Before the Headlines
On Families and Breaking Points
Like the rest of the world, the Reiner family tragedy last week entered my consciousness the way these stories always do: shockingly, and heartbreakingly. And I didn’t need to read the news avalanche of stories to understand the long, agonizing lead-up that occurred for this family. The years of worry, helplessness, and strain. The weeks of decompensation that so often precedes these catastrophes when a mental illness is left to spiral without effective intervention. I understood it because I’ve seen this exact scenario firsthand.
Families like the Reiners often know something is wrong long before the rest of the world does. Long before a diagnosis, before a police report, before a hospitalization, they’ve seen the subtle shifts only familial intimacy reveals: an odd comment, a drifting gaze, a disrupted routine, no response to texts or calls. Decompensation rarely arrives as a single event. Instead, it’s a slow erosion, often only visible first to those who love the person most.
Yet families are paradoxically the least empowered to respond.
When a loved one begins to decompensate—when mental illness worsens, when psychosis intensifies, when addiction intertwines with instability—families are far too often told to step back. Respect autonomy. Wait until the person asks for help. Call emergency services only if there is “imminent danger.” These instructions sound reasonable in theory. But in practice, they trap families in a cruel holding pattern, forcing them to witness deterioration while being denied meaningful tools to intervene.
The Trouble With Autonomy Versus Intervention
The Reiner family tragedy, just like the family tragedy that occurred in my neighborhood nearly a decade ago, lay this reality bare. In the aftermaths, public conversation almost always focuses on culpability and shock, on what went wrong in the final moments. Far less attention is typically paid to what happened in the lead up—when loved ones struggled to support someone who was unraveling within a system that offered few options between total disengagement and emergency force. Like countless families across the country, they were left navigating fear, love, and responsibility without meaningful authority.
Mental illness complicates the very concept of choice. During periods of decompensation, insight frequently diminishes. The person who is ill may not recognize their symptoms (a condition called anosognosia), may reject treatment, and may even perceive concern as a threat. Yet families are expected to honor autonomy even as that very autonomy erodes. Love becomes a daily negotiation between the fear of overstepping, and the terror of waiting too long.
Most families try everything they are allowed. They offer housing, financial support, rides to appointments, and endless conversations. They research medications, advocate with insurance companies, plead with overburdened providers for earlier appointments. They learn de-escalation techniques, memorize hotline numbers, absorb the language of harm reduction and boundaries. And still, within our current mental healthcare system, they’re too often left to deal with the escalating situation on their own.
But here’s the thing: restraint is not neutral.
The Reiner tragedy is not an aberration; it’s a reflection of this systemic paralysis. Families frequently see decompensation coming, but lack mechanisms to act before the situation becomes catastrophic. The system is flawed in its design because it reserves intervention for the moment of maximum danger, then expresses disbelief when the outcome is devastating. Waiting is framed as ethical restraint.
But here’s the thing: restraint is not neutral.
Restraint is a decision with consequences—one that shifts risk onto families and communities until tragedy becomes inevitable. Mental illness itself is not violence and tragedy. But untreated mental illness can be.
What families are asking for is not unchecked control over their loved ones’ lives. No. They’re simply asking for better options. Earlier, humane, medically grounded interventions that do not require violence, homelessness, or incarceration as prerequisites for care. They are asking to be treated as partners rather than obstacles, as witnesses rather than liabilities. Early intervention should not be dismissed as unethical meddling; it should be understood as preventative care when illness has compromised judgment.
Make no mistake. The absence of better options fractures families.
Some stay close, absorbing escalating harm until burnout, trauma, or fear forces distance. Others choose estrangement as an act of survival, stepping away not because they don’t care, but because they are out of choices. Both paths carry guilt. There’s also the unseen cost of eroded trust. When families repeatedly ask for help and are told “there’s nothing we can do” or worse that they are overstepping boundaries, that message wounds. It teaches people their vigilance is futile, that speaking up too early is pointless, and that all their love and care, in the end, is insufficient.
We need to move beyond the false assumption that autonomy and intervention can’t coexist. Mental illness exists on a spectrum, and so should our responses. Giving families more options doesn’t mean stripping dignity from those who are ill. It means acknowledging that decompensation itself robs people of dignity, safety, and a future. And that waiting for total collapse is not compassion, it’s systemic negligence.
If tragedies like the Reiner case teach us anything, it is this:
Denying families the ability to intervene does not preserve freedom. It simply delays care until the cost is unbearable.
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Kali is a member of the Iowa Writers’ Collaborative with her “Gaps” column.
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Thank you for expressing so well what it is like for families that can't get the help they need for their loved ones.
Thank you, once again, Kali, for bringing your amazing ability to write to this subject that way too few people understand. #FamiliesLikeOurs are so grateful.