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Delirium: everyone's psychosis

BMJ 1995; 310 doi: (Published 18 February 1995) Cite this as: BMJ 1995;310:473
  1. Malcolm Bowker

    Malcolm Bowker

    I had been feeling jaded and mildly unwell but had attributed this largely to a normal reaction to the reforms in the NHS. Fairly acutely this psychosomatic explanation became less convincing. An abdominal appendix abscess was identified, leading to an immediate laparotomy and then tertiary referral as peritonitis developed with respiratory distress. There was further surgery, renal failure, and a continuing inability to sustain normal respiration.

    While being ventilated in the intensive care unit, I do not recall sleeping or waking, except once when it seemed that I had opened my eyes after a nightmare and consciously tried to disengage from the dream, only to find that the dream and reality were identical. I had entered an oneroid state in which there were frightening delusional and hallucinatory experiences of a dramatic and fantastic kind. These incorporated uncomfortable personal existential truths, contemporary themes of serial killing, my recent correspondence with the editor of the BMJ, Satanism, and cruel fundamentalism, in which I, as an accused, would suffer horribly.

    Although protesting my (real) innocence to declared crimes, seeds of doubt developed in the isolation of my delusions, and passive acceptance of my fate and even culpability became conceivable.

    I was sure that my life was threatened in the most unpleasant way—reflecting Orwell's chilling concept of room 101 in his novel 1984* …

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