Doctors’ Consultation Finds Alicia Has Both Paranoia and Feigned Symptoms

The doctors’ consultation is the point at which Alice Gould’s apparent choice between genuine illness and deliberate deception is recast as a double condition. In Samuel Alvar’s office, Alvar, Teodoro Ruipérez, and César Arellano listen to a recording of Alice’s first account of herself on the day she was admitted, then weigh her recorded words against her clinical examination and behavior. The result is not a simple verdict that she is either ill or pretending: Alvar argues that authentic paranoia and a feigned version coexist, with the latter serving the former.

The consultation and the record

The meeting takes place on a Wednesday, as planned, before the doctors’ meeting. Ruipérez begins by reviewing his role in Alice’s admission. Her symptoms had seemed clear to him and consistent with the report from her former private physician, E. Donadío. He therefore referred her to the head of Clinical Services, Arellano, for further study and sent him a note describing what he understood to be pure paranoia, without any other appreciable syndrome. That initial formulation establishes the problem the consultation must revisit: whether Alice’s presentation can be explained by one diagnosis alone.

The record of admission complicates any account of Alice as a patient who freely chose treatment. When she insisted that she had entered voluntarily and was a professional detective, the director explained that the file followed the procedures for involuntary admission. It contained a medical certificate from E. Donadío, a physician registered in Madrid, attesting to illness and the need for hospitalization, as well as an application from her husband, Heliodoro Almenara, as her relative. Those documents do not themselves settle whether Alice is ill, but they make the consequences of the doctors’ judgment concrete: her own account of why she is in the hospital conflicts with the official basis on which she was admitted.

The institution’s open regime adds another distinction to that conflict. Montserrat Castell explains that patients can move with relative freedom around the building and grounds, attend occupational therapy, work in workshops for wages, or, with permission, travel by bus to nearby towns. Such liberty within the hospital does not make admission voluntary. The consultation takes place against that tension between visible freedom of movement and a file that classifies Alice’s confinement as involuntary.

Evidence and competing interpretations

Ruipérez’s first conclusion is supported, in his view, by the clarity of Alice’s symptoms and their agreement with E. Donadío’s report. Arellano’s examination does not simply reproduce that conclusion. Asked about the tests he administered, he reports that their results are negative and that Alice has no psychomotor disorders. These findings narrow what the doctors can claim from the examination: they do not supply evidence of psychomotor disturbance, but neither do they, on their own, decide between paranoia and simulation.

Alvar approaches the case with particular concern because he regards Alice as a potential poisoner and says that the possibility has held his interest from the first day. He also contests Arellano’s description of her conduct as free of complaint. Alvar points to the fact that by the fifth week of hospitalization a man had died at Alice’s hands. The consultation thus places behavioral evidence beside clinical findings, but the doctors do not treat those categories as interchangeable. Alvar’s accusation carries weight in the discussion, while the reported negative test results remain a separate part of the record.

Alvar’s account of Alice’s belief gives his objection its diagnostic shape. He says that she persistently thinks she is searching for the murderer of an elderly man named García del Olmo. In Alvar’s view, she intends to identify and denounce the killer, and, if the court does not take the case from her, to administer justice herself. He compares this projected course of action with that of another paranoid patient, Norberto Machimbarrena, who killed three shipmates because he believed them to be Basque separatists. The comparison presents Alice’s investigative purpose not merely as a story she tells, but as a delusion that Alvar believes could guide consequential action.

From provisional doubt to a combined diagnosis

After the doctors hear the recording of Alice’s conversation with Alvar, he asks Arellano for a provisional assessment rather than a final diagnosis. Arellano leaves open the possibility that he may later revise his view. For now, he says that the case may involve paranoia or simulation. His answer preserves two competing explanations instead of resolving the evidence prematurely, and it marks the limit of what he is prepared to conclude at that stage.

Alvar rejects the assumption that those possibilities must exclude one another. His conclusion is that Alice is an authentic paranoid patient, unaware of her condition, who also feigns a false paranoia in the service of her real delusion. The distinction between the false presentation and the underlying delusion is central: according to Alvar, deception does not make the illness fictitious, and genuine illness does not make every part of Alice’s presentation involuntary. The diagnosis therefore complicates both her claim to be a detective and the hospital’s tendency to read her conduct as evidence of a single, stable condition.

Ruipérez responds with an admiring whistle, whether from sincere recognition of the explanation or from his habitual inclination to flatter Alvar. The moment signals that the director’s formulation has offered a persuasive key to Alice’s strange presentation, but it does not establish that every doctor has independently reached the same conclusion. The consultation’s significance lies in Alvar’s synthesis: the conflict is no longer framed as a contest between a wholly genuine patient and a wholly deliberate impostor. Alice’s account can be both a performance and the vehicle of a delusion, leaving her status unresolved in a more unsettling way than either diagnosis alone would allow.