Mr. Nehru is a 32-year-old, single, unemployed man who migrated from India to the United States when he was age 13. His brother brought him to the emergency room of an Atlanta, Georgia, hospital after neighbors complained that he was standing in the street harassing people about his religious beliefs. To the psychiatrist he keeps repeating, "I am Vishnu. I am Krishna." Mr. Nehru has been living with his brother and sister-in-law for the past 7 months, attending an outpatient clinic. During the last 4 weeks, his behavior has become increasingly disruptive. He awakens his brother at all hours of the night to discuss religious matters. He often seems to be responding to voices that only he hears. He neither bathes nor changes his clothes. Mr. Nehru's first episode of emotional disturbance was 5 years ago. He admits that, starting about 5 years ago and virtually continuously since then, he has been troubled by "voices" that he hears throughout the day. For the past 6 weeks, with increasing insistence, the voices have been telling Mr. Nehru that he is the new Messiah. He has begun to experience surges of increased energy, "so I could spread the gospel," and needs very little sleep. When interviewed, Mr. Nehru is euphoric and his speech is rapid and hard to follow. He paces up and down the ward and, upon seeing a doctor, grabs his arm, puts his face within 2 inches of the doctor's, and talks with great rapidity and enthusiasm about his religious "insights."