Chapter 8. Randy’s Case: “They stole my brain and I want it back.”

8.1 Screen 1

Clinical Choices
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You must read each slide, and complete any questions on the slide, in sequence.
Neologisms

Made-up words that typically have meaning only to the person using them
Loose Associations

Rapid shifts from one topic to another, with the individual believing that the incoherent statements make sense
Alogia

A reduction in speech or speech content
Inappropriate Affect

Emotions that are unsuited to the situation
Schizophrenia
For 1 month, the individual displays two or more of the following symptoms much of the time: Delusions Hallucinations Disorganized speech Very abnormal motor activity, including catatonia Negative symptoms At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech. The individual functions much more poorly in various life spheres now than before the symptoms appeared. Beyond this 1 month of intense symptomology, the individual continues to display some degree of impaired functioning for at least 5 additional months. (Information from: APA, 2013)
Brief Psychotic Disorder
For 1 day to 1 month, the individual displays one or more of the following symptoms: Delusions Hallucinations Disorganized speech Grossly abnormal psychomotor behavior, including catatonia At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech. Individual eventually returns to the level of functioning that existed prior to the symptoms appearing. (Information from: APA, 2013)
Schizophreniform Disorder
For 1 to 6 months, the individual displays two or more of the following symptoms: Delusions Hallucinations Disorganized speech Grossly abnormal psychomotor behavior, including catatonia Negative symptoms. At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech. (Information from: APA, 2013)
Schizoaffective Disorder
The individual experiences a major depressive or manic episode at the same time as the primary symptoms of schizophrenia. The individual has experienced delusions or hallucinations for at least 2 weeks when not experiencing a major depressive or manic episode. Otherwise, the major depressive or manic symptoms are present most of the time during the schizophrenic symptoms. (Information from: APA, 2013)
Delusional Disorder
For 1 month or more, the individual experiences one or more delusions. The individual has never displayed schizophrenia. Functioning is only mildly impaired, and behavior is only minimally odd or bizarre. (Information from: APA, 2013)
Hallucination

The experiencing of sights, sounds, or other perceptions in the absence of external stimuli
Obsession

A persistent thought, idea, impulse, or image that is experienced repeatedly, feels intrusive, and causes anxiety.
Delusion

A strange false belief firmly held, despite evidence to the contrary
Catatonic Behavior

A pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing
Medication

Medication involves taking a chemical agent prescribed by a medical doctor (MD) in order to alter brain chemistry, which subsequently alleviates symptoms. In Randy’s case, a psychiatrist, who has a medical degree, could prescribe an antipsychotic medication to help control his hallucinations and delusions. The psychiatrist would continue to meet with Randy regularly to monitor his symptoms and to adjust the dose of his medication as necessary.
Psychoanalysis

A conversational treatment used by psychodynamic therapists that includes techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other indicators such as dreams. A psychoanalyst would treat Randy by seeing him 3–5 times per week for several years. Psychoanalysis is costly, and it requires a large time commitment.
Interpersonal Therapy

Interpersonal therapy focuses on problems in significant relationships in the patient’s life. Interpersonal therapists treat patients by focusing on their current relationships with the most important people in their lives. These people include partners and spouses, parents, children, and other close relatives. For Randy, this would likely be his estranged parents.
Cognitive therapy

Cognitive therapy involves challenging distorted thoughts. As a cognitive therapist, you would work with Randy to address his maladaptive thoughts, specifically his beliefs that the TV had stolen his brain. Treatment would include monitoring his irrational beliefs and trying to come up with rational responses to these beliefs.
Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy involves challenging distorted thoughts. As a cognitive-behavioral therapist, you would work with Randy to address his maladaptive thoughts—specifically, his beliefs that the TV had stolen his brain. Treatment would include monitoring his irrational beliefs and trying to come up with rational responses to these beliefs. In Randy’s case, cognitive therapy would work best in conjunction with medication.

Author: Taryn A. Myers, PhD, Virginia Wesleyan University

A man stands behind the bars of a prison cell.

8.2 Screen 2

Begin

Please note: Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook, in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.

8.3 Screen 3

Get instructions for the interview
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You are working as a forensic psychologist—that is, a psychologist who works for the court system. You receive the following referral paperwork, in which a judge is asking you to evaluate a man named Randy who is in jail due to some strange behavior that resulted in his arrest. Select the button below to review the paperwork before you begin the interview.

New Client
Randy: Case #10114

Forensic Psychological Clinic, District Court

Referral Paperwork

Client Name: Randy

Age: 32 years old

Gender: Male

Ethnicity: Caucasian

Occupation: Unemployed

Current living situation: Lives alone in a cabin in the mountains, 25 miles outside of town

Why are you referring this person for an evaluation? Randy needs a psychological evaluation to see if he is suffering from a mental disorder. His odd, disruptive behavior caused him to be arrested and charged with the misdemeanors of assault and battery following a physical attack on a waitress in a local diner and several patrons who tried to intervene. His odd behavior has continued in jail, where he bangs on the bars of his cell constantly. He has also damaged jail property—he threw his metal dinner tray at the closed-circuit television, denting it. The jail superintendent wants him charged with destruction of jail property. We are requesting that Randy be evaluated to see if he should be referred for mandatory psychiatric treatment, rather than remanding him to the penal system where he may not get adequate care.
- Judge Judith Ginsberg, District Court

8.4 Screen 4

Begin the interview

You will now ask Randy a number of questions you would typically ask during the intake interview. As you conduct the interview with Randy, begin to think about his symptoms, what his diagnosis might be, and later, what type of treatment might be most helpful to him. Select the “play” button to hear Randy’s responses to your questions. To read the transcript for these answers, select the “transcript button.”

8.5 Screen 5

Ask Randy the next question

“Randy, do you understand why you’ve been referred for a psychological evaluation?”

A middle aged man, Randy undertakes an interview for his psychological evaluation in a prison.

Transcript

Randy: [sounding distracted] Sure, I told that judge woman already. They – you – want to get inside my head. But I told her – I told her – I’ll tell you, they won’t find anything. My brain is missing, and I don’t know who took it.

8.6 Screen 6

Ask Randy the next question

“Okay. It’s important for me to explain that, since Judge Ginsberg referred you to me for an evaluation, the court is technically my client, not you. Therefore, nothing you tell me is confidential—it can all end up in my report to the judge. That being said, I will strive to use that information to make recommendations that are both in your best interest and in the interest of public safety. What we are doing today is called an intake interview. I’m going to ask you some questions that I ask everyone who I see. This information will tell me how best to help you. This may mean having you continue to see me for therapy, or it may involve referring you to another mental health professional. Let’s start. Do you remember how you ended up in jail?”

Randy takes part in the interview and talks about his lifestyle.

Transcript

Randy: I came – I come down from my cabin to town, 25 miles by the crow flies. The crows and the game and the other birds and my vegetable garden are how I get food. I collect rainwater or get my water from streams. I live off the land. I heat my house with trees. I’m a survivor – I’m a survivalist …revival survivalist. No electricity – you have to watch out for that. Very tricksty. But I come – I came to town to get a few supplies. Some groceries – I don’t have chickens, I don’t have cows, so I have to buy their by-products. What they leave behind. I buy coffee – can’t grow that in Colorado not on the mountain not on the plains. I stop by the library – such a nice lady, she gets me such nice books. Philosophy and history, none of those trash novels and hunting books. She orders them from the booksitorium, just for me. Then I always end with the diner, always the diner.

Question 8.1

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Correct.
Focus specifically on the words that Randy seems to be making up and which of the symptoms these words match.
Incorrect.

Hint

Focus specifically on the words that Randy seems to be making up and which of the symptoms these words match.

8.7 Screen 7

Ask Randy the next question

“Okay, Randy, but what happened the other day? How did you end up in jail?”

Randy talks furiously about what brought him to prison.

Transcript

Randy: The other day? The day of others? Oh! The diner. Have to watch out for the TV at the diner. The one waitress – she knows. She will turn it off, the infernal box, the TV. But she wasn’t there. I needed something to stop the noise! I asked the girl waitressing to help me stop the noise. “What noise?” she says, as if she didn’t know. What noise, what noise? The noise in my head! [smacks hands on ears] I can’t stop it, it won’t stop ever since the TV stole my brain. She tried to be funny oh she tried to be clever and told me to tell them [gesturing as if to entire room] about the noise, said she might want to listen, too. She knows better. That’s what the noise wants! So I reached over and I grabbed her – grabbed her front – grabbed her shirt and told her, I warned her “Kill the noise or I’ll kill you.” Then they were on me! So many people grabbing and shoving. So I kicked, I bit, I threatened, I fought. Then they called the police – never trust ‘em! I tried to trust ‘em years ago, the boys in blue, they just ignored me and the TV got worse and now my brain is gone. [suddenly quieter, somewhat fearful] But when I saw them I knew – I knew it was THEM. And so I said to them, I told them, "So, it's you. You’ve been after me for years – putting arsenic in my garden, taking money out of my bank account. And stealing my brain – don’t think I forgot that. But you will pay for this. The Chief is looking for you."

8.8 Screen 8

Ask Randy the next question

“How long have you felt like the TV was stealing your brain? When did you first start having these experiences?”

Randy angrily talks about his college life and his parents.

Transcript

Randy: They’ve been there. They’ve been there and I didn’t even know it. Ohhh yes, they’ve been there. Really noticed it in college. Oh that man, the Dean. He tried to hide it, but oh no, he was the problem. He stole her, my girlfriend. She broke up with me – it had to be him. And the probation, for academics! 3.8 GPA my first year, straight A’s in high school. And he tries to say “probation.” [raising his voice] For what? For majoring in history? For trying to learn from the past? For sleeping and eating junk food when he stole her – stole her? He said I didn’t go to class! Class didn’t need me to go. So he expelled – expelled me! I think he was threatened by me. [quieter] But I was glad, because then I got to live at home with the TV and then I realized they were there. I would yell at them, in the TV! When they – the parents – when they were gone for the weekend, I fixed it. I pulled out the box, the cable box, the brain-sucking box, and I hammered that TV. Smashed it good. They – the parents – they didn’t understand. I explained it so clearly that the box was taking thoughts from my brain and sending them to the TV and I didn’t want everyone to hear the thoughts – they’re mine! [becoming upset, more emphatic.] My thoughts belong to me, and to no one else. Whoever tries to take them is going to have to pay. So I talk to them, all the time, I have to tell them. One, two at a time, I talk to them. They’re so clever ... others say they can’t hear them.

Question 8.2

Based on his initial report of his symptoms, which of the following psychotic disorders could Randy be suffering from? Select all that are possible diagnoses for Randy. To review the definition for each term, select the term.

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Schizophrenia

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Brief Psychotic Disorder

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Schizophreniform Disorder

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Schizoaffective Disorder

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Delusional Disorder

Correct! You identified the psychotic disorders Randy could be experiencing from his initial description. Randy’s symptoms could be schizophrenia or schizoaffective disorder. His symptoms have lasted much longer than a month or even six months, so he is not suffering from brief psychotic disorder or schizophreniform disorder. He is experiencing hallucinations in addition to delusions, so it is not delusional disorder. Keep these disorders in mind as you listen to the rest of Randy’s interview.
That is not quite right. Randy’s symptoms could be schizophrenia or schizoaffective disorder. His symptoms have lasted much longer than a month or even six months, so he is not suffering from brief psychotic disorder or schizophreniform disorder. He is experiencing hallucinations in addition to delusions, so it is not delusional disorder.

Hint

Think about how long Randy has had his symptoms, as well as which symptoms he is experiencing.

8.9 Screen 9

Ask Randy the next question

“Randy, what happened in jail? The judge told me you had some difficulties while you were there.”

Randy raises his hand and talks about his problem with the TV placed in the prison interview room.

Transcript

Randy: They took me and they locked me up in over overnight – overnight. And there was a TV right there, right outside the bars. Like they knew, like they were taunting me or trying to get information. So I tossed ... I threw my plate at the thing ... the TV thing. I asked them: Why are you doing this to me? You stole my brain, what else do you want? What else does it want?

8.10 Screen 10

Find out more about Randy’s past

That sounds very upsetting, Randy. I can understand why you might react the way you did, even though I recognize that it is not necessarily an appropriate reaction. I’d like to change gears here for a minute and learn more about you. Tell me about your childhood. What was it like growing up in your family?

Randy talks about his family.

Transcript

Randy: Three boys – one older, one younger. My big brother, the older, he left us ... he shot himself when he was only 30 – 30! So much to live for ... He had a good job – all supposed to have ... [lecturing self] “Son, get a good job!” said the parents. He could live among the people. He didn’t have to live off the grid, like me. So why did he shoot? My dad is an electrician, he was strange, always strange, I think because of the electricity – tricksty. Paranoid, he was, always watching – he knew. My mom taught kids, elementary kids. She learned, she learned how to deal with dad. [As if lecturing himself] Be quiet, be passive, appease him. Otherwise ... the bad side. They – the parents ... didn’t talk, not much, and when they talked, only arguing.

Question 8.3

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2
Correct.
Think about how both genes and the behavior of others might have influenced Randy, and consider the details of his childhood that he has shared.
Incorrect.

Hint

Think about how both genes and the behavior of others might have influenced Randy, and consider the details of his childhood that he has shared.

8.11 Screen 11

Ask Randy the next question

“It sounds like you have had quite a bit to deal with in your life, Randy. Have you ever seen a mental health professional, like a psychiatrist, a psychologist, or a counselor?”

Randy continues with the interview.

Transcript

Randy: No, never did. Dad said no, no way. A neighbor said it would be good, would help, after I smashed the box, smashed the infernal TV. But dad said no, “no son of mine is going to a shrink, we take care of our own. Shrinks are not to be trusted.” So the neighbor asks me, do I want help? I want to keep dad happy and so I say, “I don’t need help. I’m okay now the TV is gone.”

8.12 Screen 12

Ask Randy the next question

“Randy, have you ever been in trouble with the law previously—ever been arrested or convicted of a crime?”

Randy talks about his experience with the police in the airport.

Transcript

Randy: [emphatic] No, never trouble on my part, only on their part. Tried to get help. Went to them, asked to file a criminal complaint. Against who? They say. Like they don’t know. So I tell them, I make it clear, against KBDI-TV. They ask what they did – as if the cops don’t know. So I tell them, real slow so they understand [speaking very slowly and deliberately] “Larceny – grand larceny. They stole my brain, and I want it back.” They let me think I could fill out a report, so I did, and when I left, I heard them laughing. “Boy, it takes all kinds,” they said, and I saw them throw it in the trash. So I left. I left the station and I left home.

Question 8.4

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
2
Correct.
Think about how you might react if Randy told you what he told the police.
Incorrect.

Hint

Think about how you might react if Randy told you what he told the police.

8.13 Screen 13

Review a similar case

“You said you left home. Do you have any contact with your parents now? Who do you go to for help or if you need support?”

Randy shows his hands to the nurse in anger while talking about his parents during the interview.

Transcript

Randy: [agitated and almost shouting] I left – can’t you see? I was just telling you, aren’t you listening? [Calming down] I left them – the parents – 10 years ago. That woman – my aunt, she died and left me some money. 50,000 clams. Have to keep them clams safe … them clams … so I put them in the bank. Bought my old truck – not new, can’t trust the new ones, they have TVs. Wrote them a note, the parents, “Thanks for nothing.” Packed and drove and found the cabin, where it’s safe. No parents, no contact. Off the grid. I’m surviving, I’m a survivalist revivalist ... Safer that way.

Question 8.5

Which of the following symptoms is Randy currently experiencing? Select all that apply.

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Delusions

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Catatonia

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Hallucinations

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Negative symptoms

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Engaging in risky behaviors

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Disorganized speech

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Feeling the need for less sleep

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Impairment in self-care

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Impairment in interpersonal functioning

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Feeling the need for more sleep

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Feeling depressed or down

Correct! Randy is experiencing delusions, hallucinations, disorganized speech, and impairment in self-care and interpersonal functioning.
That is not quite right. Randy is experiencing delusions, hallucinations, disorganized speech, and impairment in self-care and interpersonal functioning.

Hint

Think about not only the symptoms Randy is describing but also the ones you observed during your interview with him.

8.14 Screen 14

Diagnose Randy

From the File. You remember a former patient, Steve, who experienced symptoms similar to Randy’s. You review this case to help you diagnose Randy.

Transcript

REPORTER: Do you think you've had a difficult life?

STEVE: Oh yeah. I've had a lot of suffering in my life. I've had a lot of suffering, yeah.

REPORTER: Do you think your life has been harder than other people?

STEVE: Much harder than most people I know. How can you ask that question when I've had 71 psychiatric institutionalization?

REPORTER: Steve, can you describe the transition when you started feeling psychotic?

STEVE: Oh, yes. It's like going to sleep in a penthouse in Manhattan and somehow waking up on the suburbs of Nairobi in the jungle. It's just as dramatic as that, yeah.

REPORTER: In 1969, Steve had graduated from MIT and just finished his first year of medical school. At age 21, he suffered the first of many psychotic attacks. A world full of promise was flooded with fear and paranoia.

STEVE: How do you describe paranoia? Paranoia becomes just so incredibly intense that the feeling that everybody in the room knows what you're thinking, the feeling that everybody in the room wants to control you and get you to act in a certain way, either socially, emotionally, psychologically, spiritually, or sexually-- they're all trying to force you to do certain things and act and think in a certain way.

Question 8.6

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Both Steve and Randy have paranoid beliefs that others are persecuting them. Both patients think that others are watching them, know their thoughts, and control their thoughts. Like Randy, Steve has difficulty clearly describing what is happening to him and he feels overwhelmed by the symptoms that he experiences. Both men’s disorders have negatively impacted their quality of life.

8.15 Screen 15

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Question 8.7

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
2
Correct.
In making your decision, think about Randy’s symptoms and their duration.
Incorrect.

Hint

In making your decision, think about Randy’s symptoms and their duration.

8.16 Screen 16

Choose a treatment

Question 8.8

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2
Correct.
Think about the definition of each term.
Incorrect.

Hint

Think about the definition of each term.

Question 8.9

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2
Correct.
Think about the definition of hallucination.
Incorrect.

Hint

Think about the definition of hallucination.

8.17 Screen 17

Next Question

Question 8.10

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2
Correct.
In making your choice, think about which model best explains schizophrenia.
Incorrect.

Hint

In making your choice, think about which model best explains schizophrenia.

8.18 Screen 18

What happened to Randy?

Question 8.11

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2
Correct.
Think about what the therapists’ advice says to patients about their symptoms.
Incorrect.

Hint

Think about what the therapists’ advice says to patients about their symptoms.

Question 8.12

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There is no right or wrong answer to this question, only your personal opinion. However, cognitive therapy has shown a great deal of promise in helping to alleviate the symptoms of schizophrenia, especially when the therapy is used in conjunction with medications.

8.19 Screen 19

Real World Application

EPILOGUE

Randy works in a plant nursery after therapy.

As the psychologist, you write a report diagnosing Randy with schizophrenia and explaining why his symptoms may have led to his outbursts in the diner and in jail. Upon reading your report, Judge Ginsberg orders Randy to receive treatment, rather than than sentencing him to jail. This mandated treatment comes with conditions: If Randy does not follow through with the judge’s orders, he can be called back into court and can potentially still end up in the penal system. After considering several treatment options—such as inpatient hospitalization, an intensive outpatient program, and family therapy—the psychiatrist, Dr. Samuelson, prescribes an antipsychotic medication because she believes Randy is high-functioning enough to receive treatment on an outpatient basis.

Once his body adjusts to the medication, Randy stops hearing voices and feels like he has his brain back; he no longer believes the delusion that the television has stolen it. However, Randy is still struggling with how to integrate socially rather than staying isolated in his cabin. Dr. Samuelson refers Randy to a therapy trial of cognitive-behavioral therapy (CBT) for schizophrenia that is being conducted by psychologist Dr. Melek. Randy is fortunate to live near a city where a variety of mental health options are available to him. Randy finds that with the combined help of medication and CBT he is able to control his symptoms, and eventually he moves to a small apartment near the library in town.

At the encouragement of his doctors, Randy contacts his parents, who are extremely relieved to learn that he is still alive, and they eagerly reestablish contact with him. Randy’s father begrudgingly admits that mental health services have helped his son. His mother and younger brother visit regularly. Randy discovers a love of and talent for gardening based on his success with his own vegetable garden, and he starts working at a local nursery to earn income to pay his rent.

8.20 Screen 20

Real World Application

Watch the following clip, which shows CNN anchor Anderson Cooper trying to complete a series of tasks while undergoing a schizophrenia simulation in which he hears recordings of voices by wearing ear buds.

Transcript

ANDERSON COOPER: So I'm going to put these earphones in. They're going to try to do a series of tests. So I'm now hearing sort of whispers and voices in my head. And the first test is some number puzzles.

FEMALE VOICE: You suck and they know it. Can't you get this right?

ANDERSON COOPER: OK. So I did this test for three minutes. And I did not get a single one. It's very hard to concentrate when-- if it's like music or something constant, it's easy. But people talking to you is very difficult.

So now I'm going to be asked a series of questions by our producer, Susan. And these are basically a series of questions that a person would be asked if they were being admitted to a hospital.

SUSAN: Can you tell me what day it is?

ANDERSON COOPER: Yeah. It's Sunday, June-- I don't know, 7th?

SUSAN: So I'm going to say five numbers. And I want you to repeat them back to me after I'm done. 5, 23, 67, 2, 76.

ANDERSON COOPER: 5, 23, 67, something, 76.

SUSAN: I'm going to say five words. You don't have to repeat them, but just listen to them.

SUSAN: Cat. Book. Cigar. Damage. And rain.

BACKGROUND VOICE: Make you OK.

SUSAN: Can you name the last four Presidents of the United States?

BACKGROUND VOICE: OK for you to be--

ANDERSON COOPER: Barack Obama. George Bush. Bill Clinton. And George Bush.

SUSAN: So those five words I said before, can you remember any of them?

ANDERSON COOPER: No. It's hard when-- because sometimes voices are like whispering, and sometimes they're aggressive, and sometimes they're kind of comforting. And again, with people kind of talking to you all the time, it's--

BACKGROUND VOICE: It's OK.

ANDERSON COOPER: It's hard.

It's really-- it's incredibly distracting on the street to have somebody talk in your head. And it makes you feel completely isolated from everyone else around you. And you don't want to engage in conversation with other people. You're kind of finding yourself wanting to engage in conversation with a voice in your head. Because they're constantly being really negative and talking to you.

And everything they're saying relates to things that you're actually doing. They're criticizing things you're doing. It's like somebody is-- it's like you have a chorus watching you and commenting on what you're doing. And you can't help but-- I literally find myself wanting to respond to them, tell them to be quiet.

And it's incredibly unpleasant. This is a very, very unpleasant experiment. It's eye opening, because it really shows you what other people must be going through who deal with this on a regular basis.

But also, I cannot wait to take these headphones off. Because it's really depressing. It's very, very negative. It makes you feel very, very negative.

It's very creepy. I want it to stop.

Question 8.13

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Anderson Cooper talks about how unpleasant the experiment is for him and how difficult it is for him to concentrate on the tests and everyday tasks put before him. He talks about wanting to talk back to the voices, even though he is not schizophrenic and he knows they just a recording. He talks about how he could imagine this experience would be distracting, isolating, and depressing.

Question 8.14

lo2MWXnDvC/fCMf/QdKX+aSWbCHMLt5MqX2a8occoCN8kqJJr31fzDmD3gjbtWIgJjLtuxTDZtgsjOWpvp+CZxFDBA4+9wOiyNPZYUjVSXTr47JOar58+9X8rnx2mQYNICy02J+c4rEtPnLv0mwklJsWAR0A9smi8MA0CoKey10xDanyd6kMXSIMZB+/eIbyfmw0Ou8kNSwnF9Fbu9DvXg==
There is no right or wrong answer. Respond based on your own opinion.