I observed dramatic results in Chris from one day to the next. By the end of the first day on the much larger dose of niacinamide he was more sociable. We had guests that evening for a Robbie Burns supper and I made sure that Chris stayed in his room and took his meals there. He emerged from his room after our guests left, sat down at the piano and played some traditional Scottish tunes by ear. He hadn't been interested in music for months, other than to talk about it. The next day I took the afternoon off and came home to find Chris smiling and chuckling over some Seinfeld episodes. He hadn't laughed for months. He was a little quicker to eat and much less agitated than I had seen for a long time. The tension that we experienced together seemed to melt away.
My niacinamide insight unfortunately arrived too late to save Chris from going back on an antipsychotic. He had been too close to the edge and by all objective criteria was over the edge. I couldn't be 100% sure that pronounced changes with the niacinamide that we observed in Chris would continue. I know that if the decision were mine alone I would been willing to take the chance and not fill the prescription for a few days, but Ian would not be willing. Dr Stern would be relieved. It would allow us to say to all those well meaning friends, that "yes" Chris was on medication, case closed. Of course I knew that because of Chris's past experience with the antipsychotics that antipsychotics were not the answer for him.
The holistic psychiatrist was clearly annoyed with Ian's and my inability to prevent Chris's deterioration and said so in some rather pointed e-mails. The doctor honestly believes that supplements will fix everything and good mental health is a question of getting the supplements right. I believe that there is a human will factor at work that will trump supplements (or medication) any day in both good ways and bad.
Chris was on a minimal dose of an antipsychotic for less than a week when I decided "it was time". Chris got himself up early so he could be in time for choir practice before church. This was remarkable in itself, as Chris was usually late for choir. When Ian and I arrived at church an hour later, Chris was not in the choir. I found him in the church office, distraught. He reported that he started hallucinating on his way to church and somehow felt he had physically bent a lamppost on the way, though he couldn't be sure. When the choir director asked him to open the hymnbook he snapped at her that there was no reason why he should. At some point he lightly punched a fellow choir member in the arm. He was becoming aggressive and the minister put him in the office where we found him.
The next day Ian and I took Chris to a psychiatric clinic for an evaluation. We were hoping that they could offer us breathing space, a short term stay for Chris, maybe a week or two to allow us all to distance ourselves from an intolerable situation.