Almost Gone - Requested Opinion (by Catarina Ramos)

To: elizabethrich_clinic@gmail.com

From: brunothatchercpf_uri@yahoo.com

Dear Dr. Rich,

 As requested, I have reviewed the patient files you have sent. The reports are attached below, as is my opinion about the cases.

With no further additions,

 Bruno Thatcher

[Behavioral Specialist, Clinical Psychology Department – Clinical Psychology Faculty, URI]

Attachment One:

                  “Patient file number 10769 – Helena [Redacted]

Patient records show a recommendation from one of the doctors to a psychologist due to a mental disturbance, later dubbed as an episode.

Session notes show that the patient came with her husband – who was described as resistant. The episode was registered but the patient was never fully diagnosed – the psychologist’s notes suggested that the underlying cause would take years to be found. Medication was instead given for the symptoms described – delusions, strong headaches, time and memory distortion.

Medical records also show that the patient was not born in the United States of America, so environmental causes would be harder to pinpoint. There were also additional risks due to two miscarriages – which could have provoked an unbalanced production of hormones – and possible dormant conditions – possible past trauma, not looked into due to lack of follow-up consultations.

After analyzing this case, I believe it is possible to conclude that the patient suffered from undifferentiated schizophrenia – possibly subduing with the intake of medication, as after the consultation took place, no more episodes or disturbances were recorded.”

Attachment Two:

                  “Patient file number 89207 – Scott [Redacted]

Medical records show a possible genetic predisposition for mental instability due to a previously recorded family incident. Despite this, the patient never showed any sign or symptom of schizophrenia – as any other mental instability – before

According to Doctor Rich’s notes, the patient’s wife described a change in behavior after two occurrences surrounding their daughter: her leukemia diagnosis and later unexpected death. Such would suggest these events were the trigger behind the patient’s almost sudden behavior change. Much like the patient’s grandmother, there seems to be an obsession in a certain subject – in this case, the patient’s daughter, Emily – to the point where anything else is considered unimportant and the attention span is drastically altered. Not registered in those records, but indicated by the patient’s wife – currently under Doctor Rich’s care – are symptoms such as hallucinations and dissociation, which further emphasize the need of professional counsel and medication.

As the patient stopped going to the consultations – which could also be assumed as a symptom – and the wife seems to be the only viable source of information about his most recent behavior, there is no more viable information that can prove an accurate diagnosis, despite the symptoms described pointing at either paranoid schizophrenia or undifferentiated schizophrenia.

Considering the patient’s priors, and taking into account how his behavior changed after the trigger events, I predict that his behavior and mental health will only deteriorate as time passes, unless treated as soon as possible. Currently, the diagnosis does not, unfortunately, look favorable.”

Student Commentary: Many might not feel the same way I do about this book, but “Almost Gone” by Brian Sousa is one of those reads that just leaves the reader speechless and yet, full of so many different feelings and emotions. For that reason, I wanted to avoid things that might have been too obvious to discuss, yet still talk about mundane – if not highly relatable – moments, as those are the moments that truly make us ponder about life itself. So, in my search for that middle ground, I debated between a critic and a creative piece, deciding on the latter for its flexibility in terms of usage. However, I faced another obstacle: the characters. Obviously, I wanted to talk about them, but couldn’t really talk as them, so I had to find an alternative. That was when I thought about the two shrinks mentioned in the book, and how I could then create another specialist that being an external factor, still had some weight in how two of the most damaged characters (thought that might be up for debate) – Helena and Scott – behaved and acted in the story, in an attempt to fill in the blanks without actually doing it, using the information given to the reader throughout the chapters and a possible reason as to why they acted the way they did – or in Scott’s case, do.