My Mother, a Paranoid Schizophrenic

A middle-aged Filipino woman stood in her bedroom, naked for the third time that day, her body curved slightly to the right from stress. Her face was ashen as she wailed that bugs were crawling up her legs. But no matter what she did, she could never be rid of these pests that haunted her. The bugs she saw were all in her mind.

That woman was my mama, who was diagnosed with paranoid schizophrenia when I was in high school. Unlike my two-decade older siblings, who remember my mother for her charm, intelligence and beauty, I've known her only as a woman haunted by hallucinations, insistent about locking every door in the house and paranoid that others were trying to steal money she didn't have.

And yet, unlike my brother and sister, I'm not ashamed to face it. I'm not afraid to talk about it. We've sought treatment for my mama, and we take care of her at home.

Americans openly speak of AIDS, cancer, and other illnesses, and fight for their cures, but why not mental illness? By failing to address these attitudes, those who are mentally ill are prevented from seeking the treatment they require, and their families are inhibited from finding the support they need.

If you were to grade the national mental health system, it would get no more than a D, according to a 2006 study by the National Alliance on Mental Illness. The mental and physical health of immigrants and their children deteriorates with increasing assimilation to a U.S. lifestyle, a U.S. Centers for Disease Control and Prevention survey revealed.

Maria's madness, her family's shame

The living room reeks of body odor and two-week old garbage. Piles of dirty laundry mixed with old newspapers and coupons cover the chairs and sofa. Violet's* mother, Maria*, showers only once every other month. She washes her hands for more than 10 minutes and switches the lights on and off just to make sure they're off.

Maria battles depression and obsessive compulsive disorder. Her family believes she is also bipolar. Her one pleasure seems to be ridiculing her daughter. "I'm so much more educated than you," she hisses. She's also called Violet a demon and a whore.

"I'm not in denial [about my mom's illness], but other people are," says Violet, 25. "They know it's wrong to ignore (it), but they're not doing anything" about it.

Historically, the role of families in the treatment and recovery of mentally ill relatives has been taken for granted. Families function as the primary caregivers, directly affected by those for whom they care. But it can be very difficult for family members and others to see past the stigma of treatment.

Ana's addiction, her culture's discrimination

Elena* spent hours sitting in the same spot by her living room window, waiting for her mother, Ana*, to come home.

When she finally arrived after several days, Ana was on heroin again. She slipped off her pair of stilettos and began beating her girls with its heel. They screamed, horrified. Fighting for their lives, Elena's older sister flung a punch at her mother's face while seven-year-old Elena bolted to the phone.

Nearly 20 years later, Ana is no longer addicted to heroin, but has been diagnosed with depression, tested positive for Hepatitis C and HIV, and has Crohn's Disease.

The first time Ana started envisioning apparitions and hearing voices, she checked herself into a mental health clinic. However, the rest of her family remained in denial for years, convinced she had been faking her mental illness.

"Mexican families don't want to believe anything's wrong but [want to believe] that everything's all right," says Elena. "They think we've had to struggle and don't want people to know we're weak or that there's any weakness in our family."

Stigma is "the number one deterrent that prevents many cultures from seeking treatment," says Dr. Jei Africa, a Filipino clinical psychotherapist.

In the United States, diverging racial attitudes about mental health care run deep. African Americans are 2.5 times more likely than whites to fear mental health treatment. Overall, 26 percent of whites mention their mental health problems to a friend or relative, while only 12 percent of Asian Americans do the same. Mexican Americans born outside the United States are less likely to seek treatment than those born here, according to a Los Angeles Epidemiologic Catchment Area study. Because of their hesitation to pursue a remedy, Latinos are less likely than whites to receive appropriate care and treatment.

One size cannot fit all. "We must be open to more culturally appropriate ways to deal with illness," explains Africa. "[We can use] herbal remedies, community and family-based care, group and psychological therapy, traditional healing methods and not just medication."

"Mental illness is different to different cultures, in how they express their symptoms and their outcomes," adds Ethan Watters, a journalist who is currently writing a book about mental illness and cultural differences. "In another culture, paranoid schizophrenia maybe defined by catatonic behavior, going blank, but here in America, it is paranoia -- seeing and talking to things and people that aren't there."

Samantha's denial, her son's sadness

Imagine being a senior in high school, you're your parents' favorite child, top student in your class, and a talented athlete -- with 14 varsity letters: more than one varsity team per season. You're accepted to Dartmouth College. But then your life is suddenly disturbed, when your mother, who was misdiagnosed as a paranoid schizophrenic, dies from mistreatment.

You never graduate from Dartmouth.

This happened to Edgar's* mother, Samantha*, who now suffers from severe depression. Edgar's grandmother passed away during a time when shock therapy was administered. All his mother's siblings saw psychiatrists after their mother's death, except for Samantha, who still refuses treatment.

"It's not what she did but what she didn't do that showed me that my house was different than most kids," Edgar says.

Samantha couldn't hold down a steady job, killed time watching movies, and regularly picked her son up an hour or two late from school. She would rarely cook or eat the food she'd buy. Instead it was left to rot on the kitchen counter or spoil in the fridge.

"I spent a lot of time at my friend's house -- come home as late as I could," he says.

With a poor understanding of mental health and the tendency to categorize those suffering as "crazy," patients and their families become reluctant to seek help. When they do, only about one in three receive treatment in any given year that meets minimum standards of care.

Yet those who are clinically depressed can still live healthy, happy lives and work stable jobs with proper care and treatment. More than 80 percent of people with schizophrenia can be free of relapses at the end of one year of treatment with antipsychotic drugs combined with family intervention, according to the World Health Organization.

Danielle's death, her daughter's relief

Sometime in the late afternoon, while driving on a New York City freeway, Monica's* mother Danielle* flipped out, shouting that she was going to kill herself. Monica, now 28, was eight years old then. She leaned forward and calmly whispered in her mother's ear, "Mom, you can kill yourself another time, but you can't do it now because if you kill yourself now, you're gonna kill all of us." Within seconds, her mother steered clear of the barrier and began crying. "I'm sorry," she said.

Danielle was diagnosed with bipolar disorder.

"My mom was really beautiful, good at reading and talking to people. Her personality was magnetic," says Monica. "But people who really knew her knew she was a disaster."

Although Monica and her two younger siblings are half-Italian and half-Jewish, they were raised in a Muslim commune for most of their childhood. Rules were strict. Her mother didn't have any control over her life. However, Danielle was able to paint and draw without destroying herself. Once they left the commune, her mind began to unravel more and more.

"She was in and out of mental institutions, [would spend] two weeks sobbing and then the next week she'd be on top of the world," recalls Monica.

Danielle awoke her youngest daughter, then three, to tell her goodbye. Even though she was so young, she knew her mother was about to execute what she had long threatened to do. She went back to sleep. Later that morning, a family friend found Danielle's body in the garage. She had hanged herself.

"Life doesn't get any easier, but we do get better tools," says Monica of her mother's death. "But we only get better if we learn to face ourselves -- face our experiences."

My acceptance

My mama can't cook for herself or wash her sheets. Every morning after I wake up and before I sleep each night, I give my mama her medication. I change her diapers daily and shower her every Sunday. If ever she relapses and sees the bugs on her blankets or worries that the world has gone into disarray, I pray with her, and she calms down.

I don't consider her a burden. Since she began receiving treatment, she's more mellow and less argumentative. I love her for her toothless grin, and she often reassures me that I'm "the best in the West."

Phobia, like a suffocating fog, chokes the families of the mentally ill in America and silences their voices, experiences and questions. Sadly, I feel that I'm the only one willing to share my story -- with my face uncovered, my name unchanged, and my words unblemished.

*Names changed for privacy reasons.

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