by Anna Berry
Childhood-onset schizophrenia is extremely rare but not unheard of. I’ve often wondered if my brother had it, if perhaps his schizophrenia merely matured along with his body, rather than emerging at puberty or late adolescence, as it does for most male schizophrenics.[4] There were certainly plenty of indications during Mark’s formative years that he was destined to a life of severe mental illness.
Growing up, Mark often had difficulty with basic hygiene. I remember many late-night conversations between my mother and father on what to do about Mark’s refusal to use toilet paper when he defecated (he was almost ten at the time—old enough to know better). In high school, when most young men are fastidious about their appearance, Mark had to be reminded, cajoled, and sometimes even forced to brush his teeth, use deodorant, even bathe. My father spent an inordinate amount of time emphasizing the importance of shaving with a sharp, clean razor, to no avail—Mark’s face was always a mess of razor burn and infected cuts from ancient, rusty blades.
Psychiatrists call the poor hygiene and poor social skills typical of many paranoid schizophrenics symptoms of “disorganized behavior.”
Mark’s behavior was very, very disorganized.
His taste in clothes was odd. When most kids our age wore jeans, T-shirts, and sneakers for both school and play, Mark preferred to wear stiff gray corduroys, button-down Oxford shirts, and loafers—just like a miniature Alex P. Keaton. In the 1980s this wasn’t necessarily odd, but it was odd when you considered the fact that Mark wore these formal clothes, unwashed, day in and day out for school, play (and sometimes even sleep) until they formed stiffly to his body like a reeking second skin. The colors and styles of clothing he wore never changed from year to year, even during his teens. Every fall, when Dad took us to the local mall for our school wardrobes, Mark always picked out four identical pairs of gray corduroys and four identical blue Oxford shirts from the men’s department, and he wore them until they fell apart. Mark refused to let anyone buy him anything else to wear during regular day-to-day life, and any clothes he received as gifts other than his preferred corduroys and blue Oxfords would sit untouched in his bureau drawers.
One day in junior high, I take Mark aside after I witness him receive a particularly bad bruising from a pack of jocks, and suggest that he let Dad buy him at least one pair of normal, boring jeans. “You might not get beat up so much that way,” I say.
I’m only trying to help.
“I can’t wear jeans,” he snarls.
“Why not?”
“Because they don’t stay on my body,” he says.
I laugh at this. “What do you mean?”
“Because they won’t stay on my body,” he all-out screams. “My body won’t hold them. They won’t hold my body.” Mark then pats himself down, as if he needs to check that his body is still there.
This is probably the first example of Mark’s impaired perception or expression of reality. His brain has conjured up the idea that his very existence is somehow tied to wearing identical gray corduroy pants every day.
My mother swears to this day that she never could have managed Mark and me as babies (we were born barely a year apart) if I hadn’t been the standoffish, quiet infant that I was, a “good” baby who slept through the night almost from birth without coddling. I preferred to feed and entertain myself from the very moment I was able. I was a dreamy and introspective child, happy to be left alone all day in a playpen while my mother devoted every waking minute to trying to keep Mark from tearing the house down, and himself with it. I had a factory-loaded stronger personality and fierce, independent streak from the get-go, and Mom indulged both by ignoring me while she cosseted my needy older brother and met his every demand and whim.
I was strong. Mark was weak. And in parenting us the way she did, my well-meaning-but-naive young mother—barely an adult herself, with two babies by age twenty-three—strengthened the strong and weakened the weak.
There’s a Simpsons episode that illustrates the circumstances of my early childhood exactly. In it, Lisa Simpson is shown in flashback as a baby, lying face up on a diaper table. Marge and Homer Simpson are in the middle of changing her diaper when Lisa’s brother Bart sets the curtains on fire, then runs his toy car through the wall, then shreds the carpet. Marge and Homer drop everything and ignore Lisa to try (in vain) to control the out-of-control Bart. Baby Lisa ends up rolling her eyes, sighing, and changing her own diaper.
Scientists disagree on what exactly causes schizophrenia, though it seems to have a much stronger genetic component than other forms of mental illness. However, a strong genetic predisposition to schizophrenia still isn’t a definitive predictor of who will develop symptoms of full-blown schizophrenia. Multiple studies have concluded that childhood psychological trauma, especially in adolescence, can awaken the unique orchestra of genes that then work in concert to produce the cacophony of brain noise that is insanity.[5]
My brother was never what you’d call a “normal” child, but he didn’t become seriously ill until he was about sixteen, around the time that Dad’s marriage to his second wife, Martha, began to fall apart. By then my dad had begun an affair with Martha’s best friend, “Tracy,” and when Martha found out, she threw Dad, my brother, and me out of the house. The three of us stayed in a cheap motel for a couple of weeks, then Dad found a house for us to rent in the same school district. Tracy soon left her own husband and moved in with us. Mark, who unlike me had gotten along well with Martha, hated the whole arrangement.
Mark and Tracy never got along, and after a year or so of constantly butting heads, Mark finally suffered an all-out mental breakdown. He refused to attend school, ripped man-sized holes in our rented, suburban-tract home’s prefabricated particle-board doors with his bare hands, kicked down drywall, and made himself throw up all over the dinner table more than once—all because he thought Tracy was a member of an “alien KGB” who was supposedly trying to kill him. He hallucinated alien attacks in our backyard and threatened Dad at his job multiple times. For reasons I’ve never understood, Dad finally called Dr. Nickelback—the “Dr. Feelgood” shrink who first got my mother hooked on heavy psychotropic meds—and Dr. Nickelback recommended that Mark be immediately admitted to the brand-spanking-new private mental hospital for adolescents that Dr. Nickelback had just opened with a partner. Not surprisingly, Mark didn’t get better—in fact, he moved out of Dad’s house shortly thereafter and they remained estranged for years. Meanwhile, Dr. Nickelback’s private mental hospital later got shut down by the state for fraud, and Dr. Nickelback and his partner both lost their licenses to practice medicine due to their unethical drug-prescribing practices.
Mom was pretty much out of our lives during this period, though she does say that Dr. Nickelback did call her shortly after Mark was admitted to his private hospital and informed her that her only son was “schizo,” as Mom not-so-politely puts it now.
Although I believe my brother would have succumbed to schizophrenia at some point regardless, I believe our unstable family life didn’t exactly help matters, and it probably hastened the onset of his illness. To this day, both Tracy and I also believe that Dr. Nickelback’s questionable medical practices probably did permanent damage to Mark too.
What is schizophrenia, really?
I’m no clinician, but growing up with my brother makes me an expert in the condition by default. Psychiatrists describe two major symptom categories for the disease: positive symptoms and negative symptoms.
Positive symptoms are the obvious ones, the symptoms we see caricatured on television and in the movies: hearing voices; delusions; fear of everyone, and everything; vacant, staring eyes; rage, anger, and violent verbal and physical attacks on loved ones and random strangers alike; extreme self-involvement; strange speech patterns (rambling monotones are typical); the inability or all-out refusal to adhere to societal norms; poor hygiene; and poorer social skills. My brother has them all, even when he’s on antipsychotics.
Negative symptoms ar
e a little harder to discern. Essentially, negative schizophrenic symptoms are the absence of the subtler cognitive abilities that are present in normal people—that is, affective flattening (lack or decline in emotional response); alogia (lack or decline in speech); and avolition (lack or decline in motivation). Mark has displayed all of these at one time or another, but the negative symptom that plagues him the most is avolition. Despite having a high IQ, a college education, and the additional vocational training he received while serving in the military, Mark has refused to hold down a real job for his entire adult life—and not for lack of employment opportunities. Offered literally dozens of good, professional jobs with solid-middle-class salaries over the years at employers ranging from the VA and Disabled American Veterans to local social-service agencies and even the local university, Mark always either refuses those job offers or works at the jobs no more than one or at most two weeks at a time. His reason is always the same: “I have to have the perfect job, and this job wasn’t perfect, so I quit.”
Instead, Mark relies on others—his family, the Catholic church, his wife—for financial support. He has mastered any number of manipulative tactics to maintain a support system that will cater to his every need, tactics that he first learned by monopolizing every second of my mother’s time when he was a toddler. You might say he’s a professional moocher.
Mark is also a notorious hypochondriac. I’ll even go so far as to say that Mark has a mild case of Munchausen’s syndrome, a mental illness classified by the sufferer’s relentless fabrication of false physical and emotional illnesses to satisfy an emotional need for attention and sympathy. Whether Mark’s supposed multiple ailments are deliberately fabricated or merely another set of schizophrenia-induced delusions has never been entirely clear, but he has consistently engaged in heavy-duty hypochondriac behavior since his early teens.
To wit, Munchausen’s is most common in persons with schizophrenia and other severe personality disorders. My brother was first diagnosed as a paranoid schizophrenic in his late teens, though he has never received an official Munchausen’s diagnosis to my knowledge (the very nature of the illness means that few Munchausen’s sufferers do).[6]
Starting around age twelve—and continuing to this day—Mark’s life has always revolved around what kind of mysterious ailment he can come down with (or more accurately, come up with) next.
Throughout his adolescence and early adulthood, Mark “came down with” food poisoning, hypoglycemia, diabetes, kidney failure, impetigo (“caused” by his relentless scratching and picking at mosquito bites and pimples), fainting spells, heart arrhythmias, migraines, Lyme disease, West Nile virus, malaria, and a host of other ailments that disappeared and were replaced with something new almost as soon as someone figured out he was faking it to get attention.
Today Mark uses his advanced hypochondria to control others most of all—making manipulative demands on where everyone in our family can go, and what we can eat, watch on television, wear, and even wash our hair with in his presence because all of these things might in some way aggravate his (supposed) asthma, gastric-reflux disease, vertigo, seasonal-affective disorder, heart arrhythmia, restless-leg syndrome, fibromyalgia, or whatever other ailment he’s concocted for himself this or that week. Mark’s hypochondria is so convincing to strangers that he’s managed to manipulate unnecessary prescriptions for drugs (including several controlled substances)—and even unnecessary surgery—for these nonexistent ailments. I’ve often wondered why so many physicians—who have surely examined his medical history of paranoid schizophrenia and the long list of odd diseases that mysteriously appear and disappear, one after the other—don’t put two and two together. A convenient consequence of Mark’s constant “illnesses” is that it provides him with another excuse not to get a job, which serves to satisfy his schizophrenic avolition.
There’s an incident that illustrates both Mark’s avolition and his delusional hypochondria perfectly. I’ll go so far as to recommend that psychiatry and psychology professors use it to teach their students, in fact.
In mid-2004, Mark and his much younger new wife (an intelligent, kind, and highly-paid-but-naive computer systems engineer) decide to make a trip to Chicago to visit my husband and me. I speak with Mark’s wife, Stephanie,[7] at length on the telephone in the days leading up to the visit, and she expresses her and Mark’s desire to see some Chicago theater and sample some of its best ethnic restaurants. I’m an avid connoisseur of both, so I promise I’ll show them both a good time.
I ask Stephanie what kind of food and theater she and Mark might like to see. (Mark’s extreme political conservatism limits the subject matter he will tolerate—that’s yet another tactic he uses to manipulate others.) I suggest a production of Woody Allen’s lighthearted religious satire God, which is being produced and directed by some friends of mine at Chicago’s Chemically Imbalanced Comedy, and a trip to Devon Avenue for some authentic Indian food. Stephanie says she thinks that will be fine, but she’ll have to check with Mark first.
Over the next several days, I field several more phone calls from Stephanie, who is serving as a sort of go-between for Mark’s many demands. “Mark says that Indian food is okay as long as it’s not too spicy, and we can’t go to any restaurant that has candles on the tables,” she says. “The candles aggravate his asthma. The last time he was around a candle, I had to take him to the emergency room.”
I have to stifle a laugh. Mark and Stephanie were married only about six months ago; I stood up at their wedding in a small Catholic church where burning candles were plentiful. They’d even lit a unity candle on the altar together. As far as I could recall, Mark claimed to have asthma at the time of their wedding, and as a member of the wedding party, I was made to refrain from wearing perfume and to wash with unscented, hypoallergenic shampoo and soap that Mark had pre-approved as not aggravating to his asthma. No mention was made then of candles being a problem; this is obviously some new delusion Mark’s brain has manufactured.
“Well, that might be kind of hard,” I say. “Most nice Chicago restaurants have candles on the tables.”
“Mark says there can be absolutely, positively, no candles or open flames of any kind at any restaurant we go to. That includes Sterno heaters.”
Then I really do laugh. “Well, that will knock out most Indian restaurants. A lot of them use Sterno on the buffets, sometimes even on the tables to heat curries.”
“I’m sorry,” Stephanie replies. “No candles, no open flame. That’s just what Mark says we have to do. But he really has his heart set on Indian no matter what, so he can get tandoori chicken. Do you think one of the Indian places might put away their candles and stuff if they know we’re coming ahead of time?”
“All right,” I sigh. “I’ll see what I can do.”
I call around to the numerous Indian restaurants on Devon Avenue where George and I like to go for dinner. One of them where my husband and I are regular customers agrees not to set candles out on the night we’re coming or seat us around any Sterno heat, provided I can guarantee that we’ll spend at least $100 on our meal. That’s not a problem—knowing Mark’s ravenous appetite for food and booze, I know he’ll probably rack up that much by himself. The manager promises to seat us off by ourselves as far away from the Sterno cans on the buffet as possible. I call Stephanie back and tell her about the arrangements I’ve made, and she tells me they are probably fine.
Things seem to go all right at the restaurant until we’re about midway through the meal. There’s a half-wall dividing the semiprivate dining room we occupy from the main dining room. Mark sits facing the half-wall, so he can see what the people on the other side of the restaurant are eating. Someone orders a sizzling tandoori dish that requires a cast-iron pan be set on a rack over a can of Sterno. The family eating the sizzling dish sits a good ten yards away—and Sterno has no smoke or odor anyway. But Mark sees his opportunity, and he takes it.
“We have to leave now,” he shouts, and stand
s up.
I try to keep the scene from getting out of hand. “What? Why?”
“You told me there’d be no open flames!” he shouts, louder this time. “There’s an open flame!” Mark starts huffing and puffing, and pretends to be lightheaded. I know he’s pretending because it’s the exact same act he used to pretend he was having a hypoglycemic attack when we were kids. He starts pacing up and down, wheezing and moaning. People on the other side of the restaurant turn to stare.
My husband balls his napkin and tosses it onto the table, furious. I promised him I wouldn’t let something like this happen tonight, and less than an hour into the evening, I’ve already failed.
Stephanie immediately goes to comfort her husband. It’s clear Mark has her trained; she falls hook, line, and sinker for his manipulative act.
I pity her.
Stephanie ushers Mark out of the restaurant and out onto the busy street while George and I settle the huge bill—Mark has ordered himself the most expensive spiced roast lamb-and-chicken dish on the menu, along with two giant Taj Mahal beers, which he emptied right before pulling his dramatic-asthmatic act.
Things only get worse when we get to the theater. I’ve reserved four tickets for us to the sold-out Saturday show at Cornservatory on Lincoln Avenue, where the latest Chemically Imbalanced Comedy play is running; the only reason I’ve been able to get tickets on such short notice is because I know the show’s producer. Since we’ve blown out of the restaurant early, we are an hour early for the show and can’t sit down yet, but the producer is already setting up the box office when we arrive. I’ve promised to pay cash for the tickets on arrival, and I dig $60 out of my purse to cover the cost of four tickets—but as I do, I see out of the corner of my eye Mark giving the ramshackle theater lobby a look of disapproval.