March 19, 2021 • 17 mins
Managing severe mental illness in a loved one is hard. Today, Dr Saltz advises a listener on how to deal with a mother with a psychotic condition.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Today's question is from
a woman struggling with a mother who seems to be
seriously mentally ill. It's a long question but worth listening
to in full, But before I get to it, here's
some context. One in five adults in this country have
(00:48):
current mental illness, and one and twenty four have very
serious mental illness. During this year of the pandemic, these
numbers have only risen. The ongoing stress, fear, loss, and
uncertainty has caused more people to develop mental illness, cause
more people who were in recovery to relapse, and has
(01:10):
caused some people to develop more serious mental illness. Having
a close family member, like a parent, with serious mental illness,
takes a significant toll. Most children of a parent with
serious mental illness feels some combination of fear, anger, guilt, shame,
and helplessness. Untreated, serious mental illness can impare one's ability
(01:35):
to parent, leaving a child with low self esteem, anxiety, depression,
and even post traumatic stress disorder. Challenges range from not
fully accepting that what an ill parent says to you
is actually the illness talking and not a true reflection
of their feelings, the terror of constant unpredictability, the fears
(01:58):
of dangers to them and the danger to you, concerns
about whether you can get the same illness. Lack of
a stable, supportive and loving figure in your life and
loving someone who you feel helpless to help. Suffering alone
out of shame and embarrassment only increases the likelihood you
will have less support, less understanding of what options are
(02:21):
available to you, and less help for the psychological distress
imposed on you. It's important to speak about serious psychiatric illness,
which is no one's fault but really hard to manage. Nonetheless,
and get help for yourself as the child of a
mentally ill parent. These issues are not discussed often enough,
(02:44):
openly and publicly, which is why I'm answering today's question
at length. So let's get to it and see how
can I help dear doctor Saltz. My there has for
a long time suffered from some sort of psychosis and
(03:04):
is unwilling to seek treatment or even question whether or
not she has mental illnesses. For between fifteen and twenty years,
starting pretty soon after her divorce from my dad, she
has believed herself to be deeply involved in a battle
of good versus evil. She has visions and claims to
hear voices. She's in constant communication with dead relatives and celebrities,
(03:29):
and angels and aliens and gods. She physically fights with
her hands. It's as though she's shooting lightning bolts out
of her hands. Sometimes she'll go into a trance, and
sometimes she'll keep up a normal conversation or even drive
or grocery shop. While doing this, she imagines people around
(03:50):
her that she calls guides. She'll fight battles with the
dark side all night long and miss sleep if her
guides tell her to. She miss appointments if the guides
tell her to stay home. She lives her life entirely
based on what her guides tell her to do. She'll
drop friends or take on dangerous new relationships if that's
(04:12):
what they want. I'm almost certain She's been told to
break ties with me a few times by her guides,
but hasn't done it. I've gently suggested that her imagination
might get away from her, after which she generally will
fly into a rage, followed by the silent treatment. Her
anger towards me after each of these confrontations is extremely painful.
(04:34):
Once she completely cut off communication with me for over
three months. There is no known history of schizophrenia or
dementia in our family. There has been plenty of anxiety
and depression. My mother has been diagnosed with both as
of I, and my sibling is diagnosed with bipolar type two.
(04:55):
Mom has medicated for depression for many years, but it's
difficult for me to find out exactly what she has
been prescribed. My husband and I lost our jobs to
the pandemic, and five months ago moved in with my mother,
but things have not gone well. The other day, my
mother called me into her room and explained that my
(05:17):
higher self had come to her and told her to
warn me that if I don't join her on her quest,
something terrible would happen to me. It felt like a threat. Frankly,
after the year we've had, there is little she could
wish on me that hasn't already happened outside of fatality.
(05:38):
It was hurtful. I tried to explain what she's doing
to me in completely open and honest terms. I pleaded
with her to just accept that I'm not a part
of her spiritual world and to try to love me anyway.
She's been making me pay for it emotionally ever since.
In my family, honesty rarely turns out to be the
(06:00):
correct course. She has told me that nothing can hurt
more than your family, thinking you're crazy. I just don't
know how to respond to that. I live each day
in a space of shame, guilt, solicitous people pleasing, handwringing apology,
and glum sulking contempt. I don't want to abandon my
(06:22):
mother to her demons and just go off and live
my life without her. But what can I do? What
you are describing, specifically the voices in her head seeing
things that are not there, and the elaborate story that
is also inconsistent with reality, something called a delusion by
definition is psychotic thinking. People experiencing psychosis have some combination
(06:48):
of hallucinations, usually auditory but sometimes visual, have strange thoughts
or beliefs called delusions, have difficulty perceiving their environment correctly
and therefore feel confused a lot and often respond in
scary or confusing ways, and are likely to have difficulty
(07:10):
expressing their feelings, which can therefore come out in mean
and frightening ways. Sadly, you are experiencing all of this
with your mom. The cause of psychosis is varied and
not entirely understood, but it is due to a chemical
imbalance in the brain. A number of different mental illnesses
(07:33):
can be the cause, from schizophrenia, schizoeffective disorder, bipolar disorder,
orderline personality disorder, and major depression, and even post traumatic
stress disorder. Which type of illness your mom is experiencing
can only be diagnosed by a psychiatrist who has spent
(07:53):
some time with her really doing an adequate evaluation. A
number of mental illnesses do have a genetic component to them,
meaning they run in families. Not that you necessarily have
to get one if you have a family member with illness,
nor do you have to see a family member that
has a history of it in order to have one,
(08:15):
but it simply increases the likelihood somewhat. If you do
have a family member that has the same illness You
mentioned having a sibling with bipolar disorder, which does raise
the likelihood of both bipolar disorder and actually also schizoeffective
disorder and schizophrenia, as well as even major depression. What
(08:37):
may present as one disorder in one family member can
present as a different but associated one in another family member.
How can I help with Dr Gayl Salts will be
back after this short break. Living with a family member
(09:06):
with mental illness is specifically difficult if that person has
no insight into their illness and therefore is often not
getting treatment. Your mom's refusal to get care stems from
her lack of belief that these symptoms are symptoms at all.
This is unfortunately typical for someone living with psychosis, because
(09:29):
the delusions and hallucinations feel real, and because the illness
by nature impairs her judgment. Many people with psychosis are
terrified being labeled as crazy. They feel humiliated, shamed, angry,
and scared themselves. Many hallucinations threatened to attack or harm
(09:53):
them or their loved ones, and they live in a
paranoid fear that these inner voices and the out side
world are actually out to get them. It's painful and
scary for them, but it's also painful and scary for
you because you are left to feel helpless to help
them if they refuse it. The reality is that as
(10:17):
an adult, you cannot force her into treatment unless she
is in imminent danger of harming herself or another person.
The only way a person can be held for their
own protection and treated is if they are found legally
to lack capacity to care for themselves and are at
risk or emergently, and then later legally found to be
(10:42):
in imminent danger. But you mentioned that your mom is
being treated for depression with medication, which makes me think
that someone authorized to treat depression is seeing her. It's
possible this doctor knows or maybe doesn't know about the psychosis,
because sometimes patients in fear of being hospitalized or deemed ill,
(11:05):
hide their delusions from their doctor. While her doctor is
not allowed to speak to you. Because this is a
violation of Hippo rules, you can tell her doctor something
without getting a response. You can call her doctor and
leave a message that you know they can't speak to you,
and you don't wish the doctor to say that you
(11:27):
called to your mother, but that you want the doctor
to know that his patient is hearing voices and seeing
hallucinations and having delusions. This doctor may be able then
to uncover what is truly going on and prescribe your
mother and anti psychotic medication which would truly help her.
(11:49):
Beyond that, it is better to be honest with your
mom than pretend her psychosis is real. You can be empathic,
sympathetic that she suffer rain, wishing you could help her appropriately,
while maintaining you understand this is psychosis. I would definitely
avoid the word crazy. In fact, in general, I am
(12:13):
always talking to everyone about avoiding the word crazy, which
is just pejorative and insulting, and use the words instead
an illness in her brain. It's not her fault and
it's not yours either. You mentioned her alluding to harm
coming to you. When someone is psychotic, you should take
(12:35):
their threats seriously. If you are being threatened by her,
you should a make sure there is no weapon in
the home for her to harm you with, for example,
removing firearms or accessibility to firearms. Be leave and see
if she persists, call the police. To be clear, A
(12:58):
mentally ill person is much more likely to be the
victim of violence than a perpetrator, but it does, on
rare occasion happen, and you should protect yourself. If your
mom threatened suicide or homicide, try to have her go
to an emergency room, but if she will not, you
(13:19):
should call on authority to stop her from dangerous behavior.
The most tragic part of this is that psychotic illnesses
really are treatable, and your mom and you are suffering
a lot. Medication, supportive psychotherapy can truly help someone to
resolve psychosis. You're in a difficult spot, and honestly, it's
(13:43):
possible that living in her home may be exacerbating the
situation actually for both of you. People in psychosis often
get worse with higher emotional stress around them. Having you
and your husband around could potentially be stressful for you both.
Given you note that her illness noticeably began after a divorce,
(14:05):
she clearly does worsen with emotional stress. This is pretty typical.
She may feel your emotional distress about her, and rather
than being able to respond to it, she is declining.
In addition, the quandary of most children of parents with
mental illness is the feeling it is their duty to
(14:25):
save their parents. You actually cannot and your duty is
to first save yourself. Living with this toxic situation day
in and day out is terrible for your own mental
health and probably terrible for your relationship with your husband.
I would highly recommend you speak to a therapist. You
(14:48):
do need help working through your own feelings related to
a mentally ill mom, and you may need help removing
yourself from the situation. You are not obligated, nor will
it help either of you, to spiral down with your mother.
Though it may be financially difficult, I would suggest you
(15:08):
may be better off living outside her home. Another useful
therapy that you might consider is that of something like
Alanan meetings. While alan On is really for children of
parents who are alcoholic or drug addicted, I have found
it helpful for children of any parent who has left
them in a terrible mind due to serious mental illness.
(15:31):
It is a place to get support for and understanding
about how to take care of yourself and not own
the responsibility of your mom's suffering. To become lovingly more detached,
you might try explain it to your mom that the
way her medicine has helped her with her depression, it
could also help her with the voices that bother her
(15:53):
or upset her. It's worth a try, because the longer
someone stays psychotic, the harder it is to treat them
and have them improve. Generally speaking, this is why it's
always important to treat anyone with psychosis as early as possible.
It often responds more quickly, and it decreases the likelihood
(16:14):
of a relapse later. In this case, you mentioned your
mom is to others seen as charming and even delightful.
But generally speaking, what I want to say is this
is not totally shocking either. Some people with mental illness
can keep their symptoms under wraps, and some people with
even serious mental illness have tremendous strengths. They can be
(16:38):
highly intelligent, creative, and innovative. Mental illness does not necessarily
affect these areas, and in fact, these may be exceptional strengths,
especially in those with mental illness. I hope that was helpful.
(16:58):
Do you have a problem I and help with? If so,
email me at how Can I Help? At Seneca women
dot com. All senders remain anonymous and listen every Friday
to how can I help with me? Doctor Gail Salts
These are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Today's question is from
a woman struggling with a mother who seems to be
seriously mentally ill. It's a long question but worth listening
to in full, But before I get to it, here's
some context. One in five adults in this country have
(00:48):
current mental illness, and one and twenty four have very
serious mental illness. During this year of the pandemic, these
numbers have only risen. The ongoing stress, fear, loss, and
uncertainty has caused more people to develop mental illness, cause
more people who were in recovery to relapse, and has
(01:10):
caused some people to develop more serious mental illness. Having
a close family member, like a parent, with serious mental illness,
takes a significant toll. Most children of a parent with
serious mental illness feels some combination of fear, anger, guilt, shame,
and helplessness. Untreated, serious mental illness can impare one's ability
(01:35):
to parent, leaving a child with low self esteem, anxiety, depression,
and even post traumatic stress disorder. Challenges range from not
fully accepting that what an ill parent says to you
is actually the illness talking and not a true reflection
of their feelings, the terror of constant unpredictability, the fears
(01:58):
of dangers to them and the danger to you, concerns
about whether you can get the same illness. Lack of
a stable, supportive and loving figure in your life and
loving someone who you feel helpless to help. Suffering alone
out of shame and embarrassment only increases the likelihood you
will have less support, less understanding of what options are
(02:21):
available to you, and less help for the psychological distress
imposed on you. It's important to speak about serious psychiatric illness,
which is no one's fault but really hard to manage. Nonetheless,
and get help for yourself as the child of a
mentally ill parent. These issues are not discussed often enough,
(02:44):
openly and publicly, which is why I'm answering today's question
at length. So let's get to it and see how
can I help dear doctor Saltz. My there has for
a long time suffered from some sort of psychosis and
(03:04):
is unwilling to seek treatment or even question whether or
not she has mental illnesses. For between fifteen and twenty years,
starting pretty soon after her divorce from my dad, she
has believed herself to be deeply involved in a battle
of good versus evil. She has visions and claims to
hear voices. She's in constant communication with dead relatives and celebrities,
(03:29):
and angels and aliens and gods. She physically fights with
her hands. It's as though she's shooting lightning bolts out
of her hands. Sometimes she'll go into a trance, and
sometimes she'll keep up a normal conversation or even drive
or grocery shop. While doing this, she imagines people around
(03:50):
her that she calls guides. She'll fight battles with the
dark side all night long and miss sleep if her
guides tell her to. She miss appointments if the guides
tell her to stay home. She lives her life entirely
based on what her guides tell her to do. She'll
drop friends or take on dangerous new relationships if that's
(04:12):
what they want. I'm almost certain She's been told to
break ties with me a few times by her guides,
but hasn't done it. I've gently suggested that her imagination
might get away from her, after which she generally will
fly into a rage, followed by the silent treatment. Her
anger towards me after each of these confrontations is extremely painful.
(04:34):
Once she completely cut off communication with me for over
three months. There is no known history of schizophrenia or
dementia in our family. There has been plenty of anxiety
and depression. My mother has been diagnosed with both as
of I, and my sibling is diagnosed with bipolar type two.
(04:55):
Mom has medicated for depression for many years, but it's
difficult for me to find out exactly what she has
been prescribed. My husband and I lost our jobs to
the pandemic, and five months ago moved in with my mother,
but things have not gone well. The other day, my
mother called me into her room and explained that my
(05:17):
higher self had come to her and told her to
warn me that if I don't join her on her quest,
something terrible would happen to me. It felt like a threat. Frankly,
after the year we've had, there is little she could
wish on me that hasn't already happened outside of fatality.
(05:38):
It was hurtful. I tried to explain what she's doing
to me in completely open and honest terms. I pleaded
with her to just accept that I'm not a part
of her spiritual world and to try to love me anyway.
She's been making me pay for it emotionally ever since.
In my family, honesty rarely turns out to be the
(06:00):
correct course. She has told me that nothing can hurt
more than your family, thinking you're crazy. I just don't
know how to respond to that. I live each day
in a space of shame, guilt, solicitous people pleasing, handwringing apology,
and glum sulking contempt. I don't want to abandon my
(06:22):
mother to her demons and just go off and live
my life without her. But what can I do? What
you are describing, specifically the voices in her head seeing
things that are not there, and the elaborate story that
is also inconsistent with reality, something called a delusion by
definition is psychotic thinking. People experiencing psychosis have some combination
(06:48):
of hallucinations, usually auditory but sometimes visual, have strange thoughts
or beliefs called delusions, have difficulty perceiving their environment correctly
and therefore feel confused a lot and often respond in
scary or confusing ways, and are likely to have difficulty
(07:10):
expressing their feelings, which can therefore come out in mean
and frightening ways. Sadly, you are experiencing all of this
with your mom. The cause of psychosis is varied and
not entirely understood, but it is due to a chemical
imbalance in the brain. A number of different mental illnesses
(07:33):
can be the cause, from schizophrenia, schizoeffective disorder, bipolar disorder,
orderline personality disorder, and major depression, and even post traumatic
stress disorder. Which type of illness your mom is experiencing
can only be diagnosed by a psychiatrist who has spent
(07:53):
some time with her really doing an adequate evaluation. A
number of mental illnesses do have a genetic component to them,
meaning they run in families. Not that you necessarily have
to get one if you have a family member with illness,
nor do you have to see a family member that
has a history of it in order to have one,
(08:15):
but it simply increases the likelihood somewhat. If you do
have a family member that has the same illness You
mentioned having a sibling with bipolar disorder, which does raise
the likelihood of both bipolar disorder and actually also schizoeffective
disorder and schizophrenia, as well as even major depression. What
(08:37):
may present as one disorder in one family member can
present as a different but associated one in another family member.
How can I help with Dr Gayl Salts will be
back after this short break. Living with a family member
(09:06):
with mental illness is specifically difficult if that person has
no insight into their illness and therefore is often not
getting treatment. Your mom's refusal to get care stems from
her lack of belief that these symptoms are symptoms at all.
This is unfortunately typical for someone living with psychosis, because
(09:29):
the delusions and hallucinations feel real, and because the illness
by nature impairs her judgment. Many people with psychosis are
terrified being labeled as crazy. They feel humiliated, shamed, angry,
and scared themselves. Many hallucinations threatened to attack or harm
(09:53):
them or their loved ones, and they live in a
paranoid fear that these inner voices and the out side
world are actually out to get them. It's painful and
scary for them, but it's also painful and scary for
you because you are left to feel helpless to help
them if they refuse it. The reality is that as
(10:17):
an adult, you cannot force her into treatment unless she
is in imminent danger of harming herself or another person.
The only way a person can be held for their
own protection and treated is if they are found legally
to lack capacity to care for themselves and are at
risk or emergently, and then later legally found to be
(10:42):
in imminent danger. But you mentioned that your mom is
being treated for depression with medication, which makes me think
that someone authorized to treat depression is seeing her. It's
possible this doctor knows or maybe doesn't know about the psychosis,
because sometimes patients in fear of being hospitalized or deemed ill,
(11:05):
hide their delusions from their doctor. While her doctor is
not allowed to speak to you. Because this is a
violation of Hippo rules, you can tell her doctor something
without getting a response. You can call her doctor and
leave a message that you know they can't speak to you,
and you don't wish the doctor to say that you
(11:27):
called to your mother, but that you want the doctor
to know that his patient is hearing voices and seeing
hallucinations and having delusions. This doctor may be able then
to uncover what is truly going on and prescribe your
mother and anti psychotic medication which would truly help her.
(11:49):
Beyond that, it is better to be honest with your
mom than pretend her psychosis is real. You can be empathic,
sympathetic that she suffer rain, wishing you could help her appropriately,
while maintaining you understand this is psychosis. I would definitely
avoid the word crazy. In fact, in general, I am
(12:13):
always talking to everyone about avoiding the word crazy, which
is just pejorative and insulting, and use the words instead
an illness in her brain. It's not her fault and
it's not yours either. You mentioned her alluding to harm
coming to you. When someone is psychotic, you should take
(12:35):
their threats seriously. If you are being threatened by her,
you should a make sure there is no weapon in
the home for her to harm you with, for example,
removing firearms or accessibility to firearms. Be leave and see
if she persists, call the police. To be clear, A
(12:58):
mentally ill person is much more likely to be the
victim of violence than a perpetrator, but it does, on
rare occasion happen, and you should protect yourself. If your
mom threatened suicide or homicide, try to have her go
to an emergency room, but if she will not, you
(13:19):
should call on authority to stop her from dangerous behavior.
The most tragic part of this is that psychotic illnesses
really are treatable, and your mom and you are suffering
a lot. Medication, supportive psychotherapy can truly help someone to
resolve psychosis. You're in a difficult spot, and honestly, it's
(13:43):
possible that living in her home may be exacerbating the
situation actually for both of you. People in psychosis often
get worse with higher emotional stress around them. Having you
and your husband around could potentially be stressful for you both.
Given you note that her illness noticeably began after a divorce,
(14:05):
she clearly does worsen with emotional stress. This is pretty typical.
She may feel your emotional distress about her, and rather
than being able to respond to it, she is declining.
In addition, the quandary of most children of parents with
mental illness is the feeling it is their duty to
(14:25):
save their parents. You actually cannot and your duty is
to first save yourself. Living with this toxic situation day
in and day out is terrible for your own mental
health and probably terrible for your relationship with your husband.
I would highly recommend you speak to a therapist. You
(14:48):
do need help working through your own feelings related to
a mentally ill mom, and you may need help removing
yourself from the situation. You are not obligated, nor will
it help either of you, to spiral down with your mother.
Though it may be financially difficult, I would suggest you
(15:08):
may be better off living outside her home. Another useful
therapy that you might consider is that of something like
Alanan meetings. While alan On is really for children of
parents who are alcoholic or drug addicted, I have found
it helpful for children of any parent who has left
them in a terrible mind due to serious mental illness.
(15:31):
It is a place to get support for and understanding
about how to take care of yourself and not own
the responsibility of your mom's suffering. To become lovingly more detached,
you might try explain it to your mom that the
way her medicine has helped her with her depression, it
could also help her with the voices that bother her
(15:53):
or upset her. It's worth a try, because the longer
someone stays psychotic, the harder it is to treat them
and have them improve. Generally speaking, this is why it's
always important to treat anyone with psychosis as early as possible.
It often responds more quickly, and it decreases the likelihood
(16:14):
of a relapse later. In this case, you mentioned your
mom is to others seen as charming and even delightful.
But generally speaking, what I want to say is this
is not totally shocking either. Some people with mental illness
can keep their symptoms under wraps, and some people with
even serious mental illness have tremendous strengths. They can be
(16:38):
highly intelligent, creative, and innovative. Mental illness does not necessarily
affect these areas, and in fact, these may be exceptional strengths,
especially in those with mental illness. I hope that was helpful.
(16:58):
Do you have a problem I and help with? If so,
email me at how Can I Help? At Seneca women
dot com. All senders remain anonymous and listen every Friday
to how can I help with me? Doctor Gail Salts
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