Mental Health, Self-Determination and Personal Freedom

When I experienced my first manic episode, and for many years thereafter, my life was directed by others. Whether it be my parents, therapists, or psychiatrists, many of the decisions made about my care were dictated by what others thought would be in my best interest. This kind of influence was like a double-edged sword. On the one hand, there were truly times that I was incapable of making any decisions on my own due to the fact that I was incapacitated by my disabling condition. On the other, there were certainly periods where I was completely capable of deciding what I wanted, for better or for worse.

 For instance, when I was a patient at the Buffalo Psychiatric Center in 1982, I was experiencing a major depressive episode that was associated with my bipolar disorder. At this time, I was recommended for ECT (Electroconvulsive Therapy).

Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments.

I recall not initially wanting to have the treatment however I was made to do so.

Remarkably, this treatment did work for me and there was a marked improvement in my condition. So, in the end, despite not making the ultimate decision about my care, I did benefit from the recommendation from my treatment team.

Many years later I was faced with a different choice. I was in session with my psychiatrist and I asked to discontinue one of the psychotropic meds. This was my choice. What my psychiatrist didn’t realize in my 15-minute session was that I was hypomanic. At this point, she agreed to stop prescribing the medication, and lo and behold within two weeks I was in the midst of a full-blown manic episode. This was not a good choice on my behalf. 

This last manic episode was in 1995 and I have not experienced one since. More recently in 2012 I underwent a medication change with my mood stabilizer. I ended up experiencing a mild depressive episode, not one that was completely incapacitating, but it did make typical activities more challenging. At this point, I consulted with my therapist who recommended that I check-in with my psychiatrist, which I did. He immediately placed me on an anti-depressant and within a couple of weeks I was doing much better. The point of the matter here is that I initiated the conversation with my therapist. I was in charge. These have been hard lessons to learn, but they were a wake-up call about the importance of adherence to my treatment plan as well as being my own self-advocate.

The concept of self-determination comes into the picture when one considers the many choices that those of us living mental health difficulties face every day. By being able to participate fully in one’s recovery through such means as seeking employment, housing, and utilization of external supports, there is a significant degree of empowerment that accompanies our ability to advocate for ourselves. And with this sense of freedom we are able to change the course of our lives.

When I’m able to take control of my life in such a manner, my sense of identity, self-awareness, and self-esteem all improve. Yes, there are many external factors in my life that I am unable to control, however I do have certain freedoms that make life that much better.

Self-determination is much more about choosing one’s direction in life than just following a treatment plan. I make hundreds of choices every day, some more critical than others. But in the end, since I am the one who is able to exercise a certain level of control in my life, I have come to the realization that I do not have to become someone who is pigeon-holed into so-called categories. Yes, I may have a bipolar diagnosis, but I am much more than that. When I able to break free from the limitations that are placed on me by society I can live my life more fully and intentionally. I made the conscious decision many years ago not to be a square block forced into a circular hole. I am the master of my destiny.

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