A secret history of psychosis

When Cohen Miles-Rath walks into his father's house, the story of his psychosis is right there in front of him. There's the spot where he stood when he received a cryptic message on his phone: the devil had possessed his father's body. There's the drawer where he saw a knife with a white handle: the color of God! The Times: A selection of reading you won't find anywhere else, with tildes and accents. Get it sent to your inbox. There's the floor where, struggling for the knife, Cohen bit off part of his father's earlobe, blood splattering them both. There's the spot where, pinned to the ground, Cohen raised the knife and slashed wildly at his father's neck. The violence lasted seconds, but it changed his life forever. With the voices still echoing in his head, Cohen ended up in jail, facing charges of second-degree assault and criminal damage, crimes punishable by up to 10 years in prison. Dazed and bleeding, his father had filed charges and obtained a restraining order against him. But Cohen hadn't killed him. In the years that followed, he felt as if he had walked to the edge of a precipice. About 300 times a year in the United States, a child kills a parent, accounting for roughly 2 percent of all homicides. A large proportion of these cases involve people like Cohen: young adults with serious mental illness who live at home. When escalating symptoms of psychosis make it impossible to study or work, parents become the last remaining support. Paranoid delusions can cruelly reverse that logic and turn people against the person closest to them. Cohen fit that profile; he adored his father. At 11, he asked to move from his mother's house to his father Randy's tidy mobile home in Cohocton, New York. For Cohen's sake, Randy, a fuel truck driver with a piercing ear and a leather jacket, became a Cub Scout leader. He smiled proudly from the sidelines at every one of his son's track meets. Now, in their small town, the family became the subject of sensational headlines: "Man rips off father's ear in knife attack," one read. In jail, Cohen's hallucinations turned into terrors; his college graduation date came and went. What would weigh on him for years, long after the psychosis had subsided, was whether his father could ever forgive him. "I attacked him," Cohen told me. "It was my hands on the knife. It was me doing it, wasn't it? I remember the moment. It was me. And it wasn't me." The Lifting of the Veil I’ve covered mental health for much of my career, and I frequently find myself writing about crimes committed by people in psychosis. These cases represent a small percentage of violent crimes—about 4 percent, according to researchers—and the vast majority of people with psychosis are never violent. But they are the kind of crimes that make the news: inexplicable, terrifying in their suddenness. Sometimes they are random; a passenger is pushed onto the subway tracks. But often they occur within the four walls of a home, as in the case of Nick Reiner, charged this year with fatally stabbing his parents. (Reiner, diagnosed with schizophrenia and schizoaffective disorder, pleaded not guilty to two counts of first-degree murder.) Yet it is rare to hear these episodes of violence from the perspective of those directly involved. That's why I was intrigued last year when I received the manuscript of Cohen's memoirs, in which he recounted the spiral of delusions and hallucinations that led him to assault his father. How, I wondered, could his condition deteriorate so drastically when he was surrounded by people who loved him? And afterward, would it be possible to repair their relationship? Cohen's story began with a common disappointment during his senior year at SUNY College in Geneseo: an injury ended his career as a long-distance runner. Freed from that disciplined life, he began smoking marijuana daily. That spring, he felt something shift in the world; everything seemed to glow before him. He glided across campus, his senses heightened. Signals in the form of colors began flashing before his eyes: red meant danger; blue, safety. Sitting in his humanities class, he saw—or thought he saw—his professor step onto the podium and announce that he, Cohen, was a prophet. Cohen was experiencing psychosis, a break with reality that psychologist Carl Jung described as a "rupture of the veil." Some scientists believe these symptoms arise from changes in the neurotransmitter dopamine, which causes sensory experiences to be perceived as intensely vivid and meaningful. Hallucinations, according to this theory, occur when the brain interprets internal phenomena—like a harsh inner voice—as real, originating from the outside world. Delusions, the most common symptom of psychosis, can arise when the brain attributes intense significance to trivial items—like a black car—as clues to an underlying, transcendent story. As March gave way to April, an otherworldly presence began giving Cohen instructions. He turned on the television and saw the pale, naked bodies of dancing gods; he saw golden blood glisten from the veins in their feet. He drove to a local coffee shop and threw a rock out the window, followed by a series of red objects: a message for Satan. Randy ran home, still in his work clothes, and found Cohen in the kitchen. Cohen's mind was racing; he felt like this was the moment that would define him forever. "I felt like I had completely lost my identity," he said. "Like I wasn't Cohen anymore. I was a different being who knew everything." He paused, searching for words. "It's hard to describe, but it feels like you're... like you're God." Cohen looked at his phone and saw a cartoon of one child hitting another on the head. He felt a truth being revealed to him: the devil was inside his father. He paced the living room. "I don't want to kill him," he said aloud, to no one. "I love my dad. I can't kill him." He went into the kitchen, opened a drawer, and took out a knife. 'He's going to kill you' At 52, Randy was physically strong and weighed about 50 pounds more than his son, a star athlete. Seeing the knife, he yelled at Cohen to stop, but he didn't respond. His son's eyes looked strange, large, and dark, Randy recalled. "It wasn't Cohen," Randy said. "It was something evil, and I got scared." Randy lunged at Cohen, and they both fell to the ground. Randy grabbed the blade, which pierced his hand to the bone. Police records make it clear how close to fatal. "I didn't want to kill him, but something told me to," Cohen told officers. "He had me pinned down, and I couldn't do it." Fueling with adrenaline, Randy broke free and ran from the house. When he returned, he found Cohen handcuffed and being led to a police car. When a detective interviewed him that afternoon, he warned him not to let his guard down. "He told me I shouldn't even want him back in the house," Randy said. "He's going to kill you, that's what they told me. I was like... what?" According to researchers, there's a logic that leads people in psychosis to develop delusions centered on their family members. The most common type of delusion is persecutory, which can arise when ambiguous or social cues are interpreted as hostile. The more interactions there are, the more likely it is to occur. When Cohen got out of jail a month later, he knew he'd been lucky. In prison, a psychiatrist had prescribed him Zyprexa, an antipsychotic, and the voices subsided. Randy dropped the assault charges, and the public defender advised him to accept a plea deal that included a year of probation, mandatory treatment, and mandatory drug testing. But he'd been expelled from the university. Even minimum-wage employers were Googling him. Back in town, everyone seemed to know what had happened; the other inmates called him "Chewy." And he wasn't sure how he was going to manage without Randy in his life. The restraining order was still in place, and there was no way they could live together. In that state—uncertain, desolate—Cohen was when he saw Randy in the courthouse parking lot, waiting for him and smiling. Randy opened his arms, and the two men embraced. "I'm sorry, Dad," Cohen said. "Don't worry, son," came the reply. "I love you." The Long Road Home Last month, nearly 10 years after the attack, I drove between grain silos and harvested fields to interview Randy and Cohen in Cohocton, a small town about 90 miles from the Canadian border. Randy's mobile home looked simple on the outside, but inside it was elegant and meticulously arranged, with earth tones and grained wood. Cohen had recently become a father, and Randy—who still looks like a biker—joked gently about his anxious fatherhood. At 32, Cohen is now a social worker overseeing suicide prevention programs for the New York City Office of Mental Health. His hair is turning gray. Randy has retired and spends his time caring for a 1968 Plymouth Roadrunner. Both men are doing well. Both are also overwhelmed. They could have lost everything, they told me. "That was pretty much the worst thing I could have ever experienced; my own son trying to…" Randy said, trailing off. "I mean, I know he wasn't my son. But what if he had succeeded?" Sitting in the room where it all happened, Randy explained that he hadn't realized his son was psychotic. He had heard Cohen's lectures about Einstein's theory of relativity, his fear that the sun would liquefy rocks inside the Earth. But Randy was a working-class man. Cohen was an intellectual, the first in his family to go to college. "I thought, he's smarter than me, so he probably knows more," he said. It turned out there had been warning signs. A month before the attack, after approaching a teacher to share his fervent ideas, Cohen was arrested by police and hospitalized for five days for observation. But Randy distrusted psychiatry; when he was Cohen's age, he'd been prescribed medication after a suicide attempt, but he stopped taking it as soon as he could. His attitude, he said, was "more about getting up and doing what you have to do." Returning home from the hospital, Cohen admitted he'd lied about his symptoms to get out. The two argued about whether Cohen should take the antipsychotic medication he'd been prescribed and decided it wasn't necessary. Now Randy knows those decisions were catastrophic. He didn't blame Cohen; what drove him to violence, he told me, was an external force. "It was outside of him," he said. But there was no denying it: at an almost cellular level, Randy was afraid of his son after the attack. During that summer, every few weeks, Cohen would come back and ask: Could he come home? The idea troubled Randy. He was a deep sleeper. What if Cohen attacked him in the middle of the night? Finally, after six months, Randy agreed to let Cohen back home. "If you love your son enough, you do everything you can to see him safe. That's what being a father is," he said. But silently, without saying a word, he installed a lock on his bedroom door. On the table next to his bed, under a cloth, he kept a knife. The Burden Cohen carries his own burden. Only luck, he told me, separated his fate from Nick Reiner's. "He crossed that line," he said. "And I didn't." One of the ways Cohen has tried to heal is by speaking out as much as possible about what it means to be lost in psychosis. He gives talks, answers questions from concerned parents. He has become part of a network of families trying to rebuild their lives after episodes of violence linked to mental illness. “I feel I can speak from a unique perspective because I lived it and made it through,” he said. His memoir, Mending Reality: An Advocate’s Existential Journey With Mental Health, was published last summer by Post Hill Press. In it, he describes how he was overcome by a sense of mission that erased fear and pain, and how he navigated a world populated by presences invisible to others. This responsibility is especially weighty because he no longer takes antipsychotic medication. For a year after his release from prison, under the supervision of a trained nurse, he very slowly reduced his dosage to zero. He stopped using cannabis, which he believes contributed to his crisis. He compares his mental illness to diabetes or cancer, a chronic condition that requires constant monitoring. Almost four years ago, he went on a third date with Elizabeth Finger, whom he had met on Facebook Dating. She was a social worker, like him. She had long, wavy blonde hair and, at 31, was looking to start a family. As he dropped her off at her car, he turned to her. He needed to tell her about a mental health crisis he'd suffered seven years earlier. When he finished, he asked her to seriously consider whether she wanted to continue seeing him. "He told me he'd find things on Google," she said. "And boy, did I." Outside the Window Friends from her professional circle gently advised her to end the relationship. They told her that someone with a diagnosis of schizoaffective disorder could never have a stable life. But as the months passed, Elizabeth realized she trusted Cohen, in part because he took what had happened so seriously. She's convinced that if the symptoms return, he'll seek help before they worsen. They're both willing to take that risk. He's very attentive to any signs, which usually appear when he's sleep-deprived or stressed. He has plans in place: naps, helplines, medication. But life goes on, with or without plans. Three months ago, after a 24-hour labor, their daughter was born, a five-pound baby with cheeks as round as cherry blossoms. Both Elizabeth and Cohen hadn't slept for a couple of nights. Then, he stayed awake with the baby so Elizabeth could rest. He looked out the window into the darkness, and suddenly everything looked strange: a tree just outside seemed to be liquefying and melting into the sky. Cohen went to the window: was he imagining it? But it was still there, rising in the darkness like an inverted waterfall. He makes mental notes when these things happen. "It's a possible hallucination," he tells himself; putting it into words takes away some of its power. In the morning, he went to the window again, and the world was back to normal: behind the tree, in the darkness, a chimney was billowing plumes of smoke. That day, as he was getting ready to leave the hospital, Cohen told the midwife he was afraid his psychosis would return, and she responded with warmth and support. It's rare for a father to be so open about his symptoms. He printed out a list of helplines and support groups, like the ones usually given to people living with mental illness. Then Cohen buckled the baby into a seat in the back of the car, and they headed home. Ellen Barry is a reporter for the Times and covers mental health.