My Little Brother Is Schizophrenic

My brother and I

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The following piece, I wrote nine years ago. I remembered it when I wrote about the mentally ill Black man, Daniel Prude, who died at the hands of Rochester, New York, police. A grand jury voted this week not to indict the officers. As long as mental illness – common as it is -- is stigmatized, it will continue to be hidden and unacknowledged, and there will not be an improvement in mental health care.

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At breakfast, my brother and I sometimes fight a war of the worlds when I visit him and my mother. These days, I make a silent truce and try to accommodate him. On one side of the table, his 320 pounds spread over a bench meant for two. I look at him and wonder what his life would have been if he had not become ill.

I wonder to myself whether he would have had a family. Then, in one of his insightful moments as if he has read my mind, he says, "I have a daughter. Did you know that I have a daughter?" Because it is too painful for him to imagine a normal life out of his reach, he launches himself on a fantastical biographical journey: "I have hundreds of children." The huge number counterbalances the cipher his diseased mind tells him he is over and over again.

Schizophrenia is a group of severe disorders in which people interpret reality abnormally, according to the Mayo Clinic. It may result in some combination of hallucinations, delusions, and disordered thinking and behavior.

I tell my brother that I love him and always will love him, no matter what. But when he reaches those heights, it is useless to try to bring him down to my reality.

"I'm the king of England. I'm the richest man in the world. I'm the best DJ."

It breaks my heart to hear the rant of this madman. My little brother. I remember sharing a hot dog and orange drink with him at Nedicks after our mother shopped at Macy's in Manhattan. I remember him riding around our house on the most wanted Christmas toy that year - the battery-powered Tony the Pony. I remember him delivering Newsday on his banana-seat bicycle in our Long Island neighborhood. He achieved a black belt in karate, played trombone in his high school band, and worked for badges in the Boy Scouts.

Teachers, friends and family said that he was a pleasant, well-mannered boy.

There is no schizophrenic gene. Schizophrenia, however, runs in our family, and genetics is like throwing dice. Our mother had an uncle jailed in the attic, not unlike Mrs. Rochester in Jane Eyre. Madness is an all-consuming monster. Sadly, my brother threw unluckily.

My reality is one shared with most other people. The more I interact with others, the more it is reinforced. His reality is his own creative survival technique. The less he interacts with people, the more it is reinforced. And he is interacting less and less.

"Do you want to have lunch at our sister's next door with the family?"

"No, thanks," he says and smiles a sheepish smile. He has company himself -- better company.

I ask him how many voices he hears in his head. He names them --his junior high school girlfriend, his high school girlfriend, the CIA and a few others. During the 35 years my 54-year-old brother has been sick, I believe that the number of voices has increased to a small network. He once complained about his former girlfriends; now, he talks directly to them.

The ability of people with schizophrenia to function normally and to care for themselves tends to deteriorate over time. He showers daily now; in the past, he has gone through periods when he has refused to clean himself. Even today, he sometimes needs prodding to change his clothes which can smell stale and of urine.

I listen to his conversations with his voices --laughing and talking-- and I feel sad and

rejected. "Talk to me," I sometimes say. "I'm flesh and blood." It is said that schizophrenics have no control over their voices' identities but, I believe, that my brother feels safe with their numbers. He sometimes tells a voice to stop it, a voice telling him to do bad things. All in all, it seems that his inner world is of his own design.

Madness is not poetic; it is not romantic.

At 18, he left college in Boston in his first year and came back home. He was at loose ends. A year later, I received a telephone call in Washington, D.C. from our mother in New York saying that he had been taken to a hospital's psychiatric ward. He had begun swinging his fists at my parents, leaving behind a bashed-in plaster wall in the dining room. Our 11-year-old twin sisters and 12-year-old brother hid in a bedroom, terrified.

I flew home, thinking that there was a cure, thinking that there was a controllable cause. For years, we all believed and prayed for that. Our parents blamed marijuana; they blamed themselves, they blamed his friends. We all reached for a reason to make sense of this awful tyrant of a disease. Yes, we had schizophrenia in the family. But why wasn't I, or our sisters, or our younger brother schizophrenic?

Researchers believe a combination of genetics and environment, such as transitions and stressful life events, contribute to the development of the disease. They do not know what causes it. They do not have a cure, only the hope of controlling it. Schizophrenia is a chronic condition that requires lifelong treatment.

After a few years, our mother stopped attending a parents' support group when the moderator began to refer questions from other parents to her. She had stopped blaming drugs; she realized that drugs may have triggered his initial breakdown which may or may not have happened otherwise. She had stopped blaming our father who she thought had been too strict with him, specifically on two occasions, which, in hindsight, were psychotic episodes of withdrawal. She had stopped blaming his friends. Our father, on the other hand, refused to attend the support group. He never truly accepted his eldest son's illness. Sadly, during his last days nine years ago, he cursed his namesake in anger at his own helplessness.

"It's not easy," our 84-year-old mother says.

When we drive past, she repeatedly points out the halfway house that a social worker had recommended for her sick son 30 years ago. She rejected it because she said that he would bring friends who she could not trust nor control into her home.

His choices in friends are not good. Once, in the early days, our father gave him an ultimatum resounding with the familiar:

"You live in my house; you live by my rules."

So, my brother went . . . missing. It was frightening. Several days later, he returned in someone else's shabby old clothes and the thousands in his bank account withdrawn by a friend. Never again, my mother says. He could have lost his life on the street.

For a while, my brother seemed to be in and out of the hospital. My parents would telephone the police who got to know him. The officers often managed to talk him into the backseat of the police car before driving him to the hospital. Our mother says that he seemed to relish a stay there almost like a vacation spot, where he would meet new people and eat different food.

During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

For a few years 30 years ago, my brother worked a part-time job loading trucks for a company whose good-hearted owner hired the mentally ill. He and the rest of our family thought the situation a godsend. He was getting out, meeting people and earning dignity.

Life was fine until late one night when he was 29. He woke up our 21-year-old brother for a telephone call from a friend. Our younger brother then met up with this friend and another. The caller drove his car into a parked truck. Our brother and the third friend died instantly; the driver survived the tragedy. My sick brother blamed himself. Shortly afterward, the company owner suggested that my brother move on because he had slipped into a more remote place in his mind.

Eventually, he attended a day group. Again, he had something to do, somewhere to go. But he brought home friends, my mother says, who put their feet up on the living-room table and ignored her when she asked that they remove them. As she points out, they were big men, not small boys. She could not stop them.

Over the years, my brother's psychotropic medications have changed; the diagnosis of his condition has changed. I don't pay much attention anymore. Psychiatrists are working in the dark. The good ones admit to their ignorance.

At the start of this hell, I put a stop to electric shock treatment, my mother now tells me, minutes before it was to be administered to him. I felt that he was being used as a guinea pig. At that time, our parents would have deferred to the education and experience of the doctor. Now, if my brother is prescribed a medicine that agitates him, our mother refuses to give it to him and another drug is prescribed in its stead. One drug made him shake and drool; it was replaced with another. His drugs have caused weight gain; he smiles proudly when complimented on losing 20 pounds. Our mother also gives him a cocktail of vitamins which she insists makes all the difference in keeping him calm.

In the first years of his illness, a psychiatrist associated with a venerable institution asked whether our family would talk with him on videotape. Back then, we were all hoping for a cure, and we assumed that this interview would help us get there. I can imagine our parents asking him whether it would help their son, and the doctor answering offhandedly that it might help him. Our younger brother refused to participate; he allowed himself to be filmed, sullen and angry. Afterward, we felt exploited. We had helped the psychiatrist write a paper on families of schizophrenics.

Our mother sits on the other side of the breakfast table. She serves her son oatmeal. She says that some people do not visit because they are afraid of him. He has not been physically violent in 30 years. However, he sometimes makes inappropriate sexual overtures to women. He is all talk. But his bulk and his height overshadow most people, and his unpredictability can be menacing. Madness already scares people. Our mother takes offense at the people who do not come to the house because they fabricate excuses. She says that she would understand the truth. When he unrelentingly accuses her of poisoning his food, she sometimes takes her meal to another room.

While he talks to one of his voices, she says that she refuses to feel that his life is a waste because he will begin to feel that way, too. However, in his lucid moments, he sometimes will say as much.

"He's my son," she says, her eyes glazing over with tears. "I brought him into this world. I can't abandon him."

My eyes glaze over, too.

During this visit, he has a schedule. His hours may be anti-social ones but, at least, they are consistent. He wakes at 4 in the morning when he showers and dresses for the day. He then sits at the breakfast table listening to the radio and sleeping until our mother wakes and prepares breakfast around 7. He rarely cooks now; years ago, he caused a kitchen fire by forgetting that he had something on the stove. After eating, he watches the news and other shows on television. He has lunch and reads The New York Times thoroughly. He has dinner. He only leaves the house for doctor's appointments - bi-monthly injections for schizophrenia and regular check-ups for diabetes.

Outwardly, he is not doing much but, inwardly, he is embroiled in exhausting relationships.

Throughout the day and night, he talks to his voices who talk to him. They, too, will never abandon him.