Intended for healthcare professionals

Fillers A memorable patient

The screaming man

BMJ 1999; 319 doi: (Published 21 August 1999) Cite this as: BMJ 1999;319:489
  1. Sean A Spence, locum consultant psychiatrist
  1. London

    I had to meet two social workers and a GP on a housing estate in London. When I got there the patient was out but two of his neighbours told us that he'd gone for a walk. So we waited to see if he'd return. While we did so, it was difficult to ignore the screaming that emanated from higher up in the flats, on the third or fourth floor. The sound was guttural, like an animal: a growling, bellowing roar.

    I kept thinking that the screaming might be coming from our man, but the neighbours said not. It had been going on for three or four days and nights, continuously. They'd been going to call the police, but no one had. While we waited the screaming continued. More neighbours gathered, interested to see what was happening. Some said, “Something must be done” (about the screaming), while others were more concerned about our motives. “What did you want?” “What are you doing here?”

    It transpired that a young man—on medication—lived alone on the third floor. One of the social workers had a mobile phone and called the police. Perhaps they'd break the door down. The ambulance, called for the original patient—the one who'd gone for a walk—had to leave because of an alert.

    The police came, and we approached the flat. The growling and screaming continued. We knocked on the door, shuffling for standing room on the crowded, narrow balcony. The screaming stopped. A man opened the door. He was young, thin, and dishevelled, with beads of sweat on his forehead, and matted hair. He was surprisingly softly spoken. He let us in. There was no carpet and very little furniture. The bare wooden floorboards were covered in patches of water and the sites of small fires, lit with paper and matches but now extinguished. In the main room was a single bed, heaped with dirty clothes. There was an overcrowded dresser, but no place to sit.

    We stood in the centre of the room and the police maintained a respectful distance. A second ambulance had arrived and was parking outside. The man kept turning his attention to the flickering blue light that strobed the window. If a place can reflect a psyche then this man's room did: the blue light, beaming across his sparse and scattered objects; the disorder of his internal world. He stared apprehensively; he knew something was going on. He was edgy and acutely paranoid.

    Why was he screaming? He did it to stop the thought interference. It was the only way. Thoughts came into his head, all the time, from outside. The screaming seemed to clear his mind, helped him regain control, but then he'd need to scream again. He'd stopped his medication. Would he come into hospital? Yes.

    The crowd dispersed as the ambulance drove away. A common event in that community. Twice more that week I would stand in cramped living rooms, surrounded by the heaped possessions of psychotic people, sitting in fear in the dark. Solitary people, in small rooms, their curtains drawn for fear of their persecutors: the delusional variety, who interfere with their thoughts, and the physical kind, who regard them as strange, who hear them scream, yet do nothing. That community, where some may cry for help, while others must scream out loud.

    We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to.

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