Psychiatric Advanced Directives

Psychiatric Advanced Directives

I believe in healing & I believe in recovery.

After surviving so many tragic circumstances and injuries, I fully understand how fragile life is and why we must protect ourselves from both seen and unforeseen events, which jeopardize our health and safety. 

This presentation is a discussion on the importance of having psychiatric advanced directives. After my ‘break’, I have tirelessly searched for a health care proxy. A health care proxy is someone charged with making medical & psychiatric decisions if you or a person becomes incapacitated. 

Speaking from a position in which I was deemed incapacitated, or in plainer English, ‘insane,’ I know full well that people need a ‘point person’ to make educated and personal decisions by proxy if you or someone you love cannot speak for themselves.

While I believe so passionately in healing, rallying back, and recovery, I also believe in the beauty of radically accepting Palliative Care/Medicine. The importance of a peaceful transitional life experience when my journey here is almost complete is important to me.

I have interned in cancer wards, lived in psychiatric wards, and been ripped out of a car with the jaws of life to live in a rehabilitation ward in a hospital, helping me learn how to walk again. These experiences paint the search for a proxy with an intensity frequently felt by myself and family & friends concerned about my car in the event of future tragic circumstances.

Indeed, I am still searching for the right fit and point person to carry out my will if I lose capacity and/or am too sick to make medical and psychiatric decisions. Recently I began screening candidates & vetting them for their moral, ethical, and spiritual values. When psychiatric decisions are involved, as complex as human anatomy is, questions about mental degradation and quality of life after psychiatric emergencies go even deeper in a vast well of uncertainty.

After ten years, I still haven’t made a final selection to proxy my will. Tirelessly, I have put out flyers and solicited friends & family to fill out applications for my Health Care Proxy position in my transitional life team, but no one has answered my calling. There is no question that this might also entail co-morbid radical medical interventions. Both my physical health & mental status may one day be so compromised I cannot make decisions regarding my care. 

For your own search, I recommend rigorously interviewing all proxy qualified applicants and asking them about their availability to meet for bi-weekly updates and revisions to your preferred life-sustaining interventions and other medical & psychiatric treatment that captures your philosophy regarding transitional life events. 

Identify early your proxy’s stance on recovery. The proxy’s relative feelings and thoughts arent your general health now, and the potential to rally back and benefit from rehabilitation/further treatment will shape their future decisions about your psychiatric care.

In my personal life, I made a shortlist of applicants interested in being my proxy. I have also asked each of my potential proxy’s to prepare a presentation on their approach to and personal philosophy regarding readiness for transitional medicine and his or her assessment of your potential to benefit from psychiatric rehabilitation. 

Ultimately, this is about your care and treatment when you too sick medically or psychiatrically determined to not have the capacity to make decisions and your ongoing treatment. Make the right decision today and appoint a proxy colluding with your interests for the right care every day towards your ultimate relief and recovery. 


J. Peters

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association. Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia. "I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others." "In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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