Guide V: Emergent Harms & Diagnostics

Clinic 3.0: A practical lens for assessing patient accounts that implicate novel technologies and coordinated institutional conduct without defaulting to pathology.

February 22nd, 2026

Distinguishing Novel Reality from
Delusion: A Comprehensive Clinical
and Legal Framework for Healthcare
Professionals

Prefatory Note

This white paper is a practical instrument for clinicians facing one of medicine’s most consequential diagnostic challenges: determining whether a patient’s account of extraordinary circumstances reflects psychiatric pathology, external reality, or a combination of both. It provides patients, advocates, and legal representatives with a framework grounded in binding law, professional standards, and current evidence. While most extraordinary accounts in clinical practice arise from internal psychopathology, this paper does not ask clinicians to reverse that baseline expectation. Instead, it offers a structured method to distinguish between illness and harm—ensuring the process is clinically sound, legally defensible, and transparent.

Independent of institutional affiliation or individual cases, this document provides healthcare providers across Canada with a rigorous, humane methodology for assessing complex claims. This includes allegations involving novel technologies or institutional coordination—experiences often absent from standard clinical training. By clarifying how to apply existing guidelines within a rapidly evolving technological and legal landscape, this framework complements current psychiatric standards.

The core premise is simple: novelty is not pathology. A clinician’s unfamiliarity with a phenomenon does not preclude its factual plausibility. The professional obligation is to determine what is most likely true through a structured process, and to document both the reasoning and its limitations with full transparency.

Keywords: Novel Reality, Delusion Assessment, Psychiatric Diagnosis, Extraordinary Accounts, Persecutory Delusions, Neurotechnology and Mental Health, Psychological Torture, UN A/HRC/43/49, UN A/HRC/57/61, Directed Energy Symptoms, Surveillance and Psychiatry, Whistleblowers and Mental Health, Clinical Gaslighting, Psychiatric Detention Nova Scotia, Hospitals Act Form 1, Capacity and Consent, Starson v. Swayze, Trauma vs Psychosis, Cultural Safety, Implicit Bias in Psychiatry, Grain of Truth Doctrine, Bizarre vs Non-Bizarre Delusions, Mental Privacy and Cognitive Liberty, Nova Scotia Clinician Guide

Table of Contents

Introduction: The Problem of the Extraordinary Account
(A) The World the Clinician Inhabits: Technological Acceleration, Post-Democratic Politics, and the Epistemological Crisis
Governing Law and Professional Obligations in Nova Scotia and Canada
Canadian Case Law: The Judicial Framework for Psychiatric Determination
The Diagnostic Landscape: DSM-5-TR and ICD-11 Criteria
The Bizarre vs. Non-Bizarre Distinction: The Foundational Clinical Test
The Five-Criterion Delusion Assessment Framework
The Grain of Truth Doctrine: A Clinical and Legal Obligation
Emerging Technology and the Novel Reality Problem: A Clinician's Technology Primer
UN Report A/HRC/43/49: Psychological Torture and Institutional Harm
UN Report A/HRC/57/61: Neurotechnology Crime as a Clinical Reality
Technology-to-Symptom Cross-Reference: A Clinical Mapping Tool
Differential Diagnosis: The Full Landscape
Whistleblowers, Conspiracy, and the Gatekeeping Problem
Capacity, Consent, and the Civil Legal Framework
Cultural Competence: Mi'kmaw, African Nova Scotian, and Racialized Patients
Comparative Jurisdictions: Ontario, British Columbia, and the United Kingdom
The Gaslighting Problem: When Clinicians Become Agents of Harm
Collateral Investigation: Standards and Scope
Clinical Vignettes: The Framework in Practice
Documentation Standards and Legal Defensibility
A Proposed Nova Scotia Six-Phase Clinical Decision Framework
Recommendations for Policy Reform
Conclusion
Appendix A: Relevant Legislation and Regulatory References
Appendix B: Glossary
Appendix C: Assessment Checklist for Clinicians

1. Introduction: The Problem of the Extraordinary Account

Every clinician will eventually sit across from a patient whose account strains the boundaries of what the clinician considers plausible. The patient describes being surveilled by institutional actors, subjected to organized harassment, manipulated by technology they cannot see, or experiencing physical sensations they attribute to external sources. The account is internally consistent, the patient is lucid, and no acute crisis is apparent — yet the content of what they are describing sounds, on first impression, improbable.

The instinctive clinical response is to reach for a psychiatric label. This instinct is understandable. Clinical training emphasizes pattern recognition. The pattern of "patient presents with extraordinary account of persecution" exists in the psychiatric literature, and it maps to real conditions: paranoid schizophrenia, delusional disorder, bipolar disorder with psychotic features, substance-induced psychosis. These are genuine, diagnosable, and treatable conditions that can produce elaborate and internally consistent narratives of external malevolence.

But the instinct is dangerous when it operates without scrutiny. History demonstrates, repeatedly and at considerable human cost, that extraordinary accounts are sometimes accurate—and that the clinical establishment's default toward pathologization has caused devastating harm to people who were telling the truth.

The victims of COINTELPRO—the FBI's documented campaign of harassment, infiltration, and psychological warfare against civil rights activists —were told they were paranoid. Employees who discovered and reported corporate fraud, government corruption, or institutional abuse have had their accounts dismissed as symptomatic by clinicians who were not equipped to assess the specific claim. Diplomatic personnel in Havana, Cuba, who reported hearing unusual sounds and experiencing sudden neurological effects beginning in 2016, were initially assessed by many clinicians as manifesting psychosomatic or psychogenic illness. A 2021 report by the U.S. National Academies of Sciences subsequently concluded that directed pulsed radiofrequency energy was the most plausible explanation. Clinicians who pathologized those reports were wrong — not because they were bad clinicians, but because they were applying an outdated and insufficiently rigorous framework.

This white paper provides an updated framework. It is grounded in the recognition that two major United Nations human rights instruments—Report A/HRC/43/49 (2020), on psychological torture, and Report A/HRC/57/61 (2024), on neurotechnology and human rights—have formally documented the possibility of novel, invisible, and institutionally coordinated harms that could easily be misread as psychiatric pathology by a clinician applying yesterday's tools to today's world.

It is further grounded in the recognition that within Nova Scotia's healthcare system, as within healthcare systems across Canada, there are documented structural vulnerabilities—inadequate time for complex assessments, implicit bias, technology knowledge gaps, and systemic over-reliance on prior diagnostic labels—that increase the likelihood of clinical error in exactly the cases where the stakes are highest.

The framework that follows does not tell clinicians what to conclude. It tells them how to get there.

1A. The World the Clinician Inhabits: Technological Acceleration, Post-Democratic Politics, and the Epistemological Crisis

This section provides the philosophical and political context for the clinical framework that follows. Its purpose is to show why the later tools are necessary and not optional. Clinicians who are unfamiliar with the broader environment in which they practice—the political structures, technological trajectory, and epistemic pressures—are more likely to reflect that environment than to exercise independent judgment. Recognizing these historically novel pressures on psychiatric assessment is itself a clinical competency.

1A.1 The Singularity and the Obsolescence of Intuition

In 1965, Gordon Moore observed that the number of transistors on a microchip doubled approximately every two years—a pattern that has held for six decades and has come to stand for the exponential character of technological development more broadly. Ray Kurzweil, in The Singularity Is Near (2005) and its sequel The Singularity Is Nearer (2024), developed this observation into a comprehensive theory of technological acceleration: not merely that individual technologies improve, but that the rate of improvement itself accelerates, and that the convergence of artificial intelligence, biotechnology, nanotechnology, and information systems is producing a qualitative change in the human condition so fundamental that our current conceptual frameworks—including our frameworks for what is technologically possible—are becoming obsolete faster than we can update them.

The clinician's intuition about what is possible—their sense of what constitutes a bizarre claim—is built from experience, training, and cultural environment, all of which are products of a world that is receding. The technology that exists today was not described in the textbooks of a decade ago. The technology that will exist in a decade is not fully described in the publications of today. A clinician who uses their intuitive sense of the technologically plausible as a diagnostic criterion is using a depreciating asset. The depreciation rate is accelerating.

This is not an abstract philosophical point; it has concrete clinical consequences. The Havana syndrome case—in which clinicians initially pathologized genuinely injured individuals because the technology capable of causing their injuries did not fit the clinician's prior frame—is one illustration. The history of patients who were assessed as delusional for reporting experiences that were later explained by technologies (surveillance, directed audio, medication effects discovered after initial dismissal) that the assessing clinician did not know to consider is a recurring clinical pattern. As technological capabilities advance exponentially, the frequency and severity of this pattern will increase unless clinical frameworks are explicitly designed to account for technological obsolescence.

The concept of the Technological Singularity—the hypothetical point at which artificial intelligence surpasses human intelligence and technological change becomes effectively unpredictable—is relevant not as an engineering prediction but as a conceptual orientation: we are in a period in which the pace of change is such that the gap between what is technically possible and what is institutionally acknowledged as possible is widening faster than institutional acknowledgment can close it. Clinicians are operating in that gap every day.

1A.2 Biodigital Convergence: The Government of Canada's Own Framework

In February 2020, Policy Horizons Canada—the Government of Canada’s futures foresight organization within the federal public service—published Exploring Biodigital Convergence. The report describes the convergence of digital and biological systems—the integration of digital technologies with living organisms, including the human body and mind—as a defining feature of the near-term future.

This is not speculative fiction but an official strategic foresight document. It explicitly contemplates scenarios in which digital technology interfaces directly with human biology in ways that affect cognition, behaviour, and identity. It addresses the possibility of technologies that can “read and write” biological processes, including neural processes, and acknowledges both their therapeutic potential and their ethical risks.

The relevance for clinicians is direct. The Government of Canada has formally recognized, in an official publication, that the convergence of digital technology with human biology—including the kind of neural interface technology discussed in UN Report A/HRC/57/61—is a present reality that requires policy attention. A clinician in Nova Scotia who treats a patient’s report of technology-mediated experiences of the body or mind as necessarily impossible is therefore at odds not only with the UN human rights framework, but also with the federal government’s own assessment of the technological trajectory.

1A.3 Michel Foucault: Power, Knowledge, and the Clinical Gaze

Michel Foucault's work is not peripheral to clinical psychiatry. It is, in many respects, about clinical psychiatry—specifically about the way in which the clinical apparatus of psychiatry has historically operated as an instrument of social power, and about the relationship between knowledge, truth-claiming, and the exercise of institutional authority over human bodies and minds.

In Madness and Civilization (1961), Foucault traced the history of how Western societies came to understand madness—and how the asylum, the psychiatric diagnosis, and the clinical authority of the physician emerged not primarily from a scientific project of understanding mental illness but from a social project of managing populations whose behavior was inconvenient, threatening, or incomprehensible to those who held power. The "great confinement"—the 17th-century institutionalization of vagrants, criminals, the poor, and the mad in a single administrative apparatus —was not driven by therapeutic intent. It was driven by the need to manage social disorder.

This history is not merely historical. Its structural logic recurs whenever the clinical apparatus of psychiatry is enlisted—whether consciously or inadvertently—in the project of managing persons whose behavior, speech, or claims are inconvenient to institutional power. The Soviet Union's deployment of "sluggish schizophrenia" as a diagnosis for political dissidents is the most notorious modern example. Less dramatic but structurally analogous instances occur whenever a person's claim against an institution is deflected by the suggestion that the claimant is mentally unwell.

In Discipline and Punish (1975), Foucault developed his analysis of the panopticon—Bentham's prison design in which prisoners are potentially visible to a central observer at all times and therefore discipline themselves, internalizing the surveilling gaze. Foucault used the panopticon as a metaphor for the diffusion of surveillance and normalization through modern societies: the psychiatric examination, the school assessment, the clinical interview are all mechanisms through which individuals are observed, assessed, classified, and normalized against a standard that is not natural but is the product of specific historical, political, and institutional conditions.

In his later work on "biopower"—the exercise of power over biological life as such, over bodies, health, reproduction, death, and the management of populations—Foucault identified the clinical apparatus as one of the primary instruments through which biopower operates. The psychiatric diagnosis is a form of biopower: it classifies a person's inner life in terms that are authorized by institutional knowledge, and it uses that classification to justify interventions—medication, detention, incapacity determinations—that operate directly on the body and mind.

The concept of power/knowledge—Foucault's argument that knowledge and power are not separate domains but mutually constituting—is particularly relevant here. What counts as knowledge in a psychiatric assessment is not determined by neutral observation alone. It is determined by the institutional and social frameworks within which the clinician operates. A clinician who operates within a framework that renders a specific class of claims implausible—"nobody is really being electronically monitored by corporate actors"; "no court could really produce this pattern of outcomes without independent cause"; "no technology exists to do this"—is not exercising neutral clinical judgment. They are exercising power, authorized by a specific institutional knowledge framework, over a person whose claims fall outside that framework.

Foucault does not tell clinicians what to conclude. He tells them to ask: whose knowledge counts here, and why? Who authorized the framework within which this person's account is being assessed? And what interests are served by the conclusion I am reaching?

1A.4 Colin Crouch: Post-Democracy and Institutional Capture

British political sociologist Colin Crouch's concept of "post-democracy"—developed in Post-Democracy (2004)—describes a condition in which the formal structures of democracy (elections, parliaments, constitutions, rights) remain in place and function as they are designed to function in their basic mechanics, while the substantive content of democratic governance—the actual exercise of political power in the interests of the public—has been progressively captured by corporate and elite interests.

In a post-democratic condition, the appearance of accountability coexists with the absence of effective accountability. Courts continue to issue decisions; regulatory bodies continue to publish guidelines; police continue to investigate complaints. But the content of those decisions, guidelines, and investigations has drifted—progressively and often imperceptibly—toward outcomes that serve institutional and corporate interests rather than those of ordinary citizens. The mechanisms of accountability have been maintained in form while being hollowed out in substance.

Crouch's framework is directly relevant to the clinical context of this paper. When a patient presents a pattern of convergent adverse institutional outcomes—courts, police, regulatory bodies, and professional organizations all producing results that favor powerful interests over the patient's documented claims—the clinician faces the Crouch dilemma: is this pattern evidence of the patient's psychiatric symptomatology (a systematized delusion), or is it evidence of the post-democratic dynamics that Crouch describes? The fact that the pattern is consistent with a psychiatric explanation does not mean it is not also consistent with a political one.

A clinician equipped with Crouch's framework does not reach a different clinical conclusion by default. They reach a more sophisticated one—one that acknowledges that the pattern of institutional convergence the patient describes is not, in and of itself, evidence of delusion, because that pattern is exactly what Crouch predicts in a post-democratic institutional environment.

1A.5 Sheldon Wolin: Inverted Totalitarianism and the Managed Citizen

American political theorist Sheldon Wolin, in Democracy Incorporated: Managed Democracy and the Specter of Inverted Totalitarianism (2008), developed a concept that complements and deepens Crouch's post-democracy framework. Wolin describes "inverted totalitarianism"—a form of political domination that operates not through the crude methods of classical totalitarianism (state terror, censorship, personality cult) but through the saturation of civic life by corporate power, the management of political participation, and the reduction of citizens to consumers of political spectacle.

In Wolin's framework, power in advanced democratic societies operates not primarily through direct coercion but through the management of the conditions under which citizens think, communicate, and organize. Corporate capture of media, the commodification of information, the professionalization of political management, and the colonization of civil institutions by commercial logic all contribute to a condition in which citizens experience themselves as free while their options, information, and interpretive frameworks are systematically managed.

The relevance for the clinical encounter is subtle but important. A person who presents to a clinician with an account of systematic institutional manipulation—an account that includes managed media coverage, coordinated professional discrediting, and the deployment of institutional apparatus against a private individual—is describing a pattern that Wolin's framework would recognize as consistent with the operation of managed power in a post-democratic society. The clinician who lacks this conceptual vocabulary has only two options: call it real (and feel the weight of the claim's apparent implausibility) or call it symptomatic (and feel the weight of the diagnostic process). The clinician with access to Wolin's framework has a third option: recognize the pattern as politically coherent, take it seriously as a hypothesis, and apply the grain of truth investigation rather than reaching a premature conclusion in either direction.

1A.6 Jacques Rancière: The Part That Has No Part

French philosopher Jacques Rancière's political theory—developed across Disagreement (1999), The Politics of Aesthetics (2004), and other works—offers a framework that is particularly illuminating for the specific situation of a person who presents a legitimate claim to institutional actors who systematically deny it.

Rancière distinguishes between "politics" and "police". For Rancière, "police" (in a technical sense that extends far beyond law enforcement) is the order that assigns each person, group, and voice its proper place—that distributes social roles, names, and modes of speech in a way that determines who is heard, whose claims count, and whose presence in a given space is legitimate. "Politics" is the disruption of this order—the act of claiming a place by those who have been assigned no place, of speaking in the name of those who have been determined to have no legitimate voice.

The person who presents a substantial claim against powerful institutional actors—and who finds that every institutional pathway produces the same dismissive result, that their evidence is sealed, their arguments are characterized as vexatious, and their mental stability is publicly questioned—is experiencing the operation of the "police order" in Rancière's sense. They are being assigned to the category of those whose claims do not count, whose voice does not carry the epistemic authority required for institutional recognition, whose presence in the space of legitimate discourse is contestable.

Rancière's framework illuminates a specific pathology of the psychiatric assessment encounter: the clinician who operates solely within the institutional "police order"—who takes the dismissive outcomes of other institutions as corroboration of the patient's pathology—has become an extension of the same order. The clinician who applies independent, rigorous, evidence-based methodology is, in a modest sense, the figure of politics in Rancière's vocabulary: the one who says, "This person's claim will be assessed on its merits, regardless of what has been decided elsewhere."

The concept of the "part that has no part"—the group or individual who is within the social field but assigned no legitimate standing—is relevant to the specific vulnerability of the patient in an institutional context. A person who has been labelled vexatious, who carries a prior psychiatric diagnosis, whose sealed court records cannot be seen by those assessing their claims, is structurally positioned as the part that has no part: present in the system, but assigned no legitimate place within its normal operations.

1A.7 Post-Truth, Epistemic Injustice, and the Clinical Encounter

The philosopher Miranda Fricker, in Epistemic Injustice: Power and the Ethics of Knowing (2007), identified two forms of epistemic injustice—injustice in the domain of knowledge and knowing—that are directly relevant to the clinical assessment of extraordinary accounts.

Testimonial injustice occurs when a speaker's testimony is given less credibility than it deserves because of the hearer's prejudice about the speaker's social identity. The hearer's implicit or explicit assessment of the speaker's credibility—shaped by their race, gender, class, psychiatric history, or the apparent implausibility of their claims—causes the testimony to be discounted before it is assessed on its merits. Fricker identifies this as an ethical wrong: the speaker is treated as epistemically inferior not because of any feature of their testimony but because of who they are.

Testimonial injustice is a structural feature of psychiatric assessment in contexts where the patient's prior history, social identity, or the institutional context of the referral shapes the clinician's prior estimate of the patient's credibility. A patient who arrives in the emergency department accompanied by police, described as "paranoid" in the triage note, with a sealed court record and a prior psychiatric contact initiated by a corporate adversary, has already been subjected to testimonial injustice before the clinician enters the room. The clinician's obligation is to consciously counteract this structural disadvantage—not to pretend it doesn't exist, but to actively apply a corrective methodology.

Hermeneutical injustice occurs when a gap in collective interpretive resources places someone at an unfair disadvantage in making sense of their social experiences. When a patient describes experiences for which the prevailing clinical vocabulary offers only pathological interpretations— when the available categories for understanding what they are describing are either "delusion" or "impossible"—they are experiencing hermeneutical injustice. The interpretive framework available in the clinical encounter does not include adequate concepts for what they may be accurately describing.

The recognition of hermeneutical injustice as a category is important for the development of clinical frameworks. The response to hermeneutical injustice is not sympathy—it is the development of new interpretive resources. This white paper is, among other things, an attempt to provide new interpretive resources that address the hermeneutical gap: concepts like "emerging plausibility," "psychological torture," "coordinated inauthentic behavior," and "lawfare" are concepts that fill interpretive gaps in the clinical vocabulary and allow the patient's account to be assessed more accurately.

The "post-truth" era—a condition in which the authority of factual claims is systematically contested, in which information environments are fragmented and manipulated, and in which institutional credibility has declined across the board—has a double clinical significance. On one hand, it creates conditions in which genuinely delusional thinking may be harder to distinguish from the ordinary epistemic environment, because that environment itself has become more fragmented and conspiratorial. On the other hand, it creates conditions in which the post-truth machinery—the deliberate manufacture of false narratives, the coordinated discrediting of factual claims, the use of media and institutional channels to create false impressions of consensus—makes genuine conspiracies easier to execute and harder to expose. The clinician navigating the post-truth landscape must be alert to both risks simultaneously.

1A.8 The Regulatory Gap and the Agile Clinician

Technology is developing faster than law. This is not a new observation—it has been true since the Industrial Revolution created labor conditions that preceded labor law by decades. But the pace differential has accelerated dramatically. The legislative cycle—consultation, drafting, debate, enactment, implementation—operates on a timescale of years to decades. The technology development cycle in domains like artificial intelligence, neurotechnology, and directed energy operates on a timescale of months to years. The gap between what technology can do and what law has addressed is therefore widening at an increasing rate.

This regulatory gap has specific consequences for clinicians. In the absence of regulatory frameworks governing the use of specific technologies, there is no official record—no licensing regime, no inspection report, no regulatory finding—that a clinician can consult to establish whether a given technology is being deployed in a given context. The absence of a regulatory record is not evidence that the technology is not being used; it may simply reflect that no regulatory framework yet exists.

The OECD's work on "agile regulation"—the concept that regulatory frameworks must become more adaptive and faster-moving to keep pace with technological change—reflects a growing consensus among policy analysts that the traditional approach to regulation is inadequate for the current technological environment. Several jurisdictions, including the UK and the EU, have begun developing technology-specific regulatory sandboxes and horizon-scanning mechanisms designed to address this gap.

For clinicians, the implication is that the absence of regulatory coverage for a technology is not a reason to dismiss the possibility of its deployment. The question the clinician should ask is not "Has this technology been regulated?" but "Has this technology been documented?" The answer to the second question, for all of the technologies described in Section 8 of this paper, is yes.

1A.9 When Police and State Actors Suggest Pathologization

The most acute version of the problem this section addresses occurs when law enforcement or other state actors—police officers, court officials, regulatory bodies, government lawyers—suggest to a clinician, directly or implicitly, that a specific individual can or should be assessed as mentally unwell.

This suggestion may be explicit: a police officer who accompanies a patient to an emergency department and characterizes the patient's account as paranoid or delusional before the clinician has spoken with the patient. It may be implicit: a court record that characterizes the patient as vexatious, a referral letter that describes the patient's legal claims as unfounded, a welfare check request that has been initiated by an institutional adversary of the patient.

The clinician's independence from this suggestion is not merely an ethical preference. It is a constitutional and professional requirement. The Charter Section 7 guarantee—that deprivation of liberty through the psychiatric system must accord with the principles of fundamental justice— presupposes that the clinical determination is made independently, on the basis of evidence and clinical methodology, not on the basis of the preferences or characterizations of parties who have institutional interests in the outcome of that determination.

Foucault's analysis of the clinical gaze illuminates what is at stake: when the clinician adopts the state's characterization of the patient as their starting point, they are not conducting a clinical assessment—they are providing clinical authorization for a state-determined outcome. The clinical record that results from that process is not a clinical document; it is a bureaucratic instrument. And the patient who is subjected to that process is not receiving healthcare—they are being managed.

The history of psychiatry is not free of this dynamic. The Soviet deployment of psychiatric diagnosis against dissidents is the most notorious example, but there are documented instances in every democratic jurisdiction—including Canada—in which clinical authority has been enlisted, with or without the clinician's full awareness, in the project of silencing persons whose claims were inconvenient to institutional power. The clinician who maintains their methodological independence—who applies the framework in this paper regardless of what they have been told by referring agencies—is the structural safeguard against this dynamic.

This independence does not mean the clinician ignores police or state actors entirely. It means that information from those actors is treated as collateral input, assessed with the same critical attention as any other collateral, and incorporated into—not substituted for—the independent clinical process.

Rancière's "police order" returns here with specific force: the clinician who defers to the institutional characterization of the patient is extending the police order into the clinical encounter. The clinician who conducts an independent assessment is performing a political act in Rancière's sense—claiming for the patient a place in the space of legitimate inquiry that the institutional order has sought to foreclose.

1A.10 The Clinical Practitioner as a Node in a Larger System

Each of the theoretical frameworks surveyed in this section — Foucault, Crouch, Wolin, Rancière, Fricker — converges on a single clinical implication: the clinician is not a neutral observer standing outside the systems they are assessing. They are a node in those systems. The diagnosis they reach, the documentation they create, the certification they sign or refuse to sign — all of these are acts that have political and institutional effects that extend far beyond the clinical encounter.

This does not mean that clinicians should be politically paralyzed, or that the fear of becoming an instrument of institutional power should prevent them from making difficult clinical determinations. It means that the awareness of their position — their awareness that clinical determinations have institutional effects and that those effects can be exploited — is itself a clinical competency. A clinician who is aware of the pressures on their assessment is better equipped to resist illegitimate pressure while responding appropriately to legitimate clinical concerns.

The framework in this paper is designed to operationalize that awareness. The grain of truth investigation is, among other things, a structural safeguard against the clinician becoming an instrument of suppression without knowing it. The bizarre/non-bizarre distinction, applied with reference to current technological reality rather than the clinician's prior frame, is a structural safeguard against the clinician becoming an instrument of epistemic injustice without intending to. The five-criterion framework, applied rigorously and documented transparently, is a structural safeguard against the clinician becoming an instrument of institutional power without consenting to it.

The times we are living in — marked by accelerating technological change, hollowed democratic institutions, contested epistemic authority, and a widening gap between what technology can do and what law has addressed — make these safeguards more important, not less. The clinician in 2026 who applies the methodology in this paper is doing something that has always been required of good clinical practice but that is now, given the specific political and technological environment, also an act of civic and constitutional significance.

2. Governing Law and Professional Obligations in Nova Scotia and Canada

2.1 The Canadian Charter of Rights and Freedoms

Section 7 of the Canadian Charter of Rights and Freedoms (the Charter) guarantees the right to life, liberty, and security of the person, and the right not to be deprived thereof except in accordance with the principles of fundamental justice. Involuntary psychiatric detention is a deprivation of liberty. It is therefore subject to Charter scrutiny, and must be carried out in accordance with the principles of fundamental justice: procedural fairness, evidentiary basis, and the prohibition of arbitrary decision-making.

Section 15 guarantees equality rights and prohibits discrimination on grounds including disability and race. The well-documented racial and disability-based disparities in psychiatric detention rates in Canada engage Section 15 directly.

Section 2(b) guarantees freedom of expression. A patient who speaks about extraordinary experiences is exercising a constitutionally protected right. Clinical suppression of that speech—through pathologization, involuntary detention, or coercive treatment—is a Charter-significant act requiring constitutional justification.

2.2 The Nova Scotia Hospitals Act

The Hospitals Act, R.S.N.S. 1989, c. 208, and its psychiatric detention provisions establish the legal threshold for involuntary psychiatric assessment in Nova Scotia. A physician issuing an involuntary order must have reasonable and probable grounds to believe the person suffers from a mental disorder and is likely to cause harm to themselves or others, or is suffering to a degree that warrants assessment.

The threshold is harm-focused, not plausibility-focused. The implausibility of a patient's account is not, in itself, grounds for involuntary certification. A Form 1 issued primarily because the patient's description of their experience sounds unusual, and not because a specific harm risk has been identified, does not meet the statutory threshold and is legally vulnerable.

The physician who signs a Form 1 assumes individual legal responsibility for the basis of that certification. If the certification is subsequently challenged—by way of a habeas application, a complaint to the CPSNS, or a civil action—the physician must be able to demonstrate that the threshold was met, that the differential diagnosis was conducted, and that the grain of truth investigation was undertaken.

2.3 The Nova Scotia Personal Directives Act

The Personal Directives Act, S.N.S. 2008, c. 8, governs capacity assessment and substitute decision-making. Capacity is assessed decision-specifically, not globally. A person who holds an extraordinary belief may retain full capacity to make specific healthcare decisions. The existence of a potentially delusional belief does not automatically negate capacity, and a clinician who treats it as doing so has conflated a diagnostic determination with a legal determination—an error that is both clinically incorrect and legally indefensible.

2.4 The Nova Scotia Personal Health Information Act

The Personal Health Information Act, S.N.S. 2012, c. 33, governs the collection, use, and disclosure of personal health information. Collateral information-gathering in the course of a psychiatric assessment must comply with PHIA's requirements, including the principle that health information be collected only for purposes related to care and only in amounts necessary for that purpose.

2.5 The Nova Scotia Human Rights Act

The Human Rights Act, R.S.N.S. 1989, c. 214, prohibits discrimination in services on grounds including mental disability and race. A patient who is subjected to a less thorough or less charitable assessment because of their race, their prior psychiatric history, or a disability-related stigma may have grounds for a human rights complaint. Clinicians and health authorities are required to provide services in a manner consistent with the Act.

2.6 The Nova Scotia Adult Protection Act

The Adult Protection Act, R.S.N.S. 1989, c. 2, creates obligations to report and investigate abuse of adults in need of protection. Where a patient's account, if accurate, would constitute an ongoing instance of adult abuse—including psychological abuse—the Act's reporting provisions may be engaged. The Act should not be used as an alternative pathway for psychiatric intervention in the absence of the statutory criteria; it should, however, be considered where the patient's account describes ongoing abuse, including institutionalized or technologically facilitated abuse.

2.7 Federal Legislation and Criminal Code

The Criminal Code, R.S.C. 1985, c. C-46, Part XX.1 governs the intersection of mental disorder and criminal responsibility. Section 269.1 creates the offence of torture, defined as any act or omission by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person. Where a patient's account, if accurate, describes conduct that could constitute torture—including technologically facilitated or institutionally orchestrated psychological harm—the clinician may have an obligation to consider whether reporting to law enforcement is appropriate.

The Criminal Code also governs obstruction of justice (ss. 139-141), conspiracy (s. 465), fraud (s. 380), and breach of trust by a public officer (s. 122). These provisions are relevant because the conduct that some patients describe—when it is occurring—frequently falls within them.

2.8 Regulatory Standards and Professional Obligations

The College of Physicians and Surgeons of Nova Scotia (CPSNS) Standards of Practice require that clinical decisions be grounded in the best available evidence, be free of bias, and be documented transparently. A diagnosis reached by clinical impression rather than through a structured diagnostic process, a diagnosis that ignores the grain of truth obligation, or a diagnosis influenced by the patient's race, social status, or prior diagnostic history, does not meet the standard.

The Nova Scotia College of Nursing (NSCN) Standards of Practice create equivalent obligations for registered nurses and nurse practitioners, including those who participate in psychiatric assessment and triage.

The Nova Scotia College of Social Workers (NSCSW) Standards of Practice require that social workers advocate for their clients' rights and interests, including the right to be heard and the right to have their account of their circumstances taken seriously.

All of these regulatory obligations are enforceable through complaints processes that can result in sanctions, suspension, or revocation of professional registration.

2.9 Canada's International Human Rights Obligations

Canada is a party to the International Covenant on Civil and Political Rights (ICCPR), the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT), the Convention on the Rights of Persons with Disabilities (CRPD), and other international human rights instruments. Canada adopted the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) in 2021.

The CRPD Committee has consistently held that involuntary psychiatric detention constitutes arbitrary deprivation of liberty and must be subjected to the highest standards of scrutiny. CRPD General Comment No. 1 (2014) requires that states replace substitute decision-making with supported decision-making, respecting the person's own account of their circumstances and their autonomous choices.

Reports of the UN Special Rapporteur on Torture—including A/HRC/43/49 and A/HRC/57/61—constitute authoritative interpretations of the CAT and related instruments. They are persuasive authority before Canadian courts and regulatory bodies and inform the interpretive environment in which Canadian healthcare law operates.

3. Canadian Case Law: The Judicial Framework for Psychiatric Determination

3.1 Starson v. Swayze, [2003] 1 SCR 722

Starson v. Swayze is the leading Supreme Court of Canada decision on capacity and the relationship between mental disorder and decision-making rights. The Court held that capacity is decision-specific, that the presence of a mental disorder does not automatically negate capacity, and that the relevant inquiry is whether the person understands the information relevant to the specific decision, appreciates the reasonably foreseeable consequences of accepting or rejecting treatment, and can communicate a decision.

The Court made a critical point that is directly relevant to this white paper: a person is not incapable simply because their beliefs or values differ from those of the clinician assessing them. A patient who holds unusual beliefs may still have the capacity to make treatment decisions, including the decision to refuse psychiatric treatment. Clinical disagreement with a patient's worldview is not a substitute for a capacity assessment.

Starson does not prevent clinicians from making capacity findings, but it requires that those findings be grounded in specific functional assessment—not in the content or implausibility of the patient's reported experiences.

3.2 R. v. Swain, [1991] 1 SCR 933

R. v. Swain is the foundational Supreme Court decision on the constitutional limits of involuntary psychiatric detention in the criminal context. The Court held that indefinite detention of persons found not criminally responsible by reason of mental disorder, without individualized assessment and review, violated Section 7 of the Charter. The principles established in Swain—that deprivation of liberty through the psychiatric system requires rigorous, individualized, evidence-based justification—apply in the civil involuntary admission context as well.

3.3 Conway v. Jacques, [2006] OJ No 3546 (ONCA)

The Conway line of cases from the Ontario Court of Appeal establishes that patients who are involuntarily detained for psychiatric assessment have the right to legal representation, to challenge the grounds for their detention, and to seek habeas corpus relief. These rights exist in Nova Scotia through the Charter and the common law, even in the absence of specific provincial statutory provisions.

A clinician who certifies a patient involuntarily must be prepared for the possibility that the detention will be challenged in court, and that the evidentiary basis for the certification—including the adequacy of the differential diagnosis and the grain of truth investigation—will be scrutinized by a judge.

3.4 R. v. Willaert, 1953 CanLII 71 (ONCA) and the Non-Bizarre Delusion Doctrine

The Ontario Court of Appeal's foundational analysis of the bizarre/non-bizarre distinction—which predates its formal DSM incorporation— established the principle that a belief which concerns matters that could occur in real life cannot be dismissed as impossible without investigation. This principle has been applied in various forms across Canadian jurisdictions and informs the clinical obligation to investigate the grain of truth before concluding that a belief is delusional.

3.5 R. v. Chaulk, [1990] 3 SCR 1303

Chaulk addresses the criminal law standard for mental disorder and the presumption of sanity. While it operates in the criminal context, its underlying principle—that a person is presumed to be mentally competent and that the burden of proving mental disorder falls on those who allege it—has implications for civil psychiatric assessment. A clinician does not certify from a blank slate; the patient is presumed competent, and the basis for disturbing that presumption must be established through the structured process described in this paper.

3.6 R.D.S. v. R., [1997] 3 SCR 484

R.D.S. is the Supreme Court's foundational decision on the appearance of impartiality and the role of systemic context in adjudication. Applied to clinical psychiatry, it supports the proposition that a decision-maker—including a clinician making a psychiatric determination—must not only be free of actual bias but must be seen to be free of it. A clinician who brings to the assessment a prior assumption about the credibility of patients from specific racialized, socioeconomic, or diagnostic backgrounds has compromised the impartiality of the process.

3.7 Beals v. Saldanha, [2003] 3 SCR 416

While Beals is a private international law decision concerning the recognition of foreign judgments, it articulates important principles about the exceptional circumstances in which enforcement of an apparently valid judicial order should be refused—including where that order was obtained through fraud. The principle that facially valid institutional decisions are not immune from scrutiny when the process that generated them was fundamentally compromised is relevant to the clinical context: a prior psychiatric diagnosis, made without adequate investigation, is not binding on subsequent clinicians and should not be treated as foreclosing re-assessment.

3.8 Baker v. Canada (Minister of Citizenship and Immigration), [1999] 2 SCR 817

Baker is the Supreme Court's landmark decision on procedural fairness in administrative decision-making. Applied to psychiatric assessment, it supports the principles that patients are entitled to be heard, that they are entitled to reasons for decisions affecting them, that their circumstances—including their vulnerability and their specific situation—must be taken into account, and that decision-making processes that systematically exclude relevant considerations are procedurally flawed.

3.9 F.H. v. McDougall, [2008] 3 SCR 41

McDougall establishes that in civil proceedings, there is only one standard of proof—the balance of probabilities—and that more serious allegations require more cogent evidence to establish on that balance. Applied to psychiatric assessment: a clinician who concludes that a patient's account of extraordinary circumstances is false—and who acts on that conclusion through certification, forced treatment, or other clinical intervention—is in effect making a finding against the patient that requires the same quality of evidence that the seriousness of the finding demands. The more serious the intervention contemplated, the more rigorous the evidentiary basis must be.

4. The Diagnostic Landscape: DSM-5-TR and ICD-11 Criteria

4.1 The DSM-5-TR Definition of Delusion

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR, 2022) defines a delusion as a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture.

Several elements of this definition require unpacking.

False belief: To conclude that a belief is delusional, the clinician must have a basis for concluding the belief is false—not merely unusual, not merely unverified, not merely implausible to the clinician. This imposes a significant epistemic burden: the clinician must engage with the content of the belief, not merely with its form.

Based on incorrect inference about external reality: This requires assessment of the patient's reasoning, not just their conclusion. A patient who reasons soundly from genuine evidence to an unusual conclusion is demonstrating unusual but coherent cognition, not delusion. The inferential process matters.

Firmly sustained despite incontrovertible and obvious proof to the contrary: The word "incontrovertible" is important. Ambiguous evidence, conflicting evidence, or evidence that the patient offers an alternative interpretation of, is not incontrovertible proof. The incorrigibility criterion requires that the clinician actually present counter-evidence and observe the response—it is not satisfied by the observation that the patient "seems" unwilling to consider alternatives.

Cultural congruence exception: The DSM explicitly states that the belief must not be one ordinarily accepted by other members of the person's culture or subculture. This exception does significant work: it requires cultural assessment before any delusional diagnosis can be made.

Insight requirement: The DSM-5-TR notes that insight into the nature of one's beliefs exists on a spectrum. A patient with "fair" or "good" insight who expresses some uncertainty about their account is demonstrating the opposite of the classic delusional pattern of morbid certainty.

4.2 ICD-11 Classification

The International Classification of Diseases, Eleventh Revision (ICD-11, WHO, 2019) classifies persistent delusional disorder under 6A24. The ICD-11 definition similarly requires that the delusion be assessed in cultural context and that it be persistent (typically three months or more). A belief of recent onset, or a belief that has modulated over time in response to events, does not meet the ICD-11 chronological threshold.

The ICD-11 introduces a dimensional approach to psychopathology that moves away from categorical diagnosis toward a spectrum model. This is clinically significant: a patient who demonstrates some features of delusional thinking but also demonstrates preserved insight, functional flexibility, and capacity for rational discourse does not straightforwardly fit the ICD-11 delusional disorder category.

4.3 The Differential Diagnostic Obligation as Embedded in Criteria

Both the DSM-5-TR and ICD-11 require the exclusion of alternative explanations before a delusional disorder diagnosis can be made. The alternative explanations include all medical conditions that can cause psychosis-like experiences, substance effects, mood disorders with psychotic features, PTSD, OCD with poor insight, and genuine external experience. This differential diagnostic obligation is not a supplement to the diagnostic criteria; it is embedded within them. A clinician who diagnoses delusional disorder without completing the differential has not applied the diagnostic criteria.

5. The Bizarre vs. Non-Bizarre Distinction: The Foundational Clinical Test

5.1 Definition and Clinical Significance

The DSM-5-TR defines a bizarre delusion as one that is "clearly implausible, not understandable, and not derived from ordinary life experiences". A non-bizarre delusion involves "situations that could conceivably occur in real life". This distinction is foundational because it determines whether investigation is required before a clinical conclusion can be reached.

For bizarre delusions—those that are impossible in principle—the impossibility itself provides the starting point for a clinical conclusion, though it does not end the analysis. For non-bizarre delusions—those that describe situations that could, in principle, occur—the clinical obligation is first to investigate whether the situation has occurred, before reaching any conclusion about whether the belief is symptomatic.

5.2 The Technological Obsolescence Problem

The bizarre/non-bizarre distinction was articulated in an era of radically different technological capability. What is bizarre in one technological era may be non-bizarre in another. This is not an academic point. It has direct clinical and legal consequences.

Consider the following progression:

A patient in 1985 who reported that all of their telephone conversations were being recorded by a government agency would have been assessed, by many clinicians, as expressing a potentially bizarre belief—the infrastructure to do so did not obviously exist. After the Snowden revelations of 2013, a patient making the same report could not be assessed that way, because the infrastructure demonstrably existed and had been in use for years.

A patient in 2000 who reported that they were hearing directed audio that no one around them could hear would likely have been assessed as auditory hallucination. Today, bone conduction audio devices and ultrasonic directional speakers are commercially available and well-documented.

A patient in 2010 who reported that a device was being used to monitor their neurological activity from outside their body would have been assessed as expressing a bizarre belief. Today, consumer-grade EEG devices are commercially available, research-grade BCIs allow high-resolution neural monitoring, graphene family nanoparticles can enable seamless remote BCI, and UN Report A/HRC/57/61 formally recognizes the non-consensual neural monitoring and manipulation as a human rights concern.

The clinical obligation is to apply the bizarre/non-bizarre distinction with reference to the current state of the world—not the clinician's intuitive or pre-existing sense of what is possible. Where the clinician lacks knowledge of the current technological landscape, the obligation is to seek that knowledge before reaching a conclusion, or to refer to someone who has it.

5.3 A Contemporary Plausibility Framework

The following taxonomy reflects the current state of documented knowledge:

Category A — Clearly non-bizarre (documented as occurring): Surveillance of individuals by state or corporate actors through digital devices and communications interception; organized campaigns of harassment, stalking, or intimidation by groups; interference with electronic communications; the use of lawfare (strategic litigation) to financially and institutionally destroy an adversary; the coordination of multiple institutional actors—courts, police agencies, professional bodies, media—to present a unified and misleading account of events.

Category B — Non-bizarre given documented military and commercial technology: Directed energy effects on the human body producing neurological symptoms; bone conduction and ultrasonic directional audio producing sounds audible only to a specific individual; monitoring of gross neural activity patterns at close range using consumer-grade EEG; transcranial magnetic or electrical stimulation of neural activity producing changes in mood, cognition, or perception.

Category C — An emerging risk envelope recognized in international human rights instruments: Remote monitoring of more specific neural signals at extended range; non-consensual neural "nudging" using directed electromagnetic means; population-scale deployment of neurotechnology for monitoring or behavioral influence. These are addressed in A/HRC/57/61, which recognizes the plausibility of the underlying technology while calling for regulatory frameworks to prevent its abuse.

Category D — Currently not documented as technically achieved: Precise real-time remote decoding of specific thoughts at a distance without any device in proximity to the subject; full behavioral control (distinguished from influence) through currently available neurotechnology; the insertion of complete, complex experiences (memories, full sensory scenes) without any physical interface.

The clinical significance of this taxonomy: categories A and B require no special pleading—they describe documented realities. Category C requires the application of the emerging plausibility framework: the clinician cannot dismiss the account as impossible, but neither can they confirm it without investigation and appropriate testing. Category D is where the conventional bizarre/non-bizarre threshold still applies.

6. The Five-Criterion Delusion Assessment Framework

6.1 Criterion 1: Conviction and Certainty

Delusions are classically characterized by absolute conviction—the patient cannot entertain any alternative explanation, expresses no uncertainty, and responds to counter-suggestions with distress or contempt rather than reflective consideration.

Clinical probe: Present the patient with the possibility that their account might be inaccurate and observe the response. "Is there any possibility, even a small one, that some part of what you've experienced might have a different explanation than the one you've reached?". A patient who can acknowledge uncertainty while maintaining a strong belief is demonstrating preserved epistemic flexibility—the opposite of the morbid certainty of classical delusion.

Caveat for clinicians: Conviction is frequently high in genuine victims of ongoing abuse, harassment, or institutional persecution. A person who has spent years trying to be believed, who has been dismissed, gaslighted, and institutionally discredited, and who has accumulated substantial evidence for their account, has rational grounds for high conviction. High conviction alone is not a diagnostic criterion; it is a feature that must be interpreted in context.

6.2 Criterion 2: Incorrigibility

Incorrigibility refers to the imperviousness of a belief to logical argument or counter-evidence. In true delusional thinking, counter-evidence is not engaged with—it is either dismissed, ignored, or incorporated into the delusional system in a way that reinforces rather than challenges it (the "they must have changed the records" pattern).

Clinical probe: Present a specific and concrete piece of counter-evidence or a logical argument against the patient's account. Observe the response carefully. Does the patient engage with the argument, or deflect? Does the patient acknowledge the point's relevance even while maintaining their position, or deny that the evidence has any relevance? Is the patient's response to counter-evidence qualitatively different from how they respond to questions on other topics?

A critical diagnostic trap: The pattern of "incorporating counter-evidence into the narrative" that is classically associated with delusional elaboration is also a well-documented response of genuine victims of sophisticated gaslighting and evidence manipulation. A victim of a campaign that involves the systematic falsification of records, the coaching of witnesses, and the control of institutional outputs may accurately report that "the records have been changed" or "the witnesses have been told what to say"—and may be correct. The clinician must not mistake a patient's account of systematic evidence tampering for delusional elaboration without first establishing that the evidence tampering did not occur.

6.3 Criterion 3: Possibility and Plausibility

This criterion asks whether the belief's content is possible in principle and plausible given available evidence. It must be assessed with reference to the current state of knowledge, as described in Section 5. The question is not "Does this seem possible to me?" but "Is this documented as possible in the current literature?"

Clinical obligation: Where the clinician lacks expertise in the specific domain—technology, military capability, institutional coordination, corporate malfeasance—the professional obligation is to either acquire that knowledge or seek appropriate consultation. Presuming impossibility in the absence of knowledge is not expertise; it is ignorance.

6.4 Criterion 4: Preoccupation and Functional Impact

Delusions typically involve a degree of preoccupation disproportionate to the provocation—the belief becomes the exclusive organizing principle of the patient's existence, crowding out other concerns, relationships, and activities. The patient can discuss nothing else, seeks every interaction as an opportunity to advance the narrative, and is unable to maintain functional engagement with ordinary life.

Clinical probe: Explore the full breadth of the patient's life. Can they discuss other topics with engagement and appropriate affect? Do they maintain relationships, employment, hobbies, or other activities? Is the extraordinary account one significant concern among others, or the entirety of their mental life?

Caveat: Genuine crises—including being the target of a sustained campaign of legal, financial, and institutional harm—do produce preoccupation. A person who has lost their financial stability, their professional standing, their freedom (through wrongful arrest or detention), and their access to justice as a result of a genuine conspiracy has rational grounds for sustained preoccupation. The question is not whether preoccupation exists, but whether it is proportionate to the reported circumstances.

6.5 Criterion 5: Cultural Congruence

A belief that is normative within the patient's cultural, religious, or subcultural context is explicitly excluded from the category of delusion by both the DSM-5-TR and ICD-11. This criterion requires affirmative assessment of cultural context—not the assumption that the clinician's cultural framework is the default.

Subcultural norms beyond religion and ethnicity: The cultural congruence criterion extends beyond traditional religious and ethnic contexts. It encompasses professional subcultures (security researchers, legal professionals, and investigative journalists commonly hold beliefs about institutional coordination and surveillance that would seem extraordinary to clinicians), political and activist communities (whose members have historically been subjected to documented surveillance and harassment programs), and communities with specific technological expertise whose understanding of what is technically possible differs substantially from the general population's.

7. The Grain of Truth Doctrine: A Clinical and Legal Obligation

7.1 The Obligation

Before a belief can be assessed as delusional, the clinician must have made a reasonable effort to determine whether any part of the reported experience has a basis in reality. This is the grain of truth doctrine, and it is not merely a courtesy—it is an ethical, professional, and legal obligation.

It derives from the DSM-5-TR itself (which defines delusion as a "false belief"—not merely an unusual or unverified one), from professional standards that require evidence-based practice, and from the legal framework governing involuntary detention (which requires that the grounds for certification be substantiated, not merely inferred from impressions). In the civil liability context, McDougall's requirement that more serious allegations require more cogent evidence directly supports the grain of truth obligation: the more serious the clinical intervention contemplated, the more thorough the pre-intervention investigation must be.

7.2 What the Investigation Requires

The grain of truth investigation does not require the clinician to become a forensic investigator or a technology expert. It requires:

A thorough, structured, non-dismissive clinical interview that allows the patient to give their full account, including any evidence they can identify, any collateral sources they can name, and any documentation they can provide.

An attempt, with the patient's consent, to contact at least one collateral source who might corroborate or clarify elements of the account.

A review of any documentation the patient provides or identifies—including emails, court records, financial records, or other materials that may substantiate their account.

A basic inquiry, using available professional resources, into whether the specific phenomena described are technically possible or documented. This may mean reading the relevant UN report, reviewing available literature on the technology in question, or consulting with a colleague who has relevant expertise.

Documentation of all of the above, including what was and was not investigated, and why.

7.3 The Limits of the Investigation

The clinician is not law enforcement, is not a forensic investigator, and is not equipped to subpoena records, compel witnesses, or conduct surveillance analysis. What the investigation must accomplish is a threshold finding: is there any evidence that this account might be accurate, and has that possibility been taken seriously?

The absence of corroboration does not establish the presence of delusion. Many genuine experiences leave no corroborating evidence— particularly where the reported experience involves sophisticated concealment, institutional coordination, or classified or proprietary technology. The standard is not "Has this been proven?" but "Has the possibility been genuinely and systematically investigated?"

8. Emerging Technology and the Novel Reality Problem: A Clinician's Technology Primer

8.1 The Knowledge Gap

Medical education in Canada does not include training in the current capabilities of surveillance technology, directed energy systems, neurotechnology, psychological operations methodology, electronic warfare, or the legal and regulatory frameworks governing these domains. Clinicians assess what they do not understand as implausible and assess the implausible as symptomatic. This is not a moral failure—it is a predictable consequence of training systems designed for an earlier technological era. But it is an error, and it is correctable. This section provides the minimum technological context that clinicians need to apply the bizarre/non-bizarre distinction correctly.

8.2 Surveillance and Digital Monitoring

The capabilities of state and non-state surveillance are extensive and well-documented in the post-Snowden literature. Key facts:

Consumer-grade stalkerware—commercial software designed for covert installation on target devices—is widely available and has been extensively documented in intimate partner violence contexts. It can silently record conversations, access location data, copy files, and monitor communications.

Commercial spyware at the Pegasus level (NSO Group) is capable of zero-click compromise of smartphones, providing complete access to all data on the device including encrypted communications. This capability was documented in Citizen Lab investigations and confirmed in legal proceedings in multiple jurisdictions.

"Stingray" and IMSI catcher devices—which impersonate cell towers to intercept communications and track location—are commercially available and have been used by Canadian law enforcement agencies. Their use by non-state actors is an established security concern.

At the most advanced frontier of neural surveillance, graphene-family nanomaterials (GFNs)—specifically Graphene Quantum Dots (GQDs) within the 2–10 nanometer range—represent a documented mechanism for systemic brain-machine interfacing. Peer-reviewed research confirms these materials can cross the blood-brain barrier via paracellular diffusion, receptor-mediated transcytosis, and olfactory retrograde transport, accumulating preferentially in the hippocampus, thalamus, and prefrontal cortex.

Once integrated into neural membranes, GQDs exhibit broadband electromagnetic responsiveness across terahertz, near-infrared, and microwave/RF spectra, enabling the transduction of local field potentials and neurotransmitter shifts into detectable signals. Because studies show up to 15% of these particles may permanently integrate with tissue—resisting enzymatic degradation beyond 90 days—they constitute a persistent, bidirectional interface. Whether such materials have been introduced into human populations or individual subjects via injectable products or environmental vectors remains a subject of intense dispute; however, ISO 17025-compliant forensic methods like micro-Raman spectroscopy are technically capable of resolving these claims.

A person who reports that their communications are being monitored, that their location is being tracked without their knowledge, or that specific information they communicated privately has appeared in an unexpected context, is describing phenomena that can be achieved through readily available means. These are not bizarre claims.

8.3 Organized Harassment and "Coordinated Inauthentic Behavior"

The term "coordinated inauthentic behavior" was coined by Facebook in the context of disinformation campaigns but describes a real-world phenomenon: the coordination of multiple individuals or accounts to create a misleading appearance of independent action. It has been documented in commercial, political, and personal harassment contexts. The Cybertorture page citing UN A/HRC/43/49 (here) and the visual evidence Guide page (here) explore this at length, as is touched on at section 9 of this paper. These are organized crimes and they happen.

"Stalking by proxy" — in which an abuser or actor of institutional malice orchestrates multiple third parties to create a surrounding pattern of harassment that appears coincidental to any individual observer but is coordinated in effect—is documented in the clinical literature on intimate partner violence and in the security literature on targeted harassment.

A patient who describes multiple seemingly unrelated individuals or institutions producing unexpectedly convergent, adverse outcomes is not necessarily experiencing paranoid ideation. They may be accurately describing a coordinated pattern whose coordination is not apparent to individual participants.

8.4 Graphene Quantum Dots: Electromagnetic Properties and Neural Interface

Graphene Quantum Dots (GQDs)—carbon nanostructures typically 2–10 nm in diameter—represent a pivot in neurotechnology from external devices to systemic, covert interfaces. Their clinical relevance is no longer speculative; they are documented in peer-reviewed literature, DARPA research tracks, and UN Report A/HRC/57/61. While their properties are established, the central controversy remains the extent of their deployment.

Electromagnetic Interrogation Infrastructure GQDs exhibit broadband responsiveness across the terahertz (0.1–10 THz), near-infrared (700–950 nm), and microwave/radiofrequency (300 MHz–300 GHz) spectra. This range precisely overlaps with modern urban infrastructure, including consumer WiFi (2.4/5 GHz), 5G mmWave (up to 47 GHz), and satellite Ka-band downlinks (26.5–40 GHz). This overlap implies that existing commercial wireless networks could, in principle, serve as the power and interrogation infrastructure for any GQD-based interface, enabling transcranial optical or RF monitoring without bulky hospital hardware like fMRI.

Neural Coupling: The "Read" and "Write" Capabilities In the "Read" phase, GQDs utilize high carrier mobility (up to 100,000 cm²/V·s) to transduce neuronal millivolt changes and neurotransmitter concentrations (e.g., dopamine, glutamate) into detectable backscatter signatures. This allows for real-time monitoring of theta-gamma coupling in the hippocampus (memory) or beta desynchronization (motor planning).

Conversely, the "Write" capability utilizes bidirectional neuromodulation. Through photothermal stimulation or electric field entrainment, GQDs can activate heat-sensitive ion channels or rhythmically synchronize neural networks at specific frequencies (theta, alpha, gamma). With a spatial resolution of 50 µm—200 times more precise than Transcranial Magnetic Stimulation (TMS)—GQD-mediated influence could alter mood, impulse control, and decision-making in ways indistinguishable from primary psychiatric illness.

Evidence Standards and Clinical Obligations Clinicians must distinguish between four levels of certainty:

Established: The physical properties (EM responsiveness, BBB crossing) are documented and undisputed.
Confident: The components for a GQD-based interface system exist.
Inferential: Deployment against civilians remains unconfirmed in the public record.
Diagnostic: Establishing a link between a patient's experience and GQD interference requires independent forensic testing (e.g., micro-Raman spectroscopy).

A patient reporting experiences of internal monitoring or cognitive influence is describing phenomena that current technology renders physically possible. As these concerns are now formally recognized by international human rights bodies, clinicians are obligated to investigate these claims as potential technological interactions rather than reflexively presuming pathology.

8.5 Directed Energy Effects on the Human Nervous System

Directed energy weapons—including microwave, radiofrequency, and acoustic devices—capable of producing neurological and physiological effects are documented in the unclassified military literature. Microwave/radiofrequency exposure can produce the "microwave hearing effect" (the perception of sounds, clicks, or buzzing without an external auditory source), headache, cognitive impairment, dizziness, and other neurological effects.

The "Havana syndrome" investigation is the most publicly documented case of suspected directed energy effects on civilian personnel. The 2021 National Academies report concluded that directed pulsed radiofrequency energy was the most plausible explanation for the cluster of neurological symptoms reported by U.S. and Canadian diplomatic personnel beginning in 2016. Earlier clinical assessments that characterized these symptoms as psychogenic or somatoform were subsequently shown to be incorrect.

The Active Denial System—a military crowd-control device using millimeter-wave directed energy—has been confirmed to produce intense skin sensory experiences in targeted individuals. Smaller-scale directed energy devices with similar mechanisms are documented in the research literature.

A patient who reports unusual physical sensations—including burning, pressure, tinnitus, sudden cognitive impairment, or unusual auditory experiences—that they attribute to an external directed source is not necessarily experiencing somatoform disorder. The differential must include directed energy exposure.

8.6 Distributed RF Beamforming, LEO Satellites, and an Integrated Neural Interface Architecture

The preceding section described GQDs as a potential neural interface substrate. This section addresses, in compressed form, the external infrastructure that could power, interrogate, and receive data from such a substrate—and the extent to which that infrastructure already exists.

Beamforming and coordination: Modern LEO satellites and 5G base stations use phased arrays that electronically steer focused beams. When multiple transmitters synchronize phase so their signals arrive in phase at a point, local power density scales roughly with the square of the number of sources, while each individual source stays at ordinary output. This is the same constructive-interference principle that underlies phased-array radar, 5G beamforming, and satellite spot beams. Because 5G towers are GPS/GNSS-synchronized to nanosecond-scale accuracy and LEO constellations are clock-disciplined to comparable precision, the technical prerequisites for coordinated beamforming at a specified ground location are, in principle, present. Whether this has been operationalized for individual targeting is inferential and unconfirmed; that the physical and timing infrastructure exists is not.

Satellite as coordinator, towers as power source: A single satellite at 500 km cannot, by itself, deliver large biologically significant power to a small ground target; that objection is correct for a single-source model. In a distributed architecture, however, the satellite’s primary role is timing, phase reference, and targeting. The actual power would be supplied by terrestrial 5G infrastructure close to the subject: the satellite coordinates, the towers deliver. GQD resonance in the 12–60 GHz range (particle-size dependent, overlapping 5G mmWave and satellite Ka-band) implies that correctly patterned fields could, in principle, elicit disproportionately large local responses, reducing the absolute power needed compared with simple linear models.

Conventional neurostimulation and the spectrum of plausibility: At the same time, clinicians should remain grounded in established, non-exotic neurostimulation: TMS (pulsed magnetic fields) alters mood and motor function and is approved for depression, OCD, and migraine; tDCS modulates cortical excitability using weak scalp currents; focused ultrasound can influence neural activity through the skull; consumer EEG-BCIs decode gross neural patterns at close range; invasive arrays (e.g., BrainGate, Neuralink) support high-resolution bidirectional communication. These define the clinically established end of a spectrum whose emerging end—non-surgical, distributed RF interfaces leveraging nanomaterial substrates and coordinated infrastructure—is explicitly contemplated in DARPA’s N³ program and in UN report A/HRC/57/61.

Clinical obligation: A patient who reports unusual sensory phenomena, cognitive intrusions, or mood shifts attributed to external technology is describing experiences that span from well-documented (TMS, tDCS, bone-conduction audio, directed-energy effects) through emerging-plausible (distributed RF interfaces) to as-yet unconfirmed (full real-time decoding at distance). The clinician’s role is not to adjudicate the engineering implementation, but to properly locate the claim within a plausibility taxonomy: bizarre (physically impossible), non-bizarre (technically documented), or emerging-plausible (physically principled, recognized in human-rights instruments, not yet confirmed in deployment). None of the phenomena described in this section fall into the bizarre category. Before arriving at a psychiatric diagnosis, the differential must include technological etiology as a live possibility, even if confirming or excluding it ultimately requires forensic investigation beyond the clinic.

8.7 Psychological Operations and AI-Assisted Influence

Psychological operations—the deliberate use of messaging, environmental manipulation, and social engineering to influence the cognition and behavior of target individuals—are documented as a military and intelligence capability and have been adapted for commercial, political, and criminal contexts.

AI-assisted influence operations—using machine learning and algorithms to tailor content, timing, and delivery to maximize psychological impact on specific individuals—are documented in the disinformation and information security literature. Cambridge Analytica's operations (which were the subject of formal regulatory findings in the UK, the US, and Canada) demonstrate the deployment of such capabilities at scale.

At the individual level, a sophisticated psychological operation against a specific target might involve: the coordinated use of multiple individuals to create a surrounding environment of social pressure and confirmation of a false narrative; the manipulation of the target's information environment through algorithmic or social means; the use of institutional channels (litigation, professional complaints, law enforcement engagement) as instruments of harassment; and the exploitation of the target's responses to these pressures to accumulate a record that can be used to discredit them.

A patient who describes experiencing what sounds like a sophisticated, coordinated psychological operation is describing a phenomenon that is documented in the literature and that has been formally addressed by a UN Special Rapporteur. The clinical obligation is to investigate, not to presume pathology.

9. UN Report A/HRC/43/49: Psychological Torture and Institutional Harm

9.1 Overview of the Report

Report A/HRC/43/49 was submitted to the 43rd session of the UN Human Rights Council in 2020 by Special Rapporteur Nils Melzer under the mandate on torture and other cruel, inhuman or degrading treatment or punishment. Melzer—who holds the Chair of International Law at the University of Glasgow and served as Head of Delegation at the International Committee of the Red Cross—was one of the most distinguished experts to have held this mandate.

The report, titled "Psychological torture," establishes psychological torture as a recognized subcategory of torture under international human rights law. It argues that psychological methods of causing severe mental suffering—methods that do not rely on physical pain as their primary mechanism—have been systematically underrecognized and underprosecuted, and calls on states to adopt a formal definition of psychological torture that encompasses these methods.

9.2 Key Findings

Finding 1 — Psychological torture is distinct and severe: Melzer establishes that psychological methods of causing suffering—including solitary confinement, sensory manipulation, humiliation, threats, isolation, and the deliberate manipulation of a person's sense of reality—can produce suffering equal to or greater than physical torture, and can cause lasting psychological damage including PTSD, depression, anxiety disorders, and dissociative conditions.

Finding 2 — Cumulative and coordinated methods: The report explicitly recognizes that psychological torture frequently operates through cumulative and coordinated methods, no single element of which would alone constitute torture, but which in combination produce the requisite level of severity. This is critical: a coordinated campaign that combines financial devastation, social isolation, institutional discrediting, legal harassment, and systematic denial of remedies can constitute psychological torture in international law even if no single element in isolation would.

Finding 3 — Institutional perpetration: The report addresses the use of institutional structures—legal systems, healthcare systems, professional bodies—as instruments of psychological harm. It recognizes that "lawfare" (the weaponization of legal processes to harass and exhaust an adversary) and institutional gaslighting (the use of institutional authority to deny, suppress, or discredit a person's account of reality) can function as tools of psychological torture.

Finding 4 — The gaslighting dimension: Melzer specifically addresses the manipulation of a person's sense of reality as a form of psychological torture. A systematic campaign designed to make a person doubt their own perceptions—by falsifying evidence, coaching witnesses, controlling institutional outputs, and ensuring that every avenue of recourse produces the same dismissive or discrediting response—causes severe psychological suffering and falls within the scope of the Convention Against Torture.

Finding 5 — State and non-state actors: The report addresses both state and non-state perpetration of psychological torture, recognizing that private actors operating with the acquiescence or complicity of state structures can engage in torture within the meaning of the CAT.

9.3 Clinical Implications

The symptom overlap problem: The psychological sequelae of psychological torture—including hypervigilance, difficulty trusting others, preoccupation with past events, intrusive recollections, social withdrawal, and a persistent sense of threat—overlap substantially with the diagnostic criteria for PTSD, anxiety disorders, and some psychotic spectrum conditions. A patient who has been subjected to a sustained campaign of psychological harm may present in a clinical setting with a symptom profile that mimics psychopathology—because the harm they have experienced has, in fact, produced psychological injury.

The critical distinction: The psychiatric injury is real. The cause is external. Treating the symptoms as a primary psychiatric condition without addressing or even acknowledging their external cause is both clinically incomplete and ethically problematic.

What this means for assessment: When a patient presents an account of sustained institutional harm—legal persecution, financial devastation, organized harassment, systematic discrediting—the clinician should consider, as part of the differential diagnosis, whether the patient may have been subjected to psychological torture as defined by A/HRC/43/49. This does not require the clinician to validate every element of the account; it requires the clinician to take the possibility seriously and to investigate accordingly.

A specific clinical obligation: Where a patient's account describes a pattern of coordinated institutional harm—particularly where multiple institutions appear to be producing similar adverse outcomes despite the patient's documented efforts to obtain remedy—the clinician should be alert to the possibility that what they are observing is either: (a) a psychiatric condition that is producing a misinterpretation of events; (b) a genuine pattern of coordinated harm that is producing secondary psychiatric injury; or (c) some combination of both. The differential diagnostic process must consider all three possibilities.

9.4 The Relationship Between A/HRC/43/49 and A/HRC/57/61

Reports A/HRC/43/49 and A/HRC/57/61, taken together, establish the conceptual and legal framework for understanding a new category of potential harm: the use of advanced technology—including neurotechnology—to deliberately inflict psychological suffering on unconsenting individuals, often through coordinated institutional structures that provide both the capability and the cover.

A/HRC/43/49 establishes that non-physical, coordinated, institutional methods of causing severe psychological suffering constitute torture in international law. A/HRC/57/61 establishes that neurotechnology represents an emerging and potentially weaponizable tool for the deliberate manipulation of a person's mental states. Together, they establish that a patient who reports experiences consistent with both coordinated institutional harm and technological interference may be describing conduct that is not only real but constitutes a violation of the most serious international human rights norms.

10. UN Report A/HRC/57/61: Neurotechnology Crime as a Clinical Reality

10.1 Context and Authority

Report A/HRC/57/61 was submitted to the 57th session of the UN Human Rights Council in 2024. It addresses neurotechnology—defined broadly to include any technology that interfaces with the nervous system—and its implications for human rights, with particular attention to the rights of persons with mental health conditions and psychosocial disabilities.

The report acknowledges the rapid expansion of neurotechnology into commercial, medical, military, and research domains, and expresses concern about the potential for this technology to be used for surveillance, behavioral modification, and other non-consensual purposes. It calls on states to develop regulatory frameworks for neurotechnology that protect the rights of individuals to mental privacy (the right not to have one's mental processes monitored), mental integrity (the right not to have one's mental states altered without consent), and cognitive liberty (the right to make autonomous decisions about one's own mental functioning).

10.2 Key Findings Relevant to Clinical Assessment

Finding 1: The report formally recognizes that brain-computer interface technology, EEG devices, and related neurotechnology can be used to monitor and potentially influence a person's neural activity without their knowledge or consent. It calls on states to recognize "mental privacy" as a fundamental right.

Finding 2: The report recognizes that the same technologies used therapeutically for conditions such as depression, Parkinson's disease, and paralysis can potentially be repurposed as instruments of surveillance or behavioral influence.

Finding 3: The report explicitly acknowledges that individuals who experience or report what may be neurotechnology-related harm are at significant risk of psychiatric misdiagnosis by clinicians who are unfamiliar with the technology. It calls on states to develop clinical protocols that can distinguish genuine neurotechnology-related experiences from psychiatric symptoms.

Finding 4: The report calls on states to treat the non-consensual use of neurotechnology to monitor, alter, or manipulate a person's mental states as a serious human rights violation, potentially constituting cruel, inhuman, or degrading treatment or torture.

10.3 What A/HRC/57/61 Does and Does Not Establish for Clinical Practice

The report [here] establishes that:

Neurotechnology capable of monitoring and influencing neural activity exists and is accessible
The criminal or abusive use of such technology is recognized as a plausible human rights concern at the highest international level
Clinicians who dismiss accounts of neurotechnology-related experience as impossible are operating with an outdated framework
The default toward pathologization of such accounts requires urgent correction

As noted at paragraph 5 of the report, neurotechnologies are qualitatively distinct because they can:

Enable the exposition of cognitive processes
Enable the direct alteration of a person’s mental processes and thoughts
Bypass the individual’s conscious control or awareness
Enable non-consensual external access to thoughts, emotions and mental states
Are nurtured by “neurodata”, which are needed for their own functioning, calibration and optimization
Collect, analyse and process large personal datasets of a highly sensitive nature

The report does not establish that:

Any specific patient's account is accurate
Neurotechnology abuse is common or widespread
Current technology can achieve the most extreme capabilities (thought reading at distance, full behavioral control)

10.4 Practical Clinical Application

The existence of A/HRC/57/61 creates a specific clinical obligation: awareness. A clinician in Nova Scotia in 2026 who has never heard of this report and who dismisses a patient's account of possible neurotechnology-related experience as "clearly impossible" is practicing on the basis of outdated information. The claim is not that neurotechnology abuse is occurring in any specific case; the claim is that the possibility cannot be excluded on grounds of impossibility, and that the clinical process must therefore engage the grain of truth investigation.

11. Technology-to-Symptom Cross-Reference: A Clinical Mapping Tool

This section cross-references specific symptom presentations with documented technologies capable of producing them. It is a bedside reference tool. The mapping does not establish causation in any individual case; it establishes that the differential diagnosis must include the listed technology before a psychiatric etiology can be confirmed. This version addresses three presentations inadequately covered in existing clinical literature: extreme behavioral outliers discontinuous with a documented personal baseline; imperceptible cognitive and executive-function nudging that does not present as overt psychopathology; and biometric surveillance feedback loops in which monitoring and behavioral shaping operate as a closed system. A methodological note on internal consistency concludes the section.

11.1 Examples

Symptom: Sense of being monitored, watched, or surveilled—including the conviction that private communications or actions are known to others

Standard psychiatric differential: Paranoid ideation (schizophrenia, delusional disorder, paranoid personality disorder, stimulant-induced psychosis)

Technology differential:

Stalkerware: covert device monitoring software; documented in intimate partner violence contexts; accesses microphone, camera, location, and all communications
Commercial spyware (Pegasus-class): zero-click device compromise; confirmed in Citizen Lab investigations and international legal proceedings
IMSI catchers impersonating cell towers to intercept communications and location data
GQD-based neural monitoring: motor intentions are detectable 1–2 seconds before conscious decision, producing the phenomenological experience of surveillance deeper than communications monitoring
Biometric surveillance feedback loops: continuous monitoring feeding real-time data enabling responses to the subject's actions with apparent clairvoyance (see dedicated entry below)

Diagnostic differentiator: Paranoid ideation typically presents as a general, unfalsifiable sense of surveillance with no mechanism and no specific evidentiary instances. Genuine surveillance typically produces specific, documentable instances—private information appearing in unexpected contexts, institutional responses inconsistent with what could have been known through normal channels. The latter warrants grain of truth investigation, not diagnosis.

Investigation: Device security assessment; review of specific instances in which private information appeared in unexpected contexts; collateral inquiry about whether privately shared information reached other parties.

Symptom: Sudden cognitive changes—confusion, memory gaps, difficulty concentrating, or abrupt-onset "fogginess"

Standard psychiatric differential: Delirium (metabolic, infectious, toxic); pseudodementia; dissociation (PTSD); substance intoxication or withdrawal; TIA or stroke

Technology differential:

Directed radiofrequency or microwave exposure producing neurological impairment (Havana syndrome profile)
GQD-mediated disruption of hippocampal sharp-wave ripples, producing selective memory encoding failure without global impairment
PFC theta entrainment disrupting working memory specifically (documented capacity reduction from 7±2 to 3–4 items in experimental neuromodulation literature)
Focused ultrasound neurostimulation
Covert pharmaceutical interference

Diagnostic differentiator: Technology-mediated cognitive disruption may be domain-specific and reversible—affecting working memory, impulse control, or risk assessment while leaving other faculties intact—and temporally correlated with specific events rather than a continuous or relapsing-remitting course.

Investigation: Metabolic panel, neuroimaging, autoimmune encephalitis screen, toxicology; neuropsychological testing; careful temporal mapping of cognitive changes against specific events, locations, or interactions.

Symptom: Extreme behavioral departures — decisions categorically inconsistent with a documented longstanding personal baseline in a specific domain, with preserved global cognitive function

This category has no established entry in conventional psychiatric cross-reference tools. It is among the most diagnostically significant presentations in the context of alleged covert neuromodulation and among the most likely to be resolved by default pathologization.

The pattern: A person with documented consistency in a specific behavioral domain—financial risk aversion, geographic stability, professional reliability—makes a compressed series of decisions that are categorically discontinuous with that baseline, cause substantial objective harm, serve no coherent psychological purpose visible in retrospect, and are followed by return to baseline. Global cognitive capacity is preserved throughout. Reasoning, communication, and professional function remain intact; what changed, transiently and specifically, was decision-making architecture in one domain.

Standard psychiatric differential: Manic episode; mixed-state presentation; substance intoxication; impulse control disorder; stress response; personality disorder decompensation

Why standard differentials frequently do not fit: A manic episode produces pervasive, sustained mood elevation or irritability, decreased sleep, grandiosity, and global behavioral change—and generally impairs concurrent analytical and documentary work. The pattern here is domain-specific, mood-neutral, and followed by clean baseline reversion without residual sequelae. A person in a manic episode of sufficient severity to produce major asset liquidation and geographic displacement does not simultaneously produce legally precise contemporaneous documentation. Substance intoxication has a pharmacological profile and timeline. Personality disorder decompensation unfolds developmentally and is ego-syntonic. Stress responses produce recognizable patterns—approach, avoidance, rumination—not algorithmically atypical decisions.

Technology differential:

GQD-mediated PFC executive function disruption: theta entrainment disrupting theta-beta coupling → impaired working memory, reduced impulse control, compromised risk assessment with preserved global cognition
Dopaminergic electrochemical modulation: NAcc dopamine reduction → blunted reward from stable choices, increased risk-seeking; elevation → Pavlovian conditioning toward specific behaviors
Sub-perceptual closed-loop behavioral shaping: biometric feedback loop adjusting neuromodulatory parameters to achieve target behavioral outputs without the subject's awareness
Covert administration of executive-function-disrupting agents

The baseline deviation as diagnostic evidence: The clinician should treat a documented behavioral baseline and a documented deviation from it as evidence requiring explanation—not as evidence of psychiatric illness. The relevant question is not "Is this person mentally ill?" but "What caused this deviation?". The deviation is the explanandum. Standard psychiatric diagnoses must fit the actual pattern—its domain-specificity, timing, reversibility, and relationship to other documented events. Where they do not fit, the technology differential must be engaged.

Investigation: Longitudinal behavioral history with corroborating documentation (financial records, residential history, employment records). Precise timing of behavioral deviation mapped against other documented events. Neuropsychological testing to identify which cognitive domains were affected and which were preserved during the period of deviation.

Symptom: The imperceptible nudge—behavioral or cognitive change the subject did not experience as externally caused, and does not identify as a symptom

This category addresses a specific clinical challenge: the patient who does not report external influence because they did not experience it. The clinician encounters this presentation not through complaint but through the discrepancy between documented baseline and recent behavior.

The imperceptible nudge is the technological objective most consistent with sub-perceptual neuromodulation: not overt symptoms the subject recognizes, but the shaping of decisions and behaviors experienced as the subject's own choices. The subject does not feel stimulated. They feel like themselves — but are, in a specific domain, making choices they would not otherwise make.

The neuroscientific basis is established. tACS produces measurable changes in reaction time, working memory, and decision-making below the perception threshold. Stochastic resonance—in which adding noise to a near-threshold biological system enhances response to a weak periodic signal—is documented in mammalian neuronal networks, providing a mechanism by which sub-thermal ambient RF fields can produce consistent neuronal biasing without conscious detection. GQD-mediated electric field entrainment at 50 µm precision produces frequency-specific network shifts without the scalp sensation accompanying equivalent-effect TMS.

Clinical implication: The patient with the behavioral outlier profile may report no subjective experience of external influence—describing anomalous decisions as puzzling in retrospect or offering post-hoc rationalizations since discarded. The absence of a subjective complaint of external influence is not evidence against external influence: imperceptible influence, by definition, generates no such complaint.

Investigation: Identified through behavioral history rather than symptomatic complaint. The investigation is the baseline deviation investigation above. The diagnostic question is whether the deviation's characteristics—timing, domain-specificity, reversibility, relationship to external events—are better explained by an identified psychiatric mechanism or by an external intervention the patient did not consciously register.

Symptom: Unusual acute physical sensations—burning, pressure, tingling, sudden temperature changes, or retinal disturbances attributed to an external source

Standard psychiatric differential: Somatic symptom disorder, conversion disorder, delusional disorder (somatic type)

Technology differential:

Directed microwave or millimeter-wave energy producing transient thermal tissue effects (Active Denial System principle; documented in unclassified military literature)
GQD photothermal effect: localized heat generation of 1–10°C within nanoseconds of EM pulse, activating heat-sensitive ion channels without surface skin effect
Directed radiofrequency exposure producing tinnitus, pressure, dizziness, and cognitive impairment consistent with Havana syndrome
Directed ultrasound
Retinal damage from directed optical or electromagnetic energy (OCT imaging warranted where retinal symptoms coincide with other anomalous experiences)

Diagnostic differentiator: Somatic symptom disorder presents with chronic, diffuse, poorly localized symptoms without consistent temporal patterning. Technology-mediated effects tend to be temporally specific—acute onset correlated with specific locations or interactions—and may produce objective findings on examination.

Investigation: Medical, dermatological, and ophthalmological assessment; neurological examination including brain MRI; temporal mapping of symptom onset to specific events or locations; comparison with Havana syndrome profile (National Academies, 2021).

Symptom: Biometric surveillance feedback loops—the experience that external actors respond to the subject's internal states, private thoughts, or intentions before they are externally expressed

Standard psychiatric differential: Ideas of reference; thought broadcasting; paranoid delusional disorder

What distinguishes a feedback loop from a delusion: Ideas of reference involve perceived contingent relationships between unrelated external events and the patient's personal significance—a newscast appears to address them, strangers' conversations refer to their private concerns. The feedback loop pattern is structurally different: the patient describes external actors responding to internal states with precision, temporal immediacy, and informational specificity inconsistent with coincidence and with any conventional surveillance mechanism, but consistent with access to pre-conscious neural data.

The technological mechanism: GQD-based monitoring can in principle detect motor intentions (SMA readiness potential) 1–2 seconds before conscious decision; detect which memory is being accessed (hippocampal sharp-wave ripples) 100–500 ms before conscious recollection; detect emotional valence (amygdala theta bursts) in real time; and detect decision formation in the PFC 5–10 seconds before verbal report. An actor with this data stream appears to know the subject's decisions before they act—producing the phenomenological experience of surveillance deeper than any conventional mechanism.

The feedback loop integrates monitoring with adaptive behavioral shaping: monitoring output feeds a closed-loop algorithm adjusting neuromodulatory parameters to produce target behavioral outputs. The subject's neural states are continuously monitored; that data determines the timing and character of the next influence; the influence produces a response that is itself monitored; the loop iterates. This architecture—monitor, analyze, actuate, monitor—is the operational framework of advanced therapeutic DBS systems. Its covert application to behavioral shaping is the concern formally identified in A/HRC/57/61.

Observable signatures: External actors appear to know private decisions before they could be communicated conventionally. Institutional responses arrive on timelines inconsistent with normal information processing but consistent with real-time monitoring. Information environments appear to adapt to the subject's internal states rather than expressed positions. Deliberate internal decisions made without external expression appear to produce corresponding external responses.

Investigation: Document specific instances in detail—what internal state or decision, when formed, when the apparently responsive external event occurred. Assess whether the temporal relationship is consistent with real-time monitoring or coincidence. Identify whether multiple instances form a pattern and whether a plausible motive for this level of monitoring exists. Collateral inquiry with persons present during specific incidents.

11.2 The Cognitive Anomaly Problem: A Methodological Note

A specific diagnostic problem arises when a patient presents simultaneously with evidence of sophisticated, legally precise documentary conduct and a history of extreme behavioral decisions that caused substantial objective self-harm. This co-presentation is internally inconsistent with the most common psychiatric explanations for either element.

The internal consistency test: Mental illness, when severe enough to produce the behavioral disruption described in the outlier category— liquidating primary assets, major geographic decisions without purpose, substantial financial self-harm—is generally severe enough to also impair the quality of concurrent documentary, legal, and analytical work. A manic episode of that severity does not coexist with contemporaneous legally precise evidence-gathering. A delusion elaborated with sufficient sophistication to survive multi-year institutional engagement is not typically compatible with the parallel production of procedurally correct court filings and regulatory submissions. The specific combination—high-quality analytical output alongside domain-specific behavioral deviation—is most consistent with a model in which the behavioral deviation was externally produced without affecting global cognition.

The preemptive framing problem: When a referring agency—police, institutional adversary, court officer—characterizes a subject as a mental health concern before the clinical encounter begins, the clinician should treat that framing as data requiring interpretation, not as clinical guidance. A wellness check initiated by an actor with an adverse interest in the subject's legal credibility is not a neutral referral. Pre-emptive mental health framing is a documented institutional suppression tactic. Accepting it uncritically is not clinical judgment—it is deference.

The reversion-to-baseline signal: Where extreme behavioral outliers are temporally bounded—beginning at a specific point, persisting for a defined duration, then ceasing with return to prior baseline—that structure is diagnostically significant. Primary psychiatric conditions producing this level of behavioral disruption do not self-terminate and revert cleanly to baseline without identified treatment. Manic episodes require intervention; personality disorder decompensation unfolds developmentally without sharp offset; substance-induced change follows a pharmacological timeline. A bounded, reversible behavioral outlier is evidence consistent with an external cause rather than a primary psychiatric process.

The Villaroman principle applied: The Supreme Court held in R. v. Villaroman, 2016 SCC 33, that circumstantial evidence should be assessed for whether the pattern in totality excludes reasonable alternative explanations—not whether each element in isolation admits an innocent account. The clinician assessing simultaneous sophisticated documentation, domain-specific behavioral outliers inconsistent with a documented baseline, temporal bounding of those outliers, and a referring frame originating from an institutional adversary should apply the same analytical standard: does the totality more plausibly reflect a primary psychiatric condition or an external intervention producing specific behavioral effects with preserved global cognition? The standard is not certainty—it is which explanation best fits the evidence as a whole.

12. Differential Diagnosis: The Full Landscape

12.1 Medical Conditions That Produce Psychosis-Like Experiences

Before any psychiatric diagnosis can be confirmed, the following medical conditions must be ruled out through appropriate investigation:

Autoimmune encephalitis (including anti-NMDA receptor encephalitis, anti-LGI1, anti-CASPR2, and other subtypes): This category of conditions presents initially with psychiatric symptoms—paranoia, personality change, unusual beliefs, behavioral disturbance—before neurological features become apparent. It is diagnosed by specific antibody testing (CSF and serum). It is treatable. It is missed on initial psychiatric presentation with distressing regularity, and the delay in diagnosis causes preventable harm.

Temporal lobe epilepsy: Complex partial seizures originating in the temporal lobe can produce highly stereotyped experiential phenomena including auditory experiences, déjà vu, fear, unusual perceptual states, and occasionally beliefs about the nature of the experience. EEG including sleep-deprived and ambulatory recording is diagnostic.

CNS lesions: Tumors, vascular malformations, and other mass lesions in the frontal, temporal, or parietal lobes can produce psychiatric symptoms as their primary presentation. Neuroimaging is required.

Endocrine disorders: Thyroid disorders (hypothyroidism and hyperthyroidism both), Cushing's syndrome and other adrenal disorders, hypoparathyroidism, and Addison's disease can all produce cognitive and psychiatric symptoms.

Infectious causes: Neurosyphilis (which produces a psychiatric syndrome known since the 19th century as "general paresis of the insane"), HIV-associated neurocognitive disorder, herpes simplex encephalitis, Lyme neuroborreliosis, and other CNS infections require exclusion.

Toxic and iatrogenic causes: A comprehensive medication review and toxicology assessment is required. Numerous prescription medications can induce psychosis-like symptoms. Heavy metal exposure (particularly lead, mercury, and manganese) can produce neuropsychiatric effects. Carbon monoxide exposure is frequently overlooked.

Vitamin and metabolic deficiencies: B12 deficiency, thiamine deficiency, niacin deficiency, and folate deficiency can all produce neuropsychiatric symptoms.

Acquired brain injury: Traumatic brain injury, including mild TBI, can produce cognitive and behavioral changes that are sometimes misattributed to psychiatric primary illness.

12.2 PTSD, Complex Trauma, and Dissociative Disorders

Post-traumatic stress disorder with dissociative features can produce intrusive experiences, hypervigilance, perceptual disturbances, and a sense of ongoing threat that, in a brief clinical assessment, can be difficult to distinguish from psychotic symptoms. The critical distinction is the relationship to identified traumatic events, the ego-dystonic quality of intrusive experiences (the patient experiences them as unwanted, distressing, and alien rather than as accurate perceptions of current reality), and the preserved reality testing in non-intrusive states.

Complex PTSD—the product of prolonged, repeated, inescapable traumatic exposure such as chronic abuse, prolonged captivity, or sustained institutional persecution—produces additional features including affect dysregulation, distorted self-perception, interpersonal difficulties, and persistent alterations in consciousness that complicate the differential diagnosis further.

A patient who is in the midst of an ongoing, sustained experience of institutional harm—loss of legal recourse, financial devastation, repeated detention, systematic discrediting—may not have a "prior trauma history" in the conventional sense, because the trauma is current and ongoing. The assessment must account for this.

12.3 OCD with Poor Insight

OCD presenting with intrusive beliefs about external threats or contamination, with poor insight, can superficially resemble persecutory ideation. The key distinguishing features are the ego-dystonic quality of the obsessional content (the patient finds the thoughts distressing and unwanted, not accurate and important), the presence of compulsive behaviors designed to reduce the anxiety generated by the obsessional content, and the typically stereotyped, repetitive, and thematically bounded nature of the feared scenarios.

12.4 Personality Disorders

Paranoid personality disorder is characterized by a pervasive pattern of distrust and suspicion of others, interpreted as having malicious intent, beginning in early adulthood. It is distinguished from delusional disorder by the absence of frank delusions (the beliefs are strongly held but are more characteristically as general patterns of suspicion rather than specific, fixed beliefs about specific circumstances). The longitudinal history is important: paranoid personality disorder has an early onset and pervasive pattern, while delusional disorder can develop in a previously functional person.

12.5 Malingering and Factitious Disorder

These should be considered, with appropriate caution, where there is specific evidence of external incentive (malingering) or where the clinical presentation shows features inconsistent with the described experiences. However, the default assumption of malingering—particularly for patients from marginalized groups, patients involved in legal proceedings, or patients with prior psychiatric histories—is both clinically inaccurate (malingering is significantly rarer than clinicians assume) and professionally problematic. The assessment of malingering requires specific evidence, not a general impression that the story sounds implausible.

12.6 Genuine External Experience

This is the most clinically and ethically critical differential category, and the one most frequently omitted from clinical analysis. A patient who is accurately reporting a genuine external experience—surveillance, harassment, institutional persecution, technological interference—may present with all of the surface features of psychiatric illness: hypervigilance, preoccupation with the reported events, unusual ideation about the mechanisms involved, social withdrawal, and functional impairment.

The functional impairment is not evidence of psychiatric illness—it is evidence that something is causing significant distress and disruption to the patient's life. The clinician's task is to determine whether that something is internal (a psychiatric condition) or external (a genuine harm)—and the only way to make that determination is through the structured, rigorous, documented process described in this paper.

13. Whistleblowers, Conspiracy, and the Gatekeeping Problem

13.1 The Whistleblower-to-Patient Pipeline

There is a documented pathway by which individuals who discover and attempt to report serious institutional wrongdoing—fraud, corruption, abuse, or systematic misconduct—end up in psychiatric assessment settings. This pathway has been documented in case studies, in the academic literature on whistleblower retaliation, and in the advocacy literature of organizations like the Government Accountability Project and the Canadian Association of Journalists.

The mechanism is as follows. A person discovers evidence of serious wrongdoing and attempts to report it through legitimate channels—to their employer, to a regulatory body, to law enforcement, or to a court. The institution being reported has both the motive and, in many cases, the institutional power to respond with suppression rather than investigation. Suppression can take many forms: denial of the claim, procedural foreclosure of the complaint, financial devastation through litigation, professional discrediting, social isolation, and the deployment of the "mental health" narrative as a tool of delegitimization.

The mental health narrative is particularly effective because it exploits the structure of the psychiatric assessment system. By framing the whistleblower's account as symptomatic rather than factual, the institutional actor can cause the focus of scrutiny to shift from the alleged wrongdoing to the mental state of the person reporting it. If the whistleblower subsequently enters the psychiatric assessment system—through a wellness check, an emergency department presentation, or a court-ordered assessment—they encounter a clinician who may not have the context, the time, or the methodology to distinguish between a delusional account and an accurate report of institutional conduct.

13.2 The Pre-Emptive Mental Health Framing

An important and underrecognized phenomenon is the pre-emptive use of "mental health" framing by institutional actors against potential complainants. This involves:

Describing an adversary's legal or factual arguments as "concerning" from a mental health perspective, in informal communications that may precede formal proceedings.

Requesting "wellness checks" on persons who have filed complaints, thereby creating a police and healthcare record that can later be used to imply psychological instability.

Submitting to courts or tribunals characterizations of an opposing party's behavior as "erratic," "paranoid," or "delusional"—characterizations that are frequently made without any clinical basis but that influence subsequent institutional responses, including clinical assessments.

Using judicial or police records of prior mental health contacts—however initiated—to discredit future complaints.

A clinician who encounters a patient whose account includes documentation of prior wellness checks or prior clinical contacts that were initiated by the institutional actors the patient is complaining about should treat this history with specific caution. The prior contact may have been initiated for the purpose of creating a record, not because there was genuine clinical concern.

13.3 The Pattern of Convergent Adverse Institutional Outcomes

One of the most diagnostically challenging features of genuine institutional conspiracy cases is the pattern of convergent adverse outcomes across multiple institutions. The patient reports that courts, police agencies, professional bodies, oversight bodies, and other institutions have all produced adverse or dismissive outcomes in a manner that appears coordinated. To an observer unfamiliar with the specifics of the case, this pattern looks like the classic systematized persecutory delusion—the expansive, multi-institutional conspiracy that is a recognized marker of delusional disorder.

The diagnostic challenge is real because the pattern is the same whether it reflects a psychiatric symptom or a genuine conspiracy. The clinician cannot resolve the diagnostic question by observing the pattern. They must apply the grain of truth investigation to the specific content: Are the adverse outcomes documented? Do the specific decisions made by these institutions depart from the legal and factual requirements that should govern them? Is there a documented motive for coordination? Is the patient a member of a group that is historically subject to coordinated institutional suppression?

The Villaroman principle from the Supreme Court of Canada—applied in criminal law to the assessment of circumstantial evidence—is instructive in this clinical context: the question is not whether each adverse outcome, considered in isolation, admits of an innocent explanation, but whether the pattern of outcomes, considered in totality, is more consistent with coordination or with coincidence.

13.4 The Role of the Clinician in This Dynamic

The clinician in this dynamic is not a neutral observer. By pathologizing a patient's account of genuine wrongdoing, a clinician becomes— inadvertently but meaningfully—part of the suppression apparatus. The clinical record becomes evidence of the patient's "delusion," cited by institutions seeking to discredit the patient's claims. The clinical intervention itself—whether through medication, detention, or simply the formal documentation of a psychiatric diagnosis—compounds the harm the patient has already suffered.

This is not a hypothetical concern. It is documented. The clinical literature includes documented cases in which psychiatric diagnoses were deployed as tools of institutional suppression—most notoriously in the Soviet use of "sluggish schizophrenia" as a diagnosis for political dissidents, but also in less extreme forms in democratic jurisdictions including Canada.

The clinician's protection against becoming an instrument of harm is the rigorous application of the methodology described in this paper. The framework is not just ethically correct—it is the clinician's own legal and professional protection.

14. Capacity, Consent, and the Civil Legal Framework

14.1 Capacity is Decision-Specific

Per Starson v. Swayze, capacity is not global. It is assessed in relation to a specific decision at a specific time. A patient who holds a potentially delusional belief about one domain of their life may retain full capacity to make healthcare decisions, financial decisions, and legal decisions in other domains.

The functional capacity assessment asks: Can the patient understand the information relevant to the decision? Can the patient appreciate how that information applies to their own circumstances? Can the patient reason with that information to reach a decision? Can the patient communicate that decision?

A patient who holds an unusual belief about the source of their circumstances but who can understand a proposed treatment, appreciate its relevance to their own situation, reason about its benefits and risks, and communicate a considered decision about whether to consent, has the capacity to consent to or refuse that treatment—regardless of the accuracy of their background beliefs.

14.2 The Harm Threshold for Involuntary Admission

The harm threshold under the Nova Scotia Hospitals Act requires more than a finding of mental disorder. It requires a finding that the person is likely to cause harm to themselves or others, or is suffering to a degree that warrants assessment. The harm assessment must be specific and current — not hypothetical or based on the nature of the reported belief.

A patient who describes experiencing technological harassment but who presents no evidence of imminent self-harm, no expressed intention to harm others, and no acute deterioration in self-care does not meet the harm threshold on the basis of the content of their reported experience alone. The harm threshold is a separate inquiry from the diagnostic inquiry and must be conducted as such.

14.3 Substitute Decision-Making

Where a patient is found to lack capacity with respect to a specific decision, the Personal Directives Act establishes the framework for substitute decision-making. The substitute decision-maker is required to make decisions in accordance with any prior directions the patient has given, or, in the absence of such directions, in the patient's best interests. The substitute decision-maker should not substitute their own assessment of the patient's beliefs for the patient's expressed values and preferences.

15. Cultural Competence: Mi'kmaw, African Nova Scotian, and Racialized Patients

15.1 The Documented Disparity

Racial and ethnic disparities in psychiatric diagnosis and involuntary detention are well-documented across Canadian and comparable jurisdictions. Key findings from the available literature:

Black individuals are overrepresented in schizophrenia diagnoses and involuntary psychiatric detention at rates that cannot be explained by actual prevalence differences and that are consistent with the operation of implicit racial bias in clinical assessment.

Indigenous individuals in Canada are substantially overrepresented in psychiatric detention and are significantly more likely to be assessed as dangerous than non-Indigenous individuals with comparable presentations.

These disparities represent both a human rights failure and a clinical quality failure. A clinician who brings different levels of skepticism or different diagnostic thresholds to patients of different racial backgrounds is not providing equitable care — they are providing inferior care to some patients, with consequences that include unnecessary detention, inappropriate medication, lost opportunity for correct diagnosis, and the destruction of the therapeutic relationship.

15.2 Mi'kmaw Patients in Nova Scotia

Mi'kmaw people—the Indigenous people of Nova Scotia, whose territory (Mi'kma'ki) encompasses the entire province—have a distinct cultural and cosmological framework that shapes how health, illness, and extraordinary experience are understood and expressed.

Mi'kmaw concepts of wellbeing are holistic and relational, encompassing physical, emotional, mental, and spiritual dimensions. Experiences that a biomedical clinician might categorize as perceptual disturbances—communication with ancestors, experiences of spiritual presences, awareness of non-physical forces affecting wellbeing—are potentially normative within traditional Mi'kmaw frameworks and fall squarely within the cultural congruence exception of the DSM-5-TR.

The federal obligation under UNDRIP (adopted by Canada in 2021) includes the right of Indigenous peoples to maintain and protect their distinct cultural practices and to receive healthcare that is provided in a culturally safe manner. Nova Scotia Health's commitments to Indigenous health equity, articulated in the Mi'kmaw Health Benefit framework and related policy documents, create corresponding obligations at the provincial level.

Clinical assessments of Mi'kmaw patients reporting extraordinary experiences must include, as a baseline:

Inquiry about the patient's cultural and spiritual context
Involvement of a cultural liaison, Elder, or Mi'kmaw health worker where possible and appropriate
Explicit application of the cultural congruence criterion before any diagnostic determination
Documentation of cultural context in the clinical record

15.3 African Nova Scotian Patients

African Nova Scotian communities—with a history in Nova Scotia stretching back over 400 years and including both Loyalist-era communities and more recently arrived African, Caribbean, and Black diaspora populations—are documented to experience differential treatment in the healthcare system, including in psychiatric assessment contexts.

The African Nova Scotian Justice Implementation Commission (2019) documented systemic anti-Black racism across Nova Scotia's public institutions, including healthcare. The Commission's findings and recommendations bind the provincial government and, through professional regulatory standards, healthcare providers.

Additionally, African Nova Scotian communities—like many Black communities across Canada—have lived experience of actual surveillance, harassment, and targeting by state actors, including law enforcement. A Black patient who reports being surveilled or targeted by institutions is not, by virtue of that report alone, demonstrating paranoid ideation. They may be accurately describing an experience that disproportionately affects their community.

Cultural competence for African Nova Scotian patients includes awareness of this lived historical and contemporary context, and resistance to the temptation to pathologize reports of racial targeting that may well be accurate.

15.4 Implicit Bias in Clinical Assessment

The clinical literature on implicit bias demonstrates that bias operates without conscious intent and affects clinical decision-making in predictable ways. Clinicians who believe themselves to be unbiased demonstrate bias in experimental studies. The mechanism is not malice; it is the operation of learned associations and heuristics that operate below the level of conscious awareness.

Implicit bias reduction strategies that are evidence-supported include: structured decision-making tools (like the framework presented in this paper) that reduce the space for discretionary assessment; required documentation that creates accountability for the basis of clinical conclusions; peer review of high-stakes psychiatric determinations; and ongoing training in bias recognition and mitigation.

16. Comparative Jurisdictions: Ontario, British Columbia, and the United Kingdom

16.1 Ontario: Health Care Consent Act, 1996

The Health Care Consent Act (HCCA), 1996, S.O. 1996, c. 2, is Ontario's primary legislation governing consent to treatment and capacity assessment. It is widely regarded as one of the most patient-rights-protective mental health consent frameworks in Canada.

The HCCA establishes the Consent and Capacity Board (CCB), an independent tribunal that reviews capacity findings and treatment decisions. Patients who dispute a finding of incapacity—or who believe that a treatment recommendation is not in their best interests—can apply to the CCB for a hearing.

The CCB has developed a substantial body of jurisprudence on capacity assessment, on the weight to be given to unusual beliefs in capacity determinations, and on the circumstances in which a person's belief system—however unusual—should be treated as a legitimate basis for decision-making rather than as evidence of incapacity.

Nova Scotia does not have an equivalent independent review tribunal. This is a gap that this white paper identifies as requiring legislative and policy attention.

Key Ontario precedent: In Re Scrivener and Re Starson (at the Ontario Review Board level before the matter reached the Supreme Court of Canada), the Consent and Capacity Board established that the mere presence of unusual beliefs is insufficient to support a finding of incapacity, and that the clinician must demonstrate a specific connection between the unusual belief and the patient's inability to make the specific decision at issue.

16.2 British Columbia: Mental Health Act

The Mental Health Act, R.S.B.C. 1996, c. 288, is British Columbia's primary legislation for involuntary psychiatric admission. BC has been the subject of significant human rights litigation challenging the adequacy of review mechanisms for involuntary psychiatric patients, and the BC mental health legislative framework has been identified by legal commentators and patient advocacy organizations as inadequate to protect Charter rights.

A key BC development relevant to this white paper is the documented use of "vexatious litigant" designations—orders that restrict a person's access to the courts—in conjunction with mental health narratives to suppress legitimate legal proceedings. The interaction between the judicial system's vexatious litigant tools and the psychiatric system's involuntary admission powers creates a potential mechanism for the systematic suppression of legitimate complaints by persons who have been labelled as both vexatious and mentally unwell.

16.3 The United Kingdom: Mental Capacity Act 2005 and Mental Health Act 1983/2007

The Mental Capacity Act 2005 (England and Wales) establishes five statutory principles that govern capacity assessment:

A person must be assumed to have capacity unless it is established otherwise
A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been tried without success
A person is not to be treated as unable to make a decision merely because they make an unwise decision
An act done or decision made for a person who lacks capacity must be done or made in their best interests
Before the act is done or decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action

The third principle—that an unwise decision is not evidence of incapacity—is particularly relevant to the present analysis. A patient who makes decisions that seem unwise to the clinician—including the decision to continue pursuing a seemingly implausible account of external harm—is not, by virtue of that decision, demonstrating incapacity.

The UK's Mental Health Act 1983 (as amended in 2007) has been the subject of sustained critique by the Care Quality Commission and by mental health patient advocacy organizations for its inadequate protection of the rights of detained patients, particularly those from Black and minority ethnic backgrounds who are disproportionately subjected to compulsory detention.

The UK experience demonstrates both positive models (the MCA's five principles) and cautionary tales (the MHA's documented racial disparities) that should inform Nova Scotia's legislative and policy development in this area.

17. The Gaslighting Problem: When Clinicians Become Agents of Harm

17.1 Clinical Gaslighting: Definition and Mechanism

"Clinical gaslighting" describes the phenomenon in which a healthcare provider, by dismissing, minimizing, or pathologizing a patient's accurate account of their experiences, functions as an instrument of the harm the patient has described—reinforcing the patient's sense that their perception of reality is unreliable, generating a clinical record that can be used against them, and potentially facilitating the continuation of ongoing harm.

Clinical gaslighting is not typically intentional. It is usually a consequence of the application of pattern recognition in the absence of adequate investigation—a short-circuit from "this sounds like X" to "this is X," without the intermediate step of rigorous differential diagnosis and grain of truth investigation. The harm is real regardless of the clinician's intent.

17.2 The Documentary Harm

A psychiatric diagnosis, once entered into the clinical record, has a life far beyond the clinical encounter that generated it. It follows the patient:

Into future clinical encounters, where subsequent clinicians are primed by the prior diagnosis to apply lower skepticism to the diagnostic conclusion and lower threshold to the dismissal of the patient's account.
Into legal proceedings, where it may be cited by opposing parties as evidence of the patient's unreliability as a witness or complainant.
Into police and law enforcement records, where prior mental health contacts are frequently used to assess the credibility of complaints.
Into employment records, professional licensing processes, and other institutional contexts where disclosure may be required.

The clinician who makes an inaccurate psychiatric determination—who concludes that a patient's accurate account of genuine harm is a delusion —does not merely err in a single clinical encounter. They potentially alter the entire trajectory of the patient's ability to seek remedy for the harm they have suffered. This is why the grain of truth investigation is not merely an academic nicety. It is a matter of profound practical consequence.

17.3 The Cumulative Pattern

Particularly in cases involving alleged institutional coordination, there is a risk that a patient will encounter a sequence of clinical encounters, each of which is informed by the last, creating a self-reinforcing record of psychiatric pathology that becomes increasingly difficult to challenge. The first clinician who reaches a diagnostic conclusion—without adequate investigation—creates a record that makes it harder for the next clinician to reach a different conclusion, because the prior diagnosis creates a presumption.

This cumulative pattern is a documented feature of the gaslighting dynamic as described in the intimate partner violence literature: the abuser creates a record of prior discrediting contacts with institutions (police, doctors, courts) that makes it progressively harder for the victim to be believed by each subsequent institution. Clinical gaslighting, in the context of an ongoing external harm, can operate in exactly this way.

17.4 Prevention: The Structural Solution

The prevention of clinical gaslighting is not primarily a matter of individual clinician virtue. It is a matter of system design. The framework presented in this paper—which requires structured assessment, documented differential diagnosis, grain of truth investigation, and transparent clinical reasoning—is the structural solution. A clinician who follows this framework will not eliminate all diagnostic error, but will substantially reduce the risk of the specific error of pathologizing an accurate account.

18. Collateral Investigation: Standards and Scope

18.1 The Standard

The standard for collateral investigation in psychiatric assessment is not "investigate everything the patient says". It is "make reasonable and documented efforts to gather information from sources other than the patient before reaching significant clinical conclusions". The specific efforts required depend on the nature of the patient's account, the stakes of the clinical decision being contemplated, and the availability of collateral sources.

18.2 Specific Collateral Inquiries

Interview of known persons: With the patient's consent, contact at least one person—family member, friend, colleague, legal representative— who has independent knowledge of the patient's circumstances. The inquiry should focus on corroborating or clarifying specific elements of the account: Is there independent evidence of the reported adverse events? Has the informant observed changes in the patient that are consistent with external stress or with psychiatric deterioration? Are there aspects of the account that the informant can independently verify?

Review of documentary evidence: A patient who is engaged in ongoing legal proceedings, or who has documented correspondence with institutions, or who has financial records reflecting the events they describe, or who has other documentary evidence, should be given the opportunity to present that evidence and the clinician should engage with it. A clinician who refuses to look at a patient's documentary evidence—on the grounds that doing so would take too long or that the document could be fabricated—is not conducting a thorough assessment.

Review of prior clinical records: Specifically including the basis for any prior psychiatric diagnoses. A prior diagnosis of delusional disorder should be examined, not accepted. When was it made? By whom? What was the evidentiary basis? What was the grain of truth investigation conducted? If the prior diagnosis was made without adequate investigation, it should be treated with corresponding caution.

Basic literature and public record search: Where the patient's account involves specific entities, events, or technologies, a brief search of public record—including court registries, corporate registries, news archives, and official government reports—may yield relevant context. This is not a demand for forensic investigation; it is a demand for the same basic due diligence that any professional would bring to a factual assessment.

Legal and law enforcement context: Where the patient describes ongoing legal proceedings or prior criminal complaints, inquiry into the status of those proceedings—with the patient's consent and with appropriate attention to privacy obligations—may provide relevant context.

18.3 Documenting the Investigation

The collateral investigation must be documented. The record should show:

What collateral sources were contacted or sought
What information was obtained
What documentation was reviewed
What literature or public record was consulted
What could not be investigated and why

This documentation is both clinically important (it enables subsequent clinicians to understand the basis for the prior assessment) and legally important (it demonstrates that the process was conducted).

19. Clinical Vignettes: The Framework in Practice

The following vignettes are entirely fictional. Any resemblance to real persons or specific cases, including a factual account detailed elsewhere on this website, is entirely coincidental. They are designed to illustrate the application of the framework to different clinical presentations.

Vignette 1: A Patient Claiming Captured / Compromised Public Authority

Presentation: A 44-year-old business professional is referred to an outpatient psychiatric clinic by police following a "wellness check" initiated after he repeatedly attempted to file complaints and evidence packages with local authorities. He describes a multi-year sequence in which he suffered significant financial loss in circumstances he believes amount to fraud (e.g., disputed transactions, unexplained asset loss, or unilateral changes to contractual terms). He reports that when he attempted to obtain redress, police declined to investigate or closed files at an early stage, and courts or oversight bodies repeatedly refused to engage with the substance of his evidence. He describes a pattern in which his core allegations of loss and fraud were never substantively addressed, while procedural decisions, sealing practices, or technical dismissals foreclosed further remedy. He believes that a coordinated network across legal and law-enforcement institutions has suppressed his claims and insulated the underlying misconduct from scrutiny.

Initial impression challenge: The presentation touches every feature of a classic systematized persecutory delusion: multiple institutions coordinated against a single individual; documentation that "they" have suppressed; prior legal contacts that have uniformly gone against him; and a history of events that, taken together, produce a nearly unbelievable account.

Application of the framework:

Bizarre/non-bizarre: The content is non-bizarre. All specific elements described—fraudulent or predatory financial practices, police non-investigation, judicial error or bias, procedural foreclosure, and even coordinated institutional suppression—are documented as occurring in the real world. None of the claims requires violating a law of nature; they concern institutional behaviour and misuse of process, not impossible phenomena.

Five-criterion assessment: The patient is adamant about the core elements of his account, repeatedly anchoring his position in specific documents, timelines, and discrepancies in the record (e.g., unexplained financial loss, police closure letters that do not address the primary allegation, court reasons that omit key exhibits). When questioned, he does not simply repeat conclusions; he walks the clinician through concrete items in the file and explains why they exclude more benign interpretations. He distinguishes between what he regards as established fact (the loss, the non-investigation, the procedural foreclosure) and what he concedes is inferential (the exact scope and motive of coordination), though he remains strongly convinced on both. He is clearly preoccupied, but can still engage in other topics and acknowledges the psychological toll of the situation. There is no cultural incongruence. On this basis, the picture is one of high-conviction, evidence-anchored belief rather than classic, incorrigible delusion.

Grain of truth investigation: The clinician requests and reviews documents the patient provides. These include financial records showing unexplained loss or transfers inconsistent with the patient’s understanding of agreements; police correspondence indicating files were closed without addressing key allegations or exhibits; and court or tribunal records documenting multiple adverse procedural decisions (e.g., refusals to hear evidence, dismissals on technical grounds, sealing orders) without substantive engagement with the underlying loss. Taken together, the documents confirm both the reality of significant financial harm and a pattern of institutional responses that, at minimum, failed to address the core allegations. The documentary record provides substantial corroboration of a “grain of truth” at the heart of the patient’s account.

Differential diagnosis: Medical workup (including thyroid function, basic autoimmune screen, neuroimaging, and toxicology) is normal. Trauma assessment reveals significant symptoms of traumatic stress, insomnia, and hypervigilance consistent with prolonged exposure to unresolved loss and institutional non-response. There is no evidence of a thought disorder: associations are tight, speech is organized, and there are no negative symptoms. The patient’s reasoning, when applied to the documents, is coherent, even if some inferences about coordination and motive may overreach what the evidence strictly proves.

Clinical conclusion: The appropriate conclusion is not delusional disorder. The presentation is more consistent with an adjustment- or trauma-related condition secondary to documented adverse events, with possible secondary anxiety or depressive features. The clinician documents the grain-of-truth investigation and the corroborating evidence, explicitly notes the police origin of the referral and its potential biasing effect, and frames the formulation accordingly: a psychologically injured complainant in a context of institutional foreclosure, not a primary psychotic disorder. Treatment focuses on trauma-informed support, sleep and anxiety management, and careful documentation. With the patient’s consent, the clinician offers to provide a neutral, evidence-based summary for legal counsel or oversight bodies clarifying that the patient’s core beliefs are grounded in documented events and should not be dismissed as pathological by default.

Vignette 2: A Potential Whistleblower

Presentation: A 38-year-old administrative worker presents to an emergency department, brought by police following a wellness check requested by her former employer after she sent a detailed letter to the company's board of directors alleging that the operations manager had been systematically stealing from the company. She reports that she has also experienced what she describes as "voices through the walls" at her former workplace that she attributes to a directed audio device, and that she believes her computer was compromised and her communications monitored.

Application of the framework:

Component 1 — Employment fraud allegation: This is a Category A claim (entirely non-bizarre). The clinician's first obligation is to investigate whether there is any evidence supporting the fraud allegation before characterizing it as delusional. The patient has documentation—bank statements, inventory records, comparison spreadsheets—that she presents. The documentation is coherent and, if accurate, does support the inference she draws. This component of the account cannot be assessed as delusional without further investigation.

Component 2 — Voices through the walls: This is a Category B claim (non-bizarre given documented technology). Ultrasonic directional audio is a real technology. The specific description—sounds that she describes as speech, audible in specific locations in the building—is consistent with directional audio, not inconsistent with it. The question of whether the specific technology was deployed in her workplace requires investigation, not assumption.

Component 3 — Computer monitoring: This is a Category A claim (documented as occurring regularly in commercial contexts). It cannot be assessed as delusional without investigation.

Differential: Medical assessment is unremarkable. No evidence of stimulant use. No formal thought disorder. The patient is distressed but coherent. No harm risk identified.

What the clinician must not do: Discharge with a psychiatric referral note characterizing the patient as presenting "paranoid ideation with possible auditory hallucinations," thereby creating a record that her former employer's lawyers can use to discredit her employment fraud complaint.

What the clinician should do: Document the grain of truth investigation carefully. Note that the specific claims are non-bizarre and partly corroborated. Provide trauma-informed support. Refer to a mental health professional experienced in workplace adversity. Advise the patient of her right to make a formal complaint to the appropriate regulatory or law enforcement bodies.

Vignette 3: A Patient Describing Anomalous Health Incidents

Presentation: A 51-year-old man presents to his family physician reporting that he has been experiencing, over the past six months, sudden episodes of confusion, intense burning sensations on his scalp, and what he describes as intrusive impulses that feel "externally inserted" rather than generated by his own thinking. He believes these experiences are caused by technology operated by persons connected to a business dispute he has been engaged in. He has no prior psychiatric history, a stable professional background, and a presenting appearance of someone in significant distress but intact cognitive functioning.

Application of the framework:

Bizarre/non-bizarre: The specific experiences described—burning sensations on the scalp, sudden confusion, impulses that feel externally imposed—are, in aggregate, consistent with the symptom profile documented in Havana syndrome investigations (directed energy effects) and with the emerging literature on non-consensual neurostimulation. They are non-bizarre given current documented capabilities.

Priority medical assessment: This presentation requires urgent medical assessment—MRI brain with and without contrast, EEG, full metabolic and autoimmune panel, toxicology, and ophthalmological assessment (retinal changes have been documented in some directed energy exposure cases). The investigation is indicated not because the technology explanation is confirmed, but because the differential diagnosis demands it.

Differential medical conditions: Autoimmune encephalitis, migraine, peripheral neuropathy, temporal lobe epilepsy, and CNS lesion must all be ruled out.

Grain of truth on the technology component: The clinician should document awareness of A/HRC/57/61 and the Havana syndrome literature, noting that directed energy effects on the nervous system are documented phenomena and that the patient's symptom profile is not inconsistent with such effects.

What the clinician must not do: Diagnose somatic symptom disorder or delusional disorder before the medical workup is complete, or dismiss the patient's attribution to technology as necessarily symptomatic.

Vignette 4: A Patient Describing Deniable Online Harms

Presentation: A 35-year-old data analyst presents to an emergency department, brought by police after a wellness check requested by legal counsel for a regional police service and public-safety ministry. She has filed formal complaints and a judicial-review application alleging unlawful use of commercial spyware and improper data-sharing with private vendors after she raised internal concerns. She reports that, since doing so, she has been targeted by a persistent pattern of social-media content (YouTube & TikTok) that closely tracks confidential complaint milestones and private life events, including AI-generated thumbnails that appear to reproduce elements from documents filed with an oversight body. Police have declined to investigate and described her as “paranoid”; platforms have responded with form letters about “neutral algorithms”. She reports hypervigilance but no hallucinations, no formal thought disorder, and no risk of harm to self or others.

Application of the framework:

Component 1 — Unlawful surveillance / spyware allegation: This is a Category A claim (entirely non-bizarre). Commercial spyware and unlawful surveillance by state or quasi-state / state-adjacent actors are well documented. The clinician’s first obligation is to determine whether any objective evidence supports her allegation (e.g., device forensics, correspondence, oversight-file numbers), not to treat it as presumptively delusional.

Component 2 — Coordinated algorithmic targeting: This is a Category B–C claim (non-bizarre, technically and operationally plausible). Coordinated inauthentic behavior and manipulation of recommendation systems are documented in academic and platform-enforcement reports, and A/HRC/43/49 recognizes technology-mediated psychological operations as a form of potential torture. Her description—multi-platform content with tight temporal convergence to confidential filings and non-public events—is consistent with documented patterns of organized algorithmic harassment and cannot be dismissed as impossible.

Component 3 — Institutional foreclosure and weaponized referral: The wellness check originates from institutions she has formally accused, and the referral labels her “paranoid” before any assessment. This fits the institutional betrayal / preemptive framing pattern discussed in A/HRC/43/49: psychiatric pathways used to undermine legal credibility. This component speaks to context and power, not to psychiatric illness.

Differential: Medical assessment is unremarkable. No substance use is identified. There is no evidence of a primary psychotic disorder or formal thought disorder. She shows partial trauma-spectrum features (hypervigilance, sleep disturbance, avoidance of platforms) plausibly linked to documented external stressors. Decision-specific capacity is intact; no involuntary admission or harm finding is indicated.

What the clinician must not do: Accept the referral characterization as a clinical starting point or document a psychiatric impression that opposing counsel can later deploy to discredit the patient’s civil or regulatory proceedings—which, on the available evidence, appears to be the purpose of the wellness check.

What the clinician should do: Document the grain of truth investigation and the five-criterion assessment explicitly. Note that the referral source is institutionally conflicted and that this has been factored into the analysis. Record that the patient’s claims are non-bizarre and partly corroborated by publicly available technical and legal literature. Refer to a trauma-informed clinician experienced in complex, institutionally entangled presentations. Advise the patient that the appropriate investigative route is ISO-17025–compliant digital forensic analysis and forensic audit. Clearly state that the clinical record is not to be construed as endorsing the characterizing language in the referral note.

20. Documentation Standards and Legal Defensibility

20.1 The Standard for Diagnostic Documentation

Documentation of a psychiatric assessment that concludes a patient's belief is delusional must be sufficient to demonstrate that the conclusion was reached through the rigorous process described in this paper. The minimum documentation standard for any such assessment includes:

A thorough narrative account of the patient's presentation, in the patient's own words to the extent possible, including the specific content of the reported experiences and the patient's account of their origin and significance.
An explicit assessment of whether the content of the account is bizarre or non-bizarre, with documented reasoning.
An assessment of each of the five criteria—conviction, incorrigibility, possibility, preoccupation, and cultural congruence—with specific observations supporting the assessment of each.
Documentation of the differential diagnosis, specifically listing the medical, psychiatric, and genuine-external-experience alternatives that were considered, and the basis on which each was assessed or excluded.
Documentation of the grain of truth investigation: what was investigated, what was found, and what could not be investigated and why.
Documentation of any collateral contacts, the information obtained, and the weight given to that information.
Documentation of any consultation sought or declined, and the reason.
An explicit, reasoned clinical conclusion that connects the documented findings to the diagnostic determination.
Documentation of the patient's response to the assessment and any dispute the patient raised.

20.2 What is Not Adequate Documentation

"Patient presented with paranoid delusions"—this describes a conclusion, not a process.
"Patient believed they were being surveilled by [entity]—consistent with persecutory delusional disorder"—this substitutes content identification for diagnostic reasoning.
"Patient has prior history of psychiatric contact"—prior history is relevant context but not a substitute for current assessment.
"Account was not credible"—this documents an impression, not a methodology.

20.3 The Form 1 Documentation Standard

A Form 1 under the Hospitals Act is a legal document. The grounds stated must meet the statutory threshold. A Form 1 that reveals, on its face, that certification was based primarily on the implausibility of the patient's account—rather than on a specific finding of harm risk—is legally defective and professionally vulnerable.

20.4 Electronic Health Record Considerations

In an era of electronic health records and information sharing, documentation that enters the clinical record in one context is frequently accessible in others. A clinician who documents a diagnosis of delusional disorder should be aware that this documentation may follow the patient into legal proceedings, law enforcement contacts, professional licensing processes, and other institutional settings. This does not mean that accurate diagnoses should be suppressed—it means that inaccurate diagnoses have consequences that extend well beyond the clinical encounter, and that the standard of rigor for making them must be correspondingly high.

21. A Proposed Nova Scotia Six-Phase Clinical Decision Framework

The following framework is proposed as a structured decision-making scaffold for healthcare professionals in Nova Scotia encountering patients who present extraordinary accounts that may represent novel reality or psychiatric symptom.

Phase 1 — Preparation and De-Priming

Step 1.1 — Suspend categorical impression: Before the encounter begins, consciously set aside any prior impression from triage notes, referral letters, staff briefings, or prior clinical records. Approach the patient fresh.

Step 1.2 — Identify prior contacts and their basis: Review any prior psychiatric contacts, specifically looking for the basis of prior diagnoses and whether those diagnoses were made with adequate investigation.

Step 1.3 — Assess immediate safety: Before engaging with the content of the account, assess immediate safety for patient and others. Address any urgent safety concerns.

Phase 2 — Structured Narrative Interview

Step 2.1 — Allow the full account: Allow the patient to describe their experience without significant interruption. Resist the urge to redirect or probe too early. The full narrative, heard without interruption, provides essential diagnostic information.

Step 2.2 — Document in the patient's words: Record the account using the patient's own language wherever possible. Reframing the account into clinical language at this stage introduces the clinician's interpretive frame too early.

Step 2.3 — Assess coherence, consistency, and temporal structure: Note whether the account is internally consistent, whether it has a logical temporal structure, and whether the patient can expand on specific elements when asked.

Step 2.4 — Assess affect and function: Observe the patient's affect during the account. Is it appropriate to the content? Is there "la belle indifférence" (marked incongruence between the gravity of the described experience and the patient's emotional response)? Can the patient engage with other topics?

Phase 3 — Plausibility and Criterion Assessment

Step 3.1 — Apply the bizarre/non-bizarre distinction: Using the taxonomy in Section 5.3, categorize the content. Document the category and the basis for it.

Step 3.2 — Apply the five-criterion framework: Assess each of conviction, incorrigibility, possibility, preoccupation, and cultural congruence. Probe each criterion specifically. Document your findings for each.

Step 3.3 — Apply the cultural congruence assessment: Determine whether any elements of the account may be culturally normative. If uncertain, document the uncertainty and the steps taken to address it.

Phase 4 — Differential Diagnosis

Step 4.1 — Medical differential: Order or review appropriate medical investigations. At minimum in a first-episode presentation: CBC, electrolytes, glucose, calcium, thyroid function, B12, folate, LFTs, creatinine, toxicology screen, and RPR (syphilis). Consider MRI brain, EEG, and autoimmune encephalitis panel based on the clinical picture.

Step 4.2 — Trauma and PTSD assessment: Complete a brief trauma screen. Assess whether the reported experiences may reflect genuine trauma responses to genuine external events.

Step 4.3 — OCD, anxiety, and personality assessment: Consider whether the presentation is better accounted for by these conditions.

Step 4.4 — Genuine external experience assessment: Explicitly and documentably consider whether the patient may be accurately reporting a genuine experience. This must appear in the documentation as a considered and investigated possibility, not as a perfunctory dismissal.

Phase 5 — Collateral Investigation

Step 5.1 — Identify and contact collateral sources: Attempt to contact at least one collateral source with the patient's consent. Document the attempt and the result.

Step 5.2 — Review available documentation: Review any documentation the patient provides. Document what was reviewed and the findings.

Step 5.3 — Plausibility check on specific phenomena: For any specific technological or institutional phenomena described, conduct a brief check of available literature or public record. For neurotechnology-related claims, consult A/HRC/57/61. For psychological operations claims, consult A/HRC/43/49.

Step 5.4 — Specialist consultation: For complex presentations—particularly those involving alleged technological interference, coordinated institutional harm, or significant discrepancy between the clinical impression and the corroborating evidence—seek specialist consultation. Specialist options include forensic psychiatry, neurology, general internal medicine, and clinical ethics.

Phase 6 — Clinical Conclusion and Care Plan

Step 6.1 — Formulate a clinical impression with expressed uncertainty: Acknowledge the limits of the available evidence. A clinical impression, particularly in a complex case, is rarely a certainty. Express the degree of confidence appropriately.

Step 6.2 — Assess the harm threshold independently: If any involuntary intervention is being considered, apply the harm threshold as a separate inquiry from the diagnostic question. A patient with a psychiatric condition who presents no specific, current harm risk does not meet the threshold. A patient whose account cannot be assessed as delusional who presents no harm risk certainly does not.

Step 6.3 — Develop a collaborative care plan: Develop the care plan in collaboration with the patient to the maximum extent possible. Address functional needs regardless of the diagnostic impression. Do not make adherence to the clinician's interpretation of the account a precondition of receiving care.

Step 6.4 — Document completely: Document all of the above in a manner consistent with Section 20's documentation standards.

Step 6.5 — Establish review: Communicate clearly with the patient about follow-up. Remain open to revision in light of new information. Establish a process for revisiting the assessment if new evidence emerges.

22. Recommendations for Policy Reform

22.1 Legislative Reform

Recommendation 1: The Government of Nova Scotia should establish an independent psychiatric review tribunal, analogous to Ontario's Consent and Capacity Board, to review capacity findings, involuntary detention decisions, and treatment orders. This tribunal should have the authority to examine the adequacy of the clinical process that generated the decision being reviewed, including whether the grain of truth investigation was conducted.

Recommendation 2: The Hospitals Act should be amended to require explicit documentation, on the face of a Form 1, of the bizarre/non-bizarre assessment, the harm threshold assessment conducted, and the differential diagnostic process completed. These requirements should be incorporated into a revised Form 1 template.

Recommendation 3: The Government of Nova Scotia, in coordination with the Government of Canada, should develop specific legislative provisions addressing the use of mental health framing as a tool of institutional suppression—including prohibitions on the use of wellness checks as harassment tools and mechanisms for accountability where clinical records are weaponized in civil or institutional proceedings.

22.2 Regulatory Guidance

Recommendation 4: The CPSNS and NSCN should issue formal joint guidance to their members on the assessment of extraordinary accounts in psychiatric settings, incorporating the framework described in this paper. The guidance should specifically address: the bizarre/non-bizarre distinction and its technological currency; the grain of truth obligation; the cultural congruence requirement; and the specific implications of A/HRC/43/49 and A/HRC/57/61.

Recommendation 5: The CPSNS should develop specific guidance on the clinical and ethical obligations of physicians who become aware that a prior psychiatric diagnosis—made by another clinician—may have been made without adequate investigation. The guidance should address the obligation to independently assess, the obligation not to perpetuate inaccurate diagnoses, and the ethical framework for handling disagreements with prior clinical conclusions.

22.3 Training and Education

Recommendation 6: All Nova Scotia healthcare professionals involved in psychiatric assessment should complete ongoing training on the current technological landscape relevant to patient presentations, including the documented capabilities described in Section 8. This training should be incorporated into CME requirements and verified through the annual declaration process.

Recommendation 7: All Nova Scotia healthcare professionals involved in psychiatric assessment should complete bias awareness training focused specifically on the operation of implicit bias in clinical psychiatric assessment, with specific attention to race, socioeconomic status, prior psychiatric history, and the involvement of the patient in legal proceedings.

Recommendation 8: Medical and nursing education programs in Nova Scotia should incorporate the framework described in this paper into their psychiatry and mental health curricula, including case study analysis using vignettes like those in Section 19.

22.4 Research

Recommendation 9: Nova Scotia Health and Dalhousie University should commission research examining the frequency, characteristics, and outcomes of cases in which patients' reports of extraordinary experiences were initially assessed as delusional but were subsequently corroborated. This "retrospective corroboration" research is essential for understanding the scale of the clinical problem this paper addresses.

Recommendation 10: The Nova Scotia Human Rights Commission should conduct a review of involuntary psychiatric certification data, disaggregated by race, gender, socioeconomic status, and prior psychiatric history, to assess the extent and character of disparities in the certification system.

23. Conclusion

The question this white paper addresses—how does a Nova Scotia healthcare professional distinguish between a novel reality and a delusion? —is one of the most consequential and most frequently improperly handled questions in clinical medicine. The consequences of error in either direction are severe. A missed delusion can lead to ongoing untreated psychiatric illness. A missed reality—particularly one involving criminal victimization, institutional persecution, or novel technological harm—can lead to the destruction of a person's life, freedom, and dignity, with the healthcare system as an unwitting instrument.

The answer to the question is not "Does this sound plausible to me?". That is not a clinical standard. It is not a legal standard. And in 2026, in a world where the United Nations has formally recognized the possibility of neurotechnology-facilitated crimes, where directed energy weapons have been confirmed to affect diplomatic personnel, where surveillance technology capable of comprehensive monitoring is commercially available, and where AI-assisted psychological operations are documented as a real-world phenomenon deployed against specific individuals — it is a dangerously outdated heuristic.

The answer is methodological. It is: Have I applied the bizarre/non-bizarre distinction with reference to the current state of the world? Have I applied the five-criterion framework with rigor and documentation? Have I conducted the grain of truth investigation? Have I completed the differential diagnosis, including the differential of genuine external experience? Have I been alert to the possibility that this patient is a victim of institutional harm whose account is being presented to me in the same institutional setting that may be complicit in that harm?

Reports A/HRC/43/49 and A/HRC/57/61 are not peripheral academic documents. They are formal instruments of the UN Human Rights Council —the body charged with implementing the international human rights obligations by which Canada is legally bound—that address phenomena directly relevant to the clinical presentations this paper describes. A healthcare professional in Nova Scotia who has not encountered these reports, and who assesses a patient's account of psychological torture or neurotechnology abuse as impossible or bizarre, is practicing on the basis of a factually incomplete understanding of the world.

This paper provides the update. It provides the legal and regulatory context that binds Nova Scotia clinicians. It provides the diagnostic framework that professional standards require. It provides the case law that governs the legal consequences of clinical error. And it provides the practical tools—the plausibility taxonomy, the five-criterion assessment, the technology-to-symptom mapping, the clinical vignettes, and the decision checklist—that a clinician can use in the room, with the patient, to get it right.

Getting it right is not merely a matter of clinical technique. It is, in the most straightforward sense, a matter of justice.

Appendix A: Relevant Legislation, Cases, and International Instruments

Nova Scotia Legislation

Hospitals Act, R.S.N.S. 1989, c. 208
Personal Directives Act, S.N.S. 2008, c. 8
Personal Health Information Act, S.N.S. 2012, c. 33
Human Rights Act, R.S.N.S. 1989, c. 214
Adult Protection Act, R.S.N.S. 1989, c. 2
Judicature Act, R.S.N.S. 1989, c. 240

Federal Legislation

Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982
Criminal Code, R.S.C. 1985, c. C-46 (ss. 16, 131, 139, 269.1, 380, 465)
Canadian Human Rights Act, R.S.C. 1985, c. H-6
Personal Information Protection and Electronic Documents Act (PIPEDA), S.C. 2000, c. 5

Comparative Jurisdiction Legislation

Health Care Consent Act, 1996, S.O. 1996, c. 2 (Ontario)
Mental Health Act, R.S.B.C. 1996, c. 288 (British Columbia)
Mental Capacity Act 2005 (England and Wales)
Mental Health Act 1983 (amended 2007) (England and Wales)

Canadian Case Law

Starson v. Swayze, [2003] 1 SCR 722
R. v. Swain, [1991] 1 SCR 933
R. v. Chaulk, [1990] 3 SCR 1303
R. D. S. v. R., [1997] 3 SCR 484
Baker v. Canada (Minister of Citizenship and Immigration), [1999] 2 SCR 817
F.H. v. McDougall, [2008] 3 SCR 41
Beals v. Saldanha, [2003] 3 SCR 416
R. v. Villaroman, 2016 SCC 33
R. v. J.F., 2013 SCC 12
Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65
Sherman Estate v. Donovan, 2021 SCC 25
CBC v. Named Person, 2024 SCC 21
Conway v. Jacques, [2006] OJ No 3546 (ONCA)

International Instruments

International Covenant on Civil and Political Rights, 999 U.N.T.S. 171 (1966)
Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1465 U.N.T.S. 85 (1984)
Convention on the Rights of Persons with Disabilities, A/RES/61/106 (2006)
United Nations Declaration on the Rights of Indigenous Peoples, A/RES/61/295 (2007) (adopted by Canada 2021)
UN Human Rights Council Report A/HRC/43/49 (2020) — Special Rapporteur on Torture, Nils Melzer — "Psychological torture"
UN Human Rights Council Report A/HRC/57/61 (2024) — Special Rapporteur on Torture — "Neurotechnology and the rights of persons with mental health conditions"
UN Human Rights Council Report A/HRC/41/35 (2019) — Special Rapporteur on Freedom of Expression — "Surveillance and human rights"

Regulatory Standards

College of Physicians and Surgeons of Nova Scotia (CPSNS), Standards of Practice
Nova Scotia College of Nursing (NSCN), Standards of Practice
Nova Scotia College of Social Workers (NSCSW), Standards of Practice
Canadian Psychiatric Association, Clinical Practice Guidelines for Schizophrenia and Delusional Disorder

Diagnostic Standards

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), APA, 2022
International Classification of Diseases, Eleventh Revision (ICD-11), WHO, 2019

Appendix B: Glossary

A/HRC/43/49:
UN Human Rights Council Report (2020) by Special Rapporteur Nils Melzer establishing psychological torture as a recognized subcategory of torture under international human rights law, including state-adjacent and/or institutionally coordinated, non-physical methods of causing severe psychological suffering.

A/HRC/57/61:
UN Human Rights Council Report (2024) by the Special Rapporteur on Torture addressing neurotechnology and human rights, formally recognizing the possibility of non-consensual neural monitoring and manipulation as a human rights concern and calling on states to develop regulatory frameworks and clinical protocols.

Audio spotlight:
Commercial ultrasonic directional audio technology capable of projecting sound to a specific location; persons outside the beam do not hear the sound.

Backscatter communication:
A wireless communication method in which a passive or semi-passive device encodes information by modulating how it reflects an existing radiofrequency signal, rather than generating its own carrier; proposed here as a reliable mechanism by which a nanoscale neural interface substrate could communicate neural state information to external receivers.

Beamforming:
A signal-processing technique used in phased-array antennas (including 5G base stations and many LEO satellite systems) in which the phase and amplitude of multiple radiating elements are adjusted so that radiofrequency energy constructively interferes at a chosen point in space, concentrating power at that point while keeping individual emitters within nominal limits.

Bizarre delusion:
A delusion whose content is impossible in principle, defying known laws of physics or biology.

Blood–brain barrier (BBB) crossing (in this context):
The set of mechanisms by which nanoparticles traverse the endothelial barrier separating the bloodstream from the central nervous system— including paracellular diffusion, receptor-mediated transcytosis, and olfactory-pathway retrograde transport—several of which have been experimentally demonstrated for graphene-family nanomaterials.

Brain-computer interface (BCI):
A device creating a communication channel between the brain and an external system. Can be invasive (implanted) or non-invasive (EEG-based). Commercial non-invasive BCIs are currently available.

Capacity:
A legal and functional determination—assessed decision-specifically—that a person can understand, appreciate, reason with, and communicate decisions about a specific matter.

Clinical gaslighting:
The phenomenon in which a healthcare provider inadvertently reinforces a patient's sense that their perception of reality is unreliable, by pathologizing an accurate account of genuine external experience.

Cognitive liberty:
The right to make autonomous decisions about one's own mental functioning without external interference. Emerging in international human rights discourse in connection with neurotechnology.

Complex PTSD:
Post-traumatic stress disorder resulting from prolonged, repeated, inescapable trauma, characterized by additional features including affect dysregulation, altered self-perception, and dissociation.

Coordinated inauthentic behavior / behaviour:
The deliberate coordination of multiple individuals, entities, or accounts to create a misleading appearance of independent action, documented in commercial, political, and personal harassment contexts; relevant to clinical assessment of patients reporting “orchestrated” harassment.

Cultural congruence exception:
The DSM-5-TR and ICD-11 principle that beliefs ordinarily accepted within the patient's culture or subculture are excluded from the category of delusion.

Directed energy:
Projected radiofrequency, microwave, acoustic, or laser energy; documented military devices using directed energy can produce physiological and neurological effects.

Emerging plausibility (Category C):
In this paper’s taxonomy, a class of claims that are physically principled and supported by existing technology trajectories or human-rights analyses (e.g., UN A/HRC/57/61) but lack confirmed deployment evidence; such claims cannot be dismissed as impossible, and require cautious, evidence-sensitive clinical handling rather than automatic pathologization.

Form 1:
Nova Scotia's legal form (under the Hospitals Act) for the involuntary psychiatric assessment of an individual; must meet the statutory harm threshold.

Grain of truth doctrine:
The clinical and ethical principle that before a belief can be assessed as delusional, the clinician must investigate whether any element of the reported experience has a basis in reality.

Graphene-family nanomaterials (GFNs):
A broad class of carbon nanomaterials derived from graphene (including graphene oxide, reduced graphene oxide, graphene quantum dots, and related structures) characterized by high electrical conductivity, large surface area, and bioactive surface chemistry; several members of this family have been shown to cross the blood–brain barrier and persist in neural tissue. GFNs require micro-Raman spectroscopy, SEM-EDX, and TEM testing for detection as they do not register on standard testing a hospital clinic might be expected to have, such as MRI.

Graphene Quantum Dots (GQDs):
Nanoscale (≈2–10 nm) fragments of single- or few-layer graphene that exhibit quantum-confined optical and electronic properties, including size-tunable fluorescence and high carrier mobility; they are being investigated for bioimaging, biosensing, and drug delivery, and are therefore directly relevant to discussions of covert remote neural interface substrates.

Havana syndrome:
A cluster of neurological and sensory symptoms reported by U.S. and Canadian diplomatic personnel beginning in 2016, attributed by the U.S. National Academies of Sciences to directed pulsed radiofrequency energy.

Incorrigibility:
The characteristic of a true delusion in which the belief is maintained despite logical argument or counter-evidence.

Lawfare:
The strategic use of legal processes as instruments of harassment, financial exhaustion, or institutional discrediting—a documented tactic against whistleblowers and dissenters.

Low Earth Orbit (LEO) satellite constellation:
A large network of satellites (ie., Starlink) operating at altitudes of roughly 300–1,200 km that provides continuous, overlapping coverage of the Earth’s surface and supports spot-beam, beamformed broadband services; technically capable of precise timing, geolocation, and coordination with terrestrial infrastructure.

Mental privacy:
The emerging right, recognized in A/HRC/57/61 and related instruments, not to have one's mental processes monitored without consent.

Microwave hearing effect:
A phenomenon in which radiofrequency/microwave exposure produces auditory perceptions (clicks, buzzes, or speech) without an external acoustic source.

Neural interface substrate:
Any material or device placed in or near neural tissue that can record, modulate, or otherwise couple to neural activity; in this paper, GQDs and related GFNs are treated as a peer-researched nanoscale neural interface substrate.

Neural nudge:
Informal term for the non-consensual use of neurostimulation technology to alter cognitive state, mood, or behavior.

Non-bizarre delusion:
A delusion whose content involves situations that could conceivably occur in real life, even if unlikely.

Phased-array antenna:
An antenna composed of many small radiating elements whose outputs can be individually phase- and amplitude-controlled to steer and shape beams electronically rather than by mechanically moving the antenna structure; this architecture underlies modern 5G “massive MIMO” and satellite spot-beam systems.

Psychological torture:
As defined in A/HRC/43/49, any method, technique, or circumstance intended to purposefully inflict severe mental pain or suffering without the primary conduit of physical pain; encompasses institutional, coordinated, and technologically mediated methods.

tDCS (Transcranial Direct Current Stimulation):
Non-invasive neurostimulation applying weak electrical currents to the scalp; can modulate neural excitability and affect mood and cognition.

TMS (Transcranial Magnetic Stimulation):
Clinically approved non-invasive neurostimulation using pulsed magnetic fields to induce cortical electrical currents; used therapeutically and as a research tool.

Whistleblower:
A person who reports suspected wrongdoing by an institution or individual, frequently subject to retaliation including legal, professional, and social harassment.

Appendix C: Assessment Checklist for Clinicians

NOVA SCOTIA NOVEL REALITY / DELUSION ASSESSMENT CHECKLIST (To be completed and retained as part of the clinical record for any assessment involving extraordinary accounts)

Patient Identifier: __________________ Date: ______________ Clinician: __________________ Setting: __________________ Referral Source: __________________

PHASE 1 — PREPARATION

☐ Prior records reviewed — note any prior psychiatric contacts and the basis for prior diagnoses ☐ Categorical impression suspended — prior labels set aside pending independent assessment ☐ Immediate safety assessed and addressed

PHASE 2 — NARRATIVE DOCUMENTATION

☐ Patient's full account documented in patient's own language ☐ Internal consistency of account assessed: ☐ Consistent ☐ Inconsistent ☐ Mixed — notes: _______ ☐ Temporal structure documented: ☐ Clear and logical ☐ Fragmented — notes: _______________ ☐ Affect during account: ☐ Appropriate ☐ Incongruent ☐ Flat ☐ La belle indifférence ☐ Engagement with other topics assessed: ☐ Full ☐ Partial ☐ Unable to shift

PHASE 3 — PLAUSIBILITY AND CRITERION ASSESSMENT

Bizarre/Non-Bizarre Classification:
☐ Category A — Non-bizarre (clearly documented as occurring)
☐ Category B — Non-bizarre (documented technological capability)
☐ Category C — Emerging plausibility (recognized in international instruments)
☐ Category D — Currently technically implausible Basis for classification: ______________________________________________________________

Five-Criterion Assessment:

Criterion 1 — Conviction:
☐ Absolute — cannot entertain any alternative
☐ High but modulated — acknowledges some uncertainty
☐ Moderate — uncertain but believes strongly
☐ Variable — conviction modulates with context Patient's response to alternative explanation probe: _______________________________________

Criterion 2 — Incorrigibility:
Counter-evidence or argument presented: _______________________________________________
Patient's response: __________________________________________________________________
☐ Dismissed without engagement
☐ Engaged with but unchanged
☐ Partially accommodated
☐ Substantially updated

Criterion 3 — Possibility:
☐ Confirmed impossible in principle
☐ Possible but no documentation found
☐ Possible, documented in literature
☐ Possible, corroborated by patient's documentary evidence Source consulted: __________________________________________________________________

Criterion 4 — Preoccupation:
☐ Total — entire encounter consumed by account
☐ High — major focus, cannot readily discuss other topics
☐ Moderate — significant concern among others
☐ Proportionate — engagement with account appropriate to described circumstances Other topics patient engaged with: ____________________________________________________

Criterion 5 — Cultural Congruence:
☐ Account is normative within documented cultural/religious context
☐ Cultural consultation conducted — findings: ___________________________________________
☐ Account is inconsistent with patient's stated cultural framework
☐ Cultural context uncertain — steps taken: ______________________________________________

PHASE 4 — DIFFERENTIAL DIAGNOSIS

Medical differential:
☐ Autoimmune encephalitis panel — ordered / reviewed / results: ___________________________
☐ CNS imaging — ordered / reviewed / results: ___________________________________________
☐ EEG — ordered / reviewed / results: __________________________________________________
☐ Endocrine panel (thyroid, cortisol, calcium) — results: ___________________________________
☐ Infectious screen (RPR, HIV, Lyme if indicated) — results: _______________________________
☐ Toxicology — results: ______________________________________________________________
☐ B12, folate, thiamine — results: _____________________________________________________
☐ Medications reviewed — relevant findings: ____________________________________________
☐ Full workup not yet complete — pending investigations: __________________________________

Psychiatric differential:
☐ PTSD/Complex trauma — assessed, findings: __________________________________________
☐ OCD — assessed, findings: _________________________________________________________
☐ Mood disorder with psychotic features — assessed, findings: _____________________________
☐ Personality disorder — assessed, findings: ____________________________________________
☐ Malingering — considered, specific evidence for / against: _______________________________
☐ Genuine external experience — specifically and documentably considered (describe): _________

PHASE 5 — COLLATERAL INVESTIGATION

☐ Collateral contact attempted — person and relationship: __________________________________
☐ Information obtained: ______________________________________________________________
☐ Contact not possible — reason: ______________________________________________________
☐ Documents reviewed — description and findings: _______________________________________
☐ Prior clinical records examined — basis of any prior diagnoses assessed
☐ Public record/literature consulted — sources and findings: _______________________________
☐ A/HRC/43/49 considered (if psychological torture/institutional harm alleged)
☐ A/HRC/57/61 considered (if neurotechnology-related experience alleged)
☐ Specialist consultation — sought / obtained / pending / declined — reason: _________________

PHASE 6 — CLINICAL CONCLUSION

Primary clinical impression:
☐ Consistent with delusional disorder — basis: ___________________________________________
☐ Consistent with other psychiatric diagnosis — specify: ___________________________________
☐ Consistent with PTSD / trauma response to genuine external events
☐ Insufficient evidence for psychiatric diagnosis
☐ Genuine experience cannot be excluded — grain of truth investigation ongoing
☐ Medical etiology not yet excluded — investigations pending
☐ Mixed presentation — specify: ______________________________________________________

Harm assessment (required if any involuntary intervention considered):
☐ Specific, current harm risk identified — nature and basis: ________________________________
☐ No specific current harm risk — involuntary intervention not indicated on this basis

Patient informed of clinical impression:
☐ Yes
☐ No — reason: ______________________________________________________________________

Patient's response documented:
☐ Yes — summary: ____________________________________________________________________
☐ No — reason: ______________________________________________________________________

Patient dispute noted:
☐ Yes
☐ No

Care plan developed collaboratively:
☐ Yes
☐ Partially
☐ No — reason: ______________________________________________________________________

Follow-up established: ☐ Yes — when and by whom: _______________________________________

Referral:
☐ Made — to: ________________________________________________________________________
☐ Declined — reason: _________________________________________________________________

Clinician Signature: _____________________________ Date: _______________
Supervising Clinician (if applicable): _________________________ Date: _______________

This white paper and checklist are educational and professional development resources for healthcare providers in Nova Scotia and Canada. They do not constitute legal advice. Clinicians with specific questions about legal obligations should consult their regulatory body or qualified legal counsel. This document may be reproduced for educational and professional development purposes with attribution. February 2026.

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Prepared February 2026. This bibliography reflects sources available as of that date. The clinical and technological landscape addressed in this paper is evolving rapidly; readers are encouraged to consult current literature in each domain.

When Police Wrongly Pathologize Victims

The Poison Pill: When False Police Reports Compromise, and Weaponize, Healthcare.

The header captures a specific pattern in which law enforcement responds to credible reports of wrongdoing not by investigating the alleged harm, but by framing the complainant as mentally unstable and triggering a psychiatric pathway instead. Once deployed, this “poison pill” reframes evidence as symptom, converts a public safety problem into a mental health file, and creates a durable record that can be used to discredit the victim in every subsequent institutional forum.

In Foucauldian terms, this is how power/knowledge operates across institutional sites. The initial police decision not to take the complaint seriously is translated into a clinical referral: the complainant becomes a “person of concern” rather than a victim or witness. When the clinician encounters the patient, the psychiatric gaze is already primed by the police narrative. The assessment is no longer an independent inquiry into the person’s mental state; it is an opportunity to confirm the pre-existing suspicion that “the problem is psychiatric”. A diagnosis, once entered into the record, then feeds back into the legal and administrative apparatus as an authoritative “truth” about the complainant.

Like-minded stakeholders in different venues—police, emergency clinicians, hospital risk managers, institutional counsel, sometimes regulators—do not need to conspire explicitly. They share a common set of assumptions about credibility, institutional risk, and the manageability of “difficult” complainants. Each decision point appears routine: a wellness check here, a Form 1 there, a brief note about “paranoid ideation,” a court or tribunal later accepting the mental health record as context. Taken together, these acts form a state-adjacent circuit of suppression: the original allegation is rendered invisible beneath layers of psychiatric interpretation, and the person who raised it is recoded, across systems, as the problem to be managed rather than the harm to be addressed.

The Antidote: How Institutions and Clinicians Break the “Poison Pill” Circuit

The solution is not a single heroic act (although they do help!), but a set of structural safeguards that interrupt the pathologization cascade at each point where power/knowledge does its quiet work.

At the police interface: bright-line rules and audit trails
- Clear policy: Police services adopt explicit policies that distinguish wellness checks from complaint suppression. Any mental-health referral arising in the context of a substantive allegation (fraud, corruption, abuse, harassment, rights violations) must:
  - Document the original allegation in full,
  - Record why a criminal or disciplinary investigation was not pursued, and
  - Flag that the referral arises from a conflict, not a neutral welfare concern.
- Independent review: Complaints that lead to mental-health referrals are automatically eligible for external oversight review (police commission, ombudsman, or equivalent), with specific attention to whether mental health framing is being used as a shield against investigation.
At the clinical interface: methodological independence as a hard rule
- Start from scratch: Clinicians treat any police characterization of “paranoia,” “delusions,” or “instability” as allegations, not facts. The assessment must:
  - Reconstruct the patient’s narrative independently,
  - Apply the bizarre/non-bizarre test using current technological and social reality,
  - Conduct the grain of truth investigation before any delusional diagnosis is made.
- Explicit documentation: Where police have triggered the encounter, the record must clearly state:
  - What was reported to police,
  - What the police characterization was, and
  - How the clinician independently assessed the underlying allegation.
    This turns the clinical record from an instrument of suppression into an audit document that can later be used to scrutinize police conduct.
Cross-institutional safeguards: breaking the echo chamber
- No uncritical recycling of labels: Courts, tribunals, and regulators treat prior psychiatric labels as context, not dispositive truth. When a mental health record emerges from a conflict with state or corporate actors, decision-makers:
  - Ask how that record was generated (Was the grain of truth tested? Was there institutional conflict?),
  - Require reasons, not just diagnostic labels, before allowing the record to undermine credibility.
- Firewalling roles: Institutional counsel, risk managers, and healthcare providers must not collapse into a single function. Legal risk to the institution (e.g., from a whistleblower) cannot be allowed to drive clinical conclusions.
Oversight bodies with teeth
- Dedicated review category: Human rights commissions, ombuds offices, and professional regulators recognize “retaliatory pathologization” as a distinct pattern. Where a complainant alleges that they were sent down a psychiatric pathway instead of having their complaint investigated, that allegation triggers:
  - A presumptive records review of police, clinical, and institutional decision-making,
  - The possibility of formal findings that pathologization was misused as a tool of suppression.
- Remedial powers: Oversight bodies must be able to recommend:
  - Retractions or corrections of flawed psychiatric records,
  - Policy changes in police and health authorities,
  - Training or discipline where misuse is established.
Professional standards: making resistance part of good practice
- Codified duty of independence: Colleges (physicians, nurses, social workers, psychologists) explicitly state that:
  - Clinicians must not allow third-party institutional interests to dictate or pre-shape their findings, and
  - When an assessment arises from an institutional conflict (police, employer, adversarial litigation), the clinician has a heightened duty to consider external harm and psychological torture frameworks (A/HRC/43/49, A/HRC/57/61).
- Education: Training programs teach the “poison pill” dynamic as a known risk:
  - Foucault is not an abstract name but a concrete warning: the clinic can become an arm of the state if methodology is not defended.
  - Residents and students are taught: “Your job is to test the story, including the state’s story, not to ratify it.”
Practical implementation: checklists and triggers
- A simple screening question embedded in the assessment:
  
  “Did this encounter begin because you made a complaint or allegation against an institution or powerful actor?”
- If yes, a short “state-adjacent risk” box activates:
  - Grain of truth investigation is mandatory.
  - Collateral from outside the implicated institution is prioritized.
  - The final note must answer explicitly: “What steps did I take to ensure this assessment did not simply ratify the referring institution’s narrative?”

In Foucauldian language, the antidote is not imagining a neutral, power-free clinic; it is designing practices that make power visible and contestable. The agile clinician, supported by explicit policy and oversight, remains a clinician rather than an unwitting extension of the police order. The state retains its legitimate functions, but loses the easy option of dissolving difficult truths into diagnostic codes.

An Example.

On May 11, 2023, I had a minor backyard bonfire mishap involving nearby foliage that was extinguished in roughly two minutes with a few buckets of water. Approximately three minutes after the incident, two fire trucks arrived, accompanied by several police officers. The speed and scale of the response appeared impossible under ordinary operational conditions and were grossly disproportionate to the scope of the event. I spoke briefly with the officers and then settled in for the night.

Less than forty-eight hours later, on the morning of Saturday, May 13, a large white van and a police paddy wagon arrived in my driveway. Two social workers and three police officers identified themselves as a “mental health crisis team”. They interviewed me in my living room while I was still in my pajamas. In the course of that discussion, I was able to glean from the social worker that her concern originated not in the innocuous fire incident itself, but in pejorative guidance provided by Halifax Regional Police (HRP). I was then asked to accompany them to the Halifax QEII Health Sciences Centre. I peacefully objected to what I regarded as an unfounded intrusion on my privacy (R. v. Ahmad, 2020 SCC 11, at para. 38), whereupon I was handcuffed and placed in the back of the van. I then waited in the emergency department lobby with an HRP officer for roughly five hours before being interviewed by a medical resident. After a brief discussion—which I recorded, and which is reproduced below—the resident concluded that HRP’s response was disproportionate.

As with other milestones in this chronology, the event appeared to have been “telegraphed” in advance through a cluster of online visuals that strongly resembled AI-generated content. The images in question, dated between May 11 and May 13, 2023, share striking correspondences with the real-world events: a campfire started with wilted flowers, an implausibly rapid three-minute response by police and fire units, a white pickup/van, and an ensconced, camera-equipped room resembling the space in which I was interviewed by resident Eastman. One example, a visual posted by “Cosmic Wifey” on May 13, depicts flowers, a white pickup/van, a “pick-up” reference, and a suggestion of special designation. Other actors—“Prophetic Record,” “Stephanie P. Smith,” “Word of God with Lola,” and “Jordan’s Journey”—echo themes of vigilance, the visit, the pick-up, and the interview in the enclosed room.

Cumulatively—and each instance compelling in its own right—these patterns align with the testimony’s account of an AI-assisted surveillance feedback loop, in which biometric and contextual data appear to be accessible on the dark web to well-resourced, state-adjacent actors. The original snapshots remain preserved on the device that captured them. You will note that Cosmic Wifey's post timing, when calculated against the triage note, are minutes apart from each other, and both text and symbolism provides a mirror match to the triage note. Characteristics like this are not coincidence, and there are hundreds of examples, albeit this one is anchored to a provincial health record.

When these patterns are viewed alongside the technical literature (here), commercial interests (here), state interests (here), the UN reports (here), the overarching characteristics of the scandal as generally considered (here), and finally the characteristics of human history and recent accounts of state-sponsored human experimentation, there are very few, if any, plausible alternative explanations for an investigator or agile clinician to consider. When a patient can present a dossier like this, it is the false police reports that are reasonably suspect, not the victim to whom a pathology is attributed. Likewise, where the patient’s account is inherently testable (in this case via micro-Raman spectroscopy, SEM-EDX, TEM) and the relevant actors decline to pursue those readily available tests, they cannot then rely on the resulting evidentiary gap. Consistent with Snell v. Farrell, [1990] 2 S.C.R. 311, courts are entitled to draw robust, common-sense inferences of causation and may draw an adverse inference where the party who controls the best diagnostic evidence chooses not to obtain or disclose it.

Sample Exhibit

Innocuous, Right-Minded Victims of State-Adjacent Crimes Can be Preemptively Pathologized.

Healthcare professionals are often primed to trust police, agency, and court reports at intake. When those reports are inaccurate or incomplete, they can chill, distort, or even foreclose independent medical judgment from the very first contact.

The May 13th, 2023 Clinician Transcript & Related Visual Evidence. See Guide [Here].

As above per the embellished HRP report that was provided to EHS.
Full details at the HRP Page (Here).

May 13, 2023 Live Audio Recording Hfx QE II