A touching account of a person with schizophrenia and his family's
struggle also expalining
role of executive functioning in the condition

pl see link for photos and movie review
http://edition.cnn.com/2009/HEALTH/04/24/schizophrenia.soloist.brain/index.html


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Teen tries to quiet the voices caused by schizophrenia

By Madison Park
CNN


(CNN) -- The intrusive voices popped into William "Bill" Garrett's
head. "They're coming for you," the voices told the 18-year-old. "Find
somewhere to hide; they're going to get you."


Jennifer Ayers-Moore plays an air violin next to her older brother,
Nathaniel Ayers, in San Diego, California.
2 of 3 They told the Johns Hopkins University freshman that his
father had poisoned the family dog, his sister had injected crystal
methamphetamine into his pet lizard and his grandmother had put human
body parts into his food.

As schizophrenia took hold, the Maryland teenager became lost within
his own mind and had to leave college after winning a full, four-year
scholarship.

Garrett's experience echoes the teenage years of Nathaniel Ayers, a
promising string bass player whose musical training at the Juilliard
School was cut short by schizophrenia, a brain disorder that blurs a
person's ability to distinguish between reality and delusions.

Ayers became homeless and played Beethoven pieces on a broken violin
in the streets of Los Angeles, California. His struggles with
schizophrenia and his friendship with a Los Angeles Times columnist
inspired the movie "The Soloist," which releases Friday.

His sister, Jennifer Ayers-Moore, hopes the movie will raise awareness
about schizophrenia and has established the Nathaniel Anthony Ayers
Foundation for the artistically gifted mentally ill.

"I know there are thousands of Nathaniels, and they deserve a chance,
too," said Ayers-Moore, an Atlanta-based social worker.

Teen interrupted

Schizophrenia is the result of disrupted brain development. Males
typically get symptoms during their teens or early 20s, as Ayers and
Garrett did.

"It's a critical time for the brain," said Dr. Jon McClellan, the
medical director of the Child Study and Treatment Center at Seattle
Children's Hospital. "It's the CEO part of the brain that pays
attention, makes decisions and filters. The prefrontal cortex, that's
the last area of the brain to develop. As that area comes online,
that's when the illness presents."

In high school, Garrett won elected offices in student government and
headed the lacrosse and cross country teams. A gifted student, he
wanted to study political science and biology at Hopkins.

At home, he cooked family dinners, helped his little sister with
homework, and surprised his mother with pancakes on her birthday.

"People likened him to the perfect child before he got sick," said his
mother, Kristan Kanyuch.

In 2007, the unusual behaviors started. He slept a lot. He emptied an
entire can of bug spray in his bedroom. When he came home for a
weekend from college, he pointed to a blister on his hand that had
formed from playing lacrosse.

"Look, I have gangrene," he said. "My hand is going to rot." Then he
tried to cut off his hand with a paring knife.

His family stopped him and took him to an emergency room for a psych
evaluation, but Garrett refused to wait and left.

A week later, Kanyuch got a call from the university. Her son was
failing every class. When confronted, Garrett looked at the F's and
calmly replied, "I'm not failing anything."

In the 1970s, Ayers-Moore saw the symptoms when her family picked her
brother up from Juilliard to head home to Cleveland, Ohio, for summer.

"The look in his eye was so different," she said. "It was like you
could see into his soul, he could look into yours. It sort of startled
me a little bit. I didn't know what to say to him. On the way from New
York, I pretended I was asleep. I didn't know what to say."

Paranoid schizophrenia

About three decades later, Nickole Kanyuch, 15, watched a similar
scenario unfold as her brother, Garrett, struggled with paranoid
schizophrenia and obsessive compulsive disorder.

"I watched the big brother who I had looked up to all my life fall
apart and become someone entirely new," she said. "The boy who was
destined for greatness, who worked long and hard for 12 years to lead
a successful life, was destroyed in a mere six months."

Garrett, who had once organized his 600 books by the Dewey Decimal
system, could hardly read two sentences. The voices in his head
drowned out the words on the page, he told his mother.

Garrett, who color coordinated the clothes inside his closet, could no
longer groom himself or shower. The voices told him the shampoo and
soap were poisoned.

Kristan Kanyuch quit her financial planning job to take care of him.
Despite taking medicine, Garrett's health fluctuated. One day he was
fine; the next, he threatened to kill the neighbors. Frustrated and
facing mounting debt, Kanyuch sought help.

She joined a mental health support group. At one session, she was told
to follow simple instructions from a counselor. Meanwhile, 10 people
who stood around her talked at once. While the chorus of voices
drowned out the instructions, she realized this was how her son lived
every day.

That night, Kanyuch hugged her son. "You have to be the most
courageous person. You wake up every day," she told him.

"That's when he explained to me the reason he sleeps," Kanyuch said.
"He doesn't hear the voices. He doesn't hear them telling him he's
fat, stupid, there's a conspiracy. It's a break for him to sleep."

Although no one knows where these voices originated, they could be
triggered by wiring problems in the brain, said McClellan, who
researches adolescent psychiatry. One theory is schizophrenia causes
difficulty distinguishing thoughts from their outside experiences, "so
they experience internal thoughts and perceptions as voices," he said.

Recovery

Garrett has been a subject in two research programs searching for
better schizophrenia treatments. His condition fluctuated, and, for
months, he was on suicide watch.

Schizophrenia is a difficult disorder to treat, because one medication
that soothes one patient can make another psychotic.

"Medication or dosages can't be matched absolutely with the
individual, so there is some of that trial and error," said Dr. Thomas
Bornemann, director of the Carter Center's Mental Health Program.

Garrett tried many drugs. Some made him drowsy, others volatile and
one drug made him gain 75 pounds. Severe side effects often cause
patients to stop taking medication.

For now, doctors seem to have found one that helps Garrett. Since
March, Garrett has been at a Maryland research center that looks into
the relationship between metabolism, tobacco and schizophrenia.

After a violent visit in August, Garrett, 21, had not been home until
Easter. During the recent visit, he played basketball, Yahtzee and Wii
bowling with his family.

"He was able to carry on a conversation and play card games," Kanyuch
said. "He was interacting."

At home, surrounded by reminders all his past achievements, Garrett
said: "Mom, I was on the top of the world. Now I'm in the gutter."

His mother disagreed: "Look at it as an opportunity."

"What?" he said.

"It's not an opportunity everyone would jump at," she told Garrett.
"But as you rehabilitate, as you grow an insight into your illness,
there may be things you deal with forever. But you've had significant
experiences that you may be able to use to help other people. There's
no place where insight and advocacy [for mental health] is needed more
than in politics, which is what you wanted to do."

A life with schizophrenia won't be easy, but some with the disorder
have graduated from college, earned doctorates and lead enriched
lives, she told Garrett.

"He doesn't understand the courage he has."