

When My Crazy Father Actually Lost His Mind - thamer
http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-actually-lost-his-mind.html

======
raintrees
I went through a small version of this. My father-in-law had Alzheimer's and
was able to cover for some years by mostly answering questions by asking
questions.

Locks appeared on the property, and started moving daily, if not sometimes
hourly (different keys, combinations, etc.) I invested pretty early in a good
set of bolt cutters.

I learned quickly to start any approach and conversation with "Hey, dad"
otherwise he would seem to decide I was a stranger up to no good and try to
run me off the property.

He would have moments of lucidity where he would admit he was terrified, that
he was pretty sure he was losing his mind. But they were pretty fleeting.

I remember one night he kicked my mother-in-law out of their house, claiming
he was going to kill anyone who came in. The Sheriff was called and it was
mentioned that not only was he a Korean war vet, he had guns in the house.

That was the night SWAT stayed outside our houses (we live next door) until
morning, as my father-in-law hung up on the Sheriff's Deputies and refused to
answer any subsequent door knock or telephone call.

Early that morning it was surreal to see the SWAT team serpentining across our
lawn, guns drawn. My father-in-law answered the door, invited the Deputies in
for coffee, was confused when they took him into custody, then handed me his
keys saying he didn't know what he did, but apparently he was in trouble and I
better watch over the place.

Turned out he had a toothache no one was aware of and was having a hard time
coping with the pain, since he couldn't stay focused long enough to tell
anyone about it.

Luckily, no one was hurt over that whole period and my wife got to spend the
last year and a half with her father before he died of cancer and
complications from Alzheimer's.

It has also resulted in some long talks with my wife about how long either of
us wants to be kept alive, in the result of not being mentally with it, or
mentally awake in a failing body.

We learned quite a bit about Power of Attorney and Medical Directives, as
well.

~~~
mv
"We learned quite a bit about Power of Attorney and Medical Directives, as
well."

this is important. I see too many people say 'do whatever you can' but they do
not realize what they ask. The loss of the mind is terrible, but so also is
the complete loss of the body. Combine the two and there is real (and
expensive!) trouble with doctors 'doing everything they can'.

------
Cushman
The story is just as sad on the other side of the desk. Funding has been cut
so far the hospitals have a few percent of the beds they need, and not enough
staff to treat even those. Non-emergency outpatient services are even worse.
Most of these people are being kicked out on the street, where their illness
and substance abuse will eventually leave them incarcerated, at best, at the
hands of police who are radically untrained to deal with sick people.

You expect a schizophrenic man to argue to the judge that he shouldn't be
committed because when he said he was going to shoot his kids with a shotgun,
he didn't really mean it; you might not expect his perfectly sane court-
appointed lawyer to pick through every detail of your records looking for a
reason to let him out.

My mother called me last week upset nearly to tears by a phone call she'd had
from a "doctor" employed by an insurance company, who was trying to argue that
her patient's mania (which he knew nothing about) wasn't a serious enough
medical problem for them to pay for treatment.

At this point she's planning to get out of clinical work; she wants to help
people, but she feels like the system just isn't set up to let her make a
difference.

We need to fix this a decade ago.

------
tankbot
This article "hits home" for me and it's nice to see it on Hacker News, though
I'm sure many here aren't real interested. I found it to be a great read but
also heart-wrenching.

I am the IT manager at a non-profit Mental Health organization and I spend my
days supporting the people who support the mentally ill. I also have mental
illness in my family.

Contrary to the portrayal of mental health professionals in the piece, these
people are intelligent well-meaning individuals who are severely over-burdened
and undervalued (A masters-level social worker starts out making $12/hr).
Combined with the absurdity of state laws and general ignorance in most
communities, it's a wonder that anyone gets treated at all.

~~~
Muzza
> Contrary to the portrayal of mental health professionals in the piece, these
> people are intelligent well-meaning individuals who are severely over-
> burdened and undervalued (A masters-level social worker starts out making
> $12/hr). Combined with the absurdity of state laws and general ignorance in
> most communities, it's a wonder that anyone gets treated at all.

As far as I can see the article only mentions the actions of the social
workers. It makes no mention of their intelligence or (lack of) well-meaning.
(As an aside: "I only meant well" is an extremely effective shield against
criticism and anyone who uses it should be distrusted. Also, even a truly
well-meaning individual can do a lot of harm.)

In what way are social workers undervalued? Apparently they can't get anything
done due to the laws. How would they get more done if we paid them more?

------
edoloughlin
Single page link: [http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-
fat...](http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-
actually-lost-his-mind.html?_r=1&pagewanted=all)

------
DanBC
Cultural note:

In the UK there is someone called a "nearest relative". This person is defined
in law[1] and has some powers. If the nearest relative says that a person
should be detained in hospital the clinicians must "consider" that option.
They don't actually have to do it, but they have to record that they've heard
the request, and that they've considered the request, and that they've
declined that option.

When you are worried about the mental health of someone you should call their
GP. This can be an emergency appointment. S/he will come and assess the
person, and maybe ask for a local "crisis and home resolution treatment team"
(might not be called that in your area) to come and assess the person.
Hospitalisation is sub-optimal, patients have strict[2] rights, and so it can
be hard to have a person detained against their will in hospital. It is not
lawful to say things like "Go voluntarily or we'll section you", but sometimes
the person can be persuaded to go voluntarily.

If the person is out of the home you should either get them home and call a
GP; or call the police. The police have something called a "section 36" where
they can detain someone for a short time for assessment. This should be a
"place of safety" - unfortunately this place of safety can be the police
cells, rather than a special building.

Once someone has had a psychiatric incident it's a really good idea to make a
"Rainy Day Action Plan". You keep notes of useful phone numbers and
contacts[3] and instructions from the person about signs to look out for, and
what to try and do, and what to do when things get really bad. You make the
person write on this, and sign it. It is _their_ document, and it's important
that it's their words and wishes. This certainly helps if you need to get them
hospitalised or medicated in future.

UK law is a bit complicated. Every patient should have advocacy available, and
I certainly recommend that people try to get hold of advocates.

I am not a doctor or clinician or etc. This is just anecdotal advice from a
random internet stranger.

[1]
([http://www.dh.gov.uk/en/Publicationsandstatistics/Legislatio...](http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/DH_4002034))

[2] Sometimes those strict rights are ignored. It's very annoying.

[3] There's a lot of churn in staff in MH services. Don't expect those
contacts to stay valid for very long.

------
Alex3917
For what it's worth:

"21% of patients with bipolar disorder and a diagnosis of severe substance
abuse (alcohol or illegal drugs) were convicted of violent crimes, compared to
5% of those with bipolar disorder but without substance abuse, 5% among the
unaffected siblings of bipolar patients, and 3% among general public control
individuals."

Source: <http://www.ncbi.nlm.nih.gov/pubmed/20819987>

I haven't actually read the study much less the rest of the research on this,
but the actual statistics on this (whatever they are) seemed conspicuously
absent from this article. In fact there really really no statistics
whatsoever. It's a heart wrenching story, but there are good reasons why it's
generally not a bad idea to create public policy based solely on individual
cases.

Granted there isn't nearly as much research as there should be, and at some
level you eventually do have to go with your get because of that, but at the
same time there is a hell of a lot more evidence than was presented.

------
yonran
This story resonates with me. My mother is bipolar. Growing up she would be
fine for a year, then gradually become more active and paranoid and
spendthrift, then be hospitalized for several months, and then start the cycle
over. In 2008, she drained and overdrew the joint checking account that she
had helped me open when I turned 18 and flew abroad, costing us much distress
and thousands of dollars (she was kicked off one homebound airplane for
causing a disturbance). She was finally hospitalized long enough to recover.

But in 2011, when she had another bout, the hospitals refused to hold her for
more than a week, and she was returned home only to be a nuisance to her
landlord and a weirdo on the street. The social worker said to ask the police
to take her to CPMC or St Francis (private hospitals) who will be more likely
to hold her for long enough to recover instead of SF General, but since then
she hasn’t been an imminent threat; merely a loud, paranoid insomniac who
can’t get anything done.

It’s very difficult to reason with her regarding her illness, which she denies
when she’s manic. I don’t know first-hand the facts of her police mistreatment
or landlord interactions or whatever she happens to be angry about, so I can’t
convince her that she’s wrong. Oh, and she refuses to take her medication
because she’s convinced that they will ruin her liver. I sometimes wonder
whether a smarter, more introspective manic person would be able to deduce
logically that their paranoias are irrational and rein themselves in. But
alas, her poor concentration and temper hare never allowed her this power.

~~~
jcmhn
> Oh, and she refuses to take her medication because she’s convinced that they
> will ruin her liver.

Until fairly recently doctors had no idea how to measure minimum effective
doses of lithium, so many older people with bipolar disorder are suffering
damage to their liver, kidneys, and thyroid. Mental health practitioners also
used haldol and thorazine with a pretty loose hand - without worrying about
side effects or toxicity.

So realize that she has a reason to believe that her meds are bad for her -
because they are, they are just better for her than going un-medicated. Her
doctor or social worker should probably be the one to explain to her the kind
of testing and monitoring they do to make sure that they do as little damage
as possible.

------
sudoman
Please, let's remember that the mentally ill aren't 'evil alien[s]', as the
author describes her father. People considered mentally ill are those who
generally have emotional and/or cognitive irregularities, be they subtle or
strong. That still makes them human.

I recognize the need to expand involuntary commitment laws to include evidence
of recent events beyond the past 15 minutes of an interview. I agree that
something does need to be done about dangerous people in general, regardless
of whether they are mentally ill or not. This is a problem that needs
restrictive and supportive measures on many fronts.

However, most mentally ill people are not dangerous. The author's use of
circumstantial stories, instead of statistical evidence strongly distorts the
reader's understanding of a typically mentally ill person. In her story,
almost every mentally ill person she mentions kills someone. But as the author
says in the end, the mentally ill are statistically less likely to harm
another than to be harmed by someone else.

I think that some of what the author hopes for is a good idea, but if people
could be forcibly treated for mere delusions or minor symptoms, then that also
includes the huge percentage of normal Americans who believe in or claim to
have seen ghosts. Do unusual religious beliefs count as insanity? Are your
political views ever considered 'irrational' by someone else? What happens to
free thought and religion?

The problem with creating laws that chip away at civil liberties is that these
laws can be abused or stretched to cover people who are in a 'grey area' and
aren't a real danger. Those in power can take laws and apply them according to
their personal preferences and values, at the expense of those who do little
harm.

I think it's a good idea to have involuntary commitment laws only for the rare
dangerous cases that exist. But in addition to that, human support is needed.
Treating people well and showing gentle empathy will help win them over to the
side of those who are trying to help. In the end, let's not harm the large
majority who are closer to the middle of the grey area, and aren't dangerous.

------
SoftwareMaven
A close family member of mine has schizophrenia (fortunately it is well
managed at the moment). You cannot imagine the frustration of trying to get
good mental health treatment in our system, and that is with a willing
patient. My greatest fear is that we wind up in a similar situation as the
author, where we get stuck in the system where treatment is not the most
important consideration.

------
iuguy
Single page link for those interested:
[http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-
fat...](http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-
actually-lost-his-mind.html?_r=1&pagewanted=all)

------
mathattack
Very sad story. I think there are legal documents (Medical proxies?) that can
help avoid this. As painful as the story is, I also think the other
alternative can be abused.

------
keithpeter
"He was never still."

There are similar issues in the UK (another member has posted a summary of the
UK legal position below).

What happened to 'asylum' in the original meaning? Places of refuge?

------
ck2
So basically, early easy access to even just a family doctor willing to
describe the most basic meds and a lack of stigma attached to taking those
meds would save society and families a ton of grief and expense.

But since we are in the USA, this will take decades to happen, if ever. The
only hope is a massively profitable, universal drug is invented, then
pharmaceutical companies will fall all over themselves spending a fortune to
market it like viagra and make it "hip".

------
zygotic
Listen very carefully. I shall say this only once. Lunatics do sometimes run
the Asylumn. You are declared insane only by a society that doesn#t understand
you. I've never met a mad cat - but some quite angry panthers... Violence is
the only measure of insanity.

~~~
RockyMcNuts
hope everything's OK there.

A lot of violent people are, sadly, quite sane and otherwise fairly rational.

I'm quite sure a relative wasn't just misunderstood, but needed a bit of help
when she heard voices, didn't want to stay in her apartment because of the
spirits, withdrew all her money from the bank because the people there were
conspiring against her, and wandered the streets of NY late at night.

~~~
zygotic
Apologies for my apparent flippancy - I do not intend to offend. It's
difficult to make the point in such a small space with so few words, I was
attempting to address a larger picture. Allo Allo was a British satirical
comedy concerning the Nazi occupation in France (hence the tagline 'I shall
say this only once'). I suggest, very sadly, that you are wrong. Violent
people are demonstrably not sane or rational - especially when under orders. I
promise that I understand your concerns lie closer to home at the moment. But
people.never forget.

------
yic2
The author seems extremely harsh and unfeeling toward his father. He, or any
one of us, should try to imagine being treated like his father did -- on first
discharge from hospital, no one to pick him up but just some money and clean
clothes were dropped off at the hospital. His father must have felt too
unwelcome to even go home, and he didn't ... he went to visit his brother. On
second discharge from hospital, they were so worried he might go home that
they used a single phone call he made from hospital to the apartment as an
excuse to put a restraining order on him -- which the police reacted by
putting the father in jail. What a son! No surprise when the father acted
hostile towards his children. I honestly think the children should have found
a new apartment for their mother instead of putting father in hospital/jail.

~~~
earl
Did you read the article? Before the first hospitalization, the father had
already repeatedly assaulted the mother.

    
    
       Convinced that nameless people were trying to kill him, he slept
       no more than an hour or two a night and started drinking after
       five years of sobriety. When his suspicions grew to include his
       immediate family, he became violent and threatened suicide. At
       one point, he tried to jump out of the car as my mother was driving
       down the highway on the way to the doctor’s office. On another day,
       he poured motor oil over her windshield as she was pulling out of
       the garage. More than once, he hit her. More than once, he
       threatened to burn the house down.
    

The author also pointed out her father is a 250lb man who presumably is
significantly physically stronger than her mother. So it's quite clear why
they didn't want him going home. Further, in the emergency room

    
    
       In the emergency room, he grew belligerent, shoving a doctor and
       nearly punching an orderly. That’s when he was injected with Haldol
       and sent to PESS.
    

etc etc. And it isn't hard to see the author's torment at being forced to do
this to her father.

~~~
jcmhn
> And it isn't hard to see the author's torment at being forced to do this to
> her father.

That guilt, torment, and second guessing of yourself is one of the terrible
things that result when trying to take care of a mentally ill person. Unless
you've actually been there, and been there, and been there, and been there
again you can't understand how the experience wears you down.

I'm a empathetic and patient person, and I have had to make the same sorts of
decisions the author describes. There are no good answers - only less terrible
ones, and even those you are not sure of.

~~~
yic2
I'll admit I'm a bit biased. I have had a brief psychotic episode, committed
against my will (based on the article its hard to commit people, but in my
case, not being home at 11pm at night but walking in the street in a nearby
town -- plus a yes from a person in my family to the police did it right
away.) This in the US. So I've seen this from the other side. I felt my family
were more concerned in maintaining the appearance they were doing the right
thing and to prevent any further disruption than anything else. Nevermind if
the patient loses the ability to think or develops side effects like tardive
dyskinesia (where you can't control your tounge so it keeps sticking out of
your face and drool -- which I experienced for a day, or uncontrollable eye
tics), and weight gain which is very common. I was surprised that the
psychiatrists don't spend much time with you, its a 10 minute conversation
followed by a prescription for daily antipsychotics. Unfortunately, my parents
trust in medicine and are very conservative and thorough, so they gave me more
antipsychotic than I needed and talked me into taking it for months and
getting prescription elsewhere even though the initial doctors were no longer
involved. Your every behavior becomes second-guessed, if you become
occasionally irritated like normal people, your family thinks you didn't take
your medication or you might need help. In fact, at the end of the article,
when the father said some loving things towards his son, I wondered to myself
whether the father had said those things as part of the act to protect himself
from treatment. Its what involuntary commitment does to you.

Btw, now there are antipsychotics that are injected once a month and release
slowly.

