The fact that dj didn't even disclose what his ideas exactly were, but the Dr already knew they were objectively delusional speaks volumes haha
The doctor knew because his name was "Douglas James"
Take a closer look at this paper

1- Perfectly straight ink over the folds. Text should visibly bend, stretch or darken over the creases.
2- Mismatched fonts
3- Residual blur halos: beneath the heavier text blocks there are blurred shapes (masked or painted out existing lines before inserting new text.)
4- Shadows from folds and ambient light dont match....yet the inserted text areas remain unnaturally even in brightness and contrast, as if they were overlaid digitally.
5- Writing style is retarded (syntax, lack of appropriate medical terminologies etc.)
Dougie doctored the pic like a retard.