Psychiatric Interviews for Teaching: Psychosis

- Hi, Andy. Do you want to come on in and have a seat? I’m DrTaylor; I’m the on-call psychiatrist for this afternoon.

I got a call this morning, from your family doctor, because I think you went to see him this morning, along with your mum. And I gather that things have been a little bit difficult for you, you’ve had some rather distressing experiences. So I think your doctor thought it might be helpful for us to have a bit of a discussion about that, to see if I could help.

Would that be alright with you? - That’s fine. - Would it be alright, Andy, for you to tell me a little bit about what’s been going on?

- Well, you’re going to think it sounds stupid but my housemates are working for MI5. - Right. - And they’re… they’re doing stuff to my brain.

- Ok. - And they’re… they’re out to get me. - Ok.

That must be very difficult for you. - [mumbles] Yeah. - How long has this been going on for Andy?

- About 2 months. - Right. And how did you first work out this is what was happening?

- I came home one time and they had moved the, they’d moved the TV to the other side of the room. - Right -And I just, I knew then. - And what was it that you knew at that moment?

- That erm… that they worked for MI5. - Right, ok, ok. So it’s been going on a couple of months?

- Yeah, this new lecturer started at uni. - Right. - And he works for MI5.

- Right. - And he basically drafted me housemates in, turned them against me. - Ok, ok.

Now I’ve noticed a couple of times, while we’ve been talking, that you‘ve sort of looked round you, into the room as if you’re checking for something. Could I ask you what’s happening at those times? - Well I can… I can hear them talking about me.

- Right. Who is it you can hear? - My housemates.

- Right. So you recognise it as their voices? - Yeah, I can… I can hear them all the time.

- Right. How many voices can you hear Andy? - Three, there’s three of them.

- Ok. And do they sound real, like my voice sounds talking to you now? - Yeah, it’s odd.

It’s… it’s like I can hear them when they’re not here. - Right. So when they’re not in the house with you?

- Yeah, it’s like… Yeah, like they’re in the other room or something. - Ok, ok. And can you hear what they’re actually saying?

- Yeah, they’re talking about me. -Right, ok. -They’re always talking about me.

- Ok. -They’re always commenting on everything that I’m doing. - Right.

Can you give me an example of what they would say? - Well like if I’m packing my bag to go to uni or something they’ll be, they’ll comment on that like - Right. - ‘he’s left the house now’, or… you know.

- Ok. Anything else? Do they ever talk to each other, perhaps, about you?

- Yeah, that’s what they’re… and now they know… they’ve sort of… they’ve sort of twigged that I know about them. -Right. - And they’re saying, like, I’m making trouble - Ok.

- And that they’re gonna sort me out. - Ok, ok. What about actually talking directly to you, in the way that I am talking to you now?

Does that ever happen Andy? - No. - Ok.

So you’ve been hearing the voices of your housemates, have there been any other changes? Have there been any changes, perhaps, to the way you’re thinking? Sometimes people tell us that their thinking changes in some way – so for example, they might feel that they are getting thoughts put into their head, that aren’t their own.

Have you had any experiences like that? - Yeah. I do think things that, that aren’t me.

- Ok. - Like the putting thing… they’re putting stuff into my brain… it’s not, it’s not me. It’s not, I’m not thinking… - So different thoughts in your brain?

- Yeah. It’s like… it’s stupid stuff as well. It’s like the other day I suddenly started thinking about some woman in Coronation Street and I don’t watch any of that crap.

- Right, right. It’s not your kind of thing normally? Right.

- They’re not… they’re not my thoughts. - Right, ok. And do you have any idea how that’s happening?

Or who’s responsible? - It’s MI5. It’s this chip they’ve put in my head.

- Right, ok. - And I… I can feel it all the time. - Ok, ok.

So, so you’re getting thoughts put into your brain that aren’t your own. What about a different sort of experience, what about the experience that somehow other people are able to know what you’re thinking, even though you haven’t actually told them? - No.

They’re… no. - Nothing like that? - They’re just putting stuff in my, my head.

- Just putting stuff in… and can I just check Andy as well, that you’re not getting the experience when your thoughts just stop all together? Like you have no thoughts left? - No.

If anything there’s too much in there. I wish I could unplug it. - Ok, ok.

- Just get this thing out of my head. - Right. And you mentioned this, this chip, or this device in your brain, do you want to tell me a bit more about that?

- Well it’s… it’s a tracking device - Right. - So they know where I am at all times. - Right.

- I can feel it moving round, like rotating round. - Ok, so you can feel the physical sensation in your brain. - Yeah, yeah.

- Ok, that must be very difficult for you. - I don’t- I don’t know why they’re doing this to me - Right, ok. - I’ve done nothing wrong.

- Ok, ok. Can I just check - are there any problems Andy, with the rest of your body? Any changes in sensation or any bits that feel different in any way?

- No, I feel fine. - Right. - I’m not ill or anything.

- Ok, ok. - I just want this thing out my head. - Ok - It sounds like a very difficult time for you.

Can I ask you Andy, how are you coping with all this? How is it affecting you? - Well, I’ve not been leaving my room much.

And, so I have to wait until they go out, just to go down and get some food but. . .

- Right, right. - They’ve been doing stuff to my food now so I… - Right, ok. What do you think is happening to your food?

- They’re, they’re poisoning it. - Right, ok. Are you actually eating much at the moment?

- No. - Ok. Now with all this happening – it sounds like you don’t feel very safe.

Have I got that right? Ok. Have you felt the need, I don’t know, to take steps to protect yourself in any way?

- Well, I’ve, I’ve got a knife. - Ok. - And I’ve got like… a baseball bat.

- Right. - It’s just in case they get in my room, I just. .

. - Ok. - I don’t want to hurt anyone but I just feel like I’ve got to protect myself, it’s like, like they’re cornering me to do this.

- Right, ok. Have you felt the need to use either the knife or the baseball bat, so far? Take it out with you for protection?

- No. No, I don’t want to get caught. - Ok, ok.

- No, no. It’s just in my room. - Ok.

Has it ever got so bad Andy that you’ve felt the need to hurt yourself, or even kill yourself? As the only way out - the only way of coping with this? - Well I, I thought about getting some pills but I couldn’t, I couldn’t leave the house.

-Right. - So I didn’t, I didn’t get anything. - Right.

And when you say about getting some pills – would that be to take an overdose of tablets? - Yeah. - But you’ve not actually done anything about that so far?

- No. - Ok. In the past have you ever had any problems either with your temper or getting into fights, being aggressive either with your housemates, or anybody else?

- No, I’m not that kind of person. I don’t want to, I don’t want to hurt anybody but they’re just driving me to this. - And can I just check again, you’ve not been in trouble with the police, or anything like that?

- No, never. - Ok. With all this that’s going on, is there anywhere at the moment Andy, that you feel safe?

- Yeah, my parent’s house. - Right, ok. And have you seen much of your parents recently?

- Yeah. I thought about going back there but I, I don’t want to drag them into this. - Right.

- I don’t want MI5 knowing about them. - Right - And throughout this last couple of months, when you’ve had all these worries, have you ever worried that your parents might, in some way, be involved in this conspiracy? - I thought about it – but no.

- Ok, ok. - Can I just check out a couple of background things with you Andy? Your general health is that ok?

You’re generally fit and well? - Yeah, I’m. I’m not ill, I don’t - there’s nothing wrong with me.

- Ok. - It’s just this thing in my head. - And you’re not on any regular medication from your own doctor, at this stage?

- No, I don’t take any pills. - Ok. What about other drugs – and by that I’m meaning alcohol, cannabis, pills, anything else?

- Well, I don’t, I don’t drink much alcohol. - And what about drugs like cannabis? - Is my mum going to know about this?

- No. It’s important that I hear about this. This wouldn’t be something that we would be discussing with your mum.

- I smoke a bit of weed. - Ok. Would that be regular use or most days?

- Yeah. - And how much would you be spending on weed? - I don’t know – I get like a… I get like a ‘ten bag’ and it lasts me a day or so.

- Ok. So you have a ‘ten bag’ lasting you a day, of weed. Any other drugs?

I’m thinking in particular, things like speed or, or pills. - Done a bit of speed. - Ok.

Is that on a regular basis Andy? - I’d just go out with my mates at the weekend and we’d do a bit but… - Ok. When was the last time Andy that you would have had any speed?

- About a week or so ago. - Right, ok. Any other drugs at all?

- No… no. But I know what you’re getting at though – it’s not, it’s not the drugs. - Right.

- This is… It doesn’t matter how out my face I get. - Yeah. - This is constantly there, it’s always there.

- Ok. I guess the reason why I was checking, I think that’s what you’ve picked up on, is that sometimes when people are having the kinds of experiences that you are – they find that if they take certain drugs it can make things feel a lot worse. I just wanted to check that hadn’t been your experience?

- No. - Ok, ok. - I appreciate from what you’re saying that you’re really very worried about this MI5 conspiracy and that that’s the cause of the difficulties that you’re having at the moment.

I just wanted to check with you - do you think it could be due to anything else? I mean - I’ve obviously met people who have had similar experiences and sometimes they’re extremely stressed, some people might be actually mentally unwell and just whether any of these things might be relevant to you at the moment? - No, because I’m not ill.

- Right. - It’s them. And I’ve read books on this as well, I don’t… the government know about them.

- Right. - They know that they do this to loads of people. - Right, right.

- And I don’t know how they can get away with it. - And I’ve done nothing wrong – I don’t know why they’re doing this to me. - Ok.

- I just want – I just want it to stop. - Ok, sure. And I think I can appreciate that.

I guess what I’m wondering is whether you think there’s anything that someone like me might be able to do to help you, as a doctor? That sometimes meeting someone like a psychiatrist, or having medication or for some people even coming into hospital, for a short time might be helpful. Do you think any of those things would help you at the moment?

- I don’t… I don’t know. I mean… I’m only here really because of my mum. - Right.

- I tried to… I don’t want to worry her. I’ve tried to talk to her about it. - Yeah.

- And she doesn’t understand, she doesn’t really believe me. I mean… Do you believe me? - Well I certainly believe Andy, that you’re having a really difficult time at the moment.

I guess, what I’m not as sure about is what’s causing this - I’m less sure that this is due to MI5. I guess what I’m wondering is that perhaps you’re not as well as you might be at the moment. I mean, we’ve been through a lot of questions and what I’m thinking is we need to try and come up with a way of supporting you through this.

So I’m wondering, because I know your mum is… I think she’s waiting in the waiting room. It might be a good chance now to get your mum in and then perhaps the three of us can put our heads together, have a bit of a discussion about where to go from here and try and think of getting you some proper support. Would that be alright if I got your mum in?

- Ok. - Ok. If you want to sit there then Andy, I’ll just get your mum, ok.