When your son hears voices

THE MOTHER DRIVES her son everywhere because he is not well enough to drive. He sits next to her, and at the red lights she looks over and studies him: how quiet he is, how stiffly he sits, hands in his lap, fingers fidgeting slightly, a tic that occasionally blooms into a full fluttering motion he makes with his hand, as if clearing invisible webs from his face. He is 19 years old, 6 feet tall, 250 pounds. His eyes are more steady than bright at this particular moment; his mouth is not set in a smile or a frown but some line in between.

It has been 10 years since Spencer Haskell began thinking his classmates were whispering about him, four years since he started feeling angry all the time, and two years since he first told a doctor he was hearing imaginary voices. It has been 20 months since he was told he had a form of schizophrenia, and 15 months since he swallowed three bottles of Benadryl and laid down to die, after which he had gotten better, and worse, and, for a while, better again, or so Naomi Haskell had thought until an hour ago, when they were in the therapist's office and Spencer said that his head was feeling "cloudy."

Cloudy was the big, flying red flag that she had learned to dread. It might simply be a side effect of one of his five medications. But it could also be the quiet beginning of her firstborn son falling apart again, of hallucinations, or a dive into depression, or some other dimension of his illness that Naomi has yet to fathom.

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This is what it is like to be the mother of a son with a severe mental illness — an hour-to-hour, minute-to-minute vigil. At a time of increasing public concern about the role mental illness might have played in mass shootings in places like Newtown, Conn., and Aurora, Colo., Naomi's worry on a Tuesday in Texas is different. It's about keeping her son well.

So what Naomi is thinking about now is helping Spencer make it until Friday, when he has another therapy appointment, and when the effect of a new medication he has just started taking might become clear.

They drive to the apartment where he moved in January, when Naomi had thought Spencer was stable enough to leave the home where he had been living with her, his stepfather, and his younger brother. He had made it through the busy Christmas season working as a cashier, handling his symptoms with promising self-assurance, telling a customer who wondered who he was talking to not to worry, he just had a thought disorder.

NAOMI KNEW THAT he wanted to get back to everything he had been doing his senior year in high school, when he was first told he had early-stage schizophrenia, a diagnosis later refined to schizoaffective disorder, bipolar subtype with obsessive-compulsive elements. He wanted to study math, go to college, go out with girls. He wanted independence, and Naomi thought the apartment would be a step toward that.

Then the first week he was there he got the cloudy feeling. He said that his brain felt like it was "under a hair dryer." He told Naomi he felt "unsafe." He checked himself into a psychiatric hospital.

When he was released 11 days later, he insisted on returning to the apartment rather than home, because he wanted to keep moving forward. Naomi's 70-year-old mother moved in with him, setting up a single bed in the living room.

Naomi parks the car. She watches her son trudge up the three flights of open-air stairs, a slow, lumbering figure in jeans and a sweatshirt.

The signs she looks for: how he walks, whether he is quick or slow or heavy or aimless. How he talks — crisp or sluggish, or perhaps angrily to no one, as he had done in December, when he yelled "Stop following me!" down an empty hallway. Spencer had become deeply religious during the advent of his illness, and Naomi checks his Facebook page to see how many posts are there about Revelations, or Deuteronomy, or other biblical arcana. More than two or three is a warning sign, not because it is religious but because it is obsessive.

AT LUNCH, SHE glances at the news blaring on the TV. A young man has just stabbed 14 people at a community college campus.

She is sure that in the coming days, it will come out that the young man had an untreated mental illness, and that the parents had tried to help or didn't know. With Newtown, Aurora, Tucson, and so many other violent episodes, she had felt the same, horrible way. She felt devastated for the victims' families. And she felt devastated for the parents who, she imagined, had struggled in their own way just like her to save their sons.

But she doesn't see that kind of violence in Spencer, not at all. She has read statistics that show her son is more likely to be a victim of violence than a perpetrator of it. She has also read about the elevated risk of violence among people with schizophrenia, and knows the statistics that show their risk is higher if severe symptoms such as paranoia or hallucinations are not controlled, or if they have a history of violence or drug abuse. But that isn't her son.

As she says one day when he is not there: "I don't see that in him. And I hope I'm not fooling myself. What I see is a kind, loving, empathetic boy struggling to regain his footing in this world. That's who my son is."

Wednesday morning, he lumbers down. He piles into Naomi's car in sweatpants and a T-shirt, and they drive toward the psychiatric hospital near Houston for his electroconvulsive therapy appointment, a treatment for severe depression.

First comes the anesthesia through the IV, which he can feel moving through his hand and up his arm and then dissolving through his system. He had tried to resist sleeping before, but the feeling was so uncomfortable that he has learned to just give in. Next comes the gel, which is swabbed on his head, and then the electrodes pressed into the gel, and the electrical current, which triggers a controlled seizure, which requires placing a guard in Spencer's mouth to keep him from biting his tongue. The seizure, it is hoped, will trigger a change in his brain chemistry that might bring some relief.

ON THURSDAY MORNING, Spencer doesn't see his mother. Instead, while she is away, he talks about his life.

He says it's been almost three years since a miracle happened. He says he was a junior in high school and developed a crush on a girl who was a Christian, which led him to become a devout Christian himself, which allowed him to begin to see his intense, manic anger and paranoid thoughts as "delusional beliefs," which opened the door to understanding he had an illness.

He says it has been two years since he first heard voices — what he describes as "whispers" that would come mostly at night, along with brief flashes of images he describes as demons. If his mother was afraid of him, he says, it was because he had become terrified of himself. He says he tried to manage by working out, by doing martial arts, not because he enjoyed beating people up but because it felt good, somehow, to get beaten up, and when nothing worked he asked his mother to take him to the doctor, where he heard words like "psychotic," which terrified him even more.

He says he was angry at his mother, at his teachers, at everyone for not figuring out what was wrong with him sooner.

He says he moved briefly to Austin to attend college and study math, because he had somehow managed, even as he was becoming sicker, to get the highest score on the most difficult Advanced Placement calculus exam. But then he says he started "freaking out" that the world was going to end, which led him to think he should learn carpentry to help Jesus rebuild after the apocalypse, which he now understands was one of his first psychotic episodes.

He says he understands why, when his mother found out, she went to a court and convinced a judge that her son was a danger to himself or others, then tricked him into getting on a bus back to Houston, where he was handcuffed and taken to the psychiatric hospital, where he began to accept that he would have to manage delusions and paranoia and mania and depression for the rest of his life.

He says his medication was changed and he got better, and then he got much worse, and all the bad feelings came rushing back.

"I looked at the past and the future and I decided there was no way out of it," he says, and that was why he walked out of the facility one December day into the freezing cold and kept walking 15 miles to a Target, where he bought the Benadryl, and then went to a Wendy's, ate several burgers and chicken sandwiches and washed down three bottles of the pills with a Diet Coke, and then went to a mall and walked in circles until he got sleepy, then looked for a place he could die, and went into a dressing room at Sears.

He says he was found vomiting and seizing, and that four days later he woke up in an intensive care unit. He says people told him it was the best Christmas present ever, but he was not so sure. He says he came home, which is when Naomi told him about what she did in the days before:

She had made sure the gun at home was locked in its safe. She had put away the kitchen knives and then found herself wondering whether she should also remove the forks, and maybe the cleaners, until she started to see everything as a hazard — the trees in the yard, the car, the traffic on the road. She told her son that she loved him, and that she wanted to help improve his odds of surviving his illness, but that she knew that she could not ensure it, that it was ultimately up to him.

He says he understands that, which is why he is willing to bear the electrical currents, the pills, the constant shuffling to doctors and the constant scrutiny, and why he wants also to pull away from all that, to get in shape, to be better, to get back to studying math, to college, to driving, to everything he was doing when he first got sick.

He says he wants to reach the point that he knows is possible for people like him, where he can manage his illness instead of the other way around.

"I'm really not afraid of breaking down anymore," he says. "I've gained a lot of knowledge and control. I'm not afraid I will relapse into chaos."

©2013 by The Washington Post. Reprinted with permission.