I was sitting on the bus one winter’s morning going into Manchester when a man in the seat in front of me suddenly started talking rather loudly. At first, I thought he was on the phone, but when I looked up, he wasn’t holding a phone at all. He was talking to himself. I then realised he was unkempt, despite wearing a jacket and hat that once would have been smart, and made the assumption that he was homeless, rightly or wrongly, I don’t know. It then became clear that he wasn’t speaking about the normal things one would talk to oneself about, as we all do (maybe not in public, mind you). It became apparent to me that he was replying to voices he was hearing in his head, and reacting to things he appeared to see on the street outside the bus that I could not see. Were these auditory and visual hallucinations? He was paranoid, which made me wonder, using my limited knowledge of psychiatry, whether he was suffering from paranoid schizophrenia. It certainly reminded me of patients I had seen in the psychiatric hospitals on placement. People on the bus went silent, then strangers started giving each other strange looks, smirking and whispering. Some elderly women clearly felt uncomfortable, and got off the bus a few stops earlier than they would have otherwise. If my assumption of paranoid schizophrenia was correct, my heart goes out to this man, because it could very well have been the reason for his homelessness. This is the case for many people with schizophrenia who don’t have friends and family around them to point out that they are unwell, and that they need to seek help. He needed help, but others on the bus clearly did not perceive it this way. They were too wrapped up in their own lives of normality to realise that this man was just the same as you and I, but just needed help to get back to the life he once had, in that smart jacket and hat.
I scribbled down some of the phrases he was saying, displayed below.