But even as he said the words, Timothy could feel the insects crawling across his abdomen.

In the literature, the feeling was described as “disturbing cutaneous sensations” rather than just saying that it felt like bugs crawling on you day and night. Then you had the constant itching, which doctors tried to make sound more scientific by naming it pruritus.

He didn’t want to show Dr. Percival the scars on his arms from the scratching and from trying to use the tweezers and the razor blade to dig out the bugs that burrowed into his skin. The bandage wrapped around his left arm was keeping the fresh blood hidden today. That, and the dark knit, long-sleeved sweater.

Yet still, Timothy felt the urge to scratch at them, to swat at them, to make them somehow, somehow go away.

Somehow. Go.

Away.

But he did not. He just sat still instead and nodded knowingly to his psychiatrist. “No bugs. That’s just delusional parasitosis.”

“That’s right,” Dr. Percival said. “They’re delusions.”

But Timothy caught a hint of condescension, that subtle shift in tone that meant the doctor had moved from believing the patient to trying to understand what the patient believed.

He’d been through this before.

He’d seen how these things end.

It meant that empathy was on its way out and a diagnosis was on its way in. And at that point, it was just too hard to go back. Once doubt crept in there, the more you claimed you weren’t mad, the more convinced they became that you were.

“We both know there aren’t any bugs,” Dr. Percival went on, “but I’m more curious if they’re still bothering you.”

“All gone,” Timothy said. “I’m not here today about the nightmares or the bugs.”

“Okay. Tell me why you’re here today.”

“How do you turn it off?”

“Turn what off?”

“The noise, the voices. Is it this way for everyone?”

“What do you mean?”

Since he didn’t want his doctor to think he was crazy, Timothy hadn’t brought this up before, but today, for some reason, he felt like he needed to talk about it, just to make sure, just to be certain that there wasn’t anything seriously wrong with him.

“All the chatter, chatter, chatter,” he said. “The words and the spiderweb connections, back and forth, all the time, touching each other. Intertwining, overlapping. Threading between things, around them. Is there a way to turn it off?”

“Tell me more about this chatter. About what it’s like.”