Sometimes you need to be in the hospital. Sometimes no other place—not even your own place—feels safe. In the hospital you can find that secure holding environment that protects you from your own dark thoughts and suicidal actions, when pills and talk have failed. Author William Styron remarked in his 1990 memoir of depression, Darkness Visible, that he began to recover only when he was hospitalized: “The hospital was my salvation, and it is something of a paradox that in this austere place with its locked and wired doors and desolate green hallways—ambulances screeching night and day 10 floors below—I found the repose, the assuagement of the tempest in my brain, that I was unable to find in my quiet farm- house.”
Paranoid schizophrenia is a devastating illness of the brain and central nervous system that causes people to lose vital contact with the real, everyday world. About one in a hundred—mostly young—people will be stricken by schizophrenia during their lives and become, at least for a time, psychotic. In psychosis, the afflicted person is incapable of distinguishing between reality and delusions (fixed false beliefs), and typically suffers from visual and/or auditory hallucinations. Loss of identity and loss of autonomy are hallmarks of this disease in which the self becomes charged with terrible anxiety, feelings of unreality, irrational fears and paranoia. The schizophrenic person suffers an appalling withdrawal from all social intercourse and, all too frequently, a powerful stigma. Though some people do make partial or very good recoveries, there is no cure.
A cold Thursday morning in April on the northeast outskirts of the city. I’ve left my van running with the heater on as I wait in front of Building 10 at the Alberta Hospital Edmonton, the province’s premier psychiatric hospital. The AHE is a principal target of those who view mental hospitals as “political asylums” and anachronisms based on repression and power. But there are only about four hundred patients at the AHE these days, and most are either acute-care cases that cannot be handled by the city’s other hospitals, geriatric cases or forensic patients in trouble with the law. Only the hard core end up in here. A few patients without jackets are standing out front in the cold air having a smoke. Many mental patients use tobacco to socialize and to control their anxiety. Finding cheap smokes and trading and bumming smokes are a way of filling in time—part of the management of a long, flat day.
With a long stride and a determined look, Randy Williams exits the hospital and heads down the front stairs straight for my car. After several meetings, I still find him intimidating. With long flowing brown hair, a Fu Manchu moustache and powerful arms, Randy, who uses the name “Harley” in his e-mail address, gives the impression he could be the head of a motorcycle gang. His face is long and thin, and his large brown eyes sometimes seem full of hurt and vulnerability. A lean and muscular 6-foot-6 and in his early 40s, he’s had several years training in kung fu and other martial arts. And on top of the intimidating looks, he frequently has an aura of righteous zeal about him. When he says he intends to get the devil out of his body, he means it literally. It is, he says, a “biblical” struggle that the devil is going to lose: he’s going down, and either Randy or God will do it. When you have seen the born-again-Christian Randy draw himself up to his full size and lay down the law to some unsuspecting sinner—”Fornication is a sin and you will go to Hell for a thousand years!”—you could be forgiven for conceding the point on the spot. Randy’s religious delusions, his Bible training and his absolute assurance have combined to produce a charismatic style. You can almost see him at the pulpit of some fundamentalist church dissecting the New Testament for his flock.
Randy is about as chronic as a chronic schizophrenic person can be. He recently ended his 17th admission to the Alberta Hospital in 17 years. His first hospitalization occurred when he was 25, the most recent one when he was 42. In the first, an involuntary commitment by his sister, he was actively suicidal—he tried to kill himself with an exploding shotgun shell. In the latest episode, he was becoming psychotic and suicidal, so his landlady, Peggy, persuaded him to admit himself to the AHE. (Peggy works at the AHE and has been giving Randy room and board in northeast Edmonton for 15 years. He calls her “my other saviour.”)
We had agreed to meet out there at the hospital in front of Building 10 and then drive off in my van to have lunch at his favourite place.
“Well,” says Randy, settling his big frame onto the front seat, “I really got attacked this morning.” He has huge hands and a crushing handshake. “They were really pissed off last night, too.”
“They” are the malevolent auditory hallucinations—the voices—that plague Randy from morning to night, and they are his most prominent psychotic symptom. The lead voice is Lucifer’s.
“What were the voices saying this morning, Randy?” “Oh, ‘I hate you, Joe.’ ‘You’re such a loser.’ ‘Time to die,
Joe.’ That sort of thing. He’s got whipping power. The power of a .30-30 rifle. He is evil. He’s a liar and a thief. He hates it when the Lord is in me. When I get on the computer I can get so focused, the voices don’t bug me. They hate me learning things on the computer. The voices are so arrogant. I’m glad Michael kicked him out of heaven. The day is coming when God will take him down and avenge me. All this suffering—he has a lot to answer for.”
Randy talks about “my illness” around the medical staff, but nothing can shake his belief that his schizophrenia is truly biblical, a war of right and wrong waged inside his body.
Randy openly despises that part of his self that generates the malicious voices. His real self wants to destroy the false self, which, he claims, was inserted like a malignant growth into his body. The voices grow in volume and number in response to stress and unwelcome life changes. They are particularly vocal at night before he falls asleep. Upon waking, the voices start in on him within five minutes— “Kill yourself today.” It takes all of his concentration to shut them out on a bad day.
When Randy is in full rhetorical flight about the voices he hears and the biblical nature of his illness, he sounds like a fire-breathing backwoods preacher out of a Flannery O’Connor story. He could pass for a charismatic hot-gospeller. The people at the church he attends on Ellerslie Road in South Edmonton think he is devout, not mentally ill, and Randy wants it kept that way. As a speaker, he can be a spellbinder, a born preacher. Once a year he goes over to the University of Alberta to lecture to the second-year medical class on paranoid schizophrenia, as seen from the inside. He talks about the illness as he experiences it: how it was induced into his body through demonic magic, not the result of flawed brain chemistry; how it is hostile—it pulls him out of his body, burns his feet. He emphasizes the role of medications and the hospital, and explains that reading the Bible can help a great deal in driving off hallucinations. The students are completely mesmerized by him. “For half an hour,” says Randy’s own doctor, “you could hear a pin drop.” A student came up to him last year and said, “That was better than video.”
I’m driving now on the road that leads east from the Alberta Hospital to the Evergreen Trailer Park, the park that took a direct hit from the tornado in 1987. There’s a small mall here and a restaurant, Happy’s Pizza, that is familiar to my friend. Ordinarily, Randy is agoraphobic. Strange places, malls and big stores can give him panic attacks. He feels safe in his car, his home and the hospital; everywhere else, it’s a jungle.
This is one of Randy’s affirming days. He recently survived a bout of throat cancer (caused by heavy smoking), and the treatments tested his faith in God. But today has been good. “Never mind the voices, I love getting up in the morning,” he says. “Today I was up at 5:30 and Peggy goes, ‘Why are you up so early?’ ‘Because I’m crazy!’ I love these long days, love to stretch them out. Before, when I was on Clozaril [an anti-psychotic] I would sleep till noon and spend the day in my bedroom watching TV. But this new French drug I’m taking [amisulpride], I get a full day.
Energized! I get up early, and go to occupational therapy to learn about computers. Later, I go online and get involved in a chat line.” With some assistance from a friend and his brother, Randy is using the computer to break down the social isolation that affects all people with mental illnesses. And, despite the loss of autonomy caused by his disease, he is doing this from his own motivation, his own ambition. He is planning and following through, despite the delusions and hallucinations that are constantly with him. He insists: “You cannot ignore the delusions, but eventually you can recognize them and begin to use them.” It takes Randy up to 15 minutes to realize that one of his ideas is delusional, and it is especially hard to shake the delusions that tell him what is going on in someone else’s mind. The interesting point about Randy is that he is, to an important degree, capable of challenging his identity-destroying illness. Even though he is schizophrenic, he is able to make the world he lives in; he is not simply acted upon. The new anti-psychotic drug has permitted him to feel, to cry, to be angry, where for so long he has felt numb and dehumanized.
When we arrive at Happy’s, everything is the same as it was before. Randy hates change; he loves routine. He always orders the same meal: a cheeseburger, fries with gravy and a large glass of water. There is no talking while he eats. I make no innovations, offer no surprises. The sameness of things, the repetition of rituals, are key in his conception of order. Change is the great enemy, because the life of a schizophrenic is lived in a static, unvarying universe. Randy speaks of events that happened 25 years ago as if they occurred yesterday. Happy’s Pizza, like a rerun of a fifties western on TV, offers the sense of a world that doesn’t change.
Many people with schizophrenia are in denial. They refuse to admit that they are ill (and therefore do not take their drugs). Randy doesn’t deny that he has schizophrenia. He is upfront about his illness and the need to take medication. But he denies that his illness was acquired like other people’s. Most schizophrenia appears to involve heredity and brain chemistry, but Randy’s is “oppressed” and “biblical” in nature. “He’s still in there. He’s the voice, the source of the delusions. He is wedged in there, like a growth.” Randy says if he believed that the voices he hears were actually coming out of his own head, he’d kill himself on the spot.
Randy is about as chronic as a chronic schizophrenic person can be. He recently ended his 17th admission to the Alberta Hospital in 17 years.
Randy is, in Bob Dylan’s words, “tryin’ to get to heaven before they close the door.” Faith is a powerful anti- dote to the devil’s delusions. But it is not enough simply to read Scripture; one has to believe in it. Randy was “born again” about four years ago and baptized in the chlorinated waters of the Strathcona swimming pool. He is a fundamentalist about the Bible: it contains the way, the absolute truth. Randy’s mother recently told him that the Bible contains lies, and now he worries that she might be going straight to hell. He belongs with those who express their faith as direct emotional feeling rather than a doctrine. To him, evil is not abstract or theoretical; it is something inside us, something deep and radical that we are all fated to suffer personally and that can only be remedied by a deliverance into another life.
Those, like Randy, who experience evil as something personal, grisly and frightening, look for a prophet with a final message, a promise of deliverance from suffering after death. He looks to the evangelical, revivalist churches, with their promises of blood and miracles and supernatural events, as a solution to the evil that is inside him, masked as schizophrenia.
Still, he takes his medication, and he has learned not to talk about God and radical evil around his doctors. “The more I brought God into the situation, the crazier they thought I was,” he told me. So he talks about “my illness” around the medical staff, but nothing can shake his belief that his schizophrenia is truly biblical, a war of right and wrong that is being waged inside his body.
It is the illness, not the pills or the manufactured cages of society, that poses the greatest threat to Randy’s identity. It is a threat that he perceives as physical in nature. On a relatively good day, and while on the new French anti-psychotic drug, he said: “I still get pulled out of my body. He burns the bottoms of my feet. He squeezes my brain. He zaps me on the inside and it hurts. I want God to put him down. I want him in the pit. I’ve paid over and over.”
Yet it would be wrong to dismiss Randy simply as a victim of a particularly bad mental illness. He is far more than that. His humanity breaks through the voices and delusions as he seeks to win his struggle with his illness. He is unique, not reducible to a collection of negative and positive symptoms. We make the world we live in, compensating for the handicaps and adversities according to our lights. Randy has found a safe place in the triad of home, hospital and church—not a cure, but an interlocking set of holding environments. And through his computer and his evangelical activities, he has broken though the isolation that plagues so many mental patients.
He seeks the knowledge to engage the devil. “I’m the one who will take Lucifer down. He’ll be locked up for a thousand years because of what he did to me. I will be on the throne, but I don’t want power. I want wisdom, knowledge. I want the power to think straight.”
Randy lost his struggle with cancer and passed away in July 2003, still trying to get to heaven before they close the door.
Larry Pratt is professor emeritus at the University of Alberta, and the author, co-author and editor of nine books on Alberta’s political economy, international politics and other topics