I grew up with a brother by the name of Howard (Howie) Lee Klein, who was two years and two months older than me. He was also my only sibling to our natural parents, Arnold and Betty. Being so close in age, Howie and I shared many experiences and slept in a bunk bed in the same bedroom throughout our youth. Howie and I played vigorously in our neighborhood, an apartment complex called Pomonoc in Flushing, a community in Queens, N.Y. It was both clean and safe back in the 60s. As we grew older, we went further into our community going to our local city parks and the movie theater next door to a White Castle!! Yummm! $0.12 each – That’s eight for one dollar!
Howie loved me and was as protective as you’d expect from a big brother! We had a lot in common as we both loved sports and competitive things, as long as they were played fairly and within the rules of the game. We also both loved listening to music, especially the AM radio, which I believe had seven or eight stations at that point. There was no FM radio yet. We heard and loved mostly Motown and rock ‘n roll.
In 1972, our parents found a suburban home in a town called Rockaway in Morris County, a fairly rural part of northwest New Jersey. They wanted to give us more room to grow. The community surrounds a beautiful lake, White Meadow Lake, which has beaches and recreational activities like handball and basketball available.
**Note: I refer to my brother in the past tense throughout my blog as he is no longer with us. He passed away in 1999 at the age of 40 from a brain tumor. I’ll talk more about this at a later time.
When I was around 12 years old, and Howie 14, I started to notice my brother acting strange. I started to really question some of my brother’s statements and behaviors because they began to take on a very peculiar and bizarre feeling and tone. At the time, this both confused and scared me. I kept telling myself that he was fine at his Bar Mitzvah just the year before, and wondered if he was just having a harder time with the move than I was. I was still a young adolescent, and, honestly, didn’t know what to make of it.
Things progressively got worse for Howie. He began walking around the house muttering aloud different words or phrases like part of a conversation without any context at all. I asked him what he was saying, but he often didn’t answer me. I began to realize that he was actually communicating with himself, and he couldn’t explain this to me. He had a distracted and disengaged look about him that was most evident in his eyes. He started having trouble in junior high school even though I knew he was incredibly bright. He began to isolate himself, and stopped attending Boy Scout meetings, which was something our whole family had been involved with and loved for many years since cub scouting. He also began to be extremely moody. He seemed to become easily depressed and angry. My parents have since told me that, at that time, Howie was telling them both things that sounded fearful to the point of paranoia, and that he was frequently agitated and depressed. I remember sitting with my parents at the small, round, cluttered dining room table and asking them, “What’s going on with Howie?” They told me that they honestly weren’t sure, but knew that he was suffering inside emotionally. They told me that they had made an appointment for Howie to be seen by a child and adolescent psychiatrist. I remember them looking perplexed, exhausted, and seemingly helpless to what was going on. It was exactly how I felt.
We went to family therapy due to the numerous arguments and the tension occurring in our home. At that time, there were no obvious signs that something larger was seriously looming. Howie was first diagnosed with having a mental illness called Schizophrenia back in 1974 when he was about 15 years old. At that point, he had trouble maintaining himself at Morris Hills High School and had stopped attending classes. He told the doctor that he had begun hearing voices in his head, and that they were shouting at him and saying negative things. Howie was drawn to reading a lot of religious and philosophical books, and was reading far beyond his grade level. It should be noted that Howie had later tested out at an overall IQ of over 150 during psychological evaluations. The psychiatrist prescribed a variety of psychiatric medications for Howie to help clear his thinking, positively effect his mood, and let him rest more and sleep through the night. He agreed, at least initially, to this plan and began to take these prescribed medications although he did state that he didn’t like how they made him feel. He was sleeping better, but constantly said that his stomach was upset and that his muscles felt tight. Over the course of a few years, while I was now attending that same high school, Howie began to go on and off his medications due to the side effects. I was trying to maintain my grades and be an athlete. I was on a variety of school teams, but mainly focused my energy on cross country running and track and field. When he was off his meds, he would say that he believed that he didn’t really think he had a mental illness, that the medications were causing him harm, and began to question whether the medications were what was causing him to feel mentally ill in the first place. The family would then see Howie’s psychotic symptoms re-emerge rather quickly. He would become erratic and angry with all of us, accusing us and blaming us of wrongdoings At times, he broke furniture and punched holes in some of our interior house walls. One time, he severely threatened our father and chased him around the house with a knife. Thankfully, our father was faster than Howie and escaped harm. On that day, Howie did not perceive our dad as his real father. His illness had caused him to distort his belief system, and, at that point, he believed that our father had been replaced with a duplicate impostor who wished him harm in some fashion.
Howie also battled with depression during these years, and, all too frequently, was suicidal. This led to a number of psychiatric hospitalizations throughout his adolescent and young adult years. To my knowledge, Howie attempted to take his life three times. While unsuccessful, these were serious attempts and not cries for attention. He told us that it was too painful to live with the intrusive voices and constantly being told that he didn’t deserve any happiness or success. I couldn’t understand then that these voices were a direct distortion due to his mental illness of his own low self-esteem and severe insecurities about his capacity to achieve in the world. Our parents needed to have Howie hospitalized numerous times in short-term stay psychiatric facilities that ranged from three days to a few months in an ongoing effort to stabilize him in these moments of extreme distortions and suicidal thinking. This was especially true when he elected to stop taking his medications, but, also, when what he was taking was ineffective for the symptoms he was experiencing at that point.
The above description of how my brother’s mental illness was impacting him is factual and certainly, without any malice or intent, created a major shift in the normalcy of our family routines and lifestyle. However, it doesn’t begin to touch on the emotional and psychological impact that this had on my parents and myself. We certainly each had been jarred and shaken quite a bit through this whole process. However, we each had our different reactions and we each had our relations with Howie. For years, I shared my description of what is was like, for me personally, having a family member with a severe mental illness with my patients at Napa State Hospital. It was like a psychological atom bomb went off in the middle of the living room and sent each of us flying with emotional shrapnel in different directions!!
Again, let me clear – Howie did not intend to cause ANY turmoil, heartache, or property damage for the family. Nor did he mean to be draining of time, energy, and money from all who loved him. As do most major medical and / or psychiatric issues within a family, that reality just happened naturally. It is fairly normal and common. However, the self-harm and the potential violence that is expressed outwardly is quite unique to mental illnesses. We were scared at times for both him and ourselves. We were confused most of the time. We were constantly trying to reason and help Howie understand why certain choices were in his best interest. I learned early in my life that you can’t force someone to take a prescribed medication even if it’s for their own good and even if not taking it makes NO SENSE whatsoever. This is why this becomes involuntary once placed on a psychiatric hold in a hospital. Because, at that point, it becomes clear that the judgment of the person is impaired and they can’t choose for their own good in those moments. Once clear, there is room and time for psycho-education to occur and to help those willing and interested to really understand how their medications puts them back in control over their moods and thoughts.
We all loved Howie very much, wanted him to take better care of himself, and truly wanted him to be happy and safe overall. Now I can look back at all he went through during what was a fairly antiquated time in the late 70s with respect to the medications available to him. There have been tremendous improvements to the psychiatric medications that exist today, especially with regards to the treatment of psychosis. He also had spent a great deal of time in psychiatric hospitals that offered little to no education and treatment. During my visits with my parents, I don’t remember any psycho-educational classes being taught to help Howie build a better understanding and begin to trust his psychiatrist in hopes that it could improve his medication compliance rate and stability. Today, this readily exists and adults with similar illnesses are being empowered and educated each and every day. It is being presented in both outpatient and inpatient settings by psychiatric treatment teams so that those struggling with a mental illness, and their loved ones, are no longer left in the dark. Families are actually connected as an important support to the client / patient via the treatment team and toward their process of their eventual recovery!!