A client heard voices that he should stab Nigel Leaney. Then, during a sleep-in, a kitchen knife appeared under his bedroom door

I was at the end of another sleep-in. Ian managed it, I thought with relief as I completed my morning shave. But then I glanced down at the doorway to the sleep-in room – and felt sick. It wasn’t the best start to the day.

I’d been working with Ian for some weeks to reduce his nocturnal command hallucinations. After some initial success, using simple distraction techniques, Ian grew alarmed that the voices’ commands had changed. As well as the well-worn instructions to kill himself, the voices had also begun to command him to stab me during my sleep-in. I tried to reassure Ian that it wasn’t uncommon for such voices to turn on the professional who was helping someone to manage their voices. To an extent it was to be expected. I concluded that he usually resisted the voices’ commands and so there was little reason to suppose he wouldn’t be able to do so this time. I hoped I sounded more confident than I felt.

That night was my first sleep-in since Ian’s disclosure. Time to put the theory to the test. And here I was, shaken but still standing. The point of the long meaty kitchen knife protruding from under the doorway had just finished up resting on the carpet.

Ian was profuse with apologies. He recalled being outside the sleep-in room door, holding the knife. The voices kept telling him to wake me in order to carry out their instructions. He’d managed to resist. Casting the knife under the doorway was an act of final resistance.

His explanation put things into context. What had first appeared sinister was, in fact, a small victory. And nothing like this has occurred since. I guess it helped that we’d known each other for a long time and developed reciprocal trust and respect.

Ian still struggles with his voices. His nights are often filled with a torment that is difficult to imagine. It was triggered 20 years ago by a vicious assault that almost cost him his life. As it was, it cost him his job, his home, his marriage, in return for a life filled with suicidal attempts and ­countless hospital admissions. But still Ian works with us to try to make his life more bearable.

When Pandora closed the box only hope remained inside. And, like Pandora, sometimes it is all any of us have.

Nigel Leaney manages a mental health residential service



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