Just Today.

Just today, he was brought in because he was hitting himself in the head, and wouldn't stop. He wasn't screaming, or yelling, or being disruptive--according to his teachers, he's actually a sweetheart, but in the past couple weeks his performance had been declining, and then today, he started hitting himself in the head.  When his teacher grabbed his hand, he looked her straight in the eye and said, "I need to make the mumbling go away."

The voices had been getting louder over the past couple weeks, and it's like, really hard to learn Algebra when someone is constantly mumbling at you. Try it. So he got the idea to hit himself in the head. He figured that would do it. He's right, actually. Hit yourself in the head enough times, and everything stops.

Also, there were shadows following him. That is to say, he could see menacing shadows out of the corner of his eye--

--How did you know they were menacing?

"I just do."

So he's being followed by menacing shadows. That he knows are trying to hurt him. He walks very, very fast, so they can't catch him, to get away, to be safe. Same reason he hits himself in the head. To be safe.

The olanzapine helps a little.  I asked him if the voices say anything to him in particular.

"Not really. I mean, it's like I can almost just make out what they're saying...but if I stop, they stop. They only talk when I'm doing stuff."

Insight is what is used to describe whether someone with a psychotic disorder understands that the voices aren't real. I once had a client tell me that the entire time she was in therapy with me, voices would tell you to stop listening, and yell "NO!" and sometimes, they'd say, "she's lying to you." However, she knew they weren't real, so she just ignored them. Maybe this kid will reach that point and realize that none of it is real--the shadows, the voices, the belief he was being followed.

But today....

Today he's doped up on all sorts of stuff, so that he won't hit himself in the head, and he thinks the voices are real, and he can make them stop.

Today, he also thinks that if he tries hard enough to make out what it is they're saying to him, then he can do what they want and maybe then they'll stop.

Today, he's only thirteen, and he just wants the voices to stop.

....