06/03/2013 12:14 EDT | Updated 08/03/2013 05:12 EDT

Medicate Me, Even When I Refuse

Please, someone, make choices for me when I cannot: choose to give me the treatment that, for me, has worked in the past. Medicate me. Don't leave me to myself; I will play with those knives, and may not learn until I bleed to death what harm I have the "right" to do.


Suppose your toddler wanted to play with your kitchen knives. They are bright and shiny, and she sees you use them everyday, so she asks for them. "No," you kindly but firmly say. "They are very sharp and would hurt you." Your toddler begins to whine, then yell, then tantrum when you refuse to let her play with those knives. Do you give in, when you see how much it means to her, how upset she is that you authoritatively refuse to grant her permission? No, you are a good parent, and because you are responsible for her safety, you calm her down and redirect her to things with which she is allowed to play. The tears dry, and her smile returns -- and she is safe.

Had she been permitted to have her way and play with the sharp knives, she would have badly cut herself. She didn't understand this; she was unaware of the danger she would have been to herself. She needed someone outside herself to keep her safe, until she was older and could understand the damage a knife can cause.

Such a scenario is reminiscent of anosognosia: the inability to recognize one's own illness, often while persisting in behaviours that are harmful to oneself. While it can also occur to due neurological disorder, it is very prevalent in psychiatric illnesses such as schizophrenia. Many people experiencing psychosis do not believe they are at all ill. They refuse help, and, unless treated against their (psychotic) will, they may harm themselves or others.

But we must have the right to harm ourselves, have we not? Such reasoning parades as a constitutional right, the right to chose what happens to our bodies and brains. Move beyond that and find that the right to refuse psychiatric treatment is a growing movement. This group insists that any treatment for a mental illness is exceedingly harmful to the person -- if indeed there is such a thing as mental illness. "Mental illness," they say, is a "personal journey," something special that must not be crushed by involuntary medication or hospitalization.

Perhaps this laissez-faire is akin to letting the child play with the knives. Yes, they might get hurt, but, as they "journey" with these knives, they would discover that to hold the hilt means no pain. Some children would learn this quickly, others more slowly and with far more cuts. In other words, if someone knew that some would come out of the play wiser, and maybe even with hardly a scrape, to play with knives is indeed a learning experience. Thus, the one that is "in control" (parent) ought not disallow the play lest they dampen the curiosity, problem-solving skills, and bravery of the child, who has their own fledgling right to harm him or herself. Perhaps. But those "learning" cuts could easily kill.

Is this then a real right? In my case, is repeatedly bashing my head against a concrete wall till both my head and the wall are bloody a right? Or cuts to my arms, slit with a razor blade -- a right? It is what I do without medication; it happens when I am ill with schizophrenia in order to release the millions of microscopic rats that I delusionally believe are eating my brain. When taking antipsychotics, the rats leave, the need to self-harm fades, and I am in my right mind.

Besides the rats and bloodletting, I fall into the realm of anosognosia when I am ill. I do not know that the rats are not real, and vehemently argue with frustrated health care professionals. I do not belong, certified, on the psych ward! The rats really are eating my brain! No, I don't want your PRNs of rat-infested Ativan!

Then come the restraints and injections.

Involuntary treatment. Anosognosia: no insight, no right?

The Mental Health Act hangs on the ward wall. Our rights. I am too drugged to read it.

I attempt to hang myself in the bathroom. Again.

The "psychiatric survivors" will love this. See the results of "treatment"? I have rights: the right to life, that right to the pursuit of happiness. Surely this cannot happen amid needles and isolation rooms and medication -- oh, how much medication.

But though some psychiatrists rely overly on their psychopharmaceutical powers, my brain is in fact too sick to heal on its own. It needs something outside itself to be healthy enough to fulfil my rights. I have seen drugs fail, but I know now that some actually clear my life of psychosis. Could I have gotten there alone? No. The hangings would have continued, eventually successful. Unmedicated "journeys" for me are a hell of hallucinations, paranoia, and delusion. Please, I do want the drugs, even though I tantrum against the injections. Please, someone, make choices for me when I cannot: choose to give me the treatment that, for me, has worked in the past. Medicate me. Don't leave me to myself; I will play with those knives, and may not learn until I bleed to death what harm I have the "right" to do.

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