Emma discloses her hallucinations and delusions to Rajid

Emma’s disclosure to Rajid turns experiences she has long minimized into material for psychiatric care: she describes visual hallucinations, the fear that persists after they pass, and a suicidal conviction that had seemed to her like revelation rather than danger. The consultation makes a distinction between what she can recognize as unreal and what she nevertheless believes at a deeper level. Rajid’s response gives those experiences clinical names and leads to a plan for further assessment, while Emma’s reluctance shows how difficult it is for her to speak about symptoms she has treated as ordinary private facts.

The reluctant disclosure

The conversation begins with Emma acknowledging that she behaved strangely at their previous appointment. Rajid recalls that she seemed agitated, but connects this to her severe physical reaction to Tegretol and an elevated heart rate, both of which could have left her feeling wound up. Emma says that the conduct was not what she meant: she had been thinking strangely. The distinction matters to her. She is prepared to describe unusual thoughts as an observation, but not yet to treat them as evidence of illness.

When Rajid asks whether anything else has happened, Emma first reaches for a safe point of reference and then admits that she sometimes sees snakes. Her account is specific rather than abstract. On a narrow, dangerous cycle path running beside an eighty-kilometre-per-hour road through the polder, she once saw what looked like a snake. She tried to correct the perception by reasoning that a snake was unlikely there; on concentrating, she could see that the object was a branch. Twenty metres later, the same transformation happened again. The second apparent snake also proved to be a branch when she concentrated, but returned as a snake whenever she stopped scrutinizing it.

The visions came repeatedly, sometimes every day. The most recent period in that place lasted three months. Emma resists calling this a serious burden until she describes what remained after the images disappeared. After a storm, a branch perhaps two metres long lay across the path. Although she wanted to move it before dark so that nobody would collide with it, she could not make herself touch or kick it. She feared it might turn into a snake. Someone else eventually moved it. For Emma, the lasting fear and the small, thwarted act of responsibility—not simply seeing an image—show the hallucinations’ impact on her life. She suspects that even now she might not dare to remove a branch in that place.

Naming perception and belief

Rajid tells Emma that these experiences sound like recurring hallucinations and that such symptoms can fit a manic-depressive picture. He explains the difference between hallucination and delusion through concrete examples: a hallucination alters perception, so a person might see a wolf where there is a desk; a delusion leaves the object correctly perceived but attaches a false conclusion to it, such as believing the desk’s grain forms a code or conceals microphones. He thinks Emma is describing hallucinations in particular. The explanation gives her an available vocabulary, but it does not make the experiences easy to disclose or dismiss.

Emma also describes a different kind of disturbance: an idea or feeling that she believes despite its lack of logic. Asked what she felt when admitted, she recalls being told that Doctor Visser’s husband had died. She felt no sadness, concern, or sense of loss, although Doctor Visser had been her psychiatrist for more than two years. What struck her instead was the absurdity of discovering that Doctor Visser had children. Emma says that, at the time, all thought and feeling seemed to have been absorbed by one enormous idea.

That idea was that she had to die. The day before her admission, while making breakfast after months of depression, Emma experienced the conclusion as an unmistakable instruction: the time was right. She imagined removing herself and the misery attached to her so that she could return to what she considered important—work, productivity, and getting things done without being impeded by feeling. In her account, the thought did not present itself as a suicide plan carrying emotional weight. It seemed simply necessary, even a task to cross off an enduring list.

When Rajid points out that taking the pills would mean death, Emma agrees that she knew this fact, but says that it had somehow receded from view. She had reasoned that everyone dies eventually, so the distinction between dying by her own action and dying later seemed to collapse. The conviction brought a sense of unity, calm, happiness, and instant illumination. Emma describes it not as an ending but as a beginning, and says she wanted to preserve the feeling. She can state that she knows one cannot continue ordinary life after death, look through closed eyes, or find snakes on the path; at the same time, she says she believes those things. Her account therefore exposes a painful divide between what she can judge intellectually and what feels incontrovertibly true.

Assessment and treatment plan

Rajid asks whether Emma sees anything in the consultation room that he cannot see. She answers that the room looks fairly normal to her. The exchange does not erase her account; it distinguishes the present moment from the earlier experiences she has disclosed. He also asks her to record the relevant period on the Mood chart. Emma has not done so yet, but Rajid says her account of a weekend away could indicate a hypomanic period, perhaps even mania, despite her apparent ability to control the hallucinations and her behavior.

Emma describes coping by remaining alert, checking her senses, and having an inner editor inspect each thought. She knows that her thoughts may be wrong and tries to live around them. Rajid observes that this constant vigilance sounds exhausting. The phrase she uses for this practice—never to trust what she thinks—captures both her resourcefulness and its cost: reality-testing helps her manage unusual perceptions, but demands continuous effort.

Because of the Tegretol side effects, Rajid proposes waiting until they have completely disappeared before starting Depakine, which he says can work alongside lithium against manic periods, including delusions and hallucinations. In the meantime, he wants Emma to complete the Mood chart so they can establish how often the episodes occur and whether particular triggers are involved. He also urges her to talk about what she has disclosed rather than continue carrying it alone, noting that Lars is due back from vacation the next day. Emma finds the prospect of telling Lars about her hallucinations and readmission especially daunting, and resists the assumption that unusual experiences must be discussed with caregivers when they feel normal to her.

Significance of the encounter

The consultation joins two accounts of altered certainty. Emma’s earlier description of sudden clarity had made the world seem newly visible, while her present explanation shows how that clarity could accompany a belief that death was necessary. Her image of depression elsewhere is one of energy drained away until only fragments of the self cling to life; here, the suicidal conviction supplies an apparently simple answer to that depleted state. The contrast is not a clean passage from illness to insight: Emma can recognize the logic as unsound and still feel its force.

The disclosure also changes what can be addressed between Emma and Rajid. What she had kept private as strange but manageable becomes, through the specific example of the branch she could not move, an impairment with consequences in ordinary life. Rajid’s distinction between hallucination and delusion, request for mood records, and proposed medication adjustment do not promise an immediate resolution. They establish a way to observe recurrence and discuss its effects. The event’s decisive movement is therefore from concealment toward shared assessment, without pretending that naming the experiences has made them disappear.