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A mother helps son in his struggle with schizophrenia

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HOUSTON — The mother drives her son everywhere because he is not well enough to drive. He sits next to her, and at the red lights she looks over and studies him: how quiet he is, how stiffly he sits, hands in his lap, fingers fidgeting slightly, a tic that occasionally blooms into a full fluttering motion he makes with his hand, as if clearing invisible webs from his face. He is 19 years old, 6 feet tall, 250 pounds. His eyes are more steady than bright at this particular moment; his mouth is not set in a smile or a frown but some line in between.

“How’re you doing, sweetie?” Naomi Haskell asks.

“Fine,” Spencer says.

It has been 10 years since he began thinking his classmates were whispering about him, four years since he started feeling angry all the time, and two years since he first told a doctor he was hearing imaginary voices. It has been 20 months since he was told he had a form of schizophrenia, and 15 months since he swallowed three bottles of Benadryl and laid down to die, after which he had gotten better, and worse and, for a while, better again, or so Naomi had thought until an hour ago, when they were in the therapist’s office and Spencer said that his head was feeling “cloudy.”

“Wait —” she said, interrupting. “You described it as a cloudy feeling?”

Cloudy was the big, flying red flag that she had learned to dread. It might simply be a side effect of one of his five medications. But it could also be the quiet beginning of her firstborn son falling apart again, of hallucinations, or a dive into depression, or some other dimension of his illness that Naomi has yet to fathom.

“Yeah,” Spencer said. “Cloudy. It feels like these winds are blowing inside my head.”

A light turns red, and she glances over again.

“You’re feeling okay, baby?” she asks.

“Yeah,” he says, staring straight ahead.

This is what it is like to be the mother of a son with a severe mental illness — an hour-to-hour, minute-to-minute vigil. At a time of increasing public concern about the role mental illness might have played in mass shootings in places like Newtown, Conn., and Aurora, Colo., Naomi’s worry on a Tuesday in Texas is different. It’s about keeping her son well.

“Dear Friends and Family . . .” she had written last year, explaining her son’s illness and his suicide attempt. “I don’t believe I have fully processed the horror of my child suffering a level of torment so deep that it caused him to want to end his life. I’m afraid of what will happen to me if I think about it too much.”

So what Naomi is thinking about now is helping Spencer make it until Friday, when he has another therapy appointment, and when the effect of a new medication he has just started taking might become clear.

Tuesday afternoon

They are driving across suburban Houston, a landscape of gray four-lanes, brick strip malls and beige office parks that Naomi knows as the place where the therapist’s office is, or the doctor’s, or the drugstore, or the ramp to the highway that goes to the psychiatric hospital.

She asks Spencer if he wants to go with her to the drug store and then the community college library where he likes to study when he feels able.

There is a pause before he answers, a dash whose length Naomi measures as a sign of how lost he is in his own world at any moment — one, two, three seconds. She looks over if he doesn’t answer at all.

“Okay,” Spencer says. “I need to get my backpack.”

They drive to the apartment where he moved in January, when Naomi had thought Spencer was stable enough to leave the home where he had been living with her, his step-father and his younger brother. He had made it through the busy Christmas season working as a cashier, handling his symptoms with promising self-assurance, telling a customer who wondered who he was talking to not to worry, he just had a thought disorder.

Naomi knew that he wanted to get back to everything he had been doing his senior year in high school, when he was first told he had early-stage schizophrenia, a diagnosis later refined to schizoaffective disorder, bipolar subtype with obsessive-compulsive elements. He wanted to study math, go to college, go out with girls. He wanted independence, and Naomi thought the apartment would be a step toward that.

Then the first week he was there he got the cloudy feeling. He said that his brain felt like it was “under a hair dryer.” He told Naomi he felt “unsafe.” He checked himself into a psychiatric hospital.

When he was released 11 days later, he insisted on returning to the apartment rather than home, because he wanted to keep moving forward. Naomi’s 70-year-old mother moved in with him, setting up a single bed in the living room in front of a balcony three stories high and over a sidewalk, a drop that Naomi tries not to think about.

She parks the car. She watches her son trudge up the three flights of open-air stairs, a slow, lumbering figure in jeans and a sweatshirt.

The signs she looks for: how he walks, whether he is quick or slow or heavy or aimless. How he talks — crisp or sluggish, or perhaps angrily to no one, as he had done in December, when he yelled “Stop following me!” down an empty hallway. Spencer had become deeply religious during the advent of his illness, and Naomi checks his Facebook page to see how many posts are there about Revelations, or Deuteronomy, or other biblical arcana. More than two or three is a warning sign, not because it is religious but because it is obsessive.

She checks his text messages, though she isn’t always sure how to take them.

“I figure,” he wrote around the time of the cloudy feeling in January, “a few hundred years after the resurrection, it will be like a sci-fi novel, and we’ll have spaceships and everything and all sorts of crazy stuff . . . I will probably be an old man then but with reincarnation it is possible to go through childhood again, the right way. The Lord will make all things anew.”

She watches little things, such as whether he dries off with a towel after a shower or walks naked and dripping to his bed and rolls around. She watches whether he remembers to put on deodorant, how he eats, whether he is being considerate.

He comes back down, his backpack full of books for his computer programming and math classes, and they drive to the library.

“It’s right here,” he says as Naomi gets near the campus.

“I know, baby,” she says.

“I just thought you might subconsciously drive past it,” Spencer says.

Naomi waits out the two hours in a coffee shop next to the library, leaving only briefly to get a soda. When Spencer comes back, he smiles faintly for the first time all day.

“I did this week’s computer science assignments,” he offers. “And I read the reading for next week.”

“You must be feeling less cloudy,” Naomi says.

“Yeah,” Spencer says.

At lunch, she glances at the news blaring on the TV. A young man has just stabbed 14 people at a community college campus.

She is sure that in the coming days, it will come out that the young man had an untreated mental illness, and that the parents had tried to help or didn’t know. With Newtown, Aurora and Tucson and so many other violent episodes, she had felt the same, horrible way. She felt devastated for the victims’ families. And she felt devastated for the parents who, she imagined, had struggled in their own way just like her to save their sons.

“My heart bleeds for those parents — it literally bleeds,” Naomi says at such moments, along with a prayer. “There but for the grace of God . . .

But she doesn’t see that kind of violence in Spencer, not at all. She has read statistics that show her son is more likely to be a victim of violence than a perpetrator of it. She has also read about the elevated risk of violence among people with schizophrenia, and knows the statistics that show their risk is higher if severe symptoms such as paranoia or hallucinations are not controlled, or if they have a history of violence or drug abuse. But that isn’t her son.

As she says one day when he is not there: “I don’t see that in him. And I hope I’m not fooling myself. What I see is a kind, loving, empathetic boy struggling to regain his footing in this world. That’s who my son is.”

Now she turns away from the TV and watches Spencer eat a huge hamburger. She drives him back to his apartment and watches him bound up the three flights of stairs.

Wednesday

Wednesday morning, he lumbers down. He piles into Naomi’s car in sweatpants and a T-shirt, and they drive toward the psychiatric hospital near Houston for his electroconvulsive therapy appointment, a treatment for severe depression.

“How are you feeling?” Naomi asks her son. “It seems like you didn’t want to wake up?”

A long pause; he stares straight ahead, eyes steady.

She turns on the radio. “Are you still feeling yuck?” she asks.

No response. Spencer keeps staring ahead. Cars are whipping by on the highway. Naomi glances over at him again and again and tries to make conversation about her cellphone, about the traffic, about anything, but Spencer does not engage.

They park in front of the low, sprawling psychiatric hospital. At the front desk, Spencer does the drill for the security lady: pockets inside out, pants legs up. He walks through the metal detector and holds out a wrist for the paper hospital bracelet. They go into the waiting area for ECT patients — a brightly lit, plastic-smelling space with a sagging plant and a man in an expensive-looking suit sitting in one of the mauve chairs, eyes to the white linoleum floor. Two women sit next to him, one blinking slowly toward sleep. A young woman who works at a coffee shop leans against her husband.

“How’s he doing?” she asks Naomi with Spencer sitting right there.

“He’s better,” Naomi says, looking at her son. “Wouldn’t you say, Spencer?”

He doesn’t say. A few minutes later, he reaches over and pets his mother’s head.

“Mommy,” he says in a soft voice.

“Baby,” she says, looking at him.

A nurse calls him in, and Naomi stays in the prep area as he gets ready. He takes off his black T-shirt, puts on a hospital gown and lies on a white-sheeted bed. The nurse takes his blood pressure, pulse and temperature, tapes the IV tube to his hand and starts a saline drip. Then he waits. He has never complained about ECTs, never said he was nervous about them.

Naomi is sure that he is, though, because of how he stares straight ahead when he is in the prep area, focusing on a single point on the wall. She knows because of how her son breathes so consciously, and because he does not want her to talk to him, but does not want her to leave him, either. She stays until they wheel him into the next room.

First comes the anesthesia through the IV, which he can feel moving through his hand and up his arm and then dissolving through his system. He had tried to resist sleeping before, but the feeling was so uncomfortable that he has learned to just give in. Next comes the gel, which is swabbed on his head, and then the electrodes pressed into the gel, and the electrical current, which triggers a controlled seizure, which requires placing a guard in Spencer’s mouth to keep him from biting his tongue. The seizure, it is hoped, will trigger a change in his brain chemistry that might bring some relief.

They roll him into the recovery area to wake up while Naomi waits on the mauve chairs. After awhile, a nurse comes out.

“He’s ready,” she says.

Naomi pulls the car around to a back door, and the nurse rolls Spencer out in a wheelchair. He stands up and wobbles into the car.

“How are you feeling, my love?” his mother asks.

“Okay. My jaw hurts,” he says, woozy, rubbing his jaw. “I have a headache.”

She hands him a Tupperware container with his morning dose of pills, which he takes later on ECT days. He struggles to open it and hands it back to his mother, who opens it easily and hands him a bottle of water. He pops in the antipsychotic to keep hallucinations and paranoia at bay, the mood stabilizer to even out his highs and lows, and two antidepressants, including the new one. He washes them all down with thirsty gulps of water. He pulls off his hospital bracelet.

They go eat lunch then drive back to the apartment. Spencer wobbles up the stairs holding both sides of the railing and goes to bed.

Two hours later, he wakes up.

“Hi,” he says to Naomi and his grandmother, who are waiting in the living room.

“How are you feeling?” Naomi asks.

“Less cloudy,” he says. “I think each time my brain heals a little.”

He walks to the refrigerator and gets a huge bowl of Jell-O. He sits on the couch and props his feet on a coffee table stacked with books he’s reading: Matthew Henry’s 2,000-page, 17th-century “Commentary on the Whole Bible”; “The Words and Works of Jesus Christ”; “God’s Glory in Salvation Through Judgment.”

He opens his laptop and checks the online Jerusalem Post, because he finds life in Israel more interesting than life in America. He watches a scene from a Japanese anime cartoon in which a beautiful female character says a long goodbye to a male character who appears to be dead or sleeping in a hospital bed.

He checks his Facebook page, where he has posted a photo of himself when he was 4, blond and bright-eyed with his little brother, and another one from his senior year in high school, when he was thinner and fitter but also sicker.

“What’s going on, baby?” Naomi asks after awhile. “You want to take another nap?”

“Let’s go to the gym,” Spencer says.

“The gym?” Naomi asks.

He hasn’t felt like going to the gym in weeks.

“Yeah,” Spencer says.

So Naomi drives him to the gym. She sits in the lounge area and watches her son who was slumped in a wheelchair only four hours earlier load weights on to a bar. He benches 250 pounds. He runs on the treadmill. He walks over to the punching bag and starts hitting it with his fists.

Naomi starts to cry. If he is feeling better, she knows it might be the start of a manic phase. If he is feeling worse, she knows he is trying to hide it. Maybe the medicine is working. Maybe the psychiatrist has finally hit on the magical formula and what she is seeing right now is the start of a period of stability, the start of the life she wants for her son to have. Maybe she will get a phone call tonight that he has taken his life. The one thing Spencer had told her that she believed unconditionally was that if he ever decided to commit suicide again, he would make sure that no one suspected it.

He finishes and walks over to her, breathing heavy and sweating.

“I did back, abs and 13 minutes of cardio,” he says.

“That’s great, baby,” Naomi says.

They drive home, and Naomi watches her son walk into the kitchen, pile a tower of crackers onto a plate, smear them with butter and drench them in syrup. She watches him walk to his desk and eat them with a fork and his fingers.

It is getting late. His grandmother has gone to teach ballet. Naomi has to get home.

“How are you feeling?” she asks.

“I feel relaxed, I feel good,” Spencer says. “The headaches are mostly gone away.”

His eyes are bright and animated. His body seems relaxed.

“You feel okay to be here by yourself tonight?” she asks, getting her purse.

“Yeah,” he says. “I’ll be okay.”

“You can come home with me, bring a change of clothes,” she says, moving toward the door. “I’m about to leave — you sure?”

“Yeah,” he says.

She wants to trust him.

“And you’d tell me if you weren’t okay?” she asks.

“Yeah,” he says.

They hug, he pats her on the head and she shuts the door.

Thursday

On Thursday morning, Spencer doesn’t see his mother. Instead, while she is away, he talks about his life.

He says it’s been almost three years since a miracle happened. He says he was a junior in high school and developed a crush on a girl who was a Christian, which led him to become a devout Christian himself, which allowed him to begin to see his intense, manic anger and paranoid thoughts as “delusional beliefs,” which opened the door to understanding he had an illness.

He says it has been two years since he first heard voices — what he describes as “whispers” that would come mostly at night, along with brief flashes of images he describes as demons. If his mother was afraid of him, he says, it was because he had become terrified of himself. He says he tried to manage by working out, by doing martial arts, not because he enjoyed beating people up but because it felt good, somehow, to get beaten up, and when nothing worked he asked his mother to take him to the doctor, where he heard words like “psychotic,” which terrified him even more.

He says he was angry at his mother, at his teachers, at everyone for not figuring out what was wrong with him sooner.

“Like if somebody had been watching me throughout my first year or two in high school, at school or in my personal life, I think the mental illness would have been easily recognized,” he says. “But my family was oblivious.”

He says that he wanted to escape all of it. He says he started researching gluten intolerance and an array of other illnesses looking for any explanation other than the one the doctor had given him, which was that he was on the cusp of full-blown paranoid schizophrenia.

He says he moved briefly to Austin to attend college and study math, because he had somehow managed, even as he was becoming sicker, to get the highest score on the most difficult Advanced Placement calculus exam. But then he says he started “freaking out” that the world was going to end, which led him think he should learn carpentry to help Jesus rebuild after the apocalypse, which he now understands was one of his first psychotic episodes.

He says he understands why, when his mother found out, she went to a court and convinced a judge that her son was a danger to himself or others, then tricked him into getting on a bus back to Houston, where he was handcuffed and taken to the psychiatric hospital, where he began to accept that he would have to manage delusions and paranoia and mania and depression for the rest of his life.

He says he understands why he couldn’t go back to college, and why the psychiatrist recommended a transitional program in Idaho for young adults with mental illness.

He says he moved there with his medications, and soon after that, something like the cloudy feeling began, and got much worse. He says he noticed that he was crying for several hours a day, and that he began feeling an intense pain that he describes as like having “a burning coal on my heart.” He says he tried to draw it away by inflicting pain on other parts of his body, that he pressed a knife blade against his arm, and scalded himself with hot water. He says he began to realize that his favorite part of the day was going to sleep, when he felt nothing.

He says his medication was changed and he got better, and then he got much worse, and all the bad feelings came rushing back.

“I looked at the past and the future and I decided there was no way out of it,” he says, and that was why he walked out of the facility one December day into the freezing cold and kept walking 15 miles to a Target, where he bought the Benadryl, and then went to a Wendy’s, ate several burgers and chicken sandwiches and washed down three bottles of the pills with a Diet Coke, and then went to a mall and walked in circles until he got sleepy, then looked for a place he could die, and went into a dressing room at Sears.

He says the third-to-last thing he remembers thinking is that he was making a mistake, the second-to-last thing he remembers thinking is that he didn’t care, and the last thing he remembers is raising an arm and saying a prayer.

He says he was found vomiting and seizing, and that four days later he woke up in an intensive care unit. He says people told him it was the best Christmas present ever, but he was not so sure. He says he came home, which is when Naomi told him about what she did in the days before:

She had made sure the gun at home was locked in its safe. She had put away the kitchen knives and then found herself wondering whether she should also remove the forks, and maybe the cleaners, until she started to see everything as a hazard — the trees in the yard, the car, the traffic on the road. She told her son that she loved him, and that she wanted to help improve his odds of surviving his illness, but that she knew that she could not ensure it, that it was ultimately up to him.

He says he understands that, which is why he is willing to bear the electrical currents, the pills, the constant shuffling to doctors and the constant scrutiny, and why he wants also to pull away from all that, to get in shape, to be better, to get back to studying math, to college, to driving, to everything he was doing when he first got sick.

He says he wants to reach the point that he knows is possible for people like him, where he can manage his illness instead of the other way around.

“I’m really not afraid of breaking down anymore,” he says. “I’ve gained a lot of knowledge and control. I’m not afraid I will relapse into chaos.”

He says all that, and then he takes a shower, uses a towel to dry off, and puts on his khaki pants and blue polo shirt. He packs his backpack — a sandwich, a Bible, his glasses — and goes to work.

Friday

On Friday, Naomi picks Spencer up early for his therapy appointment, and he hustles down three flights of stairs.

“Hi, my baby,” Naomi says.

“Hi, my mommy,” Spencer says.

“Did they give you a hard time for missing work?” she asks, referring to the days he has missed because he has not felt well.

“They were happy to see me,” Spencer says.

“Everybody’s happy to see Spencer,” Naomi says.

They are driving across suburban Houston, and she is somewhat relieved. He seems better. All Naomi wants is for her son to be well.

What she does not know is that the day before, without telling anyone, Spencer quit his job, believing that it was interfering with studying and going to the gym.

Eventually he will tell Naomi, and when he does, her anxiety will soar and her heart will sink because the last time Spencer quit a job was when he was paranoid and having hallucinations two years ago. She will check his Facebook page and see several religious postings. She will tell him that a lie of omission is still a lie, and that trust is important, and that she needs to be able to trust him. She will tell herself that it is okay, that he is struggling to become more independent, but she will not really be sure.

For now, though, at a red light, Naomi is looking over at her son, and in this hour, in this minute, his eyes are brighter.

“You still feeling cloudy?” she asks. “Or are the clouds clearing?”

“The clouds are clearing,” Spencer says.

© The Washington Post Company