When Cohen Miles-Rath walks into his father’s house, the history of his psychosis is right there in front of him.
There is the place where he was standing when he received a cryptic message on his phone: The devil had entered his father’s body. There is the drawer where he spotted a knife whose handle was white — the color of God!
There is the floor where, as they grappled over the knife, Cohen bit off part of his father’s earlobe, and blood spattered over both of them. There is the spot where, pinned to the floor, Cohen reached up with the knife and slashed wildly at his father’s throat.
The violence lasted seconds but changed his whole life. With voices still racketing in his head, Cohen found himself in jail, facing charges of second-degree assault and criminal mischief, felonies punishable by up to 10 years in prison. Stunned and bleeding, his father had pressed charges, and taken out a restraining order against him.
But Cohen hadn’t killed him. In the years that followed, he had the feeling that he had walked right up to the edge of a chasm. About 300 times a year in the United States, a child kills a parent, making up around 2 percent of all homicides.
A large portion of these cases involve people like Cohen: young men with severe mental illness who are living at home. When mounting symptoms of psychosis make school or work impossible, parents are the support system of last resort. Paranoid delusions can cruelly invert that logic, turning people against the figure closest to them.
Cohen fell into that category; he adored his father. At 11, he had asked to move out of his mom’s house and into Randy’s tidy double-wide in Cohocton, N.Y. For Cohen’s sake, Randy, a fuel transport driver with a pierced ear and a leather jacket, became a Cub Scout leader. He beamed from the sidelines at every one of Cohen’s track meets.
Now, in their small town, their family became the subject of tabloid headlines — “Man Bites Off Father’s Ear in Knife Attack,” read one. In jail, Cohen’s hallucinations flared up into terrors; the date of his college graduation came and went.
What would weigh on him for years afterward, long after the psychosis had receded, was whether his father could forgive him.
“I had still attacked him,” Cohen told me. “It was still my hands on the knife. It was me who was doing that, right? Like, I remember the moment. It was me. And it wasn’t me.”
The tearing of the veil
I’ve reported on mental health for much of my career, and frequently find myself writing about crimes committed by people in psychosis.
These make up a small percentage of violent crimes — around 4 percent, researchers have found — and the vast majority of people in psychosis are never violent. But they are the kind of crimes that newspapers cover: inexplicable, horrifying in their suddenness. Sometimes they are random; a commuter is shoved into the path of a subway train. But often they occur within the four walls of a home, as with Nick Reiner, who was charged with the fatal stabbing of his parents earlier this year. (Mr. Reiner, who had been diagnosed with schizophrenia and schizoaffective disorder, has pleaded not guilty to two counts of first-degree murder.)
It is rare, though, to hear about these bursts of violence from the people who were directly involved.
So I was intrigued, last year, when I received a manuscript of a memoir from Cohen, chronicling the spiral of delusions and hallucinations that led him to assault his father. How, I wondered, could his state have deteriorated so gravely when he was surrounded by people who loved him? And afterward, would it be possible to mend their relationship?
Cohen’s story began with an ordinary disappointment his senior year at SUNY College at Geneseo: An injury had ended his career as a distance runner. Freed from that regimented life, Cohen began smoking pot daily. That spring he sensed something changing about the world; it shimmered before him. He glided around campus, his senses exquisitely heightened.
Signals began to jump out at him in the form of colors; red meant danger, blue meant safety. Sitting in his humanities classroom, he saw — or thought he saw — his professor climb up to the podium and announce that he, Cohen, was a prophet.
Cohen was experiencing psychosis, the break with reality that the psychologist Carl Jung described as a “tearing of the veil.” Some scientists believe these symptoms emerge from changes in the neurotransmitter dopamine, which labels sensory experiences as unusually vivid and meaningful. Hallucinations, this theory suggests, occur when the brain mislabels internally generated phenomena — say, a harsh internal voice — as real, coming from the outside world. Delusions, the most common symptom of psychosis, may result when the brain identifies trivial things — say, a black car — as intensely meaningful, clues to a momentous, underlying story.
As March turned into April, an otherworldly presence began giving Cohen instructions. He turned on the television and saw the pale, naked bodies of dancing gods; he saw gold blood sparkling through the veins in his feet.
He drove to a local diner and threw a rock through its window, followed by a series of red objects — a message to Satan. Randy rushed home, still in his work clothes, and found Cohen in the kitchen.
Cohen’s mind was racing; he felt the moment that would forever define him had arrived.
“I felt like I had completely gotten rid of my identity,” he said. “Like I wasn’t even Cohen. I was this separate being that knew all things.” He paused, looking for words. “It’s hard to describe what it feels like, but it feels like you’re — it feels like you’re God.”
He glanced at his phone and saw a cartoon, one boy smashing another boy’s head. Cohen felt that a truth had revealed itself to him: The devil was inside his father. He paced in the living room. “I don’t want to kill him,” he said aloud, to no one. “I love my dad. I can’t kill him.” He walked into the kitchen, opened a drawer and withdrew a knife.
‘He’s going to kill you’
At 52, Randy was physically powerful, and outweighed his track-star son by 50 pounds.
Spotting the knife, he barked at Cohen to stop, and saw that there was no response. His son’s eyes looked unusual, big and black, Randy recalled. “It was not Cohen,” Randy said. “It was evil, and I was scared.”
Randy ran at Cohen and the two men crashed to the floor. Randy grabbed the blade, which drove into his hand, hitting bone. Police records make it clear how close it was. “I didn’t want to kill him but something kept telling me to kill him,” Cohen told the officers. “He had me overpowered and I couldn’t do it.”
Flooded with adrenaline, Randy broke free and ran out of the house. He returned to find Cohen in handcuffs, being guided into a police car. When a police detective interviewed Randy that afternoon, he warned him not to let his guard down. “He said, I wouldn’t even want him back in the house,” Randy said. “He’s going to kill you, this is what they told me. I’m like — what?”
There is a logic that drives people in psychosis to develop delusions around family members, say researchers who study it. The most common form of delusion is persecutory, and can develop because individuals misread ambiguous or social cues as hostile. The more interactions occur, the more likely this is to happen.
When Cohen was released from jail, a month later, he knew he was lucky. In jail, a psychiatrist had prescribed him Zyprexa, an antipsychotic, and the voices quieted. Randy had dropped the assault charges, and the public defender advised Cohen to take a plea bargain that included a year’s probation and mandatory treatment and drug testing.
But he had been expelled from college. Even minimum-wage employers would Google him. Everyone in town seemed to know what had happened between them; the other inmates called him “Chewy.” And he wasn’t sure how to get along without Randy in his life. There was still a restraining order in place, and there was no question of living together.
This is where Cohen was — uncertain, bereft — when he saw Randy standing in the courthouse parking lot, waiting for him, smiling.
Randy held his arms out, and the two men embraced.
“I’m sorry, Dad,” Cohen told him.
“Don’t worry about it, son,” was the reply. “I love you.”
The long road home
Last month, nearly 10 years after the assault, I drove past silos and stubbled farmland to interview Randy and Cohen in Cohocton, a speck of a town 90 miles from the Canadian border. Randy’s double-wide looked spare from the outside, but inside, it was sleek and meticulously arranged, all earth tones and grained wood.
Cohen had recently become a father, and Randy — who still has the look of a biker dude — gently teased about his overanxious parenting. At 32, Cohen is now a social worker who oversees suicide prevention programming for New York’s Office of Mental Health. His hair is going gray. Randy has retired, and spends his time babying a 1968 Plymouth Roadrunner.
Both men are fine. Both are also burdened. They could have lost everything, they told me.
“That was pretty much the worst thing I could ever have gone through right there — having my own son try to. …” Randy said, trailing off. “I mean, I know it wasn’t my son. But what could have happened if he succeeded?”
Sitting in the room where it happened, Randy explained: He had not realized his son was psychotic. He had listened to Cohen’s discourses about Einstein’s theory of relativity, his fear that the sun was liquefying rocks deep inside the Earth. But Randy was a blue-collar guy. Cohen was an intellectual, the first person in his family line to go to college.
“I thought, man, he’s smarter than me, so he probably knows more than me,” he said.
There had been warnings, it turned out. A month before the attack, after buttonholing a professor to share his rapturous ideas, Cohen was detained by the local police and committed to a psychiatric hospital for five days for observation.
But Randy was skeptical of psychiatry; when he was Cohen’s age, he had been prescribed medication after a suicide attempt, but he stopped taking them as soon as he could. His attitude, he said, was “more pick up your bootstraps and do what you got to do.” On the way home from the hospital, Cohen admitted he had lied about his symptoms to get out. The two of them discussed whether Cohen should take the antipsychotic medication he had been prescribed, and decided it wasn’t necessary.
Now Randy knew these decisions had been catastrophic. He didn’t blame Cohen; what impelled him to violence, he told me, was an external force.
“That was outside him,” he said.
But there was no denying it — on some, almost cellular level, Randy was afraid of his son after the attack. Through that summer, every few weeks, Cohen would ask again: Could he come home? The idea made Randy anxious. He was a deep sleeper. What if Cohen came at him in the middle of the night?
Finally, after six months had passed, Randy agreed Cohen could come home.
“You love your child enough,” he said, “you do anything possible to make him happy. That’s what it is to be a parent.”
But quietly, without telling his son, he installed a lock on the inside of his bedroom door. On the table beside his bed, under a cloth, he tucked a knife.
The weight
Cohen carries his own burden. Only luck, he told me, separated his fate from Nick Reiner’s.
“He stepped over that line,” he said. “And I didn’t.”
One of the ways Cohen has tried to make amends is by talking as much as possible about what it is like to become lost in psychosis. He speaks to audiences. He fields questions from worried parents. He has become part of the network of families putting the pieces back together after a burst of violence that resulted from mental illness.
“I feel like I’m in a position to speak from a perspective that no one else can, because I did live through it, and I came out the other end,” he said.
His memoir, “Mending Reality: An Advocate’s Existential Journey With Mental Health,” was published last summer by Post Hill Press. In it, he describes being overtaken by a sense of mission that blotted out both fear and pain; he describes navigating a world swarming with presences that were undetectable to those around him.
This responsibility is especially grave because he no longer takes antipsychotic medication. Over the course of a year after his release from jail, under the supervision of a nurse practitioner, he very slowly reduced his dose of antipsychotic medication to zero. He stopped using cannabis, which he believes contributed to his break.
He compares his mental illness to diabetes or cancer, a chronic condition that requires constant vigilance. Almost four years ago, he went on a third date with Elizabeth Finger, whom he had met on Facebook Dating. She was a social worker, like him. She had thick, wavy blond hair and, at 31, was looking to settle down.
As he dropped her off at her car, he turned to her. He needed to tell her about a mental health crisis he had gone through seven years before. When he finished, he asked her to think seriously about whether she wanted to keep seeing him.
“He said I would find some stuff on Google,” she said. “I sure did.”
Outside the window
Friends in the field gently advised her to break it off. Someone diagnosed with schizoaffective disorder, they told her, won’t ever be able to have a stable life. But as the months went on, Elizabeth realized that she trusted Cohen, in part because he was so gravely serious about what had happened. She feels sure that, if his symptoms return, he will seek help before they become severe.
They are both willing to take that gamble. He watches closely for twinges, which tend to come on when he is sleep-deprived or under stress. He has plans lined up — naps, crisis lines, medication.
But life barrels forward, plan or no plan. Three months ago, after a 24-hour labor, their daughter was born, a six-pound baby with round, cherry-blossom cheeks. Both Elizabeth and Cohen had been awake for two nights.
Afterward, he sat up with the baby so Elizabeth could sleep. He gazed out the window into the darkness, and suddenly everything looked wrong: A tree right outside seemed to be liquefying, and melting upward into the sky. Cohen stepped closer to the window — was he imagining it? But it was still there, cascading up in the darkness, an unnatural backward waterfall.
He takes mental notes when this kind of thing happens. “This is a potential hallucination,” he tells himself; putting it into words drains some of the power away. In the morning, he stepped back to the window, and the world slid back into its normal grooves: Behind the tree, through the darkness, a smokestack was belching clouds of exhaust.
That day, as they prepared to leave the hospital, Cohen told the midwife that he was apprehensive about his psychosis returning, and she was warm and encouraging — it’s a rare father who is open enough to ask about his symptoms. She printed out a list of hotline numbers and support groups for him, the handouts commonly offered to people who are living their lives while navigating mental illness.
Then Cohen buckled the baby into a seat in the back of the car, and they headed home.
Ellen Barry is a reporter covering mental health for The Times.
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