Psych

When I held this child in my arms for the first time, I never thought that I would see him in handcuffs.  I never thought he would use drugs.  I never thought I would have to put him in a rehab facility.  I never thought I would hear doctors and therapists suggest diagnoses like attachment disorder, oppositional defiant disorder, below average brain processing speed, depression, psychosis, explosive personality disorder, and bi-polar disorder.  I never thought he would spend time in a psych unit.

At the same time that my son was freaking out in my home, beating holes in my door, and fighting with my husband, there was a terrible school shooting in one of the eastern states.  And, the sad thing about that in my own life was that I couldn’t say for sure that my son wouldn’t ever attempt something like that. When he is raging, he is totally out of control and doesn’t think about anything but the fact that he will do anything to get the results that he is after.  You just don’t know what it is like to see your son beat a hole through your door and then fight with your husband, who is just trying to restrain him.  I had no idea what lengths he would go to if he thought he was being treated unfairly by us, his parents, or the world in general.  It was awful that I even had those thoughts, but I had no idea what was going on in my son’s head.

He was given ten days by the insurance company for the doctors and therapists at the psych unit to try to figure it out.  We were lucky to get them to allow ten days.  At first, they were only willing to let him stay for five days, which would have been ridiculous.  He was rebellious and un-cooperative for the first five days as it was. 

The first thing that his therapist, Fred, said to me was, “You have one stubborn son.”

I said, “No, I have one REALLY stubborn son.”  And he laughed and agreed with me.  He expressed empathy and compassion for what we were going through and for that fact that nothing we had tried in the past had helped.  He let us know that in ten short days, we would be lucky to make any kind of breakthrough.  

Family therapy sessions were tough.  For two or three days, our son was uncommunicative and sullen.  The only thing he said to us was, "Will you bring me some of my own clothes? I am tired of wearing someone else's pants."  Even after those first three days, he would not speak to me or my husband unless he absolutely had to.  Then, he started “playing the game” with Fred, saying exactly what he thought Fred wanted to hear.  I expressed concern about that and he said that he knew what my son was doing and knew how to handle the behavior.  When playing the game didn’t get immediate results—going home and getting his X-Box back—my son started trying to manipulate me by promising to do all of the things that were on the list that he had previously sworn he would never do. 

Fred was amazing and didn’t let us fall for anything that our son tried to pull.  He was trying to make my son take responsibility for himself and for his actions and not blame us for everything that was happening to him.

The psychiatrist (I will call him Dr. Smith) spent a lot of time with my son and after a few days told us that he was going to prescribe a new medication to help calm my son down.  This was one of the breakthroughs that I was looking for.  When I researched the new medication online, I saw that this particular medication was generally prescribed for bi-polar disorder. 

Bi-polar disorder!  I had been asking doctors for over two years if my son had a type of bi-polar disorder.  His mood swings were rapid and cycling and I could often tell when an episode was going to end up in out of control behavior.  My concern was always just brushed off and I was told, “No, he is not bi-polar.”  And that was it. 

During that week of peace and quiet at home, I went to see a movie about a young adult with bi-polar disorder, who left a psychiatric hospital to go back home to live with his parents.  He didn’t like to take his medication and he had raging episodes similar to the ones that my son has.  It was interesting to see an episode portrayed on a movie screen, although the rages portrayed in those scenes were extremely MILD compared to the raging episodes that we experience in our home. 

So, for me, it was validating to know that a doctor had put two and two together to come up with the same feelings about an aspect of my son’s mental condition that I had been having.

This diagnosis could have the potential to be life-changing for him and for us as a family.     

We went back every day during the week to meet with the therapist and psychiatrist, followed by family therapy with our son.  Each time we met with them, they would shake their heads and empathize with us about how hard it was to deal with our son.  It did not seem like any progress was being made.  He still wouldn’t talk to us.  He still played the game with them.  And, he didn’t want to try to let them help him.  Every time they asked him questions about his behavior or choices he would say, “Because, I am bored.  Because, I don’t have anything in my life that I find enjoyable.  Nothing that I used to do is fun anymore.  No matter what I try I can’t find anything to do.”

And they responded with the question, “When you make the decision to be bored and to stop trying to have fun, how does that benefit you?”  He wouldn’t answer them.

As we drew closer to the end of the week, even though nothing had really changed, the next step was for our son to come up with a Safety Plan for what he was willing to do to keep himself and the family safe when he came home.  He was supposed to decide on certain behaviors, expectations, and consequences.  Fred felt that it would work out better for us if our son made the plan because then he couldn’t say, “That’s not what I agreed to do, so I don’t have to do it.”  But, he refused to try, to listen, or to give-in on anything.  Sometimes, Fred was just dumbfounded as he saw how unreasonable my son could be. 

He would send our son out of the room and give us counsel about things that we, as parents, needed to do when he came home.  He said that we should give him his X-Box back, even though we didn’t want to.  According to him, when we take something away, indefinitely, in our son's mind, it is the end of the world, life is over, and he will NEVER be able to get what he lost back.  He said that if we feel that we need to take something away from him, we should take it away for a maximum of two days. 

He also recommended that we put a door back on his room, since we had taken his door off when he smoked marijuana in there.  I was only willing to give him the door with the big hole in it and the Fred thought that was a great idea.  When he presented that idea to my son, his response was, “Fine with me.  As long as they like hearing my TV blast loudly all night.” 

To which Fred forcefully stated, “You WILL NOT be doing that.  Being disrespectful in that manner is not going along with the right to live in your parent’s house!” 

Of course, the rebuttal to that was, “I don’t want to live there anyway!”  And he began to spin everything in that direction again. 

Everything just went around and around.  We weren’t getting anywhere and were at our wits end.  What would we do after the weekend was over and he came back home?

We had just played our Psych Unit card, so what would our next course of action be if things got out of control again?

As the weekend approached, he suddenly began to cooperate and came up with ideas for his Safety Plan, thinking that if he did what was expected at the last minute, he wouldn’t have to stay any longer.  When he asked me if he could go home with us that night, Fred said, “It is not up to your parents.  This decision is not in their control.  I will confer with Dr. Smith and we will determine whether you can go home after the weekend is over, or not.”  My son began to cry and begged, “Please don’t make me stay here.  It is so f-n boring that I can’t stand it.”

I hated to see him cry.  I hated that he was going through this and that WE were all going through this.  I had certainly shed my share of tears.  I knew he was not having a good time there, but I also knew that I wasn’t ready for him to come home yet.

So, of course he got angry and went back to his sulking mood saying again that he didn’t ever want to come home with us and would rather go anywhere else than to our home.  Fred told us that we might as well leave and he would continue to try to get through to our son for awhile that night. 

During their discussion, Fred told him, “if I let you go home on Tuesday, you need to know that you will be going back to high school and that if you screw up at all, in any way, you will be put in residential treatment, immediately.  There will be a standing order waiting for you.  And, if it was my decision, alone, I would put you in residential treatment right now because you aren’t showing me that you have learned a thing in the last week that you have been here.” 

The only thing my son took from that statement were the words, “Residential Treatment.”  I received a phone call from our son a while later and he began begging me to say that if he was good all weekend, would I make sure that he didn’t have to go into residential treatment next week?

I just told him that I wasn’t going to commit to anything and that I couldn’t make any decisions, say yes, or say no to anything without his Dad, the therapist, and the psychiatrist’s input.  He hung up on me.

Five minutes later, a staff member called back and said that our son wanted to talk to me again.  My husband told him that I wouldn’t talk to my son if he was just going to get angry when he didn’t get the answers that he wanted and hang up on me again.  The staff member talked to our son, then put him on the line.  He asked us to come and see him the next night (there was no family therapy on weekends).  I agreed, but reiterated that I would not answer any questions about his release date or his future and that if he started to pester me, I would just leave. 

10 minutes after that, Fred called and told me that he wished he knew what was misfiring in my son’s brain that quickly turns a good situation into a bad one and causes everything to blow up, but he didn’t know what it was.  He wished that our insurance company would let him go into residential treatment, but he knew that it wasn’t a likely option.  He said that he should have left work several hours ago but was trying valiantly to make some progress with our son.  Even though he wasn’t supposed to work the next day, he said he was going to go to the morning meeting and fill everyone in about our son and try to figure out what to do with him.  I have never known any doctor or therapist who worked as hard to help our family as Fred did in that short time.  I will always be grateful for all of the extra time that he spent with us.  I wished we could have continued therapy with him on the outside because he has been the only person who seemed to be able to see past the games and the acting and try to get to the root of the problem. 

At the end of our weekend visit with our son, where we brought him fast food and played Uno, he actually initiated and gave me and my husband hugs when it was time for us to leave.  Wow!   

We had a fairly good time with him, but part of me didn’t trust that.  How would I know that it wasn’t just part of the act that he puts on to try to get his way?  But, then again, maybe a week in the psych unit taught him that it wasn’t as bad at home as he thought it was.

On Monday, I found out that no matter what argument or diagnosis or reason that Fred and Dr. Smith had for putting our son in residential treatment, the insurance company would not budge and would not cover a stay in the facility, or even Day Treatment.  It made me upset that our health insurance, which we had not downgraded or changed in anyway in the last three years, no longer covers any residential or day treatment for mental health or substance abuse.  Somehow they secretly red-lined that coverage without our knowing it.  Nothing was said about that change in coverage when we renewed at higher and higher rates every year.

The honeymoon period of good weekend behavior was certainly over on Monday night.  Once our son found out he wasn’t going to residential treatment, he was ready to be a jerk again.  He didn’t know that it was not allowed by the insurance company, he just knew that he wasn’t going at that point.  But, Fred did his best to put a stop to the rotten attitude by telling our son that if he didn’t shut up and listen and let us come up with a plan, he was going to change his mind about discharging him the next day.

The hour was over way too quickly and he sent our son out of the room to give us a last few minutes of reassurance and advice.  He hoped that our son would follow the rules and everything that we were working on for the Safety Plan, but he had reservations and he told us…”This is off the record.  I will deny that I ever said this to you.  But, you do have a choice tomorrow.  If you choose not to come and pick him up, he will become a ward of the state.  You will be charged with abandonment, but with all that you have gone through, and all of the information that we can release from the records of his stay here, it won’t be that bad for you and you won’t have to deal with him anymore.  I can say that I would not think badly of you if you did this.  I don’t know if anything that we have done here in the last week has helped him and I don’t want to send you home with the idea that things have been fixed because they probably haven't been.”

I almost started to cry as he was talking.  How could I possibly do that?  Would I ever really be at that point?

I asked Fred if we could meet again for awhile before I took my son home the next day and he said, “Yes, I think we should.”   He set it up for 1:00 p.m. and I said, “Are you blocking out 3 hours?”  He laughed and said he thought we would probably need that much, knowing us.  Then, he sent us to a room with our son to try to finish the going-home plan without his assistance, since we hadn’t made enough progress on it during our session.

Our Safety Plan turned out to be different than the one that Fred was suggesting, but we had to get our son to agree to something, so we took what we could get.  And then, he actually hugged us again when we left. 

That night, I either got the stomach-flu or food poisoning or both.  I was so sick all night long.  The next morning, I had to go check my son out of the psych unit alone because my husband couldn’t miss work.  I don't know how I managed it, but I pretended that I wasn’t sick the whole time that I was at the facility.  

Fred told me that if we have to go through this again, he would make sure that he was our son’s therapist and that he would do everything in his power to make sure that if necessary (and because it was the last resort) our son would get admitted to the State Mental Hospital.  

I had just been wondering why anyone hadn’t ever mentioned the State Hospital and was glad to have him alleviate my fears about having no other options.  

He powered through everything again with my son about what was expected of him at home.   My son was quietly submissive and agreed to comply with everything.  

I was terrified to take him home.  I knew that my son still felt that everything that had happened was not his fault and blamed us for all of it.  I was so sick and felt so awful that I knew I could not handle it if he freaked out when we got home.   

I let him know that I planned on going straight to bed when we got home and he said he intended to immediately begin playing the X-Box.  But, surprisingly, he asked me what chore I wanted him to do first.  And, he did one.  

That was unexpected. 

Maybe things were going to be okay.

Yeah, right…..maybe.