‘Yes, in this interview, I think we can hear pressure of speech, where the patient speaks quickly and incessantly. Also derailment, or flight of ideas, when he switches topic, sometimes in mid-sentence. That can be in response to an outside stimulus.’
‘
‘Yes, that sort of thing. You might also detect a degree of tangentiality, when he replies to questions in an oblique or irrelevant manner. To you, in your profession, that would probably sound very suspicious and evasive, I imagine.’
Cooper nodded. Evasive was the exact word that he’d used about John Lowther after his interview.
‘In this form of speech, he reaches conclusions that don’t follow logically, or his thoughts might have no conclusion at all. Sometimes the individual words are correct, but the manner they’re put together is wrong, resulting in what some clinicians call
‘That confusion in his speech was already evident a few days ago.’
‘Really?’ Sinclair frowned. ‘It varies with the individual patient, of course. But perhaps he had stopped taking the medication earlier than we thought.’
‘Will this get worse?’
‘Yes, as his condition deteriorates, he might become incoherent, using inappropriate words or mispronouncing them, or making up new words altogether.’
‘
Sinclair shrugged. ‘It’s impossible to interpret his real meaning without having Mr Lowther here for a proper interview.’
Cooper bristled. ‘A
‘My apologies. I meant a properly structured clinical interview.’
Cooper watched Sinclair gather up his notes, plucking up the courage to say what was on his mind.
‘Doctor, you said that many people who have psychotic episodes find them a positive experience.’
‘Yes. Many of them are non-clinical individuals, of course.’
‘Non-clinical?’
‘Individuals who have hallucinations but aren’t troubled by them, so they don’t seek treatment.’
‘But if they have psychiatric problems, they
‘Unless it’s a troubling experience, it wouldn’t be what we term a psychiatric problem.’
‘I don’t understand.’
Sinclair leaned back in his chair and looked at Cooper. ‘Do you believe in the supernatural?’
‘Well, I’m not sure — ’
‘No, of course not. Many of us aren’t sure. But, you see, from a neurological point of view, people with a tendency to psychotic experiences show increased activation in the right hemisphere of the brain. The same increase has been found in perfectly healthy people with high levels of paranormal belief, or mystical experiences. Even creative individuals can show a similar pattern.’
Cooper opened his mouth to ask whether that meant people who believed in the paranormal were mad, but Sinclair shook his head.
‘No, supernatural experiences aren’t themselves a symptom of mental illness. But people with different views of reality or unusual opinions have always held a rather complex role in society. Some are considered mad, while others are treated as prophets and visionaries. At the end of the day, the difference comes down to a question of contemporary social attitudes.’
‘You seem to be suggesting that almost anyone might suffer from psychosis of some kind.’
Sinclair closed the clasps on his briefcase with a click. ‘Well, it has been argued that patients with psychotic illness are simply at one end of a spectrum. Some practitioners say that psychosis is merely another way of constructing reality, and not necessarily a sign of illness at all. Only a small proportion of people who experience hallucinations are actually troubled by them.’
The psychiatrist smiled past Cooper, who turned to see Gavin Murfin hovering near the desk.
‘Well, I suppose police officers have to be feet-on-the-ground sort of people. No time for the imagination, eh? But most hallucinations are quite neutral, you know. They might simply take the form of a voice commenting on what you’re doing. People get used to that. In fact, for some individuals it’s rather comforting, as if they have a permanent, invisible companion, perhaps a loved one who’s died. Believe me, it’s not uncommon.’
‘I can imagine that.’
‘Well, now — instead of something neutral or reassuring, think of a voice that constantly makes negative comments about you and your actions. That’s the troubling sort of hallucination experienced by people in clinical groups, who need psychiatric help to deal with them. Treatment isn’t necessary unless the experience is disturbing.’
They walked down the corridor towards the stairs, passing the busy incident room on their way towards the reception area. By the front desk, the psychiatrist paused to shake hands. He held Cooper’s hand a little too long, giving him an appraising stare.
‘You know, many hallucinations occur in the phases of consciousness between waking and sleeping. You might hear your name being spoken, or get a feeling of someone being in the room, or of falling into an abyss. All of those are common. There’s a sort of paralysis that occurs in the hypnopompic stage just before waking — a sensation like a heavy weight on your chest that prevents you from moving or calling out for help.’
‘Oh, yes?’ said Cooper, wondering what he might be giving away by his expression.
Sinclair smiled reassuringly. ‘Generally, people write those experiences off as dreams, DC Cooper. They wake up. And then they get on with their lives.’
Cooper walked slowly back to the CID room, and found Murfin already at his desk, watching Fry heading towards him.
‘You know this voice that constantly makes negative comments about me and my actions,’ said Murfin.
Cooper looked up in surprise. ‘Yes, Gavin?’
‘It’s a relief to know it’s only a hallucination. I thought it was my DS.’
When Cooper had briefed her and left for the Heights of Abraham, Fry thought about John Lowther’s confusion of speech. He hadn’t seemed to mix up his words when she’d seen him on Wednesday — not the way he had later, when he was interviewed. He’d been more vague and confused than anything else. Dr Sinclair might be right. But it was rather more like a description someone else had given her recently.
Ignoring the glances of Cooper and Murfin, Fry picked up the phone and called Juliana van Doon at the mortuary.
‘Mrs van Doon, what would be the effects on a person who’d suffered only slightly from smoke inhalation?’
‘Mild hypoxia? Well, there might be effects on the voice. Coughing, hoarseness, stridor — that’s a high- pitched sound, like croup. You could look for singed eyebrows, moustache, or other facial hair. Also traces of soot in the nose or mouth, slight burns to the face.’
‘Yes, but what about their behaviour?’
‘Their behaviour?’ The pathologist hesitated. ‘This is just an informal opinion?’
‘Of course.’
‘Well, I’d say a person suffering from mild hypoxia would appear distracted, and probably clumsy in both their speech and manner. Is that what you were thinking of, Sergeant?’
‘Yes,’ said Fry, nodding gratefully. ‘That’s exactly what I was thinking of.’
32
He’d forgotten the other voices. Somehow, he’d managed to put them out of his mind, until they started to come back. It was so strange, the way the brain could shut out things that it didn’t want to know about, drawing
