psychotropic

Comorbidity

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As a child, Ruby spent most of her days alone in her room smoking, giggling one minute and then crying in despair the next. Even though her main diagnoses was Schizophrenia, I can’t help but feel that depression was another illness that affected her. Also, I had never heard of the term “comorbidity”- that is, to be diagnosed with more than one mental illness. So Schizophrenia was all I knew. I didn’t know how ignorant I was until I spoke with a friend of mine whose mother was also diagnosed with Schizophrenia.

His mother would get dressed, leave the house, and be social despite her illness. I wondered about that when he told me. Was she that woman? You know, the one who walked the streets mumbling to herself, crazed look in her eyes? Did she have moments of clarity where she interacted with people out there on the streets? I never asked.

One reason that Ruby was so antisocial is she hated her appearance. After four children she went from a brickhouse to a mini-mansion. Her skin was pocked with acne. Her wardrobe consisted of house dresses/muumuus that she wore day in and out. She never bothered to fix her hair and instead wore it under a scarf.

I know now that some psychotropic medications can have side effects such as making you gain weight and other effects. This is truer with the medications of the past forty years.

Nevertheless, her self-hatred led to isolation that was unbroken. If I wanted to see my mother, I had to walk into her world; that room that was so filled with smoke that the walls were covered in tar. I would sit with her breathing it all in. Sometimes she would talk or ask me to sit on her belly to flatten it and I would comply. That was as close as she would come to a hug or any type of affection.
In reflecting on these memories, I can you that serious mental illness affect everyone in the family and when you’re a child that does not understand “mommy’s strangeness,” you tend to blame yourself.

 

Drugs and Medication

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Psychotropic medications have their positive and negative aspects; nevertheless, I believe that each generation of psychotropic meds improves.

In the seventies, Ruby took Melarill and to this day, I am not sure how much it helped her. She still remained in bed all day laughing, crying and chain smoking. Maybe it left her without energy as she did not roam the streets like the other mentally ill folks in the neighborhood. She was our embarrassment kept behind closed doors. Over time, the medications she was prescribed changed but each one of course has its side effects that can affect the individual physically and/or mentally.

Prescribing psychotropics can be a tricky business as it affects individuals differently especially if you are prescribed more than one medication. Sometimes the mix is beneficial-i.e. decreases their symptoms and allows the consumer (patient) to function “better” even to the point of being able to fully participate in life. Other times, the consumer can have a bad reaction to the medication and/or the combination of medications prescribed. Sometimes, the consumer can end up in emergency and even to a psychiatric ward if the reaction is bad enough. This is why many consumers do not like to take their medications.

The other half of that is that sometimes the medications work so well that the consumer misleads themselves into believing that they do not need to take the medication anymore and stop. This of course can result in the consumer being hospitalized and is one of the main reasons behind repeated admittance into the psych ward. Then, there are those who self-medicate via alcohol abuse and illegal street drugs to alleviate their symptoms.

With Ruby, she was very, very thorough in taking her medications from the seventies until about the mid- 1990s. In fact, she kept a daily calendar book and would record the medications and times that she took them which is how it was easier to figure out when she stopped taking her meds. Later, I found out why.

My eldest brother had gotten addicted to crack cocaine. It was one of the worst blights to hit the African American community since the times of lynching and Jim Crow laws. It decimated families in a way that nothing had ever done before. Ruby had decided that her daily meds were an addiction akin to taking crack and stopped. That was the first time that she had been hospitalized during my adult years. The psychiatrist finally convinced my mother that her medications are an essential part of her well-being and like the diabetic who needs insulin, she needed her psychotropic meds. By this time, she was on Thorazine which left its own physiological side effects but that is another post.

That Girl that Comes to See Me

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One of the other mental health issues that Ruby was diagnosed with was Dementia. Not Alzheimer’s disease but dementia nevertheless. There have been times when not even the psychiatrist could tell whether she needed more psychotropic drugs or if it was the dementia that affected her behavior.

 For example, there was a period of time when Ruby refused to acknowledge me as her daughter. She would never say my name and along with this, she refused any forms of physical affection. My mother has never been a really affectionate person to begin with but during this period it was a lot worse. She was repelled by me. No, nothing had happened at this point between us. It was just the way she felt.

 There was really no proper way to resolve her issues during this time. I definitely did not want her to be medicated with more psychotropic drugs. The dosages she was on were pretty substantial already. I chose to accept my new moniker, “that girl that comes to see me.” This didn’t stop her from sending me to the store to buy toiletries or her fast favorite foods. Was I hurt by this? Yes, but I had come to accept that even when things were ugly between us, I would still be there.

 Some would say that this was a wonderful thing to do for Ruby. But, I had to implement some type of protocol to protect my own emotional wellbeing. After all, this is not some random patient-this is “my” mother. When she would not take her medications, her behavior became particularly ugly. During these times I would: limit my visits to ten minutes; decrease the visits per week; call the board and care to ask about her condition; make sure that she had the minimum of toiletries; and lastly, screen all phone calls from her.

 Some may say, “That was cruel! She was your mother!!” I say that I did fulfill my role as her daughter.  First, she was in a safe place. Second, I kept looking for resources to help her. It is very, VERY difficult to find a psychiatrist who specializes in geriatric care but I finally did because of my job (…will explain later). I physically checked on her enough to make sure that she was not being abused or being abusive. Ruby did not want for food or clean clothing. She could no longer be trusted in a house alone. As a working adult, I used the limited options that I had but didn’t relinquish my role as a daughter. As that girl that used to go see her, I learned self-preservation of my own emotional well-being and am the better for it.