My mom has histrionic personality disorder

How does our family deal with a mentally ill mother?

Published August 17, 2010 12:20AM (EDT)

Dear Cary,

It's wonderful that you are writing letters again. I hope your health continues to improve.

For the past two years my mother has endured a mental health crisis. It was brought on by the abrupt death of someone very close to her and began with an inability to sleep, followed by extreme anxiety and depression. At its peak, she was entirely nonfunctional. She came to live with me for two months and her condition demanded 24-hour attention. I was unable to work as she would be stricken with panic attacks in my absence and call 911. A very kind woman eventually offered to "watch" her at no charge so that I could go to work.

Medical bills mounted as a result of what I now know is called somatoform disorder, in which she became convinced that she was in grave danger from various illusory medical issues. In the meantime, back in the state where my mother lives, my brother was working her jobs (she is a gardener) so that she would not lose them and her very cheap apartment, and sending her money. She has been divorced twice and the fathers are not interested in helping out with this situation. She is in her late 50s, my brother in his mid-20s, and I in my early 30s. Neither my brother nor I have ever wanted to focus on earning a lot of money, which was working out just fine until we needed it for her care (whoops).

She has sought help from many quarters but is stymied by the fact that she has little money and cannot afford insurance, by the fact that she lives alone, and also because there is only so much the mental-health industry can do for anyone. They are working hard but this experience has taught me that they have a long way to go -- a different diagnosis from every doctor, medications prescribed with a dartboard mentality (they don't even know why several of these medications work!), and a general lack of availability. (Half an hour with a psychiatrist once per month is exactly as effective as it sounds.)

While she has regained marginal functionality, she goes up and down. Recently she insisted that my brother rush home from another state where he was finishing a well-paying construction job so that he could live with her while she tries her latest purported remedy for this ailment, which basically involves going off her meds and will doubtless result in destabilization. Whether she is correct and the destabilization will be temporary, or this will be just another draining chapter of the drama, time will tell. Of course I have mixed feelings -- some days I am filled with love and compassion, other days it is resentment and fear that the next 30 years of my life could be dominated, financially and emotionally, by this.

Before this crisis, she had personality issues, and as a result I've always hesitated to write this crisis entirely off to "mental illness," which would be something completely out of her control. Whether subconscious or not, it's like she just doesn't want to deal with her life anymore and wants to be taken care of instead. I gave up looking for a diagnosis in the first year. Unexpectedly, I ran across an exact description of her ailment earlier this week. No doctor has ever mentioned it, but I am certain this is exactly what it is -- the accuracy is eerie. It's called histrionic personality disorder, and as briefly as possible, it is about needing a lot of attention and getting it with nonstop dramatic displays of emotion. People who have it generally function well until someone dies or an important relationship disintegrates, something on which they would have based their very fragile identities. It explains so much about her, my childhood, and even about her mother.

But knowing this is a mixed bag. While I don't believe that she is limited to the sum total of the disorder, this diagnosis is not very flattering. She won't want to hear it and likely won't accept it. More likely she would accuse me of attacking her. She already thinks I am too hard on her, because I call her on some of her other behaviors. A "cure" doesn't exist. The only thing that seems to have a chance of effectiveness on this disorder is long-term therapy (the one treatment in which she displays absolutely no interest).

So my question is, where do I go from here? When she exhibits the manipulative behavior that is the hallmark of her crisis-level anxiety and depression (give up everything and fly home now, or else disaster will rain down!), do I call her on it, even though she is convinced at the conscious level that such behavior is her only option for survival? Given that this has gone on for two years and may continue for an indefinite period of time, how do my brother and I position ourselves? There is her reality, and then there is everyone else's. Hers happens to be on condition red all the time.

How can we best help her -- by challenging her as though she is able to see her ailment and at least partially recover, or has she just become an adult child, and should be indulged and treated as such? The latter feels contemptuous, but this is what mental health professionals seem to advocate -- that the mentally ill bear no responsibility for their actions. The former feels ... not compassionate, at times. When we were children, we both suffered and benefited from her version of tough love: when we cried, we were "feeling sorry for ourselves." When we screwed up, we weren't coddled -- the blame fell on us, as was right, and we were made to deal with the fallout. This made us quite strong and independent, but also, I think, with a certain inability to understand this kind of weakness, particularly when it goes on and on and on. And so there is an irony in the fact that she is precisely the person who schooled us in this independence.

I don't know how best to help her, and us. Thanks for reading.


Dear Daughter,

I have a friend whose mom has a similar diagnosis.

My friend's psychiatrist told her to break off contact, or at least not get involved emotionally, "which pretty much requires no contact when you're talking about your mother," says my friend.

However, taking care of her mom is her responsibility, so no contact is not an option.

Her mom has been in bed for the last 10 years. She refuses to get up.

Her mom was constantly putting herself in danger. Now she's in a nursing home where she can't hurt herself. "She is unhappy about being there," says my friend, "but she is safe."

Now my friend visits once a week. Plus she handles all the paperwork. "Oh, it's grim," she says. "I hate to go but I go. I stay for the agreed upon (with myself) length of time and then I get out. Then I'm happy -- for another week."

To keep life sane, she also advises: "Under NO circumstances do I give her my cellphone number. Something must be sacred!"

This friend of mine is not heartless but you gotta draw some lines or your mother will drown you.

I also have Stephannie the Researcher helping me out; she has compiled a blog listing many resources for this strange and baffling set of disorders.

As for me, I'd feel a whole lot better if your mom had insurance. Wouldn't you? Is there any way to get her insurance? Maybe she can pay something, and you can find ways to supplement it.

I know this about having crazy parents (and excuse the word "crazy," but, Hey: I mean crazy!): It's creepy and weird to treat a parent like a child. I also know this: A new tenderness can emerge once we get over the ickiness. This is liberating in its own twisted way. You realize, OK, there is no mystery here. You just balanced your mom's checkbook and wiped her ass and that's OK. Time to move on.

We who have nursed our parents through dark and trying times have learned this also: You do have the strength to deal with it. You find the strength. And that strength -- once you find it -- can stay with you. So it is a kind of gift. I realize that I'm always saying "this is a gift" and "that is a gift." But it seems to be true: If these things are not gifts, what are they?

One more thing: You need support. Reach out to people with similar experience. Build your community. Maintain your community. Keep social workers and doctors close. You will find strength there too. 

Write Your Truth.

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By Cary Tennis

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