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. 😉