My paternal grandmother had a diagnosis of paranoid schizophrenia. In 1921 she developed the delusion that my grandfather was seeing other women, that the newspapers were writing about it, and that he was poisoning her food. My father, who was four years old at the time, remembered his father taking him and his five brothers and sisters out into the yard in a dramatic episode during which my grandmother made these accusations while throwing dishes at my grandfather in the kitchen. The disturbance frightened the neighbors, who called the police. The Mounties arrived in an open touring car. They entered the house and took physical control of my grandmother. She was placed in restraints and put in the car. She was taken to the local mental hospital and never came home. She spent about ten years in that mental hospital and was then transferred to the infamous provincial hospital for the chronically mentally ill, about 120 miles away, where she remained until she died of uterine cancer in 1955.

My grandfather—"Pop," as he was called—lived with my aunt and uncle. This living arrangement seemed perfectly normal to us grandkids. Pop had his own bedroom in their house and lived a good life until he died. The thought never occurred to me that the "grandma person" was missing. It was not until my Dad received a telephone call telling him that his mother had died that my sister and I had the first thought that our Dad had a mother. In fact, as we sat at the lunch table, we looked at each other and whispered, "Dad had a mother!" It was impossible for either of us to even conceive of her existence. That was how well the family was defended against the embarrassment and stigma of her mental illness. Family members had made her absence from the family "alright," pictures of her were taken down from the mantelpiece, and her existence faded from memory.

Although my father, aunts, and uncles did attend my grandmother's funeral, no further discussion about her life or the circumstances of her death reached the grandchildren. There was nothing more than the transient awareness that she had died, which for my sister and I lasted no longer than the duration of the telephone call that Saturday afternoon. And we never spoke of her again; it seemed "OK" to let it pass.

Her memory was not further activated until the second week in my residency in psychiatry, when I asked myself why I had made a career change. All through medical school I had planned to be a family doctor—a general practitioner, as they were known then. But the subspecialty of family medicine was just beginning, and, after graduation, I was able to choose a family practice rotation instead of the usual rotating internship. This rotation offered me the opportunity to spend the first six weeks in psychiatry. I liked it so much that I decided to undertake one further specialty year of study before I started general practice.

It was during the second week of that specialty year, in 1969, that my grandmother came to mind. So I wrote a letter to the superintendent of the hospital and asked whether there was a record of her hospitalization. I identified her by name, Franziska Maier, and said I thought she had died in 1955. Several weeks later the superintendent sent me a two-and-a-half-page letter confirming that my grandmother had been committed under the Mental Health Act in 1921, had chronic paranoid schizophrenia, was delusional and regressed as she aged, and died of uterine cancer. She was buried in the cemetery on the hospital grounds. She was pregnant when she was initially admitted to the hospital in 1921. The baby girl was put up for adoption at the request of my grandfather, and there was no further record of her whereabouts.

I shared the superintendent's letter with my father, who was more or less pleased. He said it seemed to confirm what his brothers and sisters remembered. During the conversation I suggested that we might disinter my grandmother, bring her home, and rebury her in the family plot with Pop. However, this suggestion was met with a wall of anger; I was told not to play psychiatrist with the family and to leave it alone. I did not bring it up again. However, over the years, as I thought about it, I quietly made plans for my cousins and myself to bring Grandma home when my father and his siblings had passed on. I made the prearrangements and put the information in a folder, which I kept at the office. Time passed.

Then, in 1995, one of my father's brothers died, and then one of his sisters, about three months apart. After the second funeral my father called me and said, "We had better get that done." The way he said it, I knew just what he meant. He said he would take charge of the "project," the one I had referred to more than 25 years earlier. I told him that I had a folder that contained the information needed to start the process. (I had talked with a local funeral home and with an attorney, and I knew how to proceed.)

So he took over the project, and in 1996, on Labor Day—75 years after my grandmother had been taken from the family home—she was disinterred, cremated, and reburied with my grandfather. The gravestone was modified to include her name and the dates of her birth and death along with those of my grandfather. Two of her children and five of her grandchildren plus other family members were present at the graveside for the ceremony. My sister, an Episcopal priest, composed a prayer. We found a picture of Grandma in a box that had been kept under my aunt's bed. We put the prayer and her picture into envelopes and gave it to her grandchildren and to some of the great grandchildren. The process, plus the ceremony, brought a kind of closure for many members of the family. For me it had been a long, painfully denied, but successfully resolved process.

At the "party" that followed the ceremony, some of us wondered why we had not brought her home earlier. What I realized was how difficult it had been moving our family secret from repression and denial into consciousness. But more important, that day I celebrated the sense of just satisfaction that radiated from Dad at the party. It was then that he told me that after my initial suggestion to disinter her, he had mulled the idea over for five years before he contacted his siblings and suggested they mark her grave on the grounds of the mental hospital. She had been buried in a known plot in the hospital graveyard but without a grave marker. So they bought a marble headstone and marked her grave.

He also told me that one day in 1948 he was driving on the main highway between the two main cities in the province when he passed the town where his mother resided. He could see the main mental hospital building about one mile from the highway. He decided to try to see her. He went to the hospital, identified himself, found that she was there, and asked whether he could visit her. They brought him to a sunroom, where she was sitting, alone, in one of those old wicker chairs, knitting. He told her he was her son. She smiled. He tried to talk to her, but she made no verbal reply, instead continuing to smile and knit. The whole encounter lasted perhaps ten minutes. He left. He was baffled by the lack of communication. He was pleased that he had made the effort and told my mother about the visit. Nothing more was said. Upon sharing this last memory, we marveled that we had done anything at all and felt a kind of peace about the events of the day.

There are other aspects of the story, but I am sharing this story now, with this perspective in time, because the stigma of mental illness is deeply entrenched in our psyche. The fear of losing control over one's life—and over one's relationships with people whom one loves dearly—is a powerful force. My grandmother, who by today's standards would probably have benefited from neuroleptic medication and gone on to live a reasonably good life supported by her family, perhaps with serial hospitalizations, could not receive anything like modern treatment. Furthermore, once my grandmother was moved from the local mental hospital to the distant provincial hospital, my grandfather, who walked ten miles to the local hospital once a month, had to stop visiting. Furthermore, my aunt once told me that Pop had said that grandma did not respond to him when he visited with her, so he must have come to believe that they had no meaningful relationship—or worse, that her silence indicated a judgment. Thus her existence slipped from memory. She was forgotten, repressed. There was no grieving, no discussion, no debriefing, just time moving on. She was for all intents and purposes dead. Attempts to find my long-lost aunt who had been put up for adoption failed to find any trace of her.

There are times when I think back on why I decided to go into psychiatry, and I conclude that I was the grandchild given the unconscious family assignment of bringing Grandma home. That meant helping the family, but mainly my Dad, face the fear and sadness of her loss, and the anger that covered his helplessness. I have spent a majority of my career in "institutional psychiatry." I have needed to work through powerful countertransference-related feelings toward staff who have made decisions about patient care on the basis of fear or anger. It took some time for me to identify one of the principal sources of my intolerance in this area. But if you looked at my published papers on managing aggression, identifying and working through countertransference issues, and its relationship to the development and maintenance of a therapeutic alliance, it is a significant theme.

Dr. Maier is on staff at Mendota Mental Health Institute in Madison, Wisconsin. Jeffrey L. Geller, M.D., M.P.H. is editor of this column.