I received a phone message from BB’s mentor at the halfway house. He said BB had been a model citizen, quiet and reserved and doing everything he asked to help out around the buildings and grounds. I’ve been considering ways I could try to (safely) evaluate what BB said over the phone in order to decide whether he ought to be reported to law enforcement as dangerous. I have contacted a detective I recently heard about who is also from Europe. I thought he might be able to get some information on my patient and find out if there’s any chance he really committed these crimes. For my part, I believe I’ve settled on the idea of hypnotism to get at the truth. Although its usefulness hasn’t been completely proven, I believe that even the illusion might be helpful in getting this patient to open up about the violent anguish he clearly feels – without running the risk of his exhibiting actual violence.

Well, I just checked my messages from the weekend this morning, and I apparently received a somewhat frantic phone message from my new patient on Saturday night. He seemed extremely agitated and began confessing all manner of crimes which it seems impossible to me that he has actually committed. His tone and casual attitude towards violence was disturbing, but I believe something in his psyche was released that led to this outrushing of opinion and constructed narrative. This would seem to be borne out by a follow up message he left the next morning claiming he was drunk and was unsure what he might have said to me over the phone. I have not yet decided what to do with this new development. I do of course want to help him if possible, but based on the graphic nature of his discourse, I may need to recommend him to the police for further evaluation.

In the meantime, I think I’ll keep the messages as evidence and switch to a new number. I will update when I decide what else to do.

First off, some news – I’ve had some promising developments on the paper front. I spoke with a university professor at a party recently who is looking forward to seeing what comes of my Web 2.0 experiment and my work with BB. It’s been a busy couple of days, but I wanted to report on my most recent session.

When BB arrived, his appearance was disheveled. It seems he had gone out drinking with his friends and wasn’t allowed back into the co-op last night. I asked if he had given any thought to what he might do if they refused to let him return entirely. He said his friends would of course help him out, but I encouraged him to think about what meaningful work he might engage in to help him find a new life after his time of transition is complete.

We talked about how to meet people and appropriate conversation topics. He seemed to be following along and finding the experiment useful until I brought up the subject of his attitudes towards women. I asked him to pretend he saw a woman working next to him at the coop, writing a letter or cutting flowers in the garden. I told him to pretend she looked up at him and smiled. What should he say after she introduces herself? Should he shake her hand?

He got that distant look in his eyes again and said “they stay with you, don’t they? Even when they’re gone, they’re still in your head. They never leave.” I asked him what he meant. He started talking about death and how it’s a relief and how everyone deserves to die. He grew more and more agitated and only calmed down after I returned the conversation to other matters.

There is clearly much to investigate on this topic, but I need a way to do it that helps him continue to speak freely.

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.”

A new patient visited my office early last week requesting an appointment. Now that I’m experimenting with social media and “Web 2.0,” I thought this case might be an ideal test of the medium. There are quite a few mysteries surrounding my new patient. Although I can’t give out any revealing details due to confidentiality agreements, I hope that the Millennial brand of “crowdsourcing” may lead to new insights or approaches.

The patient appeared to be in his thirties and had an unkempt appearance as if he’s spent time on the streets. He was withdrawn and sullen and lives at a local cooperative where members share food and chores around the property. It includes a small garden and a “halfway home” for former homeless citizens. No family members or prior addresses were mentioned on his information form. It’s almost as if he appeared in Boston out of nowhere.

His first appointment is next week, so I will be sure to post an update after the session. In the meantime, feel free to let me know if you have any theories.

This has been a busy week! I’ve taken on several new patients, and I’m thinking about writing a paper to submit to a local university. I’m hoping to use social media to evaluate the justifiability of ‘five axis’ DSM diagnosis and perhaps develop new avenues of treatment based on group evaluations. One of the patients who came into my office this week was particularly interesting. Perhaps he will make a good test candidate.

On another note, a few months ago, I noticed this article. It has a lot to say about how connecting online can disconnect us in the real world. What do you think?

The Atlantic: Is Facebook Making Us Lonely?

Welcome to Minds and Matters! I have started this blog as a way to explore the potential of social media in the psychiatric discipline. I also plan to explore some of the ways social media are impacting our mental health. I will be posting some further information soon, so stay tuned!