Dennis is a small, stooped, disheveled 63-year-old man who complained during a routine physical of hearing voices. He was referred to a psychiatric clinic for evaluation. There, Dennis described a recent event in which he drove a fellow home from church. At this acquaintance's house, he lay down on the couch for a brief nap, and woke to find the fellow "on top" of him, so he raced out of the house. He reported that he was not sure whether this was a dream or a hallucination. Dennis went on to say that some days later a stranger on the street called him a "homo", which reminded him of a time a year or so previous when the owners of a car wash near his home also called him a homo.

Now Dennis reports that he hears voices in his head calling him a homo, and saying other derogatory things about him. He knows he is not homosexual, and understands at some level that what is happening is "in my mind". Still, he feels that everyone in his neighborhood believes that he is homosexual.

Dennis describes his mood as "lousy" and "nervous and shaky". He says he has lost weight, has no appetite and has no interest in seeing friends or going out at all. When asked specifically about suicide, he says that he's Catholic and he would not go to heaven if he committed suicide, so therefore he would not kill himself. However, he has thought that he'd be better off if "something just happened to me" to "make my heart stop".

Dennis had a similar experience 12 years ago when he heard voices blaspheming the church. At that time, he was treated as an outpatient for several months and briefly took a medication, the name of which he does not recall. Dennis's wife reports that he has always tended to exaggerate perceived insults and is quick to take offense. She believes Dennis's recent behavior is just an extreme version of his normal personality. She does say that he'd recently been "listless" and thought perhaps he had a virus.