Q. Just how much control do consumers of mental health services have over their actions?

A. Just as much as non-consumers, which is to say, not much at all.

UNLESS the consumer is currently experiencing a psychotic episode. I guess the real question here is: During a psychotic episode, can a consumer:

1. tell right from wrong?

2. actually do the right (not the wrong) thing?

Actually, there is a word for "ability to tell right from wrong": sanity. It is a legal term, but so many people think it is a medical term that I had better deal with it.

When a consumer is in a psychotic state, are they necessarily insane? We don't know for sure.

We do know that, during psychotic episodes, consumers can usually tell good consequences from bad ones, and which side their bread is buttered on.

Once there was a fire in a psychiatric center which shall remain unnamed. Patients whose illnesses had forced them to be almost completely immobile for weeks got up and got out of that hospital -- fast.

When you are manic, you usually believe that you are in control of your own actions, even though you are not. Right after something horrible happens to you (e.g., your plane has engine trouble or someone points a gun at you) you may feel very calm, cool and collected. If you are bipolar, at least, you are not actually calm.

At the beginning of a manic episode (at least if it's triggered by a sudden, horrible event) you often go into denial for several minutes. You feel absolutely no emotion. You are confident that you are fully able to handle the emergency, and you immediately go about doing just that. (This period of denial can come in really handy in certain types of emergencies, such as when a fire breaks out in the theater.)

After a few minutes, you start to feel your emotions again. But you may still be overconfident, convinced that your judgment is flawless. It is extremely rare for a person who is currently manic to say, "I am manic." Rather, you will hear, "I've got the situation totally under control." 

Control seems to be a contradictory thing. If you are positive that you are in control, you probably are not. If you are worried about staying in control, you are probably fine. And that brief period of denial can keep you calm and in control. I am sure that it has saved many lives.

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