On treatment – Ellen Barry in NYT:

‘Alone with his mother for the first time in almost a year, Andrey Shevelyov had a question: Could he come home? She sat beside him and stroked his head. The hotel room had a sour, rancid smell, and clothes lay mounded in a corner. His fingernails were long and curved and ridged with dirt. In jail, they cut off his hair, which had been matted and infested with lice.

Clean-shaven now, Andrey looked younger than his 31 years, like the gentle, artistic boy he had been before the psychosis took hold. “Zaichik,” his mother called him, a childhood nickname. Bunny rabbit. She pushed a strand of hair over his ear. He lay back on the bed and smiled, and a dimple appeared on his cheek.
“I like living with you also,” said Olga Mintonye, but it was not an honest answer.
Three years ago, when he stopped taking his antipsychotic medication, her son withdrew into delusions, erupting in unpredictable and menacing outbursts. Fearful of being evicted from their apartment, she and her husband, Sam, sought a no-contact order to keep Andrey away.’

(…)

‘As affordable apartments all but vanished in American cities, a whole tier of people with disabling mental illness were forced onto the street, where they now live in numbers large enough to disrupt civic life. Many of them are shunted into the criminal justice system, only to return to homelessness upon their release.
In an effort to interrupt this cycle, many communities are expanding involuntary treatment, a practice the country repudiated decades ago. Patient rights groups warn that forced treatment alone will never work — that in the absence of a robust social support system, it only feeds people with mental illness back into the circuit of catch-and-release. Better to persuade them to accept treatment.’

(…)

‘In that session, he told the therapist about the family tragedy, a reservoir of pain he had walled off for years. When he was 8, he watched his twin sister, Sasha, drown in a duck pond in a neighbor’s yard. The children were alone. He had tried to save her. “I’ve thought about it to exhaustion,” he said. “I’ve incorporated her into these stories I make up.” No one knows what causes schizoaffective disorder, the diagnosis he eventually received. For decades, scientists sought an answer in individual genes, only to conclude that hundreds, if not thousands, of genes are most likely involved, and that genes only set the stage. Other things must happen to trigger the disease; research studies implicate infections, cannabis use and childhood trauma, the kind of stress that leaves an imprint on the brain.
To his parents, there was no mystery. Sasha’s death had changed everything. “It’s obviously the trigger,” said Sam.’

(…)

‘Andrey says he stopped taking the medication because it caused erectile dysfunction. No physician determined whether this was the case, and his reasons quickly became beside the point. Things became so chaotic in the small apartment that in December 2020, Sam and Olga asked him to check into a hotel.
When the hotel kicked him out, he set up a tent in a wooded area near Pearson Field Airport, on the north bank of the Columbia River. Video journals that he recorded on his phone show him with tangled hair, surrounded by trash, rambling about underground vaults and sex traffickers. He would perform “shamanic dances” at the end of the runway, and sometimes the pilots would dip their wings at him when they took off. He seemed happy.’

(…)

‘After two weeks of forced medication, however, Andrey “presented as calmer,” assuring staff that his theories were just his “active imagination.” When he was discharged, his mental status was given as “W.N.L.,” which stands for “within normal limits.” He was returned to jail to await trial. The prosecutor, eager to clear this penny-ante case, agreed to release him if he pleaded guilty to a misdemeanor. He was released and dropped off at the Red Lion, a free man.’

(…)

‘“Mom, listen to me,” he roared. “Stop thinking you’re in charge of me! I’m a tactical genius who saved the world!” The outburst was loud enough to disturb his new neighbors, she warned him, but it was as if he didn’t hear her.
“OK,” Olga said. “I’m leaving now.” “Stop talking to me, I aren’t talking to you,” he yelled. “I’m a 31-year-old man who saved the world a dozen times!” Then he turned his attention back to the camera on his laptop. She wondered whether to say goodbye, but he seemed unaware of her presence. She slipped out the door, and he didn’t even look up.
He had been in the apartment for almost a month when the building manager spoke to Sam and Olga: Andrey was screaming during quiet hours, and some of the other men were afraid of him. When the manager knocked on the door, he didn’t answer.’

(…)

‘One thing, though — he missed his mother. He spoke about her, his “truest love,” in his video journals that night, after he lunged at her. The message he wanted to get through was that she needed protection.’

Read the article here.

Involuntary treatment is inhuman and most probably ineffective, no treatment is not very effective either. This is where the healthcare runs to its limits.
Painful if it’s your child.

If not, it’s easier to say, ‘people are entitled to self-destruction.’

I wrote two novels about a psychiatrist, after quite some research in the mental healthcare system in the Netherlands and Belgium. I remember the rather romantic impulse of wanting to save the patient, I was embedded with a psychiatrist working for a crisis response team.
Later, for a different project, when I was embedded in a closed mental facility for minors, I had the same impulse.

The impulse largely left me. And this article shows (once again) even parents can be worn out by their own child.

In the end the question might be, what sacrifice are you willing to make? Are you willing to go down with your beloved one?

And of course, many patients can be stabilized with medication that has less side effects that it used to have.

The psychosis as a source of creativity or even authenticity, this romanticization of certain types of illness, is largely BS. It’s not an answer to stigmatization either.

Surviving means controlling yourself, being able to adjust to what most people accept as reality. But yes, the disagreements about reality appear to have become graver and graver, some can convince others of their delusions, their fantasies about grandeur.