Prospero’s tale (about first-onset psychosis)
When I was 18, I lived in a Chelsea flophouse. There was one bathroom per floor, and I had the deluxe with a tiny sink and two-burner stove for $46 per week.
To my right was a guy with advanced alcoholism. He’d scream in the night, “Oh God, not again.” I tacked blankets to the wall to muffle his cries. It helped. On the other side was my best friend, Mark. I’d been crashing with him illegally when a room came free. As the prior occupant vacated, I raced down three flights to face the building’s owner, Mrs. S, whose office was at the front.
She knew I’d been squatting, but she liked Mark. Everyone did. She rattled off the house rules, took my money, and handed me the key to her best room. “I don’t rent it to just anyone.”
At 18 I had no clue what I wanted to do with my life, but I had multiple jobs as a waiter and bartender. Mark was a busboy, and New York in the late 70’s was in the last gasp of Disco and the sneers, postures, and screams of punk. My wardrobe ran from black to off black, and my hair had an eggplant glow by the light of day. We were club kids.
That Halloween I’d gotten my hands on a long satin-lined cape, and Mark—who juggled and talked about clown school—dressed as a jester in pink and black. I was the magician, Prospero, and he was Ariel, the sprite from Shakespeare’s The Tempest.
We hit the town and bounced from loft party to loft party, no invitation needed. There were bubble machines and drugs I now warn against. We danced till there was no sweat left, drank what was offered, and then did it again. Mark flirted and juggled, I did the same, minus the balls in the air. A good time was had by all is an understatement.
That was one of the last times I saw Mark.
Days passed. No word from my best friend.
I broke into his room. I couldn’t tell much. Maybe he’d been there, maybe he hadn’t. Neither one of us were great housekeepers.
More time passed.
And then I came home from my shift, and taped to my door was a black-and-white photo of a homeless man slumped to the ground. Over it Mark had written in black marker:
Don’t leave till you set me free.
I checked his room. Stuff had been moved, maybe stuff was missing.
I tracked down his older brother. He didn’t want to talk to me.
“Mark’s in the hospital.” He said.
“What’s wrong? Which one?”
“Bellevue. Psych. Don’t visit him.”
“You’re part of the problem.”
I asked what he meant, and it left me confused. Somehow Mark had had a mental breakdown, and I figured into it.
I went to Bellevue. Not my first time on a psych ward as a couple of years earlier, a family member had a manic psychosis and was admitted to a private hospital. That one had a grand colonial façade, manicured grounds, and starched linens. Bellevue was wire-laced windows, steel doors, and the dinge and grime from slippered feet of patients on too much Thorazine as they shuffled the halls with nothing to do and nowhere to go.
I met Mark in the big patient room.
I was not prepared.
He looked like Mark. He tried to smile like Mark. But it was forced. He had no laughter, and the spark was gone from his eyes.
We played backgammon and tried to talk.
He struggled to focus, and his words carried a sense of apology. He knew things weren’t right… that he wasn’t right. I asked him what happened and how he’d landed there. His answers were vague. He didn’t want to tell me.
I’d hear the story from others who’d either been there or heard something from someone. The recurrent kernels were that he’d been delusional, loud, strange, and rambling. It was somehow tied to our Prospero and Ariel high-octane Halloween. He’d wound up at a university dormitory where he had a lot of friends. He scared and worried people, and they either called the cops or an ambulance.
They brought him to Bellevue, where they drugged down the crazy until his hands shook and his face lost expression.
I never saw the fire of his psychosis. I visited a couple more times, but it gave him no pleasure. One of his clinicians told me that I was indeed a figure in his delusions, which he never shared with me. His brother had been right, or so I thought. And so I stopped going.
At 18 I had no hint that one day I’d be a psychiatrist and that I’d meet many Marks—in emergency rooms, in my office, or on the wards—or that I’d teach mental health professionals or write books about this stuff. “Let’s talk about first-onset psychosis. It’s most frequent in the late teens and twenties.” I review brain development and how we’re not fully cooked until our mid-20s, when our frontal lobes make their final connections. “This is when most people who develop schizophrenia or bipolar disorder will have their first major episode. It’s often in a setting of stress, such as college, the military, or doing a lot of weed or other drugs.”
Those are facts. It’s bad and scary, especially when it first occurs. But if you’re not in the business, or even if you are, you don’t know what’s happening to the person you love. You don’t know how to help them, and you don’t know the single most important thing, which I wish I’d known at eighteen.
People get better.
It takes time, and it’s different for everyone. And for Mark, and those of you with a Mark in your life, you’re not alone. Educate yourself about what’s happening. Ask questions. Check out a support group. Talk to people who’ve come out the other side. Knowledge is power, hope matters, and recovery is real.
Charles Atkins, M.D., is a psychiatrist, author, and the chief medical officer for Community Mental Health Affiliates a multi-site behavioral health and substance abuse agency in Connecticut. He is a member of the volunteer faculty at the Yale School of Medicine.
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