May 20, 2009

A Family Lost and Found

After 20 years in a mental institution, a mother is welcomed back by her children

By Leslie Hocking, M83

I’ve been a geriatric psychiatrist for more than 15 years. In my practice, I’ve seen patients who are aging with such dignity and stamina that I find myself scribbling notes in my head for my golden years every time I see them. I’ve struggled with patients whose “problem list” represents a Gordian knot of medical, neurological and psychiatric factors that humble and defy me, and ultimately resist any confident understanding. But perhaps the most unexpected resonance of my practice has involved not the patient, but the sprawling, struggling mass of family that accompanies them to every appointment.

“I remember this family because of their ability to focus on the future and leave the past alone.” Illustration: James O’Brien

I met Mrs. A. when she was in her 70s and living in one of the nicer assisted-living facilities that serve the elderly in this area. She wore brightly colored floral-patterned blouses and polyester slacks, and carried a large vinyl handbag that often appeared to be empty except for a wad of Kleenex. Her daughters were very involved in her day-to-day living, preparing pill planners, accompanying her to doctor’s appointments and managing her financial affairs.

Anyone working with Mrs. A. might justifiably have assumed that hers was a stable and longstanding family constellation. However, although her children now looked after her, she had never really been a parent to them. In fact, this was a family begun by Mrs. A. against medical advice. Due to incipient signs of mental illness, Mrs. A.’s doctor had recommended against her having children. Later in life, when referring to her doctor’s advice so many years ago not to have children, Mrs. A. always spoke with triumph in her voice about having defied her doctor. She eventually had three children, two girls and a boy.

The unraveling of her life happened gradually. During World War II, Mrs. A. had married a career military man. Much of her early married life was spent accompanying her husband as he was transferred from one Air Force base to another. Mrs. A. first began to show signs of illness during her third pregnancy, when she appeared depressed, anxious and listless, perennially fretting about the family’s financial affairs. With three small children at home and her husband overseas, Mrs. A. became determined to buy a farm that the family could live on after her husband left the service. Before long she had bought a cheap, rundown, isolated farm that she felt sure she could “fix up.”

But when she was in her late 20s and her oldest child was three, Mrs. A.’s husband was killed while trying to land his plane on an aircraft carrier. Mrs. A.’s emotional health took a dramatic turn for the worse. Her behavior became more erratic; she was depressed, wouldn’t talk or eat and even attempted suicide. In the mid-1950s she was involuntarily committed to a state hospital in North Carolina, where she remained for the next 20 years, undergoing insulin shock coma, electroshock therapy and participation in an early drug trial for Thorazine—all treatments that were common practice at the time.

She suffered alone. During her extended hospitalization, her three children were separated and raised by different family members. Mrs. A. was declared mentally incompetent, and had no say in the management of her personal affairs or in the lives of her three children.

Rounding the Family Circle

One day, out of the blue, Mrs. A.’s oldest daughter, then in her 20s, visited her mother in the hospital to tell her that she planned to marry. This milestone in her oldest daughter’s life and, perhaps more importantly, her daughter’s decision to include her, appears to have had a profound impact. The treating psychiatrist related that although Mrs. A. had previously been lost to “self pity and despair,” over the next few years, she slowly progressed toward an eventual discharge from the hospital.

During the years that I worked with her, Mrs. A.’s inclusion in the lives of her children and grandchildren grew steadily and was a frequent topic of conversation between us. Mrs. A. would arrive in my office in her wheelchair, beaming proudly and holding a large framed photograph from a recent wedding or family reunion. The latest photograph was always held facing outward, for me and any passersby to immediately see. Although Mrs. A. was never able to reflect on the journey she and her children had taken in reestablishing their family bond, her daughters were able to say that caring for their mother was essential to feeling complete in their own lives. “It wasn’t her choice to become ill,” her oldest daughter told me. “How can I blame her for what happened to us?” 

The memory that Mrs. A. had not been able to mother them when they were young—the pain and confusion of their upheaval—was not the memory of her they wanted to be their last. They, like their mother, needed to find a measure of peace.

Geriatric care lets us see into another person’s family. That, in turn, has a way of reflecting back on those of us who practice the care. When I think about Mrs. A.’s family, I can’t escape comparison to the decisions I’ve made in caring for and about my own parents. I have not chosen to live close to them (but my four siblings have). I stay in contact with them by phone, but could probably call more often.

My practice has taught me that, generally speaking, the care your children provide you in late life has a lot to do with the care you provided them when they were young. But not always. Why did Mrs. A.’s family struggle so hard for reunion and reconciliation when so many other families, separated and broken apart by mental illness, don’t make the effort? The answer is not so obvious. Perhaps for some, the possibility that they may have a genetic vulnerability for their parent’s illness makes it easiest to live as if that person did not exist. Perhaps for others, compassion and forgiveness are not enough to outweigh long-held anger and loss.

I remember this family because of their ability to focus on the future and leave the past alone. They, like their mother, were determined to become the family that was depicted in those photographs she carried.

The story first appeared in the Spring 2009 issue of Tufts Medicine magazine.

Leslie Hocking, M83, a geriatric psychiatrist, practices in Raleigh, N.C.

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