Cady realized now that she only knew the words other people had said, labels for her brother that were disputed and refined but never confirmed. She knew nothing of his experience with the illness; she had been afraid to ask. She could no longer afford the luxury of denial. Cady had quickly abandoned her search online, too easy to get paranoid and hypochondriacal, she figured. She’d surmised that a book, with its comforting physical weight and peer-reviewed levelheadedness, would offer her a greater chance of reassurance, or at least a higher bar for panic. Her heart pounded as she looked at the book’s cover.
Cady skipped to the second chapter, titled “Diagnosing Schizophrenia.” She feverishly read the first paragraph:
Schizophrenia shares many symptoms with other mental illnesses, sometimes muddling an accurate diagnosis. However, there are highly characteristic symptoms, such as the belief that someone else’s thoughts are being inserted into one’s mind or hearing (nonexistent) voices discuss one’s behavior.
Cady’s eyes raced down the next few lines, which listed the criteria for schizophrenia from the Diagnostic and Statistical Manual of Mental Disorders:
A. The presence of characteristic psychotic symptoms in the active phase: any of 1, 2, or 3 for at least a week:
1. Two of the following:
a. Delusions
b. Hallucinations throughout the day for several days or several times a week for several weeks, each hallucinatory experience lasting more than a few brief moments.
c. Incoherence or marked loosening of associations
d. Catatonic behavior
e. Flat or grossly inappropriate affect (emotional tone)
2. Bizarre delusions (i.e., involving a phenomenon that in the person’s culture would be regarded as totally implausible—e.g., thought broadcasting, being controlled by a dead person)
3. Prominent hallucinations of a voice with content having no relation to concomitant depression or elation, or a voice keeping a running commentary on the person’s behavior or thoughts …
Cady stopped reading. She had already made mental check marks next to too many of A’s subsets—she was having auditory hallucinations, although they hadn’t lasted a week, yet; 2. it hadn’t crossed her mind they were dead, exactly, but it was true they didn’t speak to her like contemporaries, and there was that old music. … and they weren’t controlling her, yet, but this morning, the woman’s voice wanted her to read something … did asking for help count as control?; 3. the voices were unrelated to her mood and arrived without warning, and they did comment on Cady’s behavior and thoughts. Her own thoughts intruded—But what if they were right? Canto Five in Inferno, Teddy and the danger—you can’t be making it up if they’re right. But what explanation did that leave her with?
Slow down, Cady told herself, don’t jump to conclusions. Crazy people don’t know they’re crazy, right? She thought the fact that she was questioning had to count for something, until she read:
Unlike patients suffering from other forms of dementia, schizophrenics can remain fairly high-functioning, with a seemingly clear and conscious grip on reality, and with intellect intact. Studies show that schizophrenia has a statistically greater occurrence in those persons of genius IQ.
But Eric was the genius, Cady reasoned, not me. Eric was an unusual, precocious child; Cady had never stood out the way he did. Her parents had his IQ tested at a young age and he scored extraordinarily high; when Cady had asked why she was never tested, her mother had said there was no need for competition, which Cady always took to mean they had wanted to spare her feelings when she inevitably fell short.
But had they been wrong? Cady had excelled in all her classes easily, especially in the humanities, and only she had perfect pitch. She didn’t share Eric’s relish for math and science, but she had never struggled in either. Eric’s SATs were perfect, Cady’s were nearly the same, though she’d attributed her score to studying, not genius. If Eric’s outlier IQ had marked him for this illness, was she far off?
Cady skipped to chapter 5, “Family Studies,” and started skimming pages. She read that siblings, along with parents and children, counted as “first-degree” relatives of the schizophrenic patient. Already that sounded bad. A large bar graph was captioned “Figure 7 presents the grand average risks of developing schizophrenia; there is a high correlation between risk and genetic relatedness.” Her eyes scanned the mini-skyline of bars at all different heights: the bar labeled “siblings” was one of the highest, showing a 9 percent increased risk of developing schizophrenia in their lifetime. The only groups with higher risk were twins and the children of two schizophrenic parents.
Searching through the interpretation of the graph data, she found a passage that was even more troubling:
While parent-child pairs share exactly 50 percent of their genetic material, it is important to note that sibling pairs share an average of 50 percent. So it is possible for some sibling pairs to have considerably more or less, with obvious impact on their similarity in all polygenic traits, including the liability for developing schizophrenia.
Cady reflexively touched her hair. She and Eric were the only ones in their entire family who had red hair. Uncle Pete always kidded their dad that he should give “that redheaded mailman” a talking-to. But it was that recessive gene from way back, hidden for generations, until it resurfaced for both of them. Cady’s memory flashed through pictures of her and her brother when they were little, particularly a photo that still sat on their mantel in the dining room despite her hating it. Cady was around five, so Eric was eight when it was taken, the same year her mother had given her an unforgivably boyish bowl haircut. She and Eric looked nearly identical.
She jumped in her seat when her phone started vibrating, rattling against the hard desk. The boy across from her peered over his glasses in annoyance. The words Home Calling gave her a bolt of anxiety, as if her parents could see through the phone. With one clean swipe, she cleared her things from the desk and darted out to the hall to pick up the call. She pushed through the heavy swinging doors into the hallway and clicked Accept on the last ring.
“Cady-cake. How are you? Bad time?” her father’s voice said. He had a way of sounding in a hurry even as he asked you if you were.
“I’m in the library, but I can talk for a minute.”
“Good, I wanted to run over your flight details for tomorrow.”
“Flight?”
“For me to pick you up at the airport. Grampa and Vivi’s thing is this weekend, remember?”
Cady’s mouth opened in a silent gasp—she had completely forgotten she was flying home tomorrow to see her grandfather and his new wife renew their two-year-old wedding vows. She felt like an idiot for letting it slip her mind, but with everything going on …
“Cady? You there?”
“Sorry, I’m here. I’ll have to email you the itinerary, I don’t have it in front of me right now. I know it was a morning flight.”
“I imagine so. Luckily the ceremony isn’t until six, so we’ll have plenty of time to go home and get changed and everything. I can’t wait to see my girl.”
“Um, yeah, same.” All Cady could think about was how she could possibly face her parents with these voices echoing in her head. Over the phone was one thing, but would she be able to hide her fears in person?
“Listen, you sound stressed,” her father said—maybe Cady wasn’t so good at hiding it over the phone either, she thought. He continued, “I know it’s only a short trip, but it’ll be nice to get a little time at home to recharge. I know I always cherished those weekends home from college when I could get a couple home-cooked meals in me.”
The tension in Cady’s chest began to ease. Maybe he was right, maybe she just needed a break. The small crack of hope was enough for her to muster more convincing enthusiasm. “It’ll be fun, I’m looking forward to it. But I should probably get back to work.”
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“On a Friday? Relax. I don’t want you working too hard.”
That didn’t sound like her father, the man who made her and Eric recite the preamble to the United States Constitution for the firm’s partners on Take Your Child to Work Day; they were aged seven and nine. “Dad, you love working too hard, I get it from you.”
“Yes, but I wasn’t always like this. Not when I was your age. I had fun back then. I was the irresponsible one, Aunt Laura was the worrywart.”
“I don’t believe you.”
“It’s true. I was fun until Laura had her accident. Then we switched places. There was only one positive outlook between us, and she needed it more than I did. So I’ve turned my worrying on you now. I’m afraid I’ve thrown you to the wolves.”
“How do you mean?” Cady asked.
“College is supposed to be a happy time, and I’m worried I encouraged you to choose an unhappy place. Maybe we should’ve kept you closer. On the other hand, I didn’t want you to get stuck with your mom and me. But I could have helped you escape somewhere … easier.”
“I wanted to go here.”
“Are you sure? Because I let your mother push me around sometimes. She can be bullheaded, in her way, you know? And I couldn’t stand to see her do it to you. But I want you to feel you had a real choice.”
“I did. I chose this.”
“All right then. That makes me feel better. I’m second-guessing everything lately.”
They were alike this way.
“Mom called me,” Cady said.
“Oh? How was that?”
“She cried.”
“Ah, yes.” Her father breathed heavily. “No one suffers like she suffers. Her idea of checking in is letting you check on her.”
Cady felt a pang; she hadn’t meant to elicit such cold words. Her parents had never had a perfect relationship, but as Eric had gone downhill, so had their marriage. Now her father often had an edge when he spoke of her mother. “It wasn’t a big deal. I was the one who brought up Eric,” she lied.
“You’re allowed to! It’s not your fault she’s sad, all right? You didn’t do this to us.”
Cady felt doubly guilty now; she hated when her father blamed Eric. She hesitated before asking the next question. “Are you and mom okay?”
His sigh sounded like a hurricane over the phone. “We’re fine, don’t worry about us. Just, the—”
“I know.”
“Right.”
Her conversations with her father included more and more of this shorthand.
“I want you to know I’m proud of you,” he added.
“I haven’t done anything yet.”
“How can you say that? You were accepted into one of the most selective schools in the country, you’ve triumphed over personal tragedy, and possibly most remarkable, you stood up to your mother. You’re the brave one in the family, remember that.”
And she was terrified. She wished he would stop saying that.
“Anyway, I’ll let you go. Don’t forget to forward me your flight info. And I love you.”
“Love you too.”
Cady clicked End and slid her back down the wall, suddenly too tired to stand. Cady hated lying to her father, but she had to get a better sense of what she was dealing with before opening up. He was the only one in her corner and she liked the way he saw her, she couldn’t bear the thought of disillusioning him. She hoped this trip home wouldn’t prove to be a mistake.
Sitting on the top step, she realized she still had her index finger saving her place in the book. She flopped it open on her lap and picked up reading:
“Genetic material alone cannot result in schizophrenia. Likewise, no environmental factor, on its own, has been proven to cause schizophrenia.”
Not even Harvard?
“Instead, it is a combination of the two. Genes form a hereditary vulnerability or predisposition, known as diathesis, to the development of schizophrenia, and these latent genetic traits, when combined with environmental stress or trauma, can manifest in full-blown mental illness. This is known as the diathesis-stressor theory.” It went on:
Environmental risk factors fall into general groups including (a) brain injuries, (b) emotionally traumatic experiences, acute or persistent, (c) demoralizing or threatening physical environments, termed “toxic environments”. …
Emotionally traumatic experiences, acute or persistent—Cady had both. Eric’s illness had weighed on the family for the last two years, and his death was the greatest trauma imaginable. As for environment—as Cady had assured her father, she had chosen an academically grueling, freezing-cold university that happened to be the same “toxic environment” that had led to her brother’s suicide on campus.
But other than that, Cady thought bitterly, reading ahead:
In principle, those at high genetic risk of falling victim to schizophrenia could avoid tipping the balance into psychosis by avoiding the kinds of environmental factors that act as triggers or stressors. In reality, these factors are not always preventable or foreseeable.
But hers were. She knew she was hurting after Eric’s death, and yet she chose to place herself in the very same “toxic environment” that had been the stage for his suicide.
What have I done?
14
Cady had already surveyed Linden Street to make sure no one she knew was in sight before she approached the historic clapboard home that housed the offices for campus counselors, tutors, and mental health services. The place was euphemistically titled the Bureau of Study Counsel, as if the only thing a Harvard student could admit to needing counseling for was studying.
The weathered gray and white clapboard might seem charming to someone in a cheerier frame of mind, but to Cady it resembled the sort of spooky old house that kids subject to Ding-Dong-Ditch. The wooden boards of the porch steps were cracked and peeling and creaked beneath Cady’s feet, so she stepped lightly, not wanting to call one decibel of attention to her entrance. The Bureau looked closed, as the windows had both exterior and interior shutters, but it had to be open. It was a building designed for discretion. And not everything on the exterior was aging; there was a wooden bench on the front porch, brand new, or at least barely used. Nobody wants to sit and relax on the porch of the school shrink.
She hadn’t heard anything else unusual since the café with Nneka, but she suffered from a sort of reverse separation anxiety, so fearful that every minute of quiet would be her last. The suspense of when her mind would next be invaded was nearly worse than the voices themselves. She felt on the verge of a nervous breakdown.
Cady pushed the doorbell and a moment later the door buzzed open. The waiting room looked like a regular living room except none of the mismatched pieces of furniture faced one another. A pretty girl wearing a hijab sat behind the reception desk with an open textbook. “Sorry, hey, what can I do for you?”
“I don’t have an appointment, but I thought maybe I’d try and just walk in and meet with someone. Is that possible?”
“There’s always someone to talk to. Are you already a friend of the Bureau’s?”
“A friend?”
“Are you in the system—have you met with a counselor before or participated in a wellness workshop?”
“Oh, no. I’m new.”
“Then you’ll need to fill out these forms. Greg is free to talk when you’re finished.”
Cady accepted the clipboard and sat on a sagging forest-green loveseat to fill the papers out. Her hand shook as she wrote her name. She would prefer no record of her being there. She suddenly remembered how Eric felt a loss of control when he got psychiatrists involved, especially the ones at school. “It’s official. There’s no going back now,” he’d said after his diagnosis. At the time, Cady had thought he was being melodramatic and stubborn, but now she understood. She wanted to talk to an expert ab
out what she was hearing, but not at the expense of her autonomy or privacy. Her parents could not know she was here, especially not her mother.
“You can go right up,” said the girl at the counter when Cady brought over the forms. “Upstairs, first door on your left.”
The stairs creaked under Cady’s feet. The second floor hallway was dark save for a shaft of light coming from a barely open door. Cady knocked. “Hello?” She got no answer, so she pushed it open.
“Yo! Hey there, come in.” The man seemed surprised, hastily pulling out headphones that were plugged into the MacBook in front of him. He looked to be in his early thirties, wearing a gray hoodie over a plaid shirt. With his wool beanie hat, thick glasses, and big, bushy beard, Cady thought he looked like Hipster Freud. He rose from the desk and reached out a lanky arm to shake her hand. “I’m Greg.”
Cady returned the handshake and awkwardly introduced herself. “Sorry, I don’t have an appointment.”
“No worries, that’s why I’m here. Please, sit down.” Greg motioned to a navy blue loveseat against the wall. The office was small but cozy with a muted oriental rug, plush upholstered furniture, and lacy grandma curtains on the window. He sat down in a tartan armchair across from her. “So, what’s up? Give me the lowdown on you, your year, house, concentration, whatever.”
“I’m a freshman, I live in Weld. I haven’t chosen a concentration yet.”
“Good, take the time to explore. Do you like it here so far?”
“It’s hard.”
“Why is it hard?”
“It’s Harvard, it’s supposed to be hard, right?”
Greg smiled. “True. But try to be specific. What’s making it hard for you?”
Cady took a deep breath before answering. “My brother. That’s why I came here tonight, actually. My brother was a junior here, last year, when he died.”
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