The patient was far more talkative this morning. It seems he was energized by recent plans his protest group has made for a demonstration outside the courthouse. He said when he first came to Boston, he hoped things would be “different” and society would be “fixed.” But except for his friends at the protest and the co-op, he said he’d seen nothing but abuse by the wealthy and sorrow among the poor. He said that no one sees it – the torture that goes into our fast-food meals, the struggles of the people at the bottom of society, the abuses by the rich and powerful. He hopes this protest will “make people see” what is going on. He hopes it will “wake them up” and cause them to take action.

When I asked “what kind of action?” he began to choose his words more carefully. “Whatever it takes,” he answered. “People will never live the lives they are meant to unless they wake up to the world as it really is.” And if they can’t live the lives they’re meant to? He responded that it’s not really living anyway.

I returned to the topic of his travels, hoping to learn more about his background and family. He was again guarded, but he answered that he was born in London. His family and friends were all dead, he said. Dead a long time ago. His memory of his journey to the US seems to be muddled. Perhaps he has a history of drugs or alcohol abuse? He said “nothing like that” is allowed at the co-op, but I cannot rule out the possibility.

When I asked about his parents specifically, he was more or less indifferent, not hostile or withdrawn as I would expect if there had been some form of child abuse that was causing his current condition. Perhaps it was some other form of authority that hurt him? That would make sense, considering his current interest in protesting.

I am reluctant to recommend medication until I understand his history more fully and the cause of his reticence. I suspect that with time to adjust to his life at the halfway house, he will be able to turn his anger at whatever injustice was committed against him in the past to more constructive ends. His participation in an outlet like protesting suggests that he is willing to work through the pain or guilt of his past by engaging in positive movements for wider social change.

Thoughts?

I had my first session with my new patient this morning, so here’s an update. Thanks for your comments so far – sorry I haven’t been able to answer them all individually. I hope this internet exercise will lead to some interesting insights without having to reveal any confidential information. I will stick to what is commonly accepted in academic journals, which should be enough for you to help me research the patient’s condition. The patient wasn’t very forthcoming this session, but we have another session scheduled this week which hopefully will reveal more.

When the patient (hereafter referred to as a “he”) came in, he was reserved and treated his environment with suspicion. I began by asking him why he came to see me. He said that his friends told him to come, that it might help him “adjust.” His friends appear to be protesters he met while living on the streets of Boston’s North End. He found a flier advertising a protest with free food. One of the protesters noticed him and offered to take him to the co-op where she volunteered occasionally.

His accent seemed foreign, and when I asked him about it, he said only that he had “been around.” He refused to elaborate no matter how hard I pressed, withdrawing and presenting me with nothing but a stony silence in response to questions about his family, his birth, and his home. As one of you pointed out, there are many possible reasons for this, but he was surprisingly hostile rather than simply vague.

He was also reluctant to talk about the protests; protesters are usually eager to talk about their causes and passions, but the patient answered questions about his personal beliefs evasively with responses like “I believe in justice” and “people deserve what they get.” I asked if he’d ever known what it felt like to be mistreated by someone in charge. This seemed to trigger a memory he wasn’t sure how to talk about and caused him to grow even more distant.

After a few more minutes of questioning, he stood up to leave. As he opened the door, he turned and said that yes, he had been wronged once, by someone important. Once – “a very long time ago.”