Divorcing a wife with schizophrenia
December 20, 2009 8:34 AM Subscribe
After 20+ years of marriage, my dad wants a divorce. Mom has schizophrenia. Please help me think through this awful situation... [very long]
My mom was diagnosed with schizophrenia seven years ago. Since then, we've been through the same vicious cycle several times: her delusions reach a boiling point, the family takes her to a psychiatrist, he refers us to a MD, who prescribes Mom antipsychotic medication. She'll comply for a few weeks, then complain the medicine makes her feel bad, and will ultimately stop taking it. I understand that a major challenge for caretakers of individuals with schizophrenia is ensuring medicine compliance. We simply cannot force her to take the drugs, and though things might seem okay for a while, we always end up back on the roller coaster. Mom's even spent a few weeks in a psychiatric hospital.
My mom's delusions deal with demonic possession and "spiritual warfare," government control of the media, evil priests, motorcycle gangs, car bombs, and a litany of other bizarre things. One thing, though, is certain to her: my dad is the bad guy. She'll wait for him to get home from work in the evening, glare at him wordlessly for a while, and explode into a tirade about his perceived infidelity or witchcraft practices or even STDs. Many times, she's in absolute hysterics and follows him from room to room screaming.
Dad's had enough. While's he's mulled over divorce several times over the years, he's always stayed with Mom. This time, he's serious: he's going to get transferred overseas for his work and leave her behind. We're both terrified, though, of what will happen to Mom. It's obvious that he still loves her very much, though he's on the brink of a nervous breakdown himself and says he cannot stay with her. The situation is so ethically gray to me: It is unfair for my dad to take such vehement abuse day after day. It is destroying his life, and he is severely depressed. On the other hand, it seems cowardly and irresponsible to leave Mom, especially when she has a medical condition. We're waiting for my brother to fly home in a few days to sit down and have a discussion about all of this, which I am dreading with every fiber of my being.
I'm willing to help Mom get set up in a place of her own near me (what she's requested several times before when divorce has come up) and check in on her and spend time with her, but I'm scared how this will affect my future. I'm in my early twenties and applying for law school. I know it's a selfish thing to say, but I don't want to end up being the one burdened with this matter. What will happen when I go to school? She can't follow me forever...
I'd appreciate any insight you might have, including:
1) What options are there for Mom's housing in the long-term? She's definitely high-functioning and can handle day-to-day tasks, though I'm scared of what will happen when she's left alone.
2) Is there any way you know of to increase or ensure medicine compliance? Dad said he's willing to make if work if she'll just stay on medicine and go to counseling.
3) Is it worth our time to seek psychiatric help again? Dad is sure that it's a waste of time given the past few years.
4) Any other advice you have on dealing with loved ones and schizophrenia.
Throwaway email: anxious.askme@gmail.com
Appreciate it.
My mom was diagnosed with schizophrenia seven years ago. Since then, we've been through the same vicious cycle several times: her delusions reach a boiling point, the family takes her to a psychiatrist, he refers us to a MD, who prescribes Mom antipsychotic medication. She'll comply for a few weeks, then complain the medicine makes her feel bad, and will ultimately stop taking it. I understand that a major challenge for caretakers of individuals with schizophrenia is ensuring medicine compliance. We simply cannot force her to take the drugs, and though things might seem okay for a while, we always end up back on the roller coaster. Mom's even spent a few weeks in a psychiatric hospital.
My mom's delusions deal with demonic possession and "spiritual warfare," government control of the media, evil priests, motorcycle gangs, car bombs, and a litany of other bizarre things. One thing, though, is certain to her: my dad is the bad guy. She'll wait for him to get home from work in the evening, glare at him wordlessly for a while, and explode into a tirade about his perceived infidelity or witchcraft practices or even STDs. Many times, she's in absolute hysterics and follows him from room to room screaming.
Dad's had enough. While's he's mulled over divorce several times over the years, he's always stayed with Mom. This time, he's serious: he's going to get transferred overseas for his work and leave her behind. We're both terrified, though, of what will happen to Mom. It's obvious that he still loves her very much, though he's on the brink of a nervous breakdown himself and says he cannot stay with her. The situation is so ethically gray to me: It is unfair for my dad to take such vehement abuse day after day. It is destroying his life, and he is severely depressed. On the other hand, it seems cowardly and irresponsible to leave Mom, especially when she has a medical condition. We're waiting for my brother to fly home in a few days to sit down and have a discussion about all of this, which I am dreading with every fiber of my being.
I'm willing to help Mom get set up in a place of her own near me (what she's requested several times before when divorce has come up) and check in on her and spend time with her, but I'm scared how this will affect my future. I'm in my early twenties and applying for law school. I know it's a selfish thing to say, but I don't want to end up being the one burdened with this matter. What will happen when I go to school? She can't follow me forever...
I'd appreciate any insight you might have, including:
1) What options are there for Mom's housing in the long-term? She's definitely high-functioning and can handle day-to-day tasks, though I'm scared of what will happen when she's left alone.
2) Is there any way you know of to increase or ensure medicine compliance? Dad said he's willing to make if work if she'll just stay on medicine and go to counseling.
3) Is it worth our time to seek psychiatric help again? Dad is sure that it's a waste of time given the past few years.
4) Any other advice you have on dealing with loved ones and schizophrenia.
Throwaway email: anxious.askme@gmail.com
Appreciate it.
I'm sorry your family is going through this but this is a very awkward question to ask anonymously; more information would be really helpful here.
Where are all of you located, how old is your mother, what is your family's financial situation and what provisions is your father willing to make for your mother's care?
Divorce could be a disaster in that it could mean your mother losing health insurance, which in her situation could be catastrophic. I also think putting your mother through a divorce is potentially problematic, and may do nothing but deplete assets at a time when they are badly needed.
I am focusing on assets here because one option is for your parents to not divorce, your dad to go overseas, the house to be sold and your mother to move to an assisted living or independent living facility with basic healthcare services. This would need to be, at a minimum, a nursing or home help staff who could help her take daily meds and let you know when she isn't, so you can intervene as needed. The cost of this varies massively by geographic location and style of facilities, but it doesn't sound like your mother can be left entirely to her own devices, and given the pattern it seems that just setting her up in an apartment near you isn't sufficient to the need.
posted by DarlingBri at 8:55 AM on December 20, 2009
Where are all of you located, how old is your mother, what is your family's financial situation and what provisions is your father willing to make for your mother's care?
Divorce could be a disaster in that it could mean your mother losing health insurance, which in her situation could be catastrophic. I also think putting your mother through a divorce is potentially problematic, and may do nothing but deplete assets at a time when they are badly needed.
I am focusing on assets here because one option is for your parents to not divorce, your dad to go overseas, the house to be sold and your mother to move to an assisted living or independent living facility with basic healthcare services. This would need to be, at a minimum, a nursing or home help staff who could help her take daily meds and let you know when she isn't, so you can intervene as needed. The cost of this varies massively by geographic location and style of facilities, but it doesn't sound like your mother can be left entirely to her own devices, and given the pattern it seems that just setting her up in an apartment near you isn't sufficient to the need.
posted by DarlingBri at 8:55 AM on December 20, 2009
I have an acquaintance who does outpatient psychiatric nursing--her entire job is to make weekly or even daily visits to clients to make sure they are taking their medications, not living in squalor, etc. Would her insurance or your state cover something like this?
posted by availablelight at 8:59 AM on December 20, 2009
posted by availablelight at 8:59 AM on December 20, 2009
I'm sorry this is happening. There just is no easy answer with this kind of mental illness. A similar sort of situation happened in my family a while back.
There are, I think, two separate issues here. The first, your dad. It sounds like he is a decent sort of guy and has tried his best. But if your mom's delusions include him as one of the bad guys, he has to get out. Not only for his own sanity, but for his safety as well. Delusional people do irrational things, and you never know what can happen. Yeah, Dad has a responsibility to Mom and to the family, but there comes a point when even the most sainted of people just can't take it any more. It might hurt to see your Dad acting in what seems like a selfish manner, but sometimes a person just has to do what's best for themselves.
And then there is the burdon that you fear may fall onto you. Same thing applies. You have to balance the responsibility you feel toward the family with the responsibility you have for your own well being.
posted by gjc at 9:08 AM on December 20, 2009 [4 favorites]
There are, I think, two separate issues here. The first, your dad. It sounds like he is a decent sort of guy and has tried his best. But if your mom's delusions include him as one of the bad guys, he has to get out. Not only for his own sanity, but for his safety as well. Delusional people do irrational things, and you never know what can happen. Yeah, Dad has a responsibility to Mom and to the family, but there comes a point when even the most sainted of people just can't take it any more. It might hurt to see your Dad acting in what seems like a selfish manner, but sometimes a person just has to do what's best for themselves.
And then there is the burdon that you fear may fall onto you. Same thing applies. You have to balance the responsibility you feel toward the family with the responsibility you have for your own well being.
posted by gjc at 9:08 AM on December 20, 2009 [4 favorites]
I don't know if this is an option where you are but I know that in the UK injections are sometimes given to schizophrenics who forget to take their medication. Someone would still have to force your mum to go to her appointment but having that fight once a week/month has to be better than every day.
Has she spoken to her doctor/psychiatrist about the side effects of her medication? There could be other options or something else they could prescribe along side her usual meds to counteract whatever it is about them that makes her 'feel bad'.
If neither of those are an option for increased compliance with her medication, don't let your Dad just dump her on you. Its not fair to you and its not at all selfish to want to get on with your own life. When your dad is gone, you might become the villain of the piece and you'll be in the same position as he was.
posted by missmagenta at 9:09 AM on December 20, 2009
Has she spoken to her doctor/psychiatrist about the side effects of her medication? There could be other options or something else they could prescribe along side her usual meds to counteract whatever it is about them that makes her 'feel bad'.
If neither of those are an option for increased compliance with her medication, don't let your Dad just dump her on you. Its not fair to you and its not at all selfish to want to get on with your own life. When your dad is gone, you might become the villain of the piece and you'll be in the same position as he was.
posted by missmagenta at 9:09 AM on December 20, 2009
Anon, This is too much for one person. Try to remember that this is no longer your mother you are dealing with.
When your brother gets home, you guys should go talk to a magistrate. I've rec'd some good free legal advice about similar issues that way. It might be as simple as waiting for one of those rages and calling the police after normal court hours, when the magistrate you've spoken to is on duty. Or there might be away to swear out what I think is called a "green warrant" and get some court-ordered observation and mandatory follow-up.
It would be helpful to know what jurisdiction you are in.
posted by Mr. Yuck at 9:13 AM on December 20, 2009
When your brother gets home, you guys should go talk to a magistrate. I've rec'd some good free legal advice about similar issues that way. It might be as simple as waiting for one of those rages and calling the police after normal court hours, when the magistrate you've spoken to is on duty. Or there might be away to swear out what I think is called a "green warrant" and get some court-ordered observation and mandatory follow-up.
It would be helpful to know what jurisdiction you are in.
posted by Mr. Yuck at 9:13 AM on December 20, 2009
The other thing I would do is talk to your dad about what he really means by "divorce." You should point out to him that while it is certainly possible to arrange for them to no longer be married, that doesn't really change the fact that you are all a family, with responsibility to each other. Divorce is not an abdication of responsibility, in other words.
Just as a case in point, my mother and father have been divorced for 35 years and my mother has been happily re-married for 30 years. My parents dealt with each other regularly as I was growing up; much less (in fact, virtually never) after I graduated university, at least until I got married and we had to deal with all of that.
Despite this, my mother is now dealing with arrangements for my father and his partner's long-term care as he and his partner are now unable to live on their own and are facing multiple health melt-downs. It's her or me, as there is nobody else, and she has elected to step up to the plate so that I do not have to. Sure, my mom is doing this because she loves me, but since you say your dad still loves your mom, I don't think a divorce will be the clean break he really wants. I don't, in fact, think he can have that, although certainly his daily life can improve if they are not living together.
Also, it strikes me as very odd, not to mention ill-advised, that your mother is not in an on-going therapeutic relationship. I think you should read this for a view of what the benefits of such a relationship are. It's not just giving out drugs; it's monitoring the psychiatric state of the patient, working with family, adjusting medications based on immediate stressors, and a huge backlog of experience to help your family navigate a course with which you are all unfamiliar. You should really, really re-evaluate this, especially in light of the fact your dad is about to absent himself as an immediate support.
posted by DarlingBri at 9:22 AM on December 20, 2009 [6 favorites]
Just as a case in point, my mother and father have been divorced for 35 years and my mother has been happily re-married for 30 years. My parents dealt with each other regularly as I was growing up; much less (in fact, virtually never) after I graduated university, at least until I got married and we had to deal with all of that.
Despite this, my mother is now dealing with arrangements for my father and his partner's long-term care as he and his partner are now unable to live on their own and are facing multiple health melt-downs. It's her or me, as there is nobody else, and she has elected to step up to the plate so that I do not have to. Sure, my mom is doing this because she loves me, but since you say your dad still loves your mom, I don't think a divorce will be the clean break he really wants. I don't, in fact, think he can have that, although certainly his daily life can improve if they are not living together.
Also, it strikes me as very odd, not to mention ill-advised, that your mother is not in an on-going therapeutic relationship. I think you should read this for a view of what the benefits of such a relationship are. It's not just giving out drugs; it's monitoring the psychiatric state of the patient, working with family, adjusting medications based on immediate stressors, and a huge backlog of experience to help your family navigate a course with which you are all unfamiliar. You should really, really re-evaluate this, especially in light of the fact your dad is about to absent himself as an immediate support.
posted by DarlingBri at 9:22 AM on December 20, 2009 [6 favorites]
On the other hand, it seems cowardly and irresponsible to leave Mom, especially when she has a medical condition.
Please keep in mind that if it's making your father mentally ill with depression, then he also has a medical condition. You too aren't willing to step up to the plate. Both you and your father have very good reasons for not wanting to deal with this.
Could you see her psychiatrist again, and explain the situation to them? They might be able to offer you more of an idea of what options are available. A case worker of some kind should be an option at the very least. It would probably be easier, though, to get her into some kind of facility where people are trained in dealing with this sort of situation. If she's high functioning enough to handle day to day tasks, then perhaps a case worker could be better for her.
being high-functioning, there's probably little that can be done to force her to take her medication. If she's not a danger to herself or others, then sectioning probably isn't an option. Perhaps there is osme kinf of time-release version of her medication that she could take?
posted by Solomon at 9:23 AM on December 20, 2009 [1 favorite]
Please keep in mind that if it's making your father mentally ill with depression, then he also has a medical condition. You too aren't willing to step up to the plate. Both you and your father have very good reasons for not wanting to deal with this.
Could you see her psychiatrist again, and explain the situation to them? They might be able to offer you more of an idea of what options are available. A case worker of some kind should be an option at the very least. It would probably be easier, though, to get her into some kind of facility where people are trained in dealing with this sort of situation. If she's high functioning enough to handle day to day tasks, then perhaps a case worker could be better for her.
being high-functioning, there's probably little that can be done to force her to take her medication. If she's not a danger to herself or others, then sectioning probably isn't an option. Perhaps there is osme kinf of time-release version of her medication that she could take?
posted by Solomon at 9:23 AM on December 20, 2009 [1 favorite]
This is a totally tragic situation. Awful, awful. I do have something similar in my family but I'm not comfortable going into details. It's not as bad as what you are dealing with, though.
But I'm not sure it's fair to call your dad cowardly. He's been your mom's primary caregiver for seven years. You don't want to do it for one day because it's so difficult. And he's the coward? Just because your dad is older doesn't mean he has less interest in living a full and happy life (or right to do so). And just because you are young doesn't mean you are entitled to live care-free while your dad alone shoulders this burden.
Neither of you is a coward. It's very difficult to be the caretaker of a sick adult. I think you all need to call in whatever support services are available through your community and insurance.
Another thing I wonder: could your dad move overseas, leave Mom behind, but not divorce her? This opens up the possibility of her getting on a regimen that works and that might mean the marriage will work again someday. It definitely sounds like your dad needs a break. Everyone here is really worried about your mom, but your dad is obviously losing it too. He, at the very least, needs a break.
Maybe this talk of divorce is his way of getting you and your brother to step up, a cry for help, so to speak.
I guess my point is to have empathy for everyone, not just your mom. Good luck to all of you.
posted by bluedaisy at 9:25 AM on December 20, 2009 [13 favorites]
But I'm not sure it's fair to call your dad cowardly. He's been your mom's primary caregiver for seven years. You don't want to do it for one day because it's so difficult. And he's the coward? Just because your dad is older doesn't mean he has less interest in living a full and happy life (or right to do so). And just because you are young doesn't mean you are entitled to live care-free while your dad alone shoulders this burden.
Neither of you is a coward. It's very difficult to be the caretaker of a sick adult. I think you all need to call in whatever support services are available through your community and insurance.
Another thing I wonder: could your dad move overseas, leave Mom behind, but not divorce her? This opens up the possibility of her getting on a regimen that works and that might mean the marriage will work again someday. It definitely sounds like your dad needs a break. Everyone here is really worried about your mom, but your dad is obviously losing it too. He, at the very least, needs a break.
Maybe this talk of divorce is his way of getting you and your brother to step up, a cry for help, so to speak.
I guess my point is to have empathy for everyone, not just your mom. Good luck to all of you.
posted by bluedaisy at 9:25 AM on December 20, 2009 [13 favorites]
I am very sorry that you all have to go through this.
Please don't feel selfish for not wanting to have your life opportunities and perhaps aspirations severely limited by taking on a major care commitment - nobody in your family signed up for this and it may well be that getting suitable outside help is the best thing for everybody involved. If you ended up as the main carer you could end up feeling resentment toward your mother (and the rest of your family if they fail to support you adequately) and this would eat you up, which would do nobody any good.
You all need to get in touch with local schizophrenia support groups and work out what facilities and support are available near you. That would also help you with feeling less alone and with practical tips for living with loved ones with schizophrenia. Your dad also needs to consult a divorce lawyer to help him understand the implications of divorce on the family finances and on how care for your mother would be funded in that case.
Even though it would be very painful all round divorce may be the only option that would allow dad to actually start over as well.
posted by koahiatamadl at 9:25 AM on December 20, 2009
Please don't feel selfish for not wanting to have your life opportunities and perhaps aspirations severely limited by taking on a major care commitment - nobody in your family signed up for this and it may well be that getting suitable outside help is the best thing for everybody involved. If you ended up as the main carer you could end up feeling resentment toward your mother (and the rest of your family if they fail to support you adequately) and this would eat you up, which would do nobody any good.
You all need to get in touch with local schizophrenia support groups and work out what facilities and support are available near you. That would also help you with feeling less alone and with practical tips for living with loved ones with schizophrenia. Your dad also needs to consult a divorce lawyer to help him understand the implications of divorce on the family finances and on how care for your mother would be funded in that case.
Even though it would be very painful all round divorce may be the only option that would allow dad to actually start over as well.
posted by koahiatamadl at 9:25 AM on December 20, 2009
I've been in a similar caretaker position although not as severe.
And I definitely agree that as a caretaker you can fall apart.
Its really good that your dad is aware enough of his limits because he can focus on being healthy himself.
If he stays with your mom and gets sick then you have double trouble.
I don't think he is being a coward, especially if he helps financially while overseas.
But what a tough situation you have...I really feel for you.
posted by simpleton at 10:09 AM on December 20, 2009
And I definitely agree that as a caretaker you can fall apart.
Its really good that your dad is aware enough of his limits because he can focus on being healthy himself.
If he stays with your mom and gets sick then you have double trouble.
I don't think he is being a coward, especially if he helps financially while overseas.
But what a tough situation you have...I really feel for you.
posted by simpleton at 10:09 AM on December 20, 2009
It is destroying his life, and he is severely depressed.
The care he is managing to give your mother right now is not sustainable if the situation is destroying him. Whether he leaves now or has a breakdown a year from now, your mother's care is in peril and it isn't your father's fault.
I haven't directly cared for a schizophrenic relative, but I know someone who does. It is exhausting and maddening to have all of that responsibility while caring for someone who doesn't believe (and actively resists the idea) that he or she is unwell. I don't think it's at all unreasonable for your father to propose a dramatic change away from the way things are now if he has had to bear this burden alone.
Your father can't do this alone, you can't do this alone, your brother can't do this alone, and your mother can't do this alone. You seem to view the current situation as a tough, yet necessary reality, but it's unsustainable. A great help to your father (and your mother) would probably be to find a more sustainable, equitable way to provide care for your mother through family as well as community resources. Find out all possible local mental health resources available to your family and to your mother. See if you can work with a third party--some type of advocate or social worker--to take some of the pressure off of your father and to effectively distribute responsibility and resources between the three of you (your father, your brother, and you).
posted by Meg_Murry at 10:22 AM on December 20, 2009 [2 favorites]
The care he is managing to give your mother right now is not sustainable if the situation is destroying him. Whether he leaves now or has a breakdown a year from now, your mother's care is in peril and it isn't your father's fault.
I haven't directly cared for a schizophrenic relative, but I know someone who does. It is exhausting and maddening to have all of that responsibility while caring for someone who doesn't believe (and actively resists the idea) that he or she is unwell. I don't think it's at all unreasonable for your father to propose a dramatic change away from the way things are now if he has had to bear this burden alone.
Your father can't do this alone, you can't do this alone, your brother can't do this alone, and your mother can't do this alone. You seem to view the current situation as a tough, yet necessary reality, but it's unsustainable. A great help to your father (and your mother) would probably be to find a more sustainable, equitable way to provide care for your mother through family as well as community resources. Find out all possible local mental health resources available to your family and to your mother. See if you can work with a third party--some type of advocate or social worker--to take some of the pressure off of your father and to effectively distribute responsibility and resources between the three of you (your father, your brother, and you).
posted by Meg_Murry at 10:22 AM on December 20, 2009 [2 favorites]
If you haven't yet, contact your local chapter of the Alliance for the Mentally Ill. They often can guide you to either adult daycare facilities or even group homes in your area for people suffering from mental illness. I worked for a man for 11 years who was on the local AMI board and whose adult son was schizophrenic. The son was displayed typical schizophrenic behavior - taking his medications at first, but then would decide he's better or that the meds were making him sick, etc. He couldn't live on his own needed care during the day when his father was at work. The AMI pointed them to a group home in Detroit, where he lived with four other similarly ill adults and a caseworker. I seem to recall that there wasn't even a charge or fee for living there, but residents had to pay for their own non-essentials like cigarettes.
Best of luck to you - you've been forced into a very difficult situation.
posted by Oriole Adams at 10:25 AM on December 20, 2009
Best of luck to you - you've been forced into a very difficult situation.
posted by Oriole Adams at 10:25 AM on December 20, 2009
I'm surprised no one has mentioned this, but it is critical for a schizophrenic being (or even being plausibly threatened) with divorce and overseas abandonment by her caretaking spouse to have an attorney engaged for her and likely have the court appoint a guardian ad litem or conservator to direct the attorney, given that your mother (a Rx-non-compliant schizophrenic) is not going to be able to competently direct her attorney in any negotiations.
Your father needs to accept the likelihood that he will have to provide for your mother's basic sustenance and health care indefinitely -- given that he's going overseas, that might mean being compelled (or agreeing to) deed over the lion's share of his assets to the conservator, since enforcing ongoing support orders would be problematic.
posted by MattD at 10:41 AM on December 20, 2009 [1 favorite]
Your father needs to accept the likelihood that he will have to provide for your mother's basic sustenance and health care indefinitely -- given that he's going overseas, that might mean being compelled (or agreeing to) deed over the lion's share of his assets to the conservator, since enforcing ongoing support orders would be problematic.
posted by MattD at 10:41 AM on December 20, 2009 [1 favorite]
This is an awful situation for all of you. I'm sorry.
I don't know if you've reached out to someone professionally but this might be a good idea at this time to help you sort through these issues (not just about your mom and who takes care of her but your feelings about your dad and yourself). You want to make good choices and to do that it might help to get the input of someone else. To start, think about taking care of yourself first in order to help you make good decisions about your family.
posted by Taken Outtacontext at 11:01 AM on December 20, 2009
I don't know if you've reached out to someone professionally but this might be a good idea at this time to help you sort through these issues (not just about your mom and who takes care of her but your feelings about your dad and yourself). You want to make good choices and to do that it might help to get the input of someone else. To start, think about taking care of yourself first in order to help you make good decisions about your family.
posted by Taken Outtacontext at 11:01 AM on December 20, 2009
Divorce is not an abdication of responsibility, in other words.
His legal duty would be removed. So it very much could be that. That needs to be worked out and fully understood.
posted by Ironmouth at 11:15 AM on December 20, 2009
His legal duty would be removed. So it very much could be that. That needs to be worked out and fully understood.
posted by Ironmouth at 11:15 AM on December 20, 2009
Since then, we've been through the same vicious cycle several times: her delusions reach a boiling point, the family takes her to a psychiatrist, he refers us to a MD, who prescribes Mom antipsychotic medication.
You're implying this is has happened multiple times - this sounds like an incredibly disengaged treatment cycle, as others have noted. Perhaps changing psychiatrists would do some good? I'd poll the Alliance for the Mentally Ill for a recommended medical health professional who follows up on treatment agressively.
IANAPsychiatrist, but since med compliance is a major problem for all delusional disorders, there is a fair amount of research into extended release medication formulations (a la norplant, where drugs are released slowly over a period of months). I don't know what is on the market at the moment.
Best wishes with the horrible situation, and try not to resent your father. He deserves to have a life too.
posted by benzenedream at 11:32 AM on December 20, 2009
You're implying this is has happened multiple times - this sounds like an incredibly disengaged treatment cycle, as others have noted. Perhaps changing psychiatrists would do some good? I'd poll the Alliance for the Mentally Ill for a recommended medical health professional who follows up on treatment agressively.
IANAPsychiatrist, but since med compliance is a major problem for all delusional disorders, there is a fair amount of research into extended release medication formulations (a la norplant, where drugs are released slowly over a period of months). I don't know what is on the market at the moment.
Best wishes with the horrible situation, and try not to resent your father. He deserves to have a life too.
posted by benzenedream at 11:32 AM on December 20, 2009
You know, I'd email or MeMail paulsc, who I believe is responsible for the long-term care of a schizophrenic family member. He might have some ideas but I'm not sure he's checking out the site these days.
Yes. Also, paging The Straightener as well, especially WRT what might be possible if she loses private health benefits through your father, post divorce.
posted by availablelight at 11:37 AM on December 20, 2009
Yes. Also, paging The Straightener as well, especially WRT what might be possible if she loses private health benefits through your father, post divorce.
posted by availablelight at 11:37 AM on December 20, 2009
I knew a man (now deceased) who was the primary caretaker for his schizophrenic adult daughter. She eventually did enter a group home which turned out to be for the best. You might investigate that.
posted by St. Alia of the Bunnies at 11:53 AM on December 20, 2009
posted by St. Alia of the Bunnies at 11:53 AM on December 20, 2009
I have a handful of relatives who suffer from psychotic episodes, so I know how stressful it can be to keep them taking their medication when they don't want to. It's true that you can't force your mother to take her medicine, but have you been completely upfront with her when she's lucid? I ask because I know that everyone's tendency is to walk on eggshells with someone after they've recovered from a psychotic episode, and no one wants to make them feel any worse than they already do. You realize things have reached a breaking point, and the possibility of your dad no longer being able to care for her will make things worse for not only her in some ways, but also for the rest of your family. She needs to be made 100% clear on that in the hopes that it might make her stick to her medication, or at least open to working with a psychiatrist to see if adjustments might be made to her medication that make her feel any better.
If I were you, this is what I would try. Get psychiatric help again, do whatever it is you did the other times where she stuck to her medication for a few weeks. During the few weeks where she is lucid, you need to be firm with her. Tell her that you love her and you know it's not fair that her medication makes her feel bad, but when she doesn't take her medication she disrupts the lives of everyone who cares for her. Ask her whether she would rather lose her husband or take her medication. Ask her whether she wants you to be able to go to law school and live the life you want to lead, or if she'd rather you give up on your dreams so you can take care of her.
Being that harsh really sucks, but sometimes it's necessary; when your mom is lucid chances are she doesn't really recall what she's put you guys through. When my psychotic family members have been put on medication and become lucid again, they really have no idea what everyone has been through. They dismiss the crazy stuff we tell them they did as somehow reasonable, I guess because it either still makes sense to them in part of their brain, or they can't handle the alternative. Unless someone is going to go off their medication, though, we mostly don't say anything to them except that we're glad they're better now. If your mom would rather have horrible delusions than take her medication, then you can assume she either doesn't realize/remember how crazy she was, or else the medication makes her feel exceptionally bad. Chances are it's a combination of the two, but the only part of that equation you can influence right now is hammering home just how awful she makes life for those around her when she doesn't take her medication.
In the end, saying all that to her might not make a difference. But I think it's an option you need to exhaust before you have her living on her own -- I don't think that's a good idea, please look into other things people have suggested before you do that. It sounds like you guys have been as patient as you can be for seven years and it hasn't worked. You're going to have to be more firm with your mom in one way or another, whether it's being more blunt about how important it is that she take her medication, or putting her in a group home, or something else.
posted by Nattie at 12:47 PM on December 20, 2009 [2 favorites]
If I were you, this is what I would try. Get psychiatric help again, do whatever it is you did the other times where she stuck to her medication for a few weeks. During the few weeks where she is lucid, you need to be firm with her. Tell her that you love her and you know it's not fair that her medication makes her feel bad, but when she doesn't take her medication she disrupts the lives of everyone who cares for her. Ask her whether she would rather lose her husband or take her medication. Ask her whether she wants you to be able to go to law school and live the life you want to lead, or if she'd rather you give up on your dreams so you can take care of her.
Being that harsh really sucks, but sometimes it's necessary; when your mom is lucid chances are she doesn't really recall what she's put you guys through. When my psychotic family members have been put on medication and become lucid again, they really have no idea what everyone has been through. They dismiss the crazy stuff we tell them they did as somehow reasonable, I guess because it either still makes sense to them in part of their brain, or they can't handle the alternative. Unless someone is going to go off their medication, though, we mostly don't say anything to them except that we're glad they're better now. If your mom would rather have horrible delusions than take her medication, then you can assume she either doesn't realize/remember how crazy she was, or else the medication makes her feel exceptionally bad. Chances are it's a combination of the two, but the only part of that equation you can influence right now is hammering home just how awful she makes life for those around her when she doesn't take her medication.
In the end, saying all that to her might not make a difference. But I think it's an option you need to exhaust before you have her living on her own -- I don't think that's a good idea, please look into other things people have suggested before you do that. It sounds like you guys have been as patient as you can be for seven years and it hasn't worked. You're going to have to be more firm with your mom in one way or another, whether it's being more blunt about how important it is that she take her medication, or putting her in a group home, or something else.
posted by Nattie at 12:47 PM on December 20, 2009 [2 favorites]
I'm the mother of a 32 year old son who was diagnosed with schizophrenia several years ago. He is also high-functioning, able to live independently. In the early years after his diagnosis his dad and I made several mistakes in dealing with the disease, actually by being overprotective and not letting him pay some of the consequences of his actions.
We learned to cope by attending the NAMI family to family, a 3 months class that teaches not only about the disease, but also how and when to deal with the medical professionals, where and what the community resources are, what to do in case of a crisis.
Finding a medication that truly works is difficult, and more difficult is adjusting the dosage that a patient might tolerate long term. Sometimes medication is not the answer: there are few studies that have looked at the outcome for schizophrenics who refuse medication. These studies seem to indicate that, for the patients who do not commit suicide, the long term outcome is fairly positive.
To get to that point family support is crucial, and by that I do not mean tolerating abuse . One of the most important thing I learned in that class was to set limits, and to clearly state the consequences of going over the limits. These limits are for the protection and the well being of the family member who is the main caregiver. For example, in the case of screaming and yelling, perhaps the police (they do have personnel trained in mental health crises) should have been called and your mother taken to a crisis center and from that to a hospital so her medicine could be adjusted.
I do think that his a good idea for your dad and your mother to separate, since he has become one of her persecutors in her mind. I do also agree with the comments that have mentioned the importance of health insurance: antipsychotic medication and the frequent hospitalizations are expensive! On the other hand, most schizophrenics do receive Social Security disability, with Medicaid after 18 months of eligibility.
As for day to day treatment, therapy to build on self-estime, peer support, and structured living have been the things that have made a difference in our son's life (and of course staying sober, because unfortunately the way that a lot of schizophrenic self-medicate is with booze and alcohol).
The very best program that I have ever run across is the Fountaihouse: there are many similar ones in major cities, structured to give hope to the mentally ill and their families.
posted by francesca too at 1:34 PM on December 20, 2009 [1 favorite]
We learned to cope by attending the NAMI family to family, a 3 months class that teaches not only about the disease, but also how and when to deal with the medical professionals, where and what the community resources are, what to do in case of a crisis.
Finding a medication that truly works is difficult, and more difficult is adjusting the dosage that a patient might tolerate long term. Sometimes medication is not the answer: there are few studies that have looked at the outcome for schizophrenics who refuse medication. These studies seem to indicate that, for the patients who do not commit suicide, the long term outcome is fairly positive.
To get to that point family support is crucial, and by that I do not mean tolerating abuse . One of the most important thing I learned in that class was to set limits, and to clearly state the consequences of going over the limits. These limits are for the protection and the well being of the family member who is the main caregiver. For example, in the case of screaming and yelling, perhaps the police (they do have personnel trained in mental health crises) should have been called and your mother taken to a crisis center and from that to a hospital so her medicine could be adjusted.
I do think that his a good idea for your dad and your mother to separate, since he has become one of her persecutors in her mind. I do also agree with the comments that have mentioned the importance of health insurance: antipsychotic medication and the frequent hospitalizations are expensive! On the other hand, most schizophrenics do receive Social Security disability, with Medicaid after 18 months of eligibility.
As for day to day treatment, therapy to build on self-estime, peer support, and structured living have been the things that have made a difference in our son's life (and of course staying sober, because unfortunately the way that a lot of schizophrenic self-medicate is with booze and alcohol).
The very best program that I have ever run across is the Fountaihouse: there are many similar ones in major cities, structured to give hope to the mentally ill and their families.
posted by francesca too at 1:34 PM on December 20, 2009 [1 favorite]
His legal duty would be removed.
As MattD pointed out, this is very unlikely to be true. Divorce laws in the United States and in most other countries do not permit one divorcing spouse to leave the other destitute, likely to become a drain on the rest of society. He can use divorce as one possible way to avoid having to care for her day-to-day or be physically present in her life. He can't use divorce to avoid having to pay for her care or be financially present in her life.
I am so sorry that you are going through this. Please make sure that your father understands the ramifications of his decision, because it affects you, your mother, and him for as long as your mother lives.
posted by decathecting at 2:11 PM on December 20, 2009
As MattD pointed out, this is very unlikely to be true. Divorce laws in the United States and in most other countries do not permit one divorcing spouse to leave the other destitute, likely to become a drain on the rest of society. He can use divorce as one possible way to avoid having to care for her day-to-day or be physically present in her life. He can't use divorce to avoid having to pay for her care or be financially present in her life.
I am so sorry that you are going through this. Please make sure that your father understands the ramifications of his decision, because it affects you, your mother, and him for as long as your mother lives.
posted by decathecting at 2:11 PM on December 20, 2009
francesca too mentioned Fountainhouse, which is a clubhouse model psychosocial rehabilitation program. There is a network of clubhouses all over the world. While they do not offer 24 hour care, they provide a place for the mentally ill to spend their days, to engage with other people in a community, to do meaningful work, and the possibility of job placement and more independent living.
A family member has spent most of her working life as a social worker in clubhouses and the really are amazing. And if you saw The Soloist, the place where he kept his cello was a real clubhouse in LA and the people there in the movie were actual clubhouse members.
posted by hydropsyche at 2:34 PM on December 20, 2009
A family member has spent most of her working life as a social worker in clubhouses and the really are amazing. And if you saw The Soloist, the place where he kept his cello was a real clubhouse in LA and the people there in the movie were actual clubhouse members.
posted by hydropsyche at 2:34 PM on December 20, 2009
The situation is so ethically gray to me: It is unfair for my dad to take such vehement abuse day after day. It is destroying his life, and he is severely depressed. On the other hand, it seems cowardly and irresponsible to leave Mom, especially when she has a medical condition.
I don't think you have any right to make this judgment. You can't possibly understand what it is like to be subject to the sort of PTSD-inducing stress and abuse he has probably been living under constantly for years. Everyone here deserves empathy, but no-one is morally obligated to subject themselves to abuse. For any reason.
posted by Justinian at 3:16 PM on December 20, 2009 [8 favorites]
I don't think you have any right to make this judgment. You can't possibly understand what it is like to be subject to the sort of PTSD-inducing stress and abuse he has probably been living under constantly for years. Everyone here deserves empathy, but no-one is morally obligated to subject themselves to abuse. For any reason.
posted by Justinian at 3:16 PM on December 20, 2009 [8 favorites]
Have you contacted your local community mental health center? Your mom should be able to get a case manager through the local CMHC that can help deal with a lot of these issues.
Has your mom ever talked to the MD about how the meds make her feel? She may have some legitimate complaints about the meds that the doc could address, which might help improve her med compliance.
posted by whatideserve at 3:53 PM on December 20, 2009
Has your mom ever talked to the MD about how the meds make her feel? She may have some legitimate complaints about the meds that the doc could address, which might help improve her med compliance.
posted by whatideserve at 3:53 PM on December 20, 2009
I'm the OP. First-- thank you to everyone who's shared their thoughts with me. I've read and reread all of your comments and taken them to heart. Like DarlingBri pointed out, I don't think there's any real point in being (more) anonymous, so I'll chime in from this account.
Geographically, my parents are isolated in Hawaii. I currently live on the East Coast and am home for the holidays. My brother is in the South. I was just turned over at my job, so I can spend as long as I need to back home, though I still need to stay on top of my rent (lease lasts through June). Financially, Dad makes a fairly good government income. He's said that he's willing to support Mom with half of his paycheck. When he changes jobs abroad, his income will be significantly higher. Mom is in her early 50's.
I'd just like to clarify my point about being "cowardly and irresponsible," which I regret phrasing that way. After wrestling with the thought of their divorce for several years, I realized that I could not fault or blame my Dad if he did go through with it. So to rephrase:
It is unfair for my dad to take such vehement abuse day after day. It is destroying his life, and he is severely depressed. On the other hand, we are overwhelmed with guilt and uncertainty at the thought of leaving Mom, especially when she has a medical condition.
Your stories and advice have given me some hope. I'm going to act on the suggestions above to get in touch with NAMI, another psychiatrist, and a divorce lawyer. This isn't something we should figure out as we go along, and it only makes sense to discover the medical, financial, and legal repercussions of divorce before making sudden decisions.
Maybe a separation rather than divorce would be in our best interests. I'll run it by Dad.
posted by travisf at 6:56 PM on December 20, 2009
Geographically, my parents are isolated in Hawaii. I currently live on the East Coast and am home for the holidays. My brother is in the South. I was just turned over at my job, so I can spend as long as I need to back home, though I still need to stay on top of my rent (lease lasts through June). Financially, Dad makes a fairly good government income. He's said that he's willing to support Mom with half of his paycheck. When he changes jobs abroad, his income will be significantly higher. Mom is in her early 50's.
I'd just like to clarify my point about being "cowardly and irresponsible," which I regret phrasing that way. After wrestling with the thought of their divorce for several years, I realized that I could not fault or blame my Dad if he did go through with it. So to rephrase:
It is unfair for my dad to take such vehement abuse day after day. It is destroying his life, and he is severely depressed. On the other hand, we are overwhelmed with guilt and uncertainty at the thought of leaving Mom, especially when she has a medical condition.
Your stories and advice have given me some hope. I'm going to act on the suggestions above to get in touch with NAMI, another psychiatrist, and a divorce lawyer. This isn't something we should figure out as we go along, and it only makes sense to discover the medical, financial, and legal repercussions of divorce before making sudden decisions.
Maybe a separation rather than divorce would be in our best interests. I'll run it by Dad.
posted by travisf at 6:56 PM on December 20, 2009
To briefly clarify my role in this mess, I was in high school when mom's schizophrenia expressed itself. Dad was abroad and my brother was in college. For two years, I was Mom's primary caretaker, deeply angry, sad, terrified, and even ashamed. But I managed to remain calm, though I had my share of breakdowns.
Since then, I've only been home on extended winter and summer breaks. My role has been to mediate, calm everyone down, reason/listen, and make professional appointments. After several years of this, I found myself snapping at my parents, hating everyone, and generally being a pain in the ass. The counseling clinic at school changed my life. While I'm much more stable now, it's hard to muster up the patience and understanding I had years ago. But I still love my family and am determined to do everything I can to make things work.
posted by travisf at 7:16 PM on December 20, 2009
Since then, I've only been home on extended winter and summer breaks. My role has been to mediate, calm everyone down, reason/listen, and make professional appointments. After several years of this, I found myself snapping at my parents, hating everyone, and generally being a pain in the ass. The counseling clinic at school changed my life. While I'm much more stable now, it's hard to muster up the patience and understanding I had years ago. But I still love my family and am determined to do everything I can to make things work.
posted by travisf at 7:16 PM on December 20, 2009
The book "I'm not sick, I don't need help!" was invaluable to me when going through a situation reminiscent of yours. It was not a panacea, but I found the legal facts useful and it made me feel less alone.
From the book jacket: "About 50% of all people with schizophrenia and manic-depression do not understand that they are ill and refuse treatment."
The feelings you describe of being angry, terrified, and ashamed are very normal in this situation. Denial is also common. You have a very good heart for wanting to do everything you can.
Good luck.
posted by cheesecake at 11:06 PM on December 20, 2009 [1 favorite]
From the book jacket: "About 50% of all people with schizophrenia and manic-depression do not understand that they are ill and refuse treatment."
The feelings you describe of being angry, terrified, and ashamed are very normal in this situation. Denial is also common. You have a very good heart for wanting to do everything you can.
Good luck.
posted by cheesecake at 11:06 PM on December 20, 2009 [1 favorite]
OP, I've been in your position.
My dad's tolerance didn't last as long as yours has, so I ended up taking care of my mom and my two younger brothers all through high school and halfway through university. One night during one of my mom's especially unhinged psychotic episodes, I realized that I couldn't take care of everyone while going to school and working part time, both things I needed to do. That night I made sure my brothers were taken care of and I left my mom to take care of herself. A few years later she ended up much worse off mentally and financially. She was involuntarily committed and forced onto medication. I hardened and became numb to her plight. Had I stayed, she would have been better off financially, but my finances would have been much worse off. I don't think I would've graduated. I don't know what would've happened to her mental health. It might have been better or it might have been worse had I chosen differently. Regardless, I don't regret my choices. I made the best ones I could, given the circumstances.
I don't have any specific advice, except to say that I understand where you and your father are coming from. I wish you didn't have to go through this. It's not fair. Email me at my handle at Gmail if you'd like to talk about it.
posted by smorange at 1:43 AM on December 21, 2009 [1 favorite]
My dad's tolerance didn't last as long as yours has, so I ended up taking care of my mom and my two younger brothers all through high school and halfway through university. One night during one of my mom's especially unhinged psychotic episodes, I realized that I couldn't take care of everyone while going to school and working part time, both things I needed to do. That night I made sure my brothers were taken care of and I left my mom to take care of herself. A few years later she ended up much worse off mentally and financially. She was involuntarily committed and forced onto medication. I hardened and became numb to her plight. Had I stayed, she would have been better off financially, but my finances would have been much worse off. I don't think I would've graduated. I don't know what would've happened to her mental health. It might have been better or it might have been worse had I chosen differently. Regardless, I don't regret my choices. I made the best ones I could, given the circumstances.
I don't have any specific advice, except to say that I understand where you and your father are coming from. I wish you didn't have to go through this. It's not fair. Email me at my handle at Gmail if you'd like to talk about it.
posted by smorange at 1:43 AM on December 21, 2009 [1 favorite]
This thread is closed to new comments.
You're being put in the position of relief pitcher for your dad. Fair or not, this is the situation and you deserve some help yourself to avoid this becoming your own hell.
posted by fatbird at 8:41 AM on December 20, 2009 [6 favorites]