Exploring Psychiatric Advance Directives

Psychiatric advance directives are not something people talk about enough. Psychiatric medication has saved my life and helped me to function and participate in events and daily activities that I wouldn't be able to do without it. It also saved my marriage and allowed me to have successful relationships with friends and family. I believe my medication is why I do as well as I do (which isn't always great, but I have joy-filled days and many accomplishments that I can be proud of, given limitations). I want to communicate these things to doctors because medication is necessary for my treatment. I can do this by formulating a psychiatric advance directive.

Consider a Psychiatric Advance Directive Before a Psychotic Episode

Given how I feel about medication, I have worried for the past decade about what would happen if I had an episode of psychosis and refused treatment. When I am psychotic, I experience anosognosia (a clinical lack of insight), and it is a legitimate concern that during a psychotic episode, I would no longer feel I need or see the benefit of medication. I didn't realize until recently that I could create a legal document with my treatment preferences that would be used if I could no longer communicate my wishes -- a psychiatric advance directive.

Many people fill out advance directives for health issues they might encounter and cannot make decisions for themselves. In my case, I want a psychiatric-specific advance directive. I want doctors to be able to decide to give me medication even if at the time I refuse it. That is important because I know I can't have a fulfilling and productive life without pharmacological interventions like antipsychotics. My rational mind knows this to be accurate, but when I am psychotic, all rational thoughts are impossible to access.

Psychiatric Advance Directives Can Include Many Details

I researched psychiatric advanced directives and the type of information that can be included. If you have a pet, you can include who you want to contact to care for your pet if you need to go to the hospital. In my case, I will include that I want my husband to have the ability to make all medical decisions for me. My husband already knows that my wish is to be treated with medication and possibly hospitalization if that is what a doctor recommends. I will also include my psychiatrist's name, primary care physician, and preferred hospital.  

Many other details can be included in a psychiatric advance directive, including what kind of treatment you don't want to receive. For example, there are types of treatment I don't want (because they make me paranoid even on good days), so a doctor needs to know that to avoid giving me that type of treatment. 

It seems a good idea to have my desires about what happens to me when severely ill made known to doctors. I have preferences, and having those preferences respected and acted upon is critical to having input over what happens in my life and how I want to address my symptoms of schizophrenia.