No One Cares About Crazy People Read online

  This out-of-sync progress ranks among the most profound natural misfortunes of humanity. For while the prefrontal cortex is taking its time, other powerful components of the human-in-progress have raced across the finish line and function without the cortex’s restraints. A young adult with a still-developing prefrontal cortex will have reached physical maturity, which of course means the capacity to reproduce and the strong hormonal drive to do so. The hormone testosterone emerges and unleashes aggressive urges. Given the formative turmoil of the prefrontal cortex, emotional behavior is under the inadequate jurisdiction of the amygdala, a small and primitive region near the center of the brain. The amygdala is about reactions—impulses—rather than rational thought, the great boon of the prefrontal cortex.

  The activity holding back the prefrontal cortex’s final maturation is a kind of neurological housecleaning. In its final development stage, the cortex must actually lose some of its prefrontal “gray matter,” the clusters of nerve-cell bodies that formed transmission routes during infancy and childhood. This “synaptic pruning” peaks in late adolescence and is necessary for a regrouping of the cortical connections and routes that will orchestrate brain functions for the rest of a person’s life, at least until old-age decay sets in.

  It is normally during this period that a schizophrenia-inducing gene cluster will activate. The reasons that this does or does not happen remain elusive. In 1983, University of California professor of psychiatry Irwin Feinberg suggested that schizophrenia could be triggered by “excessive” pruning of the cortical synapses, especially if it is accompanied by a reciprocal failure to prune certain subcortical structures. Over the years Feinberg’s hypothesis became the basis of productive refinements. In 2011, psychiatric researchers Gabor Faludi and Karoly Mirnics published a review that cited sixty references to Feinberg’s “radical new theory,” as they called it, and endorsed the growing consensus that schizophrenia is “a mental disorder with a complex etiology that arises as an interaction between genetic and environmental factors.”

  As should be evident by now, the most implacable barrier to conquering schizophrenia (besides public apathy and governmental disinvolvement) has been the almost inexhaustible complexities of the brain, with its billions of electrochemically stimulated neurons and its labyrinth of interconnecting conduits—one hundred thousand miles of axons in each human being, submicroscopically separated by up to one quadrillion (fifteen zeros) synaptic connections, or spaces between neurons.

  We can focus on just one example of these complexities and the conceptual halls of mirrors they can produce. The MRI, which affords a “look” through the brain’s gnarly protective barriers via magnetism and radio waves, has generated a wealth of new peripheral understanding—and new scientific debate—around mental illness. Scanning the brain can illuminate structural abnormalities—disconnections, say, in the pathways through which brain chemicals flow. These chemicals include the widely versatile neurotransmitter dopamine, which regulates cognition, motor control, and emotional functions. They include another vital neurotransmitter, serotonin, a mainstay of the central nervous system that governs social behavior, memory, and sexual function. MRIs are also helpful in tracking the entire trajectory of synapse and circuit formation that can damage the wiring of the brain.

  Yet our illuminations often lead only to new questions. There are simply too many variables. In September 2013, the National Institutes of Health announced a list of nine neuroscience goals, in response to President Obama’s BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), which by that point had drawn public and private pledges of more than $300 million toward developing new tools and research on schizophrenia. The research psychologist Gary Marcus at New York University, analyzing these goals in the New Yorker, noted that the report itself acknowledged the core challenge: that “brains—even small ones—are vastly complex.” He continued:

  The most important goal, in my view, is buried in the middle of the list at No. 5, which seeks to link human behavior with the activity of neurons. This is more daunting than it seems: scientists have yet to even figure out how the relatively simple, three-hundred-and-two-neuron circuitry of the C. Elegans worm works, in part because there are so many possible interactions that can take place between sets of neurons. A human brain, by contrast, contains approximately eighty-six billion neurons.9

  When sophisticated tools and techniques do manage to lead neuroscientists to evidence of abnormality in the brain, they are often stymied by yet another of the disease’s exasperating enigmas: Is the “abnormality” they are looking at a result of schizophrenia? Or is it a cause?

  This quandary is well expressed in an essay titled “The Aetiology of Schizophrenia”:

  That structural brain abnormalities exist in schizophrenia is generally accepted to be established… beyond dispute. However, the meaning of these abnormalities, in understanding the pathogenesis of the illness, is far less clear. Questions remain as to whether structural abnormalities predispose to the development of schizophrenia, [or] whether acute schizophrenic psychosis can actually damage the brain, causing altered structure… The presence of structural brain abnormalities in [unaffected] relatives of patients with schizophrenia suggests that “schizophrenia genes” are likely to be involved in (abnormal) brain development, but that the expression of the structural brain correlate of the genes is not enough, in itself, to “cause” schizophrenia.10

  The genes that underpin schizophrenia may have been favored by natural selection, according to a survey of human and primate genetic sequences. The discovery suggests that genes linked to the debilitating brain condition conferred some advantage that allowed them to persist in the population—although it is far from clear what this advantage might have been.11

  Despite these complexities, the centrality of congenital factors to the disease was resoundingly ratified in 2014 by the Schizophrenia Working Group of the Psychiatric Genomics Consortium, a collaboration among some three hundred scientists from thirty-five countries. After examining the genomes of some 37,000 people with schizophrenia and comparing them with those of more than 113,000 healthy subjects, the group claimed to have identified an astounding 128 gene variants connected with schizophrenia. These genes occupied 108 locations on the genome, with most of them having never before been associated with the affliction.12

  It’s true that contemporary research has unlocked many secrets about how the brain works. Advances have been spectacular in neuropsychology (which is, briefly, the psychiatry-based study of how reasoning works and why/how people experience impairment); in technology (such as magnetic resonance imaging, or MRI, to facilitate the study of the brain); and in the development of “psychotropic” medications, from the anxiolytic Valium to the antipsychotic Haldol and beyond.

  These techniques and findings have helped alleviate a range of relatively minor discontents. They have also shed light on electrical and chemical impulses as they move through the brain; on the nature of receptors; and on the functions of the cerebrum, cerebellum, diencephalon, and brain stem. Yet, when applied to the task of conquering the most feared and devastating mental disorder of them all, our cutting-edge tools have scarcely begun to cut the edge.

  3

  Regulars

  We arrived on the mountain-meadow grounds of the Bread Loaf Writers’ Conference in August 1988 and never went home again.

  Honoree and her mother, Honora, drove back to our Yonkers house to supervise the movers who were shoving our furniture and bulging cardboard boxes into the big van for the long haul up to Middlebury. The boys and I stayed on at the Homer Noble farmhouse for two or three days, taking our meals down in the town. The conference had ended. Everyone else had departed. Dean and Kevin, who were six and four then, had been on the campus only during the days when the conference was in session and teeming with writers and poets. This was the first time they had ever seen it empty. We walked the grounds, and I could tell that the stillness, and the vaca
nt dorm buildings and Adirondack chairs, disoriented them a little.

  Our nights in the farmhouse, the three of us the only human beings within pitch-black miles, conjured the aura of an older, Gothic New England. I was proud of my sons for being courageous enough to sleep in their accustomed second-floor cot beds, secure in knowing that I was in the adjoining bedroom. I was not so proud of myself for awakening from a dream at about 3 a.m. on the first night: a dream in which someone was pressing a finger down on an organ key, sustaining a high, eerie note. I sat up in bed. Then I realized that the keening sound was no organ key but a coyote wailing in the woods outside. My skin went clammy and my heart thumped for a few minutes. If my sons heard the howl (or my heart), they gave no sign. Out of respect for their bravery, I restrained myself from moving into their room to get over the jitters.

  “It’s all right, Dad,” they might have told me if they’d awakened. “It’s safe. We’re in Vermont.”

  Honoree, Honora, and the movers arrived in Middlebury on the third day. The kids and I locked up the farmhouse, left the key for the caretaker, and drove down the mountain to meet them at our new house. Honoree had been told of its availability. She believed that it was perfect. It was perfect. We lived there for seventeen years.

  Concealed by trees and hedges, the house sat at the end of a curving cul-de-sac on the last neighborhood street in Middlebury before horse farms took over and the rolling fields reached toward the mountains. Built of gray-painted hardwood some thirty years earlier, it appeared low-slung despite its two stories. Behind it was a small kidney-shaped swimming pool, with woods on the far side of the fence. The front was crowned by a yard lamp atop a pole at the crest of the steeply terraced lawn (nice to look at, hell to mow). Years later, in a time of turmoil for him, Dean planted a Japanese maple tree near the yard lamp. As far as I know, it is still there.

  When the boys and I pulled in, the moving men were unloading canvas-draped furniture from the van. I remember the exact spot in the driveway, the apex of the turn left toward the garage, where I stopped the car and the boys spilled out. Inside the echo-y house, looking through the front-door window, we sighted a rainbow arcing into the mountains where Bread Loaf lay. Rainbows would become familiar presences above the low-hanging tendrils of mountain fog.

  We were in Vermont to stay.

  Middlebury proved an ideal town for raising young children. In the fall Honoree began teaching biochemistry at the graystone college on the opposite end of the town, which had opened its doors in 1800. She was placed on a tenure track the following year. It was not exactly a guarantee of permanence: the first woman to have attained tenure there was only in mid-career when we arrived.

  My adjunct appointment in creative writing would commence the following year. I wrote a little, and transported Dean and Kevin to school and sports and community theater rehearsal, and then drove to Steve’s Park Diner, across the street from the town green, where I became a regular. Pretty soon, Dean and Kevin were regulars, too.

  Early on, the concept of being a “regular” caught Dean’s and Kevin’s fancies. They quickly grasped the protocol of New England diner-talk: when the waitress—let’s call her “Pauline”—approached the table, order pad in hand, and said, “Are you all set?” she was understood to mean, “Are you ready to order?” When she brought the plates and began to distribute them and said, “Are you all set?” she meant, “Is there anything else you want?” When she came back at the end of the meal and said, “Are you all set?” she meant, “Can I clear these dishes?” And when she returned shortly after that and said, “Are you all set?” she meant, “Are you ready for the check?”

  Kevin was especially proud on the day he tried out some diner-talk of his own and it worked. To Pauline’s “You all set?” he replied, “I’ll have the usual.” Only a regular would have dared order “the usual.” Pauline understood. She brought him a bagel and cream cheese. Kevin was in.

  As for Dean, he soon grew to regard Middlebury entire as his “regular” domain. One day, as the two of us walked along the sidewalk past the local Mexican restaurant, whose gaudy colors had been freshly repainted, I heard my son grouse: “Before long, you won’t be able to recognize this town!”

  I stopped in my tracks and stared at him. Grousing is not normally a skill acquired in childhood. Dean was either doing a shrewd imitation of me grousing, or he’d been richly endowed with my grousing genes. I didn’t ask him which. After a moment, we walked on.

  Honoree, the classic city girl, started a vegetable garden and planted brilliant dahlias and day lilies and purple coneflowers along the backyard fence. At the same time, she was rapidly converting herself from a career urban research scientist specializing in cultured human endometrial cells (her twenty-three publications include “Estrogen Receptors in Epithelial and Stromal Cells of Human Endometrium in Culture,” which I could explain if I had time) into an academic teacher of science.

  Dean spent happy hours inside his imagination, enraptured by gorgeous things the rest of us could not see. (The relationship of dreamy, artistically gifted children, a trait Dean shared with Kevin, to a propensity for mental illness, was unsuspected by us then; we simply enjoyed the richness of their ideas and talents.) Dean was quieter than Kevin, but once in a while he would briefly reveal the universes whirling inside his head.

  I recall a walk with Dean at Bread Loaf in the summer before we moved to Vermont. I had stolen an hour away from the workshops and manuscript conferences to be alone with him, and we strolled out along the Robert Frost Trail. The trail, half a mile down the road from the campus, is just opposite the dirt road that leads to the Homer Noble Farm. It winds through wildflowers and along a creekbed. A wooden footbridge crosses the creek near the beginning. Every few yards a signpost greets the hiker with a few lines from a Frost poem. I was reading these snippets aloud as we walked, all caught up in the sound of my rich timbre, when I heard Dean’s voice behind me:

  “I heard the wind and the water rustling.”

  I stopped and turned around and looked at him. He looked at me.

  “Go on,” I said.

  Dean shifted his gaze and thought for a bit. Then he looked at me again and said:

  “While birds were flying and squirrels were running around.”

  “That’s really good,” I told him. “Can you keep going?”

  Dean shrugged and fell silent. We walked on. Then:

  “And the trees were shaking around the wild forest.”

  We stopped again. This time I didn’t speak, for fear of breaking the spell. But I nodded at him. And he continued:

  “When I was crossing the bridge,

  “I heard the splashes…”

  I waited again. This time it took awhile; but finally:

  “…Of two sticks that fell from one tree.”

  When my gooseflesh had settled, I said, “Hey, are you about ready to head back to the farmhouse?” He nodded. I tried not to hurry him beyond the capacity of his six-year-old legs. I wanted to write those lines down while they were fresh in my mind.

  We made it in time.

  I read Dean’s poem to the Bread Loafers that evening before I gave my own scheduled reading. The audience gave a kind of low gasping thrum when I’d finished. His stuff was better than my stuff that night.

  At age ten, he switched from poetry to prose and produced this little fragment from his daydreams:

  10 Million Dollar Mansion

  Plans for Disign

  The 10 Milion Dollar Mansion will be 8 stories high. Surrounded by acres of beautiful green garden, and a iron wall you can see through. After you pay your fee, you will be treated like a rich person the rest of the day. First you will be picked up by a limousine, and a shofer will come out and open up the doors for you then drive you through the road and to the mansion itslef. When you are driveing to the mansion there will be soda pop and a T.V. that will explain the park. When you get there the shofer will open the door for you and someone will lead you to the tw
o huge doors on the mansion, then he will buzz and the butler will greet and say, “welcome to the 10 Million Dollar Mansion.”

  I read this as an expression both of Dean’s security in the embrace of our family “mansion” and of his familiar hunger to reach higher, to magically make his world more wondrous still. Dean lived dreamily in the expectation that he could transport himself to ever-greener gardens, ever-more-shimmering mansions.

  At around age thirteen, Dean got interested in sports. He played outfield in a spring-and-summer league. Commitment to the game varied among the players. The third-base person could be counted on to be tracing artistic spirals in the mud with her finger when a ground ball came wobbling toward her. Everybody knew everybody else—players and their parents. The parents sat on the aluminum slats behind the home-plate screen regardless of loyalty. And yet they were loyal. Sometimes this produced awkward moments. I remember being pressed into service as an umpire one time when the regular guy didn’t show up. I called balls and strikes from behind the pitcher because the throws back to the mound from the catcher, which the pitcher generally missed, didn’t have quite as much mustard on them as did the pitcher’s pitches to the catcher, which the catcher generally missed.

  One of the teams that day was Dean’s. The other team was coached by my dentist, who just a day earlier had removed a decaying rear molar from my mouth and stanched the bleeding with a tight wad of cotton. The dentist’s team was at bat, and I could see that the dentist, a rather large and florid man, had his eyes trained on me. He appeared to be scowling. Maybe he didn’t like the fact that the opposing nine had a parent calling the pitches. Maybe he was one of those guys. With two swinging strikes in the count, my son’s team’s pitcher hurled, and I bawled “Strike three!” The dentist rose and came to the mound on a fast trot. I spread my hands in the timeless “Chill out!” gesture.