The betrayal of schizophrenia is its irrational juxtaposition of things that vanish and things that don’t. Schizophrenia can take away the ability to connect to or love or trust another person, the full use of rational intelligence, the capacity to function in any professional context, the basic faculty of physical self-care, and large areas of self-awareness and analytic clarity. Most famously, the schizophrenic disappears into an alternative world of voices that he erroneously perceives to be external; these internally generated relationships become far more real and important than any interaction with the authentically outside world. The voices are usually cruel and often encourage bizarre and inappropriate behavior. The person who hears them is commonly terrified and almost always paranoid. Sometimes, the hallucinations are visual and olfactory as well and make a world full of actual threats into a writhing hell of inescapable terrorization. Though many schizophrenics become curiously attached to their delusions, the fading of the nondelusional world puts them in loneliness beyond all reckoning, a fixed residence on a noxious private planet they can never leave, and where they can receive no visitors. Between 5 and 13 percent of people with schizophrenia commit suicide. In some sense, though, that is the least of it; a woman whose schizophrenic brother committed suicide said, “Eventually, Mama got over Roger’s death, but she never got over his life.”
Few things could be worse than perceiving your dreams as true. We all know that lovely relief of stretching out to welcome a new day, free of shadow horrors that came in slumber. Psychosis is a gross disturbance in an individual’s ability to distinguish self from reality. For schizophrenics, the membrane between imagination and reality is so porous that having an idea and having an experience are not particularly different. In the earlier stages of illness, schizophrenics often have symptoms of depression, because psychosis itself is distressing and because of the desperate nature of schizophrenic thought. This is the time of greatest suicide risk. In later stages, emotional capacity altogether is reduced, and people may seem vacant and emotionless.
Interviewing schizophrenics, I was struck by the way those deep in the disease seemed not to feel self-pity, which contrasted sharply with my experience of people with depression and other psychiatric disorders—a frequently whiny group to which I myself belong. People in the early stages were horrified and sad, but those who had been sick a long time were not. They complained about particular delusions or felt guilty not to be functioning better, but there was surprisingly little railing at the disease itself. Many had once been headed for wonderful lives, but the woman who had been a great beauty seemed, unlike her parents, not to think about the adventures in love she would have had; a sweet-natured fellow who had been wildly popular in high school could not tell me, as his parents could, how much pleasure a lifetime of friendships might have given him; a man who excelled at Harvard at the time of his first psychotic break never talked, as his parents did, about the career he had so narrowly missed. It seemed that illness had cut these schizophrenics off from those lives so entirely that they were hardly conscious of them. They had stoic grace in relation to their illness, and I was consistently moved by it.
• • •
The first time I met Harry Watson, he undermined my perceptions of schizophrenia. Impossibly good-looking at age thirty-eight, he had such a pleasant and open expression and such an easy and amusing way of speaking that I would not have known anything was wrong if I hadn’t been told ahead of time. He was at a party thrown by his accomplished half sister Pamela and had come with his naturally elegant, casually intelligent mother, Kitty, and the three of them seemed like they could have been extras in The Philadelphia Story. “I think he always hopes it will be more fun than it turns out to be for him,” Kitty said to me later. “He starts sweating a lot. He could barely get out of bed the next day.”
Pamela and Harry share Kitty as their mother; Harry has two other half sisters via his father, Bill. The only boy and the youngest of the four, Harry was born in 1969 in California, much indulged and doted on. “He was a wonderful baseball player,” Kitty said. “When he was about ten, he said the coach had asked him to be pitcher; Harry said, ‘I don’t think I could handle that kind of pressure.’ Doesn’t that sound strange from a ten-year-old? He has told me that even at that age, he felt like there was something wrong.” Pamela, a novelist and journalist, said, “You hear this story a lot, but he was a golden boy. He was a great athlete, charismatic, the one everyone copied. Then my mother and his father, my stepfather, divorced when he was twelve, the same year I left for college. The message he had heard all along from his father was that you don’t show weakness. Instead of admitting that he felt weird, Harry just hid it.” Until he finished high school, Harry still had friends and seemed like a normal teenager. “He presents as much better than he is, so even since his diagnosis, his therapists have picked up much less than they should have,” Kitty said. “He still thinks that if he acts like he’s normal, he’ll be treated more normally by the world. All it means is that he doesn’t get as much help as he needs.”
“We had no idea what was going on for a long time, so we didn’t take steps to find him proper treatment,” Pamela said. “The results were catastrophic. He was in the hands of this greedy, incompetent, unethical shrink my stepfather had found, and none of us realized how bad that situation was. It broke Harry’s heart to find that this guy was a charlatan—something he could see only many years and hospitalizations down the road—and he was never able to trust another therapist that way.” Recognizing psychosis can be a gradual project. “For years, I would instantly forget things Harry said and did that were just not right,” Pamela said. “The year I was twenty-four and he was eighteen, he became very depressed and secretive, and my mother convinced me to come home for Christmas to talk to him. We shut the door to his room and didn’t emerge for six hours. He told me that everyone thought he was gay. He was convinced that his girlfriend thought he was gay, that all of his friends thought he was gay, that my mother and his father thought he was gay. I said, ‘That’s ridiculous! No one thinks you’re gay.’ That was a revelation, and he seemed to be freed, and I felt very good about having helped him. Taking a step back, that was a very complicated, prolonged delusion. He really needed serious treatment.”
Harry enrolled in Rollins College and majored in philosophy and studied psychology—“clearly trying to understand what was happening to him,” Kitty said. The next Christmas, Pamela and Harry went to Palm Springs to join Harry’s father and his other children. “Harry was incredibly hostile,” Pamela said. “One night, he suddenly announced that he had taken acid with one of my stepsisters. He discovered on this LSD trip that his brain always is that way. That’s, basically, a declaration of schizophrenia.” Still, despite little episodes of weirdness through his college graduation in 1992, Harry seemed to be holding on.
Four years after graduation, he became full-on psychotic for the first time, terrified of his own thoughts; he went into Langley Porter Psychiatric Hospital in San Francisco in the spring of 1996. “We started playing Scrabble, because it’s hard to know what to talk about with someone that crazy,” Kitty said. “He was pointing to a van in the street, saying that’s where the FBI had their equipment. He thought the nurses were trying to poison him, and he didn’t want to take medication. I went to his apartment after he was hospitalized and it was in complete chaos, like a reflection of the inside of his head.”
Harry was in Langley Porter for ten days. When he came out, he found a job in computer programming. “It went well for a while, and then he was saying his apartment was bugged,” Kitty said. “He had stopped taking one of his medications. I said, ‘Why don’t you come over here for the night?’ He said, ‘Your house is bugged, too, I’ll show you where the transmitters are.’ So he takes me down to the laundry room and points to where he says the stuff is. I hauled him off to Langley Porter again, and this happened on and off for years. Within three days of his leaving the hospital each time, you could fe
el the self-deception growing thicker and thicker.” The war was being lost. “Unfortunately, by then, the voices had a grip on him,” Pamela said. “How can you compete when they’re piping in there twenty-four hours a day? It is so critical that parents of kids with mental illness see it early. If we had realized when he was fifteen that something was wrong, who knows what we could have done? It wasn’t until he was thirty that he was finally helpless enough, freaked-out enough, convinced enough, that he was back in our hands for treatment.”
Kitty experienced that year as a descent into deepening hell. “His father had a place in Napa,” she said. “Harry went there for a weekend in 1997 and never left. After almost a year, I showed up one day, and when he saw me, he screamed, ‘What the hell are you doing here?’ like he was possessed by some demon. I said, ‘Your dad and I feel that you need to come back to the city, start seeing a doctor regularly, live at home with me, and get on medication.’ He said, ‘I’m not going to.’ I said, ‘If you don’t, we’re throwing you out and you’re going to be on the streets.’ I was terrified that he would take me up on that, and I had found a private eye to follow him around, so that nothing bad would happen to him. A private eye to shadow someone with a paranoid delusion that he was being tracked by the FBI. He screamed how he hated me. Forty-eight hours later he moved home.” Pamela remembered, “Harry also has a drinking problem, and in Napa he just drank. I mean, bottles of tequila, until he blacked out. It’s amazing he’s alive. Then drinking would make him incredibly depressed. That’s when he would drive to the Golden Gate Bridge and sometimes stand right on it, thinking about whether to jump. He says he came very close once. But he’s not a risk-taker, so he’s less suicidal than you would expect.”
In the months that followed Napa, Kitty found it a great relief to have Harry back at home but also a constant stress to see him lost in his madness. “I would be bringing people in the house and I never knew when he might emerge,” Kitty said. “He often went off his meds and had to be rehospitalized. I would look around his room. It was the reverse of people who are addicts. If I didn’t see any bottles, I was really worried.” He soon moved back to his own apartment. “I would go ring the bell and he wouldn’t answer, so I’d let myself in,” Kitty said. “I had to go up a very steep staircase, and he would loom at the top. I was pretty sure he wouldn’t push me down the stairs, but he would scream and it was scary.” Pamela said, “He was hugely fat, incredibly hostile and angry, and didn’t believe a word anyone said. His disdain was so evident that it was terrible to talk to him. He was becoming like Jim Morrison in his later years, holed up in the house, filling salad bowls with pasta and eating them in front of the television set. It was hard to imagine him functioning in any way, shape, or form.”
Three years after Napa, when Harry was thirty-two, Kitty wanted to give him a fresh start, and she chose McLean, the mental hospital affiliated with Harvard, as the place to do it. “Getting him out of San Francisco and to McLean was an amazing achievement,” Pamela said. “I still don’t quite know how my mother did that. He was so ensconced in his little hole in San Francisco, and she had to persuade him to go along with it because she didn’t have any legal power to make him do it.” Harry was admitted as a long-term inpatient. He began new meds and started working with the therapist he has seen ever since. Harry, who is not tall, weighed 220 pounds; the doctors convinced him that this was neither smart nor healthy, and after about six months, he put himself on a diet and started running. Other patients would hum the theme from Rocky as he went sprinting across McLean’s grassy campus.
“It was hard lugging all that blubber around,” Kitty said. “Suddenly it dawned on me, why isn’t there a fitness center there?” Kitty raised the money to build one. Harry helped pick out the equipment. Kitty’s motivation was partly that she believes in fitness, but it also gave her an excuse to be in and out of the hospital without Harry’s perceiving that she was constantly checking up on him. The fitness center now receives some seven hundred visits a month. Harry has lost sixty pounds since he went to McLean. “He runs every day,” Pamela said. “He talks of having an illness. Frankly, if you had presented me with this scenario before he left San Francisco, it would have seemed like an impossibly upbeat outcome.” But the years between his first hints of psychosis and McLean have taken their toll. “Not only was there time lost, but also the brain’s not what it was after fifteen years of psychosis,” Pamela explained. “He’s a very damaged guy, but you can see how smart, articulate, and amusing he is, and what an interesting and dynamic life he might have had. He’s sick enough that he can’t really do anything, but well enough that he understands how much he’s missing. He’s well enough to know that he shouldn’t tell other people the voices are real, but not well enough to believe it himself. He told me he was worried that ‘the board’ was going to make these terrible decisions about him. I said, ‘God, the thing about these voices that’s so unimpressive is how boring and dumb they are. I mean, the board? The cheesiest TV show could do better.’ Then we can laugh. He and I also discuss a real hurdle he has not overcome, which is that he doesn’t really want to stop listening to them. Even though they scare him, they’ve been friends.” Kitty said simply, “Harry is having a tough time deciding whether he wants to be in the real world or that other world.”
Harry now lives on his own in an apartment in Cambridge. He runs every day for an hour, watches television, and goes to a lot of movies and coffee shops. He sees his therapist. He’s interested in fish and has a saltwater and a freshwater tank. He also had a job working in a greenhouse that is part of McLean’s vocational program. But in Harry’s world, nothing is stable for long, and on one of my later visits with Kitty, she revealed that he had stopped going to the greenhouse. “His world has plateaued at the smallness that it’s at,” she said.
Kitty wears herself down with the relentless quest to help Harry up, and though she has been more successful than anyone could have hoped, her restless frustration takes a toll. “Having my own children was very freeing,” Pamela said, “because I just couldn’t live and breathe this every day.” While she was saying this to me, Pamela put her cell phone on the table between us. “I have this as much for him as for my kids. He calls me when he’s feeling deluded and needs to be talked out of it. I know that if I’m not hearing from him, things are okay.” Kitty recognizes the advantages to this situation, but is also frustrated by it. “I had hoped Pamela would be more involved,” she said. At the same time, Kitty feels that she should shoulder as much of Harry’s care as she can for as long as she can. “He’s very lonely, but as soon as anybody tries to befriend him, he starts to have paranoid thoughts about them,” she said. “He told me he went running, and this guy says, ‘Harry, Harry.’ It’s the guy who makes pancakes in the diner where he goes. They talked for a while. ‘I felt like I was a member of a community,’ he said.” But Harry and his mother also joke. Kitty has kept a hand in at McLean by redesigning inpatient rooms. Harry said to her, “Gee, Ma, it looks like I’ve brought you a whole new career opportunity.”
Finding the balance between encouragement and pressure remains almost impossible. “He’s really doing the most he can right now,” Pamela said. “Somehow, I feel like we’re twins. There’s been almost nothing he’s explained that I haven’t felt I could extrapolate from my own experience. I’m a fiction writer, and he is also a fiction writer, in his way. He creates other worlds; at times he’s lived in other worlds. There are characters; there are planets. He has a great aesthetic sense, and that infuses his delusions. It’s a very dangerous, scary, lonely world, but it also has moments of beauty in it. My mother deserves huge credit—for just never giving up. My stepfather couldn’t stay in there, fighting; it was too painful for him, but it brought out the warrior in my mother. It’s my mother, the doctors—and, most of all, Harry. He turns out to have a lot of grit. He’s a hero to me. He’s someone who’s been in Vietnam for fifteen years. He still gets up and finds things to be joyful about
. Would I have the stomach for the life he has? I’m not sure I would.”
Kitty led long stretches of a charmed life before Harry got sick. “I was a lot more frivolous before I was dragged kicking and screaming into the world of mental illness,” she said. “Now, I’m always helping people out or offering advice or finding them doctors. I’m sure it’s been character-building, but frankly, I preferred being happy and frivolous.” She knows that Harry feels guilty about the effect he’s had on her life, so she tries to minimize it. I asked her how much of her time and emotional energy Harry occupied, and her eyes filled with tears. She shrugged, and forced a smile. “All of it. All of it,” she said, almost guiltily. “I can’t help it.”
• • •
Schizophrenia is broadly categorized as having positive symptoms—the presence of psychotic hallucinations—and negative and cognitive symptoms—psychic disorganization, absence of motivation, blunted affect, loss of language (called alogia), withdrawal, compromised memory, and general decrease in functionality. One expert described it to me as “autism plus delusions,” which is an inadequate but not unilluminating description. Here is a patient’s description of her positive symptoms: “I could find no rest, for horrible images assailed me, so vivid that I experienced actual physical sensation. I cannot say that I really saw images; they did not represent anything. Rather I felt them. It seemed that my mouth was full of birds which I crunched between my teeth, and their feathers, their blood and broken bones were choking me. Or I saw people whom I had entombed in milk bottles, putrefying, and I was consuming their rotten cadavers. Or I was devouring the head of a cat which meanwhile gnawed at my vitals. It was ghastly, intolerable.”
Here, by contrast, is another patient describing the experience of the negative and cognitive symptoms: “I am all the time losing my emotional contact with everything, including myself. What remains is only an abstract knowledge of what goes on around me and of the internal happenings in myself. Even this illness which pierces to the centre of my whole life I can regard only objectively. I cannot picture anything more frightful than for a well-endowed cultivated human being to live through his own gradual deterioration fully aware of it all the time. But that is what is happening to me.” The Nobel laureate Eric Kandel described how schizophrenia takes away the wanting of enjoyment. “Imagine someone who has a great time whenever he goes out to dinner, but who has absolutely no interest in doing it,” he said. The pleasure principle says that we will always seek gratification and avoid suffering, but for people with schizophrenia, at least half of this is untrue.
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