My mom is insane - how do I cope?
December 14, 2005 2:53 PM   Subscribe

My mom is insane - how do I cope? That's pretty much it. My mother has mental health issues that I think are getting worse, and I don't know what to do, nor how to cope with it. (this is long, thanks for reading.)

Mom has always had issues with depression, but over the past 10 years, paranoia has crept in. (Like, we'll go out on errands, and when we come home, she'll think that a stranger has broken in to move a hair.) She doesn't work, and has been on Disability and SSI for quite a while.

Now, she'll either send me incoherent emails, or leave phone messages, where she'll accuse me of agreeing to do something for her that I don't remember, or getting her something, or saying I'm siding with Dad on things, etc. (They had a not so amicable breakup). When I ask her about this, she gets really defensive.

Here's a sample: "And If it is
indeed a fact that going down how can your dad's@ be @ hotmail.
At least I pay for a provider unless you're dad's is his phone company." (Now, she used to be a professional writer 20 years ago).

Now, I IM with her every day, and most of the time, she seems more rational. And when she is, she's great - funny, warm, etc. I love IMing with her. But when she gets this way, she's horrible. (In High Schoool, when she'd have these moods, she'd be outright abusive.) To top it all off, I'm an only child, I live halfway across the country, and dealing with a neuromuscular disorder to boot. (I'm working, but work and illness drain nearly all of my energy).

So - how do I deal? I want to help her, but not when she's abusive like this. I also don't want to cut her out of my life completely because of this, because I know she's not doing it rationally. But, she won't talk to her doctors about any of this, and I can't due to privacy laws. Thank you in advance.
posted by spinifex23 to Health & Fitness (18 answers total)
Correct me if I'm wrong, but confidentiality keeps her doctors from telling you things, not you from telling her doctors, no? I would think that if you informed them of these things that presumably she's unaware of or refusing to share, they'd take them into consideration in her treatment.
posted by phearlez at 3:11 PM on December 14, 2005

Well, one helpful thing-

her doctors can't talk to you, but there is no privacy law preventing you from talking to them. They might not be able to reply (or say anythin to make you feel better), but it might help her treatment if they know.

Mental illness is a very difficult thing; hang in there.

on preview: what phearlez said.
posted by JMOZ at 3:12 PM on December 14, 2005

Ah, but you can talk to her doctors about all of these things.

I manage a dental office, where we deal with these very same health laws on a daily basis.

What the privacy laws prevent is these doctors talking to you about your mother, unless she has given them written permission. I'm guessing that she wouldn't be thrilled if you asked, but there are some ways to get her to sign these forms that are completely ethical. Suggesting that in the event of an emergency you would need to have access to her doctors is often enough to get a patient to sign. Ask your own doctor for help in this area.

If she won't sign, you have to make it clear to the doctors, if you want a phone conversation, that you don't necessarily need them to address your concerns, but that you have some information that has bearing on their ability to care for your mother. Make them aware of your concerns, preferrably in a letter that you state is not to be considered part of her chart (which is your mother's property, according to these same fun privacy laws) if you don't want her to be aware of your letter. They should want this information because they want to care for your mother. If her doctors do not want this information then you may want to call whatever professional associations they belong to, because this is serious.

In Florida we have a fun law called the Baker Act (which we use as a verb, "she got baker acted,") it means that if an individual is suspected (reasonably) to be a danger to himself or others then a trip to a mental institution is in order. If your mother's state has something like this she may at some point be a candidate, and it would be good to have some evidence that you had made her doctors aware of this problem previously, which may make it easier to get her the help that she needs should things deteriorate further.

Sorry for being so long winded here, but mental illness is a very scary thing. My own sister was Baker Acted a few years ago, so if you have any questions, feel free to email me. it should be in the profile.

good luck.
posted by bilabial at 3:13 PM on December 14, 2005

She's on disability and SSI - is that due to this issue? Has she been diagnosed as having a mental disorder? Or is this due to something like a stroke?

Mom sounds like she's in bad shape - sounds like she's either getting paranoid or demented (or both). One question I'd have is how long this has been going on. If this is how she's been for a long time, then there's one set of suggestions that have to do with you learning to cope with someone with serious mental health problems. The book Surviving Schizophrenia is an example of such an approach. There are many family-oriented support organizations and groups around to help the family of people with various disorders.

If she's deteriorating, that's certainly worth talking to her doctors about, as it may mean that she's going to need extra help soon, even possibly including a conservatorship (basically a ruling that she's incompetant to manage her own affairs).

Does she live alone? Does she have anyone she trusts in her area (friend, lawyer, clergy person, doctor)? If there is a sense that she's deteriorating, you need to start strategizing and planning now, before it gets worse.

There are conversations you have to have with her when she's lucid, because none of this will be able to be discussed when she's paranoid. What you want is to have a conversation in which you, and/or trusted others tell her (with tact and delicacy) that you all are concerned about her well-being, and are getting alarmed by some aspects of her behavior. That there are times when she acts brusque and says things that are hurtful, and you know she's not doing it on purpose, but *is she aware of it* either while it's happening or afterwards.

It's during these conversations that you let her know that you want to help her, and you were wondering if it was ok to talk with her doctor. This behavior could mean that she's having bad side effects from some medicine, that she's having a non-diagnosed medical problem, that whatever medicine she's on is no longer working, etc. These are things that are vital for her physician to know. If she gives permission, there's no problem. If she doesn't, you can still contact the doctor, as people note above, and indicate that you understand that he/she can't discuss the case with you, but that you wanted to alert him to some alarming behavioral changes that are going on.
posted by jasper411 at 3:25 PM on December 14, 2005

Response by poster: Thanks for all the advice.

Now, to find out who her doctors are. I have asked her in the past, and even when lucid, she won't tell me.
posted by spinifex23 at 3:28 PM on December 14, 2005

One thing to note, I've seen people with PhDs that had to write entire THESIS (so I know their english is passable, at least) write the most incoherent and horrible emails. Stuff like:

U gunna b @ store 4 =

Yeah, I'm serious, that bad. I don't know what causes that. :-( But that alone (you mention she was a professional writer 20 years ago) isn't really a symptom, IMHO (although the other things likely are!)
posted by shepd at 3:36 PM on December 14, 2005

Now, to find out who her doctors are.

Would your dad tell you? Since you're across the country, it might be easier for him to find out. Snooping around should find a name, for example via insurance EOBs with a physician's name, or the prescribing doctor's name that will be on the side of any medicine bottles.

If she's on medicare, maybe you could ask under the pretense of helping her pick out the appropriate part D rx plan being currently implemented.
posted by neda at 3:38 PM on December 14, 2005

oops, sorry. just noticed the "non-amicable breakup" part (thought because of the email thing he was still there).
posted by neda at 3:41 PM on December 14, 2005

Response by poster: No worries, neda. Dad doesn't even want to be in the same county as her, much less the same house!

If anything, I'll snoop around when I visit her next, and check out those organizations for support groups.
posted by spinifex23 at 3:50 PM on December 14, 2005

"The Rosalynn Carter Institute for Caregiving (RCI) was established in 1987 on the campus of Georgia Southwestern State University (GSW) in Americus, Georgia. The RCI was formed in honor of former First Lady Rosalynn Carter, an alumna of GSW, to enhance her long-standing commitments to human development and mental health."

I've been very impressed with the work that I've seen from this group of people. I suppose every first lady has a cause, and Ms. Carter's is mental health. Check out some of the publications, as well...
posted by richmondparker at 4:21 PM on December 14, 2005

I hope some info here can help you because it sucks that you have to go through this. It can't be easy. Be sure to take care of yourself too - if that means talking to a counselor, setting boundaries about not having contact with your mom when she's abusive, taking time off for yourself, etc.

Also bear in mind there's a whole gray area of mental health that many people inhabit for their whole lives. They're not institutionalized but they need some outside support to make sure they do stuff like eat regularly. When stress levels are low many people are fine, but a lot of people who are kind of on the edge anyway respond to stressors (money, poor nutrition, even a long run of bad weather) by backsliding into delusions or similar. I guess I am trying to say there's a chance this will just have to be managed for the rest of her life.

An antidepressant may work wonders - severe depression can lead to delusions so that may be what has happened. Of course, there is the challenge of getting her to go to the doctor to get one prescribed.

Is there a group you can join to find support? I bet it would help to find some other people in similar situations who could share their experiences with you.
posted by selfmedicating at 5:42 PM on December 14, 2005

I give this advice with the caveat that you only use it as an absolute last resort: if you are sure that she is very much in crisis and/or is an immenent risk to herself you can call the police and ask them to do a "welfare check". If the police see evidence that she is not able to care for herself they can have her hospitalized, or at the least alert Adult Protective Services and have them try to work with her. YMMV, depending on what part of the country she lives in - in San Mateo CA, the police & social services are pretty good at handling these sort of situations. Again, this is a measure of last resort - if the police don't find sufficient evidence to have her hospitalized/alert APS, you are going to have one very pissed-off, paranoid person on your hands.

On a personal note: I used this once when a resident of the halfway house I worked at missed meds & curfew and made an unscheduled visit to his father's house. Normally, this was not that much of a big deal, but I had a really bad feeling after reading the other counselor's notes from the previous shifts. Turned out that the police were already at the father's house because the neighbors had heard screams. Because they didn't have any info to go on, they had been preparing to use lethal force upon entering the house. The police got my client to surrender and managed to get the father to the hospital where he spent a week in intensive care.
posted by echolalia67 at 7:14 PM on December 14, 2005

spinifex23, my sympathies to you AND to your mother. This rings such a bell for me that it's shocking. Particularly coming on the eve of the eighth anniversary of my mother's death.

A few years before her death my mother started exhibiting very similar behaviors:

- Accusing me of stealing/selling her things

- Paranoia regarding people in the house

- Angry/violent phone calls or multiple phone calls saying exactly the same thing

- Incoherent messages, etc.

After she died I learned that she'd been suffering with dementia and the beginning stages of Alzheimers.

I'm sorry to say I have no personal experience suggestions for you, as I did not cope particularly well, or at all really. My mother and I did not speak for he last three months of her life.

But I would suggest that you read up on dementia and Alzheimers both. Perhaps going as far as locating a support group in person or online. If I had known that it wasn't just my mother being cruel or difficult I would have been able to be there with her at the end instead of closing her out.
posted by FlamingBore at 7:21 PM on December 14, 2005

I agree -- this sounds like early dementia, which could be Alzheimer's. It could be caused by other independent factors, of course, but this is an unfortunately common side-effect of aging. It's also common for a personality to markedly change after an event such as a major operation.

(If the change is very dramatic, one possibility is a brain tumor, but it sounds like it's been there throughout in some ways.)

I definitely agree that it's time to get her to give you a medical power of attorney. You should probably also consider, but maybe later, an overall power of attorney so that you can handle financial issues for her. If you have to deal with doctors, or later find assisted living, these will make that process invaluably simpler. Persuade her that it's just in case of emergency, if need be.

I would reach out to her personal physician, and I would also try to speak to as many of her friends and contacts as possible to ask if they've noticed the changes. Give them your number and make sure that they feel comfortable contacting you if anything major happens.

Ultimately what's happening is that your relationship -- which seems to have reached an equilibrium of equals -- is changing as it did during your adolescence. You're going to have to mentally prepare yourself to parent your parent. You're also going to have to plan in advance to make sure that you don't get excessively stressed out over this, as it could negatively affect your own health and career. Have people you can talk to and go to for support.

Here's a classic book -- you can explore for others.

Good luck.
posted by dhartung at 10:21 PM on December 14, 2005

What appears to one as schizophrenia may be something else. Investigate Borderline Personality Disorder. A lot of the symptoms you describe are classic expressions of BPS.

Often the borderline condition is perceived as a vast wasteland between the neurotic and the psychotic. This vast wasteland which lies between the neurotic and the psychotic is a condition that is neither schizophrenic nor neurotic.

A condition that is neither schizophrenic nor manic may be seen as borderline.

posted by zaelic at 2:01 AM on December 15, 2005

another reason to tell her MD: when my mom seemed totally nutso it turned out that she had something wrong with a parathyroid (sort of a satellite thyroid to the main one, I think.) They took it out and she was sane again- as simple as that. We'd put up with hell for no reason. You never know- there might be an easy fix.
posted by small_ruminant at 2:56 PM on December 15, 2005

FWIW: My stepfather went more than a little sideways, mentally, in the years before he died. Massive paranoia, mostly. I remain convinced to this day that it was to a large extent a result of interactions between all the drugs his doctors had him on. I suspect the massive heart attack that killed him in his sleep was not unrelated to that, as well.

I am leery of doctors.
posted by stavrosthewonderchicken at 4:43 PM on December 15, 2005

Response by poster: Thanks for all the support, guys.
posted by spinifex23 at 8:24 PM on December 15, 2005

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