peace of the heart
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« on: May 07, 2017, 09:27:57 AM » |
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Hello, I apologize in advance for the length of my post but I am trying to include all relevant details. I would appreciate any suggestions and/or words of encouragement regarding our 16 year old son who ran away from home 7 weeks ago. He will be 17 in just over a month and in our state he will no longer be considered a juvenile or a runaway (although of course we will continue to be legally and financially responsible for him until he is 18). While we do not know where he is staying, through the grapevine we have picked up that he has found various places to crash, none of them lasting very long. Our main intention during this time has been to stay connected with him; while we have expressed repeatedly that we want him to come home, we feel that returning home has to be his choice—we are not about to “kidnap him” as we can’t keep him here and feel sure he would just leave again and be harder to find.
About 10 days after taking off our son expressed that he wanted to get back on his meds (Wellbutrin for depression, Risperdal for mood stabilization). After confirming that the potential for overdose was low and they had no street value, we made an agreement to bring him a week’s worth of meds at a time. Thus, either my husband or I (or both of us) have met up with him and usually taken him for a meal at least weekly and we exchange texts between “visits.” We have also made every effort to communicate with adults in his life—he has been going to school sporadically and we have worked out a way to get updates from the school (although this was challenging at first given that, incredibly, he convinced his main teacher not to respond to my messages…another story). He was also occasionally attending a teen drop-in center, though we heard from their staff a few weeks ago that they needed to ask him not to come during drop-in hours due to concern about drug involvement, both using and selling (which several peers had apparently reported). After we grew lax about locking them because he seemed stable, our son had rummaged through medicine boxes in the fall and admitted to self-medicating with old prescriptions (benzos and ADSD stimulants)…we took him for a drug and alcohol assessment in November and they determined he was “at risk; after that he was in counseling with them but grew increasingly resistant, as they were trying to challenge his choices and he just kept insisting that he knew more than they did. We then switched him to a less confrontational therapist who he seemed to engage with but she was conversely willing to take over a year to build rapport and not surprisingly he didn’t find this particularly useful.
Our son has seen a long list of mental health providers since he was 10. He has a history of extreme emotional dysregulation going back to his preschool days and has been both expressing and hiding suicidal ideation since he was 9 (writing on school papers “I want to die” and insisting that he wanted to run into the middle of the 55mph street to be hit by a car; he also claims to have attempted to overdose on over-the-counter medications on numerous occasions although he never told us at the time). When he was 12 we became aware that he was cutting. In the months leading up to his running away he talked more frequently about wanting to die; in fact, he stated “I’m trying to die” during an intake in January for a partial hospital program where he was not admitted due to the psychiatrist’s perception that DS was not “ready to use their program,” (I guess because DS did not want help or was not willing to make positive changes). He was also beginning to show signs of disordered eating, as he shared with his friends that he was vomiting after eating and DS even posted online about how he was “popping pills and skipping meals.” Finally, he was becoming increasingly hostile towards me and had started verbally threatening me at least once a week, when escalated (on a dime), saying he was going to kill me, that he would shoot me in the face, etc. (this usually happened when I attempted to enforce limits or boundaries, particularly around his drug use).
The clinicians he has met with to date total 7 different therapists and 7 different psychiatrists, not including those who were a part of a 5 day inpatient hospitalization and three separate partial hospitalizations. We completed a ten week family DBT program when DS was 15. We also consulted with a psychologist when he was 15 who conducted an extensive neuropsych evaluation and diagnosed DS with bipolar and ADSD. It was the PHP psychiatrist, who saw my son daily over two different three-week periods, that suggested the possibility of a personality disorder (although he also told DS that he had developmental delays “because of the way he was raised”—thank you very much).
I am a resource person—I own most all the recommended books on BPD and have researched and found a TON of information online, including countless videos, audio recordings, and even professional training materials. I registered some time ago for the teleconnections Family Connections program and though it has not become available I have listened repeatedly to the Irish version on YouTube (Open Your Mind Before You Open Your Mouth). I completed the 12 week Family to Family program with NAMI. It is my conviction that DS clearly meets criteria for BPD, although when I raised the issue with his last psychiatric provider (a nurse/addictionologist) she said that although he had BPD traits his symptoms were clearly “more biological”—as if BPD were not a biosocial disorder (and based on her age this information may have evolved since her training). When I shared my concerns with his most recent therapist she (again) insisted that her priority was to form a relationship with my son, as if there was no urgency to his increasing talk of death, his disordered eating, etc. She said she felt it was very telling that DS reported “My mom feels like I’m broken” (which felt to me like projection, as he has described himself this way when depressed and refusing school in the past; of course it’s nothing I would ever say to him but seems to be his interpretation of my trying to find help for him and his now former therapist clearly seemed to sympathize with him).
Although I am proud of researching and advocating for DS, I am beyond weary. I resent the implication that either 1) we are overreacting or 2) we are somehow responsible. My intention for years now has been to try to identify the issues accurately so that we can understand his irrational behavior and implement the most appropriate support. The culminating disappointment came in an appointment earlier this week with a new child/adolescent psychiatrist who came highly recommended by the D&A program we had signed DS up for. This doctor had a 6 month waiting list and the D&A psychiatric nurse only continued to see DS until we were able to schedule an appointment with him. In the meantime DS had run away, although he did agree to keep this appointment. I am not exaggerating when I say I spent at least 6 hours preparing the paperwork in advance of this appointment, filling out online forms and copying lists of providers, reports, medications, etc. While it was clear that the Dr. had read all the information (and he also spoke to the psychiatric nurse DS last worked with) he did not endorse my hope that his support could be helpful. On the contrary, he declared that he did not think he could work with DS if he was not living at home, and he sent me the number for juvenile probation so that I could go through legal channels to try to force DS to return. I don’t know, perhaps we should have taken these measures 7 weeks ago (although the police we reported him to never suggested it), but I need to be selective where we put our limited energy and resources, and with DS turning 17 in one month and 6 days I seriously doubt it’s even possible at this point to go through the legal process in time before DS is no longer considered a juvenile (even the P said “once he’s 17 the system is much more about punishment than helping [DS] change”). More importantly, my sense is that any such proceedings would just drive DS into hiding and we would lose what little relationship/influence we have—his entire life he has pushed back against the most reasonable limits (ie, no you may not run around the campground with a flaming stick, no you may not run around the yard in the lightning storm…) and now that he is fiercely determined to be “independent” my intuition is that any attempts to be controlling will backfire. The P said he did not feel that working with our son under the present conditions could be successful as DS is not motivated to change and may need external motivation. It is confusing and frustrating to me because it seems that the P is saying “I cannot see your son because he is not stable,” whereas if he were home and more stable he would not need as much help! He did say he would “not shut the door” and was willing to prescribe two more months of meds (which DS declined after the P told him he felt DS should return home—sigh).
Of course, the P also suggested residential treatment…it is not the first time a clinician has suggested it (the very first P we visited actually brought it up years ago), and we began to seriously consider it about 5 months ago. Do these professionals have any idea what kind of costs are involved? It did not take long to come to the conclusion that the recommended course of hiring an educational consultant, visiting different programs, hiring a transport company, wilderness therapy, followed by RTC was not remotely financially feasible as we work in highly rewarding but low paying human service & educational positions and have already depleted our limited financial resources by paying out of pocket for many of the services DS has already received (not to mention two years of private school). Aside from RTC clearly being cost-prohibitive, I am skeptical it could help DS anyway as he is as resistant as he is vulnerable. I have heard *wonderful* things about the program at McLean and wonder if we could swing a more short term program like that, but I know it’s DBT based and DS hated DBT, plus at this point he is pretty much refusing any therapy…so how could they help him if he doesn’t want help?
We absolutely have very real concerns about his safety…it seems clear that he is engaging in substance use/abuse as well as criminal activity (every time we see him he has some new material possession including watches and other jewelry as well as bikes, a battery powered scooter, and various electronics). He has zero investment in his education and has declined our offer to re-enroll him in his small private school next year. I am striving to find some sort of balance between supporting and validating him while also (as non-judgmentally as possible) providing the message that we do not condone his choices and we want to get him help. It is exhausting…I feel helpless to effect meaningful changes and in some ways it’s honestly a relief not to have him at home. I have found comfort in the Al Anon principle of detaching with love and not trying to rescue DS, but OTOH I have read very clear dictates that when a child is a minor you need to take every possible measure to force them into treatment while you still can. It doesn’t help that I am coming into this whole situation on depleted reserves as our older DD also left home to live with an emotionally abusive boyfriend just four years ago after she had been hospitalized for depression and suicidal ideation; she was gone for 14 months which was an emotional roller coaster (at least she continued both individual and family therapy for the duration and knock on wood she seems to be stable now). I have been in my own therapy for years and am currently on an antidepressant, which helps a lot but I still spend a fair amount of time feeling drained and immobilized. I welcome any words of advice or encouragement, particularly if anyone has experience dealing with a minor who has run away and who is refusing all efforts for professional support. Thanks in advance for your support!
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