A young woman contacted me this afternoon, on a referral from Dr. Moonsen. This woman, who I will call S, is romantically involved with a young man, J, who has been exhibiting a number of strange behaviors. She described them to me over the phone.
- J has apparently become obsessed with gathering and sorting of loose change. S reports that, during a routine visit to a park, he jumped into a fountain and began fishing for coins, making odd chirping noises each time he recovered one. He performs similar rituals often: once he collects a handful, he counts all the coins and places them into one of several zip-top bags that he keeps on hand. When he fills a bag to some arbitrary level, he becomes briefly overjoyed, then begins the ritual over again with a new bag. S tells me that J now carries 15 or 20 full bags of coins with him at all times, and when she tries to convince him to leave them at home, he accuses her of trying to kill him.
- S no longer lets J to drive their car after an incident four days ago: as he approached a routine traffic signal, he revved the engine, aggressively cut off another driver, then pulled the emergency brake and slid the car onto the sidewalk, miraculously avoiding any personal harm or property damage.
- With some hesitation, S described a dramatic increase in the frequency of their sexual encounters. Though she was initially flattered, if perplexed, by the surplus of affection, she became concerned when she caught him masturbating to pornography after he had already climaxed via intercourse three times in the same day. In the ensuing argument, he claimed that she would be much happier once he had “leveled up.”
I scheduled an appointment with J for later in the week.
Initial consultation with J revealed a number of entrenched delusions. When asked about his childhood, J related a detailed story in which his “home town” (which he would or could not name) had been destroyed by a fire when he was young, leaving him homeless and orphaned. I later confirmed with S that J’s biological parents are both still alive, and that he has never, to her knowledge, experienced any sort of hardship due to fire or arson.
I informed J that it may be necessary for him to take time off from work to undergo treatment, and he became visibly agitated. He professed a great deal of anxiety about needing to “catch them” before some unspecified rival could do the same. I asked him to clarify how this activity fit into his work as a recording engineer, but before he could answer he leapt to his feet and began chasing a small moth around the room. He finally smashed it against a wall, declared that it had “fainted,” picked it up off the ground, named it “Gary,” and slipped it into his jacket pocket.
I have arranged for J to be admitted as a patient under my supervision at Harbor View Psychiatric Hospital.
The patient has yet to respond to medication. The nursing staff reports that he has seamlessly incorporated all aspects of his treatment into his delusion. Each morning, when he receives his pills, he shouts “power up!” before ingesting them. He then makes several more loud declarations while careening around the room in a frenetic burst of energy. When I replayed the security footage from this morning, I clearly heard him exclaim “spinning bird kick!” before flipping into the air, splaying his legs wildly, and crashing down hard on his neck and shoulder. He did not sustain any significant injury. But until we discover the proper sedative to eliminate these outbursts, the patient will henceforth be restrained before receiving medication. At this point his is a danger to himself and those around him.
Interpreting the true meaning behind the patient’s speech is a ongoing challenge. The following is an excerpted transcript from yesterday’s therapy session.
DOCTOR: How are you reacting to your new prescription?
PATIENT: This patch sucks, man. They totally nerfed Feign Death.
DOCTOR: I… see. You’ve… you’ve had difficulties sleeping?
PATIENT: Shit, don’t tell me those assholes took out the rest bonus too. Am I just supposed to fucking farm mobs all day?
DOCTOR: Well, we… do ask that you adhere to a number of scheduled activities each day, but we also afford you several hours of free time to do with what you will. Perhaps you might consider putting it to a productive or fulfilling use.
PATIENT: Listen, I know the guild wants me to pay into the fucking bank, but I’m having enough trouble keeping my gear in repair as it stands, and that fucking epic mount don’t come cheap.
DOCTOR: [J], I don’t mean to appear prudish, but I feel that we could cultivate a more effective therapeutic environment if you made an effort to curb your profanity.
PATIENT: Whatever dickhead.
Over the past few days, the staff has observed a number of patients apparently trying to capture their flatulence in empty plastic bottles. When asked, several reported doing so at J’s behest. J denied any knowledge of the situation, but a staff member recovered this note in the common area, which clearly features his handwriting:
When I went to confront J with this evidence, I discovered over a dozen bottles stashed under his bed. They were disposed of against his protestations.
I allowed S to visit J today under my supervision. I hoped that her presence might ground the patient’s increasingly tenuous sense of reality, but I underestimated how severely his condition had degraded. Their interaction was difficult to witness, as the patient manifested one of his most obtrusive rituals to date during their “conversation.”
When S first addressed him, J produced a pen and a stack of note cards (I don’t know where he got them), and proceeded to write something on three of them. He studied each of the three several times before selecting one, handing it to S, and discarding the others. S sat in disbelief, holding the card, and asked him if he was going to talk to her. He did not respond. After a long pause, she finally seemed to accept the situation, as she read the card and asked J another question. He repeated the ritual.
Their interaction continued in this style for some time, and S showed signs of hesitant relief at the open channel of communication. (I recovered several of the patient’s cards when the session ended, and they seemed to contain only vague, noncommittal statements that varied wildly in tone and character.) At one point, S leaned close to him and whispered, “Whatever the problem is, we can fix it. And I’ll wait for you.”
J pushed away from her, stood up, and stalked over to my whiteboard. He grabbed the red pen and scrawled on a note card in large angry letters. He lurched back over to S and thrust the card at her. She read it, crumpled it into a ball, and threw it at him as she walked out. J sat back down and stared into nothing.
I recovered crushed notecard. It read, “You’re the one with the problem, bitch.”
I stayed in the room with the patient, and called in a nurse to bring him some water and 2 mg of clonazepam. Once medicated, I sensed that the patient had entered a brief moment of lucidity, and I asked him why he wrote something so vile.
“I don’t understand,” he said. “I picked the red one. It always works.”
The patient no longer responds to his name. Whenever I go to speak with him, he presents me with a note card (he cannot function without them), across the top of which he has written “Enter Player Name,” and underneath he has marked five spaces for letters. At first, I tried to write his full name on the card, but he tossed it aside and presented me with another. Now I only fill in the first five letters.
Once I’ve given him a name, he wanders the halls, pressing the card against his chest with both hands. He walks up to people and stands right in front of them, as if to initiate a conversation, but he never says a word.
I fear that, despite my best efforts, whoever once inhabited that body has been lost beyond hope of retrieval.