The Necessity Of Wonder

Over the decades spent working as a psychiatrist at Valkenberg Hospital in Cape Town, Dr. Sean Baumann has seen it all. In this extract from his new book, he shares some of his strangest cases and reveals the surprising key to recovery

At the Monday morning feedback meeting I’m informed by the nursing staff that there are three Nelson Mandelas on the ward. They’re behaving in a courteous, dignified way towards one another. There’s no dispute among them as to who the true Mandela might be – instead, they appear to respect the choice that each has made to be an eminent and revered figure.

There’s never been a Jacob Zuma in our ward. The ex-president, who’s now facing charges of corruption, isn’t a popular figure in our refracted world.

Some time ago, a very large and fierce black man from the Democratic Republic of the Congo was admitted to the high-care unit insisting he was Helen Zille, the premier of the Western Cape at the time. This was curious because Helen Zille is a middle-aged white woman. It was surprising to us that a recent immigrant from central Africa should’ve chosen to be her.

Choice is not generally a consideration in psychoses. You don’t choose to be psychotic, but I do think it’s possible that, at some level, there’s a degree of agency regarding the content of delusions.

The choice to be a Mandela rather than a Zuma isn’t random, I believe. These are two political figures who symbolize very different philosophies and moralities. The one features in our ward and the other doesn’t.

I think our patients want the world to be safer and kinder. I struggle to recall any patient in our system who believed he was evil. However deeply mired our patients are in their private psychotic worlds, for the most part a discernible theme is evident in their aspiring to help themselves and others – and perhaps to do good.