I was having a moment of self-loathing on the tube yesterday as I recalled a particularly drunken misadventure and without meaning to I groaned and hit myself in the head a few times with my book, saying: “Idiot, idiot, idiot.” Everyone on the tube turned and starred. I realised that must be what it’s like to be mad. The voice in your head becomes so overwhelming that it requires action.

I was thinking about insanity after a 30-year-old lady came into A&E last week covered from head to toe in her own shit. She was clearly psychotic. We had to sedate her to clean her up because every time we tried to wipe any of it away she would flail and scream, agonised. She was very attached to it. Still a little stinky, she was inconsolable about no longer being covered in her own feces in the examination. Eventually, we learnt what had happened. Her husband had died six weeks previously launching her into a psychotic episode where the voices in her head convinced her that her husband was not dead but inside of her. She desperately tried not to shit, becoming toxically constipated, but eventually her bowels would explode in protest, so she would scoop it up and smear it over her body trying to preserve every last pellet of her husband. It was utterly tragic and part of me wished that we had scraped her shit into a little jar to take home with her.

One in hundred people will have an episode of schizophrenia – you see people walking around with earmuffs in summer or headphones unplugged and often these are coping mechanisms. Auditory hallucinations are very persistent – like small children, telling them to be quiet or threatening them just doesn’t work. It is like your inner monologue, the wanky one that insists you’re a twat, becomes self-sufficient – it no longer needs you to exist and like a coke-fueled motor-mouthed rant it goes on interminably. Only you hear it as a constant outside noise.

I once sat in on a hearing voices class where people are encouraged to articulate their voices, talk back and negotiate with them. A pretty 20-something girl had thought her Co-op was compelling her to buy things she had no use for, and she couldn’t walk within 100 metres of the entrance. A Nigerian man’s voices were personified by a 6ft blonde transsexual and an angry midget who would constantly argue in his head. And one old lady believed her husband worked for the secret service, they had kidnapped her and planted a chip in her brain, which made her act out their will. They all agreed the best coping mechanism was using a mobile phone. They held it to their ear when they had the urge to talk to their voices so people didn’t think they were insane. Many of them had learnt to live successfully alongside their voices – the aim of the classes. The pretty 20-something girl even said she had a new voice, who sounded like a younger version of herself, except incredibly witty, and she enjoyed their conversations.

The funny thing is psych consultants are all a bit nuts too. They like to provoke patients and get their voices to act up in an attempt to prove to them they are not real. I sat in on a psych consultation with a 45-year-old who had been suffering for four years.

The doctor asked, “So, where is your voice now?”

Perfectly sane, the patient replied, “He’s in that chair,” pointing to a very empty chair in the corner.

So the psych doctor stood up, walked over to the chair and sat in it. Saying smugly, “So, where is your voice now?”

The patient looked at him, and replied, “He’s in the corner and he’s telling me, you’re a fucking cunt.” It made me think that sometimes I would quite like a voice, which I could blame for calling people a cunt.

DR MONA MOORE