There is a word for not knowing when you are sick and it is called “anosognosia.” Like everything in the world of mental illness there is controversy about it. Some people don’t believe it exists at all, while others have developed extensive research projects defending it as a term.
But let’s cut to the chase. Is there ever a time when someone with a mental illness may not know he or she is sick? The answer to that question is “yes.” I don’t know if people can deny that is true, but many people who are experiencing psychotic episodes do not know they are sick. Some people who experience full-blown manic episodes have lost insight and don’t know they are sick. When this happens family members are left to try and find a way to get their loved one treatment in the hopes of bringing them back to reality.
Forty years ago the Supreme Court ruled that in order to be committed involuntarily one must be found “a danger to himself or others.” Some states have added language to include “an immediate danger.” Sometimes this is interpreted to mean even if a person may become a possible danger to himself or others, unless it is happening in the moment the person cannot be forced into treatment.
The problem with this law is that it really discounts situations when people are unable to competently judge for themselves when help might be necessary. Although many who have mental illness may never become a danger to themselves or others they may still benefit from treatment intervention. The bottom-line is you cannot legally make someone take medications.
I have been on both sides of this issue. I have filled out papers in the court house to have a family member committed during a manic episode, only to watch the system fail and for her not to get treatment. It took about three months before I was able to get her much needed help. In the meantime, I lost a number of sleepless nights and had to deal with the danger of someone not in her right frame of mind. Just standing by waiting for the “shoe to drop.” Something bad would have happened if I had not have finally gotten her treatment because she had some major physical health issues and needed hospitalization. Without a mental state she may not have been able to communicate those life threatening physical symptoms.
In my own situation I have been involuntarily committed. Each time this happened I did not know I was ill. No matter how much anyone reasoned with me I felt like I was “fine.” I could not understand why people wanted me to get “locked up” for treatment.
Did the fact I was taken against my will into treatment cause me trauma? You bet it did. But if I were to sign a psychiatric Advanced Directive I would give family members who I trust the ability to make decisions for me, if I am unable to make them myself. And as a person who has benefited from treatment I want that intervention to take place. All this can be spelled out in an Advanced Directive.
I understand the arguments on both sides of the fence. One where people have been fighting for mental disability rights for years to remove the archaic treatment and/or abuse that took place in mental institutions. They have brought freedom of choice for the mentally ill population. The freedom to accept or refuse treatment based on patients rights.
What if you want treatment when you are well, but refuse it when you don’t know you are sick? What should happen to you? What if the treatment team recommends more high-risk treatment like electro convulsive therapy (ECT)? Do you have a right to deny specific treatment options or are you at the mercy of the providers who evaluate you?
So many questions and not one clear cut example that makes this issue any less charged. I think the best solution is to write an Advanced Directive while you are well and put that in a place where everyone can find it. This way at least some of your wishes have a chance at being carried out.
For those who can’t get a loved one treatment, my heart goes out to you. It’s just a tough position to be in all the way around. This definitely makes the case for more education, information and awareness for mental illness, so people can be in a better position to make informed choices. It’s not perfect but who wants to go back in time to the 1960’s where anyone could have someone committed into an institution. That’s not a just solution either.
For a heart-wrenching story from the Washington Post about the inability of a family to help a man in need of treatment read Behind the yellow door, a man’s mental illness worsens. It will make you think about whether or not forced treatment is humane.
To read more about Advance Directives click here Advanced Directives Information.