Far From the Tree

by Solomon, Andrew

  Susan’s father had by now disappeared from her life completely; soon, Bobbe remarried. “I wanted my life to go on,” Bobbe said. “To my friends, I just said, ‘Susan is having a problem, and the divorce kind of triggered it.’ I really wanted her out of my life, and I felt relief because somebody was taking her off my hands. I’m not proud of saying that, but it’s how I remember feeling. I wish I had known someone like present-day Susan when she was so sick, because it would have given me such hope. But there was nobody.”

  Susan was at Four Winds for four months, then out, then back for another six, and eventually at a halfway house where she stayed for nine months in 1980 before moving back home, age twenty-four. “I would come home from work,” Bobbe said, “and she would be lurking somewhere, not answering when I called her. Sam Klagsbrun said, ‘You have to tell her to leave.’ I said, ‘But how can I?’ He said, ‘Just tell her that you would do anything in the world for her if she were making progress, but that this isn’t helping her.’ So I told her she had to leave. That was probably the hardest thing I ever had to do in my life.” Bobbe wept. “She left, after writing a note that she was going to kill herself. Then she called Sam and went back to Four Winds.”

  Susan’s accounts of Four Winds are rhapsodic: “It was a psychiatric utopia. There were ducks running around, and a chicken coop. I would spend my days in the pine forest. If an insurance company heard that today, they’d freak. Sam’s treatment was incredible. I was an infant. He cuddled me; he hugged me. He picked me up out of a pothole in the pouring rain.” Klagsbrun had started a hospice program—for non-psychiatric patients with terminal physical illness—in the lodge where the psychotic patients lived. “You take someone like myself, who was clearly psychotic and not living in reality, and you face them with the biggest reality, which is death,” Susan said. “Even in my confusion, I understood it on some level, and it shocked reality back into me. Here I am, actively self-destructive, and yet these people wanted to live so desperately. It made me ask the question, which is, do you want to live or die? I realized I wanted to move towards life.”

  Susan’s emotional life began to revive. “I remember the first time I felt love, after all that. I don’t even remember who it was—probably Sam. I just started feeling what it felt like to love someone. I don’t remember it being ecstatic; I just remember it feeling like when I would go fishing as a young girl, and a sunfish would catch the hook. Just that tug on the other end of the line. After all those years of being so isolated within myself and so disconnected, the medication sucked out some of the symptoms, and as the psychosis receded, it left room for my heart to grow. There were other psychotic episodes that followed, and I wasn’t experiencing love too much during those. But during each remission, my experience of empathy and connectedness just expanded.” Susan had continued to make art, and Klagsbrun adapted a little outbuilding for her to use as a studio. “My work has a dark side,” she said, “but it’s about creativity, and creativity is about giving life.”

  When Susan graduated from her most intensive treatment phase, she accepted a job at the hospital, which came with benefits, and her insurance paid for electrolysis to remove her facial hair. She was twenty-six years old. “Preparing for the larger world was still a tall order,” she said. “I didn’t know who the president was. My ego was like Swiss cheese. I was still having a lot of catastrophic visions. I didn’t know the first thing about taking care of myself physically.” She began seeing a therapist, Xenia Rose, and stayed with her for twenty years. “She had me write up a schedule. It had ‘get up’ and ‘brush teeth’ because I had no idea what a day was supposed to look like.” Rose agreed to see Bobbe as well. “That was enormously helpful to me,” Bobbe said, “because I had to just cry and say what I thought. But Susan’s illness was not me; it was her. When I started to let go, she started to emerge.”

  By the time she was in her late thirties, Susan was reasonably stable. Zyprexa had “revolutionized” her life. She slept thirteen hours a night, but was coherent. Eventually, she switched to Abilify, which was less sedating. “I grow like lightning,” Susan said. “What you see here today is a completely different soul than I was five years ago: developmentally, physically, visually, verbally. I’ve worked very hard, on every level, at eradicating every remnant of the illness. Intermittently, I have little things trigger here and there, but they only last a day or two. Sensory overstimulation, a bit of paranoia, misperceptions and distortions in my thinking and visual world. Some people get stressed and their back goes out. I get stressed and my mind goes out. But then it comes back.”

  Of all the things that required catching up, perhaps the most challenging was romance. At the time I met Susan, she was nearly fifty and had not yet had a full sexual experience. “I’d like to experience love. But do I know what love is? So far, my mother’s it.” Susan laughed. “My poor mother. She signed me up for three different dating services, simultaneously. It was grueling. But I looked at it as a way to grow developmentally. The schizophrenia has given me the ability to find something inside of me, parts of myself that I might not have been able to reach otherwise.”

  Susan has also attempted to reconnect with her long-absent father. One day she told me she had just spoken to him on the phone, for the first time in decades. “I told him that I loved him,” she said. “It felt right to say that, despite his abandonment of me. I had written him a letter because he was turning eighty, and I thought I would free him from some guilt. I wanted him to know that he gave me the one tool I needed to climb out, which is my art, because he nurtured my creativity. He called after a week. We had a very superficial conversation about clamming or whatever he does down there, and then he became a little weepy, and he blurted out, ‘I’ll never forgive myself for walking out on all of you.’ It took all I had to hold me back from jumping in my car and driving down there. But I decided not to call again. We have too much in common.”

  Bobbe eventually came to accept, understand, and finally be proud of her daughter. She works in the travel industry and gives all her earnings to Susan. In turn, Susan has donated most of the proceeds of her sales of her rich, strange, beautiful art to Four Winds. She has taken up public speaking. Bobbe heard Susan address a mental health dinner at Grand Central Station. “I couldn’t believe it. There were like three hundred people there—and this is Susan. I mean, how did this happen?” Bobbe said. Susan’s relationship with Bobbe is almost completely resolved. “She’s definitely a stronger person than I’ve ever been,” Bobbe said. “What saved her? It was her art; it was Dr. Klagsbrun; it was the support from her brothers and me. But most of all, it was Susan. There was something in Susan that always wanted to come to the surface. I deserve a medal. I really do. But Susan deserves lots of medals. I feel really bad that she had to go through what she went through. But I also recognize that if she hadn’t, she wouldn’t be who she is today. And who she is today is the most wonderful, charming, beautiful woman. She used to say, ‘It’s the cards you have dealt to you, Mom.’ I think what I’ve finally come to terms with is that if you learn to live with things that aren’t pleasant, then, suddenly, sometimes, they are.”

  • • •

  The delusions of people with schizophrenia are not always cruel. “My son was doing the crossword,” one mother told me, “and he was really mad because the voices kept giving him the answers.” A young Indian man described his unusually affirmative delusions to me: “I would hear the leaves whispering love poems to me.” Another man said, “I wish I could find a medication that would make the horrible voices go away and leave the ones I love.” The relationship to the voices can be mediated by affection or even just urgency. A San Francisco mother said, “Even though they’re not nice, they are his friends. It’s private, and he understands them. His psychiatrist told him to be friendly to the voices and talk to them as though they were children.”

  Though schizophrenia was described in the ancient world and named a century ago, its mysteries continue to facil
itate misconceptions. Michael Foster Green, professor in the UCLA Department of Psychiatry, writes, “When an illness is viewed as inexplicable and impenetrable, people tend to react to it with one of two extremes: either they stigmatize it or they romanticize it. It’s hard to know which is worse.” Someone who has never had a third-degree burn may not know what one feels like, but having had a first-degree burn, he can somewhat conceive of that pain; depression is an extreme version of commonplace feelings. Schizophrenia is fundamentally different. The German existentialist psychiatrist Karl Jaspers has identified “an abyss of difference” between psychosis and normal thought. The schizophrenic often cannot retrieve the language he knows, but even if he could, there is no appropriate language for him to use. We can understand the horrors of psychosis only at the level of metaphor.

  Anyone who loves his schizophrenic brother or son or daughter or friend knows that this person, though afflicted with a betraying genome, is also the sum of his experiences. In his book about his brother’s illness, Jay Neugeboren writes, “For paid professionals to act as if Robert were merely a vessel of flesh in which (bad) chemicals somehow rose up once upon a time and made him ill, and in which other (good) chemicals must now be poured, deprives Robert of what he still possesses in abundance: his humanity. How not cry out against any and all attempts, when it comes to human beings with lives like Robert’s, to reduce their humanity to their biology?” Andy Behrman, a writer with bipolar disorder, explained, “Mental illness cannot be treated separately from the person; they are inextricably linked. I’ve answered the question ‘Where does mental illness end and where do I begin?’ In my case, we are one. I’ve made friends with the enemy. My treatment is successful precisely because it takes both me and my disorder into account and doesn’t delineate between the two of us.”

  Sometimes, we adduce retrospective wisdom from medication response. If you improved on Depakote, you must have had bipolar illness. If Zyprexa made you all better, you were probably schizophrenic. Useful though these agents are, however, work on them is still inconsistent, tangled in unproved theories, preoccupied with neurotransmitters that play an opaque role in illness. Reductive thinking about the nature of mental illness—the suggestion that it can be fully described by chemistry—satisfies those who fund research, and that research may help sufferers. It is also dishonest. Schizophrenia has no margins; it becomes what it invades.

  Classic schizophrenia is a horrible illness, but knowing what you or your child has can be weirdly comforting; classification builds identity. There is a community of people who have or treat the illness. But this condition operates in fine and sometimes bewildering gradations. Psychoanalyst Richard C. Friedman, who worked on the drafting of the DSM-III, said, “The problem in psychiatric diagnosis is that we have gone from an analog to a digital model, in which things are matters not of complex degrees but of a lot of ‘yes’ and ‘no’ that are like ‘0’ and ‘1.’ There are many practical advantages to classifying people, but clinical experience shows that isn’t how the mind works. You have to deal with many layers of continuous phenomena.”

  • • •

  No one has ever been able to say quite what is wrong with Sam Fischer. I met him when he was thirty-three through a psychiatrist who was treating him for schizophrenia, but another clinician produced a diagnosis of Asperger’s. Sam clearly has a mood disorder, with periods of intense depression and occasional bouts of hypomania, a nonpsychotic but excessive feeling of worth and power. His manipulative social interactions suggest borderline personality disorder. He has anxiety and phobias, signs of obsessive-compulsive and narcissistic personality disorders, and a long-running post-traumatic stress disorder. He presents, in short, a perfect multitude of psychiatric symptoms assembled in one brain as though for a gala reunion. “Nobody really understands me,” he said. “I’m too weird for that.”

  Sam was born jaundiced at less than five pounds, even though he was at term. He wouldn’t eat. The doctors worried that he was slipping away, and his parents, Patricia and Winston, spent Sam’s early life at Children’s Hospital of Philadelphia, where doctors looked for brain tumors and kidney diseases. Sam also had scoliosis and an undescended testicle that would have to be surgically removed. He never crawled and started walking late. On early standardized tests, he was, his mother recalled, “a linguistic genius, and practically retarded when it came to doing puzzles.”

  In kindergarten, Sam saw his first psychiatrist, who said he was “walking along the edge of an abyss.” In elementary school, Sam couldn’t do math, and he couldn’t write or draw because coordination eluded him. Patricia remembered, “Winston and I said to each other, ‘There are calculators now. What does it matter that he can’t do sports or drawing?’ Sam talked in complete and flowing paragraphs. At a florist shop, he’d name every really obscure plant. To us, that was wonderful; it should have been a sign that something was not wonderful. We were sure the strengths would outweigh the weaknesses, though the experts told us repeatedly that the deficits overpower the strengths for most people.”

  In fifth grade, some older boys tied Sam to a fence and left him screaming for twenty-five minutes before a teacher discovered him. He was kicked down the stairs on more than one occasion. His parents switched him into public special ed, but he didn’t fit in there, either. “It was as if Sam had dyslexia in reverse; he could read and decode things without trouble, but he couldn’t do anything else,” Patricia said.

  Sam had realized that he was gay, but was still intensely closeted in high school. Then something happened in the bathroom at school. Sam described it as “attempted rape” and said bitterly, “This bitch guidance counselor said, ‘He’s a senior and you are only a junior so we’re not going to do anything about it.’ That pretty much ruined my life.” While Sam feels the episode was underplayed, his father feels it was overplayed. Winston explained that someone exposed himself and came on to Sam. Whatever happened, Sam was traumatized and began to hear voices. He said, “They were voices from my enemies at high school, and I actually went from being very peaceful to very warlike.”

  His family took him to a psychiatrist, but Sam did not have a flying start with medication. “Moban didn’t do any good,” Winston said. “Ativan helped. Risperdal, a disaster; it screwed up his coordination. Prolixin, a fiasco; he had the dry heaves all the time. Then Mellaril. The truth sunk in that this was going to be a long haul.”

  At the end of his senior year, Sam made his first halfhearted suicide attempt. “I pulled him out of the bathtub when he was trying to drown himself. He was probably holding his nose,” Winston said. Sam seemed to function better for a little bit, but was hospitalized three years later, after a confrontation with law enforcement. “He was talking to himself and the police picked him up, and he either said, ‘I want to kill somebody’ or ‘I want to kill myself,’” Winston said. “He was in protective custody and he exploded. Eight people descended on him, putting him in restraints, and gave him Haldol. I was helpless. He was saying, ‘Give me something so I can die.’ It was terrible.” Then Sam entered what he calls “Fat Pig Sam Period.” He explained, “I was very racist and I hated everybody. From twenty-one to twenty-four I ate nothing but junk food, about eight times a day. I was obsessed with ice hockey. I don’t know what made me turn into such a horrible, disgusting, obnoxious pig, but that is what I turned into.”

  Winston and Patricia took Sam to visit Gould Farm, a rehabilitation facility in Massachusetts, and Sam stayed one night and then insisted on coming home, claiming the people there were “even fatter and sicker than me.” The Fischers were at a loss. Sam is a one-man refutation of the Freudian tenet that understanding your behavior helps you change it; he understands what’s wrong with him, which made him feel superior to the residents at Gould Farm, but he is incapable of addressing any of it, which is why he was sent there in the first place.

  After his childhood focus on botany, and his pig-period fixation on hockey, Sam became obsessed with the heyday of rock
and roll, a passion he shares with Winston. He hunts down vinyl versions of music long forgotten by almost everyone else and identifies the moment of receiving a record he’s ordered as the only time he feels genuine happiness. But he has been banned from the Princeton Record Exchange since the day he punched one of its clerks. Winston is usually left to smooth things over. “I like our time together, but it’s too much. I’m his only friend. We’re reaching a state where I don’t know how much longer it can go on. If we’d been able to leave Sam at Gould Farm, he might’ve come to an existential realization that he had to make a life or end up in a hospital, but we could never face the idea of forcing him.”

  Winston and Patricia try to support any interest Sam shows in other people. Sadly, this policy seems to enable some of his most troubling deficits. “We were in a record store,” Winston said. “There was an album cover for The Knife, which scared him. I managed to track down the lead singer’s number. Sam established a telephone relationship with him. Sam called too often, as he always does. Usually the wife or girlfriend says, ‘You have to stop letting this kid call, it’s driving me crazy.’ So that turned from being a sort of ideal moment where you explore the record that scared you, find the guy, and make friends, to being a nightmare that made him feel terrible about himself.”

  Sam spends his time making up rock bands and producing their album covers—drawing the art, making lists of songs, writing liner notes and lyrics. “My lyrics deal with love, hate, revenge,” Sam said. “They are all homosexually oriented.” Sam and I spent hours looking at his album covers. “Oblivion in Orbit. Cold realities and occasional joys of life in the British Army, of outer space, of strange phenomena, and of sex,” Sam wrote on one of them. He also plays the electric guitar and has three of them.

  Sam’s other obsession is soldiers. “They are the one group that understand me,” he said. “They look me straight in the eyes and try to make me feel unfragile, like they believe in me. Unlike my parents, who make no effort whatsoever.” To Winston, the obsession is not irrational: “His fantasy is to be protected, so he was after me to help him meet soldiers.” One might question the wisdom of indulging these yearnings for people who will be irritated by them, but part of the folie à deux is that Winston joins Sam in his troubled reality. “I found a job on this newspaper and realized that I could report on Fort Dix,” Winston said. “They gave us a tour; he got to take pictures of the soldiers, meet and talk to them.” Sam has an interest in foreign armies, as well. “When we travel to England, say, we’ll board the train to Bristol and just turn him loose,” Winston said. “He ends up having a great conversation with somebody in the services.” Patricia is highly ambivalent about all this, but defers to it since Winston spends every day with Sam while she is at work. “Sam’s psychiatrist says I have to crack down,” she said. “But how do I crack down on Winston’s niceness?”