My 35 year old step-son is in pretty bad shape. He thinks people are taking pictures and videos of him, sees simple coincidences as having some kind of meaning having to do with him and thinks his mother and biological father have some sort of information or answers that they are withholding from him. He has abused various drugs over the past 15 years including opiates, Xanax and, most recently, Adderall. Most of this drug use wasn’t to get high, per say, but to feel “normal”. The Adderall was prescribed (90 mg. per day!) after he went to a psychiatrist and told him that’s what he had been taking. The shrink took him at his word at prescribed the 90 without ever having seen his medical records. In fact, he had never been prescribed Adderall. His girlfriend did him the favor of introducing him to that beauty. Once he had the new script, according to him, he was taking much less and using the rest to barter for marijuana or services. She moved out 18 months ago and he has been a deep funk ever since. He sits in a house all day only leaving to buy cigarettes and food (and weed, I presume). He has had heightened general anxiety before I came into in the picture 19 years ago after his parents were divorced. His mother and father have been financially supporting him for well over a year. He hasn’t had a steady job in three years.
A few weeks ago his father signed the required papers and the police took him to a crisis unit. He went without a fight. He claimed he had weaned himself off the Adderall a couple of months ago (this may be true - he has taken himself off stuff before). He was released after two days and put on a new drug (off label use - I don’t recall what it is. Anti seizure , I think) and things seemed to improve a bit. In the last few days he has gone downhill. His father said he has stopped taking showers and looks horrible. They live fairly near each other in Florida, his mother and I are in NJ. It seems that he is a danger to neither himself nor others so a long-term involuntary commitment is not going to happen. He was convinced to go to a voluntary program a few months ago but was asked to leave after two or three days when he refused to get out of bed to partake in daily activities. He says things like, “I’m done” and “nothing will help” but denies suicidal thoughts.
Things are reaching breaking point. The house that he is living in is now owned by his father. He paid off the privately held mortgage that my stepson and his girlfriend took out. His father can’t really afford to keep the house much longer and wants to finish fixing it up so that he can sell it. Now, my wife and her ex are faced with the choice of supporting their son forever with the status quo or putting him on the street. We are going down in a few days in spite of the kid’s stated desire to not see his mother. According to him, “she’s a trigger” The father is travelling for work for the next three weeks and there is a real possibility that the most recent decline is a side effect of the new medicine and he could be having serious medical issues in addition to whatever is going on in his brain. We are going to try to convince him to go into a 10-14 week Salvation Army program that is local and, basically, free. His likely reply is going to be, “Fuck it. Nothing else you’ve told me to do has worked so why should this?”
So, how do you get someone who isn’t thinking rationally to listen to rational arguments as to why they need long term help? I’m beginning to realize that this “kid” is probably one of thousands who slip through the cracks and there may be nothing that can be done to help him. BTW, the father is a recovering addict (hence the divorce) who has been clean for 20 years and sees this whole thing as, pretty much, a drug problem. He and his son have been at odds since before the divorce. This son chose to stay with mom and an older brother stayed with dad. Whether drug-induced or not, there is clearly mental illness involved. I’m pretty sure there was a diagnosis of bipolar disorder sometime in the last few years. Simple drug addiction would be so much easier. This dual diagnosis stuff is a bitch. Oh, mom’s side of the family has a bit of a history of mental illness, too. There’s even more but you get the picture.
Is he willing to see a psychiatrist or a counselor without going into a program? A program may be what he needs but either one of those (assuming competence) would also be great and will be essential to his long term recovery. A psychiatrist can help get his medication straightened out, and both could help assess what type of program he really needs and help him find it. It’s hard for me to say based on what you’ve shared that SA program is the right program, but I must admit that I have have my doubts, considering his mental health issues.
My suggestion would be to focus on finding him competent competent counseling, and to start researching some sort of halfway house living situation for those for mental health problems. Do you think he would be willing to work with you on those types of steps?
I am sorry to say that I don’t think there is a good outcome here.
Most people that I know or have encountered with mental illness seem convinced that they can manage their condition themselves and / or ascribe the downsides to other people. There seems to be at least some of that going on here: self-medicating, calling his mother a “trigger.”
The best thing is probably to get him into the system, on the radar of people who can help (local mental health facilities), and what Sunny Daze said. Good luck; this is a difficult situation to be in.
I would agree from your description in the OP that the individual involved is not processing things mentally in an ideal manner.
Be that as it may, I am one of the people Dr. Drake, above, refers to as preferring to manage their condition themselves, and the main reason we do so is that the psychiatric establishment, and the state of the underlying medical understanding, hasn’t gone beyond the “stone knives and bearskins” level, in addition to which those stone-knife-weilding bearskin-wearing medical professionals have coercive powers.
Now, lots of people do find benefit in psychiatric services. But a very high percent of them sought them out voluntarily. There’s a whole lot less applause from people who were pressured or coerced into receiving treatment, and statistics don’t show such interventions to have a track record appreciably better than just leaving people the fuck alone. You’ve described a suspicious distrust on the part of your stepson. I would imagine he would be extremely wary of “help” that’s being pushed at him or pushed onto him without his consent.
Is your stepson interested in receiving some form of help?
How the hell is “tough love” going to help someone who isn’t actually in their right mind? Considering a good number of homeless people are mentally ill, “tough love” may just end up causing exactly what they’re trying to avoid.
Forgive me for jumping into an area where I do not have the level of experience that it seems you and others do - but the question I end up with is - what if the condition that needs treating manifests in delusional paranoia (suspicious distrust)? At some point the inability for the subject to provide reasoned consent is a symptom.
As a society we have to choose, not necessarily between Extreme A and Extreme B but at least pick a spot along the continuum, if you will, between respecting people’s individual freedom and self-determination even when we think they are making wrong choices based on illogical thoughts and irrational feelings, and intervening to help people even when they don’t perceive the “help” as helpful but as an attack, imposing that help against their will, coercively, as need be.
With me so far?
Now let’s dub in a few extra bits of information and viewpoint that can have an effect on where we want to put that sweet spot:
• The available “help” really, objectively is not very helpful and is indeed often permanently harmful to the recipients. Psychiatric medications are habit-forming, and lose their effectiveness over time, due to how the brain and its neurochemical receptors and its related uptake biochemistry systems tend to adapt to the psychiatric medications when their use is prolonged. Electroshock (electroconvulsive therapy) has a modality of efficacy that is said by its proponents to be “unknown” and by its critics to be a side effect of the brain damage that it causes. Socially, to be given a psychiatric diagnosis and incarcerated involuntarily carries a huge stigma and vastly increases the likelihood of future involuntary interventions and incarcerations in the same way that having a criminal record and being known to the police makes your future arrest or investigation a lot more common and likely. And, finally, many studies of psychiatric treatment where it does have good outcomes indicates that voluntary participation yeilds the most likely good results, but that there is very little evidence that involuntary psychiatric treatment helps people.
• The risk to freedom and the liberty interest of citizens, on the other hand, of having a mechanism by which people can be held involuntarily not because of something illegal they have done but because of a prediction that there are unfortunate things that they might do, should be self-explanatory and compellingly chilling to contemplate.
• Completely independent of the practices of the institution of psychiatry and its medical model of mental illness, there is a civil process by which people who are found to lack decision-making capacity can be deemed incompetent, and a guardian appointed to make decisions and provide care. These aren’t perfect, either, but they developed parallel to reasonable precautions against rich elderly people having their estates ripped from their hands by their conniving children: the standards for competency and clarity of mind put the burden of proof on those alleging that incompetency exists. It is perceived and conducted as an adversarial hearing with an awareness that damage may be done if a party is wrongly ascertained to be incompetent. It is also reversible: an individual can petition to be found competent and to have all rights restored.
It seems he at least willing to talk to someone at the SA about their program so that’s a step in the right direction. We’re flying down tonight so that I can drive him there (he has no transportation and its an hour away). He has seen a couple of psychiatrists over the years but cost is a real issue. No insurance and expensive visits aren’t a good combination. He has applied for SS but it doesn’t look good. The most recent one didn’t do any counseling, just wrote scripts. He’s been to various groups (NA & AA) but insists groups aren’t for him. From what I understand, the SA thing has a medical component as well as counseling and groups. The coercion being used has been “Get help and we’ll support you emotionally and financially or get out”. I suspect , in the end, he’ll choose the latter. Then the decision has to be made as to how much , if any, financial support is provided. Mom was a psych nurse years ago and has plenty of experience with people who just gave up on their family member. I don’t think that she could could ever bring herself to do that but something has got to give.
There’s an article in Slate today about the success of different types of coercion for addiction treatment, and a lot of it could be applicable to mental illness treatment as well. An important factor is granting the person some feeling of agency even when there is coercion being applied: give them a difficult choice, not a threat.
My concern is that it’s the wrong kind of help, and the cycle of distrust only deepens. I’m glad he’s talking to SA, however. It’s at least a first step.
Other options for you to consider: are there any programs you can find that set their payments to ability to pay? You might try calling a local crisis hotline to see if they can recommend any.
Deep breath on this one: are you (and he) willing to have him relocate to where you are? It sounds like his bio-Dad is either not helping all the way to actively enabling. You would obviously have to do a lot of talking and thinking about what that would look like to be successful amongst yourselves before you even broached that to him, but having your active support might make all the difference for him.
One option to keep an eye out for is user-run self-help. Wary (“paranoid”) schizzies are less likely to dig in their heels and often benefit not only from the sense of community and connection but also from the experience of considering each others’ problems. We don’t have user-run organizations everywhere by any means (wish we did!) but we have some and doing mutual support has proven helpful and effective.
Speaking from someone who has been in a similar place, I’m sorry, but you can’t. All you can do is establish firm boundaries and wait and hope that they decide that they need help. You have my sympathies, it’s a hard situation to be in.
I agree you can’t force someone to get help, but what suggestions do people have for being helpful for such a person be able to live a long life as happily(?) as can reasonably be expected? Not that you are the therapist that cures them, but that you support them in some way so that they don’t end up freezing under an overpass.
I have a friend who has a brother who has some mental problems (autistic and some other issues). They can’t have him living with family, since he brings losers back to the house no matter what the family does or says. So the family gives him a small allowance which allows him to rent a dump of a place where a bunch of losers mooch off of him. It sounds terrible, but realistically speaking, it may be the best possible outcome. If they gave him more money, his loser friends would take it all. If they cut him off, he would be on the street because he can’t hold a job. When they move him to a new city, he finds a new batch of loser friends which take advantage of him. And he is totally opposed to getting professional help. So it seems like all outcomes are bad, but some are less bad than others.
.You give him irrational arguments that short term help might help.
If the short term help works, then you can give him rational arguments about long term help.
My friend was worried about the demons (that were making his life miserable). I told him that his psychiatrist had substances that kept demons away.
The subject came up about a guy who was getting grief from his co-workers about all the garlic he was wearing at work (to keep away the vampires). Rational arguments weren’t working. An experienced nurse piped up and said “If I’d been there, I would have just told him that vampires don’t come out in the day time”.
It’s a rule that also works with people who are still showering daily: you start by agreeing with them. It’s more important with people who are a bit crazy, because unless you make the step, you have less agreement to start with, and have less credibility.
The aroma of Chamomile tea, if a person who is in a florid state of mental confusion can be persuaded to spend 20 minutes or so inhaling it (without drinking it) can stabilise a the mind for a period of time (an hour or so) during which the person may display a deep insight into their predicament … once the effect wears off though the person usually refuses to repeat the experience. This effect of Chamomile aroma on a psychotically chaotic mind is truly awesome to behold. For a period of time one is able to communicate with the “sane core” of the mind of someone who, a short time before, was “all over the place”.
Bit of an update. We went down and surprised him a bit with our appearance. He knew that I might be coming at some point or another and had agreed to go to SA for an interview. He wasn’t triggered by the presence of his mother which, obviously, was a good thing. The medicine he was prescribed at his brief stay at a crisis unit is Trileptal. The 30 day supply had run out the the day before but he was able to get a re-fill. (He is also supposed to go to counseling at only $3 per visit but hasn’t been going.) He say that it helps but is only partially effective. He was out of the drug for one day and noticed an immediate decline. He was much calmer than the last time his mom was with him but the house was a disaster. Overflowing ashtrays, food scraps on the counter and floors and dirty laundry strewn everywhere. In short, the classic signs of mental illness. His excuse was “I’m a bachelor. Maybe if I had a woman in my life I’d clean up.” Conversation was fairly normal and he described a a break-in that had happened a few weeks ago that occurred while he was sleeping. He claims that he awoke to someone standing in his kitchen (he sleeps on a bed in the living room) and the person appeared to be holding something at his waist but he didn’t know what. The guy (described in some detail) ran out of the house. He discovered that his wallet was missing the next day. He didn’t call the police right way because he thought the person would know and might come back for revenge. The next night he thought he heard someone kick the door a couple of times and did call the police. We can’t know if any of this happened. His wallet is missing and, as a retired cop, I can say that his house is the perfect target for a burglary. Sorting out what is real and what is delusional can be a problem. Anyway, he also said that he is absolutely certain people are recording him, taking his pictures and hears his own voice singing on certain songs on his Ipod. He knows that it sounds crazy. He even said. “If you told me this about you I’d say you’re fucking crazy. But its true.”
Anyway, the next day we went to SA and he spent maybe 15 minutes talking to someone. When he came out he told us that the counselor didn’t have much too say other than their program wasn’t really for him. Its targeted at drug and alcohol dependent people and, right now, he isn’t abusing any drugs. The counselor called mom a while later and said that the son was paranoid and delusional. He confirmed that they don’t normally put people like him in this program but that they have and its still a possibility. Son says, “I might go there if they’ll have me just to prove you wrong.” Mom is pursuing this angle.
His cell phone has been broken and turned off for quite a while (the 911 feature still worked) and he refuses to have a new one, even if we pick up the cost. He doesn’t trust them and thinks we will track him or something plus he doesn’t like the incessant calls and texts from his parents. Mom promised to not call him unless he called first and told him he could block the number or just use e mail to communicate but he flat out refused. One issue is that he checks his bank balance daily at an ATM (mom puts small amounts in for food etc.) but these inquiries are $3 a pop and deducted as soon as there is a deposit. The monthly cost is double the cost of a phone and balance checks via the net are free. He has not internet at home, just over the air TV. She told him “O.K., no phone? Stop making the balance checks or the money will stop.” He got a little pissed called this an ultimatum. This ultimatum stuff is big with him but mom said, “If that’s what you want to call it -yes.” We’ll see.
We did accomplish a fair amount otherwise - getting his license replaced, applying for free medical care at the local clinic (almost completed, but he has to go back Monday with some missing paperwork. He says he will but its a coin toss.) and a few other things. We looked into medical marijuana, which he swears works better than any medicine he has ever taken and got the ball rolling in that area - just in case. Not bad for 8 hours but now there is no way to contact him until his dad gets back in two weeks.
