Back to School For Brilliant Mind

Schizophrenic Joe Wleklinski returns with renewed hope

(Sept. 1, 2003) - CAMBRIDGE -- As Joe Wleklinski prepared last week for another semester in the pressure cooker of MIT's mechanical engineering department, he faced the kinds of problems one would predict for an elite graduate student: fusion in a tokamak reactor or the dilemmas of rarefied gas dynamics.

For Wleklinski, the broad-shouldered, blue-eyed son of a Chicago salesman, there were also some other problems. He knew that under stress, he could begin to imagine professors glaring at him from their lecture podiums, or undergraduates eyeing him with arrogant, hostile looks.

Although he blends perfectly into the Massachusetts Institute of Technology's student body, in some ways, at 28, Wleklinski is a walking case study. Seven years after he was diagnosed with schizophrenia, he has returned to the demanding academic life the disease interrupted.

His tuition is paid by Eli Lilly, the drug company that makes one of his antipsychotic medications and hopes to challenge the old assumption that people with serious mental disorders should give up hope of returning to a high-level, intellectually competitive life.

"Living with schizophrenia doesn't have to be a combination of sitting around, smoking cigarettes, and drinking coffee all day," said Dr. Ralph Aquila, chairman of Lilly's Reintegration Scholarship. Company officials said the amount of the scholarship was confidential, but graduate student tuition at MIT this year is $28,030.

Like the Nobel Prize-winning economist, John Nash, whose deterioration and partial recovery from schizophrenia were documented in "A Beautiful Mind," Wleklinski became psychotic at the outset of an exceptional career. When he was diagnosed, there were some psychiatrists who warned Wleklinski's parents, as they warned Nash's family, that it could prove too stressful or heartbreaking to expect him to function anywhere near the level he did before he became ill.

Last week, at the beginning of his third semester back, Wleklinski had reason to feel confident. He also thought his symptoms were returning. Walking across campus, he felt two foreboding changes: The days were getting shorter, and students were proliferating. It reminded him of every fall, he said, and every fall unsettles him, sending his mind into old ruts of paranoia. He went back to his room to shut off the flood of stimulus. It took him a day to calm himself, he said.

Drinking orange juice at a cafe in his residence hall -- the potassium, he says, helps clear his mind -- Wleklinski speaks with deliberation and focus, an island of stillness among passing students and busboys.

He has not forgotten his disintegration as an undergraduate, the grandiose "system" he thought would elevate him into the pantheon of physicists, and his days "haunting" his college until his mentors distanced themselves from him. Nor has he forgotten the two previous falls when he arrived at MIT and ended up relapsing.

By any measure, this return is a success. Wleklinski, whose diagnosis has since changed to schizoaffective disorder, has finished three semesters of a master's program with all A's, and lived at MIT for two. He is so much more relaxed, said one adviser, that he seems like a different person. But as he looks ahead to the ordinary activity of fall -- the bright confidence of undergraduates, the hustle-bustle, the hours inside lecture halls -- Wleklinski seems tensed, full of strategies, like a boxer preparing for the ring. Nothing about this is easy, he said.

"You have to be willing to fight all the time," he said. "You have to fight all the time."

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His presence here, as Eli Lilly points out in press materials about the Reintegration Scholarships, is challenging the old expectation that people with schizophrenia can't go on to be competitive. The reality is that most do not: When researchers at Johns Hopkins University recently looked at about 1,600 people with the disease, they found between 73 and 90 percent unemployed at any one time. Those who were working were in noncompetitive or part-time work.

Many psychiatrists still maintain that it's better not to push patients to resume their old pursuits: the disease's effects are so devastating that high expectations could turn out to be as paralyzing as low ones.

"If your family, if your friend, has high enough expectations, it's a terrible comedown for people," said Dr. E. Fuller Torrey, a research psychiatrist in the Washington, D.C. area. "In fact it becomes another defeat."

What happened to Wleklinski after his first hospitalization fell in line with that logic: Expectations contracted. His former classmates -- friends who had been overawed with his intelligence -- began speaking of him in tones that were "more sad than anything else," said John DeBoy, a friend from Notre Dame. Teachers regretfully cut off contact.

William Ellingson, a scientist who hired Wleklinski as an intern at Argonne National Laboratory for two summers, said he did "just super work" the first summer. Everyone seemed to agree that he was exceptional. But after the second summer, lab staff had let go of most of their hopes for him.

"A former graduate student of mine said, 'Joe is going to MIT? Sure. Sure. And you're going to find Dairy Queens on the moon,' " Ellingson said.

But during those years, when Wleklinski's family was shuttling from one psychiatrist to another, a change had been filtering through the field of psychiatry.

A small group of researchers, like Boston University's Courtenay Harding, had been gathering evidence that suggested schizophrenia was not a one-way street: In 1987, Harding reported the results of a three-decade study of 269 schizophrenia patients from Vermont State Hospital. After an average of 32 years, 45 percent of them had no psychiatric symptoms, and 23 percent had symptoms of less serious mental illnesses, but not schizophrenia.

That kind of improvement over time, she said, was a phenomenon almost invisible to doctors.

"What happens when people lose their symptoms and cope with them effectively, they melt into the general population," Harding said. "You don't know they're there."

Over the last decade, more hopeful language began to come from a new source: drug companies. The mid-'90s brought the introduction of a new generation of antipsychotics, which improved mental functioning and reduced side effects such as stiffness and trembling. Sales of the new class of drugs ballooned to $6.6 billion last year, making it the fourth highest-selling class of drugs, according to industry analysts at IMS Health.

Along with that came an interest in telling the stories of improvement. In 1997, Eli Lilly quietly began paying tuition for people with schizophrenia-spectrum disorders. (The criteria have since broadened to include bipolar disorder.)

The Reintegration Scholarships, which number between 60 and 100 every year, aimed to winnow out talented people with severe mental disorders -- the "candidates most likely to succeed" -- and give them a nudge to finish their schooling, said Aquila. Applicants must take psychiatric medication, although not necessarily Lilly's, and maintain a C average in order to reapply.

About $2 million in scholarship money has been distributed since 1997, said Della Burns, senior managing director of the public relations firm assisting Lilly with the scholarship. Although many use their scholarships to get graduate equivalency degrees or vocational training, organizers are particularly proud to announce recipients at elite institutions -- this year, the company is funding students at MIT, Yale, Harvard, and CalTech. Most recipients have declined to publicize their awards because they do not publicize their illnesses, Burns said.

"This has never been about publicity," Burns said. Instead, she said, it's a way of "proving that it can be done."

In its early days, the program drew criticism from psychiatrists who warned against planting false hopes, Aquila said. Torrey, who has lobbied for laws requiring medication compliance, said it is a mistake for Lilly to focus on an elite group when most must accept lower levels of functioning.

Lilly is "skimming and taking the ones who are capable of doing it," Torrey said. "I'm not sure that they're doing anything out of the goodness of their heart. I'm sure they have done focus groups, or whatever they call them, that suggest [sending the message,] 'If you take enough olanzapine (Zyprexa), you, too, can become a lawyer or an MIT engineer.' "

But when students return this fall, more and more of them will be like Joe Wleklinski -- stable on medication, so that the illness is undetectable except in a crisis, said Robert Randolph, MIT's senior associate dean of student life.

"We're finding more and more people able to manage," he said. "That's the shape of the future."

Last week, with his summer tan fading, Wleklinski admitted it freely: Every now and then it crosses his mind that he could make it without his medication. Part of that is because he is succeeding. He has the swelling feeling of invincibility he had in high school, when it seemed like every test he took broke a curve. He also remembers what it was like when he went off his medications, when he begged his parents to throw him out, or lay in bed terrified that his heart would stop.

Around him, milling on a warm evening in Central Square, are people with dreadlocks and engineer's caps, scooters, customized bikes. Among them, with his neat haircut and clear gaze, Wleklinski looks like a West Point cadet. "I give MIT credit because it's a place where things that are hard to happen, happen. It is an environment where strange, unexpected things can happen," he said. "At MIT, I seem to be all right, as long as I don't trip over my own feet."

Once, early on in his time here, Wleklinski wrote a letter to Nash, who walked the same streets during the disastrous early days of his illness. But Nash didn't write back. Now Wleklinski thinks he has an advantage over Nash, who regained his coherence 25 years after his first symptoms emerged. Wleklinski lost about five years to the illness, and feels "98 percent" sure that he will finish his doctorate. He says it with stony focus, as if he never doubted it.

"It became clear to me at some point, 'This is my life I'm talking about,' " Wleklinski said. "It must be my function to overcome this illness."

Source: Boston Globe

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