Mary was treated for cancer, the drugs also relieved her psychosis of twenty years. Her daughter Christine described her as a “psychological débutante.” Illustration by Emiliano Ponzi

By Rachel Aviv, Staff Writer for the New Yorker magazine. Published in print on July 28, 2025.

When Christine was nine years old, her mother, Mary, said, “Come here. Iwant to tell you a secret.” They sat on a brown couch in their living room,in Santa Ana, California. Mary, who was forty-three, said that a man she hadknown in medical school, a professor, was sending her messages about a plan totake her away and live in a mansion together. “I remember feeling really excited,because that fit with my sense of what should be happening,” Christine said. “Iwas really into ‘Harry Potter’ and the idea that, if you are part of the select, you cansee a bigger story happening out there.”

Mary leaned over and began separating strands of Christine’s hair, as if searchingfor lice. “Does he put listening devices in your hair?” Mary asked, about theprofessor. “Does he ever ask you to say things to me?”

Christine, the older of two sisters, said, “I believed everything she said until sheaccused me of something that I knew wasn’t true.” Mary had always been tenderand doting and practical, and, Christine said, “I just had this feeling in my bodythat she was not the same.”

Her sister, Angie, who is seven years younger, learned to follow their mother’sinstructions, whether or not they made sense. “I was taught the rules of herdelusions at the same time as I was taught other rules and norms about the world,”Angie said. She came to view her mother’s stories about the professor, and about

friends who were part of his mission, as akin to tales in the Bible. “It’s kind of like,O.K., some of these people are real, and some of these people aren’t real,” she said.

Christine was often cast in the role of the villain. Her mother would yell at her forpoisoning her pizza or hiding her keys or other menacing deeds, even as Christinetried to explain that she hadn’t done them. Sometimes Mary smacked her. (Marydoesn’t remember this.) Christine began to mistrust her own memory, too. “Mymom would accuse me of things, and then I’d be, like, Maybe I did do thesethings,” she said. In fifth grade, she asked Santa Claus for a polygraph machine. “Ijust had this baseline sense of: I could be doubted at any time.”

She felt that people might help her mother if she could just find the rightlanguage to describe her transformation. By high school, she was spending somuch time studying the Diagnostic and Statistical Manual of Mental Disorders thatshe texted a friend that she had actually “married the dsm-iv.” She explained thather mother suffered from the “fregoli delusion,” a belief that strangers weredisguised as doubles of people she knew. In her journal, Christine wrote, “Mymom has erotomanic delusion disorder with a splash of persecutory delusions.”She asked for help from teachers and a school counsellor, but, she said, the“message I got was, basically, Everybody has their shit, and you have to just dealwith it and keep getting good grades.” 

Angie has no memories of Mary before her psychosis, but Christine remembers her as a “magical, glowing figure.” Photograph courtesy the family

Mary, who was from India and had worked as a physician there for a decade,spoke so much about the professor that her husband, Chris, who worked at theCalifornia Department of Motor Vehicles, eventually found the professor’snumber and called him. “He said, ‘I am not in contact with her,’ ” Chris recalled.“ ‘I didn’t even know your wife came to America.’ ” At the professor’s suggestion,Chris scheduled an appointment for Mary with a psychiatrist. Christine sat in thewaiting room, hoping that this would be the beginning of getting back the motherof her early childhood, whom she remembered as a “magical, glowing figure.” Butwhen Mary finished the appointment she said that the psychiatrist thought shewas fine. Not long afterward, Mary kicked Chris out of the apartment andbarricaded the door with a desk and two heavy suitcases. Christine and Angieallotted extra time to get to school each morning so they could remove theobstacles.

Karl Jaspers, the German psychiatrist and philosopher, has described what he callsthe “delusional atmosphere,” a profound alteration in the way certain peopleexperience the world. “There is some change which envelops everything with asubtle, pervasive and strangely uncertain light,” he wrote. People in this statesearch for a story that explains why everything suddenly feels uncanny andominous. The “vagueness of content must be unbearable,” he wrote. “To reachsome definite idea at last is like being relieved from some enormous burden.”

Mary had landed on a story that overwrote the reality of her daughters’ lives, butthey also recognized in it a kind of emotional logic. Mary had been pressured tomarry Chris, in an arranged match, and, when they settled in America, he hadtraditional ideas about a woman’s role and restricted her freedom to pursue hercareer. Christine and Angie came to feel that their mother’s delusions—that herformer colleagues would free her from marriage and she’d be restored to her placein the medical community—were “a way of explaining how she ended up trappedin this position,” Christine said. “We theorized that psychosis was almost areasonable response.”

Christine moved to New York after high school, because her favorite book,“Underworld,” by Don DeLillo, was set there, and because it seemed like thecity where people went to escape their homes. She lived in the Bronx, near herfather’s brother, and got a job at Planet Hollywood. She wanted to be a novelist,and obsessively re-read “Underworld,” covering the pages with determinedannotations: “integrated dialogue”; “meta commentary”; “sensation of youngimmediacy.”

Angie and her mother would text Christine asking for groceries or pizza, and shewould order the food for them from across the country. Mary was still barricadingthe door. Chris slept in his car. (Eventually, he moved in with a girlfriend.)Christine worried that Angie, who was eleven, was growing up in a kind of folie àdeux, a delusional system that structures two lives. Angie said, of her mother, “Icould never figure out why she was doing these things to me, and I had this kindof emotional explanation: Other things are just more important to her. I’m onlythere as a vessel for the magical thinking.” After about a year, Christine arrangedfor her mother and Angie to move to New York, too. (Mary asked me to use onlyher middle name, to protect her privacy.)

Mary moved into an apartment in the Bronx, in the same building as her brother-in-law, and plastered the walls with tape, to prevent reality-TV shows fromrecording her and Angie through the cracks. Angie tried to bathe while hermother was asleep because Mary believed there was a camera in the showerhead,and had covered it with a sock. Angie felt as if she were living in a kind of urbanversion of “Grey Gardens,” a formative movie for her. The documentary chroniclesthe lives of a mother and daughter, relatives of Jacqueline Kennedy Onassis, wholive together for years, piles of trash accumulating around them, social conventionsbecoming remote.

After two years in New York, Mary seemed increasingly unable to care for herself,so Christine, who had enrolled at Columbia, called the city’s mobile crisis unit, ateam that assesses people in psychiatric distress. The crisis unit knocked on Mary’s

door, and, after a conversation in which she described receiving electrictransmissions through a filling in her tooth, she was admitted to Mount SinaiBeth Israel hospital, in Manhattan.

Psychiatrists there petitioned a judge for permission to hospitalize her for a monthand treat her with antipsychotics, over her objections. “I believe that she has nojudgment concerning the nature of her illness,” one of them wrote. On anevaluation form, another psychiatrist initially wrote that Mary had an “unspecifiedpsychotic disorder.” Then, perhaps uncomfortable with such a vague diagnosis, shecrossed out the phrase and wrote, “Schizophrenia.” Mary was fifty-five years old,and her symptoms had begun in her early forties, which is unusual forschizophrenia. Most people are diagnosed in their twenties or early thirties.

Christine moved into her mother’s apartment and filed a petition for joint custodyof Angie. Their father, who was living in California, did not contest the petition. “Imake breakfast in the morning,” Christine wrote in her journal, describing hernew routine with Angie. “I wash the dishes. I lock the door at night. I haveestablished, kicking and screaming, my own rightful place as an active agent in theuniverse.”

When Mary was released from the hospital, she stopped taking her medications.Neither she nor her daughters thought they had helped her. For about a third ofpeople with schizophrenia, antipsychotics do not work. “I wish my mother’sdelusions and paranoia were treatable,” Angie wrote, in a college-application essay.“However, she has lived with them for 12 years, and her institutionalization lastyear had no effect.”

Mary’s admission to Beth Israel was the beginning of a nine-year cycle inwhich she was sent to psychiatric hospitals for weeks at a time before beingreleased, unchanged. Mary said that each time she was admitted to a hospital thestaff“kept asking the same questions, and it never made anybody have a different

outlook on the situation. Everyone stayed with the same thing. It wasschizophrenia.”

After five hospital stays, including one in which the police led her to anambulance in handcuffs because she wouldn’t leave her apartment, Mary wastransferred to the Bronx Psychiatric Center, a state facility that provides long-termcare. She observed that when patients refused medications staffwould sometimescall security, and the patients would be injected with drugs, a prospect thatterrified her. “I would take the medication without any question, because I’m notrisking fighting with security,” she told me. “These people are very sensitive towhat they call ‘challenging authority.’ ” She spent her days dreading the momentwhen she’d be forced to swallow her pills.

Mary sometimes imagined that God had a reason for keeping her in the hospital,but, she said, “I did not even want to go there, because the reasoning mind makesyou feel very nervous and uncertain.” Her daily life became so narrow that shestopped noticing the weather. “They don’t remind you about the changing season—that spring is coming into summer or the winter is coming into spring,” shesaid. “You just pass the days as quickly as possible.”

Christine, who spoke to her mother every week, said that Mary never articulatedher sorrow at the time. “I would have wanted to engage on the level of ‘I’m sorryyou’re there, do you feel sad?’ And I’m sure she was having those emotions, but shewasn’t able to express them. It was always ‘I’m being attacked. I’m being held like aprisoner here.’ ” Christine felt that her mother was safer at the Bronx PsychiatricCenter than she would be anywhere else, but she felt guilty for hoping that Marywould stay there for the rest of her life.

Mary was discharged in September, 2023, after a year. A week later, shecollapsed in her bathroom and struggled to move. She was taken to ahospital in Brooklyn, where the doctors told her to stop taking antipsychotics,because they thought her condition may have been a side effect of the drugs. Thenthey discovered that she actually had lymphoma, a sometimes fatal form of cancer.

She began seven cycles of a treatment that combined chemotherapy withrituximab, a medication that targets antibodies involved in the body’s immuneresponse.

When Christine and Angie visited her at the hospital, Mary responded to theirquestions with one-word answers. Her face had a vacant expression. Christine andAngie thought she was dying. Mary did, too. She dreamed about being a child,playing with her sister and four brothers, in Kolkata, where she grew up. “I toldmyself, ‘This must be the end of it,’ ” Mary said.

Angie, who was now twenty-two and had recently graduated from Dartmouth,prepared in therapy for her mother’s death. She said, “I had multiple sessionswhere I was just crying about the fundamental things I wish she had given me,like ‘I wish she could have told me what was going on in her head,’ or ‘I wish shecould have told me she was sorry for what she did.’ ”

By Christmas, two months after beginning chemotherapy, Mary was moving alittle more freely, and she had begun to carry on conversations. Christine andAngie noticed that her personality seemed different: she was calm, outgoing, andpolite, and she often expressed gratitude. Angie texted Christine that Maryseemed peaceful, as if maybe she was “getting some post-life or death clarity?”

Christine, who was twenty-nine and had settled in London, having moved therefor a master’s degree in psychology, was struck by her mother’s ability to watch thenews and absorb the information on its own terms. For years, the television hadbeen a source of agitation; Mary had said that people were using her ideas andrepeating her lines.

One day, when Christine was visiting the hospital, Mary asked for a phone. “I sortof teased her, ‘Now you’re asking for a phone?’ ” Christine said. “I wasn’t reallymaking much of it, but then afterward I thought, Why has she asked for a phone?That’s quite unusual.” Mary already had a phone, but it was in storage becauseshe’d told Christine that it contained spyware.

Angie gave her a flip phone and, to be safe, covered the camera with a piece oftape. “She seemed fine using it, which was odd,” Angie said.

In May, a month after Mary finished chemotherapy, Christine and Angie asked apsychiatrist at the hospital to examine her. Christine said, “The psychiatrist was,like, ‘Why have you called me here? I don’t understand. She has no symptoms.’And we were, like, ‘Yeah, that’s the reason we’ve called you here.’ ”

Christine had the same feeling in her body that she’d had when her mother firstbecame ill—the sense that something at Mary’s core had changed. She tried to getthe doctors to grasp the scale of her mother’s recovery. By the summer, her cancerwas in remission. She hadn’t taken antipsychotics for months, and yet “herpsychotic symptoms are gone,” a doctor wrote. Christine told the doctors, “Shehad a twenty-year psychiatric history. Have you heard of this? Could any of hermedications have caused this?” She spoke with a neurologist at the hospital, but hedidn’t have an answer. Omid Heravi, one of Mary’s oncologists, didn’t understandwhat had happened, either. “Medicine is very specialized—we don’t get involved inother fields,” he said. He guessed only that one of the cancer drugs she’d beengiven had had collateral benefits. “In medicine, all side effects are not bad,” heoffered.

When a person recovers from an illness, it is usually seen as the end of the story.But becoming sane also causes a kind of narrative collapse, a confrontation with apersonal history that is no longer recognizable. Christine encouraged her mother’sfriends and siblings, whom she’d been estranged from for years, to get back intouch. She wanted to restore her mother’s sense of connection, but, she said, “I alsowanted them to be able to tell me—outside of my childhood memories—if this isthe person she used to be.”

For years, Christine’s friends had known little about her mother beyond the detailsof her mental illness. “Suddenly, I was, like, ‘Hey, my mom’s better now. Would youlike to call her up and talk to her?’ And that was a shocking concept for them,” shesaid. “I mean, there are a lot of people who wouldn’t necessarily be open tojumping on a call without planning, but my mom was now the type of person whois quite flexible and responsive and conversationally fluid.” Christine described heras a “psychological débutante.”

Angie, who was living in Queens and working at a firm where she analyzeddata on sexual violence, felt skeptical that their mother’s transformation wasreal. Christine said, “I felt like, If Mom can disappear, then she can come back.”

But Angie didn’t have memories of Mary from before the illness, and it felt to herlike she was being asked to believe that her mother had become a new person. “Itend to choose security over the process of discovery,” Angie told me. “I didn’thave a curiosity that felt worth the emotional risks.” Angie had always felt that, onsome level, her mother had “chosen her delusions” over her children. She didn’twant to experience that choice being made again.

Christine searched for medical papers that might explain her mother’s recoveryand allow Angie to believe in it. She read about each of the medications that hermother had taken and concluded that the key drug may have been rituximab, theimmunosuppressant. “I have a new working theory,” she texted Angie, in May,2024. “Theoretically her chemo could have incidentally cured” her.

Christine found a handful of recent case studies that documented drasticpsychiatric recoveries after people were treated with drugs that dampen immuneactivity. A 2017 study in Frontiers in Psychiatry described a woman with a twenty-five-year history of schizophrenia. She also had a skin disease, for which she wasgiven drugs that reduced inflammation and suppressed her immune response. Herdoctors noticed a pattern: when they treated her skin lesions, her psychosis wentaway. They hypothesized that the rash and the psychosis had been caused by asingle autoimmune disorder, and were cured by the same drugs. Another paper inFrontiers in Psychiatry described a man with “treatment-resistant schizophrenia”who developed leukemia. After a bone-marrow transplant, which reconstituted hisimmune system, he startled his doctors by suddenly becoming sane. Eight yearslater, the authors wrote, “the patient is very well and there are no residualpsychiatric symptoms.”

Christine also discovered a Washington Post article from 2023 about a womannamed April, who had fallen into a catatonic state at the age of twenty-one andbeen diagnosed with schizophrenia. Sander Markx, a professor of psychiatry atColumbia, first encountered April at a psychiatric hospital on Long Island whenhe was a medical student; twenty years later, he was dismayed to find her at the

same hospital, in the same condition. “She has not been outside for twenty years—out of sight,” he said, at a symposium at Weill Cornell’s medical school. He andhis colleagues gave her an extensive workup and found that she had lupus, anautoimmune disorder that, in rare cases, can induce inflammation in the brain,causing symptoms that are indistinguishable from those of schizophrenia. Afterundergoing immunosuppressive therapy, including rituximab, April emerged from,essentially, a “twenty-five-year-long coma, and was able to tell us everything,”Markx said. “We don’t have a script for this. We don’t see patients coming backfrom this condition.”

April’s case helped give momentum to the founding, in 2023, of the StavrosNiarchos Foundation (S.N.F.) Center for Precision Psychiatry and Mental Health,at Columbia, which is working to uncover biologically distinct subtypes of illnessthat have been obscured by the broad categories in the DSM. Christine sent an e-mail to Markx, a co-director of the S.N.F. Center, with a brief time line of hermother’s life. “Her psychiatric symptoms disappeared and have yet to resurfacemonths later,” she wrote. “But her current clinicians are stumped as to why it hashappened.” When Markx didn’t respond, Christine, who was visiting New York,decided that she and Angie should go to Columbia to introduce themselves inperson. Markx wasn’t in his office—he had just begun an ongoing medical leave—but they slipped a handwritten card in a pink envelope under his door and usedinter-campus mail to send cards to the other directors of the center. They tried tothink of this step, Angie said, as “the part in the documentary where the camerasgo all shaky and you get the sense that someone is about to break a hole in thecase.”

Emil Kraepelin, who developed psychiatry’s first modern diagnostic system, inthe eighteen-nineties, defined the disease we now know as schizophrenialargely in terms of its hopelessness. The diagnosis allowed hospital administratorsto separate patients with “periodic insanities” (like depression and bipolar disorder)from those who were believed to be incurable and belonged in asylums. Kraepelin

hoped that schizophrenia would eventually reveal itself to be a disease likeneurosyphilis, which was then responsible for a large portion of the cases ofinsanity in psychiatry wards. In 1913, scientists demonstrated that bacteria hadinfected the brains of these patients. “The diseases produced by syphilis are anobject lesson,” Kraepelin wrote, four years later. “It is logical to assume that weshall succeed in uncovering the causes of many other types of insanity that can beprevented—perhaps even cured—though at present we have not the slightestclue.”

Psychiatry and neurology were originally one medical discipline, but graduallyneurologists took responsibility for diseases like neurosyphilis and dementia, inwhich the pathology could be seen in an autopsied brain, and psychiatristshandled the illnesses that were left behind, their causes still a mystery.Schizophrenia, which affects roughly one per cent of the population, became thedisorder through which psychiatry worked out its identity, in part because itseemed to embody the mystery and intractability of madness, presenting basicquestions about what it means to have a self. “The history of modern psychiatry is,in fact, practically synonymous with the history of schizophrenia, thequintessential form of madness in our time,” the psychologist Louis Sass haswritten.

But psychiatrists struggled to pinpoint a single feature that unified the diagnosis.“The great question is what is this ‘something’ that underlies the symptoms,” KarlJaspers wrote, in 1963. Three decades later, the psychiatrist Ian Brockingtonwarned that the obsession with schizophrenia had stifled clinical curiosity.“Smaller, more homogeneous entities have been sucked in by the gravity of the bigidea, and annihilated,” he wrote. For decades, scientists have been searching in vainfor a biological marker that would confirm whether someone has schizophrenia.Last year, in a paper in Schizophrenia Research, seventeen international expertsconcluded that schizophrenia was defined by no single etiology, symptom, or

biological mechanism. “It is prudent to wonder if the construct around which weare organizing this information is fundamentally flawed,” the authors wrote.

Perhaps the most vivid disruption to the idea of schizophrenia as a monolithicconcept began in 2007, when Josep Dalmau, a neurologist at the University ofBarcelona, started publishing papers with his colleagues which described youngpatients with delusions, hallucinations, and sudden changes in their behavior, likeagitation and inappropriate giggling. Within days or weeks, they deteriorated,developing seizures, losing consciousness, or struggling to breathe. Dalmaudiscovered that they had a form of encephalitis, inflammation of the brain. Theirimmune systems had misidentified the NMDA receptor—a protein in the brainthat affects mood and memory—as foreign and produced antibodies that attackedit. When these patients were treated with immunotherapy, the majority of themrecovered completely, sometimes within a month.

Thomas Pollak, a neuropsychiatrist at King’s College London and the MaudsleyHospital, told me that treating patients with the condition was “revelatory anddisquieting, because some of them looked exactly like the people I’d been seeing inthe psychiatry ward. It was uncanny to see that a presumably totally differentpathway could lead to this.” Their illness, which was named anti-NMDA-receptorencephalitis, usually began in their early twenties, just as schizophrenia often does.The discovery of the illness put pressure on the artificial division betweenpsychiatry and neurology—the only two fields of medicine that focus on the sameorgan. “Many of the symptoms are shared, but we are using different words,”Pollak said.

In “Brain on Fire,” a memoir from 2012, the journalist Susannah Cahalan—thetwo hundred and seventeenth person in the world to be diagnosed with anti-NMDA-receptor encephalitis—describes how for a month, in which she swungbetween paranoid aggression and euphoria, some doctors treated her as if she werejust a difficult psychiatric patient who drank too much. “If it took so long for oneof the best hospitals in the world to get to this step,” she wrote, “how many other

people were going untreated, diagnosed with a mental illness or condemned to alife in a nursing home or a psychiatric ward?”

Since Dalmau’s discovery, scientists have identified more than twenty newantibodies linked to psychiatric symptoms. In 2020, in a paper in The LancetPsychiatry, some two dozen researchers proposed a new category of illness called“autoimmune psychosis,” which may look like a milder or incomplete form ofencephalitis, the illness never progressing beyond psychiatric symptoms.Christopher Bartley, the chief of a unit at the National Institute of Mental Healthwhich investigates the role of immune dysfunction in mental illness, said that thetwenty known antibodies may be a “drop in the bucket.” There could be countlesstargets in the brain that antibodies attack, some subset of which may alter people’sperceptions and behavior. “We have to have epistemic humility and accept thatthere are alternative models of disease,” Bartley said.

To find psychiatric patients who might benefit from immunotherapy, researchershave set up centers, roughly similar to the one at Columbia, at Baylor College ofMedicine, in Texas; King’s College London; Uppsala University, in Sweden; andthe University of Freiburg, in Germany, among other places. Some of the bestresearch into the phenomenon has been conducted in Germany, where it’s morecommon for patients in a first episode of psychosis to have lumbar punctures toaccess their spinal fluid, which can reveal the presence of antibodies. Bartleyestimates that between one and five per cent of people who have been diagnosedwith schizophrenia actually have an autoimmune condition—a figure he based onhis own lab’s research, which has not yet been published, and also on a Germanstudy of a thousand patients, the most extensive study of autoimmune psychosis sofar. “Even one per cent ends up being almost a million people in the world whoshould be treated with a different kind of medicine,” he said.

The pharmaceutical treatment for schizophrenia has not meaningfully changed inthree-quarters of a century. Many pharmaceutical companies have left the fieldentirely. To get approved for the market, a medicine that works for one

schizophrenic patient must have a reasonable chance of working for another. Butonly blunt instruments have been effective in treating an illness that takes suchvaried forms. Newer antipsychotics are more refined than earlier ones, with fewerside effects, but almost all of them work in the same broad way, alleviating somesymptoms, like hallucinations and delusions, but not other common ones, like lackof motivation and an inability to experience pleasure. Andrew Miller, the vice-chair for research in the psychiatry department at the Emory University School ofMedicine, said that the field is haunted by the early success of antipsychotics,which were discovered by serendipity, in the nineteen-fifties. “You get lulled intothis sense that, because the drugs are one-size-fits-all, the disease is also one-size-fits-all,” he said. “With autoimmune psychosis, it’s so clear that there is somethingdifferent. And then you start to say, ‘Hey, is it possible that there are other clear-cut mechanisms to pathology that we’re missing because we’re lumping everyonetogether and saying they all have the same illness?’ ”

The S.N.F. Center is embarking on a project, beginning this fall, to screen all the patients hospitalized in the New York State mental-health system for autoimmune, metabolic, and genetic disorders, to see if there are people whose symptoms can be traced to a distinct biological mechanism. “I’ve always been aware of the possibility that there are treatable causes for psychosis lurking in chronic long-term patients,” Joshua Gordon, the executive director of the New York State Psychiatric Institute and a former director of the N.I.M.H., told me. “But the notion that we could make this work practically—that we could test for it—has really only become apparent in the last few years.” The S.N.F. Center will do blood work for everyone in the state’s psychiatric institutions, offering follow- 

up testing, such as lumbar punctures, to those with unusual results. Gordon sai d that, if the S.N.F. Center identifies a few dozen patients who can be treate d effectively enough to leave the hospital, “we will be able to start answering the question of whether this is worth trying across the whole population of people with schizophrenia.” Psychiatry has a legacy of implementing drastic procedures, like lobotomies, that later come to seem like folly. But it also has a history of proffering psychologica l theories for illnesses that are not yet understood on a biological level. Severa l psychiatrists told me that they’d found themselves rereading the history of the discipline, wondering, for instance, if some of those patients of Emil Kraepelin’s whose symptoms helped define schizophrenia might actually have had encephalitis or autoimmune conditions—specifically, a subset he described as having “spasmodic phenomena in the musculature of the face” and an inability t o walk without falling. There were also questions about whether these diseases could explain a condition called “lethal catatonia,” which was frequently described as a manifestation of schizophrenia: these patients became extremely agitated, and then slipped into a stupor. In 1986, in a study that inadvertently revealed the dangers of conceptual inertia, the American Journal of Psychiatry reviewed nearly three hundred cases of lethal catatonia. Nearly all the patients in the study had been treated with antipsychotics, and more than half of them died.

After reading Christine’s description of her mother’s case, Steven Kushner, aco-director of the S.N.F. Center, arranged a meeting with her and Mary andAngie. Mary was living at a rehabilitation center in the Bronx while she regained her muscle strength. She was reluctant to meet another psychiatrist, she told me, but she felt she needed to “rise up to the level of my daughters’ studiousness.” In October, 2024, Kushner and three colleagues came to the rehabilitation center and spoke with Mary for three hours. “Her psychosis was gone,” Kushner said. “There was no other conclusion. There was no way that she could have the quality of the conversation that we had and willfully suppress psychotic symptoms.”

In the conversation, Mary recounted intimate details about her daughters’ pasts—what they would eat for breakfast, their arguments at recess—but she made noreference to the delusional beliefs that had dominated their lives. When Angietold the doctors that her mother had sometimes prevented her from going outside,even to do homework with classmates, Mary offered a practical explanation: therewas crime in the Bronx, and she worried about Angie’s safety. To explain why sheput a sock over the showerhead in her bathroom, she said that she’d hoped to filtersediment from the water. She seemed to have filled in gaps in her memory in away that was consistent with her current identity, as a sane person.

In 1911, the psychiatrist Eugen Bleuler described how schizophrenic patients arecapable of a kind of “double bookkeeping”: they may simultaneously live in two“disjoint” worlds, one grounded in shared reality, the other in private delusions.They might believe that they are the center of a conspiracy involving nearlyeveryone they see but also make small talk at a deli and remember to give thecorrect change. It’s as if the delusions occupy their own ontological category,sealed offfrom the logic used to move through the world. Now, when Mary recallsher decades of illness, it is as if she is accessing only the shared-reality side of theledger. When she talks about her time at the Bronx Psychiatric Center, hermemories sound like those of a person trapped in an environment where shedoesn’t belong. “Angie and I treat it as if she had two selves,” Christine said. “ButMom describes her self as continuous.”

The S.N.F. Center arranged for Mary to have a lumbar puncture, to see if she hadany antibodies associated with known neuropsychiatric conditions. During theprocedure, Kushner said, he could sense that Mary had once had a “fantasticprofessional identity: she was holding court, telling stories about the lumbarpunctures she used to perform, how many patients she used to see in a day.” Thetest came back negative. Kushner tried to recover a frozen sample of Mary’scerebral-spinal fluid from when she was ill—a test done on that fluid would havebeen more revealing—but the fluid had been discarded. He believed that the most

likely explanation was that she’d had a form of autoimmune psychosis for whichthe associated antibody has yet to be discovered. “I think the consensus is that weare probably only aware of the tip of the iceberg of different kinds of antibodiesthat can produce autoimmune diseases, and certainly that holds for autoimmunepsychosis,” he said.

Some people, when they recover from psychosis, understand that the strangeenemies who plagued them never actually existed. Others say that they are relievedtheir enemies stopped pursuing them, but do not disavow the reality of theexperience. “We don’t know what happens for someone who was in a psychosis fortwenty years and then they are—let’s call it ‘cured,’ ” Kushner told me. “And Ihesitate to use that word, because the idea that this word is ever used in psychiatryis so exceptional.” But, he said, “the treatment modified Mary’s biology such thatthe disease is basically gone.”

Kushner began meeting with Mary and her daughters every few weeks, in part tohelp monitor for possible signs of relapse. At the meetings, they mostly avoidedtalking about Mary’s delusions. When the subject came up, Mary was quiet, orresponded in a tangential way, changing the subject. “She has this extraordinarilypleasant way of disarming the situation,” Kushner told me. The thought of havingcaused her daughters suffering seemed too painful to allow into her consciousawareness. “There’s not an appointment that goes by where she doesn’t remark,spontaneously, that her daughters are doing well,” he said. “I don’t think that’s byaccident.”

Kushner did not believe that Mary’s memory gaps reflected cognitive impairment—on a neuropsychological exam, her memory was better than average—but healso didn’t believe that she was purposely not remembering. “To look back and say,basically, ‘Twenty years of my life were out of reality’—that would be afundamental blow to her identity as a physician and mom,” he said, a challenge to“one of our most primitive instincts, that we can discern what is real.” When Iexpressed concern about how to present the disparity in memories sensitively, he

told me, “I think that is the story. How do you reconcile with, and compensate for,all those missing years?”

When people emerge from chronic delusional states, the work of psychiatry isconsidered complete. They are largely left on their own, with two irreconcilableviews of reality. “We need to really start thinking about what happens the morningafter these disorders are treated,” Kushner said.

Christine wasn’t sure if she could call her mother “cured” simply because shelacked her previous symptoms. “She’s not fixated on things likecontamination and surveillance, but at no point has she said she’s left those beliefsbehind,” she said. Christine felt that it was taboo to talk to her mother about whoshe had once been. She suffered from the intrusive thought that if she confrontedher mother with destructive things she had done, Mary would somehow revertback to the patterns from that time and become psychotic again. “It is quite atraumatized-kid thing to say, but I sort of feel like, How greedy can you get? Don’tlook a gift horse in the mouth,” she told me.

Christine didn’t know how to have an ordinary conversation with her mother. Fortwenty years, Mary had been suspicious when Christine asked her questions abouther life. Christine now felt like an adopted child “meeting my biological mom forthe first time,” she said. She bought a book by an anthropologist called “TheEssential Questions: Interview Your Family to Uncover Stories and BridgeGenerations” to help guide their conversations. “It says, ‘Allow them to talk aboutwhat’s important,’ ” Christine said, reading from the book, during a visit to hermother’s rehabilitation center. “If no one has ever let you speak about yourself, itcan be hard,” Christine went on. “You have to kind of—”

“Think,” Mary said.

“Maybe practice—gain your voice,” Christine said.

Christine, who recorded the conversation, began with warmup questions: “Whenyou were a kid, what was your favorite activity?”

“Running,” Mary answered immediately.

“What did you like about running?”

“It makes you feel you have wings.”

“What is your favorite TV show?” Christine asked.

“ ‘Seinfeld.’ ”

“ ‘Seinfeld’!” Christine said. “What did you like about ‘Seinfeld’?”

“The absurdity.”

Every few weeks, they tackled a new theme outlined in the book: time, identity,body, belief, possessions, memory, fear. Initially, Mary answered in few words, buteventually she became much more expansive. During one session, she offered thather views on physical discipline had evolved: she no longer thought that smackingwas acceptable. Christine said, “Without relating it to me or Angie, she sort ofsaid, ‘That’s what we were taught when we were younger, but I don’t think that’sthe right way to raise a kid.’ ” Christine felt that her mother may have beenreflecting, obliquely, on what had happened in their home. “The ability to say, ‘I’vechanged my mind’ felt like as much as I could ask for,” Christine said.

For years, Christine had been documenting her life—keeping a journal, savingrecords, recording important conversations—to compensate for the fact that she,too, had blank periods in her memories, coinciding with traumatic events. Shewasn’t sure if her mother’s breaks in memory—what she and Angie called “themissing years”—were different from her own. Recently, she had come across aproverb: “The axe forgets, but the tree remembers.” She felt that maybe she andher mother had reached an impasse that was actually universal—children have

always formed their identities around blows that their parents don’t even realizethey inflicted.

Angie felt less accommodating: “I’m happy that my mom is normal now, that wecan have a deep connection and I can share my life with her. And, at the sametime, I want justice for the child who was hurt by that other mother.”

Mary’s sister, Nima, told me that before her illness Mary was “very enduring,very patient.” Mary’s recommendations from professors at medical schooldescribe her as “kind and sympathetic,” always “willing to shoulder any extrawork.” When she came out of her psychosis, Mary returned to this dutiful versionof herself. She and her husband, Chris, began speaking on the phone every day.Chris told me that he felt as if he were re-meeting the woman he had known inthe early years of their marriage. “How come I lived all these years of darkness,and she suddenly looks normal to me?” he said. “She gives me comfort. She givesme emotional support.”

He asked her to do things, like travel to India to resolve a family financial dispute,that Christine and Angie found inappropriate. They encouraged Mary not tocomply with the request. Mary had let go of her paranoia that everyone wastargeting her, but they wished she could retain a wariness about people who hadhurt her in the past. “Now that she’s better, you can see how the delusionsprotected her from people stepping on her boundaries—and she doesn’t have areplacement strategy,” Christine said.

Mary readily agreed to speak with me for this story, but she struggled to imaginethat she could be anything more than a marginal presence in it. For years, she haddescribed how people on TV were lifting ideas and plots from her life story. “Itwas like she was saying, ‘I’m important,’ ” Christine said. “ ‘I have value. I havethings to say.’ And now we’re saying, ‘You’re important. You have value. You havethings to say.’ And she can’t access that sense of deserving to be the maincharacter.”

When I first met Mary, on a Zoom call with her and Christine and Angie, I askedif I could read her psychiatric records. She said yes but warned that they would bevery boring, adding that she couldn’t remember any of her psychiatrists. “I left thememories long before I left the place,” she said. Christine suggested that weinterpret this as her mother’s gentle way of saying no.

A few weeks later, Christine told me, Mary found a pile of psychiatric records inher room: “She was, like, ‘I don’t want to see them anymore, so Rachel can havethem and can get rid of them.’ And I was, like, ‘Yes, Mom, but Rachel is ajournalist. She’s not just a professional shredder.’ ” She said that her momresponded, “I just don’t want to see them myself.”

Mary seemed to be working out her ambivalence about her memories through thispile of papers. After speaking on Zoom every week for two months, Mary and Imet at her rehabilitation center, along with Christine and Angie. Toward the endof our conversation, she stood up without explanation, walked to a cabinet,retrieved the psychiatric records, and gave them to me. “I felt like what happenedwas a miracle,” she told me. “If it will give anyone else confidence, I’ll go with it.”

There is almost no medical literature about the afterlife of madness, theexperience of letting go of what Jaspers called the “definite idea.”Autoimmune psychosis raises the possibility of a swift, full recovery—a trajectorynot typically seen in schizophrenia—and in doing so supplies a new category ofwitness: a person who can describe what it feels like to look back on a self that is,in some sense, defunct. And yet sanity does not mean that a person views the pastwithout defensiveness or distortion. (To see too clearly can lead to a different kindof insanity, depression.) One of Christine’s fears was that, in talking with hermother about what she and Angie had been through, she would “rob her of thehuman capacity for denial.”

During one of my visits to the rehabilitation center, I asked Mary if she’d like toknow how I was writing about her daughters’ memories of her illness, or if she’d

prefer not to listen to that part of the story. Christine and I sat in chairs, and Marysat on the edge of her bed, beside a wooden table on wheels that she used both foreating and as a desk. Mary quickly responded that she wanted to know what herchildren recalled. “I’ll go with that, because that way it will help me to remember,”she said.

“You remember things very differently, and it might be painful,” Christine said,gently. “Do you feel comfortable emotionally with that?”

“Yeah, go ahead!” Mary said. “I’ll remember like a mother. I won’t remember fromyour point of view.” She told her, “This is the best time for me to relate to thesememories and make amends.”

Christine shared her first memory of the illness: sitting on the couch as hermother told her that the professor from medical school was in love with her.

Mary sat straight up on the bed, holding her arms over her stomach, staringintently at Christine. She had the bearing of a diligent student determined to passa difficult test.

“You asked if they had ever put things in my hair so that”—

“Microphones,” Mary said quickly. “Microphones.” She said that the professor andhis friends kept urging her to leave her husband: “They said, ‘Don’t worry aboutthe in-laws and all—just move away and begin on your own.’ ” The friends weretrying to help, but they were also harassing her, and she had no one to confide in.“I felt like she was supposed to be there for me,” Mary said, gesturing towardChristine. “But she was talking on behalf of my friends.”

“You would think that I was repeating phrases that were said to me by otherpeople.”

“I remember that very well,” Mary said.

“As a kid, I found it very hurtful.”

“I never blamed you,” Mary said. “But my classmates—I trusted them so much.”

“I was not in contact with your classmates,” Christine said, in a measured tone. “Iwould explain that to you, but it felt like you didn’t believe me at that time.” Sheasked, “Now that I’m older, do you trust me when I say they weren’t talking tome?”

Mary said it was possible that Christine had been reading her e-mails, rather thantalking directly to the classmates, or that Christine’s father was the one tellingChristine what to say. “She was very articulate,” Mary said. “She would doeverything he would tell her.”

Mary explained that the feeling of being harassed—sometimes by people from herpast, sometimes by strangers—continued until several weeks after her cancerdiagnosis. “I felt like they were working through the doctors, and I had to take thechemotherapy just to hurt me and make me bald and make me lose weight andhumiliate me,” she said.

But then, a few weeks into her treatment, her dreams became uncharacteristicallypleasant. She kept dreaming of her sister and brothers, and they were so sensitiveand loving that she thought maybe this was the prelude to a kind of heavenlyafterlife. In time, the dreams began to feel more conscious, as if she were guidingthe scenes herself. Lying in her hospital bed, she tried to recall details about herchildhood home which she hadn’t thought about in years. “Whatever I could catchon to, I would collect,” she said.

Her reëmergence seemed to have occurred weeks before her daughters graspedwhat was happening. Her muscles were so weak that she couldn’t say more than aword at a time, and she wished she could communicate to her daughters, “I’msmiling. I’m all right with this.”

The thought that people were secretly trying to punish her hadn’t completelydisappeared, but it felt distant, a relic of a different era. When the thoughtresurfaced, she said, “I take myself out of it, and I say, ‘It’s not my burden.’ I putthe whole thing, like a gift basket, to God.” She’d been taught this copingmechanism as a schoolgirl, but until recently it hadn’t worked.

Christine felt both validated and disoriented by the idea that, between her andher mother, the facts were never really in question. “It is painful to hear thatshe still thinks I was spying on her all those years, but now she says, ‘I am so proudof my daughters—they take care of me,’ ” she said. “Maybe her interpretation isthat through the power of forgiveness she can now interact with me as her lovingdaughter. So can I make do with that?”

For a year, Christine and Angie had been speaking on Zoom with a familytherapist, to help process the changes in their mother. Recently, Mary had begunparticipating in the conversations, too. During a session, Christine suggested thatthe three of them begin a process of sharing grievances, each taking a turn. “Therewere different times when each of us was a flawed caretaker,” Christine said. Sheknew that her mother must have felt betrayed when she called the mobile crisisunit. Mary agreed: “I felt very let down because nobody trusted me enough toshare that information.” Christine began by telling her, “I did my best, and yet I’msorry I hurt you.”

Although Christine and Angie felt they had already worked out the conflicts intheir own relationship, they tried “performing a kind of play,” as Christine put it:they shared resentments—Angie’s feelings of abandonment, Christine’s sense thatAngie didn’t want her help—and then apologized, “so that at some point she cansay the words to us.” Each emphasized that she didn’t think the other was a badperson, and that it was O.K. that they remembered things differently. They triedany exonerating phrase they could think of, “in case these might be the mentalblocks for her,” Christine said.Rachel Aviv is a staff writer at The New Yorker. She is the author of “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us,” a finalist for the 2022 National Book Mary was enthusiastic about the process, but Christine sensed that she didn’t quite know what to say when it was her turn. A lifelong student of her mother’s mind, Christine had several justifications for her mother’s failure to respond in kind: she had not grown up in a culture where regrets were aired in this way; the inability to see her daughter’s perspective was a lingering cognitive symptom; in her fragile state, apologizing required a level of confidence she didn’t yet have. “At this stage of my life, I need to feel like my mother is back,” Christine told me. Later on, maybe in a few years, she said, “I’ll deal with the fact that it was an imperfect mother who was returned to me.” ♦ An earlier version of this article misstated the Texas institution that houses a center similar to the one at Columbia. Published in the print edition of the July 28, 2025, issue, with the headline “Second Life.” Critics Circle Award.