Three of us who have been in the NH mental health system for many years, at different agencies, were discussing a heartbreaking patient we had all encountered a few times each over the decades. In particular, we were discussing his mother, who was his guardian most of his adult life.
Nick was my age, born in Hungary in 1952 or 53. He came with his parents to America during the revolution of 1956. His mother was Jewish, I believe his father had been as well. She had lost most if not all of her relatives in the camps during the Holocaust. We don't know much about his father, because he went back to Hungary after a few years here. (That may say something about the marriage.)
Nick was as severely disorganised a schizophrenic as I have ever met. He was nervous, did not understand the world around him, and evoked deep sympathy among all who treated him, even as he was assaultive, accusing, and difficult. He was tormented every day of his life by what went on in his head. His mother told us his father was also mentally ill. she told us that Nick had been brilliant, especially in mathematics, as a child. This was entirely believable, but mother was the only source for this.
We went years in battle with his mother, trying to get him adequately treated, but she refused, always wanting L-tryptophan instead. He had been tried on it repeatedly, as each new psychiatrist who treated him wanted to establish a working rapport with the woman. It was never enough, or the right way, or complicated by other medications we were giving him, or undermined by providers who just didn't understand him. It was always some excuse why we could not ramp up on the antipsychotics and see if that would work.
She lived in town and came to see her son almost daily, and always had criticism for the nurses or doctors who treated him. They didn't see, didn't appreciate, didn't care about him as she did. I worked with Nick a half-dozen times over the years. I hated her. I wanted so badly to see him tried just once on adequate doses of antipsychotic medication, to see if that would relive his torment. We went to court to have her removed as guardian and twice failed. Courts everywhere are reluctant to remove involved family members as guardians, and this is observably true in New Hampshire. Plus, judges had great pity for her as well. She had nothing else in all the world. She had only her boy and their two ruined lives, and one friend she corresponded with, hundreds of miles away.
One of the other two people present felt great pity for her and thought I had always been too harsh on the woman (which is likely true in any event.) "I used to listen to her a lot. She just wanted to be heard." I acknowledged that she was indeed sad and pathetic, but still saw her as straight out of M. Scott Peck's People of the Lie, a malignant narcissist who expressed her rage and pain through the only thing she had left, which was also the destruction of her son's life. The third person sided about 60% with me that she was in some way evil , but had worked well with her and deeply sorry for her. He is a nicer person than I.
He had eventually convinced a judge to remove her as guardian, have a public guardian appointed, and Nick finally received adequate dosing. After so many years there was not much hope he would recover much, but he did improve quite a bit. He was less confused by his environment, he stopped pacing and circling, and even his face grew calmer, less lined and preoccupied. He stopped talking to voices, though he told us he still heard them sometimes. (He had been unable to even answer that question for decades.)
She died within a year, and the friend at a distance wrote to the mental health center and the public guardian to accuse them of killing her. That may at some level be true. Nick was visiting at her house when she died, and he only visited rarely. He did not speak of it after, but remained calm, less troubled. He was still in need of constant supervision. He was transferred to a more appropriate placement an hour away, and died about two years after.