“Eugen Bleuler (who in 1911 coined the word 'schizophrenia') once said that in the end his patients were stranger to him than the birds in his garden. But if they're strangers to us, what are we to them? (26)”

“I mention a paradox of psychiatry: mental illness is recognized by the patient's distorted thoughts, but treatment is largely indifferent to their content. (104)”

“If Sally had been in an accident or come down with some overtly physical disease, I would not hesitate to tell him about it, confident that his sympathies would flow in my direction as a matter of course. But psychosis defies empathy; few people who have not experienced it up close buy the idea of a behavioral disease. It has the ring of an excuse, a license for self-absorption on the most extreme scale. It suggests that one chooses madness and not the other way around. (86)”

“I remember the tale of the rabbi to whom a dead man came with a problem: he believed that he was alive. "Don't you know," the rabbi told him, "that you are no longer among the living? You are in the Land of Confusion." On hearing the story, the rabbi's son worried that he too was in the Land of Confusion. "Once you know that there exists such a world, you cannot be in it," explained the father. (208)”

“Spinoza spoke of vitality as the purest virtue, the only virtue. The drive to persist, to flourish, he said, is the absolute quality shared by all living beings. What happens, however, when vitality is inverted, and instead of flourishing, one is driven to eat oneself alive?”

“I once had a patient who used to practice the most horrible tortures on himself, and when I asked him why he did such things, he said, 'Why, before the world does them.' I asked him then, 'Why not wait and see what the world will do?' and he said, 'Don't you see? It always come at last, but this way at least I am master of my own destruction.”

“It's something of a sacrilege nowadays to speak of insanity as anything but the chemical brain disease that on one level it is. But there were moments with my daughter when I had the distressed sense of being in the presence of a rare force of nature, such as a great blizzard or flood: destructive, but in its way astounding too. (4)”