Madness roots itself in the disorganization of the mind. This disorganization is actually quite literal; the neural pathways are scattered for a schizophrenic, unlike unaffected individuals. The date on page 299 is a good example of the scattered thought process. To an observer someone may look and sound as though they are making no sense. In reality, this person posses altered sensory pathways. Their mind will attempt to apply logic to the information they receive from the world around them. Therefor, an observer may hear Aksenty Ivanovich Poprishchin refer to himself as Ferdinand VIII, king of Spain, but would not understand his time spent reflecting on empty thrones and social classes and how the anouncement that the throne was occupied somehow translated to his new identity. It's difficult for me to imagine how the narrator acts or how I'd view him. He has brought the reader into a world which where interpretion of events is so different from the way in which most are accustomed that it's challenging to translate back into reality.