Excerpts

CHAPTER ONE The Onset More than twenty years ago, I walked into the padded, otherwise bare "rubber room" at Metropolitan Hospital on the Upper East Side of Manhattan and found my twenty-four-year-old son Jeff lying alone in the fetal position on the checkerboard tile floor, next to a pool of urine. He was whimpering, "I want my mommy, I want my mommy, I want my mommy...." I had just spent more than $125,000 for his care at the Menninger Clinic in Topeka, Kansas, arguably the finest American mental hospital. I had seen mental institutions before. Shortly after World War II, I had worked as a reporter in Wichita and had written investigatory articles about the state hospitals, then known as snake pits. At the Topeka State Hospital, I had found only three frantically overworked doctors for 1,744 psychotic patients. Attendants worked thirteen hours a day, six days a week, for $130 a month (a pittance). The heavily sedated, filthy inmates sat rigid, lined up in rows, staring ahead, and rocking their lives away in silence. It was not an experience to be forgotten, most vivid, the stench. That hospital was not the worst in Kansas. I remember, too, the State Training School for the "feebleminded" at Winfield, where the smell was the same and there was not one full-time doctor for 1,366 patients. There was, however, sufficient staff to perform many of the 1,992 surgical sterilizations and castrations ordered by the State Board of Sterilization to "stabilize" the retarded and to ward off diseases and even, it was said, baldness. Writers at three of the region's other newspapers took up my cause, and I like to think the chorus of our complaints shamed the 1948-49 session of the Kansas legislature into voting for enough funds to remedy the horrible excesses. Fortunately the professional follow-up was put in the hands of Dr. Karl Menninger of the Menninger Clinic, who was close at hand and a pre-eminent thinker in his profession, as well as a charmer. But twenty-five years later, the world being a convoluted and small place, he was a fateful negative influence when my Jeff became a Menninger patient. That, however, is getting ahead of my tale. I must confess that this book is an act of perjury. I had pledged that I would never write it. Over the years, a number of psychiatrists had urged me to produce a chronicle of Jeff's travail. No, I kept insisting, I can't do it. It's too painful, too personal. Gradually, four circumstances changed my mind: * My stacks of accumulated letters, memos, hospital reports, journal articles, books, and endless memories and notes of conversations with Jeff and his many, many doctors--all evidence of my close and active involvement with his fate. Schizophrenia had become something of an obsession. * I had learned much that I thought I should share about the disease. Myths needed to be dispelled. Vital new knowledge needed to be disseminated. Promising new diagnostic data had emerged, even if still inconclusive. * My own role as a manager of Jeff's managers had matured. I was also learning from other parents never to give up on a "hopeless" psychotic, because the disease is forever in flux. One lay guide can make a difference. More information can always be explored and additional alternatives considered. * Science achieved dramatic advances in schizophrenia treatment within the last five years. One trouble-free revolutionary drug, Olanzapine, is on the market as I write. The next year will see more such medications come into routine use. Might I be producing the first optimistic book about schizophrenia? I hoped so, because I was writing on behalf of 2.5 million afflicted Americans, fifty million worldwide--one percent of the population--not to mention their families, friends, and professional caregivers. Neither Jeff's mother, Edith, from whom I have been divorced for more than thirty years, nor I had any hint that anything was to go drastically wrong with Jeff's health--not until he was seventeen. Even at that juncture, no grave complications were envisioned by his well-qualified doctors. Edith and I were already divorced and felt no serious concern when I reported from New York on Jeff's childhood to the first psychiatrist he was taken to see, the likable Dr. Vincent J. D'Andrea in Palo Alto, California, who was experienced in dealing with young people and who diagnosed "school phobia." On March 3, 1968, in a five-page, typed, single-spaced letter, I wrote him: He was the perfect baby: a calm, contented, somewhat smug and all-knowing gentleman. He always seemed to do everything just right: he ate and slept and displayed the Dr. Spock-appropriate baby behavior at all times in just the right way. He had no colic or other physical problems. Within weeks after birth he was an exceptionally handsome boy and just about everybody, male and female, volunteered comments about his good looks: his big, dark brown eyes, his pale clear skin, etc.... He was rarely yelled at ... and I'm not sure he was spanked even once. In due course, he became, if anything, a bit of a pampered star of the family because he was unusually charming and not only obviously bright but able to display his brightness to advantage.... Jeff never made friends very easily, but he always did have buddies, he was always scrappy and active in sports ... always acquitted himself well physically, was not cowardly and certainly shouldn't be pictured as a Little Lord Fauntleroy.... I can think of nothing remotely out of the ordinary about Jeff's childhood up to the divorce. Even this cheery recitation fails to measure up to my memories of the boy we came to call "the old Jeff." When he was very small, Jeff knew which knobs to twiddle whenever the TV got the shakes. If I lost my way in the car, it was Jeff who would pipe up from the rear: "Daddy, you just have to go back three blocks and turn right." That long-ago Jeff was organized, analytical, a bit perfectionistic, and he commanded a firm sense of self. He was also very, very funny and responsible. Each morning it was his exclusive job to assemble the family for breakfast. We actually did sit-down breakfasts then, and Jeff's shout while I was shaving--"Daddy, come and eat!"--is in my ear like the reveille bugle of my infantry basic training. For a hectic tour of Europe in the world's most anemic Volkswagen bus, Jeff drummed us troops together, permitting no dallying, worrying about the "preservation of the reservation," while his older brother, Ron, grumbled about "Daddy's pain-and-suffering marathon." When my book Suburbia's Coddled Kids came out in 1962, he was quizzical. I distributed campaign buttons as a promotion stunt, red ones saying "I'm a Coddled Kid," blue ones proclaiming "I'm an Un-Coddled Kid." The ambiguity gave Jeff pause. He had a need to know. He planted himself in front of me and demanded, "Daddy, are we coddled?" I said, "Yeah, maybe a little." He walked away pleased, having known the answer in the first place, and the phrase "How coddled!" became family bywords. It also inspired one of Jeff's early literary efforts. "Humphrey's Cat Goes to Florida" ran exactly 166 words, as its author recorded at the top left corner of the first and only page in his typically precise manner. It was a vacation fantasy that began: In the Humphrey's [sic] small country bakery on the resort island of Martha's Vineyard, Massachusetts, there lives a cat. This cat, unhappy in the surroundings of this famed resort, finds it necessary to go on a much needed vacation to a well known Miami Beach hotel. This hotel is the Fontainebleau. The cat did not just stay in the hotel. This cat stayed in a penthouse suite, in the right wing of the two-winged hotel. This is the same type of room that Frank Sinatra stays in for a "quick gas weekend." The Humphreys' cat stayed with the family at the $75-a-night hotel, in the penthouse suite, for seven months. Jeff had never been in Miami. He knew about the Fontainebleau from Suburbia's Coddled Kids, in which I had recycled the old yarn about the lady in mink who thrust her thirteen-year-old son at the doorman, demanding that he be carried upstairs, thereby inspiring a dialogue familiar in coddled circles: "But, madame, can't the child walk?" "Sure, but isn't it nice he doesn't have to?" From coddled kids to coddled cats was a small distance, especially for my son, an author's delight. Like his brother, he recited from Suburbia's Coddled Kids by the page, with little excuse and verbatim. When Jeff was eight, the divorce threatened to explode his life brutally. My marriage was no longer salvageable, but my disagreements with Edith had been efficiently hidden from the boys. Knowing that a divorce announcement would hit them hard, I consulted a child psychiatrist in Chicago, where we then lived. I see Dr. Robert H. Korf sitting before me in his office on North Michigan Avenue, a kindly, elderly personage wearing a weary expression that conveyed "My God, what trouble I've seen parents make for their children!" Dr. Korf knew his business. He dictated a detailed sequence of hard-nosed directives to take Edith and me out of our preoccupation with our own conflict and place ourselves in the shoes of our kids and their disrupted lives, assuring them that the divorce was in no way their doing and emphasizing the many aspects of their daily routine that would not change. Love and stability would endure for them. Dr. Korf did a good job of explaining; most emphatically, he warned us not to spring the separation and the appearance of a new woman in my life at one and the same time. That part of the counseling didn't take. Our scene played out at bedtime, and it was cataclysmic; no other word will suffice. Extremely agitated, Edith told the boys about Barbara, my new wife-to-be, of whom they had not yet heard. They reeled. Jeff fashioned a sentence with implications that still burden my conscience: "Will she be our mommy?" he wanted to know. His brother sat bug-eyed and silent in his pajamas. Their roles were soon reversed. I could never explain the discrepancy fully, but Ron was able to discuss the family sadness, to rail against it and to treat Barbara at some distance. Jeff and Barbara quickly became good friends, but the divorce was a taboo subject, then and pretty much forever after. I realized that this bottling up of a powerful event could cause trouble, and the weight of my guilt feelings has lessened but never left me entirely. How justified is it? Divorce is a notorious stressor, for children as well as divorcing adults. How vulnerable is a child to lasting psychological damage? No one can say with certainty. What will trouble me eternally is that many studies have implicated stress as a possible cotrigger of schizophrenia; the speculation runs through the professional literature like drumfire. How important a factor is it? Under what circumstances does it activate vulnerabilities of an adolescent? The doctors know just enough to keep a divorced parent imprisoned with the possibilities. I was only dimly aware of these storm clouds in 1968. (Schizophrenia still had not yet been mentioned.) In my letter to Dr. D'Andrea I wrote: Much as I tried, and always in a pleasant and inviting and certainly non-censorious way, I never was able to get Jeff to say a word about the divorce. Not one single word.... Jeff appeared on the surface to be coping so very well with literally everything that I gradually stopped prodding him about the subject. It seemed overanxious to take him to a psychiatrist to raise an alarm about something that was not happening. I suspect now that some or much of Jeff's trouble lies buried right there. One pretty nice family became two pretty nice families and settled down. Edith had enacted her dream of following the sun to Palo Alto; I had followed mine by moving my magazine-editing career to New York, the center of the industry action. The widening of our geographic distance foreshadowed some problems of identity formation for Jeff years later, but I worked as hard as I could not to allow an emotional distance to grow between the boys in the West and me in the East. What had phones been made for, after all? And notes? And cards? And audiotapes? And silly gags to be traded? Traffic whizzed back and forth. Jeff found fun aplenty and plunged into the full of it. A private new transcontinental world took shape, filled with further outrageous missions of the Humphreys' cat; a symphony orchestra of musical mice like Wolfgang Amadeus Mozart Mouse and Johann Sebastian Bach Mouse, forever uncatchable by the Humphreys' cat; and two boy adventurers named Hopalong Cassidy Jr., known as Hoppy, and Popalong Cassidy Jr., Poppy, who ballooned around the world in seventy-nine days, not eighty. Who had time for separation anxiety? Here is a "Dear Daddy" letter dated December 30, 1960, written right after Jeff moved to California: "How are you feeling? Today I am not doing very many action things. The Baylor Bears have a real live bear as a mascot on TV." Another message of the same vintage reported: "When we went to Fisherman's Wharf with Grandpa Wyden and Alice, they bought me a shell." Still another reports: "I got my new math test grade back. I got an `A--.'" And at about the same time Jeff furnished this evidence of a dogged political passion that he would never lose: "I was given a Kennedy button by a boy in my classroom named Dennis. He's for Kennedy, too. Almost everyone around here is for Nixon, but I still hope Kennedy wins." On August 11, 1963, came this word from him: "I'm writing to you on my new typewriter.... I wouldn't think you had your own typewriter when you were a boy. And such a fancy one! This one is called a Signet, made by the Royal typewriter company. This particular typewriter was imported. It was made in Holland. It is unbelievably coddled! The coddled kids deserve the finest, you know." Jeff had developed a passion for the comedian Allan Sherman and his records My Son, the Folksinger and My Son, the Nut, so for his twelfth birthday I wrote him an Allan Sherman serenade that began: Jeffrey Wyden, Jeffrey Wyden, How's by you, how's by you? How's your birthday going? A party you are throwing? That's nice, too; that's nice, too. Is it true you're modeled After a kid that's coddled? How is Humphrey's cat? She's getting much too fat. How're your table manners? Are they winning banners? Now you're an adolescent. That ought to be quite pleasant-- So are you, So are you. The day after his birthday he wrote back: "That serenade you wrote for my birthday was good. If you sent it in to Allan Sherman he'd probably use it the first time he looked at it." As so often, Jeff also tackled a sensitive subject: "I am writing you to ask whether we might be able to work on the boat and get everything but the painting done so we could get the boat finished next time you come to California." I never let more than three months go by between quick trips to California, but "the boat" was beginning to become a delicate issue. When Jeff at age nine expressed repeated hankering for a boat, I purchased an $80 mail-order kit--the parts of a surprisingly sturdy-looking rowboat for self-assembly. It was a bizarre and foolhardy venture, since I am famous as an unhandyman; the parts seemed overwhelmingly numerous, and the plans bewilderingly complex. As we uncrated the "boat," the dream vessel seemed to fade from reality. I had not reckoned with my son's determination and organizing zeal. When he wrote to appeal for a final push to get the little monster finished, we had been hammering, gluing, and puzzling in Edith's garage for three years, if, necessarily, with extended intermissions. By this time, I, too, had been seized by an irresistible drive not to concede defeat at the hands of the kit makers, who were surely laughing themselves silly into their--to us unreachable--power tools. Another year and a half would be required for the product of our mania to begin its truck voyage across the country, at about five times the cost of the original kit. I predicted that it would sink upon hitting the water. Jeff said it wouldn't, and when we shoved it very, very gently into the Connecticut River near our summerhouse in Chester, by God, it didn't! What a triumphant couple of skippers we were as we revved up the Sears outboard motor, bought on installments, and put-putted into exclusive Hamburg Cove that Sunday. When during the kids' stay with us for summer vacation Barbara found that Jeff enjoyed hanging around the kitchen to help fix meals, he became her exuberant assistant. Together, they produced The Cook-Along Book, a unique literary voyage, the "senior chef" cooperating with the "junior chef." The book was an adult hit with the Cookbook Guild. Jeff marshaled enthusiasm for a team spirit on other occasions. Though neither of my semicoddled children likes to get his hands dirty, when we found the family graves at the Jewish cemetery in Berlin-Weissensee overgrown in weeds, Jeff set about to clean them up. And what a mimic he was! His JFK imitation became a regular attraction for our adult guests. At a ludicrously costly dinner at a three-star restaurant in France, Jeff stopped the Lucullan show. Barbara had two martinis. Jeff kept filling up the empty glasses with water and sipped with deliberation, preening the while. The French onlookers, tending to literal-mindedness, must have been disgusted at those undisciplined Americans. Jeff also appreciated the laughable. We once gave a summer weekend party and laid in liberal supplies of the then-popular kinds of hard liquor. The clerk in the liquor department that Saturday morning was enchanted as I loaded up my muscular boys with case after case, and when Jeff was last to stagger away with a case of gin on his back, the man sang out, "Have a good weekend!" That was thirty years ago, but to this day the phrase gets belly laughs in our family. It means: "Watch out! Don't have too many!" Jeff worked cleverly for his laughs. In July 1963 I received a "Coupon for Happy Day" from him, signing himself as "President of New York Happy Day, Inc." The document, carefully laid out for eventual printing, urged "Read carefully" and began: "Yes, Mr. Wyden, you have been chosen to get a Happy Day.... If you are not happy with the date of your Happy Day, please see us. We can postpone it. On Thursday, August 1, 1963, you will personally be waited on by us hand and foot from morning to night. This includes such services as breakfast in bed and others. We hope you fully enjoy your Happy Day." The dark and light shadings of his days mattered to Jeff even as a small boy. It registered on him which was which. Some years after my Happy Day, he was becoming ever so slightly withdrawn, and Barbara used to try to get him rolling on vacation mornings by challenging him, "Come on, Jeff, it's going to be a big day!" After Jeff had heard this exhortation once too often, he looked up plaintively at her one morning and mumbled in exasperation: "We don't have any more little days, do we?" This plea, too, remains part of our family language. His eye for dissenting social comment and sarcasm, along with his wish to duck confrontation, likewise developed early. He was plainly declaring himself sick of parental arguments when he delivered a draft copy of a publication he called Bicker, with the subtitle The Everyday Evening Bicker. We found tremors of change in Jeff's personality easy to dismiss as normal expressions of puberty and postpuberty turmoil in an adolescent boy. When Barbara and I visited him briefly at the Stanford campus in Tours, France, where Jeff was luxuriating in his junior year in 1971, he officiated as the proverbial life of the party: bubbling French, plotting gags with new friends, too busy to pay much heed to us. We were delighted to have seen him reveal himself outside of the shell that had been enveloping him. It was to be his last--and very temporary--outbreak of sociability. "Introverted" is as strong a label as I picked to describe him earlier, never anything pathological. In a letter to Dr. D'Andrea in the watershed year of 1968, I reported: In the last two years or so, his reticence has become excessive. He has had to take a good deal of kidding about it. I've accused him of being too much of a "strong, silent type" and kidded him about being a CIA agent, as close-mouthed as a professional spy.... But he seemed to have no trouble in school, although he never seems to have functioned near the level of his potential.... He continued to be so introverted that I spoke with him about it very seriously in private. I told him that everybody has to share his fears and burdens; that I realized kids often find this hard to do with their parents and that this was nothing to be ashamed about. I suggested that he talk to his Uncle Fred, an Oakland internist whom he likes a lot, about any worries he might have. Stoically, he kept maintaining that he had no worries. I knew, of course, that this had to be nonsense, but I didn't say so and there didn't seem to be anything to be done that wouldn't have seemed like a hyper-reaction--again--to something that "wasn't there." One problem was beyond denial, however: Jeff acted as if girls didn't exist. I wrote the psychiatrist: My wife and I believe that Jeff is very interested in girls, but cannot remotely conceive of any girl getting interested in him. This is part of his low self-esteem, of which there was no evidence for at least four years after the divorce, but of which there has been plenty of evidence since. When he was fourteen we once talked about jobs available to young people and he said, "Who'd ever want to give me a job?" I hooked in to bolster his self-confidence on such occasions, but I don't suppose I ever convinced him. He has never gone to a dance and I wouldn't be surprised if he has never spoken a single personal word to a girl. He was treasurer of his Junior Achievement Group, plays in the band and on the "C" basketball team and can hardly be called an isolate. On the other hand, he almost never does anything on Saturday or Sunday night except watch TV. Our family and friends said he'd grow out of it. Jeff's creativity was pronounced, though curiously abortive. My son was a hit-and-run artist. He was brilliant with words, but even his beloved Bicker magazine consisted of mostly empty pages. He tootled his bassoon with gusto, but for only a short spell. Most intriguing and mysterious was his extraordinary devotion when he produced his ashtray. While we were living in Chicago before the divorce, Jeff decided to make a black-and-white pencil drawing of an instantly recognizable downtown scene. From his vantage point of the Michigan Avenue Bridge over the Chicago River, he zeroed in on a half-open drawbridge and the mighty skyline of famous office buildings--the Chicago Tribune Tower, the Wrigley Building, and the rest. Dominating this tableau were hundreds of meticulously recreated little square office windows, lined up with the precision of a drill sergeant straightening the rows of an infantry training platoon. Jeff handed over this highly original artwork with slightly feigned indifference, although the inscription "J. Wyden" in the lower left corner was good sized. Whoever saw the drawing was much impressed and said so. I had spotted a tiny ad in The New Yorker for a company in Port Chester, New York, calling itself Young Rembrandts. The headline was seductive: "Your Own Child's Drawing on an Ashtray." I ordered four large, rectangular ashtrays, 10 1/2 by 7 1/2 inches. I still have two of them, although I stopped smoking fifteen years ago. Guests can admire one of them in the living room; the other looks at me from near my desk as I write. The remaining two are with Jeff's mother and brother. Despite the admiration and the fuss--or, perhaps, self-consciously because of it--the artist almost never again took pencil in hand. Neither Jeff's introversion nor his extreme shyness with the opposite sex diminished with time. Sometimes it seemed almost as if Jeff wanted to vanish from view altogether. That had been the case when he was still small, and we were tourists in Copenhagen. It was pouring rain, but the boys were impatient and demanded nevertheless to be let out to play in the Tivoli amusement park. Barbara, a responsible stepmother, said she would only relent if the boys got hats. Dutifully, Jeff, Ron, and I trotted off to a decorous male hat emporium. The variety of available headgear was overwhelming, and the boys dug in. The result was the perfect verification of personalities. The extroverted showman Ron, the future politician, selected a trilby of thick, checkered Scottish wool and placed it cockily off his forehead, Rex Harrison incarnate. Jeff picked a narrow-visor cotton cap of gray so dull that it seemed to make him disappear. He pulled this magic hood down over his forehead as far as it would go. "Poor Jeff!" That became the family chorus. It has never stopped. And as early as 1968 (when his troubles first grew serious) Jeff dolefully joined the wailing for himself, at least some of the time. I think this was the summer--I have no record for this, so it may have been the summer before--when we were still neighbors of the Humphreys' cat and vacationing on Martha's Vineyard, that I became exasperated at Jeff's simply sitting about, looking lost, doing nothing. With effort, he could be moved into activities--even a class in modern dancing, for which Barbara had registered us all, more or less in desperation--but the pushing that was required to set him in motion was discouraging. Determined to break the spell--wasn't he supposed to grow out of all this?--I accused him of "moofing," a nonexistent word which Jeff adopted instantly and with affection. How beautifully it fit his lethargy and his low opinion of himself. It even broke his artist's block momentarily. With green crayons he drew a monstrous otherworldly creature, ugly and awkward, which he named Sir Reginald Moof, and presented to me as his self-portrait. The vacation moofing continued. We shrugged: What harm did it do? Other kids were into rock throwing and worse. Systematic clinical concern about negative symptoms, particularly apathy, the core deficit of treatment-resistant schizophrenics, would not arise among scientists to a significant degree until the early 1970s. Apathy, withdrawal, lack of affect and motivation, slowly turned out to be among the demonstrable manifestations of this condition among psychiatric patients. But how could we have recognized what researchers had not yet fully identified in the scheme of psychopathology? Recently, whenever I've had conversations with experts about ways, if any, to recognize the onset of schizophrenia at the earliest possible stage, I tell them about Jeff's moofing. Invariably, the doctors smile sympathetically and are quite interested. They divide more or less evenly into two camps: half say the moofing held significance for Jeff's future mental health; the other half say it didn't. None has suggested effective steps that we might have taken if some ingenious psychiatrist at the time had shown prescience. Slowly, my concerns about Jeff's development grew. My letters to Dr. D'Andrea became longer and still more numerous. Whenever I was in Palo Alto, I would see him briefly, sometimes with Jeff. The doctor was an agreeable, accessible fellow, middle-aged, soft voiced, more talkative than many of his trade, almost cozy. Edith had been referred to him by Jeff's pediatrician. Both belonged to the Palo Alto Medical Clinic, a group practice affiliated with Stanford Hospital. D'Andrea seemed to like Jeff and was not given to the neutral grunts common among his colleagues. I was further reassured by our psychiatrist's animated assurances. At the outset, he didn't think anything unusual was wrong with Jeff. The lad was anxious and insecure, sure, but not to a degree worrisome during the adolescent stages of a bright child of divorce. D'Andrea related well to anxious, insecure teenagers. Until not long before, he had been a government psychiatrist serving with one of President Kennedy's most popular innovations, the Peace Corps, which was full of intellectually precocious young men much like Jeff. Patiently, the doctor took in more ruminations from my frequent letters about Jeff's status: He has a love--even a sense of excitement--for history. But when he buckles down to a job--writing a letter, reading a book--he is painstaking and very, very slow. I wonder whether this is part of his inhibitions or something else. In his preliminary SAT tests he performed way, way below the standards of his school grades because he finished so relatively few of the questions.... Both his mother and I are deeply involved in bookish professions, but Jeff is, as always, uninvolved. This is perhaps the word that characterizes him best. He doesn't want to give of himself. Above all, he is "hassle-phobic" and will do almost anything to avoid noise and trouble. It is as if he would like to trust things and people, and occasionally does, but is always fearful of being suddenly burned. Burned--so I kept thinking thirty years ago, and still ponder now--by parents who didn't tell him that their arguments hid serious differences and dropped a separation bombshell on him without the cushioning of advance grace. Yes, there's guilt. But mostly I've learned that one has to play life as it lays and deal with the hand given at the moment. So much depends on unalterable circumstances. My infantry platoon leader, Lieutenant Ballard, who was killed during the North African campaign of 1943, had the perfect response when we trainees asked him one of life's unanswerable questions. He would muse: "That depends on the situation and the terrain." Copyright © 1997 Peter H. Wyden, Inc.. All rights reserved.