On a good day, parenting will test the integrity of your character. On a bad day, parenting will test your will to live. Parenting children with trauma histories will cause you to test the integrity of everything and everyone you thought you knew, for the rest of your life.
~J. Skrobisz

Sunday, July 11, 2010

Dialogues about Medication

I distinctly remember a conversation with the kids' birthmom many moons ago. She insisted that her diagnosis of bipolar was false, that her doctors didn't know what they were talking about and that under no uncertain terms would she take the medication they prescribed nor would she maintain the day treatment that they felt she needed.

This is a conversation I've heard in some variation many, many times from persons with bipolar diagnoses, that they have been misdiagnosed and that they don't need their medications. And equally as many times, I've talked with stable persons with a bipolar diagnosis that know the benefits of maintaining regular appointments with their psychiatrist, psychologist and above all, medicating. I'd say my experience is 50/50 for persons that follow doctor's orders and those that don't. Sadly, those individuals that choose not to, usually have the most significant challenges with their mental health issues, challenges that often include homelessness, criminal behavior and abuse. [1]

In an effort to help Sissy understand the need for and the benefit from her medications, I maintain a running dialogue about them. I don't care if she has a questionable cognitive understanding of them, I'm going to tell her about her meds anyway. When she was at RTC, the staff had to call us first before they added or changed any of her meds. They also had to send us paperwork that required our signature of approval and acknowledgment. On the days Sissy was to begin her new or adjusted meds, I always called the staff in her building and asked them to please tell her that I approved the med change so she didn't think her doctors were taking liberties. Thus, when Sissy returned home, I was flabbergasted that she knew nothing about the meds she took, why she took them or even when. I considered this a setback because before RTC, I always talked with her about her med changes.

So we began a new, discussing her meds, what each looks like, what each is named, their milligram or gram amounts and what the medication was supposed to do for her. When she's had side effects (the tremors she had back in May from the tenex) I always told her which med was causing it and the level of severity of her side effect (that is to say, if the doctors were concerned about the side effect or if it was something they felt she just needed to deal with). If there are changes in appearance to her meds because they've been filled by a different pharmacy, if there are differences in number of pills because we're giving her 2 2mg intuniv instead of 1 4mg pill, or if we're changing when we dose them because we're giving her two at breakfast and 2 at dinner, she's told. Every time. And about once a week, before she takes her pills, I pour them out and we review the purpose of each one. Then, when she has a good day, we talk about how she's feeling and we discuss which medication is helping her achieve that balance. In these conversations I always discuss a before and after scenario, particularly if she's just had another med adjustment.

Why do I spend so much effort? Because I don't want Sissy to one day have the same conversation with me about her diagnoses and medications that her birthmom did. I want Sissy to understand and accept that some people need medications to live happy, fulfilling lives, that medication is not a bad thing, that it's nothing to be embarrassed about and that it doesn't make her a bad person. We casually discuss her diagnoses and how many people suffer from similar ailments and are doing well, that there is hope and a future for her regardless of what the documents say or how many pills she must ingest daily.

Yes, it scares me that my 10 year old is on so much medication, that her mental and emotional health diagnoses are so severe that without those medications and therapeutic interventions, she could not successfully live in a home environment. But it terrifies me more that without a working knowledge of how these interventions help her, Sissy will be ignorant of their benefit and may one day conclude she doesn't need them. If she gets to that point in her thinking, I fear that success, happiness and a bright future will be unattainable.

I hope, I hope, I hope that these ongoing dialogues will not be in vain. I'm not naive or idealistic, I'm plotting a course for success knowing that Sissy might deviate from it anyway. If despite my efforts, Sissy still snubs it and chooses her own path in adulthood, I'll go to bed at night knowing that no matter what she's doing, I did what was right when she was in my home.

So many variables to consider when helping our children! So many opportunities for success. So many for failure. We must take it one day at a time. What do YOU do to educate your child about meds and diagnoses?

[1] parenting a child with many mental and emotional health challenges, I have a better understanding of what happens to adults that end up on the streets, in jails, in domestic violence situations or self-medicating with alcohol and drugs. That said, it often concerns me that the faith-based initiatives to help these persons are invariably devoid of any meaningful medical, psychological or therapeutic interventions that could help these adults achieve success. All too often the "Jesus saves" and "hell, fire and brimstone!" rhetoric falls short for these significantly challenged adults. Not only that but without medical and psychological supports, a strictly religious approach can be equally damaging and abusive both mentally and emotionally. Throw in the fact that many of these mental health issues include hyper-religious ideations and you've got a recipe for disaster of overwhelming proportions. In the mind of a severely manic, hyper-religious individual, they might believe they have been called by God to start a new congregation, accomplish that task and then lead a flock of other mentally challenged individuals or vulnerable persons down an alarming and scary road toward destruction, all in the name of Jesus and without any meaningful theological education or pastoral therapy training. The Waco, Texas mass suicide is one extreme example but there are many, many less conspicuous examples all over the world. This revelation is the very reason I will never return to a nondenominational congregation.

eh, all that is another post. sorry.


Happymom4 aka Hope Anne said...

You are a wise Mom, you know that??

Integrity Singer said...

thanks Hope Anne!

peacechaser said...

My daughter has crohns and from the start (she was in middle school) we have talked about the meds and what they do and when she takes them etc. I have insisted ontrips she be able to medicate herself because she does at home. now our situation is in many ways different than yours but yes i think it is so important for kids to know what they are taking and why and be a part of the process when they are able.

GB's Mom said...

Smart Mom. Sissy may be one of the successful ones!

Mama Drama Times Two said...

Great Post! We also go over Bobby's meds - not just so he knows what helps, but because I am terrified over when he is old enough to refuse them and the consequences of an unmedicated child. His own Mom is in total denial that she has HUGE mental health issues - despite the fact she been arrested for her delusions, is often homeless and has lost all 4 of her children. His own sister chose to self medicate starting at the age of 11 to numb the feelings of abuse and neglect. Sadly, she became a drug addict by the time she was 14. Hoping some of this sticks with him as we enter the rocky road of puberty. YIKES.

Jules said...

She insisted that her diagnosis of bipolar was false, that her doctors didn't know what they were talking about and that under no uncertain terms would she take the medication they prescribed nor would she maintain the day treatment that they felt she needed.

Why does she think her kids were taken from her?

Integrity Singer said...

lol Jules. She thinks it was a conspiracy - a secret agency that was out to get her, that she was infallible and the system worked against her, not for her, that everyone else was wrong, that she was duped, blah blah blah. She does have a schizoid affect to her bipolar which explains some of those thoughts, in particular the secret agency conspiracy theories.

Jules said...

Does Sissy feel that way too?

Integrity Singer said...

jules: no, not right now. Sissy has a good handle on her need for meds but the jury's still out - puberty is around the corner. As for Sissy's possible psychoses, she typically speaks on friendly terms with the voices in her head although I suspect they encourage her to make poor choices