Before college, Robert had exhibited no obvious signs of mental illness, Kim and Carol say.
As a child, Robert was gregarious, witty and a bit of a charmer. With big blue eyes, he could pour on the sweetness like a ladle of syrup.
Robert would often visit his paternal grandmother in Bay Village and fawn over her German-Danish cooking, which earned him heaping covered dishes of sausages, pierogies and potatoes. “He knew how to butter her up,” Kim laughs.
The charm might have been compensation for other insecurities.
As a toddler, Robert had been diagnosed with Tourette’s syndrome. Medicine helped suppress many of the compulsive movements, but kids can be cruel. Robert got into at least one fight with a classmate who had made fun of him over it, his parents recall.
In high school, Robert played lacrosse but was far from a star. “I did it mostly for exercise,” he says. At night, he hung out with his friends and smoked too much weed, he admits. Popular, he always had girls over, his brother Scott recalls.
During his sophomore year, Robert participated in a German exchange program and fell in love with the country and its language. He wanted to study international business in college and applied to the University of Toledo and University of Kentucky. “When I got into Kentucky, I thought, Great, guess I will be going there,” Robert recalls.
He was excited for his freshman year — for the freedom, for the classes, for the parties. But during the fall semester, things began to feel off, he says.
“I started hearing these voices,” Robert says. “I wasn’t sure whether they were coming through the walls or in my head.”
He also developed an intense case of paranoia. “I was convinced my friends were talking about me in negative ways,” he recalls.
Fearful of himself, Robert didn’t know what to think. “It just kept getting worse and worse,” he says.
His parents noticed something was wrong too.
After an appendectomy during his sophomore year at Kentucky, Robert accused the doctors of changing his sex organs. His thoughts grew disorganized. He began insisting to anyone who would listen that his parents weren’t his biological parents and he’d been adopted.
Worried, Kim and Carol took Robert to Dr. David Chaiffetz, a psychiatrist at the Cleveland Clinic who would later diagnose Robert with schizoaffective disorder.
“I didn’t want to accept the diagnosis,” Robert says. Crazy people were schizophrenics — not him. And before then, nothing had seemed wrong. So how could it be true?
According to Dr. Ewald Horwath, chairman of MetroHealth’s department of psychiatry, the most common age of onset for schizoaffective disorder is actually late adolescence. Although early signs such as depression or behavioral issues often present themselves earlier, they are often easily mistaken for the normal moodiness of a teenager, Horwath explains.
A history of mental illness in the Jaworski family (Kim’s aunt was placed in a mental health facility in Denmark) and Robert’s marijuana use may have also put him at risk. “Heavy marijuana use is a known risk factor for the onset of psychosis,” Horwath says.
Chaiffetz prescribed medication for Robert. But the dosages made his brain feel cloudy, Robert says, which made it “hard for me to think and rationalize.”
As a side effect to his medication, Robert lacked the energy to exercise. So he stopped taking them intermittently, which is when the problems really began.
“I really wish we had known what was going on earlier,” Kim says. “We were worried as hell.”
In early December 2012, Robert was involved in an accident while driving home from Kentucky. He had been up for 36 hours, he told his parents, and had fallen asleep at the wheel. His car had drifted into the passing lane, where it had been hit by a tractor-trailer. Robert was lucky to be alive.
When Kim arrived in suburban Columbus to pick Robert up, he immediately knew something more was wrong. His son was angry, defiant and jittery.
On the drive up Interstate 71, Kim recalls, Robert kept trying to take the key out of the ignition. “You son of a bitch, you assaulted me my whole life,” Kim recalls him saying, as Robert tried to get out of the car.
Kim pulled the car onto the median and hurriedly called 911. Police arrived and took Robert to Marion General Hospital about an hour outside Columbus, where he stayed until Christmas Eve.
It was the first of three long-term involuntary hospital stays: Marion in 2012, Windsor Laurelwood Center for Behavioral Medicine in August 2013, and Lutheran Hospital in July 2014. In an effort to get help, Robert also spent several overnights at other hospitals.
“Every time, every single time, we told the doctors he was sick,” Kim says. “We explained to them all the things he was doing when he was off his medication. We told them we wanted him to be committed long-term and have a chance to get better.”
But if the patient is over 18, Ohio law gives parents very little control over their child’s care. And hospitals can only hold patients against their will if they are generally a physical danger to themselves or to others, are unable to care for themselves and are likely to benefit from treatment.
“A parent can let the doctor know their concerns,” says Dr. Phillip Resnick, professor of psychiatry at Case Western Reserve University. “The hospital staff weighs that along with their own observations. If they reach the opinion that a patient isn’t a harm to themselves or others, they would have to release.”
In addition, financial and legal pressures work against parents. Nonstate hospitals must meet the criteria of third-party payers in order to be reimbursed for care and could face lawsuits for keeping a patient beyond what’s necessary.
In addition, Cuyahoga County is under pressure for beds. Before deinstitutionalization in the late 1950s, four state hospitals in Cleveland offered approximately 1,500 to 2,000 beds, Resnick estimates. Now the only state psychiatric hospital, Northcoast Behavioral Healthcare, has about 250 beds.
“The lengths of stay are way down,” Resnick says. “There are efforts to treat people in the community [as outpatients] and only reserve beds for the most dangerous.”
The shorter stays mean doctors don’t have time to get to know the patients or determine whether the prescribed medications are working.
“People are discharged when they are considered no longer a danger to themselves or to others,” says Rick Oliver, the director of crisis services at FrontLine Service in Cleveland, an organization that provides mental health and supportive services to county residents. “It’s not because they are necessarily better.”
Unlike other medical specialists, psychiatrists don’t have X-rays, MRIs or blood tests to help in their diagnosis. “That’s the tricky part,” says Oliver. “These brain issues are tough. If someone wants you to believe they are not suicidal, for instance, they can take steps to hide it. Violence is very difficult to predict.”
Robert, for his part, was always good at telling doctors the things he knew would get him released, his parents say. And even if Carol and Kim had gotten through to the doctors, Robert wouldn’t have willingly submitted to his parents’ care, he says.
“Anything my parents said, I did not accept as the truth,” he says today. “I thought they were trying to harm me.”
Outside the hospital, Kim and Carol could do even less to make sure Robert was taking his medication or getting mental health support. “They are such awesome parents,” says the couple’s good friend Mary Ellen Brock. “They tried so hard to get him help.”
Between 2012 and 2014, records show the couple called the Westlake police to assist with their son more than a half-dozen times. By summer 2014, Robert’s psychiatrist had become extremely concerned as well.
Robert says he felt he was part of a Chinese military government spy program. If he had not tried to kill his parents, he believed that they would try to kill him.
“It didn’t feel like I was making my own decisions,” he says now. “It felt robotic, like I was being operated by someone else.”
On July 3, Chaiffetz called the Westlake police to tell them Robert had stopped taking his medication and needed to be hospitalized, according to the call log. The court order him admitted to Lutheran later that day.
Chaiffetz advised Kim to seek guardianship over Robert. Four days later, Kim filed paperwork with the court arguing Robert was unable to make rational decisions over his own treatment or the care of himself. “We hoped it would be able to give us power over his medication,” Kim says.
But weeks before the guardianship process was complete, Robert was discharged from the hospital. Carol recalls being distraught during a meeting with Robert’s psychiatrist at Lutheran. “I said, ‘He’s still ill,’ ” she says. “ ‘What are we supposed to do now?’ ”
Kim was just as worried. “For months now, we had been watching Robert get worse and worse. We were deathly afraid of what would happen.”