On a clear, autumn day during his senior year of high school, my brother, Clint, was seated in his English class working on an assignment when he heard a voice telling him he needed to kill a classmate.
He sat upright in his chair, not sure who was speaking to him. The voice spoke to him again.
He needed to kill a classmate.
Clint asked his teacher if he could be excused from class. He felt frightened. He needed space to think about what he was hearing, about what he was being asked to do.
He walked down the hall and opened the door to the boys bathroom. He could hear the voice as though it came from a man standing next to him in the bathroom, shouting in his ear. The voice grew louder and more intense. The words bounced sharply off the brown tiles on the floor and the walls, encasing him in a chamber of taunts and commands he had no desire to fulfill.
When Clint failed to return to the classroom, his teacher went looking for him. He wasn't hard to find. She could hear him yelling. When she pushed open the door to the bathroom, she found Clint in the corner, seated on the tile floor, huddled against the wall, screaming, "I won't do it! I won't do it!"
When Clint was discovered by his teacher, my parents and I learned for the first time that Clint was hearing voices. But for Clint, this was not the first time.
A few years ago, I went to an appointment at the hospital in Perth, Western Australia, where I was to deliver my first baby. When the midwife asked me if there were any hereditary conditions in my family's health history, I told her about my brother.
"He was diagnosed with schizoaffective disorder and severe depression with psychotic features about six years ago," I said.
She wrote this down on a piece of paper in my file.
"It may be hereditary. He takes medication for it, though."
"Where is he now?" she asked, still jotting notes.
"He lives at home with my parents and attends university," I said.
At this, her pen stopped, and she looked up at me. "He's going to university? He's not institutionalized?" she asked.
In May, my brother graduated from a university in Utah with a bachelor's degree.
Clint shouldn't have graduated. In fact, he probably shouldn't be alive. According to Rethink, a mental illness charity in the United Kingdom, 30-40 percent of those who suffer from schizoaffective disorder will attempt suicide during their lifetime, and 10 percent will succeed.
Clint has experienced auditory and visual hallucinations for as long as he can remember. He is not sure when they began, but he knows that he was experiencing hallucinations when he was 13 because during that year he wrote about them in his journal.
Clint remembers that at first, the images he saw and the voices he heard were playful and friendly. Out of the chorus of hallucinations, a few male figures featured prominently among the others.
But as time wore on, the figures turned dark, violent and demeaning. Clint wondered where the hallucinations were coming from. He tried as hard as he could to block them out.
But they wouldn't go away. Clint couldn't get them out of his head. He blamed himself. He could see that no one else was hearing what he was hearing or seeing what he was seeing, so he deduced that because his thoughts were bad, then he was bad. Clint believed he experienced hallucinations because he was a sinner. He thought the hallucinations were sent to him by the devil to tempt him.
As Clint grew into adolescence, the images and voices became increasingly violent and intense. They would challenge him to harm himself.
One day when Clint was 16 and alone in the house, one of the male figures dared him to stick the barrel of a shotgun under his chin. Clint resisted, but the hallucination wouldn't let up. It yelled at him over and over again, telling him it had to be done.
At the time, our dad kept an unloaded shotgun in a corner of his closet next to his tennis rackets. The last time he used it was before Clint was born when he went skeet shooting.
Clint took the gun from the closet. He sat at the foot of our parents' bed. He was crying. He wanted the voices to stop. He put the butt of the gun on the ground between his feet and leaned over so that his chin rested on the barrel. He pulled the trigger.
Then he lay on the bed and began to cry. He thought he was losing his mind.
Schizoaffective disorder is a combination of the symptoms of schizophrenia and bipolar disorder. It is a chronic disease of the mind, manifesting itself in visual and auditory hallucinations and severe mania and/or depression.
There are multiple possible causes of schizoaffective disorder, but nothing is definitive. According to Dr. Paul J. Carlson, a psychiatrist who is a research fellow at the National Institute of Mental Health in Maryland, researchers have found evidence for genetic factors as well as a possible role for environmental factors, such as brain trauma occurring at birth or at a young age, or prenatal exposure to certain viruses or illicit drugs.
Carlson describes the human brain as containing countless chemical and electrical highways on which information is constantly processed. These highways are composed of neurons as well as chemical substances or neurotransmitters, such as dopamine, serotonin and glutamate, which carry messages between neurons. In Clint's brain, it is as though pieces of highway are missing, detoured or overly congested.
Information doesn't get to where it needs to go, causing him to register voices and images that seem to him very real but are not. These disconnects also put him at a high risk of suicide, because the voices and images are constant, demeaning and loaded with reasons why, and instructions as to how, he should kill himself. Even with medication, Clint's self-destructive hallucinations rarely let up.
Not long ago, he feared that people were coming to the house to kill him or the family. He would ask my mom if anyone had come to the door, inquiring after him, or if she had noticed anyone suspicious lurking around the neighborhood.
Some days, while he was on campus, Clint would get the feeling he was being followed. He described the paranoia as feeling the constant presence of someone behind him. When he'd turn around, no one was there.
For a long time, Clint thought people were sending messages to him through his digital alarm clock. He thought that the number of blocks of color making up a number corresponded to a letter in the alphabet and that the letters created a secret message.
He gave up decoding the numbers, because he thought possessing secret information would put the family at risk.
When Clint was diagnosed, my parents were beside themselves with grief and guilt. What had they done to bring this upon him? Had their parenting failed him? Had they unknowingly passed on a defective gene?
My mom recalled the conversation she had with the psychiatrist after he had conducted interviews with and extensive testing of Clint. The psychiatrist told her that before he said anything else, he wanted to reassure her that the illness was not the result of bad parenting. Clint had not been physically or sexually abused. He had not taken drugs. Clint suffered a severe neurological disorder. It was simply a problem with the biology of his brain.
At this, my mom broke down and wept.
Not long after Clint's diagnosis, my dad began researching the illness. He attended information sessions at the local chapter of the National Alliance for the Mentally Ill. At first my mom declined to attend. She felt uncomfortable sitting in a public forum, admitting that her son had a mental illness. But she decided to attend a 10-week NAMI course with my dad when he told her that everyone in attendance had a family member with a mental illness and probably felt the same heartache she was feeling.
In an effort to respect Clint's wishes and his privacy, for a few years following his episode at school we didn't talk about his illness outside of our immediate family and a few trusted friends. Even then we didn't have much to say. My siblings and I didn't know enough about it to discuss anything beyond the name of the illness and the symptoms, with which Clint continued to suffer.
Following his diagnosis, Clint began therapy and medication.
He wasn't excited about taking his meds. My parents, however, were convinced he had a much greater chance of functioning with meds than without them.
A distant cousin suffers from schizophrenia. Unlike Clint, his days are spent in a fog because he refuses to take his medication. The difference between the cousin's ability to function and Clint's ability to function is obvious obvious to everyone except Clint.
Clint's biological response to the medications has been that typically, after six months on one course of medication, the effectiveness wears off. Clint develops a sort of immunity to the drug. His mind outsmarts the meds. Clint knows the effectiveness has worn off because the voices become stronger.
Because the drugs are so powerful and Clint's illness is so intense, he chooses to be hospitalized to undergo the transition to new meds. He does this to ensure he does not harm himself or others during the transition.
One of Clint's greatest fears is that the doctors will run out of medicines that will work on him. He is terrified of the voices, terrified of what they might compel him to do.
When he expressed his concern to one of his doctors, the doctor said, "Clint, we will never run out of medicines to try. If one doesn't work, we'll try another. If that doesn't work, we'll try another. We'll never give up."
While my parents cling to statements like this, Clint tires of hanging on. He knows his illness is treatable, but it's not curable, and dealing with voices every day wears him down.
Clint holds out hope that he will get better. But the disease is fickle, variable among sufferers and unpredictable. He cites mathematician John Nash, whose schizophrenia went away with age. He also cites Nash's son, who continues to battle with schizophrenia.
One could say Clint leads a double life: After eight years of medication and therapy, he continues to experience auditory hallucinations, depression and suicidal thoughts on a daily basis, while he works toward entering a master's program in mental health counseling, attends courses in graphic design and holds two part-time jobs.
Most mornings, while attending university, Clint battled to get out of bed and onto campus. He felt like curling up and dying. One morning, around 10:30, our mom came to see if he was going to class. He told her no, then five minutes later, he got up. He thought, "I can either lie here and let it beat me up, or I can get up. I can't let it win me over."
He deals with the voices by talking them down. He could let them take over, or he could fight back. He chooses to fight. He tells them, "I can do this." He says he has to get angry with them. He has to tell them, "I'm a better person than you say I am." It's a constant battle, one he engages in every day.
His therapist doesn't recommend this method. He thinks the more Clint fights it, the more negativity he creates. But it works for Clint. It makes him feel stronger.
A few months before graduation, he was back in the hospital. My dad asked him if he wanted to quit his classes, push his graduation back. Clint told him that the way he saw it, he could quit or he could keep going. He had just received good grades in his classes. He decided to keep going.
I can tell Clint how remarkable he is; I can list for him how much he has accomplished, and each time my words are met with, "Oh" or "Hmm." He simply doesn't believe what I'm saying. He's lived for so long with voices telling him he's worthless he often fails to register a positive remark. He is learning to combat the negative voices with voices of his own, positive voices recounting evidence of things he's done well. His ability to do this effectively is slow in coming, but he's working at it.
In the meantime, Clint plans to attend graduate school. He recently completed volunteer service at a clubhouse for the mentally ill, where he tutored another sufferer and taught an art class. He wants to put what he's gone through, and what he continues to endure, to good use. He knows there isn't anyone who can say to him, "You don't understand what I'm going through."
Four months after my son was born, he and I flew to Salt Lake City to visit my family. While I was there, I had a long talk with Clint. I asked him why he kept going, how he resisted the urge to end it all.
He said he had been taught an important lesson in therapy. "I get up every morning hoping to find joy," he said. "That's all. Just a piece of joy."
On a Saturday in May, Clint donned a cap and gown, defied steep odds and received his college degree.When the ceremonies finished and he went home, he recommenced the fight for his life, hoping against hope that maybe, one day, he would be rid of the disease.
Therese Grinceri is a freelance writer who lives in Melbourne, Australia. She is a former resident of Salt Lake City, where she was a press aide to Gov. Mike Leavitt. E-mail: firstname.lastname@example.org