The first chapter of Stigmata introduces the reader to the story's protagonist, Lizzie Du Bose. Right away, Lizzie describes the setting of the psychiatric institution that she resides in, and Dr. Harper, her counselor. She is meeting with Dr. Harper who comes into a room with inviting surroundings to do conduct one last session before Lizzie is released back into her parents' care.
The conversation does not go into detail about the exact reasons for Lizzie's long institutionalization. They allude to Lizzie having suffered from delusions and a break from reality. It also mentions that she tried to kill herself at one point. Without going into much detail, Lizzie says that she had previously suffered for years with nightmares concerning horrors experienced by her ancestors. This all began when she inherited her great-grandmother's diary and her grandmother's quilt. Lizzie assures the doctor that this is all in the past, and she is ready to reengage with reality.
The chapter ends with several italicized paragraphs beginning with the date December 26, 1898. It is a first-person account of a Christmas dinner. The speaker introduces herself as Joy and describes watching her mother sew a quilt. Her mother says that her true name is Ayo and that she is part of a long line of "forever people" who live in a circle of time.
From the very start of this chapter, Lizzie alludes to there being much more to the story. Lizzie tells the reader that much of what she says to Dr. Harper are the lies she needs to say in order to be released. It also appears that this chapter takes place well after many of the other events of this story. It introduces the theme of confusing timelines and identities and the narrator's struggles within and outside of herself to learn the traumatic past of her family.