Which Way Madness Lies: Can psychosis be prevented? Harper's Magazine, December 2010

Anna did not simply decide one day that people were made of paper. She came to the conclusion slowly and reluctantly, several months after she first noticed that the consistency of everything around her had subtly changed. Books and chairs and buildings were no longer solid but composed of tiny, buzzing particles. She thought if she blew on a lamppost it should disperse into air. On her way to school every morning, she was perplexed by the implausibility of the process: that she could walk along the side- walk, her boots pressed against the concrete, without falling through.

Anna had always been the kind of student who would do anything to please her teachers, and from a young age she had single-mindedly pursued a career as a scholar. But by her first semester of graduate school three years ago, schoolwork had become daunting for the first time. She had studied Russian, German, and French, yet she found herself forgetting words she’d known for years. Even English no longer felt like a native language. She sometimes examined the appearance of words, the alignment of angles and curves on the page, until she lost sight of their meaning. Once, with her friends, she became so overwhelmed by the task of physically forming the sounds of words that she lost the ability to speak. She knew what she wanted to say, but she couldn’t will herself to make such odd little noises.

I met Anna last year at her Illinois home, a small, brightly painted townhouse apartment, and she tried to pinpoint when she had stopped believing in the reality she’d contentedly inhabited all her life. A petite twenty-eight-year-old with cleanly parted blond hair, she spoke in a thin, strained voice and avoided looking at me. My lips, she said, appeared as if they were moving at a different pace than my voice, and she had to bat away the thought that she was watching a dubbed film.

Anna’s mother is schizophrenic, and Anna had always found her mother’s world- view—derived in part from messages she deciphered in processed-food packaging—distasteful and impossible to comprehend. She assumed that when her mother had a schizophrenic break, the delusions had taken her by force, engulfing her. But an alternate reality did not come to Anna fully formed. Throughout her first year of graduate school, she kept monitoring her own perceptions, wondering whether they didn’t have some “tinge of unreality.” She searched for a narrative that would explain why the world was being transformed. One day, wandering the halls of an academic department, she became fascinated by the physical details of the building: tiny cracks in the wall, a light switch, a rubber doorstop that looked luminous and functionless. A bust of Plato, which she had never noticed before, seemed to be calling out to her. As she gazed at Plato’s mournful expression, she imagined that he had singled her out to unburden himself and shed light on the “overwhelming strangeness of the world.”

But after she left campus and returned to her apartment that day, the electricity of her mood passed, and she wanted nothing to do with Plato’s secrets. She blamed herself for attending too avidly to the stream of her own consciousness. “It wasn’t as if this bust suddenly started talking to me out of thin air,” she told me. “I wanted him to, and then I sort of convinced myself that he did. It didn’t feel like I was passively being subjected to another reality. It felt like I somehow actively engaged in creating it."

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