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A modern trend is for the old Mental Health Institutions of the past to be closed down and for people to be treated on psychiatric wards placed within general hospitals. I thought I'd seen everything until one day, when a man was admitted to the psych unit I was working on.

You see some bizarre sights in this business, but a man dressed as a theatrical horse standing in a casualty department in England, believing in all seriousness that he was a real horse, is not something which occurs every day.

One of the most prevalent of psychotic conditions, Schizophrenia hits about one per cent of the world population, irrespective of race, religion, ethnicity, etc. It's about as commmon as diabetes. In a similar way that knowing someone has cancer tells you very little about their actual condition, schizophrenia can be many different things to many different sufferers. Diagnosis is made from a wide range of possible symptoms, experienced over a specific time period.

It was helpful that our man responded verbally during most of our conversations with him, as none of us was well versed in equestrian. However, the intermittent horsey neighs and snorts certainy provided an interesting spectacle and a good reason to keep a handy box of tissues nearby.

It was fortunate to the humour of the situation that our man was 'happily mad'. He didn't seem particularly disturbed by his condition and despite his convictions, often quipped around the place good-humouredly. Although he appeared at times to believe he was a real horse, he seemed to realise the humour of the situation. We did wonder if he was having a lend of us for a while.

One common feature of psychotic conditions including schizophrenia, is delusions. A delusion is a fixed belief which a person holds, despite evidence to the contrary, which is out of keeping with their usual socio-religious and cultural background.

So if a priest says he is able to converse directly with God, then it would probably be deemed a claim which is appropriate to his standing. Whereas if a true blue fourth generation Aussie bloke claims he is a reincarnation of a German officer of the Third Reich and refuses to acknowledge the authority of the police, to the point of threatening the cops with a knife (another past client of mine), then you'd probably be fairly safe in saying this chap was somewhat deluded and his resultant behaviour deemed it necessary that he receives treatment before he or someone else gets seriously hurt.

Of course as is typical of psychiatry, many situations are rarely cut-and-dried. There are often many 'shades of grey' and options for Assessment Team debate, relating to when 'normality' (whatever that is) begins, eccentricity takes over and insanity is certain. But it is relatively easy when you've got a man in equestrian attire (and I'm not talking jodhpurs here) with a horse's head, neighing like the best of them, to come to a conclusion that this is not a real horse, just a man dressed up. Unfortunately, convincing the chap himself that this was the case, was a lot harder.

On one notable occasion the catering department were somewhat bemused at the requested special dietary requirements, but this just turned out to be a bit of a joke on behalf of one of the black-humoured RNs and 'Mr. Ed' was actually happy to partake of a normal human diet, with the standard knife and fork routine (no nosebags for him).

In treating people with such conditions, it is unwise to confront an individual's delusional material directly, as this can often lead to behavioural aggravation and a breaking down of the trust you are trying to develop. However neither can you agree with what they say, as this may promote a reinforcing oftheir beliefs and an untherapeutic 'collusive' relationship.

People with delusional thoughts are often totally convinced of the reality of their convictions, however bizarre; as convinced as you are that you are a member of the human race and living on the planet Earth. Prevailing treatment consists of careful doses of antipsychotic medication and cautious, reality reinforcing therapeutic relationships, where the individual is gently introduced to the other realities that most of the rest of us share...most of the time.

As it turned out, our man responded quite quickly to the antipsychotic medication and left the clinic a new man. We never heard from him again and I often wonder what he's doing now and how he looks back on this time in his life..