I couldn't not look at him, though I tried. He smelled like trash, stared straight ahead, his head leaning back on a cushion, staining it with grease. His hair was long; he had a thick beard. His eyes were glassy and distant. The fly on his tattered, dirt-stained jeans was open, his shoes were untied and almost black with filth. He was helpless. It was the saddest thing I have ever witnessed. I wanted to scream, but couldn't. I lost something of myself that day, and I've never gotten it back. Standing in the room with him, needing to scream, to shout, to break something, but unable to, I said to myself, I'm going to go crazy; I'm going to be like him; I feel it coming.
My father broke down completely, sobbing, hugging Michael, and then sitting down and laying his head on the kitchen tableâmy stoic father, my tough, no-bullshit father destroyed by a guilt you could almost see around him like a luminous aura.
Michael didn't move, didn't even eat, until my parents took him to the emergency room, simply not knowing what else to do. The nurses gave him fluids and a meal. They checked his blood for drugs and alcohol, but there was no trace of either.
Years later, when my brother was in prison, I heard the stories about Florida from my younger brother, whom Michael had confided in one day.
Michael was kicked out of a youth hostel the first day he arrived, then had lived in a small Assembly of God church for the first few weeks. The pastor let him sleep there on a cot, but wouldn't let him attend church. Michael was too disturbed, too likely to have outbursts of religious zeal that scared people, even charismatics and evangelicals, who were having outbursts of their own for the Lord. At the best of times, while Michael was living at home, his appearance was frightening; away from the constant care of my mother, the sight of him was enough to make people cross the street. He looked, at his worst, unmedicatedâunshaven, yellow teeth, hair everywhereâsomething like Linda Blair in
The Exorcist
. His looks, and his vastly unstable behavior, were exactly what got people burned at the stake in medieval times, or had their skulls drilled open so the spirits could escape, or had leeches placed on their eyelids to drain the evil energy from inside their heads. Florida wasn't so much better than this.
Other details of his journey are murky, not grounded by any specific narrative, time, place.
He was gang-raped while living among the homeless.
He paid for hookers, both male and female, with money he stole from other homeless kids; he once beat a hooker (a woman, I think) nearly to death in an abandoned house because she tried to steal his Bible, then went to a convenience store and called an ambulance.
A trucker gave him money and food, in exchange for blow jobs until Michael finally tired of him and moved to a different part of town, found a different group of kids, a different corner to hang out on.
He was robbed.
He participated in, or at the very least was present during, both rapes and robberies.
He prostituted himself for money or coffee or food or drugs.
He prayed several times a day.
A demon lived in his shoes, so he threw them away and stole a pair off a sleeping drunk.
He became seriously ill after snorting crank and was taken to an emergency room, where he was treated for extreme dehydration and cramps. He had no identification, no money. His wallet had been stolen and the only thing he had was his tattered Bible that had his name written in the front.
When the hospital called my mother, having somehow tracked her down about the bill, Michael had already vanished. My mother wanted to go to Florida to look for him, but my father vetoed this, and said that they'd never find him anyway.
Michael also had begun to hallucinate almost constantly. He saw and heard demons in malls and car washes and restaurants. He began to believe my father was sending them. He no longer felt strong surges of schizoid paranoia, evil smoldering at the periphery; he
was
paranoia, and reality, our reality, was now at the far periphery.
His confusion made him cry, strike out at people, create huge scenes in convenience stores, shopping centers, on street corners, spewing epithets with the words “thou” and “thee” all mixed up with potty talk and quotations from Revelation.
He was arrested at least twice for shoplifting and being drunk in public, though he wasn't drunk. He must have thought that Florida was hell, a place to torture and be tortured, a place where God forgot about you, where everything that could go wrong went wrong. It had literally drained the life out of him.
When he returned to us from the hospital after overnight observation, he began his visits to psychologists, psychiatrists, counselors, and rehab. He was almost twenty-two, and in many ways this was only the beginning.
SCIENCE
I have never felt more guilt than I did on the day I found out my brother was an acute paranoid schizophrenic, when I found out, finally, what all of this was. It was the opposite of the relief and elation I felt over his absence, my freedom from him. Fear is transient. Guilt, believe me, lingers.
I was seventeen, a freshman at a local state university, which was forty minutes from my parents' home. It suddenly, somewhat inexplicably, felt like my fault, all of it: his whole life, our whole lives. I started replaying everything I'd ever said about him, all the cruelest words: when I'd told everyone in school about his masturbating and they'd called him “beater”; or the time I'd told one of his old friends about the night after the Ozzy Osbourne concert, the seeing God, calling my brother “Angelhead,” some conflation of pothead and lunaticâand the boy, one of Michael's only remaining friends, never called him again; and there were so many more instances, piling up as evidence against me, pointing to how despicable, thoughtless, and heartless I had been toward my own brother.
I still feel it sometimes, the guilt. I don't mean I remember how it felt, or that I can approximate the feeling again by fixing on a certain memory that seems to evoke it; I mean I can still, to this day, feel the guilt,
the same exact guilt
I felt that day, as if it is somehow stored up in me, a part of who I am.
My mother told me of the diagnosis while sitting at our kitchen table. All the doctors had been saying he was chronically depressed, strung out. He had a personality disorder, maybe brain damage from some environmental cause, a shoddy birthing procedure. He needed more guidance. He needed moral support. He needed love. He needed lithium. He needed Prozac or Zoloft. He needed direction. He needed to get clean. A Catholic doctor asked my parents if they had thought of taking him to church.
Finally a doctor named Smith, a psychiatrist, put Michael through weeks of tests. He came back with a diagnosis of acute paranoid schizophrenia the day after the results came in. He couldn't believe no one had thought of this. Michael did not have a split personality or mental retardation or manic-depressive psychosis; he didn't have a borderline personality or a brief psychotic disorder or street-drug psychosis or prescription-drug psychosis; he didn't have psychosis because of other diseases, such as a brain tumor or viral encephalitis or temporal-lobe epilepsy or cerebral syphilis or Huntington's disease or AIDS or other AIDS-related symptoms; he didn't have narcolepsy or progressive supranuclear palsy or metachromatic leukodystrophy or congenital calcification of basal ganglia, although some doctors might point to one or some of these.
No, Michael was a textbook case, right down to the delusions and physical deterioration coming on in his late teens and early twenties. Michael, said Dr. Smith, had been essentially creating an alternate reality over the years by mixing up myriad aspects of actual reality into something no one but he could truly understand. That's what made the disease so damaging and hard to treat. You couldn't address the problemâthe mix-up in the brain, my brother's thoughtsâyou could only medicate and regulate the outward symptoms (psychotherapy wouldn't work in a case as severe as Michael's). You couldn't unravel the delusions and get him on track again, you could simply make it so the brain functioned at such a stunted level that the delusions ceased or were broken up into incomprehensible fragments of thought and, with luck, into “normal” thought patterns.
The doctor said that 400,000 homeless people were afflicted with the disease; that almost two million people had the disease in the United States, about as many as live in Miami or San Francisco. Imagine that, a whole city of schizophrenics among us. This didn't help.
I have an image of my mother staring at the dark wood of our kitchen table, saying, I don't know what we're going to do, saying this with no inflection, like the undead talking in a late-night movie. It was February. There was cold, sharp light in the room. A pitiful midday sun made geometric shapes the color of stained teeth on the kitchen floor. My mother, after hearing the news, barely spoke for days. My father sat in his favorite chair, the TV droning on in front of him, but he wasn't even looking at the screen; he seemed to be looking at the blank wall behind it.
It seemed so obvious once I knewânot that he was schizophrenic but that he was definitely severely mentally ill. I had known many “burnouts”or “heads” at school of one degree or anotherâI was, in a way, one myselfâbut no one came close to my brother's strangeness. Now I knew he was ill, but I had no understanding of paranoid schizophrenia that dayâits massive delusions, the hallucinations, the blending of color and sound, the accumulation of factsâmemories, television, history, religion, books, all manner of cultural and personal artifactsâand how they came together to form completely new and alternative notions of self and reality.
Some schizophrenics, with the right psychotropic drugs, manage to function “normally.” Because of its early onset, however, my brother's case was so severe as to be nearly hopelessâpossibly contained but never genuinely improved without huge advances in the study and treatment of the disease.
It would be years later, after reading an endless stream of books about both religion and madness, before I felt I had any understanding, and then only some, because the mind of another is ultimately unknowable; you can only approximate it with metaphor, invention, language, story; you can only impose meaning after the fact.
I knew he was sick. And, most important, I realized for the first time it wasn't his fault. I had blamed Michael, hated Michael, for his behavior. So finding out suddenly, nearly a decade after his first psychotic break, that none of the behavior was entirely his fault, was nearly unbearable, making us allâparticularly my father and Iâfeel immoral and ruthless to such a degree that shame is not a strong enough word.
My brother spent the next several months going through tests, taking different medications, derivatives of the major tranquilizer phenothiazine, to quell some of his more severe delusions. Standing in a cold, white room with generic prints on the wall, Dr. Smith, a long-nosed, balding man in khakis, tennis shoes, and a denim shirt, the kind of man you can't imagine as anything but a doctor, told my parents that often delusions were of a religious nature. In evaluating these visions or delusions, it is important, he said, to realize they are culture-bound. Many schizophrenics talk to or hear or see “God”; some think they are vampires; others believe the CIA and the president are out to get them; many believe their thoughts are being broadcast over television or radio.
He mentioned books, support groups. He was well-meaning but cold. He smiled, but acted as if he didn't want to be more involved than necessary. He knew how these things wentâevery day he saw what the disease did to young people and their families. It could be dangerous if the delusions continued unchecked, because they tended to get more elaborate, more undeniably the patient's
actual
reality. Michael showed extreme violent tendencies. Schizophrenics as a populace have a much higher instance of committing both murder and suicide (just during the writing of this book I have tallied six national news stories about paranoid schizophrenics committing homicide or multiple homicide, and those, mind you, are only the ones making the
national
news, like the Unabomber). Violence against family is most common.
If we lived in an Islamic country and the available cultural symbols and metaphors were Allah and Muhammad, Dr. Smith told my parents, he'd see and hear them; the same would be true in a country where the prevailing belief was Hindu, or Buddhist. It was a way of dealing with severe emotional pain, depression. Externalized by the sufferer, it was the devil, a huge political conspiracy, whatever. Intense internal (emotional) conflict needs signifiers. The hope for a cure, the cure itself, has a name, too: God. Good and Evil. Hope and Despair. The rigid standbys of cultural meaning.
Michael was using the available terms to name his nightmares. They were real to him, of course, but they came from within. There was still a lot about schizophrenia to learn, Dr. Smith continued. Studying the mind, all the ways it can go wrong, is like studying outer space: endless.
He looked at his watch, wished them luck. He smiled. Here were a few pamphlets.
My parents felt stranded in a new wilderness without a map. My mother kept thinking: Murder? Suicide?
Specialists analyzed my brother's thoughts via basic question and answer, measured the chemicals in his brain, the deterioration of his body. (Acute paranoid schizophrenics rarely live to an advanced age because of physical deterioration brought on by diet, lethargy, and poor hygiene.) We learned that 25 percent of schizophrenics recovered (generally mild, late-onset cases), but 15 percent killed themselves and another 25 percent had to be hospitalized and under constant supervision. There were theories that posited the disease resulted from defects in the limbic system, others that cited genetics, others still that said it was environmentally and culturally bound, a by-product of living in a polluted mental environment, the modern world. It was like learning a new language.
Michael was back living at home now. We all felt suddenly caring because of our guilt.
He spent most his time, those first weeks, sitting in a chair on the opposite side of the room from my father's chair in our den. One day he was watching Robert Tilton speak in tongues on the large TV that organized the room. I stood in the doorway. I've read that many schizophrenics don't like TV; it jumbles their thoughts. But Michael loved TV. It was up there with cigarettes and coffee and marijuana. He believed Robert Tilton was a medium, delivering messages from God directly to him; any money he had went either to marijuana purchases, his favorite thing, or to the Robert Tilton Ministries in Dallas, Texas: two, three, five crumpled dollars in an envelope with a barely legible address and “God Bless Us All” for a return address.
He got up and touched the television screen. He was wearing jeans and an old flannel shirt that lifted up as he bent over, revealing the tops of his buttocks. He had gained most of his weight back over the last few months with compulsive eating. A black woman was being healed of cancer on the screen. Tilton spoke in tongues:
Oooosssssaaaaalllaaaamaaaayaaaooobajjaaaa.
I leaned against the doorframe, my arms crossed so he understood I didn't mean to be aggressive. I asked him, as politely as possible, just above a whisper, what Tilton was saying.
Michael didn't answer. He wasn't finished listening to God.
I waited. My mother was doing dishes in the kitchen behind me. When insanity is routine, you learn to function around it, you learn that the dishes still have to be done and the lawn needs cutting, you have to go to work and school and have Christmas and birthdays and pay the bills.
During a commercial, I asked again.
He looked at me, almost smiling. I asked again.
He told me that he was asking God to take him. He said that they were trying to trick him and that he didn't know who to believe anymore.
What do you mean, trick you? Who's trying to trick you? The doctors?
Them, he said, scanning the room with his eyes, as if pointing them out to me.
Them?
He walked out of the room, bumping me as he passed, as if I wasn't even there.
Doctors told my parents different, divergent stories that intersected at points but never made a coherent narrative. Some thought it was all chemical, all biological, curable through science and medicine. They showed pictures of a schizophrenic's brain with enlarged cerebral ventricles like glowing butterflies. Others thought it was cultural, environmental. The number of schizophrenia cases diagnosed has risen sharply, in direct correlation, some say, to the rise of a frenetic, overwhelming popular culture and endless cultural stimuli and, of course, a fragmenting of anything like concrete meaning (though the increase in numbers of cases could also quite simply be a part of the higher numbers of diagnoses of all mental ailments). According to this environmental argument, which is generally frowned upon by the leaders in the field, schizophrenia might be considered a postmodern disease. (Interestingly, there are almost no reported cases among the rural Amish; largely isolated American Indians on reservations have had a remarkably low instance of the disease also.)
Statistics and more statistics. Almost 8 percent of inmates in prisons are possibly schizophrenic. Schizophrenics are 500 percent more likely to kill themselves than the general population. Only about 60 percent of schizophrenics receive treatment. Almost a quarter of schizophrenics could live independently at some point after being treated, but these are generally the mild cases. Learn from the numbers. Tally your chances. This many humans had this happen to them. This many had that. Do you see any answers in these graphs?
What was agreed upon was that whatever the origins of Michael's schizophrenia, it was serious, “chronic,” and “acute”âto the point that he would never believe he was ill, but rather that the doctors and my parents were yet more players in the conspiracy against him. He could only trust God. There was hope, but only some. New medications came on the market all the timeâClozaril, Loxitane, Orap, Haldol, Compazine, Prolixin, Stelazine, Mellaril, and many others. These might work. Things could change. But don't hold your breath.
It was probably hereditary, said Dr. Smith, but maybe not. It was treatable with medication, but only to a point, and only in some cases.
His
case is severe, so don't be too hopeful. Yet don't give up hope.
When you read about schizophrenia, you can begin to believe it is disembodied, abstract, simply
out there,
not actually having to do with human beings, with teenagers and young adults, with families. I stare at homeless people, wondering. I listen closely to stories about people who can't function at home or school. The stories that interest me are the ones about those on the fringes of society. I scan the paper for stories of people dying on the streets, winos beaten to death by kids, old men stepping in front of trains. I think, Why?