Though This Be Madness

Mad let us grant him, then: and now remains / That we find out the cause of this effect / Or rather say, the cause of this defect / For this effect defective comes by cause... — Hamlet, Act II, Scene 2

Part III: Diagnosis

When Professor McGonagall leads the boy into my office, he looks ... dead. There is simply no other word to describe him, this walking corpse she has to help into a chair. Even help is an understatement. Minerva lowers him into the seat and then arranges his limbs so that he will not simply spill out onto the floor.

Severus is here because Lily Evans reported that he attacked her in the bathroom Moaning Myrtle frequents. Although in his present state I can hardly imagine his having attacked anyone, I feared it might come to this. The last thing I wished to do was relegate him to the hospital wing permanently. I wanted to give him as much freedom as could reasonably be allowed. He is at Hogwarts to learn, after all, and he can hardly do so if continually tied to a bed. If he does indeed pose a danger, however, then I am afraid he will have to remain in Poppy's care until we can shed some light on his ailment.

Once Minerva straightens she is pale, and I'm sure I am, as well. I am only half-conscious that I have been staring at him for a long moment. Not even the portraits that line my office walls feign sleep, though one is clearly more concerned than the others. Considering that Everard Prince is the boy's great-grandfather, I can understand his interest. I shake my head, however, ever so slightly, to indicate that I shall explain once I have a little more privacy. I hope he understands.

When I turn toward Professor McGonagall and nod, she takes her leave, closing the door softly behind her.

"Severus?" I ask, surprised at the timidity in my own voice.

He is not surprised, however. He's not ... anything. He shows no more awareness of my presence than that of the man in the moon. I call his name again, a little louder, more forcefully ... but he simply sits there, staring off into space. The only movement I perceive is a slight vibration on his head, probably caused by insects crawling through his filthy, matted hair.

Hard to believe now, but a few years ago Severus' hair was quite nice: every bit as long as mine, but he kept it clean at least, even if he could not always be bothered to run a comb through it. Now, like every other aspect of his hygiene, his hair has suffered unduly. His head will probably have to be shaved, as Madam Pomfrey cannot abide lice in the hospital wing.

Briefly I wonder how his Head of House could have allowed him to degenerate into such a state, before I remember who, exactly, his Head is. I imagine Professor Slughorn would find the task of bathing Severus himself as distasteful as kissing an acromantula. And the boys with whom he shares a room would be understandably hesitant to assist him after the last episode in the showers.

Poor Severus. He really is quite alone in the world now.

I call his name again, and then I snap my fingers in front of his face, but my attempts are in vain. When I clap my hands together barely an inch from his nose, he does not so much as flinch. I can but wonder what is happening behind those unfathomable black eyes.

I hesitate to use Legilimency, and especially on a student, because in my opinion reading a person's mind is only a small step away from controlling a person's actions with the Imperius Curse. A small but important step, I remind myself, as I step closer and stare deeply into his eyes.

"Legilimens," I whisper.

And I find ... nothing. His mind is a void—every bit as blank and impenetrable to my scrutiny as his expression.

Some will tell you a wand is a necessity, and I suppose it is for those who are new to magic. The more practised one becomes at spell casting, however, the less essential one's wand tends to be. That little cone of wood with its magical core only acts as a focal point for one's power. And I, who am one of the more powerful wizards living, even if I do say so myself, rarely need my wand for routine tasks. Yet this task is far from routine. For whatever reason, our Mr Snape appears to be an occlumens naturalis, although none are reputed to exist.

I draw my wand and try again. At first my search still proves fruitless. Only a few harmless memories manifest: a toddler playing with blinking wooden blocks ... a small boy trying to mount a bucking broomstick while a girl claps and shrieks with musical laughter ... a larger boy fetching potion ingredients for his mother. But then I run headlong into a wall, stronger even than the protections on Hogwarts grounds.

The oddest thing is this wall does not seem to be of Severus' design. The energy feels so very unlike him. I imagine he does not even know the barrier exists. I prod the wall with my mind, gently at first, only testing the strength at different points. When I find a weak spot—a point I think I can exploit for entry whilst doing the least amount of damage possible—I give a mighty shove.

I break through and all at once I am bathed in bright light and colours: greens and blues, reds and yellows, in odd shapes and every orientation imaginable, all dancing to a tune that normally only Severus can hear. These spinning thoughts are unlike any I have seen before. Suddenly dizzy, I reach out as I instinctively grasp for something I can lean against to steady myself, but there are no such supports inside the mind. Therefore I close my eyes and breathe slowly through my nose to master the wave of nausea.

I have always been amazed at how much easier it is to think when one blocks out extraneous stimuli. In the short moment that I have my eyes closed, I realise to my astonishment that the boy's mind is somehow encoded. Over the din, I hear something else: An urgent whispered plea floats past me, as if the words were carried on the breeze.

"Help me! Oh, God! Somebody please help me!"

The shock of a coherent message drowning in the disorienting sea of psychedelia hurtles me backward. I land with a jolt in my own mind in my office. Severus has stiffened in the chair in front of me, gripping the arms with trembling white knuckles, a look of horror frozen on his features. His eyes roll, and he then slumps in the chair. I fear the shock may have hurt or even killed him, so I reach out a shaky hand to check for a pulse. He flinches at the slight touch and sits up after another moment, blinking as if becoming adjusted to bright sunlight.

"Oh, hello, Profess..." A smile curves his lips but falters before it reaches his eyes.

* * * * * * * * * * * * * * * * * * * * *

"'Ere! Put it down there."

"Why do you want this thing?"

"That boy. We got to keep an eye on 'im."

"'E's no danger to us, pet. 'Ow many times do I 'ave to tell you that?"

"I don't trust 'im. 'E attacked that girl in the bathroom. We might be next."

The revolting amount of white that greets me when I open my eyes immediately tells me that I'm in the hospital wing again. And again I'm bound to the mattress by my wrists, waist, and ankles. I raise my head as much as I can, straining to look around me in order to locate the Muggles. They sound so very close this time, but as usual, I can't find them.

"Let the dog in."

"I just put 'im out."

"Can't you 'ear 'im cryin' and scratchin' on the door? 'E wants in."

"'E was scratchin' on the other side and whingin' to go out not five minutes ago."

"Maybe 'e saw a cat."

Finally I relinquish the struggle and fall back onto the pillow. They're nowhere to be seen, though I wish they would shut up, since they're no longer talking about me. I try to block out their interminable prattle by focusing on the sound of my heartbeat reverberating into my ears from the pillow. A few deep breaths later, concentrating becomes easier. A moment after that it requires no effort at all. The repetitive thuds grow louder and louder until that's all I hear, and I drift off to the comforting rhythm.

* * * * * * * * * * * * * * * * * * * * *

I wake to a furious knocking on my door in the wee hours of the morning. At first I fear that young Mr Riddle has decided to throw caution to the wind and finally invade Hogwarts. But no—my watchers would have long since notified me if that were the case. Old bones take a while to set in motion, so as I pull on a pair of thick woollen socks to arm my arthritic feet against the cold stone floor, I call out to my visitor before the entire castle is roused.

"I shall be there in a moment."

Wriggling into my fuzzy pink dressing gown, I cross the room. To my relief, I discover that at my door is not a panicked deputy headmistress, but rather a beaming school nurse. Madam Pomfrey's hair is slung over her left shoulder in a braid, and she is wearing a blue bathrobe with matching mouse-shaped slippers. Her cheeks are flushed with the remnants of what I can only assume was a mad dash upstairs, and she thrusts an open book into my chest.

"I've found it!" she says in a triumphant whisper between rapid breaths.

I reposition my spectacles with one hand, even as I brush my whiskers off the pages with the other so that I can read. Then I blink. Apart from the literal meaning of the words—"premature dementia"—I must admit what is written on the yellowed pages holds little meaning for me, but I am no Healer.

"Dementia praecox?" I ask dubiously, feeling no closer to an epiphany now than when I was fast asleep. Madam Pomfrey nods rapidly, still grinning from ear to ear. I find myself reassured by her confidence, however, so immediately following a cavernous yawn, I smile as well. "Shall I put the kettle on?"

"No, I'll do it."

I nod and then jerk my head toward my small kitchen. "You know the way."

Once I have stepped aside to allow her entrance, I close the book, marking my place with a finger. After roughly three months spent in nearly continual conversation over the boy's condition, we have drunk buckets of liquid together, so she knows exactly where I keep all my tea things. And I know how fussing over people calms and centres her, as I am sure it does all Healers and mothers, so I allow it. Poppy bustles into the kitchen and launches into her explanation as I follow in her wake. Smiling, I sit at the kitchen table and again open the book.

"The disorder is more commonly known as schizophrenia these days," she says, pulling cups and saucers from the cupboards and arranging them carefully on a tray. "They've no idea what causes the condition, but a significant number of patients who develop the symptoms experienced viral infections in utero, such as his mother's influenza. Mr Snape is one of the lucky ones. Many schizophrenics are never diagnosed. For those who exhibit a gradual onset, the prognosis is very poor—"

"Meaning?" I ask, frowning as I worry that this disorder might end the boy's life before he has even had a chance to live.

She reads my expression all too accurately. "Oh, it won't kill him," she says with a shake of her head, "although upwards of ten percent of schizophrenics take their own lives. I only meant that he'll most likely always show symptoms. A quarter of schizophrenics recover fully from their first episode with no signs of a relapse. Half experience recurrent episodes, but also long periods of remission. And the rest show symptoms throughout their lives. The more gradual the onset, the less likely the patient is to ever be asymptomatic."

"What do you mean by gradual? He has only been acting oddly for a few months now."

She fiddles with the corner of a napkin, staring down at the tea tray and biting her lip. I know her quite well enough to know she is worried about telling me something. After another second or two, she drops the napkin with a small sigh.

"I think he's been having symptoms for at least two years. Such as his hygiene, for instance. They were simply too mild to recognise for what they were until he'd developed more pronounced symptoms recently."

Now I know exactly why she has been reticent. Oh how blind I've been! I stare down at my gnarled hands where I have clasped them together on the table in front of me. When Severus' parents were incapacitated, I swore I would do my very best to care for the boy, as if he were my own son. Alas, my best appears to have been far from adequate.

I look up when Poppy speaks again. Now wearing a curious expression, she has a finger pressed to her chin. "He's older, though. That is a point in his favour. When they develop symptoms at an early age—sometimes as young as eleven..." She sighs and taps my battered copper kettle with her wand, producing a thick cloud of steam. "Well, it's not good."

A moment later Poppy sets the tray between us on the table and pulls up a chair whilst I set to pouring us both a cup. "How do you know it is schizophrenia and not something else?"

Her brows knit again. "I don't. That is, I'm not completely certain—and I couldn't be without the father's records—but I've eliminated just about everything else. And his hallucinations are very telling, as are the disorganised thought patterns and speech. Two lumps," she adds distractedly, though I already have the second cube of sugar halfway to her cup. "His displaying emotions inappropriate to the current situation is also a common symptom. Plus his catatonia; the odd, rigid stances; catatonic excitement—"

"What is that?" I ask frowning and handing her cup over. "It seems like a contradiction in terms."

Poppy smiles briefly whilst taking the cup from my hand. She loves explaining the intricacies of Healing to laypersons—when she is not pressed for time. If she had a mind, I'd wager she would be every bit as good a teacher as a nurse.

"Excited motor activity ... rapid movement for no apparent reason. Such as the day Professor Slughorn said he was rushing about in Potions. I'm not sure what causes it, other than general agitation or perhaps stored up energy from the times he was in a catatonic stupor. And he ended up hurting himself, which is also fairly common. At times like those, schizophrenics require additional supervision."

I nod, and she continues.

"And I'd say his obsession with those Gryffindor boys points to paranoia and delusions of persecution.... It all seems to fit. At any rate, the treatment for all the symptoms is the same."

I set my cup down. "Treatment? There's no cure, then?"

She shakes her head, her frown becoming more pronounced. "No. But I've found a regimen of potions with antipsychotic properties that should diminish his symptoms a great deal, if not eliminate them altogether. I am no potion-maker, of course, but they all seem fairly easy to prepare. A brewer of Severus' calibre should have no trouble making them himself." She stirs in some milk with a slight frown and then rolls the cup between her palms for a moment before taking a sip.

"Psychotherapy is also recommended. It can help with feelings of powerlessness and isolation, and bolster healthy or positive tendencies. With time and therapy, he should also be able to learn to distinguish between psychotic perceptions and reality. And it can head off any problems with emotional conflicts that might exacerbate his condition. I'd say he should be able lead a normal, happy, fulfilling life ... with the proper treatment."

I nod, slowly taking in what she has said, and trying to imagine Severus seeking Muggle psychotherapy. Such a thing is virtually unheard of in the wizarding world.

"So, he will have to take these potions for the rest of his life?"

"Quite possibly," Poppy answers, nodding, after finally taking a sip. "The trick will be to find the minimum dosage that will alleviate his symptoms, which may take a while in itself. And if he builds up a tolerance, his dosages may have to be adjusted in the future. At least, I don't think we can assume that his symptoms will decrease as he grows older."

"Any particular reason?"

"Just..." She shakes her head and shrugs, again warming her hands on her cup. "The odds are against it. That's all."

"What exactly is schizophrenia, Poppy? What causes ... all this?"

I wave vaguely in the direction of the book, which lists the various types of schizophrenia and the symptoms of each, now I have bothered to read a bit. Of the three main types—hebephrenic (or disorganised), paranoid, and catatonic—Severus appears to be exhibiting symptoms of the latter two. According to this volume, that would make his particular condition undifferentiated schizophrenia, which appears to be a catch-all term for any type that does not neatly fall into one of the three main categories.

"Oh ... the disorder originates in the brain. Certain substances—Muggles call them neurotransmitters—communicate between the mind and the remainder of the body. In the case of hallucinations, the brain receives false signals from the senses, but with startling reality. The person is entirely convinced that whatever he sees, hears, smells, feels, or tastes is completely real.

"With catatonic episodes, though, I think it's just the opposite: the brain attempts to send signals to the body to move, but try as it might, the body doesn't respond. And there are structural differences in the brain, as well. Muggles sometimes use a photo they've taken of the patient's brain to aid in the diagnosis."

I have already opened my mouth to ask how Muggles photograph a person's brain when I realise that I would really rather not know. In spite of the resulting shudder, something in my mind puts these disparate bits of information together in a way that surprises even me. For now I stop just short of mentioning that I have invaded the area first-hand, but I cannot help thinking of that barrier I found inside Severus' mind.

If those colours and lights I encountered were these neurotransmitters Poppy mentioned, then they could not easily breach the barrier to get out, which could explain the catatonic stupor. And if they were bouncing around all over the inside of his head, I should not be surprised that Severus would hallucinate. I nearly did myself simply from being in their midst. Furthermore, if the barrier is dynamic and these substances occasionally find a weak point, as I did, many of them might come out in a rush, causing an episode of catatonic excitement.

And all this without a Pensieve. Perhaps age does breed wisdom, after all.

In a moment, I realise I must have been smirking because Madam Pomfrey is now staring at me with something akin to disapproval on her face. For the life of me, I cannot understand why so many people find smiling offensive. Then again, perhaps it is only when I smile.

I myself have never been much good at Occlumency, and any lies I attempt are usually transparent to anyone over the age of thirteen. There is no use in pretending: I shall have to explain.

"Forgive me, Poppy," I say, attempting to curb my grin, which only results in making me look every bit as triumphant as she did outside my door, I am sure. "How much do you know about Occlumency?"

"I've heard of it," she says, still looking dour. "But I'd be hard pressed to tell you what it is off the top of my head."

"It is an obscure branch of magic concerned with protecting the mind from external penetration." Her expression does not improve one bit. "The opposite is Legilimen—"

"Oh Albus, you didn't!"

Either she knows that term, or she has made an excellent guess. And as is the wont of nearly everyone in the wizarding world, she assumes that if I have heard of a certain power then naturally I possess and employ that power. Nothing could be further from the truth. Anyone who has read the most recent edition of Hogwarts: A History, for example, would know I taught Transfiguration, so I have heard of Animagi, but I myself was never able to master that particular talent. In this case, however, Madam Pomfrey happens to be correct.

I sigh softly. "I am afraid I did."

She opens her mouth to upbraid me most severely, I am certain, but I raise a hand to quiet her long enough to plead my case.

"In my own defence, I was terribly worried about the boy and would have done almost anything to discover what ails him."

That seems to have placated her, more or less, though her lips remain pursed and her posture stiff. I suppose that is enough to be going on with. Before she has the chance to build up a good head of steam to resume her tirade, I rise and place a hand on her shoulder.

"We had best wake Horace. I would venture that he has a long day of brewing ahead of him."

* * * * * * * * * * * * * * * * * * * * *

I wake again to the sound of a pulse. The heart in my pillow still beats loudly. It cannot be my pulse because my heart pounds in my chest in a different, panicked rhythm. But neither can I run from the sound. All I can do is turn my head from side to side to spare one ear or the other from the thundering noise for a few moments at a time.

Make it stop! Make it stop! Why are they tormenting me this way? What have I ever done to deserve this? I thought Professor Dumbledore was on my side, but I see him here sometimes, too, and I know he's at least complicit in my torture.

A hand suddenly slips in mine, and I grasp it with all my strength. Help me, please! Make it stop! Whoever owns that hand obviously cannot make the heart stop beating, but his words do comfort me all the same, however slightly.

"You'll be all right, Severus," he whispers in a voice that sounds oddly familiar. "Eventually Professor Dumbledore and Madam Pomfrey will work it all out, and you'll get better."

I cannot bring myself to risk opening my eyes, as I'm terrified of what I might see. Before I can beg him to help me, however, his hand is gone from mine and again I am alone with this beating heart pounding in my ears. I hope he's right that I'll get out of the hospital wing in the end, but I'm not sure what he means by I shall get better.

There's nothing wrong with me, is there?

* * * * * * * * * * * * * * * * * * * * *

I visit Severus daily when Madam Pomfrey administers his potions, and yet I cannot bring myself to touch him. Somehow I worry that doing so might make things worse. My heart feels as though it is being ripped from my chest every time I see him these days, but I know I would only be more worried if I did not check on him regularly. I daresay nothing is more frustrating than being one of the most powerful wizards living and being able to do absolutely nothing to help someone in pain.

Some days the boy seems almost lucid. At other times, he resembles a snarling caged beast more than a talented, promising young wizard. Poppy has infinite patience with him, no matter what he does. She never flinches, even when he bellows some of the most colourfully abusive language I have ever heard pass a teenager's lips. She also refuses to stun him whilst attending to him unless absolutely necessary. As a result, she has sustained at least two nasty bites that I know of. On the other hand, she maintains that if he were stunned all the time, we would never know when we have found the proper dosages. Not only that, but she says she would also miss out on the good as well as the bad.

Madam Pomfrey delivers the potions directly into a vein in Severus' arm with her wand. He cannot be trusted to drink them at the moment, as he might bite or spit them out. I know from experience how very painful such a procedure is. The poor boy usually whimpers the whole time and nearly chews through his bottom lip.

After she finishes for the afternoon, she places his arm back under the bedclothes as usual and then pulls the covers up under his chin. This time, however, Severus leans his face against her hand with a small smile. Today is clearly one of his good days.

"We'll get you better, Mr Snape," she whispers, stroking his cheek with the back of her hand. "I promise."

Although she soon flees to her office with a handkerchief pressed firmly over her mouth, I am glad she retained her composure at least long enough to whisper those few words of comfort to him, however empty they may be. She has been working assiduously on adjusting his dosages for over a month now, and we are both beginning to lose heart.

I take some small comfort, however, in a puzzling report I have recently received from Professor Flitwick. This morning Filius told me Severus has been steadily improving in Charms. Therefore I know not only that Madam Pomfrey will eventually find the proper dosages, but that I will also apparently request a Time-Turner from the Ministry on the boy's behalf, so that he will not have to be held back a year. I suppose I should borrow some Muggle psychiatry books from Madam Pomfrey without unnecessary delay, as I intend to counsel Severus myself. Any day now he will likely show up at my office for an appointment I have yet to schedule.