The voices in her head are like 'a hairball of souls', she said as the intertwined her fingers and rolled her hands around, creating a picture of some tumultuous, chaotic interface between herself and realities both real and dreamed.
Her psychosis is distinct from the manic patient; it doesn't fit, doesn't match. Blauer, in first describing schizophreia, described psychosis as a loss of self. She speaks of the voices and the experiences as though looking through soundproof glass at herself, at once acutely aware and immersed in the gumbo of her thoughts, but also different. "Mood incongruent", I write in the note.
Of course the word choice of 'soul' is significant. Satan and God and the bible play a strong role in her life; more than many of us who may say "I'm a spiritual person", she means it that Satan has recently chased her through the streets in the middle of a frigid night with a cohort of demons. Were they close to her? Was it just a sense of dread, or did she turn and look over her shoulder and see them coming on? The whole time, she recounts the story with the tone of an unimpressed, nonchalant twenty-something relaying a recent visit to Starbucks with her friends.
She wants to get on with her life, even says the second morning here that 'it's probably not a good idea to live according to the voices in your head', and the whole time she has an odd mix of psychosis and insight into her condition; the voices are at times external, at times her own voice acting out a part.
After a week and a half, dignity begins to appear for me in madness. The people on the ward are sick, but at the same time, just as an elderly veteran might suffer in dignified stoicism with advanced peripheral vascular disease or heart failure, these patients have their own sources of strength that they call on in the midst of the chaotic milieu of unusual inner dialogues (see, it's happening--I never would've used the word milieu on a Surgery rotation. Pretty soon I'll have to get sweater vests and jackets with elbow patches).