Photography by Kevin Roberts
"Draw a box,” says the instructor, a middle-aged woman with a pretty face, short brown hair, and a warm, clear voice. The students draw the box and lean forward, straining to hear the next step. Somebody in the back of the room is reading the weather forecast aloud in a monotone.
“OK, draw another box, with a line connecting the two,” the instructor says. Now there’s a woman’s concerned voice behind the students: “Hi! It’s Mom! How are you doing? Are your meds working?” Another voice, low and gravelly, says, “This teacher’s evil. She only wants to hurt you!” A modulated professional’s voice talks to another doctor, describing someone’s mental state. “People are trying to harm you,” several voices are saying over and over again, right behind the back row of students. “Get away, now! Go!”
“Make a circle around the second box,” the instructor continues calmly, ignoring the ragged chorus of voices repeating their comments, louder and louder.
One of the students puts her pen down, hard. She blinks back tears of frustration.
That’s the point.
The class is held by the St. Louis chapter of the National Alliance on Mental Illness. The students all have family members who are living with mental illness. This week’s topic is empathy. And Sandra Hartge is teaching from experience.
John Hartge slammed off the alarm and pulled the quilt up over his head, letting the warm darkness nearly suffocate him. Just thinking about throwing back that quilt and putting his feet on the cold floor was too much—let alone getting dressed, going outside, and making it all the way to Kirkwood High School.
It used to be easy. He used to like school. Now going there was like walking against a gale-force wind. And every time he gave up and let the wind sweep him back, it was that much harder to go the next day. Friends who were ambitious thought he’d gotten lazy—“You’re just not trying hard enough”—and the others simply didn’t get what was wrong.
Even if he’d had the energy to explain, he couldn’t say what was wrong. All he knew was that nothing was fun anymore. He didn’t want to hang out with anybody; he didn’t want to
do anything.
He hid it the best he could. His schoolwork started to slip—but from A to A–. At the end of his freshman year, after a routine visit, their family doctor asked Sandra, “Do you think John might be depressed?” She laughed out loud. “I’ve got the happiest kid in the world,” she said. “There’s no way he’s depressed.”
But in the fall of sophomore year, he started bolting: just getting up and leaving the house, going for a walk. Sandra started paying closer attention. John got his driver’s license, and soon after, he got into a fender bender—nothing major. But he cried all night long, a keening, hysterical sobbing that was so loud and so desperate, Sandra rushed around the house shutting all of the windows, afraid the neighbors would think she was hurting him.
That night, terror iced her heart. He was upset enough to want to die, over a fender bender. What was happening to her beautiful, brilliant son?
The first psychiatrist prescribed Prozac. John swung to the opposite extreme. “I would think I was the smartest, funniest, best person in the world,” he remembers, “and that all eyes were on me because I was so funny.” He shrugs, mouth quirking in a half-smile. “Later I realized, no, it was just weird.” He retells a few incidents, and now, he’s genuinely funny, his sense of humor stripped of a child’s innocence and honed sharp.
Back then, though, his mom loved his new chattiness, seeing it, with rose-colored hope, as an exuberant personality finally free to emerge. That Thanksgiving, her parents said warily, “John’s really changed,” and she said, “Yeah, isn’t it great? He’s so talkative now!”
Then he peaked and swung down, so depressed he couldn’t bring himself to shower or eat. He started cutting, slowly pressing a knife’s blade down and drawing it across his flesh. He stopped when he saw the red line of blood, felt its hot sting, knew he’d made the outside of his body match the pain he felt inside.
The psychiatrist increased the Prozac and urged him into the outpatient program at Edgewood Children’s Center, afraid he was giving up.
“There were definitely some catatonic days,” John says, leaning forward, resting his weight on his forearms. He stares into the dark, swirling reflections in his coffee mug. “Yep, I’m here,” he remembers thinking. “I exist. That’s about all I’m going to accomplish for this day.” He didn’t see a way for it to get any better. Most of the other teenagers at Edgewood were there for drug problems and were convinced they were just being punished. But he felt like he was being contained, stuck there while they waited two weeks for a new drug to take effect.
When he was released, he cut again, with crueler determination, and ended up in the hospital.
John was now on his third psychiatrist. And when this psychiatrist asked “Why do you let him not go to school?” Sandra nearly lost it. “He’s 6-foot-2. What am I supposed to do? I mean, physically, tell me how to do it, and I’ll be happy to try.”
She’d finally begun to realize that her son’s illness wasn’t her fault. Moving John from a small private school in Fenton to a big public school in Kirkwood had not caused the depression any more than the Prozac had. “You’re predisposed; that part’s genetic,” she says. “So it’s somewhere in there, waiting for a trigger to bring it out.”
“Time bomb,” John agrees dryly.
He quit high school in the middle of his sophomore year and passed his GED a month later, scoring in the top 2 percent. Then he climbed back into bed.
The fourth psychiatrist provided real help; he’d suffered depression himself, and he got it. Slowly, John started to stabilize, letting the earth settle under him, riding out the aftershocks. He was a young man now, his features taking form, and he had the slight stubble and the pale, finely drawn features of a young Shakespearean actor—Ralph Fiennes, maybe. But in the world’s terms, he was still drifting.
At 18, he got a job at Schnucks that made a huge difference: He was doing something concrete, doing it well, and getting paid. “School had been my measuring stick,” he says. “The road map was: Finish high school with good grades, go to college, get a good job. And I didn’t have a backup plan.”
Sandra had told her ex-husband, of course, and just a few close friends about her son’s problems, but nobody else. She could predict the world’s attitude toward a young man struggling with bipolar disorder. She started working from home, staying close to John, but kept at a remove by his changing moods. She felt stranded, doubly alone. She forced a smile when other women bragged about their sons’ full scholarships, and eventually she stopped going to family-oriented events altogether. For three years, she coped all by herself.
Then a friend mentioned the St. Louis chapter of NAMI and its Family-to-Family program, a 12-week course taught by trained peers, rather than professionals, that explains the biochemistry of the brain and the signs and effects of mental illness, then gives practical advice about empathy, communication, and staying sane yourself. With some trepidation, Sandra went to the first class. She left almost tearful with relief. She’d sat in a room filled with people she could talk to and know they’d understand. And they’d offered so much common sense. Even the warnings not to expect a quick fix—things could get better, but it could take three or four years—calmed her.
“When she stopped blaming herself, that was nice,” John says, relief lighting his eyes. “At first, she felt pretty powerless, but she still tried, and that was frustrating for me, because I could see the amount of emotional energy she was expending trying to help, and there just wasn’t much she could do. Oftentimes when I just wanted someone to talk to, she’d get upset, and then I wouldn’t talk anymore, because I didn’t want to upset her.”
Sandra’s smile twists. “I had to learn to listen to him talking about wanting to kill himself without reacting. Don’t fix, don’t comment, don’t get upset, don’t cry.”
Now she teaches Family-to-Family classes herself, conveying those essential but not automatic communication skills to people new to the struggle. “So many families are argumentative with their loved ones, or they try to reason with them and go on for paragraphs,” she says. “Just use short, short sentences. And ‘I statements.’”
The first time she tried an “I statement,” she was so proud of herself. John had started community college, and “he had this lovely habit of changing his medications at what I thought was not the right time,” Sandra explains. Her tone is rueful but light, free of the old angst. “I said, ‘John, I get scared when I think about you changing meds in the middle of the school year. I wish you’d wait till summer.’”
“It didn’t do any good,” she adds, grinning at him. “He changed meds anyway. But I felt a whole lot better about the way I’d expressed myself.”
The tone of their conversations started to shift. The next breakthrough came when John cut himself while his mother was home, just a room away. “I used to hover, wanting to make sure he wasn’t going to hurt himself,” she says. “When that happened, I realized, ‘There is nothing you can do about this.’ And that gave me permission. I just had to love him.”
Gradually, John began to heal to the point that he could think about the good advice he’d been getting all along. “The way to deal with anxiety isn’t to avoid anything that could make you anxious,” he realized. “I used to isolate myself so I didn’t have any anxiety. That’s not the way you deal with it. You take small steps outside your comfort zone. Now, if I focus on resolving the things that make me anxious, instead of avoiding them, it keeps the anxiety from snowballing.”
By his early twenties, he was well enough to move away from home, leaving behind his mother’s well-intentioned coddling. “I wouldn’t push him to do things that I knew would make him uncomfortable,” she admits, “because I’d be afraid to send him into a tailspin.” Now she can’t coddle him: He’s in Kansas City, living on his own, holding down a great job doing tech support for a media company. He drives back to St. Louis every once in a while to spend a weekend with his mom—or get drafted to talk to her NAMI class.
