Wall of room in Ward Retreat 1 at St. Elizabeth’s psychiatric hospital in Washington, D.C. Credit: the Otis Historical Archives National Museum of Health and Medicine.

I received an email from a Department of Corrections social worker about four years ago. She had a message for me from my older brother Michael. He wanted contact with his family after fifteen years in a prison psychiatric treatment facility, to which he had been sentenced after trying unsuccessfully to murder my mother, father, and younger brother in an arson attempt at our home in suburban Tidewater, Virginia.

In February 1992, in the early morning dark, Michael had dismantled the house’s smoke detectors, poured gas around the garage and through the downstairs hallway, and thrown matches into the black puddles, igniting wood, drywall, and carpet. He then rode off on my mother’s cobwebbed, blue Sears bicycle. He had once been a handsome, fit, quick-witted boy, but by then he was a bloated, ashtray-smelling, deranged, yellow-toothed twenty-five-year-old. A couple of hours after setting the fire, he rode back home. My mother, dressed in a nightgown and jacket, was crying and shivering in the cold as the firemen extinguished the last embers in the smoldering garage and the police collected evidence. He asked her what was for breakfast. Could they maybe go to Denny’s?

When the cops wanted to put handcuffs on him—loose, for comfort, just one of those procedures the manual insists upon, Michael—my brother figured that would be okay. He sat in the back of the police car, smiling as blue and red light sprinted around the neighborhood, flashing across the sleep-softened faces of our neighbors. He laughed. He’d really done it this time.

My brother is a paranoid schizophrenic. He used to spend much of his time reading and writing in his King James Bible, in which he found coded messages and directions about his own life. Religious delusion, across cultures and belief systems, is a common form that auditory and visual hallucinations take in cases of acute paranoid schizophrenia. This is because the schizophrenic seeks salvation from his suffering the way a person drowning seeks a gulp of air. Religion is a road map most available for this mission—a set system of archetypes, story lines, and metaphors aimed at deepest human meaning, hope in bottomless despair, and orientation within one’s own mind and experience. As the anthropologist Clifford Geertz once wrote, “Man cannot live in a world he does not understand.” When we lose touch with so-called reality, we don’t disappear into a void of meaninglessness; we reconstitute fact, experience, belief, and feeling into an alternate reality. We leave the socially acceptable level of delusion we all live in as citizens of the modern, information-glutted, wisdom-and-knowledge-starved world and enter a mental house of mirrors. We go “mad.”

In mental illness, faith and spirituality can be elixirs for suffering, but they can also be unhealthy and even dangerous obsessions, especially when those in the throes of psychosis refuse to believe they are ill, as do about fifty percent of schizophrenics. And sometimes these obsessions spill over into uncontrolled dementia and, as in my brother’s case, violence.

He used to pray loudly in pizza parlors, or at the food court in the mall, while the Christmas shoppers walked quickly by. He felt an otherworldly power roiling through his bones and blood and skin. Clouds had messages. A drop in temperature could carry hidden meaning. He believed there were demons in our house, under his bed, which he once tearfully told my mother about, sending her heartbeat into the red zone. He was convinced that my father, who was dying of cancer, almost dead, was a mystical and nefarious presence. The night he set the fire, he needed to burn out the evil—all very simple, really, the furthest thing from “random” violence. In his mind it was a necessary and even unavoidable act of destruction. Given his circumstances—evil in the house, unbearable oppression from mysterious forces, the buzzing and eye-twitching need to survive this pain—what choice did he have?

I was 21 in 1992, at college forty miles away from our home the night of the incident. I am the only one in my family to finish college, a scholarship and fellowship kid, and it was very important to my parents that I succeed, that I become a person with opportunities in his life rather than dead ends. They did what they could to protect me from my brother, and I owe them more than I can pay. Though I have always been quite academically average outside of the humanities, I was a shining star to them. I later graduated with a degree in English and journalism. I then went on to get two graduate degrees. I have written five books, all autobiographical and documentary, all driven by my layman’s interest in “abnormal” psychology and social psychology, in how we—as individuals, as a society, as cultures and sub-cultures—construct and perceive notions of “truth.” My first book—the darkest, the saddest—is a story about my brother, an experiment in biography, memoir, and journalism. I haven’t read it since going through the publisher’s galleys in 2000.

The less-selfish half of me has always wanted to help my brother, or at least help people understand his illness, its effects on sufferers, on families, on society. In the journalism and criticism I was honing—guided especially by books like Michael Herr’s Dispatches and James Agee’s Let Us Now Praise Famous Men, by the essays of George Orwell and James Baldwin—I thought that maybe a high level of prose craft could wield some power on behalf of consciousness-raising, activism, and progress. But, to be honest, the selfish half of me wanted him, by the time of the fire, disappeared, even dead; or I wanted him to have never existed. The level of stress he caused in my family felt like someone had set a grenade on our kitchen table and then asked us, my family, to carry on with life as usual.

When Michael was gone, incarcerated in a psych ward after the fire, which itself followed dozens of smaller violent and strange episodes, I felt myself rising toward light and air. I could work, study. I could have friends, lovers, could get married, have a family. Time in my life began to flow perhaps more like time in your life. I could calm down. I could read a book. I could think. I could be less depressed.

Very few problems nowadays strike me as big compared to the problem of severe mental illness in my family, in my childhood home, which went on for more than a decade, each year a little, or a lot, worse than the prior. My parents essentially had a part-time job trying to get help for my brother—new meds with toxic side effects, a treatment center that insurance would only pay for with the correct paperwork, and that only for thirty days. Then there was their need to prove, over and over, that he was in fact a danger to himself and others.

“Has he hurt anyone?” asked the voice on the other end of the line.

“Technically, no,” said my mother, “but…”

“If there hasn’t been an incident,” continued the voice, “and there is no police report…,” etc.

My parents came from humble beginnings and little means, and they had ingrained in them the working-class value of ultimately trusting and deferring to any and all hierarchical authority—medical, legal, psychiatric—even if that authority was faceless, bureaucratic, harried, and barely competent. But one thing I learned during nine years of university education was that most experts only know what they’re talking about half the time, and that our most advanced forms of knowledge are highly provisional, often shown to be naïve just days or years or decades after they seemed like breakthroughs.

The social worker wrote in the email that my brother was lonely, isolated—as, anyway, I imagined every prisoner was, as I knew every sufferer of his disease is, especially at his level of severity, because they are stuck in darkness, pain, and slippery realities. He was also “rarely any better” and often confrontational and uncooperative. My brother is a worst-case scenario. There are many like him in our prisons and on the streets—by some estimates I’ve seen, up to 300,000 in the US, but I’m going to unscientifically tell you that those estimates are way too low and it is probably more like double that. If you live in a city, you see several people suffering from severe mental illness every day you pass by a congregation of the homeless (they would be quickly rounded up in the suburbs), and as politicians (large percentages of whom live in gated communities in those suburbs) continue to destroy what is left of the social safety net, this will only increase. “Community support”—a popular phrase in mental health care—can be a euphemism for abandonment for both the sufferer and his or her loved ones. Laws regarding treatment, driven by upside-down fiscal concerns, are passed by people with no visceral connection to the problem. Let them be faced with the choice of housing a dangerously ill loved one or putting him on the street to starve, commit crimes out of desperation, or become a victim of mind-altering violence and abuse. What would you choose? Let them stand with a phone to their head, crying for an hour while on hold, listening to Muzak with one ear and the desperate prayers of a child with the other.

My brother has, I think, erased any guilt he may have felt for his prior deeds, or rather his crimes have been subsumed under his ongoing hallucinations and delusions, his anger and self- and world-loathing. His imprisonment is undoubtedly seen by him as part of a deep religious conspiracy, as everything was. The social worker informed me he had almost killed himself (he attempted suicide when I was a teenager and again when I was in my early twenties, so I wasn’t shocked) by drinking enough water, gallons and gallons and gallons, to cleanse himself of his medications, which he hates because of the side effects, and which he is forced by law to take as part of an “involuntary psychiatric commitment” every 180 days because he will not take them otherwise. The social worker and her team keep my brother from the dangers of the larger prison—potential rape, violent attacks, various types and levels of enslavement, and illegal trade—by going through the rigmarole of paperwork every six months to make sure he is medicated and in the psychiatric unit where he belongs. He drinks the water, you could say, as a search for God beneath the tranquilizing chemicals. God—his notion of God—is his only hope. By chugging the water, he rids himself of electrolytes and vitamins and minerals to the point of seizure. So he ends up in the infirmary, handcuffed and, I imagine, raging once his strength is back. I remember that rage, how impossible he was to be near, how dangerous one minute, how sad and pathetic and tearful the next.

I told the social worker I could not speak to him, nor could my mother, who is in her 60s now, living a peaceful life after many years of a damn difficult one. Call me cold, but our problem—his problem, but ours by extension—is intractable. I wish I could offer some kind of easy prescription here—something to do with politics and policy, with therapeutic philosophies or biochemical treatment protocols. But the mystery of mental anguish, of the mind on the outs with itself, of a version of hell made manifest in a suburban living room, is the one thing in my life that has brought me to the point where my only option seemed to be to pray.

To reengage my brother would be suicidal. What choice do I have? The past comes flooding back. I cut him loose to survive.