In the 1970’s, a Stanford University professor and psychologist David Rosenhan conducted an experiment on mental health institutions. The experiment’s principle aim was to determine the validity of psychiatric diagnosis. He conducted this experiment by having “pseudo-patients” fake manic episodes to get into various psychiatric hospitals around the United States. Once in the hospital, the begin to act normal. Despite their return to normal behavior after admission, they were all diagnosed with a form of schizophrenia, an obviously inaccurate conclusion.
We have somewhat improved our knowledge of mental health issues and, thus, diagnosis since the seventies. However, the results we saw in those years are not simply due to lack of knowledge. It is based on human confirmation bias and institutional incompetence (no pun intended). Thus, this type of catastrophic failure can still happen despite our increase in knowledge regarding mental health issues.
The result of this experiment begs the question: how well do we treat mental health even with a proper diagnosis? If we have such a disconnect between a manic episode and normal behavior, how accurate are we in gauging the improvement of a patient with a legitimate diagnosis?
This is an important question to consider as you age. This is especially true if you consider the fact that one in three seniors die with some form of dementia. Dementia is not simply a condition that affects the memory. It is the slow death of the brain. As such, it can cause a wide variety of mental health issues. These issues are typically treated with the use of prescription medication.
The thing with prescription medication is that the good does not always outweigh the bad (just look at the opioid crisis in America). Many times, prescription medication may treat symptoms of a disorder but essentially cause a whole different disorder through a litany of side effects. It is a personal choice, but many folks tend to want to prevent the loss of their mental dignity by forced medication.
Imagine, you begin to experience signs of dementia. You have a bad day and you experience an episode. Your family takes you to the hospital and you are prescribed a strong psychoactive drug. You do not like the way the drug makes you feel. You believe that it will accelerate the deterioration of your mental health, so you stop taking it. Your family is concerned, so they try and force you to take it, but you refuse.
After your episode, your family can no longer care for you. They place you in a facility with care for dementia issues. You are monitored daily and you are required to take your medication. You are forced to feel the effects of the drugs regardless of how you feel about it. Because of the biased nature of the workers (even though they have good intentions), they cannot accurately gauge whether you are getting better. Thus, you are forced to keep taking the medication indefinitely.
How do You Prevent This?
The best way to avoid something like this is through a clear and detailed Mental Health Advanced Directive (MHAD) couple with a Healthcare Power of Attorney document (HCPOA). A MHAD will allow you to give instruction as to the types of medications that you are willing to receive and the type of medications you do not consent to taking. Additionally, you may make instructions as to whether you would consent to being admitted and retained in a healthcare facility for mental health treatment. By law, your physician must make the MHAD a part of your medical record once it is presented to them. You may also register it with the Secretary of State.
The HCPOA is an added protection. You can give another individual, who you trust, the power to make any and all medical decisions on your behalf. Thus, the person to which you give the power (the attorney in fact) has the ability to ensure that your wishes are carried out.
You can maintain your dignity and use your own judgment to preserve your mental health through some careful preplanning. If you have question regarding powers of attorney or advanced directives, the attorneys at McIntyre Elder Law are happy to help.
Brenton S. Begley
Elder Law Attorney