For centuries what we now know as neurosyphilis was treated like any other severe psychiatric disorder.  The unfortunate victims were institutionalized, often in reprehensible conditions.  No specific therapy was available, and the disease ravaged Europe for centuries.

A biological cause for the disease, a bacterium called Treponema pallidum, was discovered in 1905.  Eventually, penicillin was found to be a curative treatment and is still the first line of treatment for syphilis today. 

A Cautionary Story 

The syphilis story humbles thoughtful physicians.  How many other cryptogenic (something of unknown origin) diseases do we commonly deal with, only to eventually discover organic causation that has specific, highly effective interventions?  Chronic Fatigue Syndrome (CFS ) comes to mind.  This is a debilitating disease that, provocatively, frequently follows a viral infection.  Afflicted patients are often thought to have pure psychiatric problems, but scientists have worked very hard to find an organic cause.

Peptic Ulcer Disease

If a causative organism for CFS is found, this would be far from the first time that the understanding of a disease process has changed.  Peptic Ulcer Disease (PUD) is another condition that seems to have been around for millennia.  It is characterized by chronic, intermittent abdominal pain, sometimes with severe complications such as bleeding from the stomach.  Emphasis on gastric acid as the culprit has traditionally conditioned treatments aimed at neutralizing acid or blocking its production.  Even with these modern interventions, severe complications still occur.

Along comes the paradigm shift.  Traditionally, PUD was attributed to lifestyle factors like diet and stress.  In 1982, however, the bacterium Helicobacter pylori was found to be present in the stomach lining of most people with PUD.  The presence of acid is still an important therapeutic target, but treating the infection with a two week course of antibiotics cures the disease in most cases.  This has correlated with a decrease in the incidence of upper GI bleeding by 23 percent.

Another Surprise… Maybe

In the context of the above, an article in the July 29, 2025 issue of The New Yorker was arresting.  It details the story of a woman who suffered a psychotic break in her twenties.  She received the conventional therapy of anti-psychotic drugs, counselling, and frequent intermittent institutionalization.  Her diagnosis was schizophrenia and she had a typically rocky and miserable course over 20 years.  Until she got better.

Three percent of adults in the US experience a “single psychotic episode” once in their lives.  It is characterized by hallucinations, delusions, disorganized thought processes, and strange behavior in general.  This disorder typically lasts a short time (two to four weeks), resolves on its own, and never recurs.

Mary, the subject of the New Yorker piece, was not so lucky.  She was sick for about two decades, until, in one of her frequent hospitalizations, she was found to have a lymphoma, a sometimes fatal form of cancer.  She was treated with chemotherapy and rituximab, a medication that attacks antibodies involved in the body’s immune responses.  Within two months, she began to be more social, displaying interests that she had forsaken for years.  When she completed the therapy for her lymphoma, she was psychologically and cognitively normal.  

Mary’s family was wary, but the improvement endured.  One of her daughters searched the medical literature and found that Mary was not alone in her improvement from psychosis after her treatment for lymphoma.  There were many such case reports, and the common denominator was the immune modifier, rituximab.

She also discovered researchers who specialized in the study of mental illnesses that have been relegated to the “functional” category,  That is, illnesses for which there is no known cause.  Neurosyphilis is the object lesson. 

Some researchers have found antibodies that can be linked to psychiatric symptoms, suggesting that schizophrenia, or some forms of it, is an autoimmune disease (this occurs when the body makes antibodies against its own tissues, such as in lupus).  One prominent medical scientist has proposed a new category of mental illness called “autoimmune psychosis.”  

Studies to identify patients who might benefit from immune modulation are ongoing.  Even if this is a small subset of patients  with what we call “schizophrenia,” the benefit for millions would be incalculable.

Medical Science

Much work is to be done before it is clear that autoimmune psychosis even exists and that specific therapies are safe and beneficial.  Medical science, and science in general, works deliberatively, testing hypotheses, rejecting hypotheses, and going on to new ideas.  But serendipity often plays a big role in the  advancement of science.  This was true Mary’s case, and there is nothing wrong with this.

As one very wise individual once said: Chance favors the prepared mind.