About two years ago, a stranger took control of Cathy von Haartman's house.
He made a racket all night, blaring music and laughing uncontrollably. He provoked arguments and drank and told Cathy, in confidence, that he was in the CIA. And that her food might be poisoned. Often, Cathy has lain awake in fear, yet she can't bring herself to kick him out. The stranger is her son.
As a boy, Anders was a gifted student, a talented artist, a lover of animals. As an adult, he is consumed — and confined — by his mental illness.
While the muttering homeless may attract stares, and the schizophrenic criminal might make headlines, most people enrolled in the public mental-health system live like Anders.
In an ordinary home. Unemployed. Invisible.
Now, their stories are coming to light. Late last year, when the state announced it planned to transform its mental-health system, hundreds of people with mental illness and their families lined up with suggestions and complaints. The message was clear: Help isn't available until things go absolutely haywire. And the basics — things like help finding homes and jobs — are barely considered.
In the absence of government help, families like the von Haartmans bear the burden.
Cathy has watched helplessly as Anders lost his car, his friends, his job and, in a psychotic state, four of his teeth.
Even though he's 28, she helps him get treatment and tries to make him take his medication, does his laundry and pays his bills. Still, he doesn't seem to get any better.
"No one knows what it's like to live like this," Cathy said.
The rest of her family, including her husband and three other grown children living at home, is worn out, too. In their youth, the siblings were close. Now they say Cathy is protecting Anders at their expense. Kick him out, they say. Find him a group home.
Cathy sighs. "I'm the only one he has," she explains. Yet every day, she questions her own judgment.
Does loving Anders mean letting him stay at home, where he's safe but everyone else is on edge? Or does it mean forcing him out in the hope that he'll finally get the help he needs?
"I don't want to be an enabler," she said, "but I don't want to feel guilty that I didn't do enough."
This is Cathy's burden.
Signs of trouble
Cathy is by no means alone, said Frank Jose, executive director of NAMI Greater Seattle, a mental-health organization. Across Washington, you'll find countless families "picking up the slack and having nowhere to turn," he said.
For 16 years, Cathy has been a Seattle elementary teacher, where she's known for infusing her curriculum with art. Whether it's making a quilt or caring for her son, Cathy throws herself into every project.
Anders began having trouble in his late teens. At first, Cathy thought it was drugs. Or maybe it was stress over his upcoming high-school graduation.
All Cathy knew for sure was that back in 1996, Anders began acting strange. A bird lover, he opened the doors of his aviary and let his pet ducks go free. Then he started giving away his belongings. He stopped doing homework and even bathing.
This wasn't the Anders his family knew. A handsome teen, he had been meticulous about his appearance. Cathy said he had been in Seattle Public Schools' gifted program and was a promising artist. One of his paintings had been put on exhibit at Seattle Opera.
Cathy was worried. But like many families watching a child's mental illness emerge, she told herself it was a passing teenage phase.
It wasn't until the school nurse called to say Anders seemed suicidal that she realized something was seriously wrong, she said.
That day, he was diagnosed with bipolar disorder, also known as manic depression, which involves swinging back and forth between frenetic highs and crushing lows.
Anders got a prescription for Prozac — the first in a long list of medications — but his symptoms got worse. He lit fires and tried to hang himself, scribbled pages of nonsense, and took a sledgehammer to the car he had worked so hard to buy.
At commencement ceremonies that June, Anders' name was called, but no one walked across the stage.
Yet over the next few months, he managed to wean himself from the drugs and returned to being Anders. He took college classes, traveled Europe and had a girlfriend. And he went back to his high-school job at Safeway. While it wasn't what Cathy had envisioned, she was relieved. Plus the job came with a crucial benefit: health insurance.
And for five years, all was quiet.
At the cabin
In early February 2002, the illness came back.
Anders and a friend were at a cabin near Mount Baker when the friend gave Cathy a call. Anders, then 24, was acting bizarre and obsessing about the movie "Fight Club," the friend said. He was sure Anders needed help.
Cathy raced up to get him. During the ride back, Anders screamed and cursed at his mother and grabbed at her arm while she struggled to drive.
Anders was out of control and Cathy was in tears.
Cathy was advised to try to get Anders into a hospital psychiatric unit. She figured it would help him regain stability and keep him safe. But like countless families before her, she learned it was easier said than done.
Anders didn't want to stay in the hospital, and he didn't meet the strict criteria that govern involuntary treatment.
Finally, three days after she drove to Mount Baker, she got him admitted, but only briefly.
Hours later, Cathy was awakened by a call from Anders. He had left the hospital, hailed a taxi and gone back to Mount Baker. Alone amid the snowdrifts, he asked Cathy to bring him home.
When she got there, she learned he had no shoes.
This time, he was disturbed enough for the hospital to hold him for a few days. There was a catch, though. Under the law, you can't force someone to take medical treatment unless they're deemed dangerous or "gravely disabled." If Cathy wanted him hospitalized longer, she would have to testify against her son.
"I felt like I was a monster in my son's eyes," Cathy said.
The judge sided with Cathy. Anders would stay in the hospital for another two weeks.
He was released in better shape than before but still was delusional, claiming he was in the CIA and worried that people were after him, Cathy said.
"He told me that I better be careful of what I ate because it might be poisoned," she recalled. "Sometimes it was difficult to know just how concerned I should be."
He was also drinking, in violation of a court order under which he was released.
Cathy cited the court order and tried to get him back in the hospital, but was unsuccessful.
"Why," she wondered, "was it so difficult to get him help when we knew he needed it?"
It was a question she'd ask again and again.
"I am the devil"
Anders managed once again to beat back his illness. He went back to work, moved in with his sister Kristina and, for two years, was doing well.
Then came Super Bowl Sunday 2004.
"It was the last time I saw my son as himself," Cathy said.
Later that night, Kristina, then 20, called crying. Anders was watching "Fight Club" and talking nonsense. To her, it signaled a break with reality.
Kristina took him to the hospital, sure she could convince them he was dangerous enough to treat involuntarily. But after hours of waiting, Anders was examined — alone — and Kristina didn't get a chance to state her case. They were sent home.
Later that night, Anders got in the car and headed toward Mount Baker, with Kristina following behind him.
What happened next will stay with her forever. Anders' friends, who were already at the cabin, had gone to bed, but Kristina couldn't close her eyes.
Out of the quiet emerged Anders. "I am the devil," he shouted as he lurched toward her.
Anders' friends came running. Kristina watched in disbelief as Anders reached into his mouth. With his bare hands, he yanked out a tooth — the fourth tooth that night, as doctors later discovered. Then he threw it at Kristina.
"I like to think he wasn't going to hurt me, but I think he was," she said.
Kristina waited while Anders' friend subdued him.
"I sat in the car in the snow and thought he would never be the same," she recalled.
The von Haartmans' house, on a quiet North Seattle dead-end, protects Anders from inquiring eyes. But inside, the house seems ready to implode.
In the two years since that night on Mount Baker, Anders has tried several new medications and been hospitalized six more times. He got a new diagnosis, schizoaffective disorder, which combines the highs and lows of bipolar disorder with the hallucinations and delusions of schizophrenia.
He lost his job at Safeway — and hence his insurance — and has enrolled in the public mental-health system, which adds even more hurdles to his recovery. Not only is he mentally ill, but he's also disengaged from everyday life.
Like others in the mental-health system, he's "just floating along," said Jose, of NAMI Greater Seattle. The system struggles just to keep people stable, much less help them get jobs or truly get better, he said. Those charged with transforming the state's mental-health programs agree it's a major complaint.
The von Haartmans live with the result. Anders is often up most of the night, sometimes for two or more days in a row, and keeps everyone else awake. His sister, Meggie, who's working on a Ph.D. at the University of Washington, says she can't study. Neither can Kristina, who goes to North Seattle Community College.
Everyone argues, whether with Anders or about him.
To Anders' siblings, it seems like he is refusing to help himself and that they're all paying the price. Sometimes they blame Cathy for letting him get away with it.
"You're enabling him," Meggie said. "And you're not even doing what's best for him."
Cathy looks away.
"She's got everything," she later said of her daughter. "He has nothing."
Yet Cathy, too, has a breaking point.
Loss of creativity
On a recent afternoon, Cathy pulled out some of her favorite artwork done by Anders before he became ill.
Here's the award-winning painting from high school of a woman and a dog. Here's one that hung in the opera house, a massive canvas with several mysterious figures looking down at a boat.
And then there are the recent paintings. There's the owl that's not much more than a stick figure. The simple brown swirl Anders calls a Coco Puff. Compared to the earlier paintings, they are empty.
It dawns on her that Anders has been resistant to treatment for a reason.
"From what I've noticed," Cathy said, "the medication has taken away all his creativity."
But there's something more. Thinking you're in the CIA, she reasons, seems better than facing the fact that you have a terrible illness.
"I bet his other life is more exciting," she said.
As Cathy displayed the paintings, Anders popped in and out. He declined to respond in any depth to a reporter's questions but did agree to be part of the story "if it would help."
Meanwhile, Cathy said she was worn out after taking him to the clinic a day earlier.
There, a caseworker gave him an ultimatum: He could choose between the hospital or a homeless shelter. They would make sure he got to one or the other.
Cathy left, racked with guilt.
"He didn't choose to have it," she said of his illness.
All afternoon, she waited to hear where the clinic took him.
Then, around dinnertime, Cathy looked out the window.
There was Anders, walking up the street like nothing had happened at all.
Maureen O'Hagan: 206-464-2562 or firstname.lastname@example.org
Who receives services
Of the nearly 130,000 people who received mental-health services from the state in 2004:
• 61 percent were adults ages 18 to 59
• 29 percent were children
• 10 percent were seniors
Where the clients are
• Most (79.2 percent) live in private residences.
• From 3 to 4 percent are identified as living in each of the following settings: institutions, 24-hour residential care, foster care, jail/juvenile detention, homeless shelter or other situation.
Sources: Mental Health Division, Washington Department of Social and Health Services, Washington State Institute for Public Policy
Mental Health Transformation project information: www.MHTransformation.wa.gov
NAMI Washington: www.nami.org/MSTemplate.cfm?Site=NAMI_Washington
NAMI Greater Seattle: www.nami-greaterseattle.org/
Washington Department of Social and Health Services, Mental Health Division:
King County Crisis Line:
Other county crisis lines: