Whispers in the Night
It began with whispers in the night. A woman in her forties — a wife, a mother, the heart of her family — began to change in ways her loved ones couldn’t understand.
Her life had already been shaken. The ancestral home was sold, her husband — a temple priest — struggled to support them on meagre wages, and relatives only blamed them instead of offering support. With her daughter nearing 25 and facing rejection in marriage proposals, the pressure weighed heavily. She carried all of it inside her, with no one to share the burden.
At first, it was bursts of anger over the family’s losses, endless nights of overthinking, and restless sleep. The family brushed it off as worry. After all, hadn’t life given them enough reasons to worry? One night, her husband woke to the sound of footsteps, only to find his wife pacing, checking every window and door again and again.
The Descent into Fear
But soon, her worry turned into something darker.
She stopped trusting the food in her own home, certain that her husband and daughter were mixing poison to get rid of her. She cooked tiny meals only for herself. She refused to meet relatives. She muttered to herself when no one was around, and when confronted, she revealed a terrifying belief: a “bad lady” was controlling her — a spirit who could punish or even kill the family if things in the house weren’t kept under her control.
Every horn that honked on the street became a sign: the lady has come for me.
Her days and nights blurred into fear.
For over a year and a half, this fear ruled her life. The family, desperate and helpless, thought she was under the grip of black magic. They carried her from temple to temple, performing rituals and prayers, spending nights under sacred roofs. For a short while, she found comfort in the temple — it was the only place she felt safe. But the moment she returned home, the terror returned. And so, every night, without her family’s knowledge, she slipped away to the temple, clinging to the only place she believed could protect her.
The Breaking Point
Then, fate struck another blow.
From these nightly visits came swarms of mosquito bites. Soon, she burned with fever, bled, and collapsed. The diagnosis was dengue haemorrhagic fever. But even then, she resisted treatment, believing it was another attempt to harm her.
The Diagnosis
It was only then that I was called. At first, the family thought I was there to calm her “irritability and reluctance.” But after hearing her fears, seeing the horror of her ordinary life for two years, and piecing together her long history, the truth was clear: this wasn’t possession. This was schizophrenia. We treated her dengue fever alongside carefully starting antipsychotics, first injectables to calm her down and later oral tablets (see psychiatric diagnostic formulation below for details).
The Recovery
Slowly, the transformation began.
In just a week, the change was visible. The same woman who had refused to eat or bathe for months began taking care of herself. Her suspicious eyes softened, she ate meals again, and for the first time in years, she slept peacefully. Her family was stunned — and relieved beyond words.
Three months later, she reached the recovery stage. She takes her medicines on her own, helps her husband by stitching clothes to earn extra income, and has once again started searching for marriage alliances for her daughter. Her husband often tells me, his voice heavy with gratitude, “You saved my wife. You saved my family.”
Lessons Beyond the Family
This story is not just about one woman. It’s about how mental illness, when misunderstood, can steal years from a person’s life. It’s about how stigma and superstition push families to temples and rituals, when what is really needed is medical care and compassion.
Schizophrenia is not a curse or possession. It is an illness of the mind, and with treatment, people can recover, regain their dignity, and return to their lives.
If you notice a loved one slipping into fear, talking to themselves, refusing food, or withdrawing from the world — don’t just think of spirits or black magic. Think of help. Think of psychiatry. Because the right treatment can make a huge difference — for the person, the family, and the community
DIAGNOSTIC FORMULATION (for professionals)
This is a 42-year-old married woman from a low socio-economic background, with no past psychiatric history, presenting with an insidious onset, continuous illness of 2 years’ duration characterized by Persecutory delusions (husband/daughter poisoning food, supernatural agent controlling family), Second-person auditory hallucinations / muttering to self, Severe anxiety, fearfulness, night wandering, repetitive checking, Social/occupational dysfunction (refusal to cook for family, social withdrawal, poor self-care), Lack of insight into illness.Course has been continuous, with religious interventions initially sought due to explanatory model of possession/black magic, delaying psychiatric care. The episode was complicated by dengue fever during the untreated phase.
Nil past, personal or family history. Premorbid personality: Responsible homemaker, religious, caring mother, no noted odd traits. MSE revealed Appearance/behavior: Unkempt, guarded, fearful, muttering to self, PMA showed hallucinatory behavior, Mood & affect: Subjectively anxious, objectively fearful, restricted affect, Thought: Persecutory delusions (poisoning, supernatural “bad lady”) (secondary to hallucinatory voices), referential ideation (secondary to hallucinatory voices), Perception: Threatening type of auditory hallucinations (second person – bad lady talking to her), Insight: 0/5, Orientation to Place and Person, Poor attention and Concentration, Impaired judgement.
Initially PANSS – 88, BPRS – 64
DIAGNOSIS – On evaluation, she fulfilled ICD-10 criteria for Schizophrenia, Paranoid subtype (F20.0) / DSM-5 Schizophrenia.
Management and Course
Dengue fever treated medically, Antipsychotics: Risperidone started at 1 mg BD, titrated to 3 mg/day, Benzodiazepines: Inj. Lorazepam 4 mg nightly (short-term), tapered to oral 1 mg later stopped, Supportive measures: Psychoeducation of family, counseling regarding nature of schizophrenia vs. cultural attributions.
Response:
By 1 week: PANSS reduced to 58; BPRS to 42 — showing significant improvement in suspiciousness, affect, and sleep. By 3 months: PANSS ~36 (mild illness), BPRS ~28 — remission of positive symptoms, residual mild anxiety, good functional recovery.
Differentials:
Delusional Disorder, Persecutory Type (less likely due to hallucinations, disorganized behavior, and functional decline). Psychotic Disorder due to another medical condition (e.g., delirium/encephalopathy in dengue — but psychosis preceded illness) Mood Disorder with psychotic features (e.g., Major Depressive Disorder with psychosis; Bipolar with psychosis). Obsessive–Compulsive Disorder with poor insight (some checking behaviors, but primary picture is psychotic).