by Patrick Appel

A reader writes:

I have a sister with Schizophrenia, and my family struggles every day with how to deal with her wants and needs.  Mental illness presents incredibly hard choices for families who deal with it, and it doesn’t help when its victims know how to manipulate your guilt into enabling. 

Let me start by illustrating some of the difficulties.  Medication can be very helpful in assuaging the devastating effects of the illness. My sister was able to work a job (with some help from her coworker – my mom) for some time while on the medication. The problem is in timing, meaning that it takes two weeks for the medication to be in the blood stream at levels high enough to be effective. This amount of time makes it difficult for her to understand the connection between the drugs and the return to sanity. It also means that she can stop taking the medication and won’t see the effect for a few weeks.  When on medication, my sister is able to function well enough to do some of the normal daily activities that we all take for granted; driving to the store, interact with people, work, etc.  When not on medication, she is irrational to the point of violence.  

Many of her attempts at living without medication were done in secret.  Our family only finds out a few weeks later, when her behavior makes her non-compliance obvious.  At that time, we have to pull back on many of the freedoms that we allow her when she is compliant.  The first thing we do is take away her car keys, as we can not put the community at risk.  And the more she has ceased her medication, the longer we keep the keys away.  Obviously, this only enrages her, and makes her spiral further into depression and paranoia (we are all conspiring to make her unhappy, etc). 

I have recently prodded my parents to sell the car, because I believe that it’s only a matter of time until she ceases compliance, and crashes the car before we notice the effects. The more I think of it, the more scared I am that there are mentally ill people on the roads right now. 

This leads me back to your post.  Patients freedom vs. the safety of public/family/themselves.  I don’t know the answers, but it is nice to see an influential blog like yours bring some attention to the subject.

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