Commit me, too! I’m ready!

Chris’s holistic psychiatrist provided an updated list of supplements before she left on Christmas vacation as a last ditch effort to get Chris through this crisis. She was not in favor of putting Chris back on an antipsychotic, although if push came to shove she reluctantly recommended a mood stabilizer that would also help with the psychotic features. Ian and I welcomed the idea of the mood stabilizer, figuring that a mood stabilizer administered for hopefully a short period would be easier to withdraw from than an antipsychotic. We put Chris on a mood stabilizer, in part to satisfy Chris’s psychotherapist, Dr. Stern, and in part to cover ourselves with Dr. Stern should the situation deteriorate further. Then there was the community pressure (well meaning people) who kept reminding us something was wrong with Chris.

The complexity of administering the supplements and making sure that Chris took them as prescribed nearly drove me over the edge. It was all the worse because this time I was dealing with a psychotic underfoot. I lined up all his supplements for the week ahead and taped them into little paper packets, twenty one packets in all. I labeled them “1” “2” and “3” for swallowing at morning, lunch and dinner. He was now taking sublingual lithium drops and sulfur drops twice a day in addition to the mood stabilizer and the other supplements. I measured out the drops and stood over Chris twice a day to make sure he kept them under his tongue. I poured two liters of water in containers for him every evening and in the morning I mixed the powdered and liquid supplements in the distilled water for him to drink throughout the day. I slathered a detoxifying cream over his liver twice a day, and dabbed a special niacin cream that is supposed to work wonders with psychosis on both temples, wrists and the back of his knees. I supervised his detoxifying epsom salt baths which he did every second day. I watched while he put his detox footpads on every second night before bed.

In short, I was becoming a bloody psychiatric nurse. Actually, I was doing more than a psychiatric nurse would do. A nurse at least gets to go home and isn’t concerned with administering supplements. I entertained fantasies of putting Chris in the mental hospital to relieve me of my round the clock caregiver duties. The only thing that prevented me from doing so is that he would have been immediately put on an antipsychotic as the price of admission.

A slight change in his supplements, the addition of the mood stabilizer and my spending a lot of time talking to him about his feelings and his responsibilities over his actions enabled Chris’s condition to stabilize a bit over the Christmas period. This intense experience convinced me that Soteria and Kingsley Hall and the Jacqui Schiff home based approach worked better than what the critics reported. However, their approach needs a staff. I was simply exhausted and doubted whether I was up to the job.

Once more a nerd

It was painful for me to see Chris reverse the gains he had made He was starting to look more and more peculiar, reverting to the nervous nerd look that had marked the first episode of his psychosis four years earlier. He buttoned his shirts up to the collar, and cinched his pants around his waist, leaving him looking like he was wearing high-water pants. His new red framed eyeglasses added a lab technician look to his already “odd-ball” appearance. Other people wondered what was happening to him, too. Instead of asking Chris what was going on, they spoke to me. “Oh, he’s just going through a rough patch, ” I tied to reassure them, not very convincingly. What looks like relapse may often be recovery I told myself every day or I might have completely given up hope. As the autumn progressed, Chris lost interest in going to choir practice and in continuing with his voice lessons. Ian and I insisted that he drop his two university courses before he failed them. Through all of this, we continued to work with Chris’s holistic psychiatrist to fine tune his supplements.

Then came an e-mail from Dr. Stern. While we all had agreed at our last family appointment that this was probably a necessary crisis for Chris and that with time and support he would emerge stronger, she was now suggesting strongly that he go back on both an antipsychotic and an antidepressant. She was worried that he was suicidal because he had told her in an indirect way that I thought he was suicidal. This was a miscommunication on his part about what we were discussing.

I pulled Chris aside. “Chris,” I hissed, “there are at least two things that you can tell a psychiatrist that are guaranteed to have them pulling out the prescription pad. One is to admit to hearing voices, the other is to mention suicide in any context.” Dr Stern was doing what any psychiatrist would do under the circumstances. She was protecting herself. I was very disappointed and somewhat angry with her. She knew we were against the medications because they had never worked for Chris. We engaged her specifically to help get him off them and now she wanted to throw all that away because she thought he might be suicidal.

Many people will side with Dr Stern here, because, after all, they will reason that you can’t be too careful when it comes to suicide, but I disagree. If you mention the word “suicide” to a psychiatrist, I suspect it doesn’t matter in what context you mention it, the fact is the “s” word has been said and psychiatrists have to consider their license and the very real possibility, in some countries at least, that they will be sued by the family if a tragedy does occur. I was not willing to have Chris’s recovery postponed and perhaps delayed forever by going back on medications. Dr. Stern saw Chris once a week. I saw him every day and I felt that my judgment as his mother trumped her judgment as his psychiatrist, even though I felt she was a very good psychiatrist in many other ways.

I sat Chris down. “What you decide to do about the medication is up to you,” I said. I deliberately avoided trotting out the reasons why I was against the medications. Chris knew them only too well. Chris confessed that, among other things, he was afraid that if he went back on medications, he would never be able to function at university. It was true he wasn’t functioning now at university, but the medications could make it worse, in my opinion. However, I said nothing. Chris sent an e-mail to Dr. Stern, copied to his holistic psychiatrist, Ian and me, saying that suicide was the last thing he had in mind and he was sorry if he misled her. He said he wasn’t against the medications, he just didn’t believe in them for himself.

“My feeling, he wrote,” “is that I am the cause of my own depression, but I hope that it will lift just as the clouds melt away after a summer thunderstorm.”

Social breakthrough

Keeping in mind that there can be multiple explanations for a single event, Chris’s progress following our Family Constellation sessions with Dr. Stern in July 2006 went like this:

In November 2006, Chris entered into weekly psychotherapy with Dr. Stern. That same month, Emily, the daughter of my university roommate, stayed with us for a weekend. She and Chris went skiing for a day. “How was Chris?” I asked her. “Quiet,” she said. “He was very polite and considerate, but only spoke to me if I spoke to him first.”

In February Emily came back for another visit and some further skiing. “How was Chris?” I asked her, hoping that I knew what she would say. “Oh, just great. He talked with me the whole time. I didn’t need to prompt him. What a big change from November!”

The magic had happened. Chris could now converse with people he didn’t know or didn’t know well. Sometime between November and January, seemingly from one day to the next, he began acting “normal,” despite the fact that he was still on low doses of two antipsychotics and had been on them for thirty-six months and in a day program for twenty-two of those thirty-six months. His day program had ended six months earlier. He left the day program still very much into his shell and not able to establish eye contact with people.

Using holistic therapies, he achieved social breakthrough after seventeen months of vitamin supplements, eight months after the assemblage point shift, six months after Family Constellation Therapy and after three months of seeing Dr. Stern once a week.

He began phoning up friends he hadn’t seen for years to suggest that they get together. He wanted to be around people. This was huge. For Ian and me, it was like a stone had been lifted from us.

From February 2007 on, Chris continued to improve. Dr. Stern and Chris’s holistic psychiatrist worked together over the next year to gradually eliminate his medications while continuing his weekly psychotherapy. His weight dropped as the medications were lowered. By March 2008, he was off all his medications. To illustrate the extreme caution that needs to be exercised when lowering medications, it took almost one whole year for Chris to come off 25 mg of clozapine. By June 2008 his weight was normal once again and he was able to exercise more.

Ian’s and my mistake following this breakthrough was to begin to build up our expectations of Chris. We became impatient for his moving on with his life.