‘Unpredictable?’
‘No, I think we can predict him: if any idea has no possible basis in fact, he’ll love it.’
‘Excessively sensitive? Cannot cope with criticism? Imagines the world revolves around what other people think of him? Needlessly worries about his appearance?’
‘Sounds like you’ve met him!’
The doctor remained expressionless; he was trained not to be susceptible to what patients thought he wanted them to say. The Praetorians, like all patients, found this off-putting. From the vigiles, Vinius recognised the deadpan method; he thought Themison was overdoing it.
‘Has he always been this way? Or did it come on, for instance, in early adulthood?’
‘Could be.’ Vinius took this question, remembering that scene on the Capitol.
‘Was it triggered by an extended period of stress, or some catastrophic event? Witnessing a violent death, for instance?’
‘That fits.’
‘How old was he?’
‘Eighteen.’
For once Themison nodded. ‘That would be typical… And what about his childhood? Did he suffer deprivation?’
‘There is said to have been relative poverty — no family silver on the sideboard, if you count that as hard luck.’
‘I meant in another way. Could your friend when young have felt he was somehow insignificant? Unloved? Considered worthless?’
It was still Vinius supplying answers: ‘His mother died, his father spent a lot of time away. I don’t know what happened domestically; he may have been passed around family members, but they were a clannish family and I doubt he was really neglected. He may have been jealous of an older brother who was always a favourite. Well, he must have been. Very jealous. He probably grew up thinking whatever he did, it would never be good enough.’
He thought briefly of Felix and Fortunatus. There were ways to live with strong older brothers, without losing your sense of self.
‘And what brought you here now?’ asked Themison. ‘Is his intellectual capacity suffering? Does he function normally?’
Gracilis took the lead again. ‘He is bright, energetic, takes an interest in everything. He functions, functions well. Generally.’
‘But?’
‘Very extreme behaviour on occasions. Unreasonable. Dangerous.’
‘You mean you think he is going mad?’
There was a long pause. All three men breathed a little faster than previously.
Themison, frightened, attempted to react as if they had merely said their friend had a septic rash. ‘I shall need more details.’
‘He believes his wife has been unfaithful.’
This time Themison shocked the Praetorians by exploding with laughter: ‘You call that extreme? Every husband in Rome believes the same. A large proportion are correct.’ Gracilis and Vinius exchanged glances, each wondering what the doctor’s wife had to put up with. Apparently unaware of his self-revelation, Themison continued, ‘I am not joking. Always remember that when patients seem to harbour delusions, there may be a grain of truth there. It confirms their fears and makes it harder either to diagnose their illness, or to convince them there is anything wrong… Has your friend been violent?’
They nodded.
‘Has he harmed anyone? Do you need an opinion for legal purposes? Has a victim pressed charges?’
Gracilis laughed harshly. ‘Won’t happen.’
‘But you have approached me because you feel deep concern.’ Themison now sat up more. ‘I can give guidance on patient management, though most of my work concerns wounds to the body, as you know.’
‘You do study the mind, doctor?’
‘Oh yes. I tend gladiators. Preparation for physical combat includes good mental health.’
‘I am glad you think that — ’ The centurion looked as though he would like to discuss this thesis professionally.
But Themison had reached the point where he was ready to contribute, a moment in any consultation where he expected to hold the floor while patients, or their concerned ‘friends’, listened admiringly. ‘This is my opinion, based on what you say. You may have been describing a condition we call “paranoia”. From para meaning “beyond” and noos, “the mind”. Do you know Greek?’
‘Enough to be xenophobic!’ scoffed Gracilis rudely. ‘So if “paranoia” means “beyond the mind”, what does “beyond the mind” mean in good Latin?’
‘Outside the boundaries of reason,’ Themison explained crisply. His actions and speech became much more comfortable. ‘We all carry the seeds of paranoia within us. However, most people can tell when their fancies have no reality, and often holding crazy ideas is temporary. With paranoia, extreme suspicions last. It can be as mild as “that slave gave me a funny look just now” or as severe as “the plotters have cunningly drilled a hole in the ceiling to spy on me”. Let me outline some symptoms you may recognise: anxiety, feelings of being threatened, difficulty forming social relationships, jealousies regarding the sexual fidelity of a spouse, preferring his own company, secretiveness, eccentric and aggressive behaviour, a heightened sense of self-importance…’
‘Exactly.’
‘Does he suffer hallucinations?’
‘Not that we know.’
‘Is he hearing voices?’
‘Seems not. Is that good?’ queried Vinius.
‘Better than nothing.’
‘Can you do anything?’ asked Gracilis.
‘Even if I could, such patients are not amenable to being treated. Their suspicion that people are plotting against them leads them to resist any suggestion they are ill; they see this as part of the sinister plan, the plan they must try to outwit. Even if they do seek help, they tend to disrupt any prescribed regime, toss away medicine, obstinately take against their doctors-’
‘It’s a waste of time trying?’
‘There is no cure.’
‘He will never get better?’
‘The condition is chronic. He may perhaps get worse.’
‘That could be unfortunate! So what do you advise?’
‘It is important to resist his crazy ideas. Stand firm. Do not undermine the poor fellow, but tell him firmly you assume he has his reasons for thinking that way, but you cannot agree with him. This condition is very hard on friends and family, because of the unremitting need to deal with someone who denies he is afflicted and resents help. Such patients are wearing to live with and, as you probably appreciate, to be constantly under suspicion while innocent may exasperate his associates until they do turn against him. Those who love him will feel rejected.’
‘Those who love him may be rejected.’
‘Exactly.’
‘This is bleak.’
‘Not entirely. Such patients can have great creative talent — and can be capable of immense kindness to others — but even those who admire him may not dare to reassure him, in case the slightest phrase is misinterpreted.’
Themison paused. The Praetorians were too despondent to react.
‘Well, at least from your friend’s point of view, although he suffers terribly — and believe me, his delusions do make him truly miserable — even so, his affliction is not fatal… Though we must all die,’ said the doctor lugubriously.
‘That’s what you think!’ snapped Decius Gracilis dryly. ‘He’s almost a god. Half the buggers sitting up among the constellations nowadays are his dead relatives.’
