A person at the Ask the Doctor session received thunderous applause after his outcry that the opposing camps in the AOT debate haven’t been able to reconcile our differences. Assisted outpatient treatment or AOT is an evidence-based practice for schizophrenia.
In analyzing the details I disagree with what the guy said for one specific reason: people who view AOT as coercive have to date offered no reasonable alternative. The fact too is that not every individual who receives AOT takes medication.
I’m in the camp that aligns with family members of loved ones who have anosognosia–that is, the lack of awareness that you have an illness.
Dr. Xavier Amador, PhD created the LEAP Institute to give family members tools to help their loved ones get and stay in treatment. On page 45 of his book I Am Not Sick I Don’t Need Help (get the current 2010 edition) he lists over 10 research studies that link anosognosia to frontal lobe lesions in the brain.
“Consumers” think anosognosia doesn’t exist and this is one way I differ from them. I’m Dr. Amador’s number-one fan. He created the LEAP technique for family members to use with loved ones. The LEAP technique is not coercive. It can work where other methods might fail.
I’m confident that Dr. Amador is right when he states that a psychiatrist should first of all determine if their patients exhibit anosognosia so that the doctor can promptly use the LEAP technique to treat the patient.
If you’re against AOT, what kind of treatment do you propose? The LEAP technique is an approach that I think is a great option.
Since 2002, in all my years as a mental health activist, no one has proposed a viable evidence-based alternative to AOT. Trust me: I’ve heard the alternatives: taking a person who is psychotic into a room and talking to them quietly. Another option a mother proposed was “to allow the progression of the disease.”
I kid you not a mother proposed allowing the progression of the disease.
As a person with a diagnosis: I gave up my “right” not to take medication when it became clear I needed to take medication. I didn’t want to “die with my rights on.” As a citizen of the world, I have the duty to uphold the social covenant with other people in society: to be a responsible citizen.
Easily eight or nine years ago at HealthCentral I wrote: “I would rather be dead than psychotic.”
I don’t agree with the idea that “medication is a choice.” I’d rather not take medication yet I have no choice. That’s the bottom line: for a lot of people we’ve chosen to take medication because the alternative is no option.
I will go to my grave championing the right of individuals diagnosed with schizophrenia bipolar and other mental illnesses to have a full and robust life.
Having life-long paranoia and delusions is not an option I champion when taking medication can allow someone to live symptom-free or have minimally intrusive symptoms.
Seeing a loved one doomed to be actively psychotic the rest of their lives is NOT something I champion either.
I understand that others like the guy at the conference think AOT is coercive. Yet I’m adamant that the alternative: life-long psychosis: is not something I can get behind.
Mothers and fathers: I’m on your side. I’m the family member of a loved one with a severe illness. Forced treatment might just have saved his life.