As I've mentioned in a previous post, I've got an aging parent with a mental illness. My mom's illness was adult onset, meaning one day in her late twenties (happily married, 3 healthy kids and excelling in her demanding career) her world spun on a dime, turned inside out and detonated. One minute my parents were hanging out with my maternal grandma in her kitchen, the next minute my mom was mid-psychotic break and screaming about hallucinations that had erupted from thin air. From my toddler years on through pre-teendom, everything as far as I saw it, was pretty mild mannered. I was aware my mom had a mental illness, but I didn't really understand what that meant. I knew she saw a special doctor and took a lot of medicine for it, and that the medicine made her sleep most of the day. She cooked, she took me to and from school (volunteering there for a time), we played cards and baked cookies together and so much more. Looking back, there were a few odd conversations here and there, but my point is I didn't get what mental illness really was because there wasn't anything to understand from my perspective. 

The older I got the more it seemed like she struggled. I was 13 or 14 the first time I visited my mom in a psychiatric hospital. It was the first time she'd been committed in over a decade and the decision clearly weighed heavily on my dad. I didn't realize this was coming, though I was completely aware of how things had been escalating in ways I'd never seen before. For the record, my mother did not self harm, nor was she a danger to us. She was paranoid, experienced intense hallucinations and delusions and basically believed no one could ever love her. She had such terrible moments that she cried great, wrenching, shrieking sobs all through the night. It wasn't something that went on for months on end either. When it starts, we're off to the psychiatrists. Medicines are adjusted or switched. We wait to see if there's an improvement. This time, she was going to have to go to the hospital. My dad came to me the night before he was going to take her (or maybe he was getting ready to take her in the middle of the night - we've had to do that before but my memory isn't exact here) and finally said that she was going to have to go away to the psychiatric hospital for a while to get help. He explained that when she was a kid, her dad had done things to her that a father shouldn't do and that was why she needed help. He said it was time I knew because of what I might be hearing until she was better and in the future. I can't tell you how much I appreciated this honest conversation, and many others we had about my mom's issues, over the years. 

It's been around a decade since my mom was last in a psychiatric hospital. By that time, my parents were living with my husband and I. This was the first (and so far only) time I was involved in getting her committed. A lot went into the tsunami that this was, but the short version is my mom tried therapy to deal with her childhood trauma for the first time ever. There is no greater understatement in the world than to say, this did not go well. The best part about all of this is, at the same time we (my dad and I) struggled to get my mother help and just keep our heads above water, my now ex-sister-in-law and brother threw a fit because I wouldn't let her family come to our house for Christmas so they could see the grandchildren. (Nevermind that until this they had been alternating the holidays between families, or just hosting it at their own house.) Half the time my mother hallucinated these people were climbing in trees outside her bedroom at night and taunting her, but we seriously had to fight this battle?! One of the ex-sister-in-law's sisters-in-law showed up at our house anyway and made some catty comment about she had shown up against our wishes.  My mother dissolved into tears in front of the whole family and couldn't be calmed down, so everyone just ended up having to leave. I think when I finally write a book about all of this, which is probably unavoidable, the title should be: And I'm the asshole? My dad and my husband will find it appropriate and hysterical. Everyone else will be less than amused. But I've gotten off track...

Having to get my mom committed to a psychiatric hospital when she was in deep in psychosis was a lot harder than I expected. It took two trips to the ER in the same night. She tried (and almost succeeded) to get me arrested. Luckily in the very next breath she told the nurse the anti-anxiety medicine they had given her a few hours earlier was actually some kind of stimulant. The nurse turned back to me, her expression instantly apologetic, and told me that she'd personally been the one who administered the shot and that she would now call for the on-call doctor to have her taken to the psychiatric ward. I had purposefully been the one to take her into the triage area. My dad was in the waiting room, but I figured after decades of doing this alone, it was time somebody step up. 

In the intervening years, my mom was referred to the best psychiatrist she's ever had. This woman is amazing and I try not to think about what my mom's life could have been like if she had access to modern psychiatric practices and this doctor. If you are not familiar with 1970s psychiatric practices, they make respectable horror stories, but not as much as the previous decades if I'm being fair. But her current doc has come into the picture too late to prevent some of the obvious damage made by other doctors and treatments, so we're doing the best we can with what we have. The mere mention of the word therapy sends my mom into full flight or fight mode. She's also terrified of any medicines that are prescribed to improve memory. She lives in fear of the possibility of remembering more and so believes that strengthening even short term memory is bad. 

My mom is officially a senior citizen. When we had the last go-round with a hospital, my dad and I had a talk about at we're just trying to get her life as good as it can get. The best balance of quality and quantity. But, at some point we knew we were going to move beyond that and have to cope with what was next. Over the last year, maybe two, my dad and I have had more talks about where she's really at. There has been an impressive decline of some kind. Is it situational? We've gotten good at learning her cycles and patterns to notice an issue before it becomes a 'hospital' issue. Her psychiatrist appreciates that.  Is it medication? Is this particular medical cocktail no longer meeting her needs, which has happened to her in the past.  Is it medical? Does she have some kind of underlying medical issue that she may not be aware of but is making her feel unwell and impacting her mental state? Is it an evolution of the disease as she ages? She's been diagnosed with some form of mental illness or another for almost 40 years. Is there a new phase to this thing we didn't consider was coming since we were so busy trying to take it day by day? 

At first I thought the increase in problems she was having might be situational. It made sense to me, it fit the pattern as a few things were going on that took my attention away from her. It doesn't seem as likely to me as issues continue. As far as medication, time will tell, but this feels different. You can tell when her meds aren't helping. This isn't quite the same. 

For the medical aspect, she's seen routinely by a handful of specialists and her primary care doc. She has enough peripheral medical issues that her blood work is monitored closely for a variety of things and nothing has turned up. My biggest concern in this area is some kind of dementia or Alzheimer's. She already couldn't pass a memory test between her medications and the state of her mind from everything. I remember visiting my mom's aunt in the nursing home when I was a kid. The memory of this relative sitting in a wheelchair in the hallway and clutching her Little Debbie box of treats my grandma had brought her has been at the forefront of my mind lately as I look at my mom when she's confused. 

The possibility of my mom's mental illness evolving shouldn't take me off guard as much as it does. Logically, most diseases impact people in different ways as they age. What starts as aching hands turns into trouble holding things then knots at your knuckles and loss of movement. But I think naively, just as I never considered my dad slowing down and needing naps every day, I never considered what aging mental illness was going to be like. It'll be easier for her to be upset by anything, harder for her to calm down and move forward. Harder for her to follow a conversation, easier for her to get confused and her brain to just stall. 

At her most recent visit to the psychiatrist, I addressed the concerns head on. I could tell by the look on the doc's face as she observed her for a few minutes that she was concerned. She requested info from my mom's other doctors and told us honestly that it was probably time to start talking about dementia, Alzheimer's and just plain aging with a mental illness. I felt relieved and sick at the same time. Mom's appointments have been pushed closer and the first follow-up after that visit is very soon. I am anxious but hoping for the best.

I've been saying something to my parents over the past few months, particularly when my mom has a rough day: We have to find a new normal. I am a control freak (Does it show? I'm sure it's not a hard guess as to contributing factors) but over the last 8 months I'm trying to learn to let go. 40-something years ago my dad negotiated all this on his own, with a bunch of little kids, and the help of my mom's mom when she could. Almost 10 years ago I stepped in and told my parents they wouldn't have to handle this alone anymore. We've created a new road before, we can do it again. We've got to figure out what is going to work for all of us now and work towards that. 

This excessively long post comes courtesy tonight's hiccup. We're just starting out on this latest new normal business. I've gotten my mom adult coloring and puzzle books to try to improve her grey matter. She's crazy smart, but doesn't want anyone to know, so crossword puzzles are good way for her to show off a bit without making her too antsy. She's losing her eye sight, so for her birthday my brother got her a large print puzzle book. Lately I have her get out the puzzle while I'm cooking dinner so she can spend time with me and I can make sure she's getting some non-threatening thinking in. She starts off doing the puzzle herself, then as her eyes get tired and she can't see to read well enough anymore, I take over and ask her the clues. Except tonight when I go to help she's all upset because she said she finished yesterdays herself. (She hadn't.) Several careful questions later, it was evident that she didn't really have a good grasp of when she was, who everyone was and what had been going on. In any other senior, I know exactly what you'd be thinking. But this has happened with my mom for years upon years. It's just not something that has been very common lately. And this confusion and being out of place lasted until she went to bed. It usually doesn't go on without other occurrences for that kind of time either. 

So in addition to whatever random and whimsical things I write about on this blog, there will be plenty of posts like this. Understand, this is not for anything other than my processing my experiences (and maybe for someone else to find this and go "I'm not alone!") and cataloging them for future me to reflect. Right now, I have both my parents, flaws and all. I'm deliriously grateful for that. I am grateful and happy and pensive and serious and silly and macabre and joyful and in general a regular imperfect person with a slightly unique set of experiences. Chances are that for the time being though, I'm going to be purging things like this out of my head as this is my first time exploring them through writing and (obviously, hello??) things are happening in this area of my life right now.