Committable Concepts: Anosognosia Transcript

 Anosognosia. 

Anosognosia is a neurological condition that is typically associated with some form of damage to the brain and characterized by an inability to understand an objectively identifiable injury or impairment. An example of this might be a person who has experienced a stroke that resulted in paralysis in the left side of their body. That person's left arm might be paralyzed. They might be unable to control that arm in any meaningful way, but if asked the person would adamantly state that their left arm works just fine. In a situation like that, A physician might look at the totality of this person's symptoms, scans, tests, and medical history, and then conclude that anosognosia is an appropriate diagnosis. But in the context of mental health conditions this term, anosognosia, is simply defined as lack of insight. 

So, why is this distinction important? The distinction between a neurological condition involving a more objectively identifiable impairment as opposed to simply lack of insight. This distinction is incredibly important because lack of insight is just an opinion. It might be an educated opinion, but it's still just an opinion. And by co-opting this term, anosognosia, and applying it to mental health conditions that opinion is being deceptively associated with the full weight of that more objective neurological condition. That opinion is being packaged as a medical certainty and then presented to legislators, courts, and journalists, as justification for further depriving vulnerable people of their rights. 

So, when the term anosognosia is misrepresented in this way, not only does it risk eroding the legal rights of vulnerable people, but it also further compounds the dangerous misconception that people diagnosed with mental health conditions are biologically deficient, that we are objectively inferior, and that our thoughts and our feelings don't need to be considered because science says that we are broken.  

So, anosognosia is a neurological condition with a specific meaning but lack of insight is just an opinion, an opinion that is far too often leveraged to devalue and dismiss the humanity of vulnerable people experiencing distress.

Committable Concepts: Voluntary Transcript

  Voluntary.

In the context of psychiatric hospitalizations, the term voluntary, or voluntary admission, or conditional voluntary, doesn't actually mean that your time in that facility will be voluntary, because you can't just leave whenever you want to. The specifics of this can change significantly from state to state, but generally speaking, when someone signs a voluntary admission to a psychiatric facility, they can't just leave. They will have to ask for permission to leave.  And once that request for discharge is submitted, then it essentially starts a clock, a specific window of time during which that facility has to decide whether or not they are going to allow you to leave. That window of time is determined by state law. So it could be 24 hours, or 48 hours, or 72 hours, and it may or may not include weekends and holidays. 

And so, what happens if you are in a psych facility as a voluntary admission, you request discharge, and the facility decides not to let you go? Typically, when that happens, the facility converts your voluntary status to an involuntary status, which means that the facility has chosen to begin a process that will allow them to keep you detained inpatient until such a time where either they decide to let you go, or you get to appear before a judge at a commitment hearing. So, signing a voluntary does not mean that you can leave whenever you want to, you have to formally request discharge, and once you do that the facility has an opportunity to convert your voluntary to an involuntary.

I want to be clear though, this decision of whether to sign a voluntary or risk being detained involuntarily,  that is an incredibly personal decision. There is no one right answer to this. But whatever decision is right for you read everything before you sign it, and if you need accommodations to do that, ask for them. And if possible, keep all of the paperwork that you are given and take note of what you are told about this process because all of that might become useful if you reach the point of a commitment hearing.

Committable Concepts: Antipsychiatry Transcript

Antipsychiatry. 

Antipsychiatry is not a term that has any clear, universal definition so the meaning of this term is generally entirely within the context of how it is being used. If a person publicly identifies themselves as being antipsychiatry, then I think it could be appropriate to ask that person, how do you define antipsychiatry? And they may answer you, or they may not. Either way, it is important to remember that no one should ever be made to feel that they have to explain their identity to others. It's okay to be curious, but it's also perfectly okay for someone to choose not to answer any questions about who they are and what they believe. 
Okay, so another context in which the term antipsychiatry is used is when someone does not identify themself as being anti-psychiatry, but is being called antipsychiatry by someone else. In this context, the term anti-psychiatry is almost always being used as an attempt to insult or demean the person it is being applied to.

I think it could also be appropriate in a situation like this to engage with curiosity and ask, what do you mean when you say antipsychiatry?" However, no one should ever feel obligated to engage with a person who is attempting to insult them. Even if you can't prove with 100 percent certainty that whatever was said was intended as an insult, if you feel like someone is trying to insult or demean you then it is perfectly appropriate for you to choose not to respond.
So in conclusion, antipsychiatry is not a clearly defined term, it means different things to different people, but it can sometimes be used as an insult or to undermine someone's perspective. 

Don't do that. 

Don't be an asshole.

Committable Concepts: AOT Transcript

Assisted outpatient treatment, also referred to as AOT, is a form of involuntary outpatient commitment that is a court order. And the details of this are going to vary state by state, but generally speaking, an outpatient commitment is a court order listing a series of requirements that the person targeted by the court order must comply with.

These court orders usually require some form of medication. They can require that the person live in a certain place, it can require that the person engage with specific people for treatment, it can require that the person periodically return to the court to appear before the judge, it can require drug tests, in some places it can require electroconvulsive therapy.

So the court order creates a judicially enforced form of surveillance and coercion that says to the person, do what we say, or else. Or else what? Right? What can happen to that person if they don't comply? So, again, it varies state by state, but generally speaking, if you don't comply, it will automatically trigger an evaluation and that evaluation will determine whether or not you are detained in a psych facility. And since typically one of the basic requirements for AOT is that the person has previously been involuntarily hospitalized, and since involuntary hospitalizations are often traumatic, sometimes debilitatingly traumatic. Then imagine what it would be like to spend a year or more with a court order that says either you do what we say or we might force you back into one of the most traumatic experiences of your life. Imagine spending a year or more living in the community with that threat looming over you.

That is what AOT is. It is the threat of potentially traumatic consequences used to make a person comply with whatever it is that they are being told to do.

Committable Concepts: Teaser Transcript

Hi, this is Jesse Mangan, host of the Committable Podcast. We're launching a new series for the podcast called Committable Concepts. With each episode of Committable Concepts, we're going to try and explain something related to the commitment process in three minutes or less. Topics such as what is a civil commitment?

What is an outpatient commitment?

Voluntary versus involuntary?

Lack of insight?

Do weekends and holidays count?

With Committable Concepts, we're going to try and explain all of these topics and more, and each episode will be three minutes or less. So if you like learning about mental health laws but can only take hearing my voice in short doses, I get it. I feel the same way. And Committable Concepts just might be the solution that both of us have been looking for.

Committable Concepts. Coming soon to a podcast feed near you.