“Donna” is a woman in her mid-60s. I met her at the cooling center. She was sitting alone, talking to herself and to the voices inside her head.

Donna has schizophrenia, the most debilitating of mental illness. She was psychotic, not based in reality at all. Donna believed she had “magical powers” and that was her only reality. One day when talking with her I told her I had a bad back. Her eyes immediately lit up! She was going to “cure” my back! She then proceeded to place her hand on my back and chanted her magical words. She asked if it was better and I said “Yes, thank you Donna.” And then I gave her a hug.

After that we were the best of friends. When I went there she would wave me over and we would chat about her powers. And I would listen. To validate Donna and her reality gave her some peace, I hope. Of course I will never know, but that’s ok. Its not about me.

Donna’s story is unique in many ways. She has a husband, grown children and grandchildren. Her family is very wealthy, so she had the best of care for many years and was compliant in taking her medication.

She had met her husband in college. That’s where she had her first psychotic episode and was diagnosed with schizophrenia. This diagnosis often manifests when someone is in their late teens or early 20s, but not always. As time went on, Donna raised her family and stayed on medication for her illness. She had no further psychotic episodes and the voices in her head were gone. All of her children went on to be successful and had no evidence of any mental illness. I was never sure how many children and grandchildren she has.

So all was fine until Donna decided to stop her medication. She gave no reason to her family. Her behavior changed radically, as was expected. She once again heard voices and responded to them. Her family became very concerned. Her behavior became more unpredictable. She would be up all hours of the night and sometimes would leave her home and wander around, talking to herself. Because of the American Disabilities Act, her family was helpless in forcing her back on medication.

Donna is a very intelligent person. Mental illness does not affect intellect, just behavior. She did very well convincing others she was just fine. As a result, her family was unable to get conservatorship.

One afternoon when her family was visiting, Donna attacked her granddaughter. She had never been violent before. Shocked, they called police and she was put on a 72-hour hold due to being a possible danger to herself or others. Her family encouraged her to stay inpatient so she could get better. As was her right, she refused and left. They could not stop her. They were devastated. Her granddaughter was not injured but the trauma she experienced has no words to describe. I was not able to find out how old she was at the time.

Donna became homeless. And still is. She continues to refuse treatment and medication. She has not had any other violent incidences. She has few friends. I have no idea where she sleeps and if she is safe.

The tragedy is that mental illness is not a choice. It can and does devastate families communities and affects all societies. It knows no boundaries and affects all cultures, races and countries. Patients often describe it as demons in their head.

Some will take drugs to quiet the voices. Its hard to know if you see someone talking to themselves if they are schizophrenic, taking drugs or both.