For years, April Burrell could often be found near the nurses’ station at a psychiatric hospital in New York State.
She rarely interacted with the world around her. She needed help with basic daily activities, resisted physical contact and appeared unable to recognize the relatives who traveled hundreds of miles to see her.
This was not the life anyone had imagined for April.
Before her illness, she had been an exceptional student with plans for a career in accounting. But at 21, her life changed abruptly. She began experiencing hallucinations and severe psychiatric symptoms and was eventually diagnosed with schizophrenia.
Her condition became so profound that she spent years in a state of catatonia.
Various treatments followed, but the young woman her family remembered never fully returned.
More than two decades later, however, doctors decided to reconsider something fundamental.
What if April’s psychiatric symptoms were only part of the story?
The investigation that followed revealed evidence of an autoimmune disease affecting her brain. After intensive treatment aimed at suppressing that immune response, changes began to appear that her family had waited decades to see.
April started reconnecting with the world.
Her story is extraordinary, but its real significance is more complicated than the viral version of a woman who simply “woke up after 20 years.”
Before the illness, April was building a very different life
April grew up in Baltimore as one of seven children.
Her family remembered her as bright, sociable and intensely driven. She played volleyball and excelled academically, eventually graduating at the top of her class.
Numbers came naturally to her.
She helped her father with financial records and property management and later enrolled at the University of Maryland Eastern Shore to study accounting.
She was also remarkably practical. Her family recalled a young woman who could handle tasks ranging from bookkeeping to household repairs.
Then, in 1995, when April was 21, her family received a troubling call from one of her professors.
Her behavior had changed dramatically.
She became incoherent and began experiencing visual and auditory hallucinations. A traumatic event reportedly preceded the onset of her symptoms, although details have remained private to protect her.
April was hospitalized and eventually diagnosed with schizophrenia.
Her family initially tried to care for her at home, but her needs became overwhelming.
By 2000, she had been admitted for long-term psychiatric care at Pilgrim Psychiatric Center on Long Island.
Her family kept making the journey
April’s relatives lived hours away in Maryland, yet they continued visiting her once or twice a month.
The person waiting for them was profoundly changed.
She often did not recognize them. She disliked being hugged or kissed and appeared largely disconnected from her surroundings.
There were occasional fragments that seemed strangely connected to her former life.
At times, April would talk to herself about financial transactions or move her fingers as though she were working through calculations.
For her family, those moments must have been difficult to interpret. The woman who had once been so comfortable with numbers appeared to be somewhere behind the illness, but they had no reliable way of reaching her.
Meanwhile, doctors tried established psychiatric treatments.
April received antipsychotic medications, mood stabilizers and electroconvulsive therapy.
Nothing produced the recovery everyone hoped for.
A medical student remembered her for nearly two decades
Around the time April arrived at Pilgrim, a Dutch medical student named Sander Markx was working there as a Fulbright scholar.
April was the first patient he encountered.
She also became one he could not forget.
Markx later described her as among the most severely ill patients he had ever seen. She would sit near the nurses’ station staring ahead, unable to care for herself or participate meaningfully in ordinary life.
At the time, Markx was only a student. There was little he could do to alter the course of her treatment.
His career moved forward.
He became a psychiatrist and researcher at Columbia University and developed an interest in precision psychiatry — an approach that seeks to understand the individual biological mechanisms that may contribute to psychiatric symptoms rather than relying exclusively on diagnostic categories.
Almost 18 years after first meeting April, one of his younger colleagues, Anthony Zoghbi, visited Pilgrim.
When Zoghbi returned, he described a profoundly catatonic woman he had encountered near the nurses’ station.
Markx immediately recognized the description.
He asked whether her name was April.
It was.
The patient he had met as a medical student was still there.
This time, the investigation went much further
With her family’s consent, April underwent an extensive medical reevaluation.
This was not simply another routine psychiatric assessment.
A multidisciplinary group of more than 70 specialists became involved, including psychiatrists, neurologists, neuroimmunologists, rheumatologists and medical ethics experts.
The investigation began revealing abnormalities that demanded attention.
Blood testing showed numerous autoantibodies, suggesting abnormal immune activity against her own body. Brain imaging also revealed abnormalities involving her temporal lobes, regions that play important roles in memory, emotional processing and other cognitive functions.
Eventually, the team concluded that April had systemic lupus erythematosus with neuropsychiatric involvement.
Lupus is an autoimmune disease in which the immune system mistakenly attacks the body’s own tissues. It can affect the skin, joints, kidneys, blood vessels and other organs.
It can also affect the nervous system.
Neuropsychiatric manifestations of lupus can include cognitive difficulties, mood disturbances, seizures and psychosis. Catatonia has also been reported, although it is uncommon.
April’s presentation was particularly difficult because she apparently lacked some of the more recognizable physical signs commonly associated with lupus.
Her illness had manifested primarily through her brain and behavior.
Was her schizophrenia diagnosis simply wrong?
This is where a careful reading of April’s story matters.
It is tempting to reduce the case to a dramatic sentence: doctors thought she had schizophrenia for decades, but she actually had lupus.
The medical reality is more nuanced.
April genuinely experienced severe psychosis and met clinical criteria consistent with a serious psychiatric disorder. Her symptoms were not imaginary, nor was an autoimmune explanation necessarily obvious when she first became ill.
What changed was the understanding of what might be contributing to those symptoms.
Medicine’s knowledge of the relationship between immunity and psychiatric illness has expanded considerably.
Researchers now know that certain autoimmune neurological diseases can initially resemble primary psychiatric disorders. Anti-NMDA receptor encephalitis, for example, can begin with hallucinations, paranoia, agitation or other dramatic behavioral changes before additional neurological signs emerge.
The concept of “autoimmune psychosis” has consequently received increasing scientific attention.
An international consensus published in The Lancet Psychiatry in 2020 proposed a cautious framework for identifying patients whose psychosis might have an autoimmune origin.
That does not mean most cases of schizophrenia are caused by autoimmune disease.
It means that, in selected patients, doctors may have good reasons to investigate beyond a primary psychiatric diagnosis.
Doctors decided to target April’s immune system
Once the team believed an autoimmune process was contributing to April’s condition, they faced another question.
Could treating it make a difference after so many years?
April underwent an intensive course of immunosuppressive therapy.
Her treatment included high-dose intravenous corticosteroids, cyclophosphamide and rituximab. These are powerful medications capable of suppressing or modifying immune activity, and they carry potentially serious risks.
There was no guarantee that decades of severe illness could be reversed.
Yet clinicians began noticing changes.
One way they tracked April’s cognitive abilities was with the Montreal Cognitive Assessment, commonly known as MoCA.
One task involves drawing a clock.
Before treatment, April’s attempt was little more than an unrecognizable scribble.
After the first treatment cycles, something resembling part of a clock appeared.
Later, she produced a nearly complete one.
It was a small drawing on a piece of paper.
For the medical team, it was evidence that something significant might be happening.
Then her doctor walked into the dining room
Improvement did not happen all at once.
April continued experiencing psychiatric symptoms, and there were moments when members of her medical team questioned how much recovery was possible.
Then Markx walked into a dining room where he expected to see the patient he had known for years.
At first, he thought she wasn’t there.
A woman in the room looked different. Her posture had changed. Her facial expression was different. She seemed more present and engaged with her surroundings.
It took him a moment to realize who he was looking at.
It was April.
After decades of profound illness, something in the way she inhabited the world had changed.
Her family began seeing signs of the woman they remembered
By 2020, April had improved enough to leave the psychiatric hospital and move to a rehabilitation facility.
The COVID-19 pandemic delayed the family reunion that followed.
When her relatives were finally able to spend time with her again, they did not find a woman magically restored to the person she had been at 21.
But they found something they had been missing for years: recognition.
April remembered the Baltimore home where she had grown up.
She remembered her academic achievements.
She recalled her brother’s wedding, where she had been a bridesmaid.
She recognized a niece she had last seen as a small child.
During a video call with her father, she noticed that he had lost his hair.
She laughed.
For a family that had spent years visiting someone who often could not recognize or embrace them, moments like these were enormous.
She did not literally “wake up” after 20 years
This distinction is important because April’s story is frequently summarized with language suggesting that she suddenly awakened after decades.
Catatonia is not a coma.
It is a complex neuropsychiatric syndrome involving disturbances of movement, behavior and responsiveness. Some people become nearly motionless and silent. Others may maintain unusual postures, resist movement or show repetitive behavior or agitation.
Catatonia can occur in several different conditions.
Historically, it was strongly associated with schizophrenia. Today, clinicians recognize that it can also occur with mood disorders, neurological diseases, metabolic disorders, infections, medications and autoimmune conditions.
April’s recovery was also gradual rather than instantaneous.
It unfolded over months of intensive treatment.
And it was not complete.
Reports about her case noted that she continued to require support and later experienced a setback when maintenance treatment was not administered as intended.
That detail makes the story less sensational, but considerably more important.
This was not a miraculous cure.
It was a complicated medical response in a patient whose condition had been considered largely irreversible.
Does April’s case mean schizophrenia is autoimmune?
No.
One remarkable patient cannot establish the cause of an illness affecting millions of people.
There is growing scientific interest in interactions between the immune system and the brain, and researchers continue investigating whether inflammation, autoantibodies or other immune mechanisms contribute to psychiatric symptoms in particular groups of patients.
There are also clearly established autoimmune neurological disorders that can produce psychosis.
But these patients represent a subset, not everyone diagnosed with schizophrenia or another psychotic disorder.
That distinction matters because the medications used to suppress the immune system can have serious adverse effects. April’s experience is not evidence that people with psychiatric illness should seek immunosuppressive treatment without an appropriate medical evaluation.
Instead, researchers have proposed specific warning signs that may justify further investigation in certain cases.
These can include an unusually rapid onset of psychosis, catatonia, seizures, movement disorders, altered consciousness, autonomic instability and unusual responses to standard psychiatric medication.
Depending on the circumstances, further evaluation may involve blood tests, brain imaging, an EEG or analysis of cerebrospinal fluid.
The goal is not to replace psychiatry with immunology.
It is to recognize that the two can sometimes overlap.
April’s case opened another question
After her improvement, researchers began examining other long-term psychiatric patients for evidence that autoimmune disease might be contributing to their symptoms.
Another patient described in connection with this work was Devine Cruz, a woman diagnosed with schizoaffective disorder and intellectual disability who had already been diagnosed with lupus during adolescence.
After receiving immunosuppressive treatment, her hallucinations reportedly stopped and her ability to distinguish real voices from those produced by her illness improved substantially.
The two women’s histories are sometimes mixed together in online retellings.
April was not the patient known to have lupus from approximately age 14. That detail belongs to Devine’s story.
The distinction illustrates a broader problem with extraordinary medical stories: once they begin circulating online, details can migrate from one case to another until the simplified version becomes more familiar than the documented one.
The most important part of April Burrell’s story isn’t the miracle
It would be easy to end this story by saying that doctors finally discovered the “real” disease and gave April her life back.
Reality does not offer such a neat ending.
She did not regain the decades she had lost.
Her recovery was incomplete, and she continued to need medical care.
Nor does her case overturn what medicine knows about schizophrenia.
What it does show is why some unusual psychiatric presentations deserve another look when there are clinical reasons to suspect something more.
The brain does not exist separately from the immune system or the rest of the body. A biological disease can sometimes produce symptoms that look overwhelmingly psychiatric, and different medical mechanisms can lead to surprisingly similar outward behavior.
For most patients, another investigation will not uncover the same explanation doctors found in April.
But for the small number whose psychiatric symptoms are connected to a treatable neurological or autoimmune process, recognizing that possibility can change the course of a life.
For more than 20 years, April’s family continued visiting a woman who often seemed unable to recognize them.
Eventually, she could remember their shared past again.
She could hold their hands.
She could look at her father on a screen, notice how much time had passed — and laugh.
Perhaps that is what makes her story so difficult to forget.
Not that medicine discovered a universal answer, but that after decades in which there seemed to be no more questions worth asking, someone decided to ask again.
Sources
Richard Sima, A Catatonic Woman Awakened After 20 Years. Her Story May Change Psychiatry, The Washington Post, June 1, 2023.
Thomas A. Pollak et al., Autoimmune Psychosis: An International Consensus on an Approach to the Diagnosis and Management of Psychosis of Suspected Autoimmune Origin, The Lancet Psychiatry, 2020.
Columbia University Irving Medical Center, reporting and institutional material concerning April Burrell, Sander Markx and precision psychiatry.
Peer-reviewed medical literature concerning neuropsychiatric systemic lupus erythematosus, catatonia and autoimmune causes of psychosis.