Thirty-two-year-old Franklin lives in a cabin in a remote rural area of Montana. He moved there
10 years ago after he left his parents’ home in suburban Sacramento, California. The cabin has no
electricity or running water. Franklin considers himself a survivalist; he heats his house with wood and gets his water from a nearby mountain stream and collected rainwater. He grows vegetables and kills
game and birds. He has a 15-year-old truck that he uses to go into town, an 80-mile trip from his isolated
home. He inherited $100,000 from an aunt several years ago. He keeps the money in a passbook savings account in town and withdraws cash when he needs it. He doesn't have regular employment, but people
have found that he will take on most any physical job, if he is in the mood.
When Franklin goes into town, it is usually to withdraw some cash from the bank, buy a few things from the grocery store, such as coffee, milk, and sandwich ingredients, treat himself to lunch at the diner, and
go to the library. On these trips, he might pick up an odd job or two.
The people who know Franklin refer to him as "a bit odd" but harmless. He often mumbles to himself when eating or working. Those who pay close attention notice that he appears to be carrying on a
conversation of some sort. Franklin wears worn-out clothing and has long hair and a bushy beard. He
often appears dirty and disheveled, but he is not so different in that regard from other men in the area who do manual labor.
The diner where Franklin often eats lunch has a television that is always on. The television seems to
frustrate Franklin, and he often mumbles, "Turn that thing off. It’s messing with my head." One of the waitresses typically humors him and does so. When that waitress isn't working, the television stays on.
On those occasions, Franklin doesn’t stay long.
One day, Franklin burst into the restaurant in a fit. He was pulling at his hair and talking loudly. He asked
the waitress to give him something to stop the noise. What noise, she asked? He said, "The noise in my
head. Since the television stole my brain I can't stop the noise." The waitress, concerned, said, "Why
don't you tell us what kind of noise is in your head?" At this point, Franklin reached over the counter and grabbed the waitress by the blouse and shouted, "Kill the noise."
A scuffle ensued as the patrons in the restaurant rushed to the waitress's defense. Someone called the
police and they quickly came to investigate. He then calmed down and told the officers, "So, it's you. Go ahead and take me. You have been after me for years—putting arsenic in my garden plot, taking money
out of my bank account. And stealing my brain—don’t think I forgot that. But you will pay for this. The
Chief is looking for you."
What is the most probable diagnosis? Why?
Which symptoms of this disorder are present? Which are absent?
What further information would help you ascertain if this were the correct diagnosis? Name at least
two, and how they would help.
Would you add any specifiers? If so, which would you choose and why?
Which conditions that the DSM-5 recommends for a differential diagnosis list would you need to
consider? And why?
