by Marin Sardy
* * *
—
The thing about the game is that when Mario dies it is you who decides what happens next. As in life, you do not die with him. You remain young and strong and fully composed of flesh and bone and sinew. But then you press the Start button and he appears again. As before. And you go on, and you begin to believe in endless second chances. That in every way the logic of the game will reach beyond the screen. That there will always be another opportunity for your pain, for your brother’s pain, to be redeemed.
Vagabond
Things had changed, mysteriously and suddenly. In 2009, as winter crept in, Tom set up a camp for himself under a boat in the yard across the street from Dad’s house. It was a fairly large wooded lot that bordered on a small creek, and amid the trees there was an old wooden fishing boat stored upright under a large blue tarp. Tom established himself beneath it, in the sheltered space between the tarp and the hull.
Later, when I learned of this, I felt that Tom’s circumstances had never seemed more unreal. Under a boat. It was a phrase everyone repeated, as if it meant something. He wasn’t just living in a yard directly across from Dad’s house, but also under a boat. We kept saying it. As if by holding up the phrase and turning it, by passing it around almost as a talisman, we might use it to catch the light and discern the meaning of what was happening. This was the way things changed with schizophrenia—jarringly, seemingly without preamble, leaving you to wonder what you missed and forcing you to conclude that you missed everything.
* * *
—
Dad had last seen Tom one evening when he stopped by the house, not long after Halloween. Excited, Dad washed his clothes and convinced him to take a shower and wash his hair a few times, and he gave him a haircut and some new clothes. They went out to dinner. Things went well, and although Tom was “pretty out there,” Dad wrote, he seemed “neither worried nor unhappy.” Dad brought up the question of where Tom could live for the winter, but Tom said he had lots of places to stay, and when Dad tried to give him a hundred dollars, he would only take twenty. It wasn’t yet apparent that something was getting worse for Tom, his mind on the verge of spinning into darker places.
Sometime later, Dad learned that Tom was under the boat across the street and had been living there for a few weeks. The neighbors had known Tom since he was a little boy and had always liked him, so they said they didn’t mind it. At first, Dad let it be. The spot under the boat was quiet and safe. But eventually it got very cold, and Dad, worrying, went to see if Tom was okay. Tom lashed out, raging at Dad for coming over and poking around, shouting repeatedly to go away, stay away. Stunned, Dad backed off and didn’t bother him again.
Around that time, Zach was living in a house nearby with an unused bedroom and convinced his roommates to let Tom live there rent-free. Though Tom was more agitated than usual that winter, he at first seemed content, just quietly hanging out in the bedroom they gave him. But soon there was friction with one of the roommates, and then when they learned that the owners were going to sell the house, Tom began to believe that he had bought it. Things came to a head one day when Tom was home alone and took the only key, locking the roommate out of the house. (It was Dad who finally got the key back, calling Zach’s house and inviting Tom to dinner, offering to wash his clothes, and then digging through the pockets to find it.) Zach had to tell Tom he could no longer live there. Soon he was back under the boat.
In early spring, after a few weeks of increasingly erratic behavior, Tom started ranting and screaming obscenities at the neighbors who owned the boat. Dad had gone to Girdwood for the weekend and so wasn’t there to step in. The neighbors, alarmed, called the police, and when the cops arrived, Tom asked to be taken to API. This was, as far as we knew, the first time he had ever actively sought psychiatric care.
ALASKA PSYCHIATRIC INSTITUTE
Admission Psychiatric Evaluation Admission Date: 04/14/10
IDENTIFYING DATA: This is the second Alaska Psychiatric Institute (API) admission for this 32-year-old unmarried Caucasian male. Past psychiatric evaluation indicates the patient is college educated, at one point achieving a 3.9 grade point average until onset of psychotic symptoms.
PRESENTING PROBLEM/CHIEF COMPLAINT: The patient was referred to the Alaska Psychiatric Institute from the Psychiatric Emergency Department at Providence Alaska Medical Center for evaluation of psychosis. The patient was floridly psychotic during this interview but appeared to be making a good-faith effort to be cooperative with assessment and interventions.
HISTORY OF PRESENT ILLNESS: The patient has a history of schizophrenia. Apparently, he has been living under a boat in the neighbor’s yard. Providence reports that the patient was seen hallucinating and was threatening to kill his neighbor. His neighbor was scared and no longer wants the patient to live on his property. The patient arrived to Providence wearing a shirt that was full of burn holes from cigarettes. The patient was loud, disorganized, and threatening. He was held in psychiatric observation and given Zyprexa Zydis to treat his psychosis but without resolution. He remained disorganized and psychotic, and it was felt prudent to transfer to API for further assessment and stabilization. The patient was cooperative with escort to the interview room. He was malodorous and appeared disheveled. The patient spontaneously offered several bizarre tangential narratives with delusional content. He referenced having his voice stolen by an Alaskan Native, and therefore, he must talk in an accent. He then assumed a British-style accent but stated he was actually from Germany. He referenced “moral clouds” and how he interacts with them. He displayed loose associations, and overall, he was quite disorganized. He had difficulty answering basic interviewing questions; for example, when I asked if he has seen a doctor recently, he responded with an explanation of how he doesn’t like doctors, but he likes docks in the ocean and that he is actually a sailor; and overall, it was difficult to elicit reliable information. He self-identified as feeling in psychiatric crisis. He states he comes to API periodically for a “check-up.” He denies feeling suicidal or homicidal.
MENTAL STATUS EXAMINATION: He appears thin. He makes sparse eye contact. His affect is mildly anxious. There was no display of agitation. He was cooperative, pleasant, and easily engaged. His speech was rambling. He was alert and fully oriented to person, place, date, and situation. His memory and concentration are distracted. Judgment and insight are impaired.
* * *
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This was when my sisters and I learned of the boat, of Tom’s camp across the street. Dad hadn’t mentioned it to us. I didn’t ask why. It was easy enough to guess. Probably it was just too painful—too difficult to say out loud, three times, to three different daughters.
But now, suddenly, Tom was saying yes to the help he was offered—including medication. He stayed at API for a few months, during which time his treatment went beyond merely minimizing symptoms to include “person-centered” therapy, which would help him learn how to manage his illness and build the skills he would need to function consistently in day-to-day life. Eventually he signed a release-of-information form, allowing API to contact Dad, who visited and noted that Tom was beginning to seem a bit like his old self again. I began to believe that this thing had finally turned around, that Dad’s terrible gamble was at last paying off.
But in August, after Tom was transferred to a halfway house, he had trouble there and was sent back to API for another stint. And sometime around then, unexpectedly, he revoked the release of information and cut off all communication with Dad. He didn’t say why he did it, but I suspect it had to do with finding himself again without an adequate place to live—that this brought up his old anger at Dad or triggered his paranoia. Whatever the case, it meant that Tom would be attempting the difficult process of rebuilding his life on his own, without Dad’s help.
And he faltered. His second stay at the halfway house did not work out. Nor did he go back to
API. By late September, he was homeless again.
* * *
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Adrienne flew home. Her schedule required that she make the trip while Dad was out of town, but she stayed with her friend Lindsey’s parents and had their support. She found Tom near Lynn Ary Park one day when he came up behind her and started walking alongside her, his stride matching hers. They sat on a bench and talked for a long while, and on subsequent days she met him at a soup kitchen downtown, where he went every day for lunch. He was still relatively coherent from the medication he had taken at API—enough that their old ease, their rapport, came right back. Enough that he could describe his experiences somewhat and answer her questions. He told her many things that surprised us, things we had been wanting to know, things we had no idea what to do with.
He was camping in the woods beside the Coastal Trail, walking a few miles into downtown every day to eat lunch at the soup kitchen, stuffing his pockets with extra cookies and fruit, staying until the last twenty minutes, when they gave away the extra sandwiches. It seemed to be his only food. He had a sleeping bag but no tent, no cold-weather clothes, and he was worried about the coming winter. He spoke of getting up in the middle of the night to move around and warm himself, sometimes once every hour, sometimes more, all the way through to morning.
When Adrienne asked if he needed anything from the store, he asked for some toilet paper and Pepto-Bismol. He had diarrhea and had nowhere to wash his clothes, nowhere to shit besides the woods. When she probed, he replied casually that it happened sometimes, and it was easy to guess what might be the cause—jail food, dumpster food. She took him to Lindsey’s parents’ house so he could change and shower while she washed his dirty clothes. As he stripped down, she saw his body, how it endured—strikingly chiseled, sinewy, not an ounce of fat. She told him he could sleep there, but he refused. Nor would he show her exactly where his camp was, and at the soup kitchen she noticed how guarded he was around the other diners. It was clear that Tom’s illness had impaired his ability to gauge others’ intentions, making it hard for him to discern the safety of new situations and the trustworthiness of strangers. It was best to just keep to yourself, he told her, because you never knew what others were going to do.
She bought him hats, long underwear, thick socks, Carhartt pants, a down vest. He was concerned that he was strapping her financially, so she said they were just things she had lying around, that he may as well use them if he could. She didn’t have enough money to buy a bivouac sack to keep his sleeping bag dry, but she did give him a hundred dollars and a Wal-mart card and told him about a program she had learned of, through which churches opened their doors to the homeless on nights that dipped below twenty degrees. He was happy for all of it, especially the clothes.
His talk often turned to his recent stay at API. He had liked it there and was shocked when they told him he was being transferred out to a halfway house. He had thought he was going to get to stay indefinitely. He explained, too, that he sometimes had what he called “episodes”—what sounded like flashes of aggression or violence that came on in moments of desperate confusion. He was visibly troubled by the fact of the episodes and told her that one had happened at the halfway house. She gathered that he had difficulty coping in the less controlled group setting—the activity, the intensity of people being loud and unruly sometimes. After an episode, because of the episode, he had left. Whether this was by his choice or theirs, she couldn’t tell.
The episodes had happened, too, at API, where they had been bad enough that the staff had physically restrained him at least once. This was scary for him, had grown warped in his memory, and he spoke sometimes of API as a bad place. But he was also confused about that, telling Adrienne that he thought perhaps API staff had not actually restrained him but had instead sent him to jail. It came out that he hated jail, that it was a hard, harrowing place for him. He said repeatedly that it frightened him. That was the word he used—frightened. What was worse, he didn’t seem to know what he had, in the past, been arrested for. It was as if jail was something he couldn’t see coming, something he felt could just happen to him without warning. So, he explained, he had decided that if he ended up in jail again, he was just going to close his eyes. That was how he would manage. He would just keep his eyes closed.
Now he was worried about API as well, because if API had sent him to jail, that meant he could never go back to API either. Adrienne, listening to it all, was struck by the depth of his confusion, and by the genuine need with which he asked her what she thought had happened. “He had a sense that he didn’t know,” she told me, “but didn’t know what part he knew and what part he didn’t.” When she checked with API about their policies and reported back to him that API would not have sent him to jail for any reason, Tom was immensely relieved. So she pressed the point that API was a safe place, and kept talking about it, trying to assure him that he could always return there.
There was a voice, too, that frightened him. A bad voice, a voice that he could hear coming back now that he was off his medication. It was talking to him while he spoke to Adrienne, telling him things about her, things that were not good, though he refused to say what. He knew, he said, that it was just a voice. A nurse at API had talked about it with him, teaching him how to deal with the voice, how to question it, how to choose to ignore it. And for a while, medication had made it disappear. Adrienne called API and tried to speak with that nurse, but he would not return her calls. We figured that he was probably not allowed to speak to her without Tom having signed a release of information.
Even while homeless, Tom was still trying to apply the skills he had developed at API. He had learned the importance of having a routine, and he kept a daily schedule that he carefully followed, walking each day after lunch to the public library. It seemed that the care he received at API had truly helped him, and just as much that he wanted to keep helping himself. Not understanding why he had abandoned his treatment, Adrienne asked if he disliked his medication. But he said no, he didn’t mind it. Why, then, did he stop taking it? “Because,” he said, “I don’t think that’s what God wants for me.”
It was comically, cosmically sad.
* * *
—
I was impressed by what Adrienne had accomplished. She had done everything right, everything I felt I could not have managed if I had been in her place. “I would have collapsed,” I told her.
“I did,” she said. She caught the flu, and when she got back to Santa Fe, still sick, she went out and got drunk with some friends—loud and rowdy and jubilant, standing on a table, taking off her shirt—until it got late and the bartender cut them off and she felt herself flip into a kind of post-traumatic shutdown in which she couldn’t speak, couldn’t be around people. And a guy she was with thought she was being rude and turned on her, angry, accusatory. She ran out onto the back stairs and called her ex-boyfriend and asked him to talk her down because he was the only person who knew how. And he did. And then she went back into the bar but her friends had all gone home.
* * *
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I had assumed that when Tom sought help of his own accord, the mental health system would be there to provide what he needed, with or without Dad. I was now beginning to see how dramatically wrong I had been. The whole tactic of pushing him into homelessness now felt deeply, painfully misguided. It had taken four years for it to drive him to seek help—four years of isolation, trauma, and unremitting psychosis—and now his homelessness seemed to only be keeping him ill.
I ran my mind in circles trying to come up with new ideas. I was by now researching schizophrenia in earnest, for my own writing, but most of what I learned was not directly applicable to solving our problem. And as before, my thoughts were not new to Dad. The only viable long-term solution to Tom’s problems appeared to be what social services referred to as “permanent supportive housing”—an apartment where he could not
only live but also get the extra assistance he would need to live safely and comfortably over the long term. Staying at one of Anchorage’s halfway houses, where he could get help and guidance with daily living and medication, was supposedly a necessary step toward reaching the next level of independence, but these transitional residences didn’t appear to have the quiet and private space that Tom needed.
If it had been up to me, I might have tried some of my other ideas just to see if they could work. But it was not up to me, and to be fair, I had not devoted the time to the problem that Dad had. “I have spent hundreds of hours thinking about this,” he sometimes told me, “maybe thousands.” In one frustrated email exchange, he wrote, “It is not like these ideas never occurred to me. I have been working on this since Panama and have not found a solution. I would love it if someone would show me the way.”
The fact was, this had gotten away from us. And Tom was a moving target. For a long time, his words about God were as baffling to me as anything he had ever said. Only much later did they start to make sense, as it dawned on me how hard he had been trying to help himself when Adrienne saw him, as I grasped that he couldn’t manage the system’s demands. It occurred to me that, if he had wanted to keep taking his medication, his inability to tolerate the halfway house environment would have cost him his access to it. I began to suspect that his idea about God was not a cause but a justification—that, unable to get his hands on his medication after leaving the halfway house, he concluded that it was not what God intended.
