ABSTRACT
Sean was a twenty-four-year old, single, second-year law student referred for psychological intervention by his GP who noted clinical features of panic disorder and low mood. At interview he appeared anxious and when asked about his chief complaint he started by saying ‘You might think I am mad but . . . it is hard to explain . . . I feel as if I am not the real me. It’s like I am permanently looking at my own thoughts . . . I know it’s me thinking but it feels as though I am not in control of them. It feels as though the world around me has changed. It’s as if I am in a film or looking through a goldfish bowl, everything looks strange’. It was evident that no metaphor was to Sean’s full satisfaction. He offered to share some notes that he had gathered ahead of his consultation and proceeded to read a list of expressions describing his experiences. ‘It’s weird but I often look at my parents and they look strange almost unreal, they don’t feel like my parents and the more I look at their faces the more unfamiliar they get’, ‘I often feel as if my arms don’t belong to me and I have to move them to convince myself that it’s me who is moving them’, ‘Sometimes my voice sounds weird not like mine, as though I have no control over it’. Sean explained that his biggest fear was that he was ‘going mad’. He was terrified that the use of marijuana had permanently damaged his brain and that he was developing Alzheimer’s dementia, which was causing him to forget about his own identity. This feeling was particularly acute in situations where he found himself ‘as if suspended, as though my memories had no continuity, no past and no future, and I am afraid I may forget who I am’. Sean reported spending most of his day checking if he was still himself but it never felt right. He occasionally looked into the mirror to
see if he had changed and he often tried to recall past personal events in order to reassure himself that he did not have Alzheimer’s.
