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Question: Midge is a 72-year-old woman who lives with her daughter in a rural community in southern Appalachia. She has been the permanent caregiver for three of her great grandchildren whose parents have lost custody. Her granddaughter is currently in jail for drug charges. Her daughter works two jobs to keep the family afloat and has little time. Midge's daughter has been noticing a decline in Midge's ability to care for the three children ages 4 to 9 years and Midge has been sending the kids to school unkempt without any lunch money. The school has called Midge's daughter several times alerting her to the children's situation. Her daughter can't take more time off from work.
Her husband died of lung cancer 10 years ago when she moved in with her daughter.
According to her daughter, Midge has been having hallucinations of a person sleeping on the woodpile in the back of the house. She is terrified that this person might come into the house to hurt the children and has been seen by neighbors walking down the dirt road with the three of them in tow. Sometimes the person on the woodpile sings old hymns and Midge will sing with them.
Midge has no history of psychiatric illness.
What precipitating factors could be contributing to the current symptoms?
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