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Now Mental Health Patients Can Specify Their Care Before Hallucinations and Voices Overwhelm Them

Ariel Wolf, 25, has been hospitalized over 30 times since age 13, when she began cutting herself with razor blades. Her brain directed her to inflict injuries meeting “certain dimensions of width and depth and location on my body,” she said recently in a cafe near her home in Winston-Salem, accompanied by her service dog, Jubilee.

She’d slash her arms, elbows, shoulders and feet, photographing the wounds and sewing them up with fishing line. “By the time I got to 5,000, I was sitting in the bathroom all night, obsessively cutting,” she said. At 15, aiming to remove her appendix, she sliced a three-inch gash, stopping only when her mother came home.

At 17, during months of psychiatric hospitalization, Ms. Wolf, who has bipolar disorder with psychotic features, swallowed staples and shoved a paper clip into her thumb. But just before her birthday, she completed a directive, allowing her parents to participate in her care after she turned 18.

That helped save her, she said. Her parents communicated her directive’s preferences, including objections to electroconvulsive therapy and antipsychotic medications. Before having the document, she believes doctors sometimes considered her obstinate and forced treatment on her.

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