It's been a while for a mental health update. That is actually great news, as it means that things have calmed down a bit since our last crisis. 

First of all, I've been schooled on the vernacular. There are many advocates in the field who've walked away from the idea of 'mental illness' or even mental health. 

Schizophrenia and bi-polar are serious brain diseases, not well understood, and mostly only managed rather than cured.  They affect the brains of the afflicted, and renders them not like the people they once were, although they look the same. 

Parkinson's, Alzheimer's and Lou Gehrig's Disease are a serious brain diseases, not well understood, and mostly only managed rather than cured. they affect the brains of the afflicted and renders them not like the people they once were although they look the same.

If you describe Parkinson's, Alzheimer's, schizophrenia and bi-polar, they are strikingly similar. And yet.. We would never say that someone with Parkinson's has a mental illness.  We would never wait for a person with Alzheimer's to actually harm someone before we hospitalized them for their own benefit. We would not allow someone with Alzheimer's to deny treatment, because we would have compassion on the fact they don't know they're sick enough to need treatment.  

When someone with Alzheimer's gets lost on the streets, the police are sent to find and return them to care. When someone with schizophrenia gets lost on the streets, the police are sent to arrest and jail them. 

So, my loved one has a serious brain disorder. Words matter, and I will fail and refer to mental illness, but know that I would never refer to my mother-in-law with Alzheimer's as having mental illness. I will try to do better.  

My loved one with a significant brain disorder has been home in our new community and house for two months.  They've been med-compliant for two months. Their meds have changed a bit, with a higher twice-daily dose of a mood stabilizer to address the bi-polar manic symptoms, and a monthly long-acting injectable antipsychotic for the hallucinations and delusions. Our loved one is finding the side effects much easier to tolerate, as well as finding the meds more helpful, particularly for the manic episodes. To be clear, manic episodes are not necessarily excessively happy. They're just excessive- really really excessive.  Our loved one is also a little resigned that life seems better for the rest of us when they take their meds.  It helps that our loved one lives on the second floor, has enough autonomy to largely make their own decisions, and that I bring up the meds twice a day. They've not declined or argued to take them even once.  This is a huge win/win.  This is not likely to be a permanent improvement. The nature of the disease is that it is cyclical, and the efficacy of meds changes over time. We will likely face another crisis and hospitalization, but for now we have a med-induced truce.  

This is probably the most stable we have seen our loved one in over five years. One of the interesting things about schizophrenia is that there are two kinds of symptoms, those that add to the personality - like hallucinations and delusions, and those that take away from the personality - like loss of executive functioning, impulse control, normal social interactions. The symptoms that take away parts of personality can occur for five years or more before the noticeable additive symptoms. For our loved one, we observed what is referred to as a psychotic break in December 2018. But in hindsight, the symptoms that removed parts of their personality had been present for years before that.  To us, it looked like normal teenage bad behavior, if not a little excessive. It's probably been nearly 10 years where their behavior has been affected by this disease. And now, with the new-found med-compliance, things are much more like they were before.  It's lovely. And unfortunately, not permanent.  

This is also the first time in at least three years when our loved one has been able to go out, meet real people, and socialize. In the recent past, our loved one's interactions have largely been with people online, with interactions with our loved one's 60,000+ Instagram followers (truth). This social media presence has further supported our loved one's belief that they are famous, which in a way they are. But now, they're able to also go out and meet people.  For this, my husband and I are exceedingly glad.

The greatest challenge is that now, we're living with a young adult who is able to make their own decisions about when to go out, who to see, who to bring home, and how to behave. For many years, we had to deal with a social media presence that we didn't necessarily love, but now we have people coming in the house. Now our loved one goes out late at night, and like all normal parents, we worry.  We've had to have conversations with our loved one about how we're learning how to peacefully coexist, and love and support them, and about any boundaries we need to place for us.  But like all adult children, our boundaries need to focus on us and our needs, rather than on our expectations of what they'll do or not do. We can certainly tell our loved one what we hope they'll do or choose. And we can tell them what we expect, as they're behavior affects us. For example, if you miss an appointment for us to take you to the grocery store, we'll go again when it's convenient for us, not necessarily when you awaken. 

It's definitely a challenge to remember that they should be allowed to make their choices, and that we don't get to rule their life. We've actually had a great conversation about how we're learning to live together in this new house and community, so we all need to have a little grace as we figure it out, both us and them. 

So for now, the significant brain disorder is at bay. So now is the time we're working with them on normal young adult things like budgeting, and shopping, etc.  At some point, the illness will rear its ugly head, and we'll be back in crisis mode. For now, peace.  Or at least peace-ish.