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Guest Blogger: Magaret Altman MSW
In the history of mental health there has been a lack of attention paid to the emotional and physical process that a family endures as they observe and try to help a mentally ill loved one. This process is a traumatic one that shatters the vital core of the family and leaves devastation in it’s wake. Each family member and the cohesive framework of the family system is impacted by the deterioration of their loved one and by the mental health system that fails as a treatment opportunity, as a safety net and as a social/psychological resource. The family’s on-going traumatic experiences effect parents, grand-parents, siblings, cousins and children who are not yet mature enough to understand what has blown the family apart and created chaos and ruin in its path.
The field of Epigenesis informs us that stress and trauma effects the genetic core of our being and that gene changes are passed down through the generations. This scientific fact awakens us to the lasting impact that living with stress, and emotional pain will have upon future generations . Trauma, as we now know, doesn't just terrify or horrify us—it also forces us to make profound biological adaptations in how our brain operates and this effects thinking, decision making and planning. When the brain detects serious threats to our bodily survival, traumatic stressors such as severe accidents, disasters, violence, abuse, or betrayals, the alarm system in the brain is activated and literally hijacks the rest of the brain's operations in order to put all systems in emergency mode until the threat is escaped or overcome. Family trauma has long lasting emotional, physical and social implications and it has become a problem that our society can no longer ignore.
Mental health reform in the domains of; access to care, identifying people who need but cannot accept help, bringing families into the treatment team and applying all treatment methods that are effective is the key to relieving the suffering of a multitude of people.
This article delineates the 3 primary stages of Family Trauma (Seeing, Searching, Securing) with input from family members who have written about their lived experiences. Their voices and expressions will be available in a film “Shattered Families” produced by Dr. Stephen Seager.
1 Seeing the deterioration “No one understands like other parents. No one”
Watching a loved one spiral into confusion, isolation, harmful behaviors and paranoia is an emotionally traumatic experience for a family member. Many of the serious mental illnesses such as Schizophrenia, Bipolar Disorder and Major Depression are characterized by behaviors that may begin in childhood but are not diagnosed until adolescence and early adulthood although the current trend is for earlier diagnosis. The expression of symptoms; hallucinations, delusions, paranoia, unpredictable behavior may be taken as adolescent acting-out at first or as drug/alcohol related behaviors and families often are in hyper aware observation mode as the problem begins to escalate. Many parents attempt, at first, to mitigate the situation themselves by pampering the individual or simply leaving them alone. They watch and wait and some deny the critical nature of the deterioration for awhile. This is a stressful time for the family as they hope that things will go back to “normal”. Soon it becomes clear that the situation has become dire. There are angry arguments between parents, siblings are ignored, young children are in shut down mode or act out, the family begins to break apart as family members are in opposition about what is going on. The cohesive framework of the family is weakened as each member struggles to make sense of the behavior that they witness and they are unsure of what to do. As they stand by in a helpless position other people may intrude with comments and suggestions. There is shame and embarrassment along with fear and anger.
A mother speaks “There is a sense of helplessness, alarm and fear when the person does not respond to your outreach and your efforts are responded to with anger and suspicion. You know something is terribly wrong and at this stage, without information, all you can do is try to make contact and watch the frightening process unfold.”
A Father speaks “He was no longer the boy he knew – the happy-go-lucky child with the black mop of hair who preferred to play with the family's pots and pans than his own toys. He was someone else.”
The “Seeing” phase often culminates with a crisis that propels the family into frantic activity.
From a 76 year old grandmother “ On this particular morning, M didn't smile back. His face was flat and his eyes were stony and he began speaking in a deep voice in a bizarre language that confused me. M then stepped toward my bed, brandished one of my metal walking canes, and struck me in the head with it. I cried out and tried to stand up but my legs failed and I toppled to the floor.
As I lay, M hit me again and again in the head, continuing to speak in his strange language. I remember that I raised my hands to shield myself but M continued undeterred: he beat me until my fingers broke and the white bed, the white walls, the white vaulted ceiling were splattered with blood.
1 Searching for Help
This is a very disruptive phase for families who have had reality hit them hard and they know that their loved ones need urgent care. The family system often remains in turmoil; divided on the existence of a critical problem and/or what to do about it. As we will see in the narratives below, some members continue to deny the seriousness of even the existence of a problem due to the stigma attached to mental illness and their belief that love will conquer all problems. Others begin a frustrating course of contacting doctors, agencies, tip lines, other relatives and come face to face with impenetrable barriers. The barriers to obtaining help are massive. They begin with the individual who does not believe that he or she needs assistance and the professionals who may have met with the person and cannot give information due to legal constraints. And then the walls continue to grow and family members become desperate, angry and very depressed. The abuse is cumulative and stress usually results in sleeplessness, fatigue and other physical symptoms that are lasting. We read the descriptions from parents, siblings and others who are in a cycle of pain and who experience the broken the mental health system; inability to obtain vital information, the lack of hospital beds and the laws that make involuntary commitment difficult , the terribly short stays in hospital and lack of treatment programs to monitor out patient care.
Throughout this tragic process the mentally ill loved one continues to deteriorate, in front of the families eyes, in a home where chaos reigns and parents have completely lost control.
A brother speaks “I emailed her doctor many times, a well-known psychiatrist and professor at a world-class university. Usually there was no response at all. When there was, it was just a brief statement: “he has yet to give me permission to speak with anyone.”
A mother speaks “She became increasingly delusional and paranoid. I emailed her doctor many times, a well-known psychiatrist and professor at a world-class university. Usually there was no response at all. Pretty much this regulation tells loved ones that, 'I'm sorry, but your son must die or your brother must die, or your sister must die, or your mother must die, or your grandparents must die, before we can get your family member the treatment that they need,' " she said. "I mean, does that make sense?"
Calls to the crisis team are useless On more than 20 other occasions, by a mother’s count, the family were told by crisis intervention staff that either it wasn't worth pushing for a commitment or that her son didn't meet the criteria
From a sister “ She suddenly exploded at me after hours of nursing a perceived slight. Her brain tells her things that aren’t true, so she doesn’t always act right. She can’t help it, and she loves us. “She has yet to give me permission to speak with anyone.”
The family exists in a state of fear “ Living in fear; He said that they didn't understand what was going on and that if they stood in his way he would "blow their heads off."
A mother is shaking in terror “I cried in the waiting area. The accumulation of a year's worth of anguish and stress was now compounded by a new realization for her: I no longer felt safe living with her own son.”
The mentally ill person speaks please send the police out to shoot me."
A father explains that short stays in hospital are not effective; “Under Pennsylvania's involuntary commitment law, a hospital must release a person when they are no longer considered a danger to themselves or others and medical staff judge that person can be placed in the "the least restrictive" setting to achieve treatment. Pretty much this regulation tells loved ones that, 'I'm sorry, but your husband must die or your brother must die, or your sister must die, or your mother must die, or your grandparents must die, before we can get your family member the treatment that they need,' " she said. "I mean, does that make sense?"
The behavior of the mentally ill person crosses the line into criminal behavior as the family seeks treatment. One day, after hearing a song play on a local radio station, Michael interpreted it as a message from God to head to town and find her. The woman soon filed a restraining order against him and Michael was fired from the Kutztown Tavern.
There is Jail and Prison as the person devolves into paranoia and delusions. An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem.
From a mother My son was handcuffed, clad in a white jumpsuit, my son was shown being led by a police officer into the Berks County Courthouse in Reading. As he walked, his head lolled from side-to-side and his eyes were listless – as if he were in a trance. Barely looking at the camera, he raised his middle finger in its direction. Due to a lack of free beds in Wernersville State Hospital, he waited a month longer in Berks County Prison before he could be transferred.
When attempts to get help fail and the loved one faces life in the streets or a cycle of jail, hospitals and death, the family will take the person back into the home. There are many programs for those with drug and alcohol problems but few for the seriously mentally ill. The Government Agency; SAMSHA has prioritized funding for high functioning and drug and alcohol programs and limited funding for the mentally ill programs.
Parents and grand-parents will come to the rescue, often risking their health, their lives and their relationships. The family shifts into a protective mode attempting to keep people away, to reduce interference, to create a calm and loving atmosphere. But they live in states of constant fear and hopelessness.
1 Securing and Protecting the Loved One
In the process of trying to maintain a safe place for the mentally ill family member, many have decided that calling the police is dangerous. For parents of children with mental illnesses, this scenario is the stuff of nightmares. Many of these parents—often still caretakers for their adult children—are reluctant to call 911 in fear that a poorly trained officer will escalate a mental-health emergency into a crime. But faced with violent or self-harming children and a lack of support services, they often find they have no other options.
For parents of children with mental illness, calling the police for help when a kid becomes violent or agitated can devolve into a nightmare.
A narrative from parents description; On Nov. 12 of last year, 37-year-old T left the home she shared with her mother and teenage daughter in nothing but a nightgown for the second time that night. Knowing that A—diagnosed with bipolar disorder and schizophrenia—was barefoot and out in near-freezing temperatures, her family called the police for help bringing her back.
Within an hour of their call, A would be dead, as a result of being physically restrained by officers with the Cleveland police. Though A was neither armed, violent, intoxicated, nor suspected of criminal activity, according to the wrongful-death lawsuit filed by her family against the city of Cleveland, she was slammed onto the sidewalk, and her face pushed into the pavement, before she was handcuffed and left unconscious and half-naked on the street.
For parents of children with mental illnesses, this scenario is the stuff of nightmares. Many of these parents—often still caretakers for their adult children—are reluctant to call 911 in fear that a poorly trained officer will escalate a mental-health emergency into a crime. But faced with violent or self-harming children and a lack of support services, they often find they have no other options.
From a mother Her schizophrenic son was said to have “charged at police” after she called 911. “It was rapid fire – boom, boom, boom, boom. I didn’t hear no warning,” she reports.
“What’s wrong with you guys?” her son said after he was shot – which, according to witnesses, were her son’s last dying words.
As the family tries to secure and protect their loved one they, in turn, become more isolated and fearful. Some families accumulate guns and others remain behind locked doors rarely venturing outside. The children are confused and socially isolated, often performing poorly in school. They have learned not to speak about the situation at home and rarely come to the teachers attention because they remain in a shut-down state.
Like a pebble thrown into a pond the ripples of trauma spread outwards as the stone sinks into the mire. As you read this article do you recognize any of the families that are speaking out? Perhaps your family is experiencing these traumatic events, or your neighbor? It is never so far away that we can, if we are caring and responsible people, let it remain hidden and allow the pain to go on unabated.
M. Altman MSW margiealtman@yahoo.com
