My son has been arrested

I strongly believe his current psychotic episode was caused by receiving a bill for $42,000 from a hospital in another state. He was involuntarily admitted there in Dec. 09 after a suicide attempt. Then when he tried to check himself out, he was civilly committed. In all he was there about a month. When the hospital realized that Medicaid in our state wouldn't pay the bill, they demanded my son pay it. He called them and tried to talk sense into them, but they were rigid. He hadn't been doing well up until then, but after that he took a huge nosedive. He's the worst I've ever seen, and I date it to receiving that insurmountable bill. He actually used to be quite interested in maintaining a good credit rating.

People say that. There are people who will provide this service for a very small fee. I'm going to try and get him to agree to allow me to be the payee. If that becomes problematic, we'll hire someone.

Yes, it's been suggested to me. I don't like it as an option. I really want to leave the ultimate decision in my son's hands. At this point if he refuses to continue to take the medication - while we're seeking alternatives to medication - I'll ask him to live elsewhere. The negatives of forcing treatment outweigh the positives IMHO. Aside from the emotional toll of being forced to take powerful and potentially dangerous medications, I find that using force lowers my son's trust, damages our relationship, and pushes him to run away (which is why he was in another state in Dec. 2009 - he was fleeing the force/coercion he was experiencing about medication from both me and the mhc).

Right now I'm watching him work this one out for himself. He hates the medications. He hates them worse than the psychosis. On the other hand he's not too keen on the psychosis either.

Last night he spit out the medication. The result was a sleepless night and problems in his living situation (i.e., I was really pissed off that I didn't get enough sleep). This morning he asked for the medication. He was trying to negotiate a lowered dose at bedtime. I'm trying to negotiate staying on the prescribed dose until he has a chance to see his new pdoc (May 17).

The power he has to make up his own mind, to try different things and see how they work out, to reject what he doesn't find helpful, is worth far more than the (hopefully) temporary discomfort of psychosis.

Tonight: a sleep mask and ear plugs for me!

I made a brief report of how my son was doing last night under the gluten-free diet thread. Message #24.

He did take 30 mg of Zyprexa last night, in fact he was in so much distress he was eager to have it. Z has been a very effective med for him in the past, at a lower dosage. I remember it as being very sedating. He took it at night and it knocked him out for 12 to 14 hours. Currently it's barely making a dent. Another reason to prefer alternatives in addition to or instead of medication.

I did sleep well. He saw my sleep mask and asked if he could use it, but I put in ear plugs and closed my door at about 11 pm and slept soundly through the night. He was in so much distress because he couldn't sleep, so I felt a bit guilty abandoning him, but I needed the sleep badly.

Costello,
I sincerely hope this gets better soon for both of you. I know the toll it takes. My son is just one step right behind yours. I too feel quilty arguing with my son to take his meds, it phisically makes me ill. He is so distressed when he's psychotic and I don't think he's capable of making clear desicions to take his meds or not, that's why I push it. I don't know if I'm right or wrong anymore. I'm just afraid of all the bad things that can happen when he's psychotic.
Take care, I hope this resolves soon. (Oh, yeah, one more thing...I am payee rep for my son because his pdoc "wrote an order" for that :/...)
bcuz

I can identify with this. I don't know which way to jump.

I do strongly believe, though, that every competent adult has the right to refuse treatment. Maybe it's my legal background. We live in a country where people are guaranteed certain civil rights by the constitution.

The problem, of course, is what if the person isn't competent to say what they want? When my son is psychotic, he's not competent. But I've known him between psychotic episodes when he was competent, and he's consistently refused medication during those periods. That's good enough for me.

I've been reading Elyn Sak's book on forced treatment. She proposes essentially what I've done. During the first psychotic episode, force treatment. When the person's thinking clears up, ask them whether they would like to be forceably medicated during any future psychotic episodes. Then, unless they're a danger to self or others, honor their wishes.

There's an excellent Fred Friendly seminar on this topic. I recommend it highly: http://mindsontheedge.org/watch/fullprogram/

Elyn Saks is one of the panelists as is Fred Frese. Dr. Frese states at the end of the program that he himself has been civilly committed and forcibly medicated on numerous occasions. And every time his thinking clears up, he thinks, "Thank God someone cared enough to help me." Unfortunately my son has never said that. He has always said, "Don't ever do that to me again."

Dr. Frese is a board member for the "Treatment Advocacy Center" -- for whatever that is worth. I feel sure he believes in what he says.

Yes. I respect his opinion the same way I respect the opinions of the people on this forum who've suffered with the terrible distress of psychosis. I haven't been in their shoes and it would be presumptuous of me tell them what's best for them.

I've noticed there are people who fall firmly in the pro-medication camp and firmly in the anti-medication - and all flavors in between. My greatest hope is to give my son the freedom to explore and find what works best for him.

Fred Frese is only one of the panelists on the Fred Friendly seminar I mentioned above. There are a variety of opinions represented.

I know I've voiced my opinion on meds before (strongly), but I feel it's important to add to that thought. I don't think they work for me, but that doesn't mean they don't work for everyone.

I think my problem is twofold. On the one hand, I didn't like the side-effects. On the other, I've got an already-obscenely high tolerance to chemicals in general, so I build up a tolerance to Invega, Zoloft etc. pretty quickly. I always heard about people who basically lived on Xanax for years, and I couldn't do it - stuff had no effect after a month or so. They had me on quite a cocktail, and it worked. ...for a little while.

Couple that with the ridiculous cost of medication these days, and it just wasn't worth it to me. I could be sorta-kinda-most-of-the-time-maybe stable and broke, or occasionally (if intensely) disjointed, but I could eat.

Still, I've known a few folks who were on meds who did quite well by them. The inconsistency of positive results is part of what makes me believe that the medical world knows a whole lot less about what they're talking about, and instead run on the "hey...we pumped this guy full of <pill>, and he stopped screaming! Keep doing that!" platform.

I'm very happy to have found my son's new pdoc. We haven't met with him in person yet, but I spoke with him at length on the phone. In his view the benefits of medications are overstated and the downsides are understated. He also insists on psychotherapy rather than relying on meds alone which is what the mhc has been doing. I do hope my son likes him.

The people who do well on medications tend to strongly believe it's the only answer. Or at least that's been my experience. I almost feel like I'm abusing him by not forcing medication.

My poor son is taking 35 mg of Zyprexa a day now. 5 in the morning and 30 at night. (The Zyprexa website recommends a maximum daily dose of 20 mg.) At this point it's doing very little to help him. He's still hallucinating and delusional. It didn't even help him sleep last night. For him there's going to have to be a different answer.

This, to me, is a very good sign. I've yet to encounter a psychiatrist who didn't rely solely on pills, and didn't bother communicating their intentions with me.

I wouldn't say you're abusing him at all. Being there for him while giving him the ability to choose how he's helped (when he's able to) is wonderful, imo.

As to the Zyprexa - ouch. That's a heady amount of drugs there. Granted, I'm explicitly -not- a pdoc so I can only offer my perception on it, nothing professional or meaningful beyond opinion.

Given all you've described up to this point, it sounds to me like you're making a lot of headway. I, for one, commend your efforts. The world needs more people like you, costello.

EDIT: Gah, I almost forgot - I was going to comment on my roller-coaster experience with Invega.

It was so weird...I'd have decent stretches of lucidity, where I thought/felt/etc clearly, and was doing great. Then, just out of nowhere, I'd have this massive psychotic episode, like it all just built up and exploded. Terrified my poor wife. She didn't want me to take that stuff anymore...she's used to my occasional oddities and adjusts well enough, but not so much to that.

Continues to amaze and touch me how people are so willing to help each other and bare their souls.... to the ones experiencing/suffering from these conditions I applaud you for reaching out for support and at the same time offering to help others (parents like me who are struggling). I posted a lengthy post in the Borderline Personality Disorder Forum -- regardng my daughter's recent violent behaviour and after reading the above I felt compelled to comment. I don't live wth my daughter but if she wanted to move back I don't know what I would do. I am afraid to live with her because she has threatened me physically and acted out violently. If she hurts me, that is not good... why would a parent let a child live in their home if there was potential of the child to hurt them physically? I don't mean to be rude or insensitive, but as much as I think of my daughter's safety... I need to think of mine too....if I feel in danger around her..I won't have her living with me.... and also when she vsits I refuse to be alone in the house with her now. My husband or son must be with me also. Forgive me, pehaps I don't know the whole story and I'm butting in mid way.... I will always be there for my child and support her... but will not put my life in danger. (then how can I possible be of help to her?)

There is no reason in the world that you should feel bad about your safety. None.

I'm a slightly bitter person when it comes to the psychiatric field (and society in general), but even I can recognize that my condition is only half the issue - the other half is, with equal if not greater importance, others and their safety/well-being. It's all well and good that I'd like support and understanding, but it has to be a two-way street - I have to be patient and understanding with those who are genuinely making an effort to do exactly that.

As a caretaker (heck, as a human being) your first responsibility should always be to *your* well-being first. To put it in perspective; if there ever comes a day when I have threatened my wife - even just a little bit - I fully expect her to retaliate with every legal and sensible option she has at her disposal, because there is nothing in this world that requires her to suffer harm by my hand, or my words. It would hurt me, sure, but it's what reasonable people do when unreasonable people decide to hurt them, and that's how our society works. Just that simple.

Don't ever feel guilty about protecting yourself. You've done no wrong by anyone for feeling that way.

I wouldn't either. I don't believe my life is in danger, though. If I did, he wouldn't be living with me. I guess it's a judgment call. I was going to say it's based on knowing my son, but recently I don't feel like I do know him. He's done so many things that are so uncharacteristic of the man he was before.

Actually I have some prior experience with this. Six and a half years ago I adopted a teenaged boy from foster care. He had some major behavior problems which including becoming physically aggressive with me. It seemed to freak everyone else out, and people were telling me to get rid of him (I hadn't finalized the adoption at that point).

I don't know. Maybe I'm a risk-taker or a damned fool, but I stuck with him and he got the aggressive behavior under control. His issues are probably more like your daughter, more of a personality disorder kind of thing.

I told him I'd call the police everytime he hit me - and I did. Then one day he hit me. I looked into his face the split second afterward, and I clearly saw that he was thinking, "Oh, ****. Why'd I do that?" It occurred to me that his impulse control was virtually non-existent. He acted first, then thought. And he was suffering from PTSD due to exposure to extreme domestic violence. It struck me that he wanted to change, but he wasn't capable of it.

I got him a course of neurofeedback, and his impulse control went from something like the bottom 1 or 2 percentile to above average for his age. He's only 19 right now, but I really believe that if I hadn't helped him get the skills to control this behavior, he would have become a wife and child abuser. He still may, but he's got a better chance now.

I come from a family where people don't hit other people. My parents didn't spank. I didn't spank. We don't hit. In fact, I've never been physically injured by another person striking or pushing me or throwing anything at me. Neither of my sons has hit me hard enough to leave a bruise, or even a red mark. I think that's why I don't have as much fear about it as other people seem to. My experience and my expectation is that people aren't going to hurt me physically.

My concern about my (bio) son is that he's often not in touch with reality, and if he comes to believe that I've done something horrible, he might become physical again. And the whole thing seems so unpredictable to me.

Edited to add: I hope this post doesn't come off as sounding like I'm criticizing anyone who would have decided not to allow their child back home after he or she has been aggressive. I just wanted to detail my own personal experience with physical aggression which contributed to my decision.

I recall how concerned you were a few weeks back when this all began costello. I said then, something will shift although we can't know what it will be. And truly, there have been some profound changes...

- He's been in and out of the hospital.
- He's given the mhc residence a shot and didn't seem to like it.
- A caseworker is off the case
- There's a new pdoc who sounds promising
- It sounds as if, for now at least, your son wants to make use of the medications. That probably won't last but it also sounds as if he has a doc who might be more open to supervising a tapered withdrawal.
- He's on a new diet that might prove helpful.
- You might have found a way to ensure that you get some more sleep.

As for the financial aspects... do you think your son might agree to give you a portion of his check to cover room and board each month while keeping the rest for his own personal necessities? Would there be anything left that he could call his own after he paid the costs of living with you? If not, can you fill in any gaps by making use of local support services such as food banks or clothing exchanges?

A lot has changed, and I'm feeling a bit more hopeful. Especially with a couple of nights of decent sleep under my belt.

I think he's going to be easier to work with on the money issues too. I'm hoping to get him to hand over most of his check at the beginning of the month, leaving him with a couple of hundred for spending money. I'll put it in a separate account to pay his bills and buy his food. I'm going to try and keep really good records, so he can see that I'm not stealing from him (that old paranoia!). Unfortunately recordkeeping isn't my strong suit. If it becomes a problem we'll go the payee route.

He makes enough that - if he's living with me - he can pay his bills, save a little, and have some spending money.

How's the gluten free diet? Hope your son has a good birthday

Early signs are positive and he's motivated to stick with it. His sleep quantity and quality has improved. And he's having less anxiety. Since these are two things that people with celiac say often improve with the gluten-free diet, it seems reasonable to assume that it's the diet that helping my son.

It may also be that being out of the hospital and/or the huge amount of Zyprexa is doing it.

I'm hoping we can just stick with it for a while. When he gets in to talk with his new pdoc, we'll talk about ways to tease out what's helping - by lowering the Zyprexa dosage or by trying a gluten challenge.

Costello,
I'm so happy for you (and your son) that things are going in a positive direction. I keep thinking, what if a gluten free diet is the answer? I've talked this over with my son, but there's no way he will try it, even though his brother and myself would be on the same regimen. He is still so paranoid of me, I guess he thinks I'm trying to poisen him. Costello, you really are an inspiration to me. Please keep me posted.
-Pat
(I forgot there are 2 different threads)

Yep. I've been there before and will probably be there again. I've had him so distrustful that everything I do is suspect. And I've had him so disorganized that even when he wants to cooperate he can't.

Even now he's not thinking too straight some of the time. But we're out in the country and no one else is taking him into town, so I can supervise him pretty closely and remind him of the gluten. He's all for the diet and feels it's helping him.

Just go on the diet yourself and see what happens. Maybe he'll be less fearful if he realizes it's not some special diet that only he's eating.

About the "what if it's the answer..." comment: I think that all the time. My son is 26 today. If there's some magic bullet out there for him, I don't want to find it at 50 or 60 or 70. I want it when he's young. Maybe there's no magic bullet, but if I get any leads on a relativeily easy fix, I want to try it.