From the archive
My Mother’s Impossible Choice: Schizophrenia or Its Treatments
Suzanne Sherman recalls her mother’s struggle with schizophrenia, a notoriously difficult illness to treat. Roughly five percent of those diagnosed die by suicide. For some patients, though, the remedies can be almost as painful as the underlying disease.
I was in seventh grade and Led Zeppelin was my favorite rock band. One day, I heard “Stairway to Heaven” coming from the living room. My mother liked folk music—not rock. I went in to see what was going on.
There she was, sitting cross-legged on the carpet by the stereo cabinet, playing one of my Zeppelin albums. When I asked what she was doing, she looked up at me with an eerie smile. "Do you hear what they’re saying?"
Robert Plant was singing that words sometimes have two meanings. I knew the song well.
"They know," she whispered. With her eyes, she implored me to understand.
I would never listen to that song again.
That night, my father—whom she had divorced five years before because he did not believe she was hearing voices and hallucinating during a first yearlong psychotic break—came to the house and took her to a private psychiatric hospital. Then he stayed with my brother, sister and me while she was gone. Her problem, which had seemed to disappear before they split up, had returned. Ranging in age from ten to fourteen, we were too young or too intimidated by it all to ask questions, and he did not say a word about what had happened with our mother or what was going to happen now.
Two weeks later, my father brought her home from the hospital, carrying her suitcase and a bucket of KFC for dinner. Within minutes, he left for his apartment across town. He had undoubtedly already gotten the news we were about to hear.
At the dinner table, while my siblings and I sorted through the cardboard KFC bucket for the pieces of chicken we wanted, my mother said, "Kids, I have something important to tell you. The doctor gave me a diagnosis." We stopped what we were doing. "I have paranoid schizophrenia, with chronic depression and anxiety." Paranoid schizophrenia? What was that? Depression and anxiety were easier to understand. I had heard of them.
She told us her doctor had put her on a medication called Thorazine. He promised it would help. The hallucinations, delusions, and voices in her head would go away. Valium would stop the anxiety. The depression might go away too. The doctor would eventually add another drug, Stelazine, to her daily dose of medications to lessen the side effects of the Thorazine, he told her. I would learn years later that Stelazine is an antipsychotic drug that serves the same purpose as Thorazine. Prescribing it must have been all he knew to do.
“Prescribing it must have been all he knew to do.”
My mother was forty years old the year she started taking the flagship drug that was supposed to change everything. New in the 1950s, Thorazine was emptying mental hospitals and reducing the frequency of lobotomies. The drug did quiet some of her symptoms, but it also left her heavily sedated, cognitively dulled, and visibly altered. Crucially, it did not give her back her life.
If I had been older than twelve at that time, I might have called her doctor to ask whether he understood what the medication would really cost. My mother was a Wellesley graduate, a classical pianist, a trained singer. After she began taking Thorazine, she would never read a book again, play another Beethoven sonata, sing onstage, keep a job, or return to the life she had known. If I had called and her doctor had had anything to say, it might have been, "I’m sorry."
Meanwhile, my mother smoked the days away, sitting on the couch in front of an overflowing ashtray, staring into space. She left the house for psychiatry appointments, bought groceries, and went to the bank to cash her alimony and child support checks. At six o'clock in the evening, like clockwork, she would put a simple dinner on the table for her three children. After dinner, dishes collected for days on the kitchen counters until she could manage to load the dishwasher.
Thorazine was her only hope.
After a few years on Thorazine, my mother found and lost a job as a legal secretary within three months. It was her second failed attempt at employment. When I gently asked what was going on for her, she confided that part of her face was getting paralyzed. "Side effects from the medication," she said. She told me, too, that her short-term memory was going. "Can you tell your doctor you want to quit the medications?" I asked. "I did," she said. "He won’t let me." We sat with that fearsome fact.
My mother knew she was on a path with no exit. A few days after her forty-fifth birthday, she wrote a full-page letter addressed "To my beautiful children" explaining that she hoped we would forgive her, that she could not live with or without the medication. She put a period after the word "Goodbye." That tiny dot carried a huge weight—the life she had lived and loved, the illness that had overtaken her.
That summer, I went to the library at the University of California, Santa Cruz, where I planned to transfer in the fall for my sophomore year. I wanted answers. I wanted to learn about schizophrenia and the drugs the doctors gave my mother for it.
Outside the modern building, redwood trees in the surrounding forest climbed to the sky. At the reference desk, I asked for psychiatric journals and took some to an empty, spacious room on the third floor. The room’s floor-to-ceiling windows made me feel I was in the privacy of the treetops.
My heart thumped hard as I turned pages, reading medication names I did not recognize. It was obvious the articles and advertisements were aimed at psychiatry professionals. It was just what I was looking for. And then I landed on a full-page advertisement for Thorazine.
“At Last!” the oversized text at the top of the page boasted. “A drug to treat patients with schizophrenia. Most patients can function with regular treatment.” Thorazine’s great virtues were listed. Below them came the warnings:
(1) Patients should avoid consumption of alcohol. (2) Patients should never stop Thorazine suddenly or without medical supervision or catatonia can occur.
I paused reading that. My mother had made both of those mistakes. When she quit taking her medications a year earlier without her doctor's consent, my brother came home from school to find her sitting on the couch in an unresponsive stupor. Catatonic. She was hospitalized for two weeks and put back on her medications.
I continued reading the possible side effects. The list filled a third of the page:
mask-like face, loss of short-term memory, drowsiness, dizziness, inability to concentrate, blurred vision, confusion, psychotic reactions...
Wait a minute. What was this? Thorazine was supposed to stop psychotic reactions. I flung the binder across the table and watched it slide to the floor.
For years I have been haunted by "if only." If only she had lived long enough to see what the future could bring. A quarter of the way into the twenty-first century, however, not enough has changed. Psychiatry knows far more than it did when my mother was diagnosed in 1973. Depression is often treatable with the right medication and dosage. Schizophrenia, however, remains one of the most difficult psychiatric illnesses to treat, and there has been far too little improvement with antipsychotic medications.
In 2024, hope peeked over the horizon with FDA approval of a new medication called Cobenfy. The first antipsychotic drug to work through a different biological pathway from earlier medications, Cobenfy shows real progress. But the cognitive impairment and emotional flattening common with schizophrenia remain challenges in treatment, and long-term outcomes of the new drug are still unknown. The side effects have changed from my mother’s era, but they are real.
The central challenge is still here—finding treatments that patients can live with. A landmark study published in the New England Journal of Medicine in 2005 (the CATIE study) found that seventy-four percent of patients with chronic schizophrenia discontinued their assigned antipsychotic medication before eighteen months. The reasons included inadequate symptom control, intolerable side effects, and patients’ decisions to stop treatment—underscoring the difficult balance between managing symptoms and preserving quality of life. Suicide statistics are sobering: Approximately five percent of all people with schizophrenia will die by suicide.
And I have to ask: How much is acceptable to lose in the name of treatment? How much quality of life should a patient have to sacrifice? My mother's psychiatrist would not work with her to find another path, despite the side effects she told him about. His approach was to suppress symptoms at all costs. And the price was high. She asked him to take her off the medication, and he refused. Eventually, to try to save herself, without her doctor’s guidance she quit the medication all at once, became catatonic within days, and was put back in the fatal loop.
I know the answers are not simple. My mother suffered from hallucinations, delusions, and paranoia, and she needed treatment. But should success not be measured by more than symptom reduction? At what cost is the relief? Who gets to decide what losses are acceptable? I would like to see quality of life measured alongside clinical outcomes. What a difference could there be if psychiatrists treating patients with schizophrenia routinely asked: "How much quality of life can my patient preserve?"
Some patients might accept profound cognitive slowing in exchange for relief from psychosis. Others might choose differently if properly informed and given caring support for managing their illness in other ways. The goal should not simply be survival. It should be helping people remain as complete as possible in who they are beneath the illness. Perhaps the most important conversation is not only about finding better drugs; maybe it is also about redefining the meaning of successful treatment.
My mother's impossible choice—to live with the medication or without it—is as real today as it was fifty years ago. The side effects are different, but the calculus has barely changed. How does a person fairly live with the unlivable? Suicide may be what ended my mother's life, but schizophrenia is what killed her.
Suzanne Sherman is a memoirist. Since 1996 she has taught memoir writing at colleges, online, and in workshops. Her latest memoir is Living in the Long Shadow (She Writes Press, 2026; distributed by Simon & Schuster).
