Psychotic son

[Despairing_Dad]

I have a 30-year-old son who left home about 10 years ago. Unknown to me, he had been taking cannabis since his late teens. He lost interest in his University course and dropped out, preferring the thrill of cannabis. He tried MDMA once but was hospitalized with a seizure. A few years ago he came back home in a psychotic state.

He spent 6 weeks in a secure psychiatric unit, diagnosed with drug-induced psychosis. He was a lot better when he came out, though somewhat robotic; he moved in with a new girlfriend, started a new job, and was on low dose of anti-psychotic medication which a year later he started to taper.

Since then he has had three further psychotic episodes, each 6-18 months apart. The first seems to have been triggered by an argument with his girlfriend. The second was triggered by a return to cannabis, after he convinced himself that it wasn't to blame for his earlier psychosis. Now he is psychotic again. He is too "spaced out" to say what the trigger was, but he enjoys his weekends most when drunk so this was a likely factor.

After Episode 3 he left his clean-living girlfriend, forswore alcohol (but only for a couple of months), and started vaping. During the current episode he went back to his girlfriend for comfort, and she got him to restart medication. Otherwise his psychosis worsens each day; he needs to take it for a few weeks before being weaned off it. He is becoming reluctant to take it, though he denies any side-effects, and there is some doubt that he really is taking it this time.

The recurring bouts of psychosis are concerning. During the current episode he crashed his motorbike, albeit unintentionally. This is not a sustainable lifestyle. Do we just wait until he or an innocent bystander gets injured, perhaps fatally?

He has seen several psychologists. He likes those that absolve him of blame, and dislikes those who suggest moderation in drinking or drug-counselling. In any case, he disregards their recommendations.

It might help if he had to report daily to a pathology-centre, to have a blood-test for alcohol, nicotine, or other mind-altering drugs, with a week's confinement as penalty for breach. This would eliminate the main psychosis-trigger & allow his mental state to be monitored. Is there such a facility? What do you suggest?

[Croix]

Dear Despairing Dad~

It is a terrible thing to see your son going off the rails like that, he will probably seem nothing like the person you brought up, except maybe in short periods. If his mother or other family are involved it will be terrible hard for them too. Grieg, frustration, feelings of despair and even guilt can be almost overwhelming.

I would suggest that you -and any other family -seek counseling and medical support to keep yourselves as well a possible.

I'm sure you will have tried everything you possibly can. Talking does not good, even getting hm to see there is a problems can be just about impossible as times. I guess the one bright spot is his girlfriend who sounds very sensible, though the strain on her must be immense too.

I do not know the arrangements in your state, in mine there is a crisis assessment and treatment team (CATT) who can be called in immediately to see if a person has the ability to take care of themselves and if they are a serious potential threat of harm to themselves or others.

They can then place the person in a secure environment such as he has been in in before and after a hearing involving two doctors and family can be placed on a compulsory medication order and released. This order normally involves regular assessment and therapy as well

If the medication is not taken it is given involuntarily.

This is all very difficult and the crux of the matter has to be the findings of the team at the time they are called, without which the whole chain of processes does not even start.

I do not know if this whole system exists in your area, or if calling such facilities is feasible. I guess if he becomes in one of the states I've just described. Can you say if in fact such systems are there for you?

I know the above is only a slim chance, normally a person only received effective treatment if they realise there is a problem and wants to take an active part in the treatment.

So the only think I can say that I'm sure will do good is for you to look after yourself. While the problem exists you need daily respite, and another side to your life away from this. May I ask if you do have medical/counseling support? Also if you have another to help share the burden?

Croix

[Despairing_Dad]

Thank you, Croix, for your sympathetic post - I had never heard of CATT. I have just found the equivalent in my state (Qld) - "Acute Care Service". This might be just what we need in an emergency.

In the meantime the anti-psychotic medication seems to be taking effect again, though his girlfriend describes him now as "like a zombie". I feel really sorry for her; she is smart, with a professional job, caring, a lot younger than him, and very pretty. Her reward was to be dumped by him because (as he told my wife) he does not like being restricted to one woman. I can't understand her continued devotion to him.

I should clarify that, when not psychotic or drunk, he is largely his old self. He holds a permanent job (thanks to very accommodating employers), and lives independently. However, the anti-psychotic medication does make him a little robotic even on the lowest dose - which is perhaps why he dislikes taking it. In a way I am pleased that this latest episode of psychosis caused him so much discomfort. Perhaps now he will get the message to in future avoid the drugs that trigger it. Or else he will be on anti-psychotics, or in confinement, for the rest of his life.

[Croix]

Dear Despairing Dad~

Yes I know that at least some anti-psychotic drugs have adverse side effects, including 'zombification' (if there is such a word). I hope you son will be able to manage and not need them in the future.

With his girlfriend, love and care can make many go to great lengths for the one they love, I was saddened to hear of your son's remark.

I've found CATT good, and only hope your Acute Care Service does the same. There has to be something to rely upon in an emergency.

You mentioned your wife, may I ask how you are both coping?

The fact your son has an understanding employer is a blessing

Croix

[Despairing_Dad]

We saw him today. He lives an hour's drive away. He is vastly improved, though gaunt and nursing some ugly wounds from his bike-crash. He did not seem robotic, and rarely lost concentration. He says he will cut down on his drink (I had hoped to hear "cut out"), will take the anti-psychotics for a month, and will see a psychologist. At least he is acknowledging that something has to change.

I asked him why he hadn't taken the anti-psychotics sooner. Why does he always wait until he is too psychotic to realize that he needs them? He said that in every case the beginning of psychosis felt like just the opposite of what it is. In every case it felt like some kind of epiphany, some mystical awareness of ultimate reality. I put it to him that the reality was that he was becoming trapped in his own mind, and he didn't disagree. I put it to him that no one can be a good judge of his own state of mind, and that he must be with someone on a daily basis who can assess him. I didn't suggest that he return to his girlfriend because tbh I feel so sad for her.

As to how my wife and I are coping, well, she is consoled by her Christian faith, and I try to take a philosophical view of things. I believe in a free society, and that inevitably means the freedom to make bad decisions. Since he is a free agent, I do not feel responsible for his actions. (Indeed, all drugs - including alcohol and tobacco - have been banned from our house since our first child was conceived almost 35 years ago.) The irony is that he has traded his freedom for slavery, since he is fast becoming a slave to his addictions.

I wonder if his idea of seeing a psychologist is really the best course of action. His girlfriend suggests "rehab", whatever that involves. I do think he would benefit from talking to ex-addicts who have turned their lives around, but I don't know of any such support-service.

[Croix]

Dear Despairing Dad~

I'd suggest you call either our own 24/7 Help Line on 1300 22 4636, or Lifeline on 13 11 14 and talk to them about rehab opportunities in your area. If they are unsure they may well be able to point you at an organization that will be able to help.

As for seeing a psychologist, I guess that would depend upon the particular one. I tend to favor a psychiatrist for a variety of reasons, including much wider training and an ability to prescribe and supervise medication, however they can be expensive (there is a however Medicare safety net each year) .

The fact your son realises that there is something that needs to be addressed and that the feelings that lead to the trap that meds are not needed is a plus.

Taking a 'philosophical view of thngs is not easy, our children are so special to us, and to see their illness and/or mistakes is so hard.

While they are indeed adults the comfort, wisdom and love of a parent can be sorely needed.

Croix

[Despairing_Dad]

I've passed your suggestions on to my son's girlfriend, since he is more likely to take advice from her than from me, though even she often says that he never listens to anything she says. I hope he will make an effort to call these numbers himself, since he is much more likely to proceed with something that he feels himself in control of.

I shall follow it up with them in a few days and see what has been done. He is difficult to get hold of because phone calls and emails tend to go unanswered, and he simply severs contact if he hears something he does not like. My wife has been afraid to approach him since he snapped at her a few weeks ago for expressing concern (justified, as it turned out) at his state of mind. He bridles at the idea of being advised by a parent; in this he is totally unlike our youngest son.

The stabbings in Sydney yesterday made me think of my own son. It hasn't yet been reported whether the culprit was once a heavy user of cannabis or other drugs, but that seems to be a common factor in similar cases. It amazes me that a drug which destroys the mind of a substantial minority of users can be widely considered harmless. All it takes is for the anti-psychotic to be suspended, or for heavy drinking to render it ineffective, and they can be conditioned to do things which are totally out of character.

Thank you again for your help.

[Croix]

Dear Despairing Dad~

I've not been around much for a little while and was interested to see if matters have improved any.

Relying on his girlfriend and hoping he will make calls personally sounds like a good plan, sometimes it take a long time, but there is hope

Croix

[Despairing_Dad]

The day after my last post, my son was found disoriented by a housemate, asking "Who am I" and "Where am I". His friend called an ambulance, and when my son refused to go in, they forced him in.

My wife and I went to the hospital within a few hours. He was confined in the Psych Ward, waiting to see a doctor. He said little, except to ask why he was in a hospital. After a two-hour wait, we saw a doctor. She saw my son alone for about 20 min, then all of us for about 10 min. It ended with her tentatively recommending a depot injection on a monthly basis, and also (at my suggestion) drug/alcohol counselling. I mentioned rehab, but she said that it only really works if the patient is willing. At the end she expressed unease at releasing our son immediately, and she looked relieved when I said we expected as much.

My son improved rapidly after the anti-psychotic was administered, but then declined to have visitors, on the grounds that he needed "space". His now-ex girlfriend was quite hurt, as was my wife. His care-team called me today (a week since he was confined) to say that he would be released shortly, and that they were making a compulsory order for the depot-injection recommended by the original doctor, contrary to my son's wishes.

I hate the idea of compulsory medication, but in this case the voluntary approach has clearly failed. It seems that the early stages of psychosis are perceived as pleasurable, and so my son could not be relied on to take an anti-psychotic in time. I hope he won't react by taking harder drugs to overcome the throttling effect of the anti-psychotic.

[Croix]

Dear Despairing Dad~

One of the important things is that unless matters are good the prescribing/treating/doctor/case manager needs to get a clear picture of how things are. That may not come from you son, who could either genuinely beleive all is ok, or simply minimize matters to be cleared of the order.

Family and those who see how things are on a daily basis need to keep in touch with the doctor involved. Even if due to patient confidentiality they cannot be told anything there is nothing to stop them making their own report for the doctor to consider.

The doctor is of course right, involuntary rehab is not likely to have a positive effect. I'm glad the medication did have a beneficial effect.

Very worrying and frustrating time for you, your wife and also his ex. Being rejected or blamed is heart-breaking. Do you all have adequate support?

Croix