My Brother’s Bat­tle — and Mine

The Washington Post Sunday - - Outlook - By Asra Q. No­mani

MOR­GAN­TOWN, W.Va. ’ll take a knife and cut up your uterus,” said the voice on the other end of the line. I shud­dered, but got off the phone gen­tly, be­cause the speaker was some­one I love very much. My brother spoke those chill­ing words to me last Oc­to­ber, but the re­cent sui­cide-mas­sacre at Vir­ginia Tech brought back the an­guish of that day.

Like so many, I mourn for the vic­tims and their fam­i­lies and friends. But strange as it may sound, I also con­nect with the killer and his im­mi­grant fam­ily, and my sad­ness ex­tends to them. Since the early 1980s, my brother has been bravely bat­tling an in­cur­able ill­ness called schizoaf­fec­tive dis­or­der that hit him on the thresh­old of adult­hood. It’s a brain dis­ease re­lated to schizophre­nia, char­ac­ter­ized by mood swings, thought dis­or­der, psy­chosis and bursts of vi­o­lence. When he’s be­ing treated, my brother is kind, thought­ful, lov­ing, a ge­nius in world his­tory and bril­liant at soc­cer, a sport he had hoped to play pro­fes­sion­ally.

The day he threat­ened me last year, he had re­fused to go to the hospi­tal for a reg­u­lar dose of a new in­jectable an­tipsy­chotic drug his physi­cians were try­ing. I had urged him to take his medicine, prompt­ing the out­burst. In the pre­ced­ing months, he had been “de­com­pen­sat­ing,” psy­chi­atric jar­gon for melt­ing down, as the new medicine wasn’t work­ing well. We’d been there be­fore. Over the years, my fam­ily had been on the fir­ing line be­cause of my brother’s ill­ness. Once, he punched me in the head. He has kicked, scratched, hit and spat on our par­ents. Ear­lier last year, he had bro­ken down our mother’s bed­room door and pum­meled her. But we al­ways knew it was his ill­ness speak­ing, and we al­ways loved him. And we knew that he was suf­fer­ing.

This wasn’t the Amer­i­can dream that our par­ents — like the par­ents of the Vir­ginia Tech killer — were chas­ing. They had im­mi­grated to the United States in the 1960s in search of bet­ter lives than our na­tive In­dia could of­fer. My brother and I joined them in 1969, when I was 4 and he was 6. Like Se­ung Hui Cho and his sis­ter, who were born in South Korea, my brother and I are part of the “1.5 gen­er­a­tion,” who come to the United States as chil­dren.

Now psy­chi­a­trists are learn­ing some­thing about this gen­er­a­tion. A study pub­lished in the Schizophre­nia Bul­letin last year found “com­pelling ev­i­dence” that im­mi­grants have an el­e­vated risk of de­vel­op­ing schizophre­nia and other types of psy­chotic disor­ders. A 2005 Jour­nal of Psy­chi­a­try ar­ti­cle re­ported that “so­cial de­feat,” or the “chronic stress­ful ex­pe­ri­ence of out­sider sta­tus,” can make mi­gra­tion an “im­por­tant risk fac­tor” for schizophre­nia. While my brother de­te­ri­o­rated, I went out, like Cho’s sis­ter, and be­came the sup­posed im­mi­grant suc­cess story, pri­vately in an­guish all the while.

“IAway from home in those early years of my brother’s dis­ease, be­fore cell­phones, I thought about get­ting a pager so my mother could reach me if my brother beat her up. I have lived in dread ever since that I’d get a phone call say­ing that my brother, who lived at home, had killed our par­ents. When he threat­ened me last fall, my fam­ily and I made a heart-wrench­ing de­ci­sion for the sake of ev­ery­one’s safety: We had him com­mit­ted to a psy­chi­atric hospi­tal.

Wvery week, our na­tional men­tal health cri­sis comes to life for me when I drive a lit­tle more than an hour on I-79 South to a place called We­ston, W.Va. Head­ing through town, I pass a sprawl­ing build­ing of na­tive blue sand­stone that was opened in 1858 as the Trans-Al­legheny Asy­lum for the In­sane. It’s closed now, re­placed by a state men­tal hospi­tal up the road from the Mys­tik Moun­taineer Mart.

At the new hospi­tal, be­hind the locked doors of the G-1 unit, my brother has been treated for the past six months, slowly get­ting bet­ter. It’s not the in­sti­tu­tion of ex­posés past. Last week­end, a nurse gave my 4-year-old son and me a tour of the rec room, the in­door swim­ming pool area, the neatly stocked li­brary and the cafe­te­ria.

But it’s also not pretty. Not long ago, my brother was punched in the jaw by an­other pa­tient. A male nurse dis­lo­cated two fin­gers while pulling them apart. As I vis­ited my brother last week in a locked room for vis­i­tors, the as­sailant waved to me through the glass win­dow, his ear­lier vi­o­lence ap­par­ently forgotten.

My brother is due for a men­tal health com­mis­sion hear­ing this week to de­ter­mine whether he should be hos­pi­tal­ized for an­other six months. “I’m scared,” he told my mother and me, and I knew he was get­ting bet­ter. It’s ra­tio­nal to be afraid of be­ing com­mit­ted to a psy­chi­atric unit. Be­cause ofWest Vir­ginia’s new leg­is­la­tion, he prob­a­bly will be dis­charged soon for a six-month “tem­po­rary ob­ser­va­tion pe­riod” that or­ders him back to the hospi­tal if he doesn’t take his medicine. The bar will not be vi­o­lence.

As a psy­chi­atric nurse let me out of G-1, we stood for a mo­ment at the door be­side a sign that read, “Cau­tion. Elope­ment Risk.” “We wouldn’t leave some­one bleed­ing on the streets be­cause they didn’t want to go into the hospi­tal af­ter a hit-and-run,” the nurse said to me. “Why aban­don the men­tally ill?”

As the nurse went back into G-1, I caught my brother’s eye through the sliver-of-glass win­dow on the door. My heart ached, but I knew that he wouldn’t be a threat to oth­ers as he re­ceived the treat­ment he crit­i­cally needs. Then the door clicked shut. e were one of the lucky fam­i­lies. We live in a state where such an act is pos­si­ble, be­cause the leg­is­la­ture wrote new laws in re­cent years that al­low men­tal health com­mis­sion­ers to ex­am­ine med­i­cal his­to­ries, among other things, when judg­ing whether peo­ple are likely to se­ri­ously harm them­selves or oth­ers. Too many states do not al­low the con­sid­er­a­tion of med­i­cal his­to­ries.

As some­one who has spent 25 years painstak­ingly nav­i­gat­ing men­tal health laws to pro­tect my fam­ily, my brother and so­ci­ety from vi­o­lence, I be­lieve that fu­ture mas­sacres like the one at Vir­ginia Tech and oth­ers can be avoided. But it will take much-needed re­form of out­dated state laws based on the con­cept, dat­ing to 1972, that peo­ple must be of “im­mi­nent dan­ger” to them­selves or oth­ers be­fore a court can or­der them into treat­ment.

On the books, in part due to the lob­by­ing of the Ar­ling­ton, Va.-based Treat­ment Ad­vo­cacy Cen­ter, most states have de­parted from the “im­mi­nent dan­ger” stan­dard. In re­cent years, 23 states have low­ered the bar to in­clude a “need for treat­ment” stan­dard to de­ter­mine whether some­one should get court-or­dered treat­ment, ei­ther out­pa­tient or in­pa­tient. New stan­dards in North Dakota, for in­stance, con­sider whether there has been a “sub­stan­tial de­te­ri­o­ra­tion in men­tal health.”

But an at­ti­tude re­quir­ing dan­ger­ous­ness pre­vails, not al­low­ing men­tal ill­nesses to be treated as the med­i­cal con­di­tions they are. Penn­syl­va­nia re­quires a per­son to be of “clear and present dan­ger,” and Vir­ginia has re­tained the “im­mi­nent dan­ger” stan­dard. That was what hand­cuffed Vir­ginia Tech po­lice when an English pro­fes­sor warned them about Cho’s dis­turb­ing class­room be­hav­ior. Trag­i­cally, in Jan­uary, the Vir­ginia Gen­eral As­sem­bly passed up an op­por­tu­nity to broaden the cri­te­ria, tabling pro­posed re­forms in fa­vor of wait­ing for a com­mis­sion re­port — due in 2009.

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COUR­TESY OF ASRA Q. NO­MANI

The au­thor at age 4, with her brother, 6, aunt and pa­ter­nal grand­mother.

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