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You are sitting in your house, pootling away at whatever-it-is-you-do; typing, polishing silverware, hoovering, watching telly – when you suddenly get the feeling you are being watched. You glance outside and sure enough, just over the road is a van which isn’t usually parked there, a man sitting in the front seat. Over the next hour the feeling intensifies, bringing with it the first shivers of unease, emotional nails on a chalkboard. You check outside again. The van is still there, but the man has vanished – to where? You try to rationalise the feeling, but you can’t and that unease gathers force, coalescing into a chilling fear. You try to think…think! You need to tell someone, you need help, and safety – the police. Yes!

You grab the keys to your car. The van doesn’t move as you hurry towards your vehicle but as you glance down the street you see a man and his dog pacing towards you. In the distance you hear shouting – you can’t make out the words but the tone is undeniably threatening. On the other side of the street a woman watching out of her window turns to stare at you, and that fear transmutes into blind terror. The world blurs and you slam yourself into the driving seat, keys scrabbling for the ignition. The man and his dog draw closer, then closer still, coming for you up the pavement. The engine roars into life and you drive, drive like you’ve never driven before, driving in fear of your life, trying to keep a level head and failing as the nightmare descends on you completely.

And now you’re sitting in a room opposite a man in a suit. He seems friendly, but his eyes are cold. Next to him is another man, casually dressed, and across from him is a young man introduced as a student. The man in the suit gives his name, and he’s a doctor. The casually dressed man who collected you from the police station has already told you that he is a community psychiatric nurse. He has a soft voice.

“Do you know where you are?”

One of the take-home messages I’ve found relating to acutely psychotic patients is that, initially, they respond exactly as anyone might to a set of circumstances. The difference is that those circumstances – be that their beliefs or their sensory inputs – are not based in reality. In chronic disease things are different as structural changes in the brain begin to take hold but initially, it’s just a person who is scared (or elated!) and in this case believes he is being spied on and persecuted for lies he told in the past. When I say believes, I mean it in the sense of a psychotic delusion – it is true and cannot be refuted by rational thought because they know it to be rational. Finally, he heard indistinct, intimidating voices that he could hear on an almost constant basis. The combination of those three things – the feeling of paranoia, the knowledge that you are being hunted down, and the sound of people coming after you…would you panic? I would.

Our brains are a fine balance. Food for thought.

While the above paragraph is evidently fabricated, it is based on a real case and the student in the writing is me.

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