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MICHELLE’S CASE
Michelle brought by her parents to a Psychiatrist because of her unusual behaviour. Based on the client’s report,
“At one point, I would look at my co-workers and their faces would become distorted. Their teeth looked like fangs ready to devour me. Most of the time, I couldn’t trust myself to look at anyone for fear of being swallowed. I had no respite from the illness. Even when I tried to sleep, the demons would keep me awake, and at times I would roam the house searching for them. I was being consumed on all sides whether I was awake or asleep. I felt I was being consumed by demons.”
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ASSESSMENT AND DIAGNOSIS [CASE ANALYSIS NO.2]
RAMONA K. CASE
When she was 20 and had been married only a few months, Ramona Kelt was hospitalized for the first time. According to records, her mood had been silly and inappropriate, her speech disjointed and hard to follow. She had been taken for evaluation after putting coffee grounds and orange peels on her head. She told the staff about television cameras in her closet that spied upon her whenever she had sex. Since then, she had had several additional episodes, widely scattered across years. Whenever she fell ill, her symptoms were the same. Each time she recovered enough to return home to her husband. Every morning Ramona’s husband had to prepare a list spelling out her day’s activities, even including meal planning and cooking. Without it, he might arrive home to find that she had accomplished nothing that day. The couple had no children and few friends. Ramona’s most recent evaluation was prompted by a change in medical care plans. Her new clinician noted that she was still taking neuroleptics; each morning her husband carefully counted them out onto her plate and watched her swallow them. During the interview, she winked and smiled when it did not seem appropriate. She said it had been several years since television cameras bothered her, but she wondered whether her closet “might be haunted.”
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ASSESSMENT AND DIAGNOSIS [CASE ANALYSIS NO.3]
MELANIE’S CASE
This was Melanie’s first pregnancy, and she had been quite apprehensive about it. She had gained 30 pounds, and her blood pressure had been slightly too high. But she had needed only a spinal block for anesthesia, and her husband was in the room with her when she delivered a healthy baby girl. That night she slept fitfully; she was irritable the next day. But she breastfed her baby and seemed to listen attentively when the nurse practitioner came to instruct her on bathing and other postpartum care. The next morning, while Melanie was having breakfast, her husband came to take her and the baby home. When she ordered him to turn off the radio, he looked around the room and said he didn’t hear one. “You know very well what radio,” she yelled, and threw a tea bag at him. The mental health consultant noted that Melanie was alert, fully oriented, and cognitively intact. She was irritable but not depressed. She kept insisting that she heard a radio playing: “I think it’s hidden in my pillow.” She unzipped the pillowcase and felt around inside. “It’s some sort of a news report. They’re talking about what’s happening in the hospital. I think I just heard my name mentioned.” Melanie’s flow of speech was coherent and relevant. Apart from throwing the tea bag and looking for the radio, her behavior was unremarkable. She denied hallucinations involving any of the other senses. She insisted that the voices she heard could not be imaginary, and she didn’t think someone was trying to play a trick on her. She had never used drugs or alcohol, and her obstetrician vouched for her excellent general health. After much discussion, she agreed to remain in the hospital a day or two longer to try to get to the bottom of the mystery.
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