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One of my patients, a 23 year old schizophrenic, had been telling me for several weeks that he was going through hell. I realized he was suffering severly. Recently he posed a question to me which threw a more vivid light on his entire situation and gave it more meaning.
He said to me: “Doctor, I've meant to ask you a question for some time and I could not do it because I felt so badly. Now I feel better and I want to ask you that question. You know I did not want to live and I'd had the thought of jumping from the roof. Did I perhaps do this and am I now in hell? I felt that you had a pact with the devil and were getting me better so that I could be inducted and sent to Vietnam. There is an army also in hell, you know. In Vietnam I was tortured. Tell me, AM I REALLY IN HELL NOW?” I told him that I did not believe in the existence of a hell or a devil. I also said that I believed we can bring about plenty of hell for ourselves here on earth.
His question had increased my feeling for the intensity of his suffering and challenged me to attempt to relieve his burden. In my answer I found a way to attack his unreal world and connect his tormenting problems with the world of reality where some solutions can be found for even quite severe problems.
Several aspects of this challenging question are worth noting. The patient had given a “reasonable” account of how he may have gotten into hell. He spoke of hell as a place familiar to him.