To tell the story of Bertha Gifford, it's necessary to tell a little of the story of arsenic itself.

The first verifiable test for arsenic poisoning was created in the 1830s by James Marsh.

The Romans had laws regarding poisoning as early as 100 BC, and the ancient Assyrians had knowledge of arsenic centuries before that.

Despite its deadly properties, arsenic has historically been used to treat everything from asthma to skin cancer.

It was still the main treatment for syphilis until the 1940s, when penicillin became widely used cosmetically.

Arsenic was also found in many of the beauty treatments of Bertha's time.

An advertisement from 1904 promises that Doctor Campbell's safe arsenic complexion wafers and Foulds medicated arsenic so have been used by actresses, society ladies, and people of refinement everywhere.

They had never failed to give a perfect complexion, and they are guaranteed to be absolutely safe.

Bertha was born into a world where arsenic had been hailed for its healing properties, but its history as a poison was equally well known, and it can be a painful way to die.

The effects of lethal arsenic poisoning can include intense nausea, vomiting and abdominal pain, difficulty swallowing, headaches, confusion, numbness, and tingling of the extremities, rashes, peeling of the skin, rapid heartbeat, and low blood pressure.

Cramps.

Muscle weakness.

Dimming vision.

Intense bloody diarrhea.

Blood vessels leaking plasma into the surrounding tissue.

Cerebral bleeds and dead tissue across gray and white brain matter.

Respiratory failure.

Acute renal failure.

And seizures.

Many times, death is ultimately caused by cardiovascular collapse and hypovolemic shock, where there is no longer enough fluid left in the body for the heart to pump the blood and oxygen needed to stay alive.

These severe symptoms can sometimes last multiple days before death.

The trial of Bertha Gifford, a middle aged farm wife and self-trained rural nurse, began on November 19th, 1928.

The Franklin County Courthouse was standing room only.

The rows filled with reporters, white collar professionals, suntanned, farmers, elderly women and young mothers with children of all ages.

The crowded courtroom listened to the judge read off a single charge.

The murder of Edward Brinley by arsenic poisoning.

There may have been some murmurs in the gallery.

By now, the rumors had moved beyond local gossip.

Berthas alleged crimes had made the newspapers.

They suggested that there were more deaths, many more.

But how much of it was true?

Bertha and Henry Graham were married in December of 1894, in the parlor of Buren's Hotel in Hillsboro, Missouri.

They had one daughter named Lila.

The marriage was not a happy one.

Eventually, both Bertha and Henry had other lovers.

supposedly what happened was that Henry got interested in another woman.

And so then Bertha started kind of paying attention to this, younger man named, Eugene Gifford.

Henry was seen around town with somebody else dating somebody else.

That apparently angered Bertha.

All of this is just from family stories handed down.

Bertha had also been seeing somebody else.

She'd been seeing Gene Gifford, and Gene was ten years her junior, so she was 30.

He was 20, but they were dating.

Henry was dating somebody else.

Sometime in late August or early September of that same year, Henry Graham contracted some sort of ailment, likely pneumonia.

It was bad enough that he was sent to DeSoto, where he was seriously sick with complications of diseases.

Most people assumed he would die.

It was even falsely reported that he had.

Henry was eventually well enough to move into the Commercial Hotel in Hillsboro.

His parents came to visit on October 29th, where they found him confined to his room.

He would never recover.

Henry died in his bed on November 3rd, 1906.

Henry Graham came down with pneumonia while he was sick with pneumonia.

Bertha was at his side.

However, one ancestor says that he died vomiting, So it is rumored that Bertha assisted her first husband in his transition to the other side.

But there's no evidence, no solid evidence other than family folklore to substantiate that.

Henry died, supposedly kind of mysteriously, a lot of the things that we hear about the mysterious deaths, though, that took place in Bertha's, life were kind of weren't really considered mysterious at the time.

They were kind of considered mysterious in retrospect.

Bertha received $150 from an insurance policy after Henry's death.

She would marry her young man, Gene Gifford, on September the 1st, 1907.

In the lobby of the same hotel where her previous husband had died just ten months earlier, And she went ahead and married Eugene, and they moved to Catawissa, Missouri, which is along the big River.

And started settling in the community there.

She was accepted into the community.

She started, blossoming as a local nurse, which is not what you would think of now.

There was no education other than, she had potions that she had made up for various things that were probably herbal based.

So she started nursing anyone who would be ill in the, in the neighborhood, and she would get her little black bag and put on her little white outfit with her little apron and go to the house.

And oftentimes she would invite them back to her house where she could pay 24 hour attention to them.

husband, Gene, was a farmer.

He didn't own farms.

He he worked on farms He kind of leased farms, I guess, and worked for other people.

But, he was kind of the boss, you know, at various times.

And the hired hands would come and she would feed them.

And so she kind of not only got a reputation as a nurse, as you say, but also kind of reputation as a cook.

sometime in either late 1911 or early 1912, Gene brought his mother, a widow named Emily, and his younger brother James, to live with them.

Soon Genes mother would be dead.

after they moved to the Catawissa area, Eugene Gifford's mother came to live with them.

And she died not too long after that, you know, got sick.

And, of course, Bertha nursed and took care of her, and she ended up dying.

Emily, who was Eugene's mother and her son James.

So Eugene's brother James both moved in.

And honestly, Emily didn't last that long.

Reports later claimed that she suffered severe stomach pains before her death.

The local doctor, William Hemker, listed the cause of death as aortic regurgitation, There was no mention of stomach pain in his notes.

Gene's brother James would die the following year in May from complications due to whooping cough.

There was no mention of stomach pain.

No one in the community seemed to question these deaths, including Doctor Hemker.

About a year after James died.

Jean and Bertha had a son.

They named him James.

In early 1915, 15 month old Bernard came down with pneumonia.

Bertha volunteered to help finish nursing the boy back to health.

Four days later, he died.

In late February of 1921, two year old Margaret also developed pneumonia.

Bertha again came to nurse the child.

Margaret died within days.

Two years later, in March of 1923, seven year old Irene became ill.

Bertha came to nurse her.

Irene died within days.

George and Frances Stuhlfelder buried three of their children in just eight years.

Frances would eventually testify in front of a grand jury We did not think there was anything strange about the death of our children until this investigation was begun.

Everybody in this part of the country knows that Mrs.

Gifford had a wide reputation as a nurse.

She was thought to be a sort of good Samaritan.

Whenever anybody got sick, she went to see them and helped them with medicine and help to take care of them.

When Bernard got sick in 1915, Mrs.

Gifford came over and told me not to bother about the child.

She said to go on with my farm work.

That she would look after him.

Doctor Williams had been treating him and said he had pneumonia.

The night after Mrs.

Gifford came, he began vomiting and kept on until he died.

Four days after Mrs.

Gifford came over.

In the winter of 1921, my little girl Margaret also caught pneumonia.

We called doctor Hemker, and he prescribed for Mrs.

Gifford, as usual.

Came over to nurse the sick baby.

She told me the baby looks to me as if she's awfully sick.

I don't think she'll get well.

At the end of the second day.

Margaret began to vomit.

And after another three days, she died.

Irene had always been troubled with worms, and when she got sick in 1923, we called Doctor Hemker.

He prescribed some stomach powders, and she seemed to be getting on very well.

When Mrs.

Gifford came by, Mrs.

Gifford nursed her and she started to vomit.

She was sick nine days when she died.

Francis Stuhlfelder, 1928.

On February 20th, 1917.

Gene Gifford met his neighbor, Sherman Pounds on the road, staggering and apparently very drunk.

Gene brought him into the house, where Bertha reportedly nursed him throughout the afternoon.

When he didn't improve, they called in doctor H.A.

Booth.

By the time doctor Booth arrived, Sherman had slipped into unconsciousness and died soon after.

The cause of death was listed as acute alcoholism.

The death of Sherman didn't seem to affect Bertha's relationship with the other family members.

In 1922, Sherman's daughter Marguerite needed to run some errands, and she left her three year old daughter Beulah, with Bertha as a babysitter.

A few hours later, reports say that Marguerite came back to find Beulah suffering from terrible stomach pains.

Marguerite called on Doctor Hemker, but it was too late.

Within minutes of his arrival, little Beulah was dead.

Acute gastritis was the diagnosis.

Three year old Beulah would be buried days later.

In November of 1917, James Ogle, a sometimes hired hand of Genes, got sick in the Gifford house.

He died the next day.

Newspaper reports from ten years later claimed that he died in agony.

Doctor Hemker listed the cause of death as pernicious malaria gastro enteric type, a diagnosis that would have included extreme abdominal pain, a symptom of some of the more dangerous forms of malaria at the time.

Something James Ogle certainly could have contracted in rural Missouri, just miles from the Mississippi River.

By 1924, Bertha's daughter Lila from her first marriage, was grown, married and living in Detroit.

Lila, now had a young daughter of her own, Arta Ernestine.

That same year, Arta would come to stay with Bertha, Gene and their son James, who was now ten, at their farmhouse.

Mom and I were in Missouri and she was taking me basically on a tour of different places.

And later in the day she said, oh, nonchalantly, I meant to tell you about the schoolhouse and how Bertha burnt it down, and I questioned her immediately about that and said, what do you mean?

And I said, intentionally?

And she said, yes, absolutely.

Bertha had gone to the school board and asked that a new school be built because her granddaughter, Ernestine, my mom, was going to come and stay with her and go to that school, and the school wasn't good enough.

It was old and she wanted a new schoolhouse built, and the school board told her, no, we don't have the funds for that.

And that night, Bertha took kerosene and doused this old schoolhouse with the kerosene and set it on fire.

And I asked my mother, how do you do know this?

And she said, oh, I overheard my grandmother talking about it.

And Bertha was boasting to one of the neighbors that she had intentionally burned the schoolhouse down.

And I found this outrageous and probably just folklore, because it was so unbelievable until, Mark Houseman, who was at that time a historian with the Washington Museum, found a newspaper article that talked about the schoolhouse in Catawissa burning- suddenly burning down one night.

And lo and behold, they had to build a new one.

Then there was the Schamel children.

Nice boys.

The mother had died and their father was sort of up against it.

And I agreed to take them in.

That one boy.

The oldest.

Lloyd.

I think that was his name.

He was sick when he come here on Saturday.

Well, he didn't get any better.

And he died the next Tuesday.

Then Elmer, his brother.

He died about a month after that.

He was only sick 3 or 4 days.

I don't know how they come to die either, but, you know, children will get children's diseases and I guess they got some sort of sickness and died.

Ed wasn't so well that night.

And the next morning I went to Saint Louis.

When I came back late in the day, he was pretty bad.

And he died that night.

Too much booze, I guess.

Anyway, we had Ed's wife there and his family and his uncle Phil.

And when he died and his Uncle Phil wouldn't pay for the funeral.

I said we'd pay for it and let them pay his back.

I says to my wife the other night that we're not going to take anybody else in.

We've been hearin of these things.

People say it around here, and a person gets a lot of thanks for being generous.

Of course, we didn't poison any of these people.

Gene Gifford.

1927.

The county prosecutor, Frank Jenny, spent several months gathering new evidence.

to indict Bertha after Ed Brinleys death.

Possibly the most sensational things to turn up during the investigation were the poison ledgers.

At the time, druggists required people purchasing poisons to sign a book.

Bertha's name appeared multiple times.

Sometimes within days of someone dying.

With this new information and willing witnesses, including the mother of the three dead Stuhlfelder children, Frank Jenny would succeed in getting an indictment against Bertha.

On August 23rd, 1928, for the killings of Ed Brinley and young Elmer Schamel.

Two days later, Police Chief Andrew McDonnell would arrive at the Gifford's home and arrest Bertha for murder.

So in 1928, my mother, was staying on the farm with her grandmother in Catawissa.

She remembers sitting out in the front yard.

It was a hot August summer day.

She was with her Uncle Jim, Bertha and Gene's son, and she said, we were just trying to think of something to do.

And the sheriff's car pulled up.

And when the sheriff pulled up, he asked to see Bertha.

Jim took her up to the house.

My mother, Ernestine, followed along and they went inside.

Bertha put a hat on, powdered her face.

My mother watched all of this transpire and the sheriff took her away.

They didn't know why at the time.

in custody, chief McDonnell would convince Bertha to admit to giving arsenic to both of the Schamel boys and Ed Brinley.

She agreed to sign a statement.

It becomes very contentious because when the sheriff sat her down to interview her, he asked her a number of questions.

And as he did, she readily admitted that she was giving arsenic to people, that she was caring for specific people, including Ed Brinley.

She admitted this, but at the time, you have to understand that she was taking arsenic herself because it was thought to be a medicine of some kind.

So she was taking small amounts for her high blood pressure because she was very vain.

She admitted this in this questioning period, the sheriff wrote it up as her statement that she gave arsenic to Ed Brinley, that she gave it to, the twins, the Schamel twins, and ask her to sign it, which she did, but immediately it was leaked to the press and characterized as a confession.

And he arrested Bertha and finally ended up getting a confession out of her.

He kind of befriended her, acted like he was her friend, at least.

And, she admitted, finally admitted killing the two.

Or not.

She didn't admit killing him.

She maintained from the very end that she had done intentionally.

But she did admit, giving arsenic to the two family boys and to Brinley.

But she claimed that she was doing it for medicinal purposes.

And, of course, arsenic was used as a as a medicine, for medicinal purposes back in those days.

And it was also used women particularly used it as a, beauty enhancer.

It made their skin, clear.

It kind of cleared up, blotches on their skin and so forth.

Her statement was almost immediately published in several newspapers across the state.

Some would later question whether she was able to get a fair trial so close to the alleged crimes, and with a jury that had most likely already read her contested confession before ever stepping foot inside the courtroom.

I, Bertha Gifford, hereby a state of my own free will, without threat or promise of immunity.

Then my husband and I lived near Catawissa about August 8th, 1925, when George Schamel brought his sons Lloyd, nine years old, and his son Elmer John, about seven, to our house, where he and they made their home with me.

Lloyd was sick at the time.

Doctor Hemker waited on him and left some medicine for him.

I put some arsenic in the medicine before I gave it to him, and Lloyd died about on August 11th.

About September 18th, 1925, Elmer John took sick.

Doctor Hemker was called and left some medicine for him, and I put some arsenic in it.

And Elmer John died about September 22nd.

About May 15th, 1927, Edward Brinley, 48 years old, drove up to our house.

He was drunk.

He came in, sat down for a little while, then got up and went out and fell down on the concrete walk.

My husband went out and brought him in, fixed the bed for him in the front room and laid him on the bed.

His mother came over and insisted he call a doctor.

So I called Doctor Hemker.

He left some medicine for him and I put some arsenic in the medicine.

He died May 16th.

In all three cases, the patients were suffering from severe pains in the stomach.

And I put arsenic in the medicine to quiet their pains.

I don't want to live.

I want to tell the truth.

I told you about giving some of them arsenic.

Maybe I gave some others arsenic to.

Bertha Gifford, 1928.

In September of 1928, the bodies of Ed Brinley and the two young boys were finally exhumed.

George Schamel would walk through the cemeterys overgrown grass and weeds himself to help the grave diggers find his buried sons.

The postmortem results indicated arsenic poisoning.

Despite the indictment being for both Ed Brindley and Elmer Schamel, Prosecutor Frank Jenny had decided to only put Bertha on trial for the killing of Ed Brinley.

Some say he wanted another chance if she was acquitted this time.

Over the course of the trial, there was expert testimony about hooch, moonshine and arsenic.

Ham sandwiches, lemonade, and large drafts of water, and how each might affect a human body.

There was also testimony from both Ed Brinley's widow and his mother.

Both recounted their version of events the day Ed died, and how he had been given food and drink at the Gifford home.

Ed's mother even claimed that Bertha had held Ed's head up so he could drink the lemonade she had made him.

But the most influential testimony must have come from chief McDonnell, the arresting officer, In fact, the defense actually did succeed in getting the the written confession thrown out.

They were they wanted to have the whole confession and and, the chief of police police's testimony all thrown out.

Well, they did get the confession, the written confession thrown out, but they still allowed the chief of police to to testify as to what she had confessed, you know She told me she was in a peck of trouble.

She said she had been accused of giving poison to persons she had never harmed.

So I told her it would be the best thing for her to tell me all about it.

She was worried about going to jail.

I reassured her, explaining we never sent women to jail and she could stay in my office all night.

She told me she'd given poison to the two Schamel children, Lloyd and Elmer, and to a man by the name of Ed Brinley.

Just a little arsenic to quiet their nerves.

She said she'd put a little arsenic in a spoon, poured some medicine on top of it, and stirred it around before giving it to the boys.

She then told me about Brinley coming to her house near Catawissa drunk.

Someone called the doctor and he left some medicine, but it didn't do much good, so she put some arsenic in it, just a pinch to relieve the pains in his stomach.

I take twice that much myself.

So I asked her why she did.

And she leaned over towards me and answered.

Confidentially, I'll tell you.

I take it to make me look young.

When my eyes are puffed and my heart goes thumping.

Are you telling me the truth?

I wanted to know if she'd given the arsenic with the right intention.

She answered yes, that she had given the arsenic to help them.

She insisted arsenic didn't kill.

She had taken lots of it herself, and she wished she had some right then.

Along with Chief McDonnell's testimony, the poisoned ledger was presented as evidence showing that Bertha bought arsenic on the day Ed Brinley died.

They also showed how she hadn't wanted his body exhumed, and that the postmortem examination showed arsenic in Ed's body.

The state rested its case.

The defense immediately asked the court to throw out the charge, since first degree murder required intent to harm, and the state's witness had said himself that Bertha never wanted to hurt anyone.

Prosecutor Jenny argued that with the number of suspected deaths, there was no way Bertha could not have realized the results of her actions.

The judge agreed, and the defense's request was denied.

Bertha's team began their defense.

They called Bertha's husband Gene to the stand.

This was the only reported time that Bertha showed any real emotion during the trial, as she watched him testify.

Gene claimed that Bertha had suffered from a nervous illness for the past ten years, the result of menopause.

Gene talked about Bertha pacing the floor for 2 or 3 nights in a row every few weeks, and she was restless and would often just sit in silence.

Four others were called up to testify that Bertha was nervous, morose and excitable.

After a recess and a private consultation with several doctors, the defense team changed their plea, not guilty by reason of insanity.

fact that that they had exhumed the bodies and found out that there was enough arsenic in there to be lethal, you know, more than enough to kill, kill the people, you know, so, you know, it was, really at the trial.

It really was not a question of her guilt so much as whether or not she was insane, I think that, the district attorney, definitely the prosecuting attorney, definitely wanted to at the beginning.

He said he wanted Bertha to hang.

He thought Bertha had poisoned a number of people.

She deserved to die.

He was looking for the death penalty.

But I think as they went into the trial, what he saw was a woman with a third grade education, a woman who possibly had had good intentions.

And again, I'm not trying to defend Bertha here, but I'm saying it is possible that she was just a psychopath and a serial killer.

During the trial, multiple psychiatrists, referred to at the time as alienists, were called to the stand.

They were asked to answer what basically came down to a single hypothetical question if a woman had in fact done and said all of the things that Bertha is accused of.

Would you say that person is insane?

They all answered yes.

they had these psychiatrists come from Saint Louis and testify in the second day of the trial that Bertha was essentially, that that she had schizophrenia.

They had not interviewed Bertha themselves.

They had not done anything to evaluate her.

They simply listened to the transcript of the trial from the previous day, read back to them, and they went, okay, yeah, sounds like a crazy person.

So she must be.

And so they testified that, so that they could substantiate the fact that she was schizophrenic so she didn't have to hang and she could be remanded to an institution for the criminally insane.

It took the jury a little over three hours to bring back a verdict.

Not guilty by reason of insanity.

They all marched out and said that she was crazy.

You know, and so , not she was guilty, but that she needed to go into a hospital.

Women, I don't think, would have given her as much of a break as that particular jury did.

I think that the men were this sounds just awful when you say it out loud, that they were so biased against the thought that a woman could be a cold blooded killer, that they were looking for that alternative.

Following the trial, Bertha was committed to State Hospital Number 4 in Farmington, Missouri, known today as the Southeast Missouri Mental Health Center.

On her first day there, they did an intake evaluation of Bertha and what they decided after a very extensive interview was that the doctors there, the institution found, no sign of schizophrenia.

They said, we don't see any psychosis in this woman.

She seems perfectly fine.

So after assessing her, they.

She lived her life in the institution.

She was occasionally assessed for her.

I think she she was physically assessed, I think once a year.

But in terms of her, mental state, she was never reevaluated.

Bertha was still in the institution when she passed away.

She had complications from.

She needed gallbladder surgery.

According to the medical records from the institution, she needed surgery and which meant that there were no funds for that and meant that somebody in the family had to pay for it.

Unfortunately, she passed away from complications from that.

when I was in Missouri with my mother doing research on Bertha.

And I talked to this woman on the phone, and I pleaded with her and said, my mother and I are here in Missouri.

Is there any way we can come by and pick up records or a photocopy of of her record?

And I was told, no, you need a court order to do that.

I was told that repeatedly.

We can't legally do that even though it's been that many years.

When I got back to California many weeks later, I opened my mailbox.

One day and in the mailbox were was a photocopy of Bertha's complete file from the institution.

There was no note, there was no explanation.

It just appeared there.

when she died, Gene brought her back.

They had a plot.

And, Bertha was born in Morse Mill, and so they had a family plot in Morse Mill.

She was buried there.

The plot, I think, probably originally originally was owned by Bertha.

And her first husband, Henry.

So they're all there in the same plot.

Henry's grave is there.

Berthas grave, is there.

She was buried in the same cemetery as her first husband.

Eugene's brother.

James.

Her mother in law and and the brother were all in there.

Gene is at her feet, which I thought was symbolic.

Somehow I don't know if he actually is buried at her feet or not, because her gravestones kind of in a tree, which means it probably has moved as the tree grew.

And you look over here and here's her first husband, and there's her second husband's brother, and you look around and there's, I only had to go to four cemeteries to be able to document every single, every single kill, every victim.

Summarily, I would say I have no idea.

That's how I would sum it up.

I want to believe with all my heart, knowing my mother, my grandmother and Bertha, my great grandmother.

Well, I didn't know her, but I now know of her.

I want to believe that she was filled with a certain amount of hubris as she started to take care of people, she she got herself a white nurse's outfit.

She carried a little bag.

I know that when Henry Graham died and she married Jean, they lived in Morse Mill.

And again, I'm sure tongues were wagging, but they left that area and they moved to Catawissa and the farmhouse, and she reinvented herself.

I know what that's like to do that.

I had another life.

Once upon a time, I ended up leaving the town that I lived in because of some scandal or alleged scandal.

I reinvented myself.

So I understand that, I want to believe that Bertha just had that hubris, that pride that was so intense she felt powerful.

And then that feeling of power, she started administering.

The arsenic, whatever it was to people, because she thought she could cure them.

She thought she could, you know, probably she got accolades.

She clearly did.

People called her the Good Samaritan.

She liked that feeling.

And I think I want to believe that that's what it was.

I don't want to believe that she intended anyone ever to die.

But again, at the time, people were taking arsenic for health reasons.

And as someone who didn't have medical background, she might not have known giving them too much would kill them.

You would think eventually she would figure that out.

If enough people died.

But then again, we only know that three bodies were exhumed before her trial.

So a lot of the information, a lot of the evidence is just gone now to history.

You see a lot of fights about whether she was.

Actually insane or not insane.

And I think that I personally think that they did her a favor by putting her into this bucolic cottage hospital versus death row, and that that worked for her in a, in a society that didn't really give women a lot of credit at that point.

So?

I don't really think she just did it purely out malice.

I mean, I think that she was just crazy.

You know, I, I think she had some other reason, you know, either she, like, the grand great granddaughter said she was, wanting to build herself up as a nurse or or she didn't realize how much she that she was giving in too much or something.

I don't know that she was totally innocent, but I don't think she was just a pathological killer, either.

I. I think there was some in-between area there.

Like I say, she's just, Well, I think they got it right when they said.

When they said she was insane.

I'll put it that way.

Between 1906 and 1927, an estimated 18 people died while under Bertha's care, many of them small children.

But did she choose to kill them?

Bertha openly admitted to giving arsenic to Ed Brinley, as well as Lloyd and Elmer Schamel, She also alluded to others.

She consistently purchased significant amounts of arsenic over several years.

Despite this, Bertha was only ever tried for the murder of Ed Brinley, and she always claimed that any arsenic she administered was always meant to help, not harm.

Only three bodies were ever actually tested for arsenic poisoning.

How should history view Bertha Gifford, the rural Missouri farm wife and self-taught country nurse?

Was she a cold blooded killer, an arrogant fool, or a well-meaning good Samaritan who was completely unaware of the pain she may have caused?

Or maybe she was something else entirely.

The state of Missouri never released Bertha back into free society.

On her death certificate.

A diagnosis of paranoid praecox psychosis is listed, a condition that would later be classified under schizophrenia, a severe mental health diagnosis that can include delusions and hallucinations.