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Comment by thowaway655321x | Hacker News Reader

Using a throwaway for potentially obvious reasons. I have a very hard time having empathy for my mom. She is diagnosed manic depressive, bipolar, schizophrenic. I've witnessed her deteriorate over my entire life. You can tell me all day that it biological. I can utterly accept that. I can't accept that a bright woman has fucked up her life to the point where she is homeless. That she has alienated all those who would help her. That she would destroy her own environment and blame the imaginary. We've had to decide to leave her to herself and not help due to the manipulation that comes with it. Her phone is blocked. We've moved addresses. I don't know if empathy is the right answer. It sucks. The whole thing sucks.

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Sometimes mental illness turns a person into the moral equivalent of a natural disaster. We don’t exactly blame natural disasters for arriving. They didn’t intend malice towards us. But we don’t therefore let them destroy our homes or kill us because there was no malicious intent behind the disaster. We batten down the hatches, make our homes storm and earthquake proof, we douse fires in water and build protective cellars.

Sometimes when mental illness turns a person into a malicious abuser, we have to protect ourselves regardless of whether we blame them fully for their actions or not. Nature turns the person into a disaster (sometimes, it’s not like EVERY case is like this), and when it does that, we’re justified in doing want it takes protect ourselves, to keep from being abused or harmed - not blaming them doesn’t mean we have to go out and stand in the storm, so to speak.

Here’s wishing you peace and happiness. :)

This is a great perspective for reconciling the "not their fault" idea (which science seems to support overall) with practical measures in daily life. Excellent.

I have nothing but sympathy for you. You no doubt wrote this knowing some, perhaps most people would not understand your decisions and chastise you for them. They don't understand, maybe never will.

At the same time, I implore you not to give up. For people with mental illnesses like you describe, access to reliable Healthcare is everything. A good doctor who monitors their medications is everything. If I were to describe the situation in engineering terms, I'd say that every single support such a person receives is load bearing. Which is why it can be just so difficult, when only one failing can lead to collapse.

I hope you are able to help her, provide her with something. If nothing else, try to put a roof over her head. Being homeless makes all of those other problems of access worse.

It does suck. I hope you try again. If you need someone to chat with feel free to reach out to me. My email is mayreply at my name dot com.

> A good doctor who monitors their medications is everything

Even if you have good healthcare most doctors and even most specialists are terrible at dealing with anything that they don't see on a daily basis. Having a spouse with multiple rare chronic ailments has been eye opening.

I have to ask, why is it his responsibility? If his childhood is so bad that he has no connection to her why should he work to improve her life rather than the life of any other homeless or mentally ill people?

It's like a double whammy. Not only is your childhood destroyed, you now are somehow considered by society responsible for her just because she is your biological mother.

I don't think they're suggesting that it is his responsibility, they're encouraging him to keep trying (because he's in a better position to help than most are) rather than berating him for not trying.

Why is he in a better position? She probably will try to manipulate him more than a stranger trying to help. Also, he is bound to get triggered interacting with her. I would think he would be in a worse position to help her then others.

Responsibility is a loaded word, especially in these cases. I'm not sure it's what you intended, but your simple question has a much more judgemental and condemning tone than the entire post you're replying to -- even though you are defending the OP.

It's really hard to help a neurodivergent person. Normally, that requires having a special type of strong love for that person, the type of love that exists from parent to child (and not the other way around) for obvious evolutionary reasons...

That said, the state in a truly civilized society could take better care of people who aren't neurotypical. Something I believe is lacking in the US.

Just wanted to share that I am dealign with a similar situation and I feel the same way. In my case I am convinced my Mom has schizophrenia but she refuses to be evaluated. She is also a bright woman who has screwed up her life by accusing everybody who cares about her of stealing from her or working against her in some grand conspiracy. Everything revolves around her and everything is always somebody else's fault. When I was a kid I believed the world was working against us but when I grew up I realized that was not true it was just my Mom. A small piece of me cares for her but most of me hates her.

This is about clinicians who are getting paid to deal with the person though.

They should expect to have their efforts to "help" be sabotaged for seemingly no reason, be betrayed as a means to get self esteem, constant testing of boundaries, etc. Then they should make the decision of whether to take the project before ever needing to interact with the person.

What country are we talking about here?

Any country, I would think. You know a country where psychiatrists and other doctors work without getting paid somehow?

The US military provides free care of this sort to members and their dependents. They get paid a salary by the government, but don't charge the patients for care per se.

I'm quite confident that's part of why therapy did me so much good. He wasn't going to make less money by actually being effective.

The point, as far as my post was concerned, is that the doctor is getting paid. Not who is paying them.

Well, there's a lot of situations in the US where the need for the doctor to be paid becomes a blockade to getting care, particularly for those in need of mental health.

Just because healthcare and money are mentioned in the same paragraph doesn't mean the discussion is about public vs private healthcare.

Its actually pretty disturbing to me that multiple people felt necessary to share their opinion about that here.

I had been helping my bipolar ex-girlfriend all the time, and yet she did things to hurt me and push me away.

I share the same feeling with you, although I'm still struggling if I should help her.

Similar situation, though my girlfriend has borderline. It's a struggle, one that I occasionally wonder about the worthiness of, but I try to help her through her problems. I just wish I knew how to address the root issue.

Two years working in support trying to perform RCAs on arcane issues and I can't find an answer to why my girlfriend is angry sometimes. It's disheartening to say the least but I haven't given up yet.

Do you ever have a feeling that you’ve finally found the RC, only to have that feeling shattered two hours later?

The book I Hate You - Don't Leave Me helped me a lot, especially the SET communication skills.

Learning DBT skills (The Dialectical Behavior Therapy Handbook) helped me a lot too especially emotional regulation.

Having an amazing therapist who was supportive as well as a professional and personal support network helped too.

I have borderline and I think working on myself has ironically made me a much better communicator. So there's hope.

I don't know if this is the right explanation but I think someone with BPD is essentially a burn victim except with feelings. I am super sensitive and extreme. You're either amazing or the worst person in the world. When things get bad, I don't have any memory of good times. I can only see black or white- no grey.

This comes from my childhood. My parents were extremely abusive. My dad told me to kill myself when I was suicidal. That's how I survived my childhood. I needed a clean slate and forget all the bad things. Today it hurts me more than it helped me then.

In the past when I got upset, it was instantly I think we should break up. The pain whatever it was, was intolerable. And all those break up pains add up. Not only do they hurt me, but it hurt my partners. And I didn't feel like I could survive the feeling of being broken up with, so I was always trying to protect myself by breaking up first. It's still my first instinct whenever I get a whiff of something going bad - shit, do I need to end this? But now I keep it to myself. I wait. I put my crazy emotions together. Talk calmly. Use a lot of I statements. When you did this, it made me feel this. I'm lucky to have a ridiculously supportive partner. I think he's an alien or at least superhuman. We've never raised our voices at each other once since we've been together except to say I can't hear you from the bathroom haha.

I've gotten a lot better. I'm still working on myself. I hope this helps a little and I wish you and your girlfriend the best.

https://www.verywellmind.com/support-empathy-truth-set-for-b...

Psychotic disorders can turn sweet people into highly aggressive people. It's heartbreaking to see.

It's important to say that mental illness probably doesn't increase risk of violence by much.

eg, this study:

https://jamanetwork.com/journals/jama/fullarticle/183929

> In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI, 3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR, 1.2; 95% CI, 1.1-1.4; P<.001 for interaction). The risk increase among those with substance abuse comorbidity was significantly less pronounced when unaffected siblings were used as controls (28.3% of those with schizophrenia had a violent offense compared with 17.9% of their unaffected siblings; adjusted OR, 1.8; 95% CI, 1.4-2.4; P<.001 for interaction), suggesting significant familial (genetic or early environmental) confounding of the association between schizophrenia and violence.

Doesn't your own link say that there is a ~2.6 times higher likelihood of violent offenses in schizophrenia compared to the General Population? Of course, it does say that the effect is significantly more pronounced with a 'substance abuse co-morbidity' but I can't seem to find the likelihood of a substance abuse co-morbidity with schizophrenia in this paper.

There also does not appear to be a definition for what they define as a 'substance abuse comorbidity' Looking it up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669586/

"Schizophrenia Patients Report Consistently Higher Rates of Substance Abuse Than the General Population, Notably With Respect to 4 Licit (Nicotine and Alcohol) and Illicit (Cannabis and Cocaine) Substances"

it also says this is not to be used as a baseline for studies but if Schizophrenia is commonly co-morbid with substance abuse then pointing out that mental illness doesn't increase violence by much seems like a red-herring.

> Doesn't your own link say that there is a ~2.6 times higher likelihood of violent offenses in schizophrenia compared to the General Population?

No.

It tells us that people who are mentally ill are about as violent as the general population unless they also have substance abuse.

> it also says this is not to be used as a baseline for studies but if Schizophrenia is commonly co-morbid with substance abuse then pointing out that mental illness doesn't increase violence by much seems like a red-herring

When trying to predict risk of violence knowing that someone has schizophrenia tells you almost nothing. Knowing they have substance misuse tells you a bit more.

And knowing that people with schizophrenia are not more violent than the general population means community treatment is easier to provide.

"In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%)"

thats a 2.5 difference in patients with schizophrenia compared to the general population

> When trying to predict risk of violence knowing that someone has schizophrenia tells you almost nothing. Knowing they have substance misuse tells you a bit more.

That is simply not true though. Substance abuse changes the rate at which it happens but Substance abuse seems to have a high comorbidity with Schizophrenia and while the rate is significantly lower when there are no substance issues it is still higher. Substance abuse, per the link you provided, creates a 3rd and fourth population subset (1: schizophrenics 2: neurotypical 3:Schizophrenics with Substance abuse 4: NT with Substance abuse) Which after your response, seems like you're being intentionally misleading in order prove your point.

You don't have to have the same compassion for parents and others; they're too close. Have compassion for yourself first.

She might be mentally ill and a shitty person...

Also, sometimes you can have empathy, but can't personally handle someone. You have to do what's best for yourself, also.

This is a good time to employ some Occam's Razor: if we've already accounted for the shittiness via mental illness, what is our reason for introducing an additional explanation? Are certain extreme mental illnesses not enough to account for the most shitty of behaviors?

Because sometimes people were shitty even before they became mentally ill ...

What is the difference between being shitty and mentally ill?

They can be related but don't have to be.

Shitty people sometimes become quite pleasant as dementia progresses. Some really nice people become completely nasty. Sometimes there is no change.

The drowning person panics and drags you under.

The shitty person pushes you overboard.

So you are saying a mental illness is where you dont intend to cause harm? That would mean serial killers have perfect mental health.

At least in my girlfriend's case, she seemed to feel regret after the maniac episode is over.

That's dependant on the mental illness. What if your illness is you just dont care about anyone.

I suppose the answer to that depends on how meta you want go get, so to speak. But at its most basic, some people are just assholes without being irrational, stressed out, etc. Though you could easily argue they weren't raised right and are being stupid, basically.

I'd argue that all negative behavioral issues are mental illnesses. One way to classify it would be biological mental illnesses and learned mental illnesses. For example autism being a biological one and PTSD being a leaned mental illness.

Any time you have multiple people interacting, you will have some friction, even in a hypothetical situation where all involved parties have perfect mental health. Many times, behaviors are classified as "negative" based on a judgemental third party perspective.

I raised two special needs sons. They are okay in part because I wondered why they did things. I was curious about the first person perspective. I was interested in finding out "What's their motivation?"

So I think this is a much more complicated thing than you are making it out to be. People have a relationship to themselves. They have a relationship to their environment. They have a relationship to other specific individuals and to a larger society.

Mental health discussions often posit that you are mentally healthy if and only if you get along smoothly with other people. They often don't wonder at those other elements and they don't question the possibility that maybe it is the other people who are all messed up, not you.

I think this is a vastly complicated topic. It is both broad and deep. It touches on psychology, sociology and philosophy.

And I don't know that HN is really a suitable place to try to dig into it in a meaty way, frankly.

I tend to agree with this argument. And I think it's about time to start treating maladapted social behaviors as broken minds.

> I'd argue that all negative behavioral issues are mental illnesses.

Who gets to decide what is a "negative" behavioral issue?

I assure you that the computer types will be among the first to be medicated to to take the edge off their "negative" behavioral issues.

As what, a toddler?

A person can be a shitty person, or a shitty person because of mental illness.

Occam's razor prefers the first, right? You're introducing an additional explanation.

Occam's razor is the simplest explanation, not the simplest statement.

Tautology has no explanatory power.

Incorrect explanations have less explanatory power.

This is true, but Occam's Razor is "the simplest explanation is usually correct", so we have an infinite regress.

Not if they've already been diagnosed with a mental illness, which is the situation at hand.

ok, so this is more like the Linda Problem. It is more likely that a person is a shitty person than a person is a shitty person and has a mental illness.

Hmm, there's an element you've left out of the situation that makes it different from a straight Linda Problem though. In logical terms, it looks like this.

  mental_illness -> shittiness
  being_a_naturally_shitty_person -> shittiness

And we know know two things: 1) the person in question is exhibiting shittiness 2) the person in question has been diagnosed with a mental illness. So:

  mental_illness = true
  shittiness = true

Whether being_a_naturally_shitty_person is true or false is something we have no information on.

So, from that starting point, we already have an account for the shittiness being exhibited since:

  mental_illness -> shittiness

  and

  mental_ilness = true

So if we want to go ahead and make the additional claim that being_a_naturally_shitty_person = true —you're violating Occam's Razor by introducing an unnecessary second cause when we already had a sufficient first one.

This is often the case. More generally, every crook has a sob story. And it's important to not let that cloud your judgment.

In judging a harmful person's character, all that matters is whether that person has definite potential to become a net-good person given spiritual instruction, social support, medication, or whatever. But if such a process is infeasible, then the person needs to be written off. Some people are irredeemably lost, and the only thing you can do is love them and pray for them, at a great distance.

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