The Renfield Syndrome by Clifford Beck - HTML preview

Chapter 21

Eventually Caspian was admitted to a treatment room in the hospital’s small psychiatric department. He had been required to change out of his clothes and into a set of paper scrubs. He did not ask why but assumed it was for his safety. His clothes had been put in a large plastic bag and handed off to a security officer. He would get them back upon either his discharge or transfer—if admission to another hospital was warranted. Soon the social worker arrived and, with Reuben and Dorothy, sat in the treatment room with Caspian. As small as the room was, Caspian was quite comfortable as he knew everyone there. Shortly a middle-aged man walked in with a chart. He appeared to be in his early 60s and sported a nearly white beard. Sitting in a chair across the room from Caspian, he made a brief visual examination, looking at his expression as well as any odd behavior. Aside from a slight suspicious look on his face, he saw nothing of interest.

The doctor glanced over the sparse notes that had been compiled upon his admission and, folding the chart, laid it on his lap.

“Caspian, right?” he asked. His question was met with little more than a nod.

“Okay,” the doctor continued. “I’m Dr. Sinclair. I’m one of the psychiatrists here at the hospital.”

Caspian became visibly nervous, realizing his fear of being ‘analyzed.’ He was uncomfortable with the idea of anyone trying to ‘get into’ his head. He had become a very private person and felt quite strongly that unless he chose to share them, his thoughts were his own. The doctor noticed how Caspian broke eye contact and looked away toward the floor. Realizing that most people are uncomfortable in the company of a psychiatrist, Doctor Sinclair set the chart on the chair next to him and tried to engage Caspian in casual conversation.

“Caspian,” he said. “What happened?” Looking down at the floor, Caspian paused as he tried to find the words to describe the experience that brought him to the hospital.

“Well,” he began. “I got into painting. You know, just to blow off some steam and maybe distract myself.” The doctor hung on his every word. “From what?” he asked.

Again Caspian hesitated as he tried to think of where to start. How far back did he need to go?

“Well, first my mother abused me from a pretty young age,” he replied. “I’m not even sure when it started, but I know I’ve had anger issues for a long time.”

Now, Doctor Sinclair picked up the chart and started writing notes. If he were to send Caspian on to a private doctor or a hospital where he could receive better care, their conversations would have to be documented.

“You’re writing this down?” Caspian asked.

There was the intimidation again. “Well,” Doctor Sinclair began. “This is a hospital, and the health care relies pretty heavily on documentation.” Although Caspian understood his point, it did nothing to ease the anxiety of his life being recorded for others to see.

“So, Caspian,” he continued. “When did you start hearing voices?” Clearly the doctor didn’t have all the facts and likely assumed that anyone who came into the hospital with signs of psychosis must be experiencing hallucinations. This was not the case. Well, not really.

“I don’t really hear voices,” Caspian answered. “They’re just whispers.” The doctor continued with his notes. “So, where are these whispers coming from?” he asked.

Another pause. How do you describe a hallucination, even to a trained psychiatrist? At this point, Caspian was becoming visibly uncomfortable not only with the questions being put to him but also with the tension created by how he would answer them. “At first, I heard them as I was going to sleep or waking up,” he said. The doctor nodded his head, knowing these experiences are common with many people as he documented the terms ‘hypnagogic’ and ‘hypnopompic.’ One occurs when someone is just falling asleep, while the other occurs when they begin to wake. Although the whispers started during these phases of sleep, they had managed to creep into Caspian’s waking life, expressing themselves from the painting that still hangs on his bedroom wall.

The idea of auditory hallucinations expressing themselves from an inanimate object was not surprising to Doctor Sinclaire, but he had only one question about it.

“Reuben tells me you did a lot of painting,” he began. “What was it about this particular painting that seemed so unique? Why did you pick this one to hang on your wall?” This had never occurred to him before today.

“I guess it just seemed to say something that the others didn’t,” he replied. “I guess it’s the eyes.”

“So, you painted eyes on this one?” Doctor Sinclaire asked.

The deeper the conversation got, the more uncertain he had become about everything. He was even beginning to doubt his sanity.

“Doctor,” he began. “Do you think I’m crazy?”

At this point, Doctor Sinclaire put the folder back on the chair, and searching for an answer, answered his question with another question.

“Well, Caspian,” he began. “I hear that question a lot, and to be honest, we don’t use that word here. I don’t even know what it means. Now, do I think there’s something going on that needs to be addressed? Yes. It’s just a matter of what approach to take.”

“I don’t understand,” Caspian replied. This statement terrified him, as he understood it as which hospital he would be locked up in. Given his past, he knew he would never be able to deal with any level of confinement, and having expressed this fear only served to limit the doctor’s choices for an effective treatment.

“Well,” Doctor Sinclaire replied. “There’s hospitalization. We have a limited program and would admit you for about a week for intensive therapy and medication.”

Caspian sat back in his chair, and taking a deep breath, tried to fight off the idea of being confined for any amount of time. The doctor, sensing his concern, leaned forward and, speaking in a gentle voice, attempted to dissuade his fear.

“We could handle this through outpatient services—counseling and medication management. Does that sound okay?”

It didn’t take Caspian long to agree, knowing that this was likely his only option.

“When do we start?” he asked. The doctor wrote another note in the chart then asked what he believed to be a critical question, one that Caspian’s treatment would hinge on. “Alright,” he said. “But let me ask you this: are you safe to go home?” Caspian was confused. He thought they were there to discuss the whisper coming from the painting. “What does that mean?” he asked. Most people understand that question as soon as it’s asked.

“Well, let me ask you this,” the doctor continued. “Do you have any thoughts of hurting yourself or anybody else?” Caspian paused for a moment, knowing that if he gave an honest answer, he’d likely be locked up. The only thing he wanted to tell the doctor was that he had killed his mother, revealing every detail. But that would get him into far more trouble. “I don’t think so,” he replied. He let the conversation die as the doctor seemed to go through a mental list of other questions.

“Any drug use?” he asked. “What kinds of drugs?” Caspian replied.

Doctor Sinclaire interpreted his answer as evasion and noted in his chart that substance use was likely. “So,” the doctor said. “This whispering: is there anything about it you might understand? Any words?” Caspian didn’t have to think very long to reach an answer.

“I’m not sure,” he answered. “Sometimes it sounds like words, but I just can’t make anything out.” Now, Reuben spoke up, wanting to know how Caspian’s treatment would progress.

“Well,” the doctor began. “I’m not seeing a lot of things I would call psychotic, but I do want to put him on some Risperdal—just a small dose as a preventative measure. I would also like to refer him to a psychiatrist.” This word did not settle well with Caspian, and believing that only crazy people saw psychiatrists, he immediately spoke up in protest.

“Doctor,” he began. “Look, I’m not fucking crazy, and I don’t think I need to see a psychiatrist. Isn’t there some other way? I mean, I’ll take the pills, but a psychiatrist?”

Doctor Sinclaire nodded his head. He had heard many people try to wiggle their way out of therapy with this exact rationale. ‘I’ll do this but not that.’ People don’t think much of taking pills, but put them in a chair in front of a psychiatrist, and they suddenly feel as though someone has labeled them as insane. They would come to this conclusion, never realizing that the word ‘insane’ is strictly a legal term and is never used in a clinical setting.