by Ron Powers
Honoree and I had begun to feel that these factors might soon shape a career for him, one that would consummate his journey back from his years of pain and persecution and sense of guilt and devastating loss.
It wasn’t to be.
The breakup with the woman who had so captured his heart delivered the final blow to his stability and self-esteem. He took a couple of grease-monkey jobs at auto-repair shops, hoping to reforge his identity as a sleeves-up workingman, the sort of guy he had encountered again and again on his pickup-truck rambles around the state. And the sort of guy that the woman he’d come cross-country to be with had admired. (A favorite accusation of Dean’s in those roiled years was that I had never taught him to work with his hands. It was true, and I had lived with this damning verdict as one of my failings as a father, until it struck me years later that, hell, nobody had taught me to work with my hands, either.) At any rate, Dean admired working people as much as he loved the wilderness and its rugged solitude.
Communications from him often were argumentative, or unrealistic regarding his goals, or—worst of all—rambling and out of focus.
And then, one autumn day, as if fulfilling Robert Frost’s dictum—“Home is the place where, when you have to go there, they have to take you in”—Dean came home.
I spotted his green pickup when I turned off the hillside dirt road onto our driveway. He’d pulled it up against the rising pine woods behind our house. The sight of the truck didn’t surprise me. Dean had never been one to announce his intentions. What did surprise me was the mastiff whose great muzzle suddenly filled my open window, its ears back, its brown eyes boring into me, a heavily clawed paw resting on either side of its jowls. This was Rooster, a ninety-pound mixed-breed boxer and pit bull (neutered) that Dean had adopted in Maine.
As I later recounted to friends, it took only a few seconds for me to realize that the dog was a pussycat, and a few applications of disinfectant cleaned up my car seat nicely.
Dean was home, and we took him in.
It would be wonderful, of course, to write that Dean’s restoration was swift after he came home that autumn of 2011. It wasn’t. More years would have to pass before a serious psychotic break, the third or perhaps fourth of that period, drove him into the care of a brilliant young psychiatrist in our state who earned Dean’s trust, broke down his years of anosognosic rejection of antipsychotic medications, and steered him back into the light that Kevin had reached for.
His symptoms were merely distracting at first: long nightly soliloquies at the dinner table, not conversations, but rants, tirades. Interrupting them carried a price.
His alienation deepened as his disease now commenced its executive control over his thoughts and actions. His voice had dropped and thickened again to the tough-guy tones he’d used before his Colorado conversion. Paranoia moved in. Neither Honoree nor I knew when a casual, even deliberately innocuous remark would unloose a stream of invective that quickly would pivot and focus on subjects, and, sadly, ethnic groups, that are the usual targets of paranoid thinkers.
This was not Dean. This was the thing that had colonized Dean’s brain. We knew this, but the knowledge brought us no comfort. To the contrary, it nearly incapacitated us with the same sense of helplessness we’d experienced as we had watched Kevin deteriorate. Since early adolescence Dean had despised medications, counseling, and hospitals. Unlike Kevin, he had gained the legal prerogative to refuse all of these. Dean was an adult when his schizophrenia resurfaced in force. He could not be admitted against his will to a psychiatric hospital or to accept psychotropic medication. That is, unless psychosis drove him into a state of emergency. Laws such as this, on the books in most states, are testaments to one of the most abject and—I almost wrote “maddening”—self-contradictions in the universe of mental health treatment. Their tight constraints, bureaucratically plausible yet recipes for calamity in life situations, require that a mental illness victim demonstrate “danger to self or others” before police and doctors can take control. In practice, this requires that a sufferer must come right up to the brink of committing demonstrable harm—violence—before restraints may be applied. The instances in which that “brink” is crossed are engraved in countless families’ memories.
And so—as with countless families—Honoree and I sat back and awaited the horrible inevitable: hoping against hope that the crisis would hit the slender boundary between the imminent and the actual.
I don’t think that either of us gave up hope entirely. I had studied Dean all of his life, as had Honoree. When I told her, as I did many times, “He is a lion. He will come out of this,” I was not whistling in the dark. I meant it. I just didn’t have any idea how this would happen.
He continued to eat and sleep in our house while paring communication with us to near zero. He continued to refuse counseling and medications. He ceased his mountain excursions with Rooster. He ceased going outdoors much at all. A bulky fieldstone fireplace, doubling as a support pillar for the roof, separates our kitchen from our living room. Dean took to striding around this pillar, sometimes for hours at a stretch.
At intervals he would rouse himself from this torpor and make erratic gestures toward launching a small-business career. Clinging to his Portland fantasy, he decided to open an auto-repair shop. We loaned him the money to purchase a small Quonset hut on property just across the New York state line about twenty-seven miles west of Castleton. He bought a used camper and often slept on the grounds. He got the interior into shape. He put up new beams, new insulation, installed a new floor. I have a photograph of Dean wearing welder’s glasses and staring at a flame in front of him. And then it went south. Dean lost all interest in rehabbing the hut or starting a repair business. This was—is—another common symptom of schizophrenia: the inability to sustain interest and enthusiasm.
It was now 2012. Dean was thirty-one.
One overcast afternoon late that fall, I approached the Quonset hut from the west. I was driving home from the Albany airport. I thought to turn off the highway and pop in for a visit.
Dean was sitting on a folding chair in the back of the camper a few yards from the hut as I rounded the corner. A few empty beer cans littered the little wooden platform in front of the door. Dean was hunched over, and it looked as though he had been weeping.
He got to his feet and let me hug him around the shoulders. “First time in a long time you’ve hugged me,” he grumbled. I kept my arm around him and guided him to the car, and we drove home, where Rock Bottom awaited us.
Christmas Eve was hell, and Christmas Day was worse. We argued fiercely over something or other that night—there was no avoiding it—and Dean awoke keening the next morning. Soon he was out of the house and striding down the curving dirt road, banging on doors and announcing that he was the Messiah. Some of our neighbors, unaware of Dean’s condition, seemed to see this as an excessive celebration of the Nativity. Telephone calls went out to the Castleton police. A call from the Powers household was among them. By the time Dean reached the bottom of the hill, a young officer stood outside his squad car waiting for him. Dean resisted getting in, and the officer was obliged to use some force, tempered with patience. Had it happened in any of many other locations around the country, Dean’s struggle might have been his last action on earth. I had never been so thankful for living in Vermont.
The officer drove him to the hospital in Rutland, where he was admitted as an emergency patient, sedated—this much was permissible without patient approval in our state—and held over for a month of examinations. Then, due in large part to Dean’s obstinate yet articulate arguments—truth be told, he could be a genuine pain in the ass in these situations—the doctors decided to release him into the care of a nearby recovery facility, one of the few of its kind in the country: Spring Lake Ranch, a working hillside farm for drug and mental patients in rehabilitation, had opened in 1932. Kevin had spent some weeks there in the last twelve months of his life and was helped, temporarily.
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sp; Dean agreed to spend three months at Spring Lake while accepting medications. He begged out after a month.
Spring 2013 came, and the weather turned warm, and at Lake George, New York, the resort area forty miles southwest of Castleton, people were starting to take out sailboats and test the shallow waters near the beaches for swimming. I had encouraged Dean to check out the area for recreation and maybe for meeting a girl. Circumstances came very close to making me wish I had never mentioned it. After he had left the house one morning, an ex-girlfriend texted Honoree to tell her that Dean had left a post on Facebook that suggested he was contemplating suicide. Around noon, Honoree tried calling him on his mobile phone. No answer; not even a ring. We drove to the Quonset hut. Dean was not there.
The familiar acid dread crept into our stomachs. We tried to think whom we might call. The possibilities were heartbreakingly few. We sat and looked out our living room window, hoping to see Dean’s pickup churning up the road below us to the house. The truck did not appear. We telephoned the Castleton police and reported him missing. That night we hardly slept.
The following morning we reached the police department in Glens Falls, some twenty miles south of the beaches. Yes, the desk officer told my wife: men in his department had come upon an abandoned green pickup truck on a short dirt road near the lake that matched the description Honoree had given him. Its doors were locked. Through the window, the officers could see a mobile phone lying on the driver’s seat. They decided to tow the truck to the department in Glens Falls.
Honoree gave the officer Dean’s name and our telephone number, and then, as we had several years ago after Kevin’s 4 a.m. call from Boston, we sat in our living room and waited for whatever was to happen next. Later, we both recalled how matter-of-fact it all seemed this time. We were numb, of course, and we silently braced for the moment when grief would burst through the numbness. Dean had muttered—albeit rarely—about suicide. Kevin had never mentioned it.
After an hour or so of silence from the telephone, I grew convinced that Dean was gone from us. Honoree did as well. I meditated dully on the question of what it would be like to live on with both our sons the victims of suicide. What it would be like to sleep, or try to sleep, or try to stay awake when the dreams were active, as they still were regarding Kevin. To arise and shower and dress in the mornings, buy groceries, pay tax bills, watch a television program, open the front door and step outside and get into the car and go off to risk making eye contact with a member of the damned human race.
To gin up the energy to give a shit about anything was what it all boiled down to. In my self-anesthetized state, the most optimistic thought I could manage was that neither of us would likely live that much longer anyway.
The phone finally rang between three and four in the afternoon. A Glens Falls officer was on the line to tell us that our son was in the hospital in the town. They’d identified him from the information Honoree had provided to the police department. A group of swimmers, heading for the wooded shore, had noticed Dean as he began to lower himself into the shallow water, on his back. He has since denied what we understood at the time to be true: that he had filled his pockets with rocks.
The swimmers hauled him out of the water. He did not resist. They called the Glens Falls police, who arrived and escorted him to the hospital. When Honoree and I arrived, Dean was in a sedated sleep, but he awoke to the sound of us. My wife and I later talked about his first moment of recognition. We had both noticed it, and each of us agreed that we would never forget it. His lids pulled back from his hazel eyes, and then his eyes came alive, and then he grinned. It lasted only a moment, that grin; and it has lasted ever since: a wide, unrestrained grin of pure joy. It was the grin of a child who had been through a nightmare experience and awakened to find his mother and father bending over him, embodiments, as they had been since time began, of the simple verity that things were going to be all right.
And they were to be. But—to quote Saint Augustine—not yet.
Again, our son was released after a few days of emergency care. The hospital was in another state and had no jurisdictional authority to retain Dean after that. Again, he came home.
His liberation from psychosis required one final harrowing episode. One further step toward the actualization of danger-to-self-or-others. That, and then the entry into his life of a psychiatrist who understood him: a young professional of empathy, insistence, and negotiating skill. He used all of these assets to wrest Dean from the gravitational belt of anosognosia, compelling our son to recognize that without an enduring commitment to regular counseling and regular medication, he would live the rest of his life in the fogbound cycle of psychotic crisis followed by temporary recovery. Or worse.
The psychiatrist’s name was—is—Gordon Frankle.
It all came down in September of that year. I had decided, with Honoree’s consent, to attend a writers’ conference in Texas. What was the worst that could happen? I found out the answer via telephone from Honoree the morning after I arrived in Archer City, Texas. Dean was back in the emergency room. Not long before her call to me, she had heard his panicky voice as he made his way up from his downstairs bedroom. His shirt was splotched with blood. Dean had tried to plunge a pocketknife into his chest. The folding blade had collapsed against a bone. Honoree called 911, and the arriving paramedics rushed him to Rutland Regional Hospital. I caught the next flight home from Dallas.
This time his hospital stay was long and arduous. Even given his gesture toward suicide, a judge needed to rule on whether permission of involuntary treatment could be granted. Because of bed shortages, Dean was forced to spend the first two weeks in a barren, windowless emergency room without pictures, mirrors, or anything with color, nothing except a bed and sheets. He passed the time in a state of fury.
Gordon Frankle delivered our son back to us, and to himself.
Not overnight, though. Dean spent twelve days in a psychotic state without medication, and then several more weeks in a regular bed. Yet, despite his typically overwhelming caseload, Gordon Frankle brought our son along slowly and carefully. He tested and balanced Dean’s regimen of antipsychotics by slow increments. Eventually he settled on a regimen of Haldol, delivered in monthly depot injections, which Dean maintains to this day.
Just as importantly, Dr. Frankle made time to talk with Dean; to talk seriously and probingly with him, measuring the length and intensity of conversations according to our son’s capacity to understand and respond.
Confidentiality will keep Honoree and me from ever knowing the content of these conversations. Yet knowing the content is not essential. What seems essential to us is that they worked.
It was late autumn before Dean was released. By this time the colonizing demon was nowhere to be seen or heard. The boyish smile we had glimpsed months earlier in Glens Falls was back. He had been chatting with hospital staff members who weeks earlier had been obliged to grapple with his bellicosity. “Your son’s a great kid,” an orderly told us during an early visit.
He was released shortly after a November snowstorm. He called us to announce that he intended to celebrate by walking the fourteen miles from the hospital to our house. To home.
He made it halfway before it got dark and he called again to ask for a ride. The next day he asked us to drive him to the pickup spot so he could complete his triumphal walk home.
21
Someone Cares About Crazy People
The future of mental health care is being shaped along two trajectories. Along one of them races scientific progress. Along the other path inches social reform.
If science fails, it will not have been for lack of trying. A Rand Corporation study found that more than 220,000 mental health research papers were published between 2009 and 2014, supported by more than nineteen hundred funders worldwide.1 The United States dominated the field, the report stated: as both the largest producer of research at 36 percent of publications, and as the largest recipient of government and private fund
ing at 31 percent.
The recent trajectory of science and technology clearly has revitalized the hope—indistinct though it remains—of a cure for chronic afflictions such as schizophrenia. Progress in this area has been stunning. Neuroscientists speak of a golden age, borne along by such breakthroughs as the gene-editing tool CRISPR, the so-called “brain-to-text” decoding system, the revolutionary rise of optogenetics.* 2 In 2014, the Sweden-based global technology developer Luvata finished work in its Waterbury, Connecticut, labs on the leviathan INUMAC.* This most powerful MRI scanner—to date—contains a magnet capable of lifting a sixty-metric-ton tank and containing more than 125 miles of superconducting cable. The magnet and cable produce a field strength of nearly twelve teslas—units of measuring flux density—which greatly exceeds any MRI system. This will enable the giant instrument to produce ultra-high-speed, crystal clear diagnostic “snapshots” of events in the brain. It sells for about $270 million.
Advances such as these have virtually enabled scientists to set up shop inside the brain, creating submicroscopic observation posts in its neural pathways. In the words of one neuroscientist, “Fundamentally [they show] that bipolar disorder, and in fact all mental illnesses, are brain disorders of a biological nature that warrant proper investigation including scanning. And that that will be of clinical utility in the near future.”