She was never on time to clinic appointments. Leaving her apartment was not simple when it required pushing aside the furniture she had pushed against the front door the night before, and even the furniture was no protection against the threats she perceived.

She said strange men burrowed into the apartment after dark, right through the door, the chest of drawers and the armchairs. They entered her body, and then they ate her up from the inside.

It took years before she told us this. We might doubt her, but she knew it happened. Numerous expensive antipsychotics made no difference at all.

She smoked heavily, partly from anxiety and partly because, like many chronically institutionalized patients, she had been bribed into placidity with cigarettes years earlier. Before her first psychotic break, she had been a singer. Smoking was not good for her voice, of course, but under these harrowing circumstances, quitting was impossible.