May is the month of Mother’s Day, academic graduations, and – of course – flowers after April showers. It is also Mental Health Awareness Month, designated by an appropriately springy green ribbon. In my hometown, decades ago, it was also the month of Public School Community Days, when anyone could visit their neighborhood schools. And so, all day I’ve been thinking about my “Crazy-Great-Aunt Margot,” which was, I’m ashamed to say, how she was called in my family long ago.
This is the time of year – the only time of year – I was likely to see Crazy-Great-Aunt Margot. She and my grandmother were sisters just a little over a year apart in age, born in 1900 and 1901, respectively (“I’m a Victorian,” she’d say proudly, “Libby’s an Edwardian!”) and they’d stayed close, even when continents and sensibilities separated them. I’m not sure when Margot’s mental illness began to manifest, but it wasn’t helped by the sudden death of her husband while they were touring Eastern Europe in the late ‘50s, and she’d had to “bring his body home” on a trip that took weeks by steamship and rail.
A few years later, my mother, with two rambunctious toddlers and a full life, engaged Margot to babysit. One day my mother came home to find me nursing a badly burned hand, angry blistered bands marking where Margot had pushed my palm onto the electric stove-top burner to teach me a lesson. Margot was thereafter banished (her word) from our family by my evil (also her word) mother.
In order to see me and my brother, she would attend the Public School Community Days in May. She’d turn up, all four feet three inches of her, dressed hat to heel in purple velvet and lace, telling all our teachers how they weren’t doing the lessons right and regaling our classmates with loud litanies of the lives, loves, and violent deaths of the kings and queens of England. By middle school, my brother and I had blanket permission slips to leave school when we saw her coming. Well into our college years, Margot would send us birthday and holiday cards, their cheerful messages scrawled over by her dark, Proustian narratives of my mother’s evil and her own great virtues. By turns we found her hilarious and a little scary. When my father died, three of his burlier business partners were deputized to block her entrance to the funeral.
It wasn’t until many years later that I came to appreciate – and grieve – just how much Margot must have suffered through decades of probably undiagnosed and definitely untreated bipolar disorder, paranoia, and/or schizophrenia. In the end, she was hospitalized with malnutrition and advanced kidney disease after years of refusing any help and defending her decaying redoubt of a house against neighborhood vandals and the weather. I don’t know how she died, but I hope it was with lots of good meds on board and someone holding her hand.
Today, as I thought of Margot as I often do this time of year, I so wish she had lived in a time when her illness might have been managed, her suffering relieved, her life and the lives of those who tried to love her, made even a little easier by the full chest of therapeutic tools we now have. Those tools may soon include psychedelic-assisted therapies, which hold great promise for addressing the kind of mental, existential, and spiritual suffering Margot clearly had in spades.
I also think about all the Margots and their families out there now, who have lived for many, many years with profound mental illness and now find themselves aging and ill from other causes. Hospice and palliative care clinicians meet them every day and must try to manage the mental and behavioral distortions and emotional-relational-spiritual storms on top of debilitating physical illness. It is a huge and increasingly common challenge.
Our webinar this month is Recognizing and Responding to Mental Health Issues in Palliative Care Practice, presented by Dr. Nathan Fairman, palliative psychiatrist and Health Sciences Clinical Professor at the UC Davis School of Medicine. It’s an important topic, and I hope you’ll tune in. On August 7, we’ll host a “miniconference” on Psychedelic-Assisted Therapies in Palliative Care (watch for details). There’s also an excellent article in Hospice News on “How Palliative Psychiatry Can Support Quality of Life, Symptom Management.” Palliative care, coming as it often does well down the road of a person’s path toward death, can’t cure protracted mental illness, but with skill, effective tools, and sympathy, it can reduce suffering and manage behaviors so that other symptoms and pain can be addressed and relieved.
Dear Aunt Margot, rest in peace.