For example, I never have told any of my doctors about my obviously failed suicide attempt that happened when I was undiagnosed, socially isolated, in the first year of my illness. I just don’t tell them because it is in the past and I have my ego back up and running.
I was evaluated to be prone to suicide AFTER my ego ran out of gas, around the age of 40. I asked my medical ethics professor if telling me that my prognosis was something along the lines of suicide by middle age was unethical and she quickly said yes. However, that is just at first glance. Given some information such as my demands for truth (which is a big deal that goes back to Immanuel Kant) the evaluator did in fact follow Kantian Deontology and told me the exact truth and did not sugar coat it one bit. I was declared autonomous (honors psych student with a 3.8 GPA) and was told the truth, which I had explicitly demanded to be told. He did ask me if I was sure I wanted to hear what the results were and I said yes.
Personally I think due to my autonomy, it was not unethical, it was ethical in an appeal to some older philosophies. It was actually a direct appeal to Kantian Deontological ethics, which I just studied for like two hours and conversed with my mom, (who went to Notre Dame, she knows her shit) about for about half an hour yesterday.
Has your treatment been ethical? Have you withheld any information from your doctors?
There were some times when I downplayed how serious my symptoms were because I feared going into the hospital or I exaggerated how often I was taking my meds, but that was long ago. I am very honest and direct these days. A doctor can’t help if they don’t know exactly what’s going on.
I think that you should tell your doctor about your failed suicide attempt - this is vital information about yourself.
The urge to commit suicide may crop up again, and then what - you need to be as honest and open with your doctors on all of your symptoms and behaviors. Unreported symptoms only hurt the patient in the long run - the correct treatment and meds need to be set in place
i’ve not purposefully lied, but i’ve said things that are false.
ex: “did you ever ___?”
me in thinking on it doesn’t remember ever having had, so i say no.
then later someone else reminds me, don’t you remember that one time, etc?
and then the memory comes to mind.
i try to write these things down to keep track and later correct myself, but i’m not always great with keeping track of things, thus the problem.
my recall is shoddy, but my ethics are not. i agree that you should tell your care team, but i can understand why you might not want to. i don’t like having to correct myself because it makes me look, i feel, discombobulated, and i look that way enough without adding salt to the wound. i agree as well, however, that the best care is when both parties are as informed as possible.
EDIT: in thinking on this more, i’ve also when i’ve been really ill have refused to give information. like, said, “expletive expletive i’m not telling” or things along those lines. it never made things better. i think also much of what i say when i’m less well is probably not exactly true. but i believe it to be.
There has been some serious breaches of ethics in my psych treatment. I can’t call them on it, because every time I do they punish me in some way - hospitalize me or change my med’s. I’ve learned to be careful what I say to pdoc’s. The nature of these breaches is very strange, and no one would believe me if I said what they were. All I can say is that according to my perceptions there has been some very unethical dealings with my case.
Didn’t really hide anything from the doctors, which at one time wasn’t probably the best thing from an consequentialist viewpoint, since I was contemplating about if some people want me to kill myself and told the staff about it. As a consequence I had to report every full our to the staff, which made me even more anxious and paranoid. So in this case it probably wouldn’t have hurt anyone if i kept it to myself. But more generally I think it was right from situational viewpoint.
Well I was a different person back then and feared hospitalization at the time. I did know the rule about danger to oneself or others because my sister had been committed for a bipolar mania episode, she was a danger to herself and they took her in. I had to skip a week of class to get evaluated, for example, and I made A’s and B’s that semester, taking two honors upper division psych classes and three other classes. I justify my omission of truth by my high functioning. At the time, I had thought my symptoms were real and had hopes to hear that I was just crazy.
I basically functioned highly at all costs. I remember the incessant voices while in class and how I wanted to go berserk while sitting classrooms, I just kept it together and then went to the gym and was one of those nutjob guys who lifted too much. People would stare at me while I worked out, I was one of those guys who put a WTF amount of weight on the bar and worked out non-stop, and wasnt even that big, just muscular, not bulky, but surprisingly strong. I had my time as a powerlifter and now keep the weightlifting to a minimum with a very intense but 45 min long workout program called german volume training. I basically hardly rest in between exercises and make what takes people well over an hour happen in less than an hour. It is appropriate and I am bigger than I have been since I was 18, I was seriously big at 18. I had time to workout 5 nights a week back then.
It is ancient history now, I practically have my psych major finished, I need just a few more classes to get my major requirements done, the rest are prerequisites and electives. I have some ridiculous number of hours of psych classes completed with all A’s and two B’s in the psych program, I made a B and a B+ in the two neuroscience classes I have taken- probably because I was nucking futs and hungover or still drunk half of the time. I have been on medication for over a year. I am a junior now, what I did as an insane freshman who was just taking intro to psych is what a different person did.
I realize what happened to you was in the past - if you feel uncomfortable mentioning the word suicide attempt to him for fear of him committing you (this wont happen its in the past) then maybe you could tell him that you were prone to suicudal thinking in the past. When I saw my current doctor I gave her a detailed paper on my entire history of symptoms - yes even the ones from my past. Psychiatry relies on the information that you give your doctor including past symptoms - I just think personally that you are going about it the wrong way - you are fooling no one but maybe yourself
That’s paternalistic of your doctors, to give orders. Mine don’t do that. They use the engineering method with me and offer treatments and I say yes or no. There was one time I was ordered to do something- I had been offered latuda instead of geodon, took it, and I became fully psychotic. I called my doc and he could tell I was raving mad, so he just said “take the 80mg Latuda NOW.” That was the only time I had been given an order by him. The latuda ended up just making me worse for some reason, so I saw him in person and he put me back on geodon, a higher dose of it too, after me suggesting it. The engineering model is basically when doctors offer treatments and the patient is informed of them and accepts or declines. I am quite informed about psych meds, he knows I am a psych major concentrating in neuroscience (as of today I am, that might change, I like the neuro stuff but chemistry sucks) and so he gives me a printout, a lengthy printout on a drug he offers and asks me if I am familiar with it. Latuda is too new and wasnt in my textbook, believe it or not. It sounded good on paper but it has a reputation for terrible akathisia and zero sedation. I need some sedation.
For example, I was taking abnormal psych and learned about strategies for dealing with anxiety. Perfomance anxiety is often treated with beta-blockers. So, my therapist and I talked, he suggested a beta-blocker, I knew just a tiny bit about them and said OK and then my therapist called my psychiatrist and recommnded a beta blocker. Psychiatrist called me and said it was a great idea and started me on 20mg before going to class.
I just took 80mg extended release of a beta blocker and have been for like a year. I take it every day now to combat tremors, high blood pressure and anxiety. It has multiple uses, I qualify for all of them. In very high doses it works to ease anger and aggression. My dose isn’t that high, obviously, or I wouldnt be lifting weights and listening to Slipknot all of the time.
i’m well aware of my legal rights, especially given how many i’ve been stripped of. i spose when i’m totally out of my head whatever awareness is left does tend to be more intuitive though.
Do keep in mind that if a patient is not autonomous, rights can be stripped away. If you are obviously psychotic, they can override your autonomy “for your own good”.
Of course there are things wrong with what I just said. The class I am taking is all about arguing about this stuff, not just learning it. LOL
It’s controversial, very controversial. I wanted to hear some fellow patient’s experiences to formulate a stance on autonomy.
When I think about it… I’m sure there is something somewhere my doc doesn’t know… Plus… as I heal and do new things and become a different person… He’s meeting me all over again.
The 17 year old… angry… out of his head… raving/ screaming punk who was brought in under restraints was not the same man as…
the deeply depressed, flattened, out of touch 23 year old who came close to suicide… (Yes… my doc knows about that… as well as the police… The EMT’s… the ambulance drivers… the 911 dispatcher… the docs who had to pump my stomach and stitch me back together) …
neither of those people are the current 29 year old who is going to school, holding a job and learning how to live again.
I’ve had a few really horrid docs who have said and done some horrid things… that might border on unethical.
But the doc I’ve been with the longest and keep coming back too… I do believe I’ve been treated ethically. I don’t always like what he has to say… I don’t always want to hear it… but he says it anyway. Now that I am being more proactive and self- managing… he takes what I’m saying into consideration.
when I was 17 and the only thing I ever did was fight him, flip him off and spit on his floor… he had nothing to go on. So he just put me on basic meds and tried his best with the NO information given.
When I was 23 and I was covering his desk in milk cartons and drawing on his walls and withdrawing and telling him that I was fine… It wasn’t me… it was them… it was all them… he again, I feel… did the best he could with the lack of information given…
But now… we have more discussions and give and take and listening. The more effort I made… the more effort he made. That seemed fair.
there have been times I was not acting in the interest of “My own good” or even my own safety. My parent’s had to step in.
I don’t know if this falls under the label of “ethical” or not but I had a therapist who did not believe in AA and told me I didn’t need it anymore. We argued a bit about this but NO ONE is going to talk me out of something that is proven to work AND saved my life. I realize there will always be people who have will various negative opinions of programs like AA, CA, and NA. But no one else has been in my shoes and knows the misery I was in as an addict, the things I did and had done to me in my addiction, and how I could not stop on my own. This therapist was a good one except for this issue but I strongly believe it was irresponsible and inappropriate of him to try and turn me off of AA.
But getting back to the question, I don’t tell my psychiatrist everything. We just rarely get into the past, we focus on the PRESENT and my life NOW. He tries to bolster my self-esteem and confidence. He tries to explain that my fears are mostly paranoia, that everyone is leaving me alone. He asks general questions like how am I feeling, how is my life is going, He has put me on a new med and asks how it’s working. I haven’t been in a crisis for quite awhile so life has slowed down.
I’ve kept hidden my memories of domestic violence when I was 15, particularly about who it was with, I used to be honest, around the time; got told I was a liar and then I suppressed it, I told everyone it was all abusive hallucinations (even though I do have some nasty ones anyway, so not a complete lie) and then hid it from myself. It’s rearing up again and I think this time for good. So for all the time I’ve been with adult services, I’ve lied about that and even though these memories make me unstable, like recently. I’ve tried talking about it, with my nurse, but I have a huge block. It just makes me burn up and really physically show anxiety I shake, lose speech, and want to cry.
I’m aware this needs to come out. I’m looking into private therapy.
I’ve had some very unethical treatment, I had some very unprofessional doctors who were manipulators. One was a complete power freak who needed to be in control (this was inpatient) he would smile and I felt threatened; I didn’t trust him, he was horrid. Things like not doing room searches when I was a suicide risk, and then me doing something but not upping my observations. Also drugging me to the max and then bringing me off it without weaning me off it.
Not keeping confidentiality when they should have. Being laughed at (yes, by staff).
However, this was all adolescent services, I’ve had impeccable treatment from adult services, I have a good report with both doctor and nurse; they’re both very good with me, I couldn’t ask for more!
i’m on depot injections not of my own choosing, i assure you. it infuriates me actually, the fact that i’m on treatment order.
i can’t say i’ve been really upset about restrained in hindsight though. inpatient, or even being hauled off, i mean. i understand why people called on me. i feel badly for frightening people. not by threatening them so much as them watching me is frightening and they don’t know what to do. and even the restraining. there’s nothing else they can do to stop me when i’m hell bent on getting stuff out of me.
i’m not psychotic now though and i’m IRATE at being on depot injections. but that’s perhaps another topic and don’t want to clutter your thread. with the whole medical ethics thing, though, yes, i do think a lot of things should be options, including my autonomy to take my life. but i also get that if i get caught or if i can’t explain well enough what i’m doing, they have no choice but to try and stop me. i wouldn’t want things on their conscience anyway.
When I went to my first official therapist I completely left out my psychotic symptoms and only talked about my anxiety for fear of being put on medication or locked up. I’m over that fear now and I’m trying to be as open as possible. The doctor I spoke with was very kind and sympathetic. I feel confident that my trust will not be betrayed, but if it is I am running far, far away!
Interesting stories, folks. I think that I am autonomous and have been since I was diagnosed. Like the moment I was diagnosed. I think how you carry yourself has to do with how doctors judge autonomy- I was off my rocker but spoke articulately (and still do) and was well-dressed, very athletic and well-groomed at the time of my evaluation. He remarked on how “together” I seemed on the surface but how I was “very crazy” in reality.