A. is different . His illness presents more flamboyantly, is classified as manic-depressive illness. He takes street drugs and does not fit in with parental bidding. He finds his own accomodation and secures a job with the Local Authority Social Services, a job he retains in one guise or another for twenty-two years.

He is - curiously in the light of the final denouement - often involved when ill with damage to cars and car parks, and in a later bout - trying to enter parked cars.

He has two early hospital admissions, which show up a rapid decline into florid activity when he becomes ill.The admissions confirm the diagnosis.

He leaves home and his support thereafter is from a lady friend - a psychologist whose work is counselling - who remains as his direct contact, but the relationship falters and wanes from time to time.

A. tries many times to secure a domicile for himself which they may both occupy , but this never transpires and he has frequent changes of address - and family doctor. His friend and he never have the same address, which becomes important when he finally relapses - her position as his closest observer then becomes important.

His illness is succesfully managed between 1988 and 1996 by his acceptance of lithium medication ( a chemically simple salt substitute known to help in the recovery of manic-depressive illness ) and to be able to prevent recurrences when it is taken regularly so as to keep a blood level within a certain range.
This is achieved despite his often wishing to reduce and omit the medication , and despite the various addresses and different family doctor registrations. There is fair connection with community mental health nurse services. What may be missing is any significant exchange by those services with his long continued friendship.

The sick notes from his family doctor are protective of his employment and network prospects and are usually condensed as 'anxiety' or an equivalent vagueness. A. himself seems to have used 'drug induced psychosis' a label adopted provisionally in his first admission, but later revised to Affective illness; manic-depressive kind.

Reorganisation in his employment by the LA Social Services Department brings him to negotiated redundancy with some unsettled feelings about that.
Three months later he has himself raised, and then immediately discontinued, his lithium. His explanation later is that he was also having medication for blood pressure and the two were not agreeing and might be incompatible - a reasonable conclusion. He very soon became tetchy, irritably sensitive and abrupt.

During a three day period his behaviour becomes erratic and impulsive. He drives off to Wales in a truck he has acquired with his redundancy money, develops an excitable variety of misunderstandings, returns to be near his companion, who is then subjected to excitable and aggressive interlocutions - without direct physical danger.

Police and Ambulances are called and see him.
He is able to calm himself, present well enough, and to persuade them that he will seek other help.
The next day he sees a family doctor, rejects in a reasonable way offers of specialist consultation or hospital care, saying instead that he will find professional help for himself.
This does not happen.

He drives away in his truck and knocks down, fatally, victims in the way.

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