One Caregiver's Challenges
Jean Doppenberg7/1/2009
Being caregiver to your mother-in-law would be difficult enough if the elder woman's only affliction was bipolar disorder. Kammay C. believes her life might be somewhat less stressful if her husband's mother, Biji O., wasn't also schizophrenic. Add in Alzheimer's disease and a cultural divide between Chinese and American medicine. Altogether it makes Biji, 81, an exceptional and complicated case, with a triple diagnosis of mental illness and dementia that has taken its toll on her family.
"The Chinese believe that a person is born with mental illness, that you don't just 'get' it later in life," says Kammay. Alzheimer's disease, in particular, is significantly under-diagnosed and under-treated in China, where people are considered "old" at 60, and many view the disease as a natural part of aging.
Biji lived her entire life in the Canton province of China, growing up under the brutal dictatorship of communist leader Mao Tse-tung. During hard times, she was bought and sold twice at the tender age of 8 to work in other people's homes as a maid. In her teens, Biji was wed in an arranged marriage, and she gave birth to six children over the years. She raised her family with an iron hand and believed in physical and verbal punishments. Later in life Biji began to exhibit increasingly delusional behavior, irrational fears, and memory problems. She had violent outbursts, many of them directed at women. Her husband cared for her as best he could, until his death in 2007.
The widowed Biji took to wandering the streets of her neighborhood in Canton, yelling obscenities, disturbing neighbors and shopkeepers, and alienating friends. She fired seven different home care workers hired by her family, then changed the locks on her house. At times she had trouble remembering the faces and names of her children.
A year later, Kammay and her husband Shawn, healthcare professionals living in California, flew to China to visit his mother. Shawn returned to America early to start a new job, but Kammay stayed behind to evaluate Biji's mental and medical conditions and get better acquainted with her mother-in-law.
Kammay quickly determined that Biji needed medication. Complicating the situation was the strong belief of Biji's children that traditional herbal remedies, not western medicine, should be used to treat their mother's dementia and psychiatric disorders. That’s when Kammay and Shawn decided that Biji should be brought to America for treatment.
In California, Kammay set to work making the older woman comfortable in the couple's rented apartment. Without anti-psychotic medications, Biji’s aggressive behavior continued unabated. She shouted profanities and threw objects from the apartment's balcony, ripped down all the mini-blinds, and was physically abusive to her home care workers and Kammay, who has the scars on her arms to prove it.
"I didn't know what to do," says Kammay. "I had put my career on hold to care for this woman, and I was becoming just like her – angry and mean. I was so stressed, and my marriage was suffering. I couldn't let Biji's condition control my life, and I had to make changes. I knew I could improve Biji's quality of life, but I would have to become 'the bad guy' in the eyes of her children to do it. I would have to treat Biji like a patient, not like my mother-in-law."
Kammay made it clear to Shawn's siblings that she planned to treat their mother her way, which meant getting Biji started on the appropriate medications. A trusted psychiatrist was found, and anti-psychotic and Alzheimer’s drugs were prescribed. Kammay then visited several nursing homes, but all of them rejected Biji based on her history of violent behavior.
A more suitable environment was necessary to properly care for Biji, so Kammay and Shawn purchased a home with an ideal bedroom and bathroom arrangement for the elderly woman. "I've made our house like an institution for her, but I've decorated it like a home," explains Kammay. She has added many soothing comforts for Biji’s benefit, such as candles, a tabletop fountain, bamboo accents, and soft Asian music playing in the background.
Kammay now employs two home care workers that Biji obeys and trusts, including one who speaks Cantonese, and she keeps her mother-in-law on a regimented routine. "I make certain Biji is out of bed at the same time every day, takes her medications on schedule, is cleaned and dressed, and has her meals at regular times," says Kammay. “I do what I can to keep her active and moving around. If she didn't have a consistent routine every day, I believe she would decline faster."
With the proper medications and a comfortable new home environment, Biji is enjoying a better quality of life. Her daughter-in-law's life is also less stressful. "When we have one great day, it makes up for all of the bad days," adds Kammay.
