ETC Response Project

Good Morning. You’re 17 years old. You're a senior in highschool. It's a crisp fall Saturday morning and you've just woken up to the distant aroma of a freshly cooked breakfast drifting into your room from the kitchen. You push down your sheets and roll out of bed. You stumble into the bathroom, flipping on the lights and reaching for the faucet to wash your face. The cold water against your skin wakes you up enough to become aware of how hungry you are. You reach for a towel to wipe your face and eagerly make your way into the kitchen ready to feed your appetite. You say goodmorning to your family, grab a plate, and sit down to eat. Breakfast is delicious, you feel satisfied and ready to start your day. What do you want to do? [[You start your day by going back to your room and knocking out some homework ]] [[You decide you want to go see some friends]]

You roll up to your friends house greeted by a big hug and some small talk. Whats up? How's it going? You make your way into their room and call up a few other friends to hang out. In no time there's a knock at the door and your friend runs out of the room to greet your other buddies. You all talk and laugh and share what's been on your minds. Maybe you play a few video games or watch some TV or a movie. Maybe you decide to bake something while you listen to music and talk. Maybe you launch onto adn art project together, creatively brainstorming what to make but get side tracked by your conversations and laughter and end up just talking and hanging out. Whatever you decided, it's a good day. You have great friends. “Catch ya later” you hear as you walk out the door to head home. The rest of your evening is pretty low key, and before you know it you're tired and ready to hit the sack. [[Continue]]

You make your way back to your room, grab your backpack, sit down and pull out your work. Take a deep breath, focus. You have a big test on monday and it's time to study. You open your notes, grab your pen, and launch into your work. Before you know it you've made it through what you wanted to get done today. Nice work. Now you have time to go see your friends still. Or maybe you go spend some time with your family. Maybe you want to lay low for the day and read a book or catch up on some netflix. Whatever you decided, it was a good and productive day. The rest of your evening is pretty low key, and before you know it you're tired and ready to hit the sack. [[Continue]]

It's a few months later. Springtime now in fact, which means your deadline for committing to which college you want to go to is coming up. You've received your acceptance letters and got into most of your top schools; Ohio State, New York University, Emory, and Montana State. Really think about this one, it's where you're going to spend the next four years of your life. Where do you want to go? [[Ohio State University]] [[New York University]] [[Emory University]] [[Montana State University]]

“Welcome to The Ohio State University!” you hear a friendly voice exclaim as you pull onto campus. It's fall, move-in day, freshman year of college. You have boxes full of clothes, sheets, pictures, school supplies…. Everything you could think of that you might need, you packed. You're finally out living on your own. Responsible for yourself, for your studies, no curfew, you make your own decisions. Wow. This is a huge shift from living at home your whole life, but you’re so excited. You know you chose the right school and you're eager to make new friends. With your first box to unpack in your left hand and a duffel of clothes in your right, you walk down the halls of your dorm. The warm smiles of friendly RA’s greet you as you pass more and more doors until you reach your own. You walk in and look around. You have a bed, a desk, a set of drawers, a closet, and a bulletin board. Your roommate hasn’t arrived yet so you jump on the opportunity to get a headstart unpacking before the room gets too chaotic with two people moving in. You open up your box, pull out your sheets, and make your bed. Your new home. The next few hours are composed of trips to and from the car with the help of RA’s and move-in staff carrying boxes with you. Before you know it your pictures are up, your closet is full, you've moved in. It feels good. By now your roommate's arrived and small talks with you as they unpack. You're gonna get along great. [[Move Forward]]

“Welcome to NYU!” you hear a friendly voice exclaim as you pull up to your dorm. It's fall, move-in day, freshman year of college. You have boxes full of clothes, sheets, pictures, school supplies…. Everything you could think of that you might need, you packed. You're finally out living on your own. Responsible for yourself, for your studies, no curfew, you make your own decisions. Wow. This is a huge shift from living at home your whole life, but you’re so excited. You know you chose the right school and you're eager to make new friends. With your first box to unpack in your left hand and a duffel of clothes in your right, you walk down the halls of your dorm. The warm smiles of friendly RA’s greet you as you pass more and more doors until you reach your own. You walk in and look around. You have a bed, a desk, a set of drawers, a closet, and a bulletin board. Your roommate hasn’t arrived yet so you jump on the opportunity to get a headstart unpacking before the room gets too chaotic with two people moving in. You open up your box, pull out your sheets, and make your bed. Your new home. The next few hours are composed of trips to and from the car with the help of RA’s and move-in staff carrying boxes with you. Before you know it your pictures are up, your closet is full, you've moved in. It feels good. By now your roomate’s arrived and small talks with you as they unpack. You're gonna get along great. [[Move Forward]]

“Welcome to Emory!” you hear a friendly voice exclaim as you pull onto campus. It's fall, move-in day, freshman year of college. You have boxes full of clothes, sheets, pictures, school supplies…. Everything you could think of that you might need, you packed. You're finally out living on your own. Responsible for yourself, for your studies, no curfew, you make your own decisions. Wow. This is a huge shift from living at home your whole life, but you’re so excited. You know you chose the right school and you're eager to make new friends. With your first box to unpack in your left hand and a duffel of clothes in your right, you walk down the halls of your dorm. The warm smiles of friendly RA’s greet you as you pass more and more doors until you reach your own. You walk in and look around. You have a bed, a desk, a set of drawers, a closet, and a bulletin board. Your roommate hasn’t arrived yet so you jump on the opportunity to get a headstart unpacking before the room gets too chaotic with two people moving in. You open up your box, pull out your sheets, and make your bed. Your new home. The next few hours are composed of trips to and from the car with the help of RA’s and move-in staff carrying boxes with you. Before you know it your pictures are up, your closet is full, you've moved in. It feels good. By now your roomate’s arrived and small talks with you as they unpack. You're gonna get along great. [[Move Forward]]

“Welcome to Montana State University!” you hear a friendly voice exclaim as you pull onto campus. It's fall, move-in day, freshman year of college. You have boxes full of clothes, sheets, pictures, school supplies…. Everything you could think of that you might need, you packed. You're finally out living on your own. Responsible for yourself, for your studies, no curfew, you make your own decisions. Wow. This is a huge shift from living at home your whole life, but you’re so excited. You know you chose the right school and you're eager to make new friends. With your first box to unpack in your left hand and a duffel of clothes in your right, you walk down the halls of your dorm. The warm smiles of friendly RA’s greet you as you pass more and more doors until you reach your own. You walk in and look around. You have a bed, a desk, a set of drawers, a closet, and a bulletin board. Your roommate hasn’t arrived yet so you jump on the opportunity to get a headstart unpacking before the room gets too chaotic with two people moving in. You open up your box, pull out your sheets, and make your bed. Your new home. The next few hours are composed of trips to and from the car with the help of RA’s and move-in staff carrying boxes with you. Before you know it your pictures are up, your closet is full, you've moved in. It feels good. By now your roommate's arrived and small talks with you as they unpack. You're gonna get along great. [[Move Forward]]

Jump forward two months, it's October. By now you've adjusted pretty well to your new life. Living in the dorms, staying up late studying, staying up late socializing, dining hall breakfasts with your new friends, big class lectures, small class recitations, and of course the most important, you can finally navigate your way between classes without getting lost. It really does feel like a new home. You're lucky you met such great friends early on in classes and around your dorm. Of course it's been a huge transition, but you're managing it really well. You've gotten into a steady rhythm with balancing school and play. You might have even joined a few clubs. Are you a part of an art club? A sports club? A music club? What about an academic club? Think about it and decide how you wanna spend your extra time at school. Maybe you didn't join a club and instead hangout with your new friends a lot. Or maybe you take your extra time to play some music or grab a book and stalk up for alone time. However you're spending your extra time, keep up, because you really feel like you're finding your niche here on campus. [[Continue 2]]

It’s already three years later, fall of your senior year. “Hey! Where were you this weekend? We missed you, how are you?” Your friend exclaims as you meet up with them outside of class. You've been feeling a little more socially withdrawn and fatigued lately so you don't feel up to going and hanging out with friends everyday or overly socializing anymore. But don't worry about it too much, you know you're just going through a phase. You've noticed yourself feeling like this every now and again over the past few years but it's never really distressed or impaired you so it's no big deal. Everyone goes through phases of feeling more or less social right? You smile, catch up, and walk into class. You like your classes for the most part, sure it's a lot of work because it's college but you get to learn and you sit next to friends in most of your classes so the time goes by faster. Of course by now your work loads picked up, you're a senior taking all upper division classes. “I'm gonna go over to the library and bust out some work if you wanna come along?” your friend mentions as you're walking out of class. [[You want to study together]] [[You want to work on your own]]

You smile and head towards the library with them. You can kick yourself out of this little antisocial phase you're going through, just make an effort to accommodate more time for social life. You realize you do miss spending your time with friends like you used to and studying together is a great way to kill two birds with one stone. You both spot another one of your friends sitting alone at a table flipping through notes. “Hey!” they wave you over and you pull up two more chairs. Small talk followed by segments of silence as you all focus on your work make up the next several hours. You glance at your phone for the time, 8ockock already! You've been really focused and didn't even realize you missed dinner. You all grab a bite of food together after you leave the library, and then head off to go home and get some sleep before your early classes tomorrow. [[Continue 3]]

You smile and explain that you'd love to but you wanna really focus and knock out the work on your own. Of course, they understand, “For sure! I'll see you later”. You head home, headphones in, listening to music. It's a beautiful day out, maybe you'll stop by a cafe on your way home and sit outside with some work. As you walk in you spot a few friends already gathered at a table outside. They notice you and wave you over. It's good to see them even though you were set on just working alone. You do sort of miss spending your time with friends like you used to and studying together is a great way to kill two birds with one stone. Why not. You pull up a chair, briefly catch up, and dive into work. Small talk followed by segments of silence as you all focus on your work make up the next several hours.You glance at your phone for the time, 8 o’clock already! You've been really focused and didn't even realize you missed dinner. You all grab a bite of food together after you leave the cafe, and then head off to go home and get some sleep before your early classes tomorrow. [[Continue 3]]

BEEEEEP. BEEEEEP. BEEEEEP. You roll over and silence your alarm. Rubbing your eyes to wake up, your phone reads 7:30. Time to get up, wash your face, review a little bit, and head to your exam. It’s halfway through first semester, which means midterms. The cool fall air drifts into your room through your cracked window. You're really tired this morning, even though you went to sleep at a reasonable hour. In fact, you've noticed that a lot lately. You seem to always feel a little extra fatigued, no matter how much sleep you get, which has been a lot these days. But it's okay, you're in your fourth and final year of college. You have a lot on your plate and it's tiring. That's perfectly normal to be feeling a little extra tired right now. Well, if you're honest with yourself it's a lot extra tiring, but still, that's fine and normal, right? Anyhow, you close your window, slide your shoes on, grab a pen, and head to your exam. [[Continue 4]]

“Hey! Wait up!” You shout as you run over to a group of friends you spot across the street. They're heading to grab lunch, and you tag along. There isn't much catching up to do, it's about a month after midterms and your back to seeing them on a regular basis. See? That whole overly tired, recluded phase was just that, a phase. You were pretty stressed and just in a funk. You're doing great now. In fact, you've been seeing your friends a lot lately. This past week you've been seeing them everyday. You meet up with people in the mornings before class and see other friends during class who you usually end up spending the rest of your day with. You keep waking up in a good mood every day super motivated, even though you've been staying up late most nights. You sit down at lunch and eagerly launch into explaining this new, amazing idea you have. [[Your idea is related to a new art project you want to make]] [[Your idea is related to environmental sustainability]]

Okay. You launch in. You have this great idea about creating murals on all the buildings in the community to utilize art to promote acceptance and all inclusiveness. You need to get a permit for street art? Or permission from each of the individual property owners you want to paint on? Well, you haven't finished sorting through all the logistics yet but you know it's a great idea. You're rambling on about where and what you'll paint. It's one of the best ideas you've ever had. Your friends are all smiling and listening but aren't as enthusiastic as you are and you don't understand why. “It's a great idea, but slow down” huh? “All week you keep spouting out new grand project ideas, which is great, but think about the logistics, and do you really think this is gonna make that much of an impact?” one of your friends says. Okay. take a deep breath. They have a point. You have had some new grand idea almost every day this week. But why don't your friends support you..? Or maybe you're just overreacting. They move onto a new conversation but you just can't shake how they disregarded and underestimated your idea. You cut into their conversation, not sure what they're talking about because you're not really listening but you need to feel heard - you assert that they don't seem to care and it upsets you. In fact it's upsetting you more than you realize. You start raising your voice at them and in your frustration you grab your bag, leave some money on the table and walk out. You feel blatantly disrespected, like they just disregard your ideas. As your walking home you wonder, was my reaction too extreme? Was I too hostile with my friends? [[You go back and apologize]] [[You stand by how you feel and keep walking home]]

Okay. You launch in. You have this great idea about getting the coffee shops to offer free refillable coffees to anyone who brings their own mug. You explain, think about in the library, for early morning classes, so much waste is produced through all the single use cups students go through. If you entice people by saving money, they'd save $3.30 on every single coffee, who wouldn't go for it? “Well how would the businesses not lose profit?” one of your friends asks. Of course, they are spending less money on cups, you explain. “I’m not sure that'd be enough” your friend replies. “Think about the logistics, cups cost little to nothing, and how impactful do you think this could really be? All week you keep spouting out new grand project ideas, which is great, but slow down” Okay. Take a deep breath. They have a point. You have had some new grand idea almost every day this week. But why don't your friends support you..? Or maybe you're just overreacting. They move onto a new conversation but you just can't shake how they disregarded and underestimated your idea. You cut into their conversation, not sure what they're talking about because you're not really listening but you need to feel heard - you assert that they don't seem to care and it upsets you. In fact it's upsetting you more than you realize. You start raising your voice at them and in your frustration you grab your bag, leave some money on the table and walk out. You feel blatantly disrespected, like they just disregard your ideas. As your walking home you wonder, was my reaction too extreme? Was I too hostile with my friends? [[You go back and apologize]] [[You stand by how you feel and keep walking home]]

You head back to the restaurant you were all grabbing lunch at, and apologize for overreacting. It feels a little awkward and they tell you it was a lot but accept your apology and say they'll catch you later. You head back in the direction of home, still feeling undervalued and upset but you brush away the remnants of disrespect you feel, you don't have time for that anyhow. You have too much school work to do and too much progress to make on this big idea to let others distract you right now. [[Continue 5]]

You shake away the intruding regret of your actions and standby how you feel. No. They hurt you, they acted like your idea isn't important. You brush away the remnants of disrespect you feel, you don't have time for that anyhow. You have too much school work to do and too much progress to make on this big idea to let others distract you right now. [[Continue 5]]

It’s now spring semester senior year. You can't believe how quickly college flew by. You have a job lined up for after graduation so you aren't too worried about post-graduation life but it's definitely going to be different. A lot of your friends are moving back home, but a few plan to stay in the area like you, so that'll be nice. That huge idea you had last semester? Yeah that didn't work out. Don't get too upset though, it's only because you dropped the project for a new and better idea you had, but then dropped that project for another different idea. After a few weeks you became tired of all these ideas and went back to focusing on your school work and your social life. Well, mostly your school work now. You've been feeling socially withdrawn again and pretty tired. You know it's nothing serious because just a few weeks ago you were at your normal pace, keeping up with friends, classes, and any other hobbies you have. You decide you're just in another one of your slumps you get sometimes. This one feels a little worse though. In fact, you haven't really felt motivation to do much at all lately. Your friends you still see in classes, which you try to attend regularly still, but sometimes it feels really hard to stay focused. Social events? You just don't have the energy to keep up with all of that at the moment. It bothers you a little bit because you do miss hanging out, but it's not worth all the effort, and even when you do go out someone usually says or does something that just pisses you off or bothers you to the point where you can't shake it. It's okay though, people change and your friends just might not be a great fit for you anymore. And as far as feeling reclusive right now, that'll pass. Every time you've felt like this before it always passes. [[Continue 6]]

Congratulations. You made it through college. It's late spring and earlier today you walked across the stage and received your diploma. Doesn't It feel like yesterday when you were deciding what school to go to? You feel good. You're proud of yourself. And you should be, you worked hard for four years and made great memories. You’re walking across the parking lot towards your car after the ceremony and notice someone walking a few yards away toss their empty plastic water bottle on the ground. This bothers you a lot. They're littering. For a split moment you consider picking it up and recycling it for them, but then you feel angry and decide they should be called out for their actions. You shout at them to pick up their trash. They turn around and apologize but their initial action of throwing it on the ground pissed you off too much. You don't stop shouting at them when they pick it up. In fact it feels kinda good to assert yourself and you don't stop yelling until they dash away far enough they can't hear you. But then you feel bad. You just yelled at someone you don't know. Pretty aggressively too. It almost felt out of control. But no, you were in the right. You’re superior to them because you do the right thing and they were littering. They're in the wrong. [[Continue 7]]

After graduation you move into an apartment nearby where you'll be starting work in about a month. It's an important place because it's where you intend to live the next several years. You spend the next few days packing, moving, and unpacking boxes. All the long hours of manual moving sparks a small desire in you to reach out and get some help from your friends. Unfortunately you aren’t very close with them anymore. But it's okay, it turns out they weren’t nearly as smart as you or as capable. You're better without them. Plus you've been feeling tons of motivation recently to fully invest yourself into modeling your new home the way you want. You buy new furniture, new bedding, new light fixtures. You aren't worried about money at all. You're starting a real job soon! You know exactly what you're doing. You log endless hours into decorating, redecorating, getting everything just so. First you set up your new bed frame with your new mattress and your new bedding. This has to be first so you can have a place to sleep. But as you keep working you find that you don't even need that much sleep! You're so psyched on your project that it feels like nothing else matters. Right when you think you've finished you take a step back and realize it’s not done. Different lights. Different Rug. You're committed to making it perfect. [[Continue 8]]

Goodmorning. You wake up on your couch - you must have fallen asleep while you were working on your apartment. What time is it? You wipe your eyes and look at your phone. It reads 1:15. You have no idea how long you slept, it must have been a while if it's the afternoon… you must have needed it. Suddenly you're aware of the sharp hunger shooting through your abdomen. When's the last time you ate? You can't remember. You lethargically move to get up and go grab some food but theres a throbbing in your head that makes it nearly impossible. You notice you feel pretty achy and weak too. You worked yourself too hard and your lack of sleep and appetite caught up to you. You really don't feel good. [[You call the doctor]] [[You decide you're fine and sleep it off]]

You reach for your phone, call your doctor, and make an appointment for later today. [[Continue 9]]

You lay back down on the couch attempting to sleep it off. You know that the only thing wrong is your lack of nourishment and sleep, but the pounding in your head and aching body is unignorable. After a few hours of lying in your incomfort you push aside your stubbornness, reach for your phone, and make an appointment to see the doctor later today. [[Continue 9]]

You're in the waiting room of the doctors office. You hear the gentle voice of a nurse call your name, “The doctor will see you now”. You stand and follow her down a hall into the second room on the left labeled 2. “The doctor will be in in just a moment,” the nurse says as she softly closes the door behind her. A few minutes later there’s a knock followed by your doctor entering the room and shaking your hand. You tell him your symptoms and explain it’s simply because you got too caught up in your project and forgot to eat or sleep much for a few days. Wait, no, a week. Yeah, you count back the days, it had been about a week. The doctor cuts you off to ask a question but you abruptly tell him to let you finish your story and not interrupt. And he does. When you're done speaking he starts asking you not medical, but personal questions like; Do you find yourself becoming overly invested in projects like this frequently? You think back to all the ideas and projects you would temporarily invest yourself into in college. The ones that your friends always told you to “slow down on”. Maybe you do have a pattern of this. You talk for a while with the doctor. He prescribes you rest and electrolytes. He says you simply wore yourself out. But that's not all. He also refers you to the psychiatric department within the hospital. He asks you to just go answer a few questions. You realize you did just spend most of your savings and an entire week's worth of non stop energy into modeling your apartment. That extent of investment isn't something you can recall ever doing before. Now that you're not in the middle of the project you realize how extreme that is and you feel foolish, and honestly, a little humiliated. [[You decide to go to psychiatric services]] [[You decide not to]]

You've been diagnosed with Bipolar I. What you experienced in your apartment was your first manic episode. The “slumps” you felt throughout college were early onset depressive episodes. You're medicated now and your outbursts and episodes feel stable. But you also feel less pleasure as you go through your daily life. You label it as feeling numb. You understand the medication regulates your moods but you miss the level of emotion you used to experience. It’s fine you're glad you don't dip into depressive episodes anymore and you can't risk another manic episode. You lost too much money last time and it took too much of a toll on your body. You know that. So you take your medication. [[Continue 11]]

It's the end of summer. You’ve started your new job. Your starting salary is decent so you can't complain much but your coworkers frustrate you a lot. They always accuse you of getting off task. You had to have a disciplinary meeting with your boss a few weeks ago about your short temper. You wanted to explain your temper wouldn't be so short if your coworkers were more competent but instead you bit your tongue and returned to your work. You think they don't like you because you come off as unempathetic, but you attribute that to the fact that they don't deserve your empathy because of their incompetence. After a few more weeks your boss calls you into her office again. She tells you there's been more complaints about your temper and hostility. You don't feel like you've been having unreasonable reactions lately, and this really pisses you off. You shouldnt be reduced to a level of inconsiderateness. You Quit. [[Continue 12]]

It's the end of summer. You’ve started your new job. Your starting salary is decent so you can't complain much but your coworkers frustrate you a lot. They always accuse you of getting off task. You had to have a disciplinary meeting with your boss a few weeks ago about your short temper. You wanted to explain your temper wouldn't be so short if your coworkers were more competent but instead you bit your tongue and returned to your work. You think they don't like you because you come off as unempathetic, but you attribute that to the meds. After a few more weeks your boss calls you into her office again. She tells you there's been more complaints about your temper and hostility. You don't feel like you've been having unreasonable reactions lately, and you're still on your medication… Maybe it's not working? No, you know its doing something because it numbs you out. If you're still getting complaints about your behavior while on your meds you might as well stop taking them right? Your coworkers aren't happy with your performance now and you hate the way the drugs feel so why not? [[You decide to go off your medication]] [[You decide to stay on your medication]]

It's a few months later. After you quit your job you bought a plane ticket and flew to Los Angeles because you felt a calling to become a movie star. You know you're not crazy. There is a higher calling for you in this life. But while you were in LA you ran into some legal trouble. You aren't sponsored by an acting agency and when you couldn't book any auditions you showed up at the door of an agency, when they asked you to leave you got violent. You tried to beat up security and ended up in a hospital. They asked you a lot of questions, ran a few tests. You've been diagnosed with Bipolar I. What you experienced in your apartment and when you flew to LA were manic episodes. The “slumps” you felt throughout college were early onset depressive episodes. You're medicated now and your outbursts and episodes feel stable. But you also feel less pleasure as you go through your daily life. You label it as feeling numb. You understand the medication regulates your moods but you miss the level of emotion you used to experience. It’s fine you're glad you don't dip into depressive episodes anymore and you can't risk another manic episode. You lost too much money last time and it took too much of a toll on your body. You know that. So you take your medication. [[Continue 13]]

It's five years later. The warm sun soaks into your skin as you stroll across a grassy yard. Sounds and smells of spring fill your senses. You're having a good day. Well, as good of a day as you can, which is pretty mundane and repetitive of every other day you've had for the past three months. You're living in a mental institute. This isn't your first time here though, you get discharged and usually end up back in the facility within a few months. Sometimes it's because you go off your meds because of how numbing they feel and sometimes it's because you need stronger medication because your symptoms are worsening. But it's okay, there's good food here and the staff treats you well. They wake you up each morning with a warm smile followed by some fresh breakfast and a cup of pills. The rest of the day usually entails walking outside, watching TV, and sometimes you venture to strike up some small talk with other patients. Though you don't particularly like any of them. A lot of the people here are really weird and they appear to be incredibly impaired by their disorders. You think a lot about how lucky you are to barely be affected. Of course you know that your mania is bad because you'd always end up spending more than you intended, and your depressive episodes prevented you from having motivation to do, well, essentially anything. But you're on strong meds and while you're here the staff makes you take them regularly so you feel perfectly normal. Well, relatively bored and numb, but normal. You're also on new meds for schizophrenia. The doctors tell you that your ideas over grandeur and short patience you've experienced are because of that. You take the meds they give you but that doesn't stop you from knowing deep down that you aren't just “mentally ill”. You are meant for something more than all of this, you feel a calling from the universe and you just have to be patient, behave, and get released again so you can go back off these strangling medications and pursue what you were put on this earth for. [[Continue 14]]

You went off your medication a few months ago. Apparently it was helping you because shortly after you stopped taking it, you quit your job during another manic episode. You bought a plane ticket and flew to Los Angeles because you felt a calling to become a movie star. You know you're not crazy. There is a higher calling for you in this life. But while you were in LA you ran into some legal trouble. You aren't sponsored by an acting agency and when you couldn't book any auditions you showed up at the door of an agency, when they asked you to leave you got violent. You tried to beat up security and ended up in a hospital. You're back on medication. The hospital released you because your moods seemed more stabilized once you were back on meds. You have to keep taking them. That was one of the agreements with your discharge. You're frustrated but you do as you're told. You're back home now, but you lost your job and have no income. You need to start looking for new jobs, and maybe start looking for a smaller apartment. It's going to be hard to keep up with rent without an income. [[Continue 13]]

You've stayed on your medication but your “unreasonable outbursts” at coworkers worsened. You don't understand why everyone thinks you're unreasonable. Theyre just all extremely incompetent. You're pretty bored most of the day. You know that you have a purpose in life greater than anyone you know, they don't get it. Today was just like any other day; you woke up, got dressed, went into work, barely survived that intolerable place, and returned home. Your apartment is pretty messy nowadays. You've always been a tidy person but right now you don't have to clean. You're above that, maybe you should hire a cleaning service so you never have to stoop as low as picking up your own trash? Good idea. In fact, you should have a personal chef too. You're serious, it's a great idea. Full staff. You just need to compose a plan that gets you rich enough. That shouldn't be too hard, you're the smartest person you know and you're capable of achieving anything you set your mind to. [[Continue 13]]

It's 3 years later. Since your first hospitalization, you've been regularly in and out of institutes every few months. But now you've been here almost a year. You don't like your medications, they are too strong and give you terrible headaches. You just don't feel like yourself at all anymore. The doctors tell you your condition is too severe to be unmedicated and they force you to take them while you’re locked up in this place. Your treatment team administers you several different antipsychotic drugs, each with varying and irregular results. They explain to you that because there is so much uncertainty of mental diagnosis and proper treatments they have to try various methods of treatment and see how well it works. You hate it. They don't even know exactly what is best for you and they shove pills down your throat everyday. Your life has become various doctors administering various pills to you everyday. You find less pleasure in walks and no desire to watch television. How is that productive? Sitting in front of a screen that is brainwashing you. It's ridiculous that Televisions are even legal. The only thing that keeps you going is your purpose on this earth. God spoke to you. He did. Not many believe you but you've been chosen by him. The only good part of living amongst mentally ill patients is that you get to tell them about your mission. The nurses and doctors disregard you. Do they not understand the significance of God reaching out to a human directly? They'll see soon, you are the chosen one. You're waiting for your upcoming discharge so you can go off these medications, or maybe switch to a lower dosage, hear yourself think again, and pursue your purpose. [[Continue 15]]

Finally. The doctor tells you you'll be discharged within the following weeks. Your aggressive tendencies appear to be under control, and you stopped trying to explain how God spoke to you to these people because they are too imcompetant to understand you. As a result they mark your “delusions'' as under control as well. The doctors might not all be against you, maybe you can talk them into lowering your dosage so that your worst symptoms are under control but you can think more clearly and feel like yourself. “Before your discharge we will be administering a dose of Prolixin Decanoate to you” a nurse explains. What?? This isn't a pill you've ever taken before. “Because of its long lasting effects, it'll be easier for you to maintain your progress post discharge. It's an injection”. Is she serious?! You break into a fit of screaming and crying. The uncomfort of chemicals being forced into you orally daily is bad enough. They're trying to inject you!? No. You won't have it. [[Your anger overwhelms you, you don't have a choice, you lash out. ]]

You instinctively reach to grab for the nurse, if she isn't able to tell the other doctors what she's decided, then maybe you can just stay on your pills. Before you get to her though security is grabbing you and dragging you and tieing you down. You can't hear what they're saying over your screams and the throbbing in your head. They shove something in you through a needle. You sleep. [[Continue 16]]

You've decided to go to court on the basis to prevent the hospital from forcibly administering psychotropic medication to you against your will, in the absence of an emergency. From here on out, you, the reader, will take the perspective of either the judge or medical staff. Choose wisely, it will be the lens through which you read through and the position on which you hold power over the patient you have been living through the eyes of. [[I'm the judge for this case]] [[I'm the psychiatrist for the patient]]

“Order in the court!” your gavel hits the podium in front of you. You acknowledge the patient's right to a due process hearing before psychiatrists can administer drugs against the patient's will. The hearing begins. You welcome the plaintiff, the patient, to the podium. “I've been doing better” they begin, “I've been controlling my temper better and making improvements. I want to be healthy. I want to think clearly and these antipsychotics fog up my brain. I want to find joy in little things again. And these high doses of pills keep me from fully accessing my emotions and they want to increase the dosage and invasiveness of my medication.” The patient continues on to explain their stance; understanding the positive effects of their treatment thus far but also the inhibitions and high intrusiveness it results in. You hear the medical staff explain the importance of providing a safe environment for the patient, staff, and other patients. You: [[Propose a compromise]] [[Further question the medical team]]

“Order in the court!” The judge’s gavel hits the podium in front of you. He acknowledges the patient's right to a due process hearing before you may administer drugs against the patients will.The trial begins. The Judge welcomes the plaintiff, your patient, to the podium. “I've been doing better” they begin “I've been controlling my temper better and making improvements. I want to be healthy. I want to think clearly and these antipsychotics fog up my brain. I want to find joy in little things again. And these high doses of pills keep me from fully accessing my emotions and they want to Increase the dosage and invasiveness of my medication.” Your patient continues on to explain their stance; understanding the positive effects of their treatment but also the inhibitions and high intrusiveness it results in. The judge proposes a compromise. “Medication may still be administered, however, the least invasive and restrictive options should be utilized in medication.” he states. You know this is not enough of a compromise. Your patient has a history of not taking self administered, oral medication. You explain that off of medication they are a physical threat to themselves, to other patients, and to staff of the institution. The shift to a more invasive form of medication is a matter of safety. [[The Judge further questions you]]

You propose a compromise. Medication may still be administered, however, the least invasive and restrictive options should be utilized in medication. The medical team explains to you the patient's history of not taking self administered, oral medication. “Off of medication they are a physical threat to themselves, to other patients, and to staff of the institution” a psychiatrist explains. You acknowledge this and: [[Revise your compromise]] [[You decide to further question the medical team]]

You ask the medical team to further explain the patient's symptoms and behavior that lead to his diagnosis and treatment. The team of professionals list the patients symptoms including: socially withdrawn, hostile and extreme reactions to criticism, oversleeping at certain times, decreased need for sleep at other times, difficulty focusing, excessive spending, feeling overly enthusiastic and high for a few weeks at time (mania), restlessness and impulsivity, talking very fast with racing thoughts, easily distracted between ideas, easy agitation, severe delusions of being the modern Jesus Christ, expressing a lack of empathy. “And explain the process and certainty of the patients diagnoses.” You continue to speak with the medical team. They explain that the patient displays clear symptoms and behaviors of Bipolar I as well as Schizophrenia. However, they also continue to explain that psychiatric diagnoses always have a level of uncertainty, given the nature of no formal blood work or brain scan being able to diagnose a mental disease. Had the patient seen a doctor before their first manic episode, they would have most likely been diagnosed with Major Depressive Disorder. Or in early stages of schizophrenia symptoms can often be confused with personality disorders such as Borderline or Antisocial Personality Disorder. You think for a moment. [[Because psychiatric diagnoses are so uncertain, you decide the final decision belongs in the hands of the patient rather than the doctors]] [[You propose a compromise]]

Instead of demanding the hospital refrain from administering invasive medication, you order the Prolixin injection levels be lowered to a minimum maintenance dose. The staff psychiatrists are discontent with this ruling and demand that this amount is insufficient. [[Further Question The Medical Team]]

You ask the medical team to further explain the patient's symptoms and behaviors that lead to his diagnosis and treatment. The team of professionals describe the patient's symptoms including: socially withdrawn, hostile and extreme reactions to criticism, oversleeping at certain times, decreased need for sleep at other times, difficulty focusing, excessive spending, feeling overly enthusiastic and high for a few weeks at time (mania), restlessness and impulsivity, talking very fast with racing thoughts, easily distracted between ideas, easy agitation, severe delusions of being the modern Jesus Christ, expressing a lack of empathy. “And explain the process and certainty of the patient's diagnoses.” you continue to speak with the medical team. They explain that the patient displays clear symptoms of Bipolar I as well as Schizophrenia. However, they also continue to explain that psychiatric diagnoses always have a level of uncertainty, given the nature of no formal blood work or brain scan being able to diagnose a mental disease. Had the patient seen a doctor before their first manic episode, they would have most likely been diagnosed with Major Depressive Disorder. Or in early stages of schizophrenia symptoms can often be confused with personality disorders such as Borderline or Antisocial Personality Disorder. You think for a moment. [[You decide that because psychiatric diagnoses were so uncertain, the final decision belongs in the hands of the patient rather than the doctors]] [[You refine your initial compromise]]

“Because psychiatric diagnoses are so uncertain, the final decision belongs in the hands of the patient rather than the doctors.” You state. “Whether the potential benefits are worth the risks is a uniquely personal decision”. The team assures you that the drugs administered in the past have in fact reduced their symptoms and increased the safety of the patient and those around them. “This patient is a physical threat to themself and others unmedicated '' One psychiatrist reiterates. [[You refine your initial compromise]]

You refine your initial compromise. Instead of demanding the hospital refrain from administering invasive medication, you order the Prolixin injection levels be lowered to a minimum maintenance dose. The staff psychiatrists are discontent with this ruling and demand that this amount is insufficient. "The patient is a physical threat to those around them. They need a high dose of an invasive medication," a psychiatrist from the medical team insists. "Maintenance and control over this patient's behaviors is incredibly important." You stop them. The patient’s capacity to decide on a particular treatment is limited but not to be fully disregarded. This hearing is regarding the absence of an emergency. The doctors may forcibly administer stronger psychotropic medications when necessary in the presence of an emergency. However, an injection is an invasive form of treatment and a minimum maintenance dose allows for a compromise between the staff and the patient. [[Conclusion. ]]

You ask the medical team to further explain the patient's symptoms and behavior that lead to his diagnosis and treatment. The team of professionals list the patient's symptoms including: socially withdrawn, hostile and extreme reactions to criticism, oversleeping at certain times, decreased need for sleep at other times, difficulty focusing, excessive spending, feeling overly enthusiastic and high for a few weeks at time (mania), restlessness and impulsivity, talking very fast with racing thoughts, easily distracted between ideas, easy agitation, severe delusions of being the modern Jesus Christ, expressing a lack of empathy. “And explain the process and certainty of the patients diagnoses.” You continue to speak with the medical team. They explain that the patient displays clear symptoms and behaviors of Bipolar I as well as Schizophrenia. However, they also continue to explain that psychiatric diagnoses always have a level of uncertainty, given the nature of no formal blood work or brain scan being able to diagnose a mental disease. Had the patient seen a doctor before their first manic episode, they would have most likely been diagnosed with Major Depressive Disorder. Or in early stages of schizophrenia symptoms can often be confused with personality disorders such as Borderline or Antisocial Personality Disorder. The team assures you that the drugs administered in the past have in fact reduced their symptoms and increased the safety of the patient and those around them. “This patient is a physical threat to themself and others unmedicated '' One psychiatrist reiterates. You think for a moment. [[You ask about the capacity of competence the patient holds]]

You refine your initial compromise. Instead of demanding the hospital refrain from administering invasive medication, you order the Prolixin injection levels be lowered to a minimum maintenance dose. The staff psychiatrists are discontent with this ruling and demand that this amount is insufficient."The patient is a physical threat to those around them. They need a high dose of an invasive medication," a psychiatrist from the medical team insists. "Maintenance and control over this patient's behaviors is incredibly important." You stop them. The patient’s capacity to decide on a particular treatment is limited but not to be fully disregarded. This hearing is regarding the absence of an emergency. The doctors may forcibly administer stronger psychotropic medications when necessary in the presence of an emergency. However, an injection is an invasive form of treatment and a minimum maintenance dose allows for a compromise between the staff and the patient. [[Conclusion. ]]

You are asked to further explain the patient's symptoms and behavior that lead to his diagnosis and treatment. You list the patients symptoms including: socially withdrawn, hostile and extreme reactions to criticism, oversleeping at certain times, decreased need for sleep at other times, difficulty focusing, excessive spending, feeling overly enthusiastic and high for a few weeks at time (mania), restlessness and impulsivity, talking very fast with racing thoughts, easily distracted between ideas, easy agitation, severe delusions of being the modern jesus christ, expressing a lack of empathy. [[You continue on to explain the diagnosis process]] [[You conclude your statement]]

You continue on to explain that the patient displays clear symptoms and behaviors of Bipolar I as well as schizophrenia. You also explain that psychiatric diagnoses always have a level of uncertainty given the nature of no formal blood work or brain scan being able to diagnose a mental disease. Had the patient seen a doctor before their first manic episode, they would have most likely been diagnosed with Major Depressive Disorder. Or in early stages of schizophrenia symptoms can often be confused with personality disorders such as Borderline or Antisocial Personality Disorder. You emphasize that though diagnoses can be uncertain, there is a clear history in your patient of symptoms and aggressive behaviors and delusions decreasing when they regularly take the prescribed medications. [[Continue 18]]

The judge pauses a moment, then asks, “And how certain is the diagnosis process given that large variety of symptoms?” You explain that the patient displays clear symptoms and behaviors of Bipolar I as well as Schizophrenia. You also explain that psychiatric diagnoses always have a level of uncertainty given the nature of no formal blood work or brain scan being able to diagnose a mental disease. Had the patient seen a doctor before their first manic episode, they would have most likely been diagnosed with Major Depressive Disorder. Or in early stages of schizophrenia symptoms can often be confused with personality disorders such as Borderline or Antisocial Personality Disorder. You emphasize that though diagnoses can be uncertain, there is a clear history in your patient of symptoms and aggressive behaviors and delusions decreasing when they regularly take the prescribed medications. [[Continue 18]]

The Judge continues the case, “Because psychiatric diagnoses were so uncertain, the final decision belongs in the hands of the patient rather than the doctors. Whether the potential benefits are worth the risks is a uniquely personal decision”. You reinforce to the judge your statement reassuring him that the drugs administered in the past have in fact reduced the patients symptoms and increased the safety of the patient and those around them. “This patient is a physical threat to themself and others unmedicated '' you reemphasize. [[You continue on to discuss the capacity of competence the patient holds]] [[You continue by emphasizing the reasoning behind increasing the invasiveness in order to maintain post discharge]]

Your patient is competent enough to have the capacity to understand the objective differences between treatments but doesn’t understand the way the drugs are actually helping them, you explain. They can tell the difference between a needle and a pill. And they can feel the difference between a low and high dose, however, they cannot objectively see the differences in their own behaviors between high and low dose medication. You emphasize the importance of properly maintaining the patient on medication. The Judge responds, refining his initial compromise, “Instead of demanding the hospital refrain from administering any medication, I order the Prolixin injection levels be lowered to a minimum maintenance dose.” [[You’re discontent with this ruling and demand that this amount is insufficient]]

You continue by explaining that damage that your patient can cause off of medication. You exemplify the violent reactions you've experienced and the extent of delusions your patient has. The judge responds, “Instead of demanding the hospital refrain from administering any medication, I order the Prolixin injection levels be lowered to a minimum maintenance dose.” [[You’re discontent with this ruling and demand that this amount is insufficient]] [[You accept the compromise]]

This amount of medication is not enough. The patient is a physical threat to those around them. They need a high dose of an invasive medication, you insist. Maintenance and control over this patient's behaviors is incredibly important. The judge stops you. “The patient’s capacity to decide on a particular treatment is limited but not to be fully disregarded. This hearing is regarding the absence of an emergency. You may forcibly administer stronger psychotropic medications when necessary in the presence of an emergency. However, an injection is an invasive form of treatment and a minimum maintenance dose allows for a compromise between yourself and your patient.” [[Continue 19]]

You worry this amount of medication is insufficient but as a psychiatrist you know your patient’s capacity to decide on a particular treatment is limited but not to be fully disregarded. A higher dose of the Prolixin injection would be ideal but the patient has the right to their treatment process in the absence of an emergency. An injection is an invasive form of treatment and a minimum maintenance dose allows for a compromise between yourself and your patient. [[Conclusion. ]]

You're frustrated this process allocates the final decision to the legal system, handing power to an individual who has limited contact with the patient themselves and holds no responsibility for the patient’s care. You worry this amount of medication is insufficient, a higher dose of the Prolixin injection would be ideal. There is nothing else to be done though, you cannot forcibly administer your patient any treatment in the absence of an emergency that is not approved by the legal system. [[Conclusion. ]]

The goal of this activity has been for you, the reader, to build empathy and understanding for individuals struggling with mental diseases. Too often, especially in cases like this one, a patient is viewed not as a person like you or me, but as some objective mentally ill figure. It is easy to forget that involuntarily committed mental patients deserve the same rights and options as you would want in that position. However, other patients and staff in the hospital have the right to protection from harm from high risk patients, such as seen in this case. All involuntary patients have a right to a due process hearing before psychiatrists can administer drugs against the patients will. Specific guidelines for establishing when the patient’s right to refuse psychotropic medication can be overruled: (1) the physical threat of the patient to other patients and staff of the institution; (2) the patient’s capacity to decide on a particular treatment; (3) the availability (and existence) of less restrictive alternatives; and (4) the nature and extent of risk of permanent side effects from the treatment being proposed. In practice this model leads to more ‘negotiations’ between patient and psychiatrist, that is, psychiatrists are more ready to listen to the patient’s complaints about medication and adapt to them. However a major flaw in the method is that it allocates the final decision to the legal system, handing power to an individual who has limited contact with the patient themselves and holds no responsibility for the patient’s care. [[Conclusion]]

How do we protect patients' rights to have a say in their treatment process while also providing a safe environment for the patient themself, staff and other patients? The extent of intervention, and how to decide when that intervention is ethically acceptable, is extrememly controversial and subjective to the individual viewpoint from which one stands.

You further question about the capacity of competence the patient holds. A psychiatrist on the patient's medical team explains the patient is competent enough to have the capacity to understand the objective differences between treatments but doesn’t understand the way the drugs are actually helping them. They can tell the difference between a needle and a pill. They can feel the difference between a low and high dose. However, they cannot objectively see the differences in their own behaviors between high and low dose medication. The medical professional emphasizes the importance of properly maintaining the patient on medication."The patient is a physical threat to those around them. They need a high dose of an invasive medication, maintenance and control over this patient's behaviors is incredibly important." You stop them. The patient’s capacity to decide on a particular treatment is limited but not to be fully disregarded. This hearing is regarding the absence of an emergency. The doctors may forcibly administer stronger psychotropic medications when necessary in the presence of an emergency. However, an injection is an invasive form of treatment and a minimum maintenance dose allows for a compromise between the staff and the patient. With more information you return to your prior compromise, "The hospital may administer medication in the form of an injection, however, I order the Prolixin injection levels be lowered to a minimum maintenance dose.” [[Conclusion. ]]