risk for suicide. Other factors of concern for John that increase suicidal risk include, being unmarried, not working, feeling hopeless, experiencing psychic anxiety, loss of his mental health, and a low level of social involvement/support (Kaplan and Sadock, 1991, p.555).
John’s hallucination of Charles, a positive symptom, appears, as well. An explosive episode occurs as John is caught in an internal struggle between his mathematical brilliance and his cognitive impairments. He acts out his struggle in a fight with himself. (The fight is seen from John’s perspective, so it does not appear to be odd. For John, Charles is real. However, in reality Charles does not exist and John is fighting with himself). In his desperation, his thoughts include suicide, “…go on, bust your head, kill yourself…,” and his behavior includes diminished impulse control, i.e., throwing the desk out the window. However, he is able to attribute those thoughts and actions to Charles, rather than himself. Following each of these actions, the voice of Charles also reinforces John’s belief in himself through words of support, friendship and recognition of John’s brilliance. Thus, John prevails.
From the time of John’s arrival at Princeton University until this point prodromal symptoms of his illness, as mentioned earlier, symptoms prior to the full syndrome –before the full onset of the illness- have appeared which include deterioration in functioning and an increase in positive and negative symptoms.
Kaplan and Sadock (1991, p.333) identify prodromal or residual symptoms as social isolation or withdrawal, impairment in role functioning as wage-earner, student, or homemaker, peculiar behavior (eg., collecting garbage, talking to self in public, hoarding food), impairment in personal hygiene and grooming, blunted or inappropriate affect, digressive, vague, overelaborate, or circumstantial speech, or poverty of speech, or poverty of content of speech, odd beliefs or magical thinking, influencing behavior and inconsistent with cultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, “sixth sense,” “others can feel my feelings,” overvalued ideas, ideas of reference*), unusual perceptual experiences (e.g., recurrent illusions, sensing the presence of a force or person not actually present) and lack of initiative, interests or energy.
*to be defined later in the text
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