Snow was piling up on a Saturday morning in February as Theresa and I sat at my kitchen table talking. A petite woman with black hair framing an attractive Italian face, her wide brown eyes seemed to question and plead for the answers we both knew couldn’t be found in any book of rules. A psychologist who specializes in evaluating and treating troubled youth, Theresa’s son Jesse’s bi-polar disorder exploded onto the landscape of their lives like a bomb that had been quietly ticking, unnoticed, for years. Jesse was in his junior year of college, on a study trip abroad, when he called in the middle of the night. He told his father, Sam, who had answered the telephone, that he was calling to say good-by, that he would never see them again, and that they had been good parents.

Until that pivotal moment, Theresa had never questioned that her son would do well in life. “He had gotten straight A’s in his first two semesters at [a prestigious university]. He never told us that in his fourth semester he stopped going to any of his classes because he thought he knew everything, and he’d gotten all F’s.” She sighed, continuing to describe how, once she learned that Jesse had been put on disciplinary suspension, she suggested he take a break and spend a year with relatives in her Midwestern home town. She thought the pressure of such a demanding school might have been too much for him. But when she got a letter from the university saying he could re-enroll if he wished, she called him. Jesse accepted the offer and proceeded to have a successful summer semester, until the fateful trip.

Though his call had sounded suicidal, Theresa said that wasn’t the case: “He smelled things in the air (olfactory hallucinations) and thought his food was being poisoned. He interpreted everything they said as some secret message. He really did believe he was poisoned and was going to die.”

The day after Jesse’s call, Sam flew to Europe to bring him home. Theresa said the trip was a nightmare for her husband. Jesse kept leaving his seat to walk around the airplane, rambling to the other passengers in a foggy, disconnected way. Theresa drove to JFK to pick up Jesse and Sam, still believing that once she had a chance to talk to him, everything would be okay. But Jesse didn’t come back like the son she’d known: “He came back a stranger.” Once he was back in the familiarity of home, Theresa was sure the son she’d known would begin pulling out of this nightmare. Instead she would find him sitting and staring, unable to carry on a conversation.

Having struggled with depressive episodes throughout her life and aware that others in her family had, as well, she assumed Jesse was dealing with what she called a “psychotic depression.” She never considered that he might have a serious form of bi-polar disease. After a few days with no signs of improvement, Theresa and Sam took Jesse to the local hospital. But Jesse refused to admit himself. After two hours of trying to convince him, even crying and begging in her desperation, Jesse was finally committed. Theresa was reminded of the Exorcist, and was shaken by the sight of eerie tattoos on each of Jesse’s wrists. It took three weeks of hospitalization and medication adjustments to stabilize him.

Like many parents, it’s hard to know if an adolescent’s moodiness is just part of the hormonal and identity adjustments of being a teenager, or a sign of something more serious. Theresa had reassured herself that Jesse’s moods were no different from those of his older brother, Ethan, who, “all of a sudden in his twenties got adjusted, found the girl of his dreams, and has been doing great. So I didn’t worry about Jesse,” she explained.

“How different it would have been if it had been the other way around,” I suggested, “and Jesse had been the older one.” Theresa nodded, adding that she had worried much more about Ethan than about Jesse. Ethan’s finally doing so well soothed Theresa into a false security that had her ignoring some of the signs in Jesse that would, in looking back, point to the mental illness that would detour his expected future: “Once when he was five and we were on a plane that hit some turbulence, he started to scream that the plane was going to crash. Everyone could hear him. That’s kind of unusual for a five-year-old. And he would have panic attacks as a kid and come to me saying, ‘Mom, I’m having a heart attack.’ I knew what they were and would tell him, “No, Jesse, you’re having a panic attack. You need to calm down.’ But he would insist he was dying.”

Not long before we spoke, Jesse had told her that when he was twelve years old, he would take a set number of steps around their pine tree before he would get on the school bus. He knew it was unusual and didn’t tell anyone about it. In high school when he was popular, had a girlfriend, and did well in school, any concerns that Theresa had were easily dismissed. Any quirks were easy to dismiss in the context of his overall success and happiness.

We talked about what a struggle it is for parents to know what is a problem and what is just normal developmental adjustment. We don’t want to miss something important, but we don’t want to panic and pathologize our children, either. “Looking back I don’t think I would have wanted him on medication when he was having the anxiety attacks as a child, because he was happy,” Theresa mused.

Now that Theresa, Sam, and Jesse have recovered from the shock and adjusted to the realization that Jesse’s illness will be a constant presence in their lives, Theresa still struggles with how to manage her relationship to Jesse. “I never know what to expect from Jesse. One moment he is open and vulnerable, talking about the insecurities that come up when he’s sitting in his psychology class at the local college, and in a flash he’s yelling at me for what I said when I was trying to be kind and helpful.” Her eyes filled with tears as she went on, “I get angry sometimes, but you never know when to draw the line. Can he help it or not? You just never know. When he comes into the house it’s so unpredictable, and he will sometimes start mocking and mimicking me, especially about things that I don’t like about myself, so it’s really affected my self-esteem.”

“So even though you know he can’t help it,” I said, “it still hurts.” “Definitely,” Theresa replied, “and he’ll get overly abstract or philosophizing, so that when I call him on something or argue a point, he’ll say,’ And what does that say about you?’ And that drives me nuts.”

Theresa and I share the bond of being mental health professionals who have been unable to save the sanity of our own flesh and blood and have learned that the only sanity we can save is our own. “I think because I’m a psychologist I worry about the right and wrong thing to say. I wish I could just be there and not judge or direct him in any way, but at those times he’s beyond direction.”

“It seems that ideally you would be able to not take any of it personally, like the staff in a psych ward. But you’re Mom,” I said, remembering all too well how I struggled with what to do and how I was being perceived by the counselors and staff who worked with Erin. “I know I shouldn’t take it personally, but when you’re at the psych unit visiting and he says, ‘I hate you. I want you to leave,’ it’s hard not to take it personally,” she said softly, as her eyes filled with tears again.

Another area we discussed was Jesse’s disruptive behavior. “You think because he’s smart you should be able to sit down and explain things to him, and he’ll understand. But he doesn’t,” Theresa noted. Jesse’s lack of insight and awareness about his impact on others continued to frustrate her and Sam. “Sam won’t go to basketball games with him anymore because he’s too embarrassed about how Jesse acts. And Sam is hard to embarrass!” She chuckled.

We spoke about regrets—how much she worked while Jesse was growing up, the impact of his father’s alcoholism—yet Theresa also knew that she did what she could to compensate by spending every Saturday with Jesse when he was young, doing something special together. “And then you hear about other people’s kids—doing well, getting married—and it really hurts,” she said, her dark eyes moist with the weight of never-ending grief mirrored by the still-falling snow heavy on the spruce trees outside.

Jesse’s early dreams of acting, writing, and teaching reminded me of Erin cart-wheeling across the stage at her dance recitals or engrossed in drawing at the kitchen table where Theresa and I now sat. What seemed so alive and inevitable when our children were young would never be. “If I hadn’t lived through it, I couldn’t have imagined how I would survive,” I said. Theresa nodded. When I asked what would have helped her during the early stages of Jesse’s crisis, she answered, “To be told that you can get through it.”

Theresa, now divorced from Sam, has moved back to her hometown, where there are many more services available for Jesse. They found a psychiatrist to help manage Jesse’s medications, and even though he may never have a career, Jesse was dating, had made friends in his support groups, and was living peacefully with Theresa in her childhood home.