How can I support Mom through Dad's failing mental health?
January 31, 2013 7:19 PM   Subscribe

My Dad is in his late 60's and through some combination of age, TIA's, and overmedication, he is at some times out of it and inappropriate, and at all times tired and lethargic. My Mom is struggling horribly with this as she's unwilling to see herself entirely as a caretaker, and she enables him with regards to alcohol and drugs, and beats up on herself over things she can't control. I'd like to support her and give her good guidance without being overly harsh.

This question is vague but the situation must be somewhat common.

Mom would be better served by just taking charge of his care, but part of her wants to still let him be the traditional husband in the the relationship. I think Dad could be healthier if he got his meds under control (Valium, muscle relaxants, opiates for pain from gout/tendonitis/etc) but he has to get there first. He's got lots of time where he's just your random rambling dad, and I love that, but more often he's falling asleep in his soup, or confusing my wife with my brother's' wife, or - often - making really inappropriate japes in company; this is the one that really breaks Mom's heart. It doesn't end there, but you get the idea. He's also slowly returned to heavy drinking; Mom has given up fighting on this front - step by step - and he really shouldn't drink with some of his meds. She was also giving him pain meds that were prescribed to her, until recently, but she says she's stopped.

Mom wants to see him return to being in charge and so she's hesitant to just take charge of his meds and care. On one level, she knows he's not competent, but on another, she's not willing to admit this to herself. She's very healthy and vital for her age and she could be living right now. She knows this, but beats herself up about it for even thinking about it. I've talked to her about getting some therapy but she's worried the therapist is going to berate her for not abandoning dad like her friends have already done.

My Mom is an amazing person who has given everything for family and my dad. When I talk to her, I have strong feelings about what she should do and how she enables and I'm worried it makes me sound unsupportive and harsh. I'm pretty upset right now but I have concrete questions: What resources or books can I suggest to Mom? Specific strategies for her? Recommendations?
posted by ftm to Human Relations (10 answers total) 1 user marked this as a favorite
This is not really a straightforward "caretaker" situation. It sounds like your dad has a drinking/drug abuse problem. She can't fix this for him. As you suggest, she is really limited to stopping the enabling, which means no buying alcohol or giving him drugs or shielding him from the consequences of his drinking/drugs, right up to a separation. You might tell her that she consider going to AA meetings.
posted by murfed13 at 7:37 PM on January 31, 2013 [1 favorite]

Murfed13 is on the right track, but an Al-anon group might be more appropriate. Given the medical issues your dad is dealing with, is he connected with a health care provider that might direct your mother to a social worker to help her deal with those aspects of his life (It might feel less threatening than a "therapist" to her, but might provide some of the same types of support)?
posted by HuronBob at 7:39 PM on January 31, 2013 [2 favorites]

Best answer: 2nding Al-Anon or therapy, and a few other points:

would your mom be able to get your dad in either to see a pain clinic/pain specialist, or even better, into what's called "pain rehab"? (Not all locations have a program like this, but they are a godsend if available and pain clinics usually know about them). They are marketed as programs for people who want to reduce or get off pain medications, which most people with chronic pain at least pay lip service to wanting, so usually you can get people to sign up for these without too much argument, although then they will often try to delay or procrastinate the start of the program.

I'm not sure who your dad's primary care is right now, but no primary care physician who knew about his heavy drinking problem would be or should be comfortable with his medication regimen of benzos, muscle relaxants, and opiates, and what you describe of his behavior clearly includes oversedation. He needs to see someone else as soon as possible. Combining these medications (especially with poor judgement) and heavy alcohol use is a recipe for potential respiratory failure, beyond all the other interpersonal problems it's obviously causing him.
posted by treehorn+bunny at 8:51 PM on January 31, 2013 [8 favorites]

It sounds like your father has not been responsible in taking care of his health for a very long time, his inaction (and irresponsible actions like self-medicating with pain killers and reoccuring overuse of alcohol) have caused his health to decline, but you are blaming your mother and trying to force her into a role she does not want. If you believe your father needs caretaking then you should step into that role instead of putting that expectation on her. If you are unwilling to give up your life to pick up the pieces of the choices made by an addict/alcoholic yourself then perhaps you would instead arrange for admittance to a hospital/nursing home for your father.

Your mom sounds like she needs a significant break from being around your dad to re-evaluate what she is willing (and not willing) to do. That she is afraid of therapy, because the therapy will most likely reveal that for her own mental and physical health she should not be responsible for your father's choices, indicates to me that she knows she will possible need to leave or significantly change the relationship she has with a long-term self-destructive person before she becomes collateral damage.

You are trying to tell someone that their relationship is all wrong, they are making the wrong choices and that you have a better way for them to live. How would you feel about your mother getting up in your business and telling you what you were doing with your SO was wrong? Criticism of her is going to get you nowhere positive. Instead you should either step up yourself and do what you expected her to do, or support your mother in whatever decisions she makes with dealing with a person facing the (health and interpersonal) effects of a long term addiction.

To answer your specific questions, I would recommend the books Co-dependent No More and the Dance of Anger for your mother (and possibly you as well) as well as seeing about hiring a social worker to access any programmes that will give her respite care beyond what you are able to provide.
posted by saucysault at 11:45 PM on January 31, 2013 [1 favorite]

Response by poster: Thank you all for the advice and especially for the pain rehab suggestion, treehorn+bunny. I just wish we could know which of his issues are permanent and health-related and which can be solved by better managing his drug intake so that kind of thing, if effective for him, would be a great start.

My Mom is unwilling to tell the doc about his issues with managing his drugs or his alcohol intake because she's worried they'll withdraw his medicine completely. Privately, I think this would probably be the best thing that ever happened to him, but of course I can't know his actual pain level or other details about the situation.
posted by ftm at 6:57 AM on February 1, 2013

Where do your parents live? Most (all?) states have a Department of Aging, or Department of Adult Services - google "[Parents' State] Department of Aging" for a link.

Your mom can also try a consultation with a geriatric social worker. Even if your dad refuses to go to counseling or a pain clinic or AA, a social worker might be able to help your mom find ways to cope. And nthing AlAnon for mom, and you if you want to attend.
posted by Rosie M. Banks at 7:58 AM on February 1, 2013

If you are concerned for his health and feel he is not being honest with his doctor there is nothing stopping you from contacting his doctor and bringing up your concerns/what you have witnessed. Obviously the doctor will not break confidentiality but can listen to your information and evaluate it.
posted by saucysault at 8:35 AM on February 1, 2013

Best answer: You need an intervention for both of your parents. Your mom is being co-dependant and your dad is using both drugs and alcohol inappropriately.

Your mom needs to understand that her role has changed and that it's okay to reach out for help (like a visiting home health aide). Until she can come to terms with her new life and situation, she can't really be of much help to your dad. Phrasing it this way can be helpful:

"Mom, I see you struggling with Dad and his failing health. I believe that your actions are contributing to his decline. Please come with me to Al-Anon to understand this dynamic, and let's get Dad some serious help so that he's not drunk or high, but managing his pain appropriately. We all need to have an honest discussion with Dad's doctors, and we need a good pain management plan for Dad. You are the one person in this that can help Dad live a vital and healthy life, and YOU need to change, before the situation can get better."

Also, be willing to have your own boundaries. "Mom, I'd like to help with that, but until you agree to meet with Dad's doctors and manage his health appropriately, I won't help you continue in destructive behavior."
posted by Ruthless Bunny at 8:48 AM on February 1, 2013

Best answer: National Association of Area Agencies on Aging (n4a) Can you go with your Mom & Dad to the doctor, and review his meds, as well as asking the doctor about drinking? Sometimes doctors just keep adding meds, and forget to assess the big picture. A pharmacist can also be a big help. I doubt the doctor would withdraw all pain meds from a person in pain. Is he eligible for physical therapy? That can get someone out of the house and moving, which helps a lot.

Your Mom might benefit from a caregiver's group, and lots of understanding. It's hard for her, and probably for your Dad, to have the roles reversed, and being a caregiver is exhausting. She may be allowing him to be over-medicated because when he's alert and active, it's too much work for her to care for him. Is there any chance of getting her some help?
posted by theora55 at 11:43 AM on February 1, 2013 [1 favorite]

If it would help in convincing your mom, I think the withdrawal of pain medications as a sudden move is highly unlikely. Narcotic withdrawal in someone like your dad who is opiate dependent is extremely unpleasant, and benzodiazepine withdrawal is potentially life-threatening/can cause serious side effects. Trying to help him taper off the use of these medications would be far more likely. I can definitely understand, though, if your mom is reticent to even have them tapering/reducing the meds - knowing that she has to live with him and it might be very challenging for him to deal with that if he has been using them at high doses for a long time, or that he might increase his alcohol use for self-medication if his prescription meds are reduced. That could be a reason why a rehab-like solution might be a better one - hope this could be discussed with his doctor to find the right path.
posted by treehorn+bunny at 10:11 PM on February 1, 2013 [1 favorite]

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