Medical Examiner

Honor Thy Mother

My mom had long struggled with borderline personality disorder. I struggled with how much I could help her.

Black and white photo of a woman covering her face as if in despair
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One searing-hot D.C. afternoon—the kind that feels like a wet blanket from a hot washing machine has been draped over your head—the phone rang, and a case worker from Adult Protective Services of New York asked why I hadn’t been showing up to court. This call came as a surprise for many reasons. I lived four states away and I wasn’t aware I was being sued, just to name two. It turns out my mother had stopped paying the rent on her rent-stabilized Manhattan apartment the year before, and as I had co-signed her lease, the landlord wondered if I intended to pay them back.

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I groaned. My 1-year-old was in a wrap on my chest, nestled just above the seven-month bump of her incipient brother, and my husband and I had just signed our first mortgage. If there’s a good time to get embroiled in a lawsuit in another state alongside your unstable, perennially rageful mother, this wasn’t it.

I had been paying at least some of my mother’s expenses for years. She had struggled with mental illness all her life and had “retired” from (read: been asked to leave) her law firm years before I was born. She raised me on disability checks, food stamps, and a willingness to run a mini-bed-and-breakfast out of the third bedroom in our apartment. When I graduated from college and got my first real job—a poorly paid gig as an editorial assistant at Random House—I always had a line item for her electricity bill, or some of her rent, or the credit card, alongside my own. But she had gotten into financial trouble and hadn’t told me.

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If we are lucky, our parents raise us to adulthood providing for our every need. They feed us, clothe us, house us, get us educated, take the brunt of our teenage moods. And once we get over the shock of our parents transitioning from people who provide care to people who need care, it may seem natural that we return the favor.

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But this is a harder question for adult children of challenging or unstable parents. Just as the costs of elder care can drain the savings of adult children and set them up for their own retirement shortfall, the strain of caring for a parent with significant issues can put us perilously close to a mental health crisis ourselves. How much can we give without putting ourselves at risk?

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My mother had me late in life, and by the time the first of my circle started wondering if their parents were OK living alone, my mother had already been in and out of crisis for years. The symptoms of her disorder included manipulation, paranoia, and the inability to respect—or even, really, bear the existence of—boundaries between herself and her child. She was charming, brilliant, loving, and rageful. She lied compulsively, including fabrications about such small matters as the number of husbands she’d had, her own last name, and the identity of my father; unraveling that mystery was the work of decades, and became my memoir Never Simple. But her most basic needs could require so much of me, too. I had never been my mother’s day-to-day caretaker, but I had organized large swaths of my life around her needs: eschewing grad school because it wasn’t feasible to take years out of the workforce, selling my eggs when she was short on rent, hurrying over to wrestle her off the floor when she had—like the woman in the old Life Alert commercial—fallen and couldn’t get up.

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“This is textbook codependence,” a friend chided me. And it was. But it was also plain old garden-variety dependence. She couldn’t hold a job; most days she didn’t even leave the apartment. She reeled in friends with her charm and charisma and drove them away with outsize fury at the smallest of slights. There was, simply put, no one else to take care of her when she could no longer take care of herself.

Now Adult Protective Services had stepped in to explore housing options for when she was inevitably evicted. Could she come live with me? It was clear that for the caseworker, this was a rhetorical question. An elderly woman was being evicted; of course her only child would take her in.

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Except I wouldn’t.

My reasons were both maternal and selfish. In the worst of her rages, my mother could be violent, and dementia had made her rages more frequent. I had one tiny child and was about to have two; I couldn’t imagine giving her unfettered access to them. I would never be able to leave them unattended, even to go to the bathroom, even at night. How could we live like that?

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But also, I didn’t want to. My mother’s borderline personality disorder and major depressive episodes led to, often, a dozen voicemails a day either screaming in rage or weeping in apology for the way she’d raised me. I knew that at the base of it all, she was miserable. She had driven away everyone else in her life with her paralyzing fear of abandonment and her temper, and her only child—one of the only people who would still speak to her—had moved out of reach. It’s exhausting to live with a brain that sends up flares of panic at unpredictable moments, to lose relationship after relationship, to feel every emotion scraped raw. Her behavior wasn’t intentional, in the sense that she had no control over it. But that made it no less damaging. My heart quailed at the idea of sharing a roof with her again, all of us swept up in the tornado vortex of her illness. I had mostly stopped taking her calls. Writing checks assuaged my conscience when I felt I couldn’t risk my own mental health by sticking my head in the blast furnace of her rage.

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There are programs to help the impoverished elderly, and many of them are better than you’d expect. There are One Shot Deal programs that help people stay housed after an emergency, and assisted living facilities that accept Medicaid and Social Security subsidies, and home health care aides to help with food prep and basic care. The problem with all of this, of course, is that the elderly person has to agree to it. Accepting that they need to allow strangers to help with the activities of daily living—eating, bathing, using the bathroom—can be a hard adjustment. Dementia complicates the picture. So does mental illness. My mother was struggling with both.

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For two years following that phone call from APS, my husband and I pulled out every idea we could think of to get her somewhere safe and affordable. We found assisted living facilities that would accept a Medicaid subsidy; she scoffed—how could we think she’d consider Brooklyn? We located one-time grants to help with her rent; no, she insisted, she’d already done that, they’d turned her down. (We called. The grant writers had never heard of her.) We sent her stacks of applications, made her appointment after appointment to tour facilities with open beds. She refused to go. Without her express consent, the facilities told us regretfully, there was nothing they could do. APS had already tried, twice, to get a court to assign her a guardian. The petitions were denied. She was impaired, the judges agreed, but not enough to take away her agency. An admirable position, with one small problem: It was about to leave her homeless.

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If she couldn’t care for herself, and if the court wouldn’t step in, and if she fired aide after aide, and if her family and friends had long since been driven off, whom did that leave? Only me. And after decades of paying her bills, cleaning up her messes, and taking her abuse, I had reached the breaking point where I was being asked to risk something I couldn’t bring myself to: my own sanity, my children’s safety. I was taking my hands off the wheel. Only a monster would allow her mother to go to a homeless shelter, I thought miserably. I was now that monster.

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In June 2019, the marshals drilled through the lock and took my mother to the Franklin Women’s Intake Shelter in the Bronx. She stayed there five weeks, refusing my last-ditch offers of housing placements. She briefly moved to an assisted living facility, and by July she was dead. Sixty years of chain-smoking had taken their final toll.

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In the years since my mother’s death, I still wrestle with what I could or should have done for her. We like to think of moral decisions as having one correct answer, if only we can figure it out. But when it came to my mother, too much was never enough. I paid what I could—in time, in money, in worry—to keep her safe and housed. But when the final choice surfaced—to save myself and my family, or to go down with her—I chose myself.

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