Marie was making the two-hour drive to visit her aging father when her husband, Greg, calls to tell her their son, who is dually diagnosed with bipolar disorder and addictions, has left the house with a stuffed backpack. The scene is frighteningly similar to an incident that occurred a year prior when Marie’s son left home, went off medication, became homeless and experienced a near fatal overdose. And yet, that morning, only hours before, her son had been in a bright mood talking about starting a new project. Greg also reported that their son had thrown away personal effects including family portraits that had been in his room. He was angry and arguing with his father before he left and some of his thinking was illogical. In that moment, he exhibited signs of suicidal behavior, for him most probably by drug overdose. Marie and her husband had been at this juncture before.
Parents of adult children who live with persistent mental illness say that when things are going smoothly and without incident, “You are always waiting for the other shoe to drop.” Parent / advocates maintain a mental state poised for an abrupt change in plans or even crisis. When asked, “How are you doing?” They say things like, “We are good today,” which implies change will happen, and not always for the better.
Our Behind The Wall contributors have become accustomed to this hyper-vigilant state of being. Jennifer, who was diagnosed with bipolar and borderline personality disorder, had been working and living on her own successfully when her mother, Esme, received a call that she had been rushed to the hospital after a near fatal overdose. Maika’s son, Riley, was earning A’s and positive feedback from his instructor of a difficult community college pre-law class. Maika was optimistic and felt her son was in recovery when Riley stopped taking his medication, a decision Maika was against and that lead to a long downward spiral and a string of harrowing events: a psychotic break, an encounter with the law and a six-month jail term where he continued to suffer from psychosis and was badly mistreated.
Parenting an adult child who lives with mental illness feels like living on an earthquake fault line. Just when a parent feels their child has found footing with a good formula for treatment, a cocktail of meds that addresses anxiety and depression for example, and a routine that works, yoga classes or a even a part- or full-time job, inevitably something changes.
The unpredictable nature of mental illness manifests in small and significant ways. A person living with mental illness works harder than others to function in daily life and his parent/caregiver is constantly monitoring: watching for changes in mood, voice, or thought. Some days, the mental illness gets the upper hand for a day, or maybe a week, after which a person is capable of resuming a regular life. Other times, the ill person makes a bad choice—like going off medication —that causes abrupt change, and requires caregiver intervention to prevent further harm.
Parenting a child with a persistent mental illness requires flexibility. One must sway to new developments. From planning a simple vacation to establishing living arrangements, there must always be an “out-clause.” Parents soon learn that to be available to help their child, they must set-up their own life—their jobs and living situations—to handle change and crisis. They choose flexible jobs or arrange for backup help in advance. Dan, whose daughter lives with schizophrenia, is fortunate to be able to work from home. There were times his daughter could not be left alone at home alone. He still needs to be available for her on short notice to pick her up from her university and take her to the hospital or bring her home for a needed rest when life becomes stressful.
Maintaining constant vigilance of a person who lives with mental illness is necessary because not doing so could mean missing a sign marking the beginning of a life or death scenario. But this kind of constant vigilance can be psychologically and physically depleting. And despite their critical role in supporting their mentally ill loved one, parent/caregivers often put their own well-being last.
Living and caring for a mentally ill person requires a unique flexibility, a willingness to accept the day-to-day, sometimes hour-to-hour changes. Marie’s son was hopeful in the morning and angry by the afternoon, potentially on track toward crisis. But he remained sober, found someone to talk to, and came home with a positive attitude. Crisis averted. What a difference a day makes.