Moors Murderer Ian Brady remains “chronically psychotic” and should remain in a hospital setting for treatment, his mental health tribunal heard today.
The child killer suffers from long-term paranoid schizophrenia which does not "just fade away and die", according to the clinician in charge of his care at high security Ashworth Hospital in Merseyside.
Brady, 75, was constantly paranoid about the Home Office and the Prison Officers Association, and believed hospital staff were acting as their agents.
His wish that he could "send cancer in an envelope" to one doctor was one example of anger which was the driving force for his paranoia, a panel sitting at the hospital was told.
Giving evidence, Dr James Collins said Brady also had paranoid beliefs about fellow patients who he thought were spying on him.
He wrongly believed that others were out "to get at him" and he responded by spilling shredded oats cereal outside one man's door and smearing the chair of another with jam and honey.
But Dr Collins said he was not aware that Brady was paranoid before he was jailed for life in 1966 for murdering five youngsters in the 1960s, burying their bodies on Saddleworth Moor above Manchester.
He said he had managed to hold down a relationship with his partner in crime, Myra Hindley, a job and "sideline work" as a pornography dealer when he was a young man.
He was transferred to Ashworth Hospital in 1985 after previously displaying psychotic symptoms since 1967.
Dr Collins said he believed his illness is "clearly still active".
"He is better, much better and able to control it (the illness) but his life is still severely handicapped by his disorder, his mental illness," he said.
"He is acting like someone who is chronically psychotic."
An expert witness called by Brady's legal team had previously told the panel that Brady was not suffering from schizophrenia but from a severe personality disorder which could be handled in prison.
The murderer, who has been on hunger strike since 1999 and is force-fed through a tube, claims he has faked psychotic episodes in the past.
Brady has said he wants to end his life in prison where he could not be force-fed.
Dr Collins said: "I am not aware that he was paranoid before he went into prison. I am aware that he held a stable relationship with Myra Hindley for many years. He held down a job for many years. Paranoid people struggle to do that.
"As a sideline to work, he dealt in pornography as a young man. You have to make contact with others, buy and sell from people.
"You are really going to struggle to maintain those relationships without talking with other people."
But Brady falls out with everyone wherever he goes, in prison or hospital, through paranoia driven by anger, said Dr Collins.
Since 2012 there had been 11 noted references in hospital records of him talking to himself.
There had also been repeated incidents of Brady secretly scattering cereal outside the next-door cell of a patient by whom he felt threatened and of smearing jam and honey on a chair used in the day room by another patient.
But there was no basis for his antagonism towards either and he was deluded, the tribunal heard.
"When he was younger, he would have it out with these guys," said Dr Collins. "He had to get his revenge on them by other means.
"The smearing of jam and honey on this guy's chair in the day area is clearly designed to wind him up.
"It is surreptitious revenge for the personal belief that this man winds him up. (But) This guy has done nothing."
Brady also held paranoid views about people in authority, the doctor said.
He accused an ophthalmologist who was carrying out a cataract operation on him last February of looking in the wrong eye, while he said he wanted to "send cancer in an envelope" to a doctor who was part of the panel that granted him the public hearing for which he had fought since 2002.
Eleanor Grey QC, representing Ashworth Hospital, which opposes any bid to transfer Brady to prison, asked Dr Collins what he thought would happen if Brady was allowed to return to prison.
"I think he will be delighted," he said. "He will have won after all. There will a period of triumph.
"Then there will be a period of him thinking about what is going to happen.
"He has always said prison is horrible. He had a horrible time at Durham and he would not come out of his room at Parkhurst.
"He is going to be frightened... he won't admit it. He is going to be dreading the consequences. I am not sure he will come out of his room.
"Those are all significant stresses."
He said he thought it might be "relatively quick" for Brady to return to his status of 1985 when he experienced overt hallucinations and that it could take "only a matter of weeks".
Dr Collins added that Brady would have problems in being returned to a system run by organisations such as the Home Office and the Prison Officers Association which were the "core of his delusions".
The hearing was told that Brady was still smoking after 60 years and had chronic obstructive airways disease but his health was better after last year when he suffered from a recurrent chest infection, had an epileptic fit and suffered two broken bones in his spine.
Brady was not present today at the morning session of the hearing, which is being relayed to the press and public at Manchester Civil Justice Centre.
He walked out yesterday after complaining that he had heard evidence "ad nauseam" cited by Ashworth Hospital and did not want to sit in when Dr Collins was giving evidence.
Brady and Hindley lured children and teenagers to their deaths, with their victims sexually tortured before being buried on Saddleworth Moor.
Pauline Reade, 16, disappeared on her way to a disco on July 12 1963 and John Kilbride, 12, was snatched in November the same year. Keith Bennett was taken on June 16 1964 after he left home to visit his grandmother; Lesley Ann Downey, 10, was lured away from a funfair on Boxing Day 1964; and Edward Evans, 17, was killed in October 1965.
Brady was given life at Chester Assizes in 1966 for the murders of John, Lesley Ann and Edward.
Hindley was convicted of killing Lesley Ann and Edward and shielding Brady after John's murder, and jailed for life. She died in jail in November 2002 at the age of 60.
Brady returned to the hearing room as cross-examination of Dr Collins began from his barrister, Nathalie Lieven QC.
Wearing a black jacket, shirt and tie, he was seen to read court papers of the case as the evidence continued.
Dr Collins said Brady had experienced a "whole range" of psychotic episodes, with "many of them pleasant" such as talking to Laurel and Hardy, Cilla Black and Mrs Gandhi.