Patient File 10634

__NOWYSIWYG__ ''This contains excerpts of the file of Patient #10634, who resided at the Collingwood Asylum for the Criminally Insane from 1954-1959. The file is incomplete, but some parts of the admission form and case papers are still intact.''

Admission form:

Patient Name: -withheld for privacy-

Age: 23

Gender: Female

Occupation: None

Place of abode: No fixed address

Date of admission: April 12th, 1954

Marital status: Single

Native place: Port Highmount, Ohio

Religious persuasion: None

Previous admissions: None

Observed symptoms prior to admission: Though the patient was of no fixed abode, it is reported that she tended to reside within the doorways along one particular stretch of road not far from the home of her parents. According to statements made by her father, she would frequently appear at their door to ask for shelter, money, food or other amenities. The father is adamant that he loves his daughter but they have no more left to give - the patient has frequently abused their trust and has even been violent towards her mother. He recalls one incident in particular in which the patient, having been refused money, appeared to "switch off"; she closed her eyes and repeatedly struck her head against the frame of the door until the father managed to pull her away. She received hospital treatment and the explanation provided at the time was that it was a fall or various other form of accident. Blame was not attributed to the patient. Another account provided by the father states that [the patient] once spit on, hurled abuse at and struck her mother in the stomach when she answered the front door. Other residents of the street where she most often slept report numerous accounts of "odd" behavior. One Mrs Siebold recounts a time where she saw the patient sitting alone, facing the fence of a garden with her back to the street, and when approached by members of the public, she would simply scream until they left her alone. One Mr Allinson describes [the patient] as "unholy", stating that she would often walk up and down the street at any time of day or night shouting obscenities and blasphemous phrases. When asked to stop, she would scream and then continue. However, none of the above incidents were reported as a matter of concern to the police or any other point of authority.

Offense committed/reason for admission: At around noon on March 2nd, 1954, the patient left the street near her parents' home and attempted to ask several members of the public for assistance with a number of bags she was carrying. These bags contained belongings she had retrieved from her parents' home over a number of years. According to the patient's statement to the police, almost everyone she asked refused to help her apart from one "nice handsome man with a strange hat". The patient describes the man as being "very kind, nicer than [her] father". They walked together down a residential street roughly one mile from her parents' abode. According to witnesses, [the patient] was loud and jubilant, talking about how she was going to board a train to the next town, meet a wonderful husband and live in a big house. One resident, intrigued by the vociferous "child-like" ramblings, opened his front door to try and hear the rest of the conversation. According to him, it was not very much a conversation - her male companion simply smiled and nodded occasionally and they continued walking. No witnesses can report on the time between this event and the time that the police were called to the site of a dead body two days later. The victim was later identified as -victim name withheld-, a man from Port Highmount, who had not been seen by family and friends since the morning of March 2nd. The body was not intact when it was found. The smallest toe from each foot and the smallest finger from each hand were missing, and it appeared that there had been an attempt to remove the victim's left eye. The victim appeared to have been stabbed multiple times in the chest, neck and abdomen. A short while after the discovery of the body, a member of the police force on patrol in the East Balfort area of Port Highmount, roughly half a mile north of the crime scene, came across a woman covered in blood, carrying three full paper bags. When he asked after her welfare, she claimed that the blood was not her own. The officer arrested the woman and took her to the nearest precinct station. Once there, her belongings were examined and two human finger digits and two human toes were found amongst a bag of broken children's dolls. A blood-drenched knife was discovered in another bag containing empty food cartons.

This is an extract from the interview transcript:

Inspector: Would you like to tell me how those fingers and toes came to be in your possession? [Patient]: I stole them from a nice man. Inspector: Is that nice man dead or alive? [Patient]: There was a lot of blood. A lot of blood. A lot of blood. Inspector: Is that man dead? [Patient]: There was a lot of blood. Inspector: We found a man surrounded by a lot of blood on Fermont Street. That man was dead and he was missing some fingers and toes. Did you hurt that man? [Patient]: I couldn't get his eyes. I tried so hard. I couldn't get his eyes to come out. Inspector: Why did you want his eyes to come out? [Patient]: He was staring at me. He stared at me before the knife and he stared at me after the knife. He was a nice man but he stared at me. I don't like people staring at me. Inspector: How did you meet this nice man? Did he tell you his name? [Patient]: No names. He asked for my name but I didn't tell him and I told him not to tell me his name because I didn't want them to know. Inspector: You didn't want who to know? [Patient]: Them. The ones who tell me what to do. Inspector: What are their names? Can you tell me who they are? [Patient]: They don't have names. I don't know if they are people. I can't see them. I hear them. They tell me what to say. They tell me what to do. Inspector: You hear voices? How often do you hear them? What do they tell you to do? [Patient]: They tell me to hurt myself, to hurt other people. I hear them always. Every day. All the time. I scream because when I scream, I can't hear them. But screaming hurts and I can't do it always. Inspector: Okay. I don't think I am equipped to handle this interview. You need to see a doctor. But before I go, I need you to tell me exactly what the voices told you to do to the nice man. Can you do that for me? [Patient]: They told me to get the knife. I have the knife in case someone tries to have sex with me. They told me to get the knife out of my pocket. They told to stab him once in the heart, once in the neck, and once in the belly, so they would know that he is dead. When I stabbed him in the heart, he was shocked. His face scared me so I kept stabbing because I didn't want to see his face like that anymore. Then they told me to cut off one finger from each hand so he would hurt too much to grab me, and one toe from each foot so he would hurt too much to run after me. After he was dead and his hands and feet wouldn't work anymore, he was still staring at me. I couldn't stand it. So I tried to cut out his eye but it wouldn't come out. I really tried. I just didn't want him to look at me anymore. Please don't send me to jail, I don't like people looking at me. They all look at me and they call me crazy. Inspector: I need to leave the room now but I will do my best to make sure no one stares at you. I will call a doctor and they will look after you.

Sentencing: The patient/offender was charged with murder in the third degree but was judged incompetent to stand trial. The patient/offender was found guilty of manslaughter citing diminished capacity on the grounds of insanity. She was sentenced to an indefinite term of incapacitation and ongoing psychiatric treatment at the Collingwood Asylum for the Criminally Insane.

Case papers: Note - most of the patient's case papers were destroyed when the asylum was closed. Only a very few sheets of paper remain, and the written text is badly damaged by age and air contamination. There are many prolonged gaps in session reports but others, which were clearly of relevance to each other, were sealed together. Patient #10634 was treated by one Dr Emelian Pryce.

Session dated April 30th, 1954: Patient shows little engagement in sessions so far. She refuses to answer questions with anything other than her patient ID and the phrase 'no names'. I am unsure as to whether this refers to her reluctance to engage with me, her refusal to exchange names with her victim at the time of her offense or her not knowing the names of the entities she hears in her head. She sits with her body shielded and slightly facing away from me, and diverts her face from direct eye contact.

Session dated August 18th, 1954: I attempted an electric shock treatment on Patient #10634 this morning. She remains unresponsive in our current therapy session. She has spoken only to repeat her Patient ID a number of times.

Session dated July 14th, 1955: Patient is responding well to continued electroshock treatment. She has requested a lower dose of chlorpromazine as she suffers terrible restlessness. I will trial a lower dose for a period of 14 days.

Session dated July 28th, 1955: After reviewing the medications the patient is receiving and her behavior, I have decided to re-introduce a higher dose of chlorpromazine as the patient has reported an increase in the activity of the voices in her head. However, she has shown progress whilst receiving drug treatment in that she has isolated three voices, named them A, B and C, and is able to verbally reject them, though it is unsurprisingly unsuccessful in driving them away. During today's session, she spoke of a moment of clarity in the night which allowed her to see that she had done wrong; but she refuses to accept full responsibility, claiming that she would never have hurt anyone if the voices hadn't told her to.

Session dated September 20th, 1956: I attempted today to engage the patient with a photograph of the fellow patient she injured during the disorder of last week. She immediately shut down and regressed to repeating her Patient ID number over and over, in a raised voice. I sedated her and as she awoke, she simply said "They told me I had to hurt someone - it was either me or one of the other patients." I am increasing the chlorpromazine dosage.

[I am given to understand that between October 1956 and August 1959, patient files were in the process of being moved from one room to another and due to a fire in the old file room, most of Patient #10634's files from that time, along with many others, were destroyed.]

Session dated July 23rd, 1959: Patient is of low mood and was largely unresponsive to my questions about her wellbeing. I asked about her family, to try and elicit a response and she began to cry. I comforted her and ended the session.

On July 25th, 1959, Patient #10634 was found hanging in a janitorial cupboard. It is unclear how she gained access to the cupboard but nevertheless, she was pronounced dead by a medical professional at 15:47 after nil attempts to revive her. Near her corpse was a note that simply said, "Patient #10634. No names. No names. I'm sorry."

No-one knows to this day what caused her mental health to decline when she had appeared to be getting better; it is a crying shame that her records are lost and we will never understand what happened to her. In what is left of her medical records, there appears to have been no solid diagnosis. One quack suggested that she may have been possessed by demons. Many other doctors suggested schizophrenia. Some suggested manic depression. Dr Pryce's notes are short and largely uninformative, but hospitals were overcrowded and doctors overrun with too many patients so this is far from unusual.

However, one thing that remains a mystery is this - the postmortem examination revealed that the patient had been dead for at least three days. According to the notes of Dr Pryce, he was holding a session with a dead patient. So the question is: did Pryce get the date wrong? Was the coroner mistaken about the time of death? Or did something more sinister happen to Patient #10634...?