Friday September 7, 2007


Last night I dreamed of James. As it sometimes happens in dreams, the man in my dream looked very different from the real-life James, but I knew it was him, I could feel he was the same person.

In my dream, James was cutting a man’s throat.

Without saying a word, without hesitation.

He was standing behind the man, who was shorter than him, and all of a sudden James grabbed the back of the man’s hair, pulled a knife out of thin air, and started to slide the man’s throat from left to right, slowly, inexorably. Blood spilled out from the open carotid, strong red streams, never ending. The dream was so vivid than when I woke up I felt sticky, guilty, as if I had somehow participated to the slaughter myself.

Do I feel any responsibility for what James did, or might have done? It’s hard to say. But what is worse is that it could have hardly been prevented: patients’ behaviors during hypomaniac episodes are unpredictable.


I took a good look at him today when he came into my office: he’s always calm, his eyes are clear and he always shows a polite but honest smile on his face. How can he be a murderer? Images from my bloody dream were superimposed to what my eyes were actually seeing, in a strangely blurry vision. For the first time in my career I didn’t know how to handle my patient, and it scared me. I let him talk. For the first time in my career I didn’t listen to what my patient was saying: my hears were filled with the sound of my blood running through my veins, the sound of fear, adrenaline. I’ll have to make peace with myself next time I see him.

Better times will surely come,
Dr. Alexander Williams