Can ‘Mad Maps’ Offer Patients a Way to Take Charge of Their Psychiatric Care?

Like advanced directives for the dying, DuBrul explained, mad maps allow psychiatric patients to outline what they’d like their care to look like in future mental health crises. The logic is: If a person can define health, while healthy, and differentiate health from crisis, that person can shape his or her own care. The maps are not intended to be rejections of psychiatry, though they could be that. The maps are designed to force patients and family members to plan ahead—to treat a relapse as possible or even likely—in order to avoid, or at least minimize, future mistakes.

When Jonas was 16 months old, Giulia and I put a bottle of anti-psychotics in our medicine cabinet, just in case. This might seem reasonable, but it was silly. We hadn’t yet heard of mad maps, so we’d never discussed what a situation would have to look like for Giulia to take the pills, and that made the medication useless. Was she going to take them if she wasn’t sleeping enough? Or was she going to wait until she was already psychotic? If she waited until she was psychotic, she would also likely be paranoid, meaning that she wouldn’t take the pills willingly. Me convincing her to do so at that point would be almost impossible.

…This is where mad maps offer a shard of hope. Giulia and I, finally, are trying to make one, and now that we’re doing so I have to concede that in some ways, Laing was right: The treatment of psychosis is about power. Who gets to decide what behavior is tolerated? Who chooses how and when to enforce the rules? We started trying to create Giulia’s map by discussing the pills in the medicine cabinet. Under what circumstances would Giulia take them, and how much would she take? I took a hardline approach: No sleep for one night, pills at maximum dosage. Giulia wanted more time before jumping to medication, and favored starting the dose out light. We argued bitterly as we outlined our positions and punched holes in each other’s logic. Ultimately we had to sit down with Giulia’s psychiatrist to figure it out. Now we have a plan—for one bottle of pills. It’s a small victory, but a genuine step in the right direction in a world where such steps are rare.

—From “My Lovely Wife in the Psych Ward,” a recent essay by Mark Lukach for Pacific Standard. In the piece Lukach discusses his relationship with his wife Giulia, and how it shifted from husband to caregiver and back again after she suffered a psychotic break.