On the day, five years ago, that I had my aunt Barbara committed, she'd traipsed half naked through the hallway of her apartment building, then sat on her couch lighting pieces of paper on fire and watching how close the flames could come to her fingers. She was popping so many pain pills and sedatives that she could barely stand; both sides of her forehead were bruised from her regular tumbles. Barbara had become a danger to herself, and her aides weren't able to contain her.

At 67, Barbara had been battling stomach cancer for nearly a year. But her battle with mental illness reached much further back. Among my earliest recollections of her was watching my father, his arms tight around her waist, lifting her and carrying her out our front door as she screamed hysterically. Perhaps she had tried to clock me on the head, as she'd done before; perhaps she'd simply lost herself in a fit of maniacal caterwauling.

When under the sway of a delicately balanced mix of antipsychotic medications, Barbara could be positively delightful—a "well-educated eccentric," as a close friend once said. She could express empathy and was capable of poignant acts of kindness: When my mother disapproved of my fiancé, she ran interference by defending him and then bought us half of our wedding registry. Although Barbara remained provocative and easy to outrage, her medication prevented her from edging into the full-blown delusional paranoia that had sidetracked her since girlhood.

She enjoyed close friendships, but never married or, to my knowledge, had a lasting romantic relationship. Her most intimate connection appeared to be with someone who didn't exist: a floor-banging stalker who she imagined had followed her from apartment building to apartment building, always managing to move in directly above her. She secreted away hundreds of hours of cassette tapes she considered proof of this lifelong adversary—not just the noise from above, but also the endless hang-up calls she claimed were made to her on a sometimes-daily basis, and the break-ins that were mysteriously never captured on the expensive security cameras she'd had installed. Arranged in a closet alongside the tapes were spiral-bound notebooks filled with copies of double-sided handwritten letters to the FBI, building landlords and friends that chronicled the years she'd spent seeking their assistance to stop this fictive harassment.

Members of our family—myself included—would allow ourselves to get only so close to her. Once, a cousin having lunch in a diner saw Barbara eating by herself. Rather than join her, or say hi, she slipped out. Barbara inspired in all of us a survivalist need to run away before she could tear into us with her paranoid recriminations, which could surface even through the veil of her meds. She was one of those free radicals in a family who didn't have a family of her own. To her siblings, she was the baby sister who was orphaned just as she graduated from college; my mother especially had always looked out for her, until she fell chronically ill and couldn't anymore. And so when Barbara got sick, the task fell to me to help care for someone I had avoided all my life because, even in my adulthood, she scared me.

Just days before the surgery that would confirm her fate—the tumors in her stomach were inoperable; she would die soon—Barbara named me one of her two health proxies (the other was her best friend). I didn't know exactly what being a proxy meant. But I knew what I feared: Her paranoia would lead her to accuse me of, by turns, hurting her and abandoning her, trying to kill her and conspiring with her doctors to keep her sick. When complications from chemo forced her off the drugs that had allowed her to be halfway sane, that is exactly what happened. Even something as simple as bringing her a package of cookies inspired charges that I was trying to poison her.

I wasn't always by Barbara's side, but when I was, it was for hours at a time—often days, sometimes weeks, in a row. I missed my husband and kids. I also missed a lot of work, and as the months wore on, I grew resentful. During the final weeks of Barbara's life, I began to feel as though I were completely losing hold of myself—my life as a wife and mother, my professional identity and my sense of self as a good and decent person. When someone tells you over and over that something is wrong with you, that you are malicious and untrustworthy, you can begin to believe it, even when you know your accuser is insane.

The last time I saw Barbara, I sat at her bedside with her psychiatrist, the one behind the magical medication cocktail that had given her life the look of normalcy. It was disconcerting to be with this man who knew so much about me—all of it from Barbara's perspective. He knew about the fights we'd had. "Does she really think I would try to hurt her?" I asked him.

"It's hard to convince her that you wouldn't," he said. At this point Barbara was skin and bones, her eyes sunk deep into their sockets and her lips receding so much that her teeth appeared bucked. She sat up in her sedated haze and made a noise that sounded like she wanted to eat. I spoon-fed her the chicken soup her best friend had made, and some chocolate pudding. She struggled to swallow, and my eyes began to burn from the tears I was holding back. I wished I could have loved her more; I wished I hadn't seen her as such a burden. All I could do, right then, was make sure she didn't choke. I looked over at the psychiatrist, who was smiling. "You're the only one she eats for," he said. "You're the one she trusts."


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