Author's note: CW for today is in-depth writing about psychotic disorders, so please take care if you're sensitive to that sort of bizzo. Please drink your water, take your medications if you need to, and be gentle with yourself!

FriendlyNeighborhoodHufflepuff: When I was in North America, I had some bread in a restaurant and it kind of tasted a little bit like sweet yoghurt! Now I wonder what the Walmart bread tastes like, too :O Is it sweet? Will we ever know?!

Lothlórien was such a cool place. I had forgotten how much I missed the fun of climbing up the trees in Oropher's halls until I had once more started scaling up the branches of the huge mallorn trees to get to the balcony to Glorfindel's and my room.

Naturally, Glorfindel, ever-ready for the next dose of adrenaline, was joining in the fun before long, and as has always been our wont, our own enthusiasm fuelled each other's excitement. Soon, climbing turned to jumping from tree to tree, to sliding down the branches and trunks like they were bannisters on a staircase.

We only did most of these things when we were sure we wouldn't get caught, lest we evoke the hysteria of a frantically worried Elrond, who would no doubt read us several riot acts. Unfortunately, though, our eyes weren't everywhere, and we did travel awfully quickly on our new mode of transport.

About a week and a half into our stay there, after Glorfindel and I thought everyone had gone to bed, we had jumped the balcony and started zipping around on the branches like we were a luge team, and had been having an absolutely splendid time doing so for a good half hour.

As we made to take a curve, our strategic leaning and jumping was suddenly thrown off by a panicked, suspiciously Elrond-like screech of "RHODRI! GLORFINDEL!" coming from somewhere behind us.

In the time it took for him to deliver that short but dramatic admonishment, we were sufficiently distracted that we leaned incorrectly, and it was game over from there. We shot directly over a prickly broken branch before flying into the air and landing in a crumpled, tangled heap on the ground some three metres below.

We lay there for a moment, winded and groaning, and by the time we made to sit up, Elrond, Celebrían, and Olórin were already standing over us.

"Well, really, you two," Elrond said, pursing his lips and putting his hands on his hips. Celebrían rolled her eyes and shook her head, smirking mirthfully at us. Olórin wasn't even trying to hide his amusement, and started giggling loudly.

"Ai! And your pants! Look at you both! You're bleeding!" Elrond exclaimed, pointing at our legs. I looked down and saw that the inner legs of both Glorfindel's and my pants were torn, and the two of us had splinters ranging from pinhead size to the length of toothpicks hanging out of our thighs. Olórin's laughter amplified into shameless cackling now.

"Oh," I said blankly, noticing some minor discomfort. I turned to face Glorfindel, who was examining his wounds with fascination. "I suppose we'd better get these taken out, beloved."

"Yes, you had!" Elrond said with a nod. "Come, we'll escort you to the healing wing. Honestly, I don't know what possesses you two to do such foolhardy things sometimes…" He put an arm under Glorfindel, Celebrían doing the same for me, and they frog-marched us off to the healer's, Olórin still howling and slapping his knee where they'd found us.

When we were about a hundred metres away from the doors to the hospital wing, we could hear some sort of loud, miserable moaning echoing down the corridor, and the sound only seemed to intensify as we drew closer. The four of us exchanged looks, and kept going.

We entered to find three different healers clustered around a young adult with long, brown hair, attempting to hold him still while he writhed in agony, his eyes tightly shut all the while. In the corner, the people who appeared to be his parents watched on, holding each other and looking absolutely distraught.

"Please stop…" the Elf sobbed loudly. "Be quiet… stop hurting me, please…"

I watched on in fascination for a moment. It almost looked to me like he was in the throes of an acute psychotic episode. Whenever he got a hand free, he would claw at his head and neck until the healer caught hold of it again.

"Here," said a fourth healer who beetled over to him, a small glass of red liquid in hand that I recognised to be a very powerful soporific. "Drink this. It will make it stop."

The Elf reached out, down the glass in one go, let it fall to the ground where it shattered on the tiles, and his groaning was instantly replaced with long, deep breaths.

"What's going on?" I asked, unable to keep my curiosity to myself. Elrond nodded, equally as keen to make sense of what was going on.

"We do not know," said one of the healers to me as he bent down to pick up some of the pieces of glass. "He has been in here all evening with this. We cannot see any injury on him, he has not ingested any poisons, or if he has, he has had every antidote possible."

"How was he before he was brought here?" Elrond asked the parents.

"He was telling us he could hear a voice without seeing the source of the noise," the mother said, taking a step forward together with the father.

"That has been going on for a week or so," added the father. "He has had headaches as well, and of late he just wants to stay in quiet places and sleep most of the time."

Elrond raised an eyebrow and looked at me. I frowned. "I wonder," I said to them, "if I might ask you a few more questions about your son. I have experience in working with people with similar complaints and might be able to be of some help."

They nodded quickly. "If you think you can help, please, ask us anything," the father said, the mother nodding emphatically.

"Have you got a spare room I can borrow where I might speak to these two, at all?" I asked the healer closest to me.

"You ought to get those splinters out first," he said to me pointedly, gesturing at my bleeding thighs.

"I'd really prefer not to wait," I replied quickly. "And I have a feeling they would rather not, either," I gestured at the parents.

The healer shrugged. "If you wish it," he said, bidding me to follow him to a door that opened into a consultation room with a desk and some seats. I shambled in like John Wayne, the parents close behind me, and shut the door.

After a quick ethics and confidentiality rundown and a brief explanation of my job, we were ready to start.

"All right, so, so far what I know is that… ah…" I paused, realising I hadn't yet caught the boy's name.

"Glamren," the mother supplied.

"Thank you. So I know that all this started for Glamren around a week ago. He started hearing a voice out of nowhere, getting headaches, feeling things crawling, and he's been withdrawing from things he usually does."

"That is correct," the father confirmed.

"And all of this is completely out of character for him?"

"Oh, yes," the mother said with a nod. "He is a very social boy. He loves to dance and play the harp. It is a complete shift in his personality and behaviour."

"Has he been seeing anything that isn't really there?"

They paused a moment, and then shook their heads.

"What about any strange, new beliefs that make no sense at all, but in which he is genuinely confident and you cannot gainsay?"

"There… might be something like that," murmured the father thoughtfully, glancing at the mother for confirmation. "It was what prompted us to bring him here, in fact. He had started shouting, much like what you saw before, that he hated he had been the one chosen to suffer like he is."

I nodded, noting down everything on a blank piece of paper I saw on the desk.

"Has anything like this ever happened with him before?" I enquired. "Any talk, for example, of being chosen to suffer?"

"Never," the father said, both he and the mother shaking their heads firmly.

"How about in the rest of the family? Has anyone had similar sorts of issues before?"

"Not that we know of," the mother said, frowning a little as she seemed to mentally double-check hers statement.

I scribbled her answer down. "Do you know if anything traumatic has happened recently to him or in your social circles? A death, perhaps, or a very big shock?"

The parents sat with my question for a moment and then shook their heads in synchrony. "I do not believe so," the mother said. "He would have told us if there had been. We three are very close, and he is very open with us."

I twirled the pen in my hands. This was most curious. So far, this all the makings of a psychotic disorder of some sort, but at the same time, I had been under the impression that Elves were impervious to diseases of the brain. They didn't fall ill the way humans did. Any mental problems were usually the result of a flawed thinking pattern that cemented itself and gave rise to problematic behaviours and emotions. And yet, here was this boy, totally throwing that assumption out the window, and there didn't seem to be any trace of injury or poisoning. How could an Elf get sick like this? Unless, of course, he wasn't really an Elf.

I raised an eyebrow at my own idea, and the mother and father looked at me curiously.

"This is a bit of a long shot," I began slowly, "but I'll ask just to be sure. Glamren is your own, self-made offspring, yes?"

They looked bewildered but confirmed that he was indeed produced through their own efforts.

"Are you both completely Elven? There is no history of any other races in your lineage?"

Their eyes widened now as they appeared to vacillate between offence and shock.

"Some races, such as Men, are prone to illness," I explained patiently. "I am not here to cast judgement on who your relatives may be, but I require an honest answer to be able to exclude this factor."

With a notably displeased look, the father assured me that both sides of the family were of wholly Elven descent.

Well, there went that theory.

"Noted," I said calmly as I wrote it down. "Well, what you've described so far is reminiscent of a group of illnesses known as psychotic disorders, strange though it would be that an Elf has it."

I paused and frowned inwardly as I considered how impossible this all felt. "If he hasn't been poisoned," I continued, "and hasn't received any serious injuries, that narrows down the list of potential culprits to about four. I'll still have to ask both you and him a few more questions and we will have to wait another few weeks to give at least a preliminary diagnosis."

Three of the possible disorders had essentially the same symptoms but varied depending on how long the symptoms had persisted. The shortest of these was a brief psychotic disorder, which involves hallucinations (hearing imaginary voices, seeing things that don't exist, false sensations on the skin- anything the five senses detect that isn't there), delusions (an unshakeable belief in something that is clearly not true, e.g. believing you're god, thinking you're being followed by spies), and dysfunction in speech, movement, and a sudden withdrawal from everything—which last no longer than a month. In the mid-length schizophreniform disorder, these symptoms last up to 6 months. In schizophrenia, the symptoms persist beyond the 6 month period.

The fourth disorder, schizoaffective disorder, is schizophrenia with symptoms of major depressive disorder, and that was the one I had to rule out now.

The father nodded. "Ask us anything," he said quickly. "I… ah… will not take offence like before. I apologise," he added remorsefully.

I shook my head and held up my hand. "It's not a problem. I know you're worried about your boy. Listen, how has his mood been?"

"Variable," the mother replied. "At the start, he was only slightly bothered by the voice and was otherwise very happy, but since it has persisted and he began to feel tortured, he has been very sad. When the voice is quiet, though, he seems much better, calmer, even hopeful that this is the last of it. Then, when it returns, he becomes unhappy again."

"So his mood depends entirely on what the voice is doing and how tortured he feels, is what I'm hearing."

They nodded.

That ruled out schizoaffective disorder, leaving us with the other three to work with.

As I started to explain my possible conjecture to them, a loud scream came from the other room which sounded like it had been produced by Glamren. The parents' faces filled with fright, and they turned the chairs over as they bolted out of the room. I waddled out behind them as quickly as I could only to see that Glamren had indeed woken, and was now being restrained at the arms by two healers again as he seemed to try and break free from their grasp. I went over and stood close to him.

"Glamren! GLAMREN!" I shouted at him amid his screams, and he paused and looked up at me tearfully, whimpering as he twisted fruitlessly.

"My name is Rhodri. Your parents have told me what has been going on with you, and I might be able to help, but I will need to ask you a few more questions. Can you talk with me?"

He stifled a sob and nodded a little, eyes closing in agony as he did.

"We cannot let go of him for you to take him into that room back there," one of the healers said to me, shaking her head. "Not when he has been moving around like this."

"Very well," I nodded. I glanced up at Glorfindel, who gave me a quick nod and departed with Elrond and Celebrían to a treatment room in the back.

"Glamren, I want you to tell me about what's going on in your head," I said clearly, loud enough to be heard over his soft, despondent groans. "How did this start?"

"I w-woke up like this one morning," he whispered. "The voice started to talk and growl, but I thought it would go away on its own, that maybe it was an animal in my room somewhere that I could hear, but it has been following me all this time."

"And you think it's torturing you, your mother and father say."

"It is," he said between cries. "The voice is so angry with me. I am in so much pain, and I cannot do anything any more. It doesn't happen to anyone else, and I don't know why it's picked me…"

At this point, Glamren broke down into low, wavering sobs and started beseeching again. "Please leave me be… stop… enough… I beg of you, stop…" his voice grew forceful.

"What is the voice saying to you right now, Glamren?" I asked, gently tapping the side of his face to get his attention. "Tell me what the voice is telling you."

"Dark… so dark… horrible… evil… my prison…" he whispered.

I blinked. "Is that what it usually says to you?"

"Some-t-times it is crueller if I argue back" he choked. "Sometimes it hurts me."

"What does it do when it hurts you?" I asked, tapping his face softly again as he started looking away. "I need you to concentrate a little longer, Glamren. Tell me what the voice does when it hurts you."

"My head…" he groaned. "It growls at me and makes the inside of my head burn."

"Burn…" I repeated. This was odd. Headaches were common enough in psychotic disorders, but a burning pain was a description I hadn't heard before. That was surprisingly severe. I stood there for a moment wondering what on earth I could do for this kid. There was no medication in Middle-Earth for psychotic disorders, and I wasn't qualified to start him on anything anyway. Therapy would be of some help, but the primary way to manage psychotic disorders was with medication. And now it seemed like he might have some other disease totally out of my specialty on top of that!

As I went to ask him about the voice now, he let out an almighty scream, and with what must have been one of the most impressive displays of graceful aggression I had ever seen, raised his legs and booted both healers holding his arms straight in the solar plexus. They crumpled on the spot, and before anyone else could get to him, he had bolted out of the hospital wing.

He didn't get very far, though. In fact, once in the corridor, he failed to run in a straight line for more than a few metres. Even his body wasn't straight. He was hunched as he loped gracelessly, and toppled over like he had fallen off a bicycle.

"Christ, he's about to have a seizure," I muttered, and we bolted over to him. I gently put him onto his back and held his head steady in my hands, but the seizure I was expecting never came. He just lay there, howling miserably. I slowly took my hands away, and saw some redness on the thumb of my left hand.

"Blood?" I gently twisted his head to get a better look at where it had come from and saw a small trail of it in his ear. He hadn't smacked his head on the ground when he landed, thankfully, so it wasn't an immediate injury.

This was something else. There was no mental illness that made you bleed from your ears. And yet, the voice let him know pain was about to arrive.

"I… I think there's something in there," I murmured slowly, "And I think it's still alive." I looked up quickly. "Did you check his ears?" I asked the head healer.

She frowned at me. "We had a brief from the outside, but there was nothing we could see."

I shook my head. "No, it's in too deep now, we won't see it unless we look right inside his ear canal with a light and a magnifying glass. I think it's buried its way right in, which is why he got dizzy and fell over."

I gently picked Glamren up and carried him back to his bed, rolling him onto his side as the healers fetched some instruments and started to investigate his ear. After a few moments of angling, the head healer let out a gasp.

"There is a moth in there!" she exclaimed. Well, that explained the odd voice. I recalled watching moths go absolutely bananas for the glow of my balcony light in London. Reading out there on a summer's evening meant the quiet was periodically interrupted by a soft bonking sound as they collided with the bulb. "Dark, horrible prison..." the inner canal of an Elf ear certainly must have felt that way for a moth. That growling must have been the critter flapping its wings for all it was worth in the foolish hope it woukd mysteriously be able to fly out the way it had come.

Glamren's mother looked absolutely horrified, and the father blanched and looked like he was about to pass out.

"Ma'am, you'd better prop your husband up before we have to peel him off the floor, too," I said to her, pointing at her spouse. She quickly put an arm under him and guided him over to a chair.

I hoped the healers could entice the moth to simply back out on its own, because I imagined it would put up quite a fight if they had to drag it out with forceps or some similar implement. That much, however, was way out of my scope of practice.

I decided to waddle into the back room and get the others, now that the excitement was over. I opened the door, and Glorfindel, Elrond, and Celebrían looked up at me expectantly.

"He has a moth in his ear," I said with a shrug. Their mouths fell open as they followed me outside. Apparently, bug infestations like this were unheard of. I supposed there was a first time for everything.

As we came out, I saw the healers dose the boy up with another glass of the red sedative, and they started fiddling around trying to get this disgruntled creature out of his ear canal.

"Now," Elrond said crisply, "Let's not have any more delays and get these things out of your legs."

"Oh, right," I said absent-mindedly. "Thanks for the reminder, Elrond." On impulse, not quite knowing why, I strained a little, and with that, the splinters fell out of my legs, making a small tinkling sound as they hit the tiles. I bent over and looked at my thighs, and apart from looking a little bloodstained, there was no trace of injury on them.

I swiped up the splinters and looked up to see Elrond, Celebrían and Glorfindel staring at me with wide eyes.

"Cool, huh?" I said with a grin. "I didn't even know I could do that until just now!"

"This doesn't mean you get to simply return to sliding around on the trees like they're waterslides, Rhodri," Elrond said quickly, looking at me sternly.

I groaned. "Yes, Naneth." Elrond rolled his eyes, and after I threw the splinters out, we made to leave. The healers barely looked up from their work as they tried to coax out this beleaguered creature.

"Did you still want those splinters out?" the head healer asked as she angled a tool down Glamren's ear.

"No, thanks, all sorted," I chirped as we went out the door. "Best of luck with that moth!"

I heaved a sigh of relief as we walked down the halls together.

"You looked quite concerned for a while, there, Rhodri," Celebrían said to me after a while.

"I was," I admitted. "I thought he had something that I lack the resources or qualifications here to treat properly. Thankfully, I was wrong. We are very lucky to be impervious to most of the illnesses that affect mortals. The things some go through…"

I shook my head and felt a small ache as I recalled my practice in London. Some of my clients suffered intense psychiatric symptoms (often from psychotic disorders) that had not responded to medical treatment, or were survivors of such appalling circumstances that I had to take a short break between them and the next appointment so I could cry it out. It had been such a long time since I'd had anything to do with that part of my career, and to revisit it so suddenly had been quite trying.

"Perhaps a belated Happy Hour is in order," Glorfindel said with a small smile. Celebrían and Elrond nodded solicitously, and not five minutes later, we were on some unspecified balcony, sipping on cloudy apple juice and horsing around.

"If we may, Rhodri, Glorfindel," Elrond said after we'd finished our fourth round of Fortunately, Unfortunately, "Celebrían and I would like to accompany the two of you to the tailor's when we return to Imladris."

Glorfindel chuckled and raised an eyebrow. "What, do you the two of you think we are so irresponsible as to not know the way there, or that perhaps we will simply forget to have them mended?"

"Not at all," Celebrían said with a smile as she shook her head. "We just want to watch the two of you explain to the people there how your pants got into that state in the first place."

In an astonishing moment of role reversal, Glorfindel and I were the ones giving Elrond and Celebrían withering looks as they tittered behind their glasses. This had been one hell of an odd day.

Psych Notes

Schizophrenia

NB: Symptoms of schizophrenia are divided into 'positive' and 'negative'. In this context, they do not mean 'good' and 'bad,' but rather refer to problematic additions (things that shouldn't be there that are) and problematic absences (things that should be there that aren't). Items 1-4 are examples of positive symptoms.

PART A: At least two of these, and one of them must be the first three:

Hallucinations

Delusions

Very disorganised speech (e.g. incoherence, rapidly changing topics without context, making up words, using the completely wrong word for something ('word salad'))

Very disorganised, repetitive, or listless behaviour ('catatonia') (e.g. odd postures, very rigid or overly flexible, agitated movements that repetitive or seem to have no purpose, inactivity)

Negative symptoms: no motivation, decreased emotions and/or display of emotion, low energy, not talking much, isolation, lacking social skills, uninterested in or unable to maintain relationships

PART B: Symptoms persist for at least 6 months.

PART C: Symptoms are not due to another underlying disorder e.g. schizoaffective disorder

The same symptoms but for shorter periods are classed as brief psychotic disorder (goes away after 1 month), or schizophreniform disorder (goes away within 6 months).

Schizoaffective disorder
This disorder is essentially a twofer (if you'll pardon the expression) of schizophrenia and either major depressive disorder or bipolar disorder. You'll recall the hallmark indicators of depression in the previous chapter. Bipolar disorder involves cycling between episodes of depression and mania (which I will explain below)

PART A: Part A of schizophrenia criteria, and at the same time, the patient must also experience symptoms of a depressive or manic episode

Manic episode: at least 1 week for most or all of the time of- happy, excited, or agitated mood with lots of energy, during which time the person may not sleep much, behave in risky, hedonistic or irresponsible ways (e.g. driving quickly, sleeping around, spending huge amounts of money), feel invincible or god-like, be very talkative, have racing thoughts.

PART B: If the depressive or manic symptoms subside, the patient must still experience delusions or hallucinations for at least two weeks

PART C: The depressive/bipolar symptoms are there for the majority of the illness.

Differential diagnosis

There are a lot of disorders that need to be ruled out when diagnosing a psychotic mental illness- more than I listed in this chapter, mostly because I wanted it to have a hint of storyline and not just be a university lecture :P

In this instance, Rhodri needed to be sure that when Glamren was upset, it wasn't because he was showing signs of a mood disorder like depression or bipolar, as then he would have fit the bill for schizoaffective disorder. Glamren wasn't showing a hint of a manic episode, of course, so that was off the table.

There can often be a lot of overlap between some of the negative symptoms of schizophrenia and depression, such as withdrawing from society, not being interested in things you used to be, and generally feeling 'flat.' Where schizophrenia begins to distinguish itself from depression (and thus schizoaffective disorder) is that there are no real 'lows' of sadness. There will be distress from the hallucinations/delusions, as these are often very unhappy experiences (voices that insult you or threaten to kill you, being afraid the government is spying on you, etc.). But it will usually take the form of intense fear, agitation, or paranoia, which are predictable reactions if you genuinely believe someone is out to get you, or if you are hearing an incorporeal voice constantly telling you you're an awful person. Sadness doesn't automatically fit in there, though.

According to his mother and father, Glamren was not showing any signs of deep sadness. He would howl and sob from fear and distress when the moth spoke, and also from the pain the moth caused as it buried further into his ear canal. When the moth would finally shut up for a while, though, and stop nibbling at his eardrum, Glamren was calm. Rhodri didn't get enough assessment done to be able to ascertain how emotionally flat he had become, however, because Glamren did that majestic double-kick and absconded.