PSYCHOLOGICAL EVALUATION
MANEHATTAN PSYCHIATRIC HOSPITAL
CASE NUMBER: 51097
Inside this thick, tan folder lies your memories from your childhood. At least that's what you've been told. When they relieved you from the hospital, you took it because it was the only way you could remember what your childhood was like. This would be the second time you've read the folder, and it certainly wouldn't be the last. You gingerly open the folder, and begin inspecting the contents. The first thing you notice everytime you open the folder is a picture of yourself, as a young colt. You stare at it for a few moments before proceeding. What follows is your entire childhood.
Case No.: 51097
Building No.: 7
Examiner: Dr. Riley Sigmund
PURPOSE FOR EVALUATION: Patient has been admitted to Manehattan Psychiatric Hospital due to early signs of depression and possible psychotic features. Purpose for evaluation is to screen for evidence of depression and other possible psychotic ailments.
BACKGROUND INFORMATION: Patient was born to Pegasus-ponies. According to report from patient, his relationship with parents was "wonderful." Mother and father medical reports include no diseases, psychological disorders, or psychical abnormalities. Parents have no history of substance abuse or mental problems. Parents were not known to be aggressive or abusive to patient. No known relatives of patients were found. Until death of parents, patient was reported by faculty of Cloudsdale Junior Flight School to be, "brash, assertive, kind-hearted, playful." This is no longer the case. Patient was not to leave hospital grounds, due to the fact that there was no one that could be trusted (relatives, guardians, etc.) to attend to him. Instead, child was to be kept at hospital until he was officially mentally stable, be turned over to foster parents, or, the less favorable option, until he had grown old enough to be on his own. Medical staff had questioned the ethical morals behind this, but this was settled quickly. As the patient could not be allowed to leave, patient was educated by tutors brought into hospital. Patient had been attentive to teachings but showed no determination or motivation to attend teachings. Patient has, as said by tutors, to have an adequate education, averaging out with others in society. The medical staff and I had done this to assure that the patient could function in society.
REPORT FROM POLICE CASE: Reports of robbery around Cloudsdale were slightly higher than normal. For every event of robbery, no pony was harmed. However, this is not the case for this crime. Forced entry of victims' home is evident. Hinges on door are destroyed. Evidence implies that more than one pony was involved in entry. No visible hoof-prints can be found on door. Sign of struggle is evident as well. Female victim was forced into living room, male victim as well. House is ransacked for valuables, such as jewelry, collectibles, etc. Victims are then murdered. Male victim showed bruising, cuts, scrapes. Laceration to aorta was cause of death to both victims. Suspects then leave residency. According to faculty of Cloudsdale Junior Flight School, child of victims had not left school grounds to be at crime scene. Witness statements verify this. Statements from witness that had found child, (name omitted) follow:
She had seen the home of her neighbors ajar. Witness moved closer to inspect home, and noticed that door was kicked in. Witness reported to hearing cries coming from a colt. As witness approaches living room of residency, she reported to seeing the child of her neighbors laying between the two bodies of the victim. Child was reported to be covered in blood of victims and calling for parents. When child was approached, witness could see that child's coat had dried blood, stating the possibility that the child could have been there for hours. When authorities came to investigate the crime scene, child was taken to medical hospital to be examined for injuries. After no injuries were present, child was seen to be depressed and lonesome. Child refused to cooperate with police staff. Due to the possibility of psychological problems, child was transferred to Manehattan Psychiatric Hospital after no relatives could be found.
MENTAL STATUS EXAMINATION: After multiple tests expanding over the course of a couple of years, results were insignificant. Patient, at first, had showed signs of a possible recovery. However, patient became less motivated to participate in examinations. Patient had changed his attitude. He was closed and uncooperative. His mood was consistently sad. Speech functions began to deteriorate, as child was isolated from society, other than medical staff present at hospital. Vocabulary and grammar skills were appropriate for his age. Memory functions were less than adequate. Patient had trouble remembering certain events, however, still had a recollection of other childhood events. Unfortunately, patient still had memory of crime scene of his parents. Patient reported to night terrors, hallucinations, and depressive episodes. After seven years of various techniques, including rational-emotive therapy, cognitive reframing, and other repeated attempts to help the patient cope with death of parents, medical staff began losing hope as well. Patient took notice of this, as patient had also began to become even less motivated than he had previously been. Again, patient still had visions of crime scene of parents. After repeated failures to help the patient, the medical staff and I had decided to gain the help from a unicorn doctor who specialized in memories. We knew the cause of the patient's depression was the crime scene, so we had hoped the unicorn could erase that memory. Since the patient was beginning to lose memories, time was of the essence. The unicorn doctor had come to perform the procedure. However, the procedure had gone wrong. The doctor had lost control of the procedure, and instead of helping the patient, only caused significant damage to his hippocampus. The following is a line from the neurological report that followed the accident:
Direct damage to the hippocampus is evident. Upon taking an MRI, brain activity in the portion of the temporal lobe that was associated with memory below average. Memories prior to the accident will be lost, however, the rate of how often these are lost is unknown. Memories after the accident can still be formed, however, they will only be retained by the level of significance it had on the patient.
The patient, now only a year from being able to legally leave the hospital, had grown to be pessimistic. He no longer trusted the medical staff. I was the only examiner that he talked to anymore. Patient had become hostile and aggressive. Patient still had tendencies to be depressed, and I had found evidence of suicidal tendencies. Patient was still suffering from night terrors, but refused to share them with me. However, I believe they are directly related to his parents.
RESULTS OF EVALUATION: The patient hardly benefited from the years of medical practice and procedures we had performed on him. The strength of his memory had become horrible. Many parts of his childhood were now gone, ranging from his time at the Cloudsdale Junior Flight School, to joyous events and memories with his parents. Unfortunately, he still retains the memory of his parents' death. Patient has no desire to interact with others and also has a hard time trusting others. As I noted above, he no longer trusted the medical staff except for me, which he hardly does. Patient cannot converse with others very long, however his language skills are remarkable for someone who has refrained from speech. These language skills are evident in the reports he was asked to fill out. He was very descriptive when asked to describe his vision of his parents' death. Anything other than memories or social-interaction doesn't seem to be affected by this vision of his.
SUMMARY/RECOMMENDATIONS: Unfortunately, the patient has not recovered from the psychological conditions he has, which are (some of these are not caused by the death of his parents): MDD (major depressive disorder), retrograde and anterograde amnesia, suicidal tendencies, low-self esteem, aggressiveness, trust issues, psychosis, paranoia, anxious, delusional. With all of these mental conditions, the patient is incredibly mentally unstable. However, two issues prevent us from helping him any longer; 1: He will soon be of legal age to leave the hospital. Under law, we can no longer force him to stay. He has also made the decision to leave the day he can. 2. The city of Manehattan is no longer funding the hospital. Instead, a new institution will be created somewhere else in the city.
The patient will not be able to make any relationship with anypony. His mental condition will not allow him to build a trust with someone else, and his speech is less than adequate. The problem is not forming sentences, but rather it is the lack of interest to form sentences. After asked to evaluate his condition once more, he stated, "I no longer wish to communicate with anypony else." He also is incredibly aggressive towards others, but fortunately, only when he feels threatened. However, he can easily feel threatened. Although he will not be able to build a relationship, he can still communicate for basic needs. I discovered this when I saw him ask one of the medical staff for food. Although he responded bluntly and emotionless, he can communicate with others, just not enough to build relationships.
Due to the crippling mental state that the patient is in, I've convinced him to monthly report to my new office. This will allow me to keep in contact with him, so that I can evaluate him to see if his condition worsens or not. I will also prescribe him anti-depressants, now that he is of legal age to ingest them. However, I do not feel that this will benefit him. There is nothing more I can do to help this patient. Years of medical practice on him has only, unfortunately worsen his condition. Although I put my trust in my medical team, I'm beginning to believe that it would have been much more beneficial to have put him in a foster home or orphanage. Years of isolation from the outside world only prove to destroy what social skills he had before the death of his parents. The only hope for him is if that memory or vision, or whatever he has decided to classify it as now, of his parents' murder, becomes erased, much like his other memories. But, he seems to have latched himself onto that memory. I believe that he may blame himself for their deaths, regardless of the fact that he had nothing to do with it. Unless previous memories of more, "happier" times are returned, the patient shall continue to be depressed.
Honestly, I myself cannot help but feel responsible for his conditions. In all of my years of helping patients recover from whatever they were suffering from, this is the only patient that I've not only been able to help, but only made worse. I know that he blames me for his conditions, and I take full responsibility for my poor decisions to keep him in the hospital, and for destroying his memories.
Please let me know if any additional information is needed concerning the results of this evaluation.
_________________________________
Riley Sigmund, Ph.D.
Psychologist
That was it. Your entire childhood, written in the form of a psychological analysis. You despise this report, with every fiber of your being. Yet, you cannot get rid of it. This report defines you. It explains why you are the way you are. Somehow, you find comfort in that.
Although you have anterograde amnesia, which means you have trouble creating new memories, you remember just a few hours ago when you left the institution. You remember, although hazily, walking towards the main lobby. You knew all of the medical staff, and they believed that you knew them on a personal basis. Quite the contrary, actually. It wasn't that you despised them, but rather you've had enough. You've had enough of all of them trying to fix you. You knew you weren't able to be fixed. You walked up to the receptionist desk, and the receptionist immediately knew you.
"So, this is it, huh?" She asked politely.
You didn't reply. This is what you were fed up with as well. They all knew what mental condition you were in, even you knew yourself at this point. Why had she tried to cheer you up? You were well beyond the point of recovery, so why did she bother? This is what angered you. You were ready to release years of pent-up anger all in one burst of rage. But you controlled yourself. That was one ability you had left, to suppress your anger. The receptionist then hands you a clipboard. On it was the release form. The piece of paper that would release you back into the free world. Without any hint of hesitation, you sign the form, drop the pen, and begin to walk out.
"Wait!"
You stopped, and turn around and see the receptionist holding a saddle-bag.
"This is from all of us at the Manehattan Psychiatric Hospital. We're giving you a few hundred bits to help you get settled somewhere. Dr. Sigmund also said it would be best to give you your case file for your own reference. I also want to say how much we deeply regret not being able to give you the proper help you needed. We... w-w."
You noticed that she was holding back tears. Why did she care about you? You were just another patient that failed to recover from their state. She never finished her sentence. She simply put the bag on the counter-top and walked away. You were confused.
"Was it my fault? What did I do?" you thought to yourself.
Regardless, you were glad. Less social interaction for you. You opened the saddlebag to see the other contents of the bag. Inside, was your file report, a small bag containing the few hundred bits. This was the first time you read your psychiatric report. There were also three small yellow containers, which contained your anti-depressants. There were also three apples. You and your psychiatrist discussed taking the pills, and you had agreed. But really, you only decided to take them to help ease Sigmund's fear of you committing suicide.
You strap on the saddlebag, and walk towards the exit. You stop before the exit. You've only been outside on two other occasions. Both being when there had been some sort of accidental fire where everyone had to evacuate. You take a look at the outside world, and you feel your heart beating. This feeling is one you've never experienced before. Or maybe you have when you were younger. Not that you would remember. You continue to walk, your heart's beat getting stronger with every step you take closer. You place your hoof on the door handle, you push forward, and feel the sun shine on your darkened coat.
For the first time, you take a breath of fresh air. You extend your wings that you haven't used in years. You let the light dilate your eyes. It was, admittingly, one of the few moments that you truly felt at peace. However, that only lasted for a few seconds.
After that, you promptly left the city. You knew that if you truly couldn't communicate with others, that you must leave Manehattan. You would never survive in the city. You continued down the road without looking back and stopped a few miles away, taking a rest near a tree. That was where you read your report the second time. You placed the report back in your saddlebag, and took out one of the yellow containers. You read the label out loud.
"Anti-depressants. Take two every 24 hours. DO NOT TAKE MORE THAN THE PRESCRIBED AMOUNT." reading each word with a blank statement.
You place them back in. You weren't going to take any yet. You just got up and continued on your way. You honestly didn't know where you were going, nor did you care. You were just glad to be alone.