TIM FLEW TO Austin with his siblings in late July, eighteen days after Pam and I were married. For the first month of our marriage, we had all five children with us—seventeen-year-old Verena, sixteen-year-old Tim, fifteen-year-old Larissa, twelve-year-old Lizzie, and eleven-year-old Ben.
We all had some adjustments to make. Tim had spent most of the last year in locked facilities where all his daily routines were regulated. Now he decided when to eat, sleep, bathe, and come and go. Austin was a new community for him, culturally different from both central Connecticut and the northwest. Pam was also a new adult in the picture for Tim. Her personality was very different from Linda’s, more low-key. He did not know how she would respond to him or what our joint expectations of him would be. Fortunately, though, Pam was willing to work to help Tim be successful and prepare him for adulthood.
Pam and Verena were adjusting to what Pam said later was like “an invasion of aliens from Connecticut.” Our lifestyle was much louder and more chaotic than they were used to. Austin was a big university city and was more diverse racially and culturally than central Connecticut, and that appealed immediately to my growing children. Lizzie observed that she saw many more people who looked like her than she ever had before. Larissa spent the month trying to decide whether she wanted to stay in Austin or go back to Connecticut. Lizzie and Ben were worried about being asked to choose between mom and dad. And I was getting used to being seen as a Texan, working at a brand-new job in a brand-new community.
We did not waste time getting Tim into treatment in Austin. We quickly made appointments for him with a new psychiatrist and a new mental health counselor.
At the first visit with his psychiatrist, Tim and I realized we weren’t in Connecticut anymore. The psychiatrist was wearing cowboy boots with his suit. Tim grinned when he saw them and began to act a little silly. The psychiatrist didn’t seem to notice. He invited us into his office, reviewed Tim’s medical history, and then asked a question.
“Do you know you’re adopted?” he asked my six-foot, three-inch African American son, as I, his five-foot, nine-inch white father sat there next to him. Still smiling about the cowboy boots, Tim could not contain himself. We always found the question a little absurd when it was asked, and usually irrelevant. Adoption, after all, does not cause schizophrenia.
“Adopted?” Tim said with mock astonishment. “I’m adopted? Dad,” he said turning to me, “did you know I was adopted?”
I played along. “Adopted? You’re adopted, Tim? I didn’t know you were adopted,” I answered. “It’s news to me.”
“It’s news to me, too, Dad!”
We had our joke together, but the psychiatrist just sat there, stared, and entered something into his computer. We decided later that he probably didn’t get our alien Connecticut humor.
Tim left the appointment without having established much of a relationship with the psychiatrist but with prescriptions for trazodone and Geodon in hand. The psychiatrist told him he’d see him again in a few weeks and warned him sternly against mixing his medications with marijuana or any other drugs. That warning bothered me because I knew that Tim would probably use marijuana again soon and because the psychiatrist didn’t really take the time to do more than say “don’t.”
Tim’s new counselor was a friendly, even-tempered, unpretentious, low-key woman. Tim liked her but went to sessions only reluctantly and infrequently after the first couple of months. He was tired of therapy and did not think that it had helped him much after he left Dr. D behind.
Meanwhile, we approached a small private school—I’ll call it High School 5—to see about enrolling Tim. Verena had graduated from the school in May. While it had no special education program, its staff provided plenty of individualized instruction, and Verena had thrived there. Tim interviewed with the principal and several teachers. These interviews went well, and the principal told us that the school would admit Tim on two conditions. The first was that we pay for extra tutoring in math. The second was that we enroll Tim in the ninth grade once again—his fifth start on a ninth-grade curriculum.
During this transition, Linda took a trip to Austin and visited with the school’s staff. While she came away with a favorable impression, she worried about Tim’s transition to Austin in general. In particular, she wondered how we would manage to keep Tim away from drugs and alcohol. She was skeptical about his recent sobriety; he had admitted to staying “straight” only so that he could get out of Riverview.
I was worried about this, too. But based on Tim’s history, I didn’t think it was possible for us to keep Tim away from drugs and alcohol in any community. I replied to Linda in an e-mail: “Tim will not be able to function in society if he doesn’t begin taking responsibility for his own sobriety. You and I can’t protect him; we can just support him to make good decisions about who he hangs around with and what he does.” At this point I was hoping we’d get a year of sobriety, if even that. I had long since learned to take things one day at a time.
Linda was also concerned that Tim might not be able to avoid being arrested in Austin. I thought that would be a problem anywhere, and I could only reply that staying out of trouble was Tim’s responsibility. She also wondered if a small private school would be up to the challenge of educating Tim. The school had no track record of being able to handle a child with Tim’s issues. “What if he had psychiatric symptoms? How would staff know what to do? Would they do the right thing?” she worried. Tim’s psychiatrist and counselor were also recommending a specialized treatment program for Tim. But neither Linda nor I thought this would be a good choice because he had already spent so much time inside institutional walls during the past year. And we had both wanted to try a small private school a few years earlier to see if individualized instruction might work better for Tim after the debacle of his sixth-grade due process hearing.
I may have been grasping at straws, but I at least wanted to exhaust all the possible educational options before giving up on Tim.
Linda worried about Tim’s social skills development and also wanted to know about his path to independence now that he was nearly an adult. We needed to start thinking about his learning to drive and getting a job. I told her I’d support his job search and drivers ed. so long as he remained sober.
Linda was satisfied enough with my replies to support Tim’s enrollment at the school. Pam and I covered the $6,000 tuition cost and the cost of tutoring. His regular school district was not required to pay for it because the placement was not part of any IEP.
In late August, Linda met with Connecticut school officials to cobble together a transcript from Tim’s time during his four earlier “freshman” years to send to Austin. All told, Tim had earned only 5.25 credits toward his high school diploma. This was discouraging enough, but things were actually going to get worse. The struggles of Tim’s teen years—his ongoing battles with mental illness and drug use, the challenges in getting him an education, his desires for independence and to feel normal and accepted by his peers—all would come to a head during the coming school year.
The school was located in central Austin, about a mile north of the University of Texas campus. It was in an old, beat-up A-frame building on a couple of shady acres, next to an old estate house and not far from a municipal golf course and a shopping center. As a new school, it was just completing the accreditation process. The facilities may have been modest, but the academic program was rigorous. Tim would have to work hard to succeed there, but he and his teachers initially seemed committed to his success.
A week before school started, Tim began getting into trouble again. He started climbing out of windows to leave our house at night because he did not want us to know when he was coming and going. He didn’t hide his tracks very well—he usually left the window open and the screen against the wall. We sat him down and told him he was free to go out at night so long as he honored his curfew and used the door.
He began dirtying and damaging the kitchen with his food preparation and cooking. He made small knife cuts in the Formica counter tops, forgot about food cooking on the stove, and forgot to turn off the burners after he finished cooking. We established some basic cooking rules and increased our supervision of him.
He began to lie and steal again. One day, Verena noticed that a large sum of money was missing from her room. Tim and Ben both insisted that an acquaintance of Verena’s had taken it, but Tim was a prime suspect. We never found the money. Years later, Ben admitted that Tim had told him to lie about having seen someone else enter the house.
We began to realize that Tim was out buying drugs at night and using the kitchen to cook them. He denied this, but we insisted that he go to therapy more often and attend Narcotics Anonymous meetings. With the encouragement of his therapist, we also asked him to sign a behavior contract with us—even though these had not had much effect on Tim in the past.
Pam and I tried to make the contract simple and straightforward, and to enforce it as consistently as we could. We asked him to do six things—go to school, stay off drugs, not break laws, keep the house safe and clean, continue with therapy, and abide by a curfew. In return, we gave him permission to leave the school campus for lunch, as most of the students did because the school did not have a cafeteria. We agreed to consider letting Tim move out of his upstairs bedroom and make a “man cave” in the large heated and air-conditioned garage. We also agreed to reward Tim for good behavior by taking him on special food-shopping trips once a week and to teach him to drive.
There were three consequences for violations of the rules. He could be grounded for up to five days, he would have to accept the legal consequences of any law breaking without us bailing him out, and each time he was discovered using drugs there would be a three-month delay in his driver training.
Tim never did learn to drive.
He signed the contract but refused to comply with it. One night, he missed his curfew. We didn’t hear from him for hours and couldn’t reach him on his cell phone. It was close to three in the morning when he called us for a ride home, as if nothing were out of the ordinary.
Right after that, Tim went out three straight nights without permission, each time staying out past curfew. The second day, we brought him to appointments with both his psychiatrist and his counselor, and both said that he was not taking his treatment seriously. That night, he was gone for three hours and came home stoned and hostile.
Tim’s mood swings were very wide. One day, he fixed himself a big plate of spaghetti and put it down on the coffee table in the family room, then went back to the kitchen to get a drink. While Tim was in the kitchen Pam’s dog Jazz started happily eating away at Tim’s dinner. After shooing her off, Tim surveyed the damage to his meal, shrugged his shoulders, and sat down to eat what was left. At other times, however, Tim seemed a completely different person—disengaged from the world, surly, contrary, defiant, and irrational. Whether this was the result of his mixing illegal drugs with his prescribed medication or not, Tim was showing full-blown symptoms of serious mental illness again.
The first weeks at school briefly interrupted Tim’s downward spiral as he once again aimed to please the new adults in his life. He worked hard, but it didn’t always show in his results, even with nightly support from me to complete his homework. When Linda e-mailed me to see how Tim was doing, I was able to answer truthfully: “Doing fine right now. Going to school every day, doing homework, going to counseling, and being good.”
Tim’s teachers were not as positive in their assessments. As with many of his previous teachers, they saw that he had a great deal of difficulty with spelling and math, was inconsistent in all his written work, and was not completing tasks on schedule. And they came to the same conclusion as others had before them—they interpreted this as evidence that he wasn’t trying hard enough. I explained that this was not the case, that he was actually making a considerable effort, and I encouraged his teachers to focus on his classroom participation.
Tim was also having difficulty making friends at school, but he had no trouble making a few enemies. The friends he did make were not a good influence on him (nor he on them). They used drugs and alcohol and engaged in petty theft. Tim had to attend his first “Responsibility Committee” meeting at the school in mid-September. This was a joint student-faculty committee charged with resolving disputes between students and determining consequences when students broke school rules. Tim was upset and didn’t tell me what the problem was. That night, however, it was clear that he took whatever criticism he had received to heart. He worked especially hard on his homework, logging two full hours on it. He asked me for help spelling every word correctly on his English assignment. But he also talked seriously for the first time about dropping out of school. I encouraged him not to make any rash decisions.
I knew that Tim was struggling. After so many disappointing educational experiences during the past few years, I was pessimistic about Tim’s chances for success at his new school after only a month of observing his teachers’ reactions to him. I tried to stay positive when I wrote to the principal that “it’s way too early for me to predict how this will all come out, but, despite the struggle, I see a lot of good things.”
Despite my optimistic words, I knew what was coming next.
Tim began skipping classes. At the end of September he went before the Responsibility Committee again for what turned out to be the third time in two weeks. I was invited to attend.
Recognizing that they were losing Tim quickly, one member suggested easing his academic load by having Tim drop one course and pick it up in the summer session. The committee members agreed, and together with Tim they decided that he would drop math because he felt most overmatched there.
Focusing on his remaining subjects, Tim improved his effort. He did not miss any classes during the next couple of weeks and did homework with me every night. At best, though, he maintained only a C average. He stayed close to home and continued to steer clear of most drugs. He also took his Geodon every day and met every other week with his counselor. While he still made big messes in the kitchen and needed constant reminders about his hygiene, he volunteered to help out around the house at times and used deodorant daily. It turned out to be a one-month respite.
Tim’s first-quarter report card arrived at the end of October. His teachers’ comments were more positive and offered insight into the type of student Tim could be. His English teacher wrote:
I am happy to see the cloud of apathy beginning to lift. These last few weeks have allowed me to glimpse the intelligence and insight you have been carrying around in that head of yours. Of course, that’s not to say that it will be all smooth sailing from here. I need you to take on the responsibility to arrive in class on time and awake. You will need to convince yourself to spend more time studying. There will be more independent work in this class as we move through the year and this means you will need to develop some strategies for staying on top of it. I know you can do this, it is just a question of how we can work together.
Over the next few weeks, however, Tim began to use drugs again, especially marijuana, and he occasionally drank alcohol. He had shied away from alcohol since the incident when he passed out in the park, so this was a new problem. We noticed it at home, his teachers noticed it at school, and Tim reported it to Linda when he talked with her on the phone.
In November, he was arrested for shoplifting. He went to a supermarket during school lunch hour and was caught trying to steal a bottle of wine. He was charged with three misdemeanor violations, and the police gave him a ride back to school. He had to appear in municipal court, pay a fine, and do community service. He also had to meet with the principal the next day. The school considered expelling him, but the principal offered an alternative. Tim could remain at school, but he would have to stay on campus during lunch period, participate in a drug treatment program, and have his urine tested. Tim’s initial reaction was that he preferred to drop out of school.
Upon reflection, Tim came up with another option: he claimed that his mother had told him that she would welcome him back to Connecticut at any time, “no questions asked,” and that she would have a more lenient attitude about his drug use. When presented with this plan, Linda said that of course he was welcome to return to Connecticut if he wished, but drug treatment was nonnegotiable. Fuming, Tim agreed to the conditions imposed by the school, and he grudgingly attended an NA meeting in Austin in addition to continuing his counseling.
Pam and I had a talk with Tim after this. We told him that no matter what we felt or believed, and no matter what his mental health issues were, others outside the family were going to look at him through the lens of what they considered to be normal and acceptable. His mental illness was not going to give him a pass about his “self-medicating.” He was going to be held responsible for all of his actions as he got closer to adulthood. So that was how we intended to treat him while offering supervision, guidance, and boundaries appropriate to someone his age and with his needs and experiences. He was going to be accountable for living by the rules of our house, his school, and the city of Austin, no matter how he felt about them.
Unfortunately, Tim stopped taking his medication at this point. It was an exercise in poor judgment, and one that neither Pam nor I could alter. It was also the unintended consequence of a conversation he had with his psychiatrist. Because Tim was using illicit drugs, the psychiatrist said that he didn’t want to give him more prescriptions and risk a drug interaction. So the psychiatrist stopped writing prescriptions for him. Tim interpreted this to mean that he had a free pass not to take his medications anymore.
“Why don’t you just take them?” I asked him one day.
“Because they even me out too much,” he responded.
“Even you out? Isn’t that good?”
“No, they kind of make me feel like you, all even all the time, not like myself. I like being hyper sometimes.” Illicit drugs, on the other hand, let Tim be Tim.
Treatment noncompliance has long been recognized as a significant problem in the recovery of people with schizophrenia. In fact, it has been estimated that as many as three-quarters of all people who are prescribed psychotropic medications will stop using them within a year (Mitchell and Selmes 2007). The reasons include unpleasant side effects, stigma, and a sense that the medications aren’t helping. Having to take pills every day is also an inconvenience to some. So Tim’s reaction was not unusual. On the other hand, we know that many of these same people self-medicate with illegal drugs. As marijuana becomes more available, either as a legally prescribed drug or as an entirely legal drug, it will be interesting to see what this means for people like Tim—and if it becomes part of the arsenal of drugs used to tame symptoms of mental illnesses.
Tim completed the fall semester in mid-November with a few C’s and a few incompletes. The one bright note was in English, where he scored a 78 and his teacher commented: “Tim, what a rally! You really pulled through at the end. I think you are well on your way to making the transition from not being a student at all to being a good student. I’ve seen your writing skills improve and your study habits are even starting to take shape.” I felt good about this; I had spent hours with Tim at our living-room desk facilitating those study habits.
Our family dynamics were changing. Larissa, who was turning sixteen, joined us in Austin in January to spend a year at Austin High School. She threw herself into school activities and made friends. While this gave Tim new opportunities to socialize with Larissa, whom he had missed, it also disrupted his routines. Larissa did not always give Tim the time he wanted, preferring to spend her free time with a boyfriend, girlfriends, or at school social events when she wasn’t working on her homework. He had to fight for her attention, and he had another difficult period of adjustment.
Tim’s bedroom was across the hall from Larissa’s. He played music loudly, disturbing her when she was trying to study. He barged in on her without knocking or knocked loudly on her door when she was talking to friends, leading to squabbles and arguing, often when Pam and I were trying to get some sleep down the hall. After he broke Larissa’s door one day, we finally agreed to let Tim move into the garage. We fixed it up with an old rug and moved Tim in with a bed, a chair, a couch, a stereo, and an old television. When it got dirty we just pushed everything aside and hosed the floor down.
We spent January swinging on a pendulum with Tim. On January 7 he was arrested for possession of alcohol. The principal at his school was not pleased, but since it hadn’t happened during school hours he did not expel Tim. Tim had to appear in municipal court, where he was required to take part in an alcohol education program for minors. He completed that program in April. Mid-month, the pendulum swung back. Tim stayed up most of the night working on a major project for school and completed it. He was proud of it and got good feedback at school. On January 23, the same day he was due in municipal court for his alcohol possession arrest, Tim was arrested for shoplifting during school lunch hour again. Shoplifting was a Class C misdemeanor, and he was referred to youth court. He was assigned to do more than thirty hours of community service, which he completed by June.
As his volatility increased, Tim’s capacity for good decision making declined. Early in March, Linda visited and took Tim to San Antonio. He left her behind on the River Walk, and she was unable to locate him for hours. That he was seventy miles away from home with no money and no means of getting back on his own made no impression on him.
He also attracted new acquaintances, some of them teenagers and some older, who showed up at our house at all hours of the night. More than once, when Pam and I went to wake Tim for school in the morning, we were startled to find some stranger also sleeping in Tim’s room. His explanation was always that the person just needed a place to stay. Tim’s older friends were often just there to use drugs and party with him. A few months later, Pam came home one evening to find a group of people in our family room, eating our food and getting high. She had to throw them all out of the house by herself. She was still shaking with fear when I saw her; Tim just shook his head.
Tim’s interest in drugs did have one unintended benefit late that winter. It helped him to improve his reading, research, planning, and science skills. He told me that he had decided to grow mushrooms in the garage. He finally learned to use a computer while doing a tremendous amount of Internet research on the subject. He organized a list of supplies, including wood to build an incubator box, starter kits, fertilizers, and purifiers, and started acquiring these items using his allowance. One day, he asked if he could use a piece of old plywood. I heard sawing and hammering, and a couple of days later he had built a perfectly serviceable box. It still needed a lid, he told me, and a week or two later he had attached a plastic top with working hinges. An air purifier came next—something he badly needed in his room anyway—and then fertilizer. He put everything together, and after a few weeks, was finally ready to grow. Nothing happened. He made some adjustments and tried again. Still nothing. However, over a couple of months working on the project his reading and fine motor skills had improved, his focus was good, and he stayed mostly sober. He soon lost interest, decided that mushroom growing wasn’t for him, and turned his attention to researching how to make a bomb. (He did not succeed in doing this, either.)
In late March, a few days after his seventeenth birthday, Tim met some people who were going to California. He asked if he could hitch a ride with them. They said yes and took him fifty miles to northern San Antonio, where they left him. He called us from a gas station looking for a ride back to Austin. He was upset when we picked him up not because the people had left him but because he really wanted to go to San Francisco.
Tim began to behave much more badly during March, after his mushrooms failed to grow. He repeatedly forced the dog into his room and tied her there so she wouldn’t get away, then forgot about her when he left. He also collected knives and slingshots. He made no threats with them, but we were worried anyway. Whenever we found them lying around the house, Pam would bring them to work to hide them. She eventually acquired quite a collection. If Tim realized they were gone, he never said anything. He just went out and got more.
Tim’s volatility finally got him expelled from school, just weeks before completing his freshman year. On April 1, he and another student got into a fight, which Tim had instigated. He was immediately suspended and was scheduled to go before the Responsibility Committee the next day. The committee recommended expulsion and asked Tim to suggest an alternative punishment if he wanted to stay. He declined to do so.
We immediately enrolled Tim in our local public high school—I’ll call it High School 6—hoping that he could finally complete his freshman year. We didn’t want him to know that he could refuse to go to school at his age. We also found a charter school run by a local nonprofit that was willing to consider admitting him in August. The nonprofit had a companion AmeriCorps work program for young people who had either dropped out of school or were at risk of dropping out. If Tim qualified for both the charter school and the AmeriCorps program, he could complete his high school education while getting paid and earning up to $4,700 in scholarship money to use anytime in the next seven years for post-secondary education.
Tim was interested in the AmeriCorps program, and he interviewed for it in April. He learned that there might be some AmeriCorps openings as early as June and decided to apply for one of those. The program offered two types of jobs: in construction building energy-efficient houses in East Austin or landscaping work in county parks.
Tim arranged for a second interview to present his case to AmeriCorps. They told him candidly that his odds of getting into AmeriCorps were not high because they accepted only twenty-five of over eighty applicants. He put his best foot forward, however. He told them that the AmeriCorps program was his motivation for going to the charter school. He was willing to continue in the high school program in August if he could get into the AmeriCorps program in June. But he didn’t think he would go to school anymore if he couldn’t get the work assignment, too.
I admired his tenacity in negotiating, and while he awaited a decision I took stock of his situation. The clock was running out on his childhood and his time in school. He had been a student at the private school for a total of eight months. He had earned two credits there, giving him a total of 7.25 credits toward a high school diploma. He had significant learning disabilities and had not been successful in any of the schools he had attended.
He had been suspended from, or asked to leave, four different schools, and no dismissal had ever resulted in improved behavior.
Tim’s illness was getting worse as he got older, and with inadequately integrated care he had regressed academically the longer he stayed in school. He didn’t have much of a track record as he attempted to sell the nonprofit program on his strengths. All Tim had learned in school so far was how to fail. And, after he was surprisingly successful at convincing the nonprofit to accept him into both the AmeriCorps and charter school programs, he was about to be offered one more opportunity to put failure to the test.