Psychiatric Ethics: When it’s difficult to tell

I am always aware of the ethical dilemmas we face in daily life. There are particular types of conundrum psychiatric patients face. One of these is the “What do I choose to say?” conundrum. 

For example: last Friday, my psychiatrist changed my medication. “Big deal”, the novices mutter dismissively; but to those in the know, when I mention that it was a rapid and radical medication change, the penny begins to drop – especially as he sent me away to make this change by myself, at home, with no extra professional support. (To put this in context, the last time I went through a comparable medication change, I was in hospital for about one month. And that was just one month ago.)

It has been hell. Yesterday the anguish was such that without the loving voice of my sister down the phone, a good dose of sedatives, and taking the time to blog about why I would never choose to kill myself (thank you, interwebs!) was sufficient to pull myself back from the brink.

Then came the dark of last night.

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I took my usual evening medications, but the dark still pressed in around me. I’m afraid to say I was weak, and I overdosed. First up, I called my therapist’s message bank to say I didn’t think the medication change was going too well outside hospital. I then wrote down the medications and doses I’d already taken, then the current time and the extra doses I was about to take. Thirty-eight minutes later I did the same thing. Twenty minutes later, and forty five minutes after that, the exercise was repeated. If something went wrong, I needed there to be a record of what had been done, and why. Finally I attained oblivion.

I want to be clear here: the exercise was not to kill myself; I simply needed to escape consciousness, completely, and for a very long time. I deliberately ‘mixed and matched’ medications so the total load of one type was well below the lethal limit. This was the wrong thing to do, but last night the pain in my psyche justified the deed. 

Today, I face the ethical aftermath of that decision. I clearly am not coping with this medication change on my own, but I do not want to go back into hospital. I need more support, but if I utter the word “overdose” then there will likely be just one direction the conversation will take. 

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So, I must proceed carefully. My therapist returned my call. He said that if I wasn’t coping, I must call my psychiatrist and let him know. My therapist did not ask me any questions, so I didn’t face any ethical dilemmas there. (You may have noticed I’m not the lying type.) I called my psychiatrist’s office and simply told his receptionist I was having difficulty with the medication change, and would the doctor please call me back at his convenience? He is a busy man: I may not receive a call until tomorrow. Tomorrow is Friday. The hospital will most likely be full, and no beds available. Admission averted (phew). 

Excellent: I have discharged my moral duty to my therapist, and my psychiatrist. Now to the more difficult question of the duty I hold to myself.

I can still feel the residual drugs in my system, so it is not safe to drive. It is a cold, rainy day and an injury to my right ankle precludes walking anywhere. I am stuck at home, alone. My memory is too fleeting to read, and my concentration span too short for TV or DVDs to be sufficiently diverting. 

Blogging helps. I know very few people read these notes, but the act of putting my thoughts in order on the screen acts as both a calmative and an anxiolytic. 

I now know what I must do, what I have so often done in the darkest days: live just ten minutes at a time. Get a large sheet of lined paper and write down what I will be doing for the next ten minutes: “Drink cup of tea.” “Do dishes.” “Shower.” “Watch ten minutes of …”

Watch this space. I trust we will, in virtuality, meet again.

8 Comments

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8 responses to “Psychiatric Ethics: When it’s difficult to tell

  1. I admire your willingness to not let suicide be an option. Medication changes are terrible, and psychiatrists rarely understand the physiological and mental changes that occur. Looking forward to another post. Best of luck.

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    • Thank you so, so much – you understand! I am still pretty cross (you may, if your lexicon allows, substitute the words “fucking outraged”) that my psychiatrist decided to change my medication BACK eight days ago during a routine follow-up consultation and did not seem to consider hospitalization an option.
      It has been hell, and now I am grudgingly yet voluntarily submitting to a different type of hell – the institutional life of a psych ward.
      Thank you for your words of support. Should you feel like sending any more in the near future, I’m sure they’ll be appreciated. Lapped up, in fact.
      (Even though the ward I’m going into doesn’t have WiFi … good old USB tethering!)

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  2. Psych hospitals are a entirely different world. One simply cannot even understand unless they have been there. And with that being said, I am in utter disbelief that you can have a computer! Within the past year, I have been in the hospital 8 times, and in residential treatment for 12 weeks. We weren’t allowed shoe laces (or hair clips, make-up, hairspray, hair conditioner..etc), let alone computers or cell phones.

    I am glad that you are making the choice–it is always much more difficult to be committed. Human rights are practically voided when you are committed–length of stay determined by the psychiatrist, involuntary blood tests and procedures, little say in after care..

    It is amazing and shamefully difficult to find a good psychiatrist. I hope that you have one that you trust and whom knows you well enough to know what you need and where your baseline is.

    Hang in there.

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    • [bugger, looks like I just lost a good length of reply]
      Thank you for your kind thoughts. It is a very difficult decision. As to your remarks re the restrictions put on patients – do you mind if I ask a few questions in return?
      First up: which country do you live in? I am in Australia. You used the phrase ‘cell phones’ so I am guessing the States? Our health systems are quite different.
      Also: were you in the public system, or the private? I have spent time in both, but generally can’t remember my short stays in the public system as I transfer to the private ASAP. The freedoms allowed to patients in the private system depend on ‘patient needs’ (interpret as you will). As I am a voluntary admission, without legal issues pending, without illicit or other drug dependency, and not presenting as an absconder or in immediate danger of suicide/self-harm, my freedoms are at the better end of the ‘patient needs’ spectrum. Having said that, I have been in a private hospital when police were called and a man subdued with capsicum spray, before being taken to an institution where ‘his needs would be better catered to’ (I must admit that, not being a smoker nor a gossip, I wasn’t a witness and only heard the sanitized version at the ward group therapy session held afterwards …!).
      Anyway I continue to write here because I am in denial about the need to pack in order to be admitted to a psychiatric hospital. [If I say it enough times, it will become easier, right?!]
      Thank you so much for your comments. If you don’t mind, please keep me in mind over the next few days.

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  3. Indeed, I am in the United States. There aren’t many private hospitals left here; however, the residential treatment center I was at was private. My insurance still paid for it but it wasn’t an involuntary commitment (or wasn’t supposed to be), it wasn’t obligated to take anyone, and if the insurance stopped paying (as mine threatened to do every other day) I was solely responsible for the costs ($1,000 US per day).

    Insurance companies have a huge say in whether or not you can be in the hospital. If you are not actively suicidal, you cannot be admitted. The hospital will know that the insurance company is not going to pay and they won’t expect that you will pay out of pocket because a week long stay costs up to $100,000 US. Sometimes an insurance company will cover a hospital stay outside of the patient being actively suicidal if the patient is going to be receiving several ECT treatments a week.

    I think that you can say “I’m being admitted to a psychiatric hospital” a hundred times and it probably won’t be any easier. At least here, there is a huge stigma associated with being in a hospital (I won’t even tell my parents!), and it is rarely comforting to be confined (although sometimes it is nice to forget the rest of the world exists). I am glad that you will have internet connection of some sort. Keep blogging–I have found that it makes it so much easier to process what is going (plus, I want to read it).

    Do keep in touch, and I will think of you often and stop by your blog to check on you.

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    • Thank you so much for that. Yes, it sounded very States-like, your situation. I have had a really bizarre, Kafkaesque experience this afternoon but am too tired to write about it now. It was so incredibly interesting (“interesting times” interesting) that it may even merit a series of blogs to unpack it all!
      There is a tremendous stigma here, too, but as a society we are trying to address it. I think our more accessible healthcare system probably helps with that. I am very glad to be able to access this amazing level of care through private health insurance levies which are themselves subsidized by our federal government. Australia is indeed the lucky country! (Well, we’ve worked to make it this way)
      The temptation is to keep typing but I really am exhausted.
      Thank you for your kind wishes – I really appreciate them.

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  4. Wishing you the best of luck. Keep writing

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