Daylight pours through the kitchen window of the small apartment. This room resembles an overexposed photograph compared to the adjacent living room, where Andy sits in the dark chain-smoking Marlboros and chuckling at Judge Wapner of The People's Court.
It may seem odd to be sitting indoors on a Tuesday afternoon behind drawn curtains watching TV, but it's routine for Andy. Sometimes he emerges from his suburban tenement to buy cigarettes or to get a meal, but mostly he sits and watches the tube. His gray hair makes him appear much older than his 35 years. The apartment, which reeks of Andy's two-and-a-half-pack-a-day habit, is decorated with basketball posters and a pen-and-ink drawing of Clint Eastwood that "might be worth something someday."
Andy is a paranoid schizophrenic. He's not a violent, child-shooting Laurie Dann; or a psychopathic Son of Sam. He's not a screamer, a mutterer, or a shopping-cart wanderer. Andy is one of the large number of schizophrenics who live in private hells--in the homes of their families, in mental hospitals, in nursing homes, in halfway houses, and in urban hotels. Generally unemployed and incapable of handling even minimal stress, schizophrenics living outside the hospital are often condemned to life sentences of listless isolation. And the cure rate for schizophrenia is not good: the "rule of thirds" is that, of schizophrenics diagnosed and hospitilized, one-third get well, one-third recover partially, and one-third remain the same. Dr. Fuller Torrey, a leading expert, writes that "if a patient is hospitalized more than three times, or if he/she has been sick even intermittently for longer than five years, the chances for full recovery become negligible."
"Schizophrenia is emerging as the worst mental health problem facing the nation," wrote a medical reporter in a recent New York Times article. Yet unlike other serious epidemics, schizophrenia rarely receives much attention, remarkable considering that two to three million Americans either have the disorder or will develop it at some point, according to statistics from the National Institute of Mental Health. Its cost to society is hard to pin down, but it is surely staggering. Some estimates reach $48 billion, more than 1 percent of the gross national product, when treatment, social services, and lost productivity are included. Yet psychiatrists in private practice rarely see schizophrenics--they are too difficult to treat and often too poor to pay.
Like AIDS, the disease has no cure; unlike AIDS, its cause is still a mystery. The belief that environmental factors cause the disease has now yielded to the widely held professional opinion that it's caused by biological factors--although external forces, like family stress, may trigger the illness. Unlike AIDS, schizophrenia doesn't attack specific high-risk groups--except youth itself. According to Dr. Torrey, three-quarters of all newly diagnosed schizophrenics are from 16 to 25 years old.
Andy was once a healthy, intelligent youth, but he fell prey to a disease that strikes without warning, tragically raiding the victim's sanity and subjecting him to years of recurring psychosis, heavy medication, and small hope of ever having a normal life again. Unfortunately, public misconceptions about schizophrenia cause many families to keep the illness a secret, fearful of scorn, blame, and rejection. In order to protect Andy's privacy, his parents wish to keep his real identity secret.
Andy grew up in an upper-middle-class neighborhood. He was a good student and an outstanding athlete. In high school, he and his brother both were reportedly watched by pro-baseball scouts. He was friendly and likable, his talent for sports earned him respect from the guys, and his Celtic good looks made him popular with the girls. He seemed destined for the good life.
Like many other young men his age, Andy wasn't sure what he wanted to do. His mother says that although attending college "was something Andy had looked forward to since he was a boy," he decided to leave school halfway through his first term, in late 1971 very much to his mother's surprise. After returning home he found work as a construction laborer, then left a few months later for Phoenix. After a week in Arizona, "Andy called home and said he was joining the Marines," his mother remembers. She convinced her son not to enlist.
Andy went instead that June to live with high school chums in Honolulu, in a tough section of Waikiki known as "the jungle." He lasted a month. "I could see a difference in him when he returned from Hawaii," his mother says. "It was like he was in outer space or something. He wasn't really concentrating." Andy had been home less than two weeks when his parents "really noticed odd behavior."
Andy tells a story about cruising the streets one night shortly after his return from Hawaii. "I was feeling like part of the city and really got into it at first," he now says. "It was like I was high without drugs." But the euphoric sensation suddenly turned ugly when Andy began believing that he was being "poisoned by exhaust pouring from tail pipes at an intersection." It wasn't long before "Andy started having hallucinations that people were talking to him through the TV," his mother says. "He began saying that my brother [a state policeman at the time] was conspiring with the FBI to get him on something," she remembers, adding that she stayed up many long nights comforting her frightened son.
Although it's thought of as a split-personality disorder, schizophrenia is not a Jekyll and Hyde disease. The split is not into multiple personalities but the division of a single personality. Psychiatrist Victor Gregory puts it this way: "Imagine that an old friend calls and says he's coming over. Fifteen minutes later the doorbell rings and you open the door to find the bill collector you have successfully avoided for months. The confusion that races through your mind at this moment is comparable to what constantly goes on in the mind of many schizophrenics."
Andy's parents suspected drugs and confronted him about that. They met with angry resistance. "He was never physically violent, but we knew we had to do something," his mother says, and during one explosive episode in which Andy locked himself in a downstairs bathroom they called an ambulance. Frightened by the prospect of being hauled away like a madman, Andy finally agreed to ride with his parents to the hospital.
"The psychiatrist diagnosed him almost immediately as a paranoid schizophrenic," his mother says. "He said he was sorry it wasn't drugs, because that was something he could possibly cure. He didn't give Andy much hope of ever getting along in the world."
Andy grew up with a generation that condoned, if it did not encourage, drug use. In the early 70s many high school students chose pot and psychedelics over Old Style and Bud. Andy's friends "chugged gusto," but they also identified with hippies and the drug scene. "I dropped acid and mescaline exactly 13 times and never had a bad trip," he says. The last time he tripped was on a quarter hit of "window pane" in Waikiki.
While mind-altering drugs, amphetamines in particular, may mimic the symptoms of schizophrenia, there's no evidence that they can cause the disease. The vast majority of psychiatrists agree on this. Still, most believe psychoactive drugs, such as LSD, can unearth schizophrenic tendencies, bringing the illness to the surface.
These days, antipsychotic drugs are the prevalent treatment for schizophrenia. They do not cure the disease but control its symptoms, so that hospital stays are shortened and rehospitalization is dramatically reduced. Prior to the use of antipsychotic medication, schizophrenia victims were often institutionalized permanently.
For six months after Andy's release from the hospital he kept a low profile, watching TV and sleeping. (He frequently mentions sleep as a kind of temporary escape from his illness.) Eventually he took a low-key job at his father's business washing company vehicles, but the medications he'd been taking, under his parents' close supervision, gradually lost their ability to control his delusions. Before long Andy was back in the hospital.
He describes in almost clinical detail the symptoms that professionals call alterations of the senses, which are especially evident in the early stages of a schizophrenic breakdown:
"One day I told my psychiatrist how good it felt to be alive. I had suddenly crossed some sort of threshold. I could look at somebody and see their soul. I got the feeling that I was the only one alive, and everybody else was an image sent from God. I couldn't figure it out. My whole orientation was off, the way I was born to see things had changed. I was enlightened, and I was thinking about things I'd never dreamed of before. I felt an indescribable love for people, and I felt I could communicate better than I'd ever done before." The spiritual revelations lasted nearly a year, but gradually "things got out of tune" and "the feeling went away."
It was during his second stay at the hospital, in early 1973, that Andy's psychiatrist suggested electroshock therapy. At that time, shock therapy was not an uncommon treatment for schizophrenia in the United States. (It is highly uncommon today, although it is sometimes used to treat depression.) It's difficult for Andy to recall the treatments, but he does remember pain. He reaches back and touches a spot at the base of his skull and says, "I still get headaches here." He had three sessions at one-week intervals, and his mother believes the shock therapy helped: "He went his longest period without hospitalization after the treatments, close to four years."
Andy remains bitterly against them, however, claiming that he didn't suffer hallucinations or delusions until after shock therapy. This may be a denial of the natural progression of his illness, a delusion, or a fact, but Andy's passion for this notion has prompted phone calls to his friends at 3 AM "to set the record straight."
Andy describes in lurid detail the visual hallucinations he experienced after electroshock: "I was seeing red everywhere, like there was blood on everything. Normal color appeared like bright neon. At times it was like I was looking through the back of my skull, through the blood and veins and out my eyes."
Six weeks after shock therapy, Andy felt well enough to return to his job at his father's company, and eventually he asked to be made a salesman. He says he saw the demanding sales job as a challenge to overcome his "temporary" illness. His parents were apprehensive at first but finally consented, hoping to bring their son back into society's mainstream.
But although medication kept the schizophrenia at bay, Andy had trouble mustering the courage to face strangers. He was afraid of exposing his sometimes bizarre behavior. And his occasional facial tics, vacant stares, and inappropriate eruptions of nervous laughter did make customers uneasy. He finally quit the job, on the brink of another breakdown. He remained unemployed for two years, living at home, sitting around the house during the day and, when the doctor took him off medication for a year, going out almost every night to drink beer at a tavern.
In 1976 he was put back on the meds, and he returned to his father's business, this time driving a delivery truck. He held the job for the next several years. During this period, Andy tried living on his own and with roommates, but he always ended up back at his parents' home a few months later. Except for a couple of relapses, Andy managed to maintain his mental balancing act until 1982, helped by daily medication and regular visits to his psychiatrist.
By 1982, however, Andy had become restless and complained to his mother about the delivery job. Lack of interest turned to lack of attentiveness, and one day he drove his delivery truck into an idling vehicle, sending a woman to the hospital. The accident so shook Andy's confidence that he quit his job and retreated to the basement den at his parents' home. He hasn't worked since, except for a brief stint at a gas station.
Although comparatively affluent, Andy's parents began feeling the economic strain of supporting an adult child after he quit working. They tried getting workers' compensation, based on a stress-disability claim related to the car crash, but found they had waited too long to file. A caseworker at the hospital told his mother about Social Security Disability Insurance, for which Andy was eligible because of his working past.
But his pride kept him from applying for federal aid. He had saved thousands of dollars by working and living at home, and saw no need to ask for assistance. About this time the family's lawyer advised his parents to get legal guardianship, which they did, giving them the right to apply for federal assistance on Andy's behalf and to control his savings.
Three years ago Andy moved out of his parents' house, after they decided that his living at home was disrupting their lives. "It was a painful decision," his mother recalls. "How do you tell your ill son that he can't live at home anymore?"
Statistics reveal that schizophrenics living at home are in the minority. Experts feel that at-home arrangements are not appropriate when the lives of family members are pulled out of orbit because everything is made to revolve around the mentally ill person. At-home situations fail especially when family members are critical, intense, and judgmental, or when the strain disrupts marital relationships. Andy says he was ready to leave home and welcomed the opportunity to live alone.
He first lived in an apartment. It was during this year that Andy began hearing mysterious voices. "Nobody in particular, just voices I've maybe heard somewhere before," he says when asked if the speakers were recognizable. "I'd be watching TV and they'd start taunting me, telling me unpleasant truths about myself and challenging my sanity." Then one summer day in 1986, while he was painting his parents' house, "The voices told me they'd give me life if I killed myself." Convinced that the voices were offering salvation, Andy took a knife from a kitchen drawer and went into the bathroom, locking himself in. The voices fell silent, but he knew they were still there, waiting for him to sever his jugular vein. Andy studied his aging image in the mirror and drew the blade to his throat. He slit the flesh below his left ear and began pulling the knife across his neck. It met resistance, and his attention turned instead to his wrists. Andy remembers how easily the knife sliced into his left wrist and how the blood oozed out onto the palm of his hand.
Even as he cut, however, he realized this "wasn't the right thing to do" and stopped. Andy then went calmly out to the patio and asked his parents to take him to a nearby hospital. He had just missed the vital veins.
Andy spent two weeks at the hospital, moving afterwards to a licensed residential-care facility. While there, he went regularly to an activity center for the mentally ill, but he quit going because he felt uncomfortable around other schizophrenics. In late 1986, with his mother's help, Andy found his current apartment. Since moving there he has suffered two relapses, but he has successfully returned to living on his own after each of them.
These days Andy talks often about getting a job, but when given specific suggestions dismisses them as unsuitable. His reasoning may appear flimsy, but apathy is a common symptom of schizophrenia. This lack of motivation is frustrating to family members and friends, who often interpret it as laziness. But as one expert remarks, "We may as well criticize them for having hallucinations."
Andy's phone calls to old friends often meet with subtle rejection. They are too busy with their own lives to pay much attention anymore, and view him as one of life's unfortunate casualties. Andy finds support from a small group of dedicated friends, a few with disabilities themselves. His psychiatrist provides support, too, but Andy says, "He talks so much about himself, sometimes I wonder who's the shrink."
According to those who have known him for a while, the most remarkable change in Andy since he first became ill in 1972 has been in his appearance. He has not aged well. His brown eyes have lost their distinctive brilliance, and his once-sturdy frame is now soft and corpulent. His jaw often hangs slack, and he sometimes speaks with a medicated slur. Andy's hair, which was once dark, has whitened so rapidly that by his 30th birthday he looked like a man of 40.
Andy hasn't bought groceries since letting his food stamp allotment run out last year. His cupboards reveal a box of Total, a can of Hormel chili, and a cellophane bag half-full of My-T-Fine candy corn. He usually eats out, either at a nearby pancake house or at one of the flock of fast-food joints near his apartment. Given his subpoverty income he is still eligible for food coupons, but he hasn't reapplied, even though his mother filled out the forms.
Andy now receives $432 a month for life from Social Security. His rent is $275; monthly medication, $100; psychiatrist's visit, $50; gasoline, $35; phone, lights, and cable TV, about $60 a month. His cigarette habit is about $20 a week. His mother manages all of his financial affairs and gives him $35 cash every four days or so. Even with insurance, his mother estimates they have paid 50 percent of an $80,000 hospital bill. "The $432 a month helps, but he certainly couldn't live on it," she says. Andy's parents have set up a trust fund, but his mother expresses concern that the account is limited and wonders what will happen to her son when that money's gone.
Although he was recently discharged from the hospital for the ninth time, Andy is enthusiastic. It's a sunny morning and he's driving the car his parents bought him. His eyes twinkle with an unfamiliar brightness as he talks about getting an education, a job, and the other things commonly sought by young men just starting out in life.
On days like these he nearly forgets his illness, except for the slight side effect of his medication called "tardive dyskinesia" or "prolixin stomp," which causes his foot to dance lightly on the accelerator. A Bruce Hornsby tune on the radio inspires him to talk about his greatest hope in life, to "lick my illness." The song is about rich men and poor men and how all you've got to do is look out an open door to see what's going on around you--something Andy's done for the last 16 years. The question is whether he'll ever be able to get up and walk through it.
Art accompanying story in printed newspaper (not available in this archive): illustration/Richard Laurent.