The Mother Who Learned To Trust
“I really don’t need medicine. I am fine and I applied to the fire department and I will be a firefighter.”
This is a typical response from a man. In our culture, we raise junior John Wayne types — tough and independent.
He was in the room with his mother, who was fighting back tears. ”I have tried everything to make him take medicine. I can beg him, but he does not take it very often.”
The young man in question was doing what we call “attending to external stimuli” 19 years old and stubborn, he sat there talking softly, almost inaudibly, apparently to imaginary people only he could see. He was smiling with them, laughing with them. The conversation was intermittent. It would go on for a few moments; then, he would suddenly be denying his illness to me again, asking how soon this less interesting conversation with a real person could all be over.
I wanted to tell his mother something optimistic. I wanted to encourage him. I have done psychiatric assessments for all manner of public services, from police to border patrol to prison guards. The young man was simply not an appropriate candidate for the fire department. But maybe there was something he could do — like related office work — but he would have to admit he had a problem, and tell me what he wanted and why, and then I would do my best. And I could only do my best to help him fix it.
I told his mother that insight could come later, but I certainly could not predict when. I asked her if he had always been in denial of his difficulties — through all of his three hospitalizations — with three suicide attempts we knew about. It was hard to believe his denial had been this categorical throughout the entire process.
She told me the denial did not become this consistent until the medication side effects started. She let me look at the bottle of medicine he had been taking when the side effects started.
At first I was surprised when she handed me the bottle. It had the name of a newer drug, which generally did not have side effects. It seemed her son had some episodes of acute dystonia — repetitive and involuntary muscle contractions that caused twisting and repetitive movements. I had not seen this side effect since the days when Haldol (haloperidol) was one of the few available anti-psychotic drugs — the drug of choice to give someone suffering from hallucinations.
Checking the medical record I noticed that this young man had refused all medication and refused to come to the clinic since the date this drug had been prescribed. According to both the medical record log and the label on the bottle, the last psychiatrist had prescribed twice the FDA maximum recommended dose of the drug.
I tried — without saying anything negative about my predecessor — to tell her that this unnecessarily large dosage was why her son had side effects. I asked if he had problems earlier, on lower doses of the drug. But flipping through the chart, it seemed to me that he had actually done pretty well for a bit.
He sat there silent. Mother was crying now, really crying. ”I trusted that doctor. He came from (she named the country in which she and her son were both born), and spoke my language and I trusted him because of that. And you — you know more than him. I can tell from how you talk. Now I will trust you. I made a big mistake. I trusted him and look what I have. Who are you? Where do you come from? You are a woman of heart, and you will help my son, but that other doctor — how could I have trusted him?”
I tried to switch the focus of the conversation. There had, apparently, been no permanent harm done. Sturdy and stalwart 19 year old men were not famous for their insight — even the ones without schizophrenia. He would get some in time, and surely I would talk to him whenever he came in, and we would not give up, since insight most often comes with successful treatment.
“You are a woman of heart,” she persisted. “Where did your ancestors come from?”
“Does it matter?” I asked her. Really, I have come to believe that people treat ethnicity as a far more important question than it need be. All mothers cry for sons with mental illness who cannot understand, or addicted sons, or cheating husbands. From all countries, in all languages. Why did she have to know where my ancestors came from? Still, she persisted — it was important to her.
I told her that my immediate ancestors came to this country from Russia. Three generations ago on one side; four on the other. (I didn’t think she meant to ask me about my lineage all the way back to Moses). I told her about the pogroms in Russia, how the government and the military allowed the population to harass and attack the Jews — and sometimes even participated. I told how their money and possession were taken away, and now they were happy to make it to America, which was a much better place for them. I told her, “Your ancestors and mine probably both had very bad times, and we all came to America so it would be better.”
She took my hand and kissed it, still crying. ”I want you alone to care for my son.” In the situation where I was stationed at the time, staff and assistants were part of my daily reality, but I said I would do the best I could.
I was content, to know that it had been possible for me, at least in this instance, to override the ethnicity question with a humanitarian answer, an American answer. And yet it hurt me that it had taken so much misfortune for me to be able to do that.