Sunday, January 11, 2009

Madness and Love

It’s been a long time since I contributed anything to this blog. I don’t even know if anyone reads this anymore.

I’ve decided to write some thoughts here about a close friend of mine. I’ve chosen this blog because its one this particular friend does not know about, and hence he will not know I have written this.

Some of you may know that after obtaining my bachelor’s degree, I lived and worked in Thailand for close to 5 years. I may dwell a bit about my experiences in general there at a later point, but for the time being I mention it because that is where I first met Charles (not his real name), and we became close friends.

At that time, Charles – a fellow American expat – was working as an ESL consultant. He later obtained a position as an editor and writer for one of Thailand’s major English-language newspapers, a dream job for a young expatriate. Charles was quite bright, funny, and had a serious interest in both the politics and cultures of the region. Charles also had a very good relationship with his Thai girlfriend. In many ways, he had a lot to look forward to with his life.

Given that both Charles and I were of the same age range, both Americans, and had somewhat similar interests, we became quite close. The expatriate lifestyle can be lonely at times, so when friends are made, bonds can be deep. Years later, I returned to the United States to go back to school, and Charles elected to continue living in Thailand as an expatriate, a big decision (one I at times wish I had the courage to have done myself), but one supported by the fact that he had an excellent job as a journalist, and his relationship with Noi - his Thai girlfriend - had become very close. They married about 5 years ago.

This past month, I returned to Thailand for a visit, to see friends, old haunts, and just go on a much needed vacation. Although I had been in email contact with Charles for some time, we hadn’t met in years. I was deeply shocked and saddened to learn that he had become afflicted with paranoid schizophrenia.

I do not know much about schizophrenia at all. I have been relatively lucky in life. I have known few people with serious mental health issues, and those I have known were for short durations and usually met within the context of work. For the most part, everything I knew about schizophrenia was derived from watching A Beautiful Mind. Charles himself does not like to talk about his condition – a disposition I understand and respect. Almost all of what I know of the disease’s initial onset with Charles was told to me by Noi.

Charles first experienced a psychotic episode while participating in a Buddhist meditation retreat. He was about 34 years old. Basically, he began hearing voices and commands in his head. The voices often urged him to do very reckless things, like jump into canals. Anyone who has visited Bangkok knows that the city’s canals are possibly among the most polluted waterways in the developing world. Although there may be some waste water treatment, it is certain that many canals flow with raw sewage and human waste. To contemplate that he was jumping in and swimming in them is horrifying.

Other times, the voices were urging him to do things that were more innocuous, but no less removed from reality. He would try and enter buildings to search for non-existent people the voices were telling him to talk to. He was urged to get on trains and buses to go places that didn’t exist. Noi was absolutely terrified. I cannot imaging how bewildering and frightening it must have been for her in those first few weeks as this behavior was unraveling.

Eventually, they went to see doctors, who confirmed that he was indeed afflicted with paranoid schizophrenia. The doctors prescribed medication. But Charles did not adhere to his medication regimen, largely because of denial. Further psychotic episodes occurred, and at the advice of a doctor, Noi began slipping the medication into his drinks. He now takes his medication voluntarily.

Although the medication successfully prevents Charles from experiencing psychosis, the side effects of the drugs are sadly, very powerful. Charles sleeps at least 10 hours a day, every day, which is really too much. When he is awake, he is sluggish and has a sub-normal level of energy. Additionally, his physical reaction time has become very slow. It seems to me that the drugs basically seem to have a strong sedating effect. Consequently, Charles really cannot engage in any sort of robust physical activity for any extended period of time. Playing sports is out of the question. Because of this, Charles has now become quite overweight, which of course leads to a host of other physical health issues. Because his physical reaction speed and overall physical coordination is now stunted, he is also much more prone to trips and falls (which can be potentially very dangerous and even deadly).

I’ve also learned that another side effect of the drugs is what is called “parkinsonism” – a derivative from Parkinson’s disease. “Parkinsonism” basically means that the facial muscles will relax into a state where they do not contract, similar to the symptom experienced by those with Parkinson’s disease. Unfortunately this means that at times Charles also has that dreadful, deadened look that afflicts Muhammad Ali and other sufferers of Parkinson’s disease.

On a more general level, Charles simply lacks the vitality and energy of his former self. I’m not sure if it’s the condition, or the medication, but he seems emotionally and mentally stunted. At times he seems to waver in and out of consciousness. It sounds horrible to say, but most of the time he is just flat out slow. To make matters worse, he enjoys drinking beer quite a bit (to the protest of his wife). I’ve got nothing against consenting adults drinking alcohol, but I can’t imagine how drinking alcohol can be good for someone with his condition and taking his medication. I can only wonder what kind of harm the mix of beer and drugs is doing to him. When he is drunk, he is so drunk he is barely lucid. It can’t be good.

His condition has also threatened Charles’ financial and professional life. About a year ago, Charles was laid off from his job as an editor and writer for the newspaper he had been with for so long. Noi told me that a significant factor was the decline in his work performance due to his condition. I can’t help but wonder if stigma and discrimination also had something to do with his dismissal as well. I have no idea if Thailand has employment anti-discrimination laws, but if they do I doubt they are as strong as those in the United States. Luckily, he recently obtained another job, although it is unclear if his condition will affect his responsibilities there as well.

In addition, the medication Charles takes is costly. A single pill costs $6, and he needs to take several a day, every day. Six dollars is not too much, but considering that his current employer does not – that I know of – offer any form of health insurance, and that the salary he makes is not comparable to a professional-level salary in the states, those costs can add up over time.

In short, paranoid schizophrenia has – at the very least – seriously affected Charles’ quality of life for the worse. One could even say it has ruined his life. Upon meeting him, I was immediately shocked at how poor his overall health and appearance have deteriorated. It is really quite sad.

One very positive note is this: His wife Noi – who has also become a close friend of mine – has stuck with Charles now since they first met many years ago. Rarely have I met a woman or known of a relationship in which the wife has sacrificed and endured so much to care for a disabled husband. I imagine some people (of any nationality) might have bailed out on a spouse who was stricken with such a horrible disease. I wonder if even I would. Luckily, Noi continues to care for her husband with genuine love and compassion. She is truly a remarkable woman and possibly one of THE most remarkable women I have ever known.

I’m not sure what will happen to Charles and Noi in the future. Although the schizophrenia has certainly taken a major toll, Charles is still a somewhat active, functioning person. He has a loving wife and friends, and both his family and his wife’s family are loving and supportive as well. He remains a close friend of mine, and we keep in regular contact. I do not know much at all about the medical aspects of schizophrenia. I don’t know if it is possible to get better. I do know that medication and treatment will continue to progress however, so I hope that in the future his medication won’t have such strong effects on him.

I wasn’t sure why I started writing this. I don’t even know if anyone will read this. It is really quite depressing, and I would say that on one level I simply wanted to write these thoughts as a way to express my sadness and shock at the fate of my friend. When a close friend or family member is stricken by such a horrible disease – or for that matter any major disease or condition with grave consequences – it gives one pause to re-examine the state of one’s own health and well-being, and those of your loved ones.

So I guess I’ll end in what will sound like one of those silly, maudlin, sickly-sweet Hallmark Card moments. Take care of yourself, your health, and the health of your loved ones. Be grateful for what you have. Love and protect those you cherish. I don’t know what else to say.