Involuntarily Voluntary: Is There Such a Thing as Choice?

Originally published at Mad in America, November 2012

If I was to sum up my career as a “Bipolar” patient, the word voluntary stands out to me more than most.  Indeed, it’s scribbled and typed all over the thousand and some odd pages of my psychiatric records.  I spoke about this in my speech at Occupy APA in New York City last month— that I was once spellbound by psychiatry, swept up in its promises of quick fixes, normalized brain chemistry, and an effectively-managed life.  I once turned to psychiatry’s disciples— the countless MDs and PhDs I saw over the years— and threw myself at their feet, my devotion to them driven by a profound desperation for answers to my emotional and existential pain, and more importantly, to the agonizing question of “Who am I?”

The answers beckoned me from the pages of the DSM, the language of which I learned diligently so that I could be a more effective and useful patient to my doctors.  I became adept at self-diagnosis and at understanding the various manifestations of my “Bipolar disorder” as well as a layperson possibly could, quick to call my doc if any new “symptoms” cropped up.  One could say that all of this is evidence of my “voluntary” status in psychiatry…  Or could one?  Despite what my records say, and despite what I told myself throughout my years as a seemingly willing patient, was I really, truly, voluntary?

Voluntary, adj.  [from dictionary.com]

  1. done, made, brought about, undertaken, etc., of one’s own accord or by free choice: a voluntary contribution.
  2. of, pertaining to, or acting in accord with the will: voluntary cooperation.
  3. of, pertaining to, or depending on voluntary action: voluntary hospitals.
  4. having the power of willing or choosing: a voluntary agent.                                                                                                 

Looking at the surface of my story— the signatures on all my voluntary inpatient hospitalization admit forms, my monthly trips to the pharmacy to pick up my scripts and take them “as prescribed”, or my twice weekly (sometimes three times weekly) drives to my shrink’s office for therapy— it is easy to argue that I was voluntary.  Legally, there is no doubt that I was: I was never committed against my will, or put under a forced “treatment” order.  However, as I’ve grown further away from psychiatry’s grips and more into a liberated, authentic sense of Self these last two and a half years, and as my mind and body have cleared themselves of a decade’s worth of psychotropic drugs, I’ve awakened to a new truth— I was never voluntary, in the truest sense of the word.  At best, I was involuntarily voluntary.

Let me backtrack for a minute.  My first experience with psychiatry was against my wishes, at the age of fourteen [side bar: I should note that I hold no blame against my parents for agreeing with the recommendation that I be sent to a psychiatrist; they were truly doing what they thought was in my best interest.  In my opinion, one of today’s devastating realities is that it is considered poor parenting in our society if parents don’t take their children to a mental health provider for emotional or behavioral difficulties, an issue that we must address as a community].  When that first psychiatrist put me on Depakote and Prozac to treat the “Bipolar disorder” she’d labeled me with [you might remember from earlier chapters of my blog that the anger I felt towards myself, my family, my school, my town, and the world at large had been deemed a symptom of ‘mania’], I did not willingly take those drugs, nor accept that diagnosis.  Thus, the very foundation of my relationship to the mental health system was based on involuntariness.  It cannot be understated that I absolutely despised the fact that I’d been labeled “mentally ill”, and even more than that, I felt profoundly violated by the foreign chemicals the psychiatrist was telling me to put in my system to change how I felt.

I worked hard at staying involuntary in high school, whether by hiding pills, slipping entirely through the cracks of any “treatment” at all for a time during my boarding school years, or keeping the fact that I’d been labeled “Bipolar” a secret from almost everyone.  No matter how much I determined to go on in this way, however, the “mental illness” seed had been planted, and broke the surface by the fall of my freshman year in college.  I couldn’t hide the painful memory of being told my emotions were symptoms of a disease, and no matter how much I didn’t want to believe it to be true, I couldn’t help but wonder if maybe the tremendous existential pain I felt on a daily basis truly was something abnormal.  Eventually, when the pain became too much to bear, I voluntarily entered a psychiatrist’s office, but not out of free will or choosing, as the dictionary defines it.  I surrendered to psychiatry because I reached a point of emotional desperation that told me I had no other choice: see a psychiatrist, or go on to the bitter end.

During the ten following years, I always thought of myself as a willing participant in treatment, diligently following orders, whether they be to increase doses or add new meds or go inpatient or go to a partial hospital program or go to an intensive outpatient program or go to an extra therapy session a week or sign a “contract for safety” or whatever the hell else it was I always agreed to do.  Smiling and nodding and impressing those doctors with my endless well of compliance made me feel important and filled me with a sense of pride, bolstered each time I saw a subtle nod of satisfaction from the armchair in front of me as once again, I said “Yes, doc.”

From the age of eighteen until my awakening ten years later, I never ran away.  I almost never fought, never screamed, and never resisted.  I say “almost”, because my last inpatient hospitalization in 2010 did, in fact, involve two security guards; to briefly sum the experience up, I mentioned the ‘S’ word to a psychiatrist, who calmly told me I needed to go inpatient immediately because I was “unsafe”, to whom I replied, “OK, I will, but can I go home first to pack a bag?” to which he answered, “No,” which prompted me to feel backed in a corner and defensive and emotional, to which he responded by calling two security guards, who arrived and told me I had the “choice” of coming with them to the unit voluntarily or involuntarily.  I “chose” the former.

Beyond that first and last minor attempt at resistance, I simply couldn’t do anything but comply, time and time again.  You see, I had no inner compass, no sense of self-confidence or self-determination, and gaining a doctor’s approval was essential for me as a young woman who felt absolutely zero approval of herself.  This was reinforced by an unconditional trust in things outside of me— in the mental health system, in the DSM, in my doctors, in “my meds”— and this trust was unconditional because I had zero trust in the one source that might have challenged such blind faith— myself.  During my time as a patient, I existed in a system that claims one person, armed with proper schooling and training, can become an expert on another person’s internal, subjective, human experience of the world.  It is a ludicrous notion to me, today— talk about Narcissistic personality disorder!— but at the time, I needed to believe that someone was an expert on me because I felt so utterly lost in my life.  And once I allowed myself to be stripped of the right to be an expert on myself, I also lost the power of willing or choosing.  Without a connection to my gut, and to my intuitive sense of right and wrong for myself, I had no true will.

Tied into this loss of will, of course, was my long relationship to psychiatric drugs.  From the get-go, I was involuntarily voluntary, never given the chance to choose freely because I was never given access to a full spread of honest information.  The story I heard was that these “medicines” balanced out a pre-existing chemical imbalance.  That they would fix my broken brain.  That they weren’t physically addictive.  That they sometimes had minor “side effects”, which shouldn’t be more than a week or two of headaches or constipation at most before my body adjusted to them.  That if I didn’t take these “medicines”, my “Bipolar” would continue to escalate.  That I had a biochemical disease requiring a biochemical solution.  I believed these things, because I heard them from the mouths of Harvard-trained doctors.  I believed these things, because I was taught to trust in Medicine.  I believed these things, because I desperately wanted them to be true.

And in a short matter of time, I was pliable as Gumby, going through the motions of life in a numbed state of disconnection and apathy, detached from my thoughts and actions, completely unaware of just how altered my mind and body had become.  The pill bottles contained invisible straitjackets that separated me from the memory of what my pre-psychiatrized life had been, all the while telling me that I was still in charge of myself and of my decisions.  For ten years, I was chemically lobotomized,  I often wonder how it is that our society fully embraces the notion that a person who’s had one too many alcoholic drinks might make “impaired decisions”, while someone like me, who once took Lithium, Lamictal, Abilify, Effexor, and Ativan every day, with a PRN of Seroquel on the side for those moments requiring immediate sedation— was seen as somehow maintaining the ability to have an unimpaired will?

I was never voluntary, no matter how much I convinced myself I was.  Only now, my mind, body, and spirit fully free from the mental health system, am I coming to understand this.  After desperately searching for answers to that once perplexing question of “Who am I?” I have found that I’m connecting with a true, authentic sense of my Self for the first time.  And that’s really what it is— the answer is not a verbal declaration, or a list of descriptive labels or categories, but rather an intuitive, innate sense of myself that lies deeper than language.  Psychiatry could never have given me this answer, with its dependence on artificially constructed classifications and definitions, and its stubborn insistence that Truth can be created out of thin air.  Nor could psychiatry have “fixed” me, because I was never broken in the first place.  I know this to be true because it took me thirteen years to figure it out, and with each day that passes in my liberated life, my inner voice grows stronger in reminding me that I am the only expert on myself.