difficult child breakdown; back to square one

[katya02]

It's happened again, a rerun of May 2008. difficult child texted both me and daughter in the wee hours this morning having obviously been drinking, saying he was cutting himself and so sorry and life wasn't worth living etc. etc. I called him and went over as his girlfriend was working third shift. He'd texted her at work so she was all worried and trying to get someone to come and cover for her, but no luck at 2 am.

He'd cut up both forearms extensively but superficially; nothing that needed stitching. He'd clotted over before I even got there. He was tearful and completely despondent, and every new idea or sentence would put him into a fresh bout of tears. I knew if I called crisis or took him to ER they'd want him to sleep off the alcohol before doing anything, so I took him home for the night until his girlfriend got off work.

His girlfriend is a sweetie. I feel bad for her. She's older than he is and clearly really wants to be with someone who is affectionate toward her. He is also very dependent on her. She told us he'd stayed drunk for two weeks when he turned 21, and in the past week he's had panic attacks again when he's been drinking. He quit his new cleaning job after a week and didn't tell us, though he told girlfriend that he had. He's been doing odd jobs around our property for extra cash and not even managing much with that. He always says he's had no sleep, that he feels unwell, his stomach is upset, his muscles are sore, he's so stressed etc. He always looks terrible; unshaven, hair unkempt, he's gained a lot of weight (used to look like a Marine), looks so 'off' that I know no one would hire him. Even the car wash in town turned him down and kept advertising.

He still seems not all there mentally. I wish he could have some neuropsychologist testing done. I think the results would be revealing if upsetting. But for now, he's still asleep downstairs, he's depressed, anxious, likely to have panic attacks when he wakes up (judging from past experience), and is unable to get or hold a job. He keeps saying he's trying, and cries about being a failure, not being able to support himself, feeling so stressed etc. He won't consider medications after his bad experiences last year (weird manic behaviors that almost got him arrested and lost him two jobs; acute dystonic reaction that was excruciatingly painful).

I hope to find someone in our area who will work with him ... but our very small town is very limited in resources. I wouldn't be surprised if he was doing more than just drinking, though his girlfriend insists not. She is not a drinker or user. I'm starting to think he should apply for SSDI (?) - disability. He honestly doesn't seem able to hold a job, even working for us. He isn't being hostile or obstructive. I'll have to get looking around to find out about how to apply, but has anyone here had experience with this? How long or difficult a process is it?

 

[katya02]

An extra detail that is typical of difficult child but puzzling and worrying ... he's back to being completely off-base about time and events. He'll come over and ask if he can eat, because he 'hasn't eaten in two days'. The next moment he'll tell me seriously that he hasn't eaten in four days. Last night he ate dinner with his girlfriend and two hours later told her he was heading out for burgers because he 'hadn't eaten all day' and was famished. She reminded him they'd just eaten and he seemed surprised, she said. All of his reports of what goes on are just that bit exaggerated or weird, so that you know it's not true; there's a kernel of truth there but the details are 'way off. If I tell him a story about something that happened, he'll respond and then two minutes later tell me a story that supposedly happened to HIM - but it's my story. And he quite seriously tells me this and expects me to respond.

This could all be due to drugs except that he's been doing it since he was six years old. It waxes and wanes in intensity. I can't account for it.

 

[GoingNorth]

Katya, I am sorry difficult child is doing so poorly.

I don't want to upset you, but SSDI will NOT pay disability to anyone where they feel that the illness is due to or complicated by alcohol or other substance abuse.

Janet probably has exact dates, but many years back they changed the standards for qualifying for SSDI.

I know that when I had my judicial hearing for SSDI, they had the option of testing me, interviewing other docs who might've tested me, etc.

 

[katya02]

Thanks, GN. I would really like difficult child to get testing done. I think there's much more going on than just the substance abuse. It's more that he gets super-anxious, can't cope with routines at work, customers, or completing a list of tasks, and either quits or gets fired. He perceives everything weirdly. He gets panic attacks and gets depressed and suicidal. He self-medicates when the anxiety and depression get too strong, I think. He went many months after his outpatient rehab last year without touching anything. He just started again this summer.

I guess I hope his medical history (early onset BiPolar (BP), all the other diagnoses) plus his current depression/anxiety/panic attacks/inability to keep a job because of all of the above would mean he would qualify. But maybe he wouldn't. Truth is, though, he cannot work right now and I don't know if he'll ever be able to handle a job. And he has NO street smarts. He's the 'friend' who got left standing in the headlights when the cops showed up in college, the one who always got into trouble when everyone else in the group slipped away. He just doesn't have those self-preservation smarts. He can't 'read' people, can't understand interpersonal dynamics and situations, doesn't know what to say or do in most circumstances. Customer interactions at a job totally stress him out. Staff interactions stress him out just about as much. From his stories I can usually tell that he has totally misinterpreted a lot of interactions; he has no insight.

 

[witzend]

It sounds like more than just substance abuse. It will be impossible to know until he gets sober, if even only for a bit.

Is there any way that you can talk him into a 72 hour hold for detox and testing? It may not even be possible now that he's not cutting, I don't know... This just sounds like "bad" waiting to happen. I'm so sorry that things are going this way.

I know he won't want to sober up in the hospital, but the reality is, they can't know what's going on until he does, and there is a possibility of a lifetime of happiness there if he will just give up those three days of misery while they clean him up and get him tested.

I have a friend who is 63 who is a real drinker. It's clear to me that something more is going on. I know drinkers, I know crazy, and I know Alzheimer's. My gut instinct is that she has early onset Alzheimer's and is drinking to have something to blame her issues on. It's like she knows what she is supposed to be doing at any given moment, but can't make her mind tell her body what to do. It's possible that your son knows - and is afraid of - that he has some other diagnosis that will be a label that he doesn't want to have. I hope he can get to the point where he knows that "drinker" isn't such a nice label, either. Even worse, "drinker" starts as a choice. Mental illness doesn't. Although he can choose to deal with both issues...

My friend, my son, other people I know, some of our difficult children here often remind me of that line in Animal House at the end when they've all been caught; "Fat, drunk, and stupid is no way to go through life, son." It's funny in the movie, but in real life? Not so much.

 

[katya02]

Thanks Witz, I appreciate it. I wish I could get him in somewhere for detox and evaluation. Locally there's a detox that's always full and never seems to take anyone, and trying to get people into the local evaluation and counseling/treatment center on a crisis basis is like trying to win the lottery. My husband, who works in our ER, can hardly ever get people in.

Your friend sounds like a parallel example with difficult child. Drinking because of something else that's going on, and the fear and attempt to cover it up. Unfortunately difficult child woke up a little while ago and wouldn't stay with us even though his girlfriend is working again tonight. He just wanted to go back to the apartment. He didn't want to talk with husband and me, although we're going to try to sit down with him tomorrow.

 

[witzend]

I'm sorry he has run off home. It feels like it is not over yet this time with him. There's really no words that I can find to do anything other than try to understand and let you know that you are all in my thoughts today.

 

[Hound dog]

I'm so sorry Katya. I know this has to be distressing and mighty painful to watch.

I know others mentioned detox........but what about just a psychiatric watch at a local unit for a few days.......perhaps longer if they feel he's too unstable to be released? With him being so depressed and anxiety ridden do you think it would be possible to get him to cooperate?

So very worrisome. And such a sad situation for him to be in. Saying prayers and holding good thoughts that this doesn't go from bad to worse.

(((hugs)))

 

[katya02]

Thank you both, I agree, I'm sure this isn't finished yet. I'm expecting more calls, if not tonight then very soon. I am going to meet with difficult child tomorrow and try very hard to get him to cooperate with evaluation. I don't know that I'll be successful at this point. Then, if he agrees, the trick is getting someone to actually evaluate him!! But I'll enlist husband and whoever he knows. Although, it's always the way, husband has to be in another city talking to attorneys tomorrow ... always something. But I'll rattle some cages myself.

I do think difficult child has serious potential for acting on suicidal impulses. His moods swing wildly, and he can go from being suicidal to being afraid for his life (which complicates emergency evaluations), but when he's 'in the moment' he's extremely impulsive.

 

[flutterby]

I'm so sorry, Katya.

Severe depression can cause those kinds of memory issues; but there could very well be something else going on neurologically, as I'm sure you know. In that case, they're probably feeding into each other and alcohol just adds more fuel.

When I was severely depressed, I was really out of it. I would forget what I was saying mid-sentence, had no concept of time, have no memory of events, etc. Even now, I remember very, very little of anything from the time period when I was severely depressed. Just bits and pieces.

At 21, I doubt difficult child has worked enough to qualify for SSDI. He'll probably have to apply for SSI. Here's some info:

http://www.ssa.gov/pgm/links_disability.htm

You can pretty much find the answers to any questions you might have on their website.

(((hugs)))
http://www.ssa.gov/pgm/links_disability.htm

 

[katya02]

Thank you, Heather. I see what you mean ... difficult child hasn't worked enough to have a record of earnings for SSDI. He did have his condition before age 22 but it looks like husband would have to be drawing retirement or disability benefits himself before difficult child could qualify on 'adult child' grounds. I guess I'll look into SSI.

 

[Nomad]

I'm so sorry...so disappointing and stressful for all concerned.

When you put Borderline (BPD) in your description line, are you talking Borderline or Bipolar? Ironically, I have been trying to ascertain the best abbreviations on these. It seems most professionals use Borderline (BPD) for Borderline Personality Disorder, but many use it for Bipolar Disorder as well. As you know, the two can be comorbid.

A friend of mine, whose daughter has Borderline Personality disorder, has had good results with- using Prozac as part of her treatment. Of course, an SSRI would almost always be problematic with a Bipolar Patient. Same with the use of stimulants.

My daughter and many of the folks on these boards are reporting really good stabilization with Lamictal. These drug has the interesting result of stabilizing and a slight lifting property as well...without inducing mania.

It's very important to know which diagnosis you are dealing with-. And of course if one has both diagnosis's...its more complicated and those activating medications still have to be avoided.

Suicide ideation could very well be indicative of both Borderline and Bipolar...but it is probably more common with- Bipolar Disorder and Bipolar patients have the highest risk of completed suicide. Medication is imperative.

by the way, I have read that sometimes people with Bipolar Illness have problems with their memory. Certainly, anxiety issues are commonplace.

I personally think the idea of helping your son get on disability is not a bad one at all. Let it be known that the process is not easy. There are hoops to jump through. Honestly, the paperwork can be difficult ... but worth it for YOU and him if you honestly feel that working full time is just never (or not for many many years) in the cards for him.

Also, even on disability, a person can work part time and in fact, it is encouraged (when they are feeling better). A good friend of mine who helps care for her sister has helped her sister get on disability and get a part time job. It is (sadly) the only really good situation I have seen, but it is an excellent situation...almost IDEAL. This woman, who has severe mental illness, with govt help, is self sufficient and can hold her head up high...doing the very best she can with her disability. It is a very wonderful situation...one in which all parties can be very proud.

YOU, my friend, at a certain point, have to protect YOURSELF. You can't be burdened by constant worry about your son's safety and mental health. Tough love only goes so far if your son is severely mentally ill. Use the tough love to push him to do the best he can for himself...but if you see that his limitations are extreme...you can give him a hand..(I think they say give someone a hand not a hand out). Help him help himself. Help him get on a more even playing ground and then encourage him to do the very best he can from this point forward.

I'm unsure if his abuse of alcohol or drugs will influence a decision re: SSDI. Surely, you might have to be a payee on the account...because if he got a hold of money he might use it to buy alcohol or drugs. Please consider getting him in some sort of substance abuse treatment program or at least some sessions with a alcohol specialist...AA program...something. Consider a Detox program if you suspect he has a dependence issue.


This is fire he is playing with.

For us, the disability process with our daughter was not super long...but a little frustrating. They kept on losing her paperwork. We received incredible cooperation from all her doctors. The deal is that if your child has a major mental illness, a physical illness and the cooperation of her physicians (at least two) then it will go through automatically. (Two serious health problems + physician cooperation and paperwork). That was the case with our daughter. They told us that this scenario happens like once in a million cases. After some weird problems with paperwork, it was approved immediately. Others tell me that it is customary to be turned down once or twice and then sometimes people hire disability attorneys. Disability attorneys are very good at what they do and tend to have an excellent track record...a high rate of success.

Side note: Consider getting your son to a psychiatrist PRONTO if he has not been to one recently...keep the paper trail going in terms of a diagnosis, etc. Also, does he have any medical problems other than psychiatric concerns? At least give this some thought.

I don't think disability attorneys will take the case unless you've been turned down once or twice previously. Sooo...if you are seriously about all of this....go on line check it out and fill out the paperwork asap. If you have to hire an attorney, the entire process from beginning (original application) to the end, might take well over a year. However, your son will get all the money from the original application ... back money...if he wins.

Hang in there.

 

[Suz]

Katya, I don't have a thing to add that hasn't already been said. I just wanted to send you a hug.

Suz

 

[katya02]

Thank you so much, I'll remember Lamictal and see if it's something a new doctor would be willing to try (IF difficult child will accept it!). I use Borderline (BPD) as a short-form for Borderline Personality Disorder; I think difficult child has both this and Bipolar Disorder. He has major identity ambivalence/issues, abandonment fears, and he self-mutilates (cuts, punches himself to the point of giving himself black eyes etc.) when extremely distressed.

I am relieved and encouraged after a long day today ... took difficult child to the local assistance office and was fortunate to get a very helpful intake worker. I brought along difficult child's big binder of medical records. She had been going to tell difficult child he didn't qualify for assistance because he'd filled out the form saying he has no medical condition or disability! She looked at his records, changed the form, and got him food stamps immediately and put in for medical assistance and cash assistance based on medical disability. The amount of cash assistance isn't much, but the really good thing is that he has to be evaluated and given a treatment plan for it to come through! The worker gave us the number for the Base Services Unit and the doctor who they work with, someone I don't know. At least it's a start and difficult child is willing to follow through on this. He was very nervous through the interview today, anxious because he couldn't remember everything the intake worker told him. It WAS a lot, but he has auditory processing deficits and executive functioning deficits that make it hard to take in a great deal of verbal information. He is still depressed but hasn't been drinking in the past 24 hours. His girlfriend is keeping a close eye on him.

Tomorrow I'm going to pick him up and have him make the calls he needs to make from our place. He'll get muddled and give up on his own. He can activate his food stamp card, call the Base Services Unit, and make arrangements for the court clerk's office to fax proof that he paid his fines and completed his probation. The other good thing is, the worker told us that if the doctor marks the evaluation 'disabled 12 months', or 'disabled permanently' then that office has Disability Advocates who help people apply, appeal, etc. for SSI/SSDI. I'm sure it's beneficial for them, since the assistance then comes out of another department's budget, but if it's available I'll take the help!

Anyway ... it was positive. I hope difficult child hangs on until his evaluation; his girlfriend is really encouraging him so I'm crossing my fingers.

 

[flutterby]

I *love* lamictal. I have very treatment resistant depression and lamictal is often used off-label for it. When lexapro was no longer enough, I added lamictal and it has been absolutely wonderful.

I'm very glad to hear how today went.

...but he has auditory processing deficits and executive functioning deficits that make it hard to take in a great deal of verbal information.

This is my difficult child, too. She's also recently been diagnosis'd with Borderline (BPD). We don't have a diagnosis on auditory processing deficits, even though I and the neuropsychologist have requested an evaluation. I just wanted to let you know that I can relate - even though there is an age difference between our kids.

(((hugs)))

 

[Hound dog]

lamictal worked wonderfully for me. I had to stop taking it when I started school as my medications make it really difficult for me to think in depth and remember things. But for moods ect..........wow, it was different as night from day.

It would be worth trying. I've heard many many people with bipolar rave about what a difference it made for them.

 

[flutterby]

It doesn't seem to effect me cognitively at all. But then, I already have cognitive issues so it may be hard to tell.

However, you cannot stop taking it cold turkey as it can cause seizures if you do. I'm sensitive to medications and I can tell within hours of a missed dose - I get really spacey.

 

[Hound dog]

Yeah, psychiatrist was not happy he had to taper me off the medications. But I was stable.....and it really did mess with my cognitive ability something awful.......not just lamictal....the other medications too I'm sure.......So I didn't want to risk it. And I'm still stable and it's been 3 yrs.

 

[BusynMember]

Confusion and lapses in memory can be schizoaffective or schizophrenia too. I wish I didn't know this, but I've been this the phospital three times and have seen many schizophrenics. Some do get stable, but before they are stable, they are very confused, say strange things, do strange things, have no concept of time, often self-harm etc. The thing I noticed the most is the look in their eyes as if something is "off"...they are not all there. I have not seen that in other mental illnesses other than severe mania. Psychosis to me seems to have a certain "out of it" appearance. I was in the hospital the first time for ten weeks (I was pregnant, suicidal, and couldn't be medicated). I learned to recognize when somebody was, as I called it, "not in his/her right mind." But many very sick mentally ill people, even schizoaffectives and schizophrenics, can get quite stabilized for long periods of time, but they have to be clean. The drinking is not a good thing and I agree he may be doing it because it's the lesser of two evils.

Gentle hugs and just a quick "I understand."

 

[katya02]

Thanks, MWM. It's crossed my mind before to wonder if there's a psychotic process going on. Given my oldest son's diagnosis it wouldn't be a total shock. I helped difficult child make calls yesterday to set up his intake appointment, arrange for proof of fines paid etc. to be faxed, and to activate his MA card. It totally stressed him out. I had to write out word for word what he should say on the phone, and when he had the script he was fine; he sounded quite normal. But when someone asked an 'off-script' question on the other end he panicked and made up random stuff, such as that he has supplementary health insurance for catastrophic emergencies only (huh?), and that he's already arranged for his previous mental health records to be sent to the new office (not!). Making the calls left him shaking and asking to just be taken home because he wanted to go to bed. We'd been planning to barbecue and take him and girlfriend to a movie but it didn't happen.

He's also lost his letter from the probation office that confirms that he completed all requirements, and various probation letters and forms from the start of his supervision were scattered throughout his accordion file with random job applications (not filled in) and pieces of junk mail.

The good news is that he's willing to leave his files and important papers with us, have his assistance stuff mailed to our address, and have me come to his intake appointment next week. He does seem to understand that he needs help with admin stuff and with his appointments. That's real progress, actually.