People with psychotic illnesses such as Schizophrenia often experience a wide range of symptoms. One common set of features are hallucinations, false perceptions with no external stimulus.These can affect any sense such as sight, hearing, touch, taste and smell as well as the perception of one's own body.

Typically a person with Schizophrenia may report auditory hallucinations - hearing voices for which there is no external evidence. These voices, which seem as real as any spoken words, may be of someone familiar or unfamiliar, perhaps even one's own voice perceived as if spoken aloud. The voices are often reported as unpleasant, perhaps making derogatory remarks about the individual themselves or commenting on the sufferer's actions.

One disturbing subset of this phenomena are command hallucinations. The voices tell the individual to do something, often leading to erratic and extremely unpredictable behaviour. The commands can be so compelling that those experiencing them feel unable to resist. Such unpredictability can make it very hard to look after these people.

In milder (although still extremely debilitating) cases, the instructions might be to walk up and down a room five hundred times or to touch something. In more severe examples the sufferer might find themselves compelled to behave more destructively. It was an example of the latter that caused an event of the bloodiest violence.

Steven, a slim quiet-spoken fellow in his early twenties, had been on the ward for three weeks when it happened. He had recently been diagnosed with Schizophrenia and spent most of his time quietly reading or watching the television. On this particular afternoon, Steven had taken himself into the bathroom for a bit of a dip. Although the staff knew he heard disturbing voices, he was responding to treatment and there was certainly no reason to suspect what he was capable of doing.

So it was perhaps by chance that one of the Staff Nurses walked into the bathroom and spotted the blood dripping down the walls of the cubicle. The security alarm was raised and the cubicle door smashed-in. In no time flat nurses were running in from all directions. There in the bath lay Steven, the blood pumping across the room from his wrists, where his left hand was hanging from the bone. Apparently unaware of any pain, he was desperately trying to cut his other hand off with the razor blade held in his mouth.

As a nurse, it's in emergency situations like this that your mind becomes extremely focussed. No time to think. Just time to do. With the years of training and experience to fall back on, you know what needs to be done. Only later will you reflect on the horror of what you've just been through. Stop the bleeding. Try not to skid on the slippery floor. Blood everywhere. Elevate the limb. Apply a compressed bandage - the towels. Keep the breathing. Keep the heart beating. Get the water out of the bath. Get him out of the bath. On the floor. Keep him warm. Blankets. Alert emergency services. First Aid trolley. Drugs. Oxygen. Defibrillator. IV fluids. How much blood loss before he goes into shock? Will he survive? What about his hand?

Events of such bloody extremes are thankfully relatively uncommon, although inpatient Psychiatric Units by their nature are places where angst and despair are often played out, behind closed doors, away from society. It can certainly put everyday life into a different perspective. Things which seem to shock others, outside the walls can seem pretty mundane in comparison.

The surgeons managed to save Steven's almost amputated hand, although it's hard to say if he will ever regain full use of it. The treatment and physiotherapy continue. He said the voices told him to do it. He said he felt no pain. And now when Steven looks down at the contracted claw which was once his right hand, he will always be reminded of the day the voices told him he was disgusting and should never be able to touch himself, or anyone else again.