José A. Alvarado Jr.

Photographer
 
Location: New York City, New York
Nationality: Puerto Rican American
Biography: José A. Alvarado Jr. is a Puerto Rican photographer dedicated to documenting class inequality, civic engagement, and contemporary issues in Puerto Rico and New York City. He works primarily in long-form storytelling, using visual imagery... MORE
Media
for The Washington Post: A catatonic woman awakened after 20 years. Her story may change psychiatry.
josé a. alvarado jr.
Jul 7, 2023
Location: New York, New York
Summary
New research suggests that a subset of patients with psychiatric conditions such as schizophrenia may actually have autoimmune disease that attacks the brain
When Devine Cruz was 9, she began to hear voices. At first, the voices fought with one another. But as she grew older, the voices would talk about her. One night, the voices urged her to kill herself.
For more than a decade, the young woman moved in and out of hospitals for treatment. Her symptoms included visual and auditory hallucinations, as well as delusions that prevented her from living a normal life.

Devine was eventually diagnosed with schizoaffective disorder, which can result in symptoms of both schizophrenia and bipolar disorder. She also was diagnosed with an intellectual disability.

She was on a laundry list of drugs — two antipsychotic medications, lithium, clonazepam, Ativan and benztropine — that came with a litany of side effects but didn’t resolve all her symptoms. She was often unaware of what was going on; her hair was disheveled, and her medications caused her to shake and drool, her doctors said.

She also had lupus, which she had been diagnosed with when she was about 14, although doctors had never made a connection between the disease and her mental health.

When Markx and his team found Devine, she was 20 and held the adamant delusion that she was pregnant despite multiple negative pregnancy tests.

“That’s when she was probably at her worst,” said Sophia Chaudry, a precision psychiatry fellow at Columbia University Medical Center and physician who was closely involved in Devine’s care.

Last August, the medical team prescribed monthly immunosuppressive infusions of corticosteroids and chemotherapy drugs, a regime similar to what April had been given a few years prior. By October, there were already dramatic signs of improvement.
“She was like ‘Yeah, I gotta go,’” Markx said. “‘Like, I’ve been missing out.’”

After several treatments, Devine began developing awareness that the voices in her head were different from real voices, a sign that she was reconnecting with reality. She finished her sixth and final round of infusions in January.

Photographed for The Washington Post, with words by Richard Sima.A catatonic woman awakened after 20 years. Her story may change psychiatry.
New research suggests that a subset of patients with psychiatric conditions like schizophrenia may actually have autoimmune disease that attacks the brain.
Washingtonpost.com
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for The Washington Post: A catatonic woman awakened after 20 years. Her story may change psychiatry. by José A. Alvarado Jr.
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