Expert: Joyce A. Anthony - 2/17/2008

Question
Good Morning Dr. Anthony,

It is encouraging to see that people like you offer your services online.

My 40-yr-old sister-in-law (we'll call her Suzy) suffers from Bi-Polar Schizofrenia.

We live out of the country and as a result, my mother-in-law is burdened with taking care of Suzy's manic ways, causing a terrible strain on family relations.

As an important sidenote, my mother-in-law is a fiesty 70-yr-old divorced immigrant from native India with very little economic support -- the father of her children was an abusive, alcoholic she married below her caste in India. He brought her and the family to the States over 30 years ago and abandoned everyone.

So back to Suzy -- Suzy's condition is critical:
1) she will not take her meds (she's on many things: Depakote ER; Cogetin; Effexor; Thorazine; Prolixin – I have no idea what these are for – she claims she takes them, but during our visits with her, she is only lucid for a couple minutes at a time in short bursts. She doesn't like the feeling of having "blunted emotions" while on her meds.)
2) She will not go to counseling and stay in a routine
3) She can not civilly live with roommates and follow rules and calls Board a Care facilities "Prisons for the heavily medicated and bored"
4) Pretty much every couple weeks now for the past several months has been living on the street, in and out of homeless shelters, prostituting herself, bothers (becomes violent) at her ex-husband's house who without hesitation calls the police on her which ends her up in a 3 to 4-day pscych hospital, only to be released out on the street to go through the whole tragic story again and again
5) Of course, in the meantime, my dutiful mother-in-law out of motherly sacrifice, love and perhaps shame enabales her daughter and gives her money, groceries, clothing, etc. which Suzy blows/loses/disregards immediately (this is often money we send to my mother-in-law to support her, but not to waste on Suzy)
6) Suzy, the insecure 9 yr-old in a 40-yr-old's "sex-craved" body does not want help (she was inducted into a Hari Krishna cult at age 16, did lots of LSD and other very hard drugs and was pretty lost for about a decade)

We have explained to my mother-in-law she may have to let go of her daughter, but admittedly, that may not be an answer for this elderly Indian woman steeped in tradition and guilt.

My husband is rather dispondent about the situation (as are his other sister and brother who live nearby) so I am trying desparately to help the family before my mother-in-law loses her own sanity and the situation destroys the family.

We would like to get Suzy into long-term-care, but:
1) we do not have the finances for private care
2) Every time she gets thrown back out on the street the doctors do not recommend her for long-term hospitalization (they make more money having these street urchins come in every couple weeks for their 4-day-government-funded stay)
3) We live out of country and feel helpless about the situation and unsure of where to go for help in the Southern California system.

Yikes, that's a lot, eh?

Any suggestions?

Thank you, Dr. Anthony!

Christine Krishnan

Answer
Christine:

Unfortunately, this type of situation happens all too often today.  The problem is that, unless "Suzy" commits a crime or is considered suicidal, she can't be forced into a mental health facility.  If the hospital keeps releasing her, there isn't much anyone else can do to get her help--unless she does it herself.

Is there any way all of you can get together and talk with your MIL?  Maybe if everyone sat down with her at the same time, it would help her understand the gravity of the situation.  Other than that, I'm afraid there isn't too much that can be done.

If someone could get legal "custody" of Suzy, by proving she is unstable, then it would be easier to find additional help.

                       Joyce A. Anthony