June 27, 2006

More on Out Patient Commitment

This is in reply to a couple of comments on my last entry: To Paula I would say, Yes, no one should medicate a person who is merely different or eccentric yet self-sufficient and causing nobody any harm. And likewise, I think we can mostly all agree that the obviously violent person needs measures taken to ensure that her violent tendencies are quelled. But what about someone in a middle position; say someone who can't really take care of himself, so is hospitalized constantly or is in and out of prison for minor offenses like trespassing and panhandling and when not is on the streets or relying on shelters and emergency care centers in various cities...In short, because he won't take the medication that would stabilize him and enable him to start living a better life, he is costing society an enormous amount of money and resources...

Does the state, impersonal entity that it is, have the right then to say, We're not going to throw our money away like this anymore, not on things that don't work. We know this med works, and he gets better and gets out of the shelter and into a group home and gets a part time job and goes to school...So now we are going to forcibly medicate him to get him back to the point where he is lucid and cares about himself and what he does! The state doesn't have to have kindness as a motive; the state is allowed to have pure economics asa motive. But isn't in fact this a kinder way to treat him, than simply to let him be out of respect for his so-called rights?

Just a thought meant to provoke argument, not hysteria...And if anyone out there is anti-psychiatry, I beg you, DO NOT reply. You are not welcome at this site.

To Yaya I want to say, Yes, I can imagine how hard it must be for you to keep on giving and supporting and being there...I do not know your situation at all, nor your daughters, so naturally I can't comment specifically. But apparently I make others the target of my delusional rage when psychotic too, and yet I cannot remember doing so, or even what I was feeling nor the feelings themselves. I have to be told I said such and such a thing, or did this or that, or accused so and so of yet another foul deed...I have to be reminded of everything, because I do not remember anything of my psychosis afterwards. It is amazing that I could write the book that I did, given how much I lose each time...I only remember things from a distance, watching me do things, not how I felt in terms of feeling the same feelings...But that is neither here nor there, except to say that I have probably been like your daughter is to you, to my twin sister, who also has had to shoulder the burden of my care when no one else could or would. And she could empathize heartily. She has even been my conservator and signed for me to have ECT. And I have been court ordered to take Zyprexa while in the it is not a long hop from there to out patient commitment, in my experience...And I still would run run run from it.

Because they still think they know more than I do, more about how I feel than I do, more about what I can tolerate than I do, more about what I am willing to tolerate than I do...and they want a solution NOW, when in fact there isn't any, not a perfect one, and so it takes tinkering with a little of this and a little of that, and in an outpatient commitment setting there's no tinkering, it's Take this pill and swallow it!

Argh...Any more thoughts or opinions?

Posted by pamwagg at June 27, 2006 08:22 PM


I have taken lithium and don't reccomend it. It made me gain weight and didn't help. I know two people who have taken it long term and one passed away at age 59 and the other is on a special diet due to kidney disease. Why do they continue to prescribe this drug when there are others that work as well or better as mood stabilizers? I really like Lamictal which is also a mood stabilizer. I take 100 mg per day. I like Lexapro too. I take 20 mg per day of that. As for Seroquel I had a bad reaction to that and discontinued it. It made me very sedated. I take 10 mg of Abilify now and it works great.

Posted by: Heather at July 31, 2006 12:28 AM

To everyone...I'm in the initial stages of becoming an advocate for my husband living with mental illness Schiz, who has been incarcerated for 10 mos. following an incident where he experienced a medical emergency which was handled terribly wrong. He is now at a facility (thankfully not prison) where is willingly takes Seroquel, lithium and lexapro. He has gained 40 lbs. and his doctor at home said she would discontinue lithium "when" he is released home. I just need to read input on the three meds. from anyone who may have first-hand knowledge taking them. Munacares

Posted by: s bullitt at July 11, 2006 10:14 AM

Dear Pam,

There are times I’m enraged at how America treats the mentally ill.

I don’t know if it’s the very vocal anti-psychiatry who has pushed for changes thereby, helping someone with a serious mental illness becomes almost impossible.

I keep hearing about rights.

The right to be psychotic… the rights of the mentally ill to make their own decisions… never mind that my sick and psychotic child could be sleeping on the street in her own waste. Never mind that my psychotic and delusional daughter can be taken advantage of by a predator. She has rights and can make her own decision.

Does this make any sense? Hell no! As a parent I’ve had to fight the system to force them to hospitalize her so she can get treatment.

Out of desperation I’ve taken legal guardianship of my daughter so I can make medical decisions for her. Even when she is very ill, she still trusts me to help her. When my daughter is lucid she laughs at what she’s done. Sometimes she remembers and is embarrassed and other times she doesn’t remember a thing just as you describe.

The one happy thing about all this is when her life is stable and we’re enjoying each other’s company, we can laugh about this. She does have a terrific sense of humor, so I’m grateful she can laugh and forgive herself for her occasional craziness.

Posted by: Yaya at June 29, 2006 07:12 PM

The agency I work as a therapist for has funding available only for schizophrenia, bipolar, and major depressive disorders. I think you hit on a large part of the problem with your statement: "....they still think they know more than I do, more about how I feel than I do, more about what I can tolerate than I do, more about what I am willing to tolerate than I do..." Nearly all clients are able to discuss their medications and talk about what works and what has failed them; and the side effects they have endured. They should be consulted and have a major part in their treatment plan.

I also think strong psychotropic drugs should not be the first order of treatment. Non-toxic treatments, dietary changes, counseling, and structured support plans should be tried before getting on the cycle (and it is a cycle!) of heavy duty drugs with their many side effects.

I've seen a close relative with a history of years of bipolar rages respond amazingly well to a treatment plan using central nervous system supplements. He is in total control of his mind now. No side effects! My bipolar clients on psychotropic drugs may do fairly well for a period of time but then they start needing medication adjustments; and complain about side effects constantly.

I'm not against psychiatry. I have a client who responded rapidly and well to two drugs given by a caring and conservative (where drugs are concerned) psychiatrist. Other clients have not done as well with their psychiatrists, and I shudder when I see their long list of psychotropic drugs, sleeping pills, etc. Sometimes I wonder how I can help clients who are so heavily medicated?

I think we need to consider the most noninvasive, gentle methods of treatment first. Save the psychotropic drugs if and when other methods fail. And always consult the client!

Finally, have you ever consulted a psychopharmocologist? If you are taking several strong medications, it would be a good idea. Warmest regards to you and your sister. I have read your excellent book and highly recommend it.

Posted by: Pat at June 29, 2006 03:30 PM

Dear Pammy,
Please remember my assertion that I realized that my argument or point of view, if you will, was full of holes and could easily be challenged, just as you so aptly did. I simply did not have the energy to make my position less vulnerable to very reasonable debate. I imagine my statements were fueled by my firm,unalterable position that I want no one ordering ME to do anything. I think it's natural for me to want to protect others from having their freedom taken away from them, even if it is for their own good and for the good of society as a whole. The questions you have offered for possible solutions from your readers are so global in nature, I personally have no practical, workable, and acceptable solutions that could possibly met the needs of all parties. You have made me think,however, about a subject that normally would not be one of my top priorities, at least at this point in my life. Thank you for your honest assessmentof and reaction to my comment.
With love and admiration, Your Peskless

Posted by: Paula Kirkpatrick at June 27, 2006 09:15 PM

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