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David Baxter

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The Ethics Of Psychosis
by Cannonier (diagnosed with schizophrenia)

I have been heavily involved in recent discussions about schizophrenia induced psychosis and the medical treatment for it. It is my belief that allowing yourself or someone else to go about freely and unmedicated while in a state of psychosis is ethically and morally wrong, as well as being irresponsible. I have suffered from schizophrenia for almost 20 years. It is indeed a physical illness caused by chemical and physical problems with the brain. While medications work for the vast majority of schizophrenics, it remains true that for a small percentage they do not work. It is also true that the side effects can be quite unpleasant and even in very rare cases kill. Having said that you should also realize that the only treatment that is proven to work for schizophrenia symptoms is those same medications.

I have experienced first hand what it is like to be in a psychotic state. The actions of someone in such a state are totally unpredictable. In the army I received training in hand to hand combat, small arms, explosives, and many other military skills. I consider myself to be potentially very dangerous when psychotic, even though I have never met the formal and customary criteria of being a danger to myself or others. It remains true that most psychotics are nonviolent, but delusional beliefs are often implicated in suicide and accidental death of schizophrenics. It is my opinion that anyone who is psychotic is a danger to himself or others simply because he is psychotic. It is readily available information that after ten years 10% of schizophrenics are dead due to either suicide or accident.

I see the biggest problem with psychosis as being able to determine when one is psychotic or to what degree. Currently there is no readily available test to determine this. I have read of two projects (one in Europe and one in Oklahoma) to build a device which is capable of measuring the minute traces of chemicals in the breath of a person with schizophrenia. There is one particular chemical which seems to indicate that the person has schizophrenia and how much of it is present may in fact determine how well his medications are working and how psychotic he is. At this stage it is too early to tell whether or not either of these projects will be able to produce a usable test. Advances in medicine are occurring at a rapid pace, however, and some such test will probably be available in the near future. For the present it will be necessary to rely on the subjective assessments that are currently used even though we all know that they are very flawed. The subjective assessment can only be made by observing the actions of a person and listening to what he tells you. Many schizophrenics become quite adept at hiding their delusional beliefs from others.

Under current law, it is possible to be quite delusional and still be allowed to roam the streets. There have been two extremely high visibility cases like this in the last couple of years. The first was the case of Russell Weston who shot two police officers in Washington D. C. Weston had been in psychiatric hospitals on more than one occasion and placed on medications. The medications worked for him so he was released, at which time he stopped taking his meds. His family had repeatedly tried unsuccessfully to seek help for him prior to the incident that ended in the unfortunate death of two police officers. The second high visibility case was the case of Andrea Yates, who killed her small children in Texas. Yates had been clearly ill and delusional for some time. The psychiatrist treating her, saw her shortly before the murders and stopped her medications because he did not think she was that seriously ill based on his observations of her. This psychiatrist had no objective test to determine how ill Yates was.

As I said at the beginning, I believe it to be ethically and morally wrong to allow someone to go about unmedicated and psychotic. I feel that the present situation in our society is not unlike the situation with drunken driving before there were readily available tests to determine how much alcohol someone had consumed. When the campaign against drunk driving began, there was a lot of resistance and many laws had to be enacted and changed. Now it is routine to do a breath analysis or blood alcohol content to determine if a suspect is drunk. Prior to this time, police officers had to go on subjective tests of how a person acted or responded to the officer and whether or not he appeared to be physically impaired. This is much the position a psychiatrist is in today in determining whether or not someone is psychotic. With the growing campaign against drunk driving, many laws were passed to determine the legal limit for how much alcohol someone could consume and still legally drive. I believe that someday in the not to distant future, equivalent standards will be set to determine how psychotic one can be and still be allowed to go about freely.

In the meantime, I as a responsible person, will continue to take my medications as prescribed by my doctor. I am aware however that I could become psychotic without realizing it, as happens to so many other schizophrenics. If that happens, it is my fervent desire to be hospitalized and medicated, even if it is against my will at that time. I believe all responsible schizophrenics should have the same views. I am aware that many schizophrenics do not share these views. Many do not consider it a serious matter to be psychotic. Some even called forced medication "Psychiatric Rape". For them, I would like to point out that I have also been psychotic. I have also been forcibly medicated against my will and placed in restraints. I think of Russell Weston and Andrea Yates and what happened to them. I then say a small prayer and thank God that I have never done anything of that kind myself, but I feel that but for the grace of God I would have.

I feel that it is the responsibility of everyone else to try to keep me from being irresponsible. I believe that telling someone else that he or she appears to be psychotic and in need of treatment is very important. If that person refuses treatment, the only responsible thing to do is have them forcibly treated. This is exactly equivalent to taking the car keys away from someone who has had too much to drink. Unfortunately, under present law it is very difficult to have someone forcibly treated. Having someone forcibly treated and medicated is not a violation of their civil rights but rather an action for the protection of that individual and those around him.

Just as was the case in drunken driving, there is a lot of resistance to the idea of forced treatment. Many of the staunchest opponents of drunken driving laws were those who were most in need of them. Many friends and family members were against harsh treatment of their loved one under the new laws. Many horror stories are available of drunken drivers who were repeatedly in traffic accidents or arrested before they actually killed someone. From what I have seen, a similar situation is likely to occur with laws about mental illness. Some of the staunchest opponents of tougher treatment laws for the mentally ill are mentally ill themselves. With the rapid advances in medical technology occurring today it is only a matter of time before new laws about mental illness come to pass. I believe that this is the new moral and ethical imperative in dealing with mental illness.
 

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