Nell Casey

What were your sister's mania symptoms?
She had delusions, was paranoid, and didn't trust others. She had interesting theories that ranged from government conspiracies to religious revelations. Her delusions were so active, creative, and oddly fascinating, but heartbreaking. Her energy was so high and agitated. I wasn't allowed to spend the night in the hospital so I had to leave her there in this horrible state. It was awful.

Which symptoms were most upsetting?
The depression was scarier than the mania, because Maud was so absent. It was as if she had exited her body. During her mania, she was outgoing in a way. But, during the depression we feared that we would not get her back. I had long conversations with her on the phone where she was crippled with doubt, pain, insecurity, and sadness. I wondered if she was going to hurt herself. I experienced this ambiguous loss of not knowing if she was going to get better and if the medication was going to work.

What was your experience with the hospital?
The doctors were trying to figure out how to ground her so the mania would not keep galloping ahead. But the people at the desk and nurses seemed bored and because of that they were provocative and tried to pick fights when we were at our lowest point. They had Maud in restraints, even though she wasn't wild, hitting, or screaming. When the staff called me, they wouldn't give information out even though she was an hour and a half away. I remember getting a call in which someone said 'you have to come, something is terribly wrong with your sister. Oh wait, I have to go there's a suicide call.' Then, the person hung up on me. I called back and someone said that it might have been about my sister, then hung up again. As it turned out, it wasn't Maud, but I had to race over there. I never knew what the staff was talking about. The hospital was completely disorganized and it was terrifying because of it. I was far away and trying to hold down a job.

How did you care for your sister?
I didn't care for Maud by myself, my mother who is an unusually dedicated person, moved from Illinois to New York to be here. If my mother wasn't here, I don't think I would have the wherewithal to do it and sustain caring for Maud. We needed to be able to pass off the baton of care giving and take care of each other. I would have burned down to an anxious crisp without my mother. Also, Maud's network of friends was incredible. Her friends were always going to Queens and checking in on her. And our family and relatives all came to visit.

My mom and I both felt like we could fix it and make it better. I did what was logical, but I also went into overdrive. I went to the hospital every day and arranged for other people to go in shifts.

I took care of a lot of medical insurance business. And, I talked to her employers and worked to hold onto her apartment. We wanted her to have a life to walk back into when she came out of it.

I went to the psychiatrist with her when she was still depressed to get a second opinion. She was struggling so much that she couldn't take in everything that the doctor said so I had to be aware of the medication. Maud went through 18 different medications, some concurrently, over four to five months before she found a combination that worked. Maud didn't have the presence of mind to know that one of her medications was actually giving her anxiety. I remember one weekend when she wasn't sleeping, she was up at six, and she was rationalizing how she was going to get better. She made new decisions every three seconds about how she was going to get better. Finally, she mentioned that one of her medications had changed and I realized that this was a side effect. Ultimately, Maud found a combination of drugs that worked for her.

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