A 24-year-old man presents to casualty having got into a fight as he thought he was being watched and felt threatened. He appears to have fractured his thumb but is reluctant to let you examine him or order an X-ray. He looks suspicious and wary. When asked about his concerns he says that over the last few months he has been carefully monitored by government agencies.
He has been hearing a voice out loud giving a running commentary on his thoughts and these are being broadcast to the government. Any machine enables the government to get inside his head and the voice is telling him it would be unwise to face the X-ray machine. The voice is not one that he recognizes and it is sometimes derogatory telling him he is stupid for giving his thoughts away for free. Initially, the voice came and went but over the last few weeks it is present almost constantly and he cannot always sleep because…
