing her carry on conversations. Sometimes she gets angry. I’d really like to hear the other side of the conversation…hear what they are saying to her.

    But yeah, you cannot reason with those who have mental problems. I’ve tried. If you think differently, then you obviously haven’t spent much time around them.

    • Jessica Burde says:

      As my partner has a schizoid disorder, and I live with him, I think I qualify as having spent ‘much time’ around people mental problems. Add in my best friend with PTSD, my brother with Ausbergers and my experience gets pretty extensive.

      There are people who recognize their mental problems and people who do not. Lumping them all in together is as wrong as lumping all of any group in together.

      When my partner has hallucinations he says to me “Jessica, I’m having hallucinations, this is what I am seeing. They’re mild, but if they get worse I’m going to need you to call my doctor.” I’d say that’s pretty damn reasonable.

  7. Lydia Kang says:

    It’s so difficult. I’ve seen patients hurt by going in either direction. Hey, love your new banner and website! 🙂

  8. Arlee Bird says:

    This is a topic that I was planning to eventually touch upon. My thought is that a person’s freedom ends when it encroaches upon another person’s freedom to the extent that it creates a hardship. If a freedom includes causing a burden upon others and becomes something that others have to clean up then that “freedom” must be put into question. In the case of mental illness no one person should be the final decider if the “patient” is in dissention, but a group of qualified psychiatric, medical, and legal experts should become the decision makers when the patient’s judgement is determined to be clouded and to the detriment of society as a whole.

  9. EArroyo5 says:

    This is a huge concern within the Department of Children and Family Services when parents are diagnosed. We can’t say they’re unfit because they have an illness yet…it is a risk sometimes. It has to be treated case by case. I don’t know. It’s not easy.

  10. i work with mental disabled adults and their daily living. this is such a struggle, too. we want to just do stuff for them but then how are we helping them to be independent? it’s a catch 22 sometimes.
    thanks for stopping by my blog and commenting. new follower here!

  11. Leigh Moore says:

    oh, wow, Laura. This is a GREAT post. And I have to say, I feel like individual freedom should be respected. I know where we are the only way people can be committed is if they’re like threatening suicide or killing others. But at some point–like for the poor lady you describe–they really are a threat to themselves. I don’t know. Hard stuff. :o| ❤

  12. Morgan Shamy says:

    Interesting topic… But I do think some choices need to be given to family… especially when you’re a threat to yourself or others around you… I’d want that if I were losing my mind!

    • lbdiamond says:

      Absolutely–involving the family, when they are available and able, is crucial. In this case, the family attempted involvement, but the patient refused. 😦 Sad, sad, sad.

  13. Jessica Burde says:

    It’s a tough question. When someone starts becoming a threat to the health and safety of others, then definitely something has to be done, even it requires tying them to a bed and forcing them to take medication. When they are only a danger to themselves… tough call, really tough call.

    Especially concerning is the fact that it is far easier to be proven insane than sane.

  14. Ciara Knight says:

    I’ve missed visiting Medical Monday. It’s always so informative. I’m glad to be back. I’ve been involved with both locked units and on the other side where we’ve been forced to commit a family member. It is so difficult to ensure the rights of the individual while protecting themselves and others.

  15. That story about Linda is terribly sad. I think my awareness of this disorder grows all the time.

  16. If the person could end up being a danger to someone else, then they don’t have the right to that freedom. The question is, how do you know who might harm someone because of their condition and who won’t? You don’t. And that’s why the argument exists.

  17. Hmm, I think if they’re a danger to themselves or others, than intervening should be considered. Someone should be looking after them, even if they aren’t.

  18. Donna Hole says:

    This type story is why I don’t work in adult services; the client’s right to self determination. I agree with their rights and am glad such legislation exists. But sometimes, as you say here, what is “right” for the client and what they want puts them at unhealthy risks. I don’t think there is a way of balancing the two. I think MH professionals just have to carry on with well thought assessments, do what they can, and celebrate the victories when the system, regulations, and best interest of the client all work the way they should.

    Not an encouraging response, I know, but life is just what it is sometimes.


  19. Wow, thought provoking post. I’m not sure at what point one intervenes.

  20. I’m not sure there’s a clear-cut line between right and wrong here. I’m not a mental health professional, but I think if there were definite indicators the patient was a suicide risk or a risk to others, then she should be hospitalized and given meds and therapy until she was stable. And on a more permanent basis if there was no one to care for her upon release. I know that’s a problem with many schizophrenics – they feel fine and stop taking meds and the cycle begins again. But without those indicators, there’s no real way to know.

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