May 1, 2023Liked by Awais Aftab

You make good points about the shortcomings of the proposed AOT law, but the status quo of favoring civil liberties isn't working so well for homeless people with psychotic disorders in my home state of Texas. And while its certainly true that medications do not work for everyone and often have troubling side-effects, I have noticed that people and organizations that call attention to iatrogenic harm never seem to point out the risks associated with not taking medications (e.g., suicide, homelessness, incarceration, and death). Roughly 300 homeless persons, many of them with serious psychiatric illnesses, died on the streets of our capital city of Austin last year. Numbers in the previous years were similar.

Law in Texas specifically prohibits a guardian from putting an adult child in a psychiatric hospital or choosing their housing--it merely provides for a little parental oversight of the $1,999 in total assets a psychotic person on federal assistance is allowed to own at the cost of burdensome annual courtroom appearances and home visits for those parents that simply are not worth the trouble. Recently, during some estate planning, I learned that I may not even be able to legally authorize my wife to put me in a psychiatric hospital even if that is what I want to happen if I lose my insight into reality. Agreement among Texas liberals and conservatives about the supremacy of civil liberties, even for those who have lost insight, makes it is nearly impossible to get anyone into involuntary treatment until they commit a serious crime and competency must be restored for them to face punishment for their behavioral symptoms while incompetent--make that make sense! Judges and taxpayer-funded attorneys at Disability Rights Texas may have never before seen a psychotic person, yet they have more influence than parents who generally have more contact and responsibility for their disabled family member's care than anyone else. It's the flip side of your point about a psychiatrist who does not know a patient being asked to make a decision, instead putting people who do not understand serious psychiatric illness in charge of making medical decisions.

Parents and persons with active psychotic disorders are unheard and unseen at meetings where policy issues are discussed by judges, attorneys, police officers, and social workers--parents and patients are unwelcome: Parents are unwelcome, seemingly because proponents of the popular trauma and adverse childhood experience narratives have convinced policymakers that parents are the part of the problem with their "what happened to you?" rhetoric; the belief in schizophrenogenic parenting never really went away based on my experience. Extremely sick patients are unwelcome, because their thoughts are too disorganized for them to contribute in a meaningful way and nobody wants to be around them anyway--they are embarrassing (i.e., stigmatizing) to the higher functioning folks when they go to jail or don't bathe often enough. But it is the parents who have lived experience unclouded by delusions and it is the seriously ill, not high-functioning peers, who make the news and lead to discussions like this one about the need for better access to treatment.

The legal obstacles to family planning and gender-affirming care we see today are similar to the obstacles that caregivers for adults with psychotic disorders have faced for decades when trying to access psychiatric care for their loved ones. The scales of justice provide ample protections for those with insight who do not want to take medicine, leaning far too heavily toward preserving the right of those who have lost insight to remain sick. Perhaps if psychiatric treatment were more valued, additional hospitals would be built instead of prisons and more beds would become available.

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May 4, 2023Liked by Awais Aftab

I am curious how many of us who have had any type of forced treatment have been asked about our experience, what hurts and what helps? I am eternally grateful that I have had the privilege of flying under the radar of the state (any state’s) mental health system. Our country continues to live in the dark ages of how to support a person with a mental health crisis or those struggling with any mental health challenge. I think I’ll write a book.

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