By Doris A. Fuller April 20, 2015
I lost my darling daughter Natalie to mental illness last month.
She killed herself a few weeks short of her 29th birthday by stepping in front
of a train in Baltimore.
The author with daughter Natalie in 2004, soon after publication
of their book “Promise You Won’t Freak Out.” (Courtesy of Doris Fuller )
Natalie and I wrote a book together when she was 16: “Promise
You Won’t Freak Out: A Teenager Tells Her Mother the Truth About Boys, Booze,
Body Piercing, and Other Touchy Topics (and Mom Responds).” The idea of a teenager telling the truth about her
secrets was such a startling concept that we were feature-page headliners in
the Baltimore Sun and about two dozen other newspapers, went on TV coast to
coast, including on one of the morning shows, and got paid to give speeches.
“Oprah” called.
In the book, we used a device to signal whenever a wild turn was
about to take place: And then . . . . In
the introduction, I defined an And then
. . . moment as “one of those critical junctures when my cheerful
sense that all was right in the world collided with inescapable proof that it
wasn’t.”
The book was published to great reviews the week before Natalie
finished high school. Amazon named it the best parenting book of 2004. It was
nominated for a national prize. It was translated into Lithuanian and Chinese.
And then . . . .
At 22, during the second half of her senior year of college,
Natalie experienced a psychotic break. In the span of a few weeks she went from
being a dazzling young adult with the world at her feet to a psych-ward patient
with an arrest record. Only much later did I learn what a devastatingly common
trajectory this was.
Psychotic disorders nearly always emerge in late adolescence or
early adulthood, with onset peaking between the ages of 18 and 25, according to
Thomas Insel, director of the National Institute of Mental Health. Scientists
don’t know why. Many researchers are focusing on abnormalities in the way the
brains of people who behave psychotically develop during adolescence. Others
are investigating genetics, prenatal circumstances and environmental
conditions.
Some consensus has emerged around the concept that psychotic
breaks like Natalie’s are not, as they may seem, abrupt but rather are the
climax of a long buildup. In this model, they are rooted in molecular changes
in the brain that begin as much as a decade before symptoms occur and progress
to an end-stage psychosis in which reality surrenders to delusion, paranoia,
hallucinations or other forms of disordered thinking. This idea suggests the
possibility, both tantalizing and controversial, that children might someday be
screened for psychosis indicators the way they are screened for other health
risks, with the hope of reducing the onset of psychosis much as we have reduced
the prevalence of heart attacks.
Natalie’s symptoms probably began in her junior year of college,
but — like nearly every other family member who ever talked to me about their
own loved one’s unraveling — I had no frame of reference to recognize them for
what they were.
She went a week without sleeping more than a few hours a night
and seemed to have endless energy. But she was traveling abroad then and
relying on caffeine to stay awake. Our family saw this as jet lag, not mania. A
few months later, she reported that one of her friends had begun whispering
whenever Natalie turned her head away. But the girls were on the road together
in close quarters and having some spats. With no history of mental illness in
the family, auditory hallucinations never crossed anyone’s mind.
Only half a year later — when the whisper of her friend grew
into a chorus of strangers issuing commands that led to Natalie’s arrests for
offenses such as trespassing — did the connection become apparent. Again,
commonplace: The average duration of untreated psychosis in America is 70
weeks, Insel says.
Like most people in the midst of psychiatric crisis, Natalie
maintained that she was fine and that “everyone else is crazy.” She continued
to deteriorate until police officers, responding to still another call, took
her to a hospital emergency room instead of to jail. After a series of
psychiatric examinations and a court hearing, she was committed to the state’s
public psychiatric hospital. She received intensive treatment for severe
bipolar disorder with psychosis until she was stable and symptom-free two
months later.
Natalie came home sane, revived and seemingly her vibrant old
self. She moved in with me for the summer and taught me how to like grilled
tofu and make egg scrambles. She concocted the best mixed salads of my life.
She filled my house with her original art, her friends and her irrepressible
spirit. Mental illness was not a theme. She returned to college to restart her
senior year. I saw her off with an emptier stomach but oh so much optimism.
And then . . . .
Three months later, Natalie abruptly stopped taking the
medications that had kept the manic swings and auditory hallucinations at bay.
Within minutes of walking through the door for a weekend at home, her
delusion-loaded thinking and behavior made it obvious that what I eventually
came to think of as “the demons” were back.
Natalie’s relapse was worse than her first break: the psychosis
and hospitalization longer, the recovery harder to achieve, the eventual
medications more complicated, the resulting future not as bright. Her second
commitment to the hospital lasted 10 months, an eternity in an era where the
average psychiatric stay is about five days and most people who are psychotic
never get a bed at all. Thanks to the intensive care, she rebounded again,
albeit more slowly, and finished her bachelor of fine arts degree. Her
attending psychiatrist from the hospital and several staff members drove 75
miles to attend her senior art show. It was a triumph for us all.
But, as is true for far too many individuals and families and
professionals who live with or around untreated severe mental illness,
the And thens continued. While
Natalie seemed happier and more productive on meds, she missed the high of
occasional mania and she hated the weight gain that is a common side effect of
the drugs she was taking. Stable, she would sometimes declare that she wasn’t
sick after all and didn’t need medication — another very common reason people
give for quitting their meds.
Yet if she even inadvertently missed a few days of medication —
even while receiving therapy and other forms of treatment — the demons would
return, and one of the first things they would tell her was to stop taking her
medicine. The second thing they would tell her was not to talk to her mom, the
most powerful other influence in her life. Each time she obeyed and relapsed,
she plunged into a longer free fall, hitting the ground harder, recovering more
slowly and returning at a lower plateau.]
The final time she entered this cycle was last fall, when
Natalie became convinced she was among the 1 in 4 people with psychotic
disorders whose symptoms improve only minimally or not at all with medications.
There were no apparent signs of psychosis, and she seemed happy and healthy to
everyone around her, but she said we couldn’t see inside her head. In November,
six years after her first break, she announced that because she was going to
have hallucinations anyway, she was giving up meds for good. Now 28 years old,
she stopped the injectable antipsychotics and oral mood stabilizers that had
helped her rebuild her life, and her mind began its final, fatal unwinding.
Natalie was a believer that treatment worked and that the
mental health system needed to be reformed so other people received the kind of
care she had when she was in crisis. She told her story in a documentary short last year about the criminalization of mental illness. She
dreamed of being a peer counselor. She said she wanted to help others as she
had been helped — until she became convinced that she was beyond help.
In the weeks since Natalie’s death, the outpouring of sympathy
and grief from legions of people who have fought demons have made me keenly
aware that the pain I feel from her loss is but a drop in the ocean of pain
created by untreated mental illness. Wrote one woman, “I have bipolar disorder
and can’t even begin to tell you how many people over the years have said to
me, ‘Be glad that is all you have.’ ‘It could be worse, you could have cancer
or some other terminal illness. . . . ’ It saddens me that so many people do
not realize that mental illness, while treatable, is not a curable disease, and
can lead to death.”
My daughter lived more than six years with an incurable disease
that filled her head with devils that literally hounded her to death, and she
did it while laughing, painting, writing poetry, advocating and bringing joy to
the people around her. She was the bravest person I have ever known, and her
suicide doesn’t change that.
“Natalie will help our society to move forward,” a postdoctoral
fellow at Johns Hopkins Hospital wrote me upon learning of the suicide. “She is
helping us to look at mental illness with the respect, the compassion and the
dignity it deserves.”
I hope so. Natalie would have loved that legacy.
Fuller is executive director of
the Treatment Advocacy Center, an Arlington-based nonprofit dedicated to
eliminating barriers to treatment for people with the most severe psychiatric
diseases.
This poem was written by Natalie Fuller in December 2013 during
a period of repeated hospitalizations when she first considered suicide to
escape psychosis. Fuller killed herself in March, soon before she would have
turned 29.
Hope
There is a little piece of glitter following me around
I see it on the carpet and I see it on the ground
that’s been following me for quite some time
guess I never noticed it before
But I know what it means, that little glitter on the floor
It’s hope.
It’s not coincidence, nope, it’s hope.
And I know that I’ve failed you
yeah I know I’ve been untrue
but that glitter on the floor
tells me it doesn’t matter any more
Cuz’ no matter how many times I fail
I’ve got hope.
This time, I’m gonna be better
and I know there’s stormy weather
Please believe in me
I will solve this mystery
and I will show you
to have hope.
It’s not coincidence, nope, it’s hope.
Someday that glitter will shine
Gonna write my rhyme until the time.
My heart’s beatin’ outta my chest
I wanna rest but that don’t impress
I gotta fight this urge
gotta get the electricity surge
I know I can do it
Beat my demons
appreciate the seasons.
I hope, hope, hope I can do it too
make all my wildest dreams come true.
