Case # 5.29 Session # 01 Date 09 / 28 / 06
37 year-old African-American male presents with signs of acute psychosis in the form of auditory hallucinations, delusional beliefs, and paranoia. Patient reports psychosis first arose approximately 6 weeks ago. No history of substance abuse, medications, or medical conditions that would cause psychosis. No evidence of mood disorder, depression, or violent tendencies. Possible diagnosis of paranoid schizophrenia. Recommend initial dosage of 12.5 mg Clozapine, increasing daily by 25 mg until cap at 200mg per day. Weekly psychotherapeutic sessions scheduled immediately.
Case # 5.29 Session # 02 Date 10 / 05 / 06
Session today focused on initial appearance of hallucinations. Psychosis first presented itself with auditory hallucinations in which a voice spoke to the patient in a dream and continued to speak upon awakening. Patient subsequently heard voice with increasing frequency during waking hours. At first, the voice offered a cryptic message expressing regret for "making them." Patient's severe paranoia manifests in the belief that the "them" refers to all humanity. Visual hallucinations presented themselves approximately 2 weeks after the voice was first heard. Visions described as scenes of corpses littering the streets. Patient sees himself in the visions as the sole survivor, walking among the dead. He is unsure as to how such a mass murder was completed or how he was able to survive it. Patient insists that the apocalypse is imminent.
Case # 5.29 Session # 03 Date 10 / 12 / 06
Patient not yet responding positively to Clozapine. Recommend continued treatment and a reevaluation in 2 more weeks. Auditory hallucinations are becoming more prominent. Patient insists the voice now actively interacts and engages him in dialogue. Paranoia has increased insofar as the voice now declares the impending arrival of an "end of all flesh." Patient insists that the voice refuses to answer questions regarding the means to this end. More hallucinations have presented themselves with elements spanning the destruction of both the human (entire cities left surreally deserted) and the natural (windswept forests shrouded in a tangible silence).
Case # 5.29 Session # 04 Date 10 / 19 / 06
Patient hospitalized last night due to self-mutilation reported by the patient's wife. Patient appears to have tattooed the inside of his wrist with a symbol of unknown origin. The ER physician was able to sufficiently curb the blood flow and put the patient onto a regiment of antibiotics to decrease the chance of infection. The tattoo ink is consistent with that of a ballpoint pen, although the wife was unable to find the needle used in the procedure. Patient insists that the mark materialized on his wrist of its own accord. He does not know what it symbolizes, but he believes that it will protect him against the coming apocalypse and is, in fact, the only preventative measure. The patient still does not know how the apocalypse will occur. He denies any religious or biblical explanations. Recommend increase in Clozapine to 250 mg daily.
Case # 5.29 Session # 05 Date 10 / 26 / 06
The tattoo has been identified as the Hebrew letter M, however the patient refuses to disclose the meaning of the mark. Patient is increasingly more disturbed by his hallucinations. He reports insomnia, saying that neither awake nor asleep can he escape the visions, in which he watches people die in mass, suddenly overcome by an inexplicable inability to breathe. He claims that the youngest died first. Patient made attempt to gain sympathy and attention by singling out Tom from a photo on my desk, saying that he would be taken soon. When asked how the patient's children would fare, he claims the voice told him that they would receive the mark and are therefore spared. Patient's wife contacted me yesterday after a pseudo-violent episode in which the patient frantically searched his three children for the mark. The wife worried that the patient would attempt to tattoo the children as well. The patient insists that he would do no such thing, that the mark will appear on its own, as he claims his did. I have recommended that the patient is taken into overnight hospitalization for the time being to protect his family from any further, more violent attacks.
Case # 5.29 Session # 06 Date 11 / 02 / 06
Patient response to hospitalization has been primarily positive. He remains complacent, content in the belief that his presence is not necessary for the manifestation of his children's preservative markings. However, the patient seems troubled by some new report from the voice. He refuses to disclose what the voice has told him. He claims he is as yet unsure as to whether I'm supposed to know. Maintains that I will find out soon, regardless of whether he divulges the information.
Case # 5.29 Session # 07 Date 11 / 05 / 06
Tom is dead. Autopsy reports indicate asphyxia, due to muscular paralysis of unknown origin. Hannah found him in the basement last night. Hospital security assures me that the patient was under constant supervision and, as such, could not have been involved in the death. It has been suggested that the patient be reassigned to another psychiatrist while I take a leave of absence. Instead, I have increased the quantity of sessions to once a day. The patient expressed sympathy for my loss and assured me that there was nothing he could have done to stop it. The youngest are the first to go. They can only hold their breath for so long.
Case # 5.29 Session # 08 Date 11 / 06 / 06
The patient claims that our work is done and it is time for him to move on. I have advised hospital security to maintain maximum surveillance on the patient at all times, in case he attempts to escape. He seems amused by the idea of hospital security restraining him any longer than he desires. Letonia has taken a particular interest in my personal life, specifically since Tom's death. Auditory hallucinations now inform him that I, too, will bear the mark. The patient seems genuinely concerned for me in light of this revelation. He warns me that I, too, will be forced to watch everyone around me die. He warns me that I, too, will be unable to stop the rising tide.
Case # 5.29 Session # 09 Date 11 / 07 / 06
He was right, of course. Hospital security reported his disappearance late last night, despite my warnings that they watch him more carefully. The mark appeared today. I could feel it burning on my wrist under the shower's heat. When I left my house, the entire street was covered in water. Nearly a foot. Passed the homeless man who sleeps in the alleyway on 2nd, but he hadn't gotten to higher ground in time. The youngest are the first to go. They can only hold their breath for so long. I can hold my breath forever. The water has already taken me. Soon, the waterline will reach my chest, then my head, but I will still breathe air. They won't though. I can see it beginning. Their lungs will slowly fill with air that's not air that's liquid and they will gasp at the sky like goldfish in murky water, gasp for air that's not there and they will be frantic and raise their children onto their shoulders but even they too will eventually be overcome except for Letonia's children, all three of them, they will live, and Letonia and me, but I will be alone because Tom is gone and Hannah will soon follow and the youngest are the first to go because they can only hold their breath for so long.
Case # 9.29 Session # 01 Date 11 / 07 / 06
52 year-old Caucasian male displays symptoms of acute psychosis including auditory hallucinations, delusional beliefs, and paranoia. No history of substance abuse, medications, mood disorders, or medical conditions that would cause psychosis. Paranoia stems from belief that the world is currently in the midst of an apocalypse. Hallucinations present as a reverend by the name of Letonia who he claims was a patient of his before he resigned from his psychiatric office two years ago. No official documents indicate that such a man existed, although the doctor kept a detailed case log of supposed sessions with Rev. Letonia spanning the last 40 days. No violent tendencies, save for self-mutilation in the form of a tattoo of the Hebrew letter M. Possible diagnosis of paranoid schizophrenia due to trauma stemming from death of his son. Recommend hospitalization in conjunction with initial dosage of 12.5 mg Clozapine, increasing daily by 25 mg until cap at 250 mg per day. Biweekly psychotherapeutic sessions scheduled immediately.