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Sunday, Nov 8, 2009
Yes, publicly supported social workers are vastly overworked. However, if you can find one in your mother's county or city, that person will know what services are available, how the law works in that state for mental health issues, and so on. They may have some ideas you haven't thought of.
I think some of the other suggestions are good too... try the prescribing physician on your mother's medications, try a crisis hotline in your mother's city or county.
If it's any help, try to think of your mother as an adult who has reverted to toddlerhood. They do ridiculous, irrational things, and have to be protected. Unfortunately, your mother has the body of an adult, with adult privileges like driving.
Good luck.
LW's mother is a clear and present danger to herself and others. Her irrational behavior is not likely to modify on her own, and it is clear that conventional interventions by those who care for her have done much good, but have, in fact, exacerbated the situation.
Certainly, there has been some good advice, inclding finding the source of the script, and requiring a response from them, reaching out to the local mental health community.....
But the truth of it is, depending upon the state, the only final recourse may be an involuntary committment to a public mental health facility where, over a period of time, her condition can be properly assessed and a course of action mapped out. The legal structure to do so varies from state to state, and can be quite complex, as this type of legislation was badly abused in years past. However, there may well be a legal construct by which you can force this woman to be placed in a mental institution against her will where various evaluative measures can be taken. She may be dealing with the absence of Paxil, she may be schitzophrenic, she may be bipolar, she may be suffering from Alzheimers - or some cocktail of some or all of the above.
An inpatient committment will allow for an effective diagnosis, and with that, decisions about her care can be made. If, indeed, she is not competent to manage her affairs, it is likely that the mental institution staff will testify to that at a guardianship hearing. If, indeed, the answer is a simple one, it can be implemented, and your mother may take it upon herself to repair her damaged relationships.
Years ago, my brilliant, but deeply alcoholic mother spun out of control following the death of my father. Her behavior became erratic in the extreme - driving her car backwards along high mountain roads in northern New Mexico - protecting her "homestead" by jamming, who knows how, three rounds into my late father's deer hunting rifle, and other such colorful but life-threatening antics. She fired the nurses we hired to take care of her, and she continued to operate in her world.....the rest of us were nuts...........
my brother and I, operating as a team, had her involuntarily committed to the state mental hospital; even in those days, it took reams of paperwork, and a substantial legal investment to lay the legitimacy of our position. Following her committment, we threw out gallons of Vodka (she was buying it by the caseload), cheap wine and collected dozens of bottles of prescription medication that she had prescribed for herself (she was a physician). We took this this potentially lethal collection of uppers and downers to the state hospital 9which filled a kitchen garbage bag) where the intake staff wondered how, frankly, she had survived, as the combinatiosn of some of the meds she was playing with were quite powerful, and it was clear that she had no sense of temperance as to dosage.. After three weeks, her behavior patterns, no longer dictated by her vicious cocktail of drugs and booze, began to demonstrate a consistent pattern, and she was diagnosed with Alzheimer's. She never lived outside of a custodial setting for the rest of her life.
As an aside, I had all of the usual steriotypical views of the state facility, and indeed, physically, the place was a wreck. however, the staff were well-trained, thoughtful and meticulous in their diagnostic approach. We had her diagnosis confirmed at Mayo's Clinic just to arm ourselves for the guardianship hearings, but the truth was, the state mental hospital did the intensive diagnostic work.
Is this fun? hardly, it is ruthlessly excruciating to take these actions (and any others that co-opt LW's mother's free will), but the only regret, in retrospect, with my late mother, was not in doing it earlier. In truth, her quality of life was better in a custodial setting (a variety of nursing homes of increasing care levels) than it would have been had she been allowed to continue to run amok at home. I don't know what the answer will be for LW's crazed mother, but it is clear that the answer will not be proffered forward by voluntary actions by this woman. The issue needs to be forced.
Yes, as many have said, primary care doctors prescribe SSRIs at the drop of a hat. And (digression) I can't help but wonder if all the direct-to-consumer advertising augments that. http://www.cbsnews.com/stories/2007/01/29/health/webmd/main2411011.shtml
Anyway, I hope that eventually the mom, if she had been on the Paxil courtesy of her regular doctor, does get a thorough psychiatric evaluation. As someone said earlier, if a person has bipolar and takes only an antidepressant, it can precipitate mania.
My family has suffered greatly from mental illness, including suicide and psychosis and bipolar disorder, going back several generations (and probably before that, but they were across the ocean, so no idea). The current generation of psychoactive medications has saved us, me included. They're not all good and they're not all bad.
As for the criticisms of the LW and CT, (1) it's so hard to be objective when you're close to the person. In fact, that's really a running theme of the letters (eg, people who probably should leave their lover or spouse but don't have the distance to see it). (2) How do you know that Cary did not communicate with this person earlier (ie, asap, rather than just at the time of publication herein), not that it's his job, but how do you know? (3) Whatever the timing of intervention owing to the problem being aired in a letter, thousands of other readers will learn and benefit. (4) "I cannot remember who it was who said that a family was a dictatorship ruled over by its sickest member..." ~ Moss Hart, Act One. Maybe this family has been in mom's thrall (whether always or only since dad's death) so much that perspective is impossible, and action stymied.
Best of luck.
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