Psyched Out

He was in the hospital the day he learned he had been elected to the Phi Beta Kappa Society. Rodney Plamondon looked for a while at the letter that told him this. He was pleased. He was the 22-year-old son of a long-haul truck driver. Rodney's future wouldn't involve driving a Kenworth.

This was good. He had dreams. He had aspirations of doing graduate work in the classics at an Ivy League school, of teaching after that. Or entering the Foreign Service. Getting into that honorary society wouldn't hurt his chances at either.

Rodney put the letter away. He had more pressing concerns.

He was, on this July 1984 day, in the psychiatric unit of a hospital in Boise, Idaho, his hometown. He was newly diagnosed as a paranoid schizophrenic. Rodney hadn't the slightest idea what this diagnosis meant for his world, but he knew that his life had changed dramatically.

"I asked the doctor if I would get better," Rodney says. "'Oh, it gets worse as you get older,' is what he said. Nice pat on the back."

It happened to me that way, too— a psychotic break out of the blue during a twentysomething life that had been shaping up quite nicely. It was difficult to build a new life out of that. There were many, many setbacks. That's the absurd deal of mental illness: You get taken most commonly in your youth, when life is just beginning to gel. You get an illness that, in many cases, is so disabling that it strips you of the psychological and practical goods essential to a decent existence. Often you get kicked right out of the mainstream, no matter how solid a citizen you were before it all went bad.

What are you going to do about that?

You have three choices: kill yourself, lead a featureless existence, or fight back and extract some measure of revenge on that which laid you low. Rodney and I rejected options one and two. Option three is no cakewalk. It takes years of determined effort before you see light at the end of the tunnel, and as you feel your way along, you've got to do it all on blind faith that something good might happen. After 15 years, I'm finally beginning to see a faint glow.

Rodney is still staring at the dark walls of the tunnel. In the past year, he's been in and out of psych units in Seattle eight times. He's lost pretty much everything—his furniture, his computer, his cat, and every scrap of fiction and poetry he had written over the past 20 years. He takes Haldol and Clozaril twice a day—powerful antipsychotics. Rodney sleeps 12 hours a day on average, sometimes 15. On his left cheek, there are flakes of skin where the pillowcase has rubbed him.

Some days, when he leaves the building, he looks as though he's been mugged and beaten. Those are his good days. Other times, the bad days, he's too paranoid to step outside. He's still warming up to fighting back.

"I keep thinking I'm going to get better," he says. "I've been thinking that for 20 years."

I've been thinking, too. I've been thinking that in the past two decades, we've come a long way in how we regard the mentally ill. You can, for example, mention schizophrenia in mixed company these days without causing half the people within earshot to gasp or cross themselves. But we've not advanced far enough. We haven't reintegrated people like Rodney into American life, except in the most marginal of ways.

I'm thinking we can do a lot better than that.

All This Torment, and No Sex

The central question before people with chronic mental illness, such as Rodney and me and the millions of other Americans who've got it bad, is this: Can you get to where you were before all hell broke loose in your brain and soul and life, before disorder became the order of the day? Can you be whole again? It's the only question worth asking. The answer is that many of even the most chronic sufferers can get much of their life back. They can have homes and jobs and careers and cars and families. Rodney can, too.

Paradoxically, the medications designed to get people like Rodney off the deck and able to reintegrate into society often limit the kind of life they can have. They are an effective baseline treatment. For some with lighter varieties of mental illness, medications are a gateway to a better life. But for many others, medications are as much a curse as a cure. Just ask Rodney. As he looks forward to a day when he's stable again, he'd like to have a girlfriend, for one thing. The trouble is that the meds that work for him render him impotent.

"A caseworker once told me that you didn't need to have sex to have a relationship," he says. "I laughed at him."

Over the past 15 years, the dominant paradigm for treating mental illnesses in America has been to use new-generation psychiatric medications and rely on them almost completely. It's a kinder approach to helping the mentally ill than the days of institutionalization, to be sure, and it has enabled millions of Americans with mental illness to realize better lives than in the 1970s. But for millions more, the approach isn't all that gentle. The meds can have debilitating side effects—cognitive and physical. It's Russian roulette when you take an antipsychotic, and it's Russian roulette if you don't.