St. Bernard’s Hospital
Three Bridges Security Ward
Patient 6651508
SCARLET, Flandre

1.  Mental Status Exam

a. Patient is young girl, claiming to be 495 years old.  Patient’s parents verify age of 7 years.  At roughly 09:30, December 6th, 1988, patient decorated two rusty wrought iron bars measuring a 1.4 meters in length with colored glass shards before plunging both into own back (see attachments 3A-3E).  While bars missed vital organs, positioning resulted in their lodging between ribs, irremovable through surgery without extremely high risk of complication.  Bars were sawed to manageable length by medical staff shortly after incident at 21:00 of same day.  Expresses extremely antisocial and avoidant tendencies, refuses to look at medical staff above waist level.  Patient is highly delusional, and may be threat to herself and others.
b. Patient’s thought process is still difficult to determine.  Refuses to answer most questions or otherwise communicate with medical staff.  Further inquiry must be made before conclusions may be reached.
c. Aside from brief outbursts of extreme fear/aggression (?) prior to sedation when notified that metal rods would be removed, patient has not shown any other signs of visible emotion.
d. Psychotherapy sessions prove inconclusive at best.  See attachments 2A to 2H for transcripts.

Attachment 2A

The following transcript documents the first attempt to diagnose and treat Patient 6651508 through psychotherapy, using juvenile accommodation 16A.

11:30, 12/9/1988

Dr. MARSIELLE: “Hello, Flandre, I am Dr. Aimee Marsielle.  I’ve been assigned to your case.  You may call me Aimee if you’d like.”

Patient 6651508 does not respond.

Dr. MARSIELLE:  “It’s alright if you don’t want to talk.”  Pause.  “Flandre, I would like it if you could draw me a picture.”

Dr. MARSIELLE passes paper and a box of crayons to Patient 661508.

Dr. MARSIELLE: “You can draw anything you’d like.”

Patient 6651508 does not respond.

Dr. MARSIELLE: “Go ahead, Flandre.”  Pause.  “It’s okay if you don’t want to.  We can do this another time instead.”

Patient 6651508 opens the box of crayons and chooses the black crayon.  Patient begins to color the page in.

Dr. MARSIELLE: “What are you drawing, Flandre?”

Patient 6651508 continues coloring and makes no response.  When patient completes the first side, she flips it over and continues coloring.

Dr. MARSIELLE: “Do you need another crayon, Flandre?  It looks like you’re almost done with that one.”

Patient 6651508 continues coloring until the crayon is completely used up.  Patient extends her hand.  Dr. MARSIELLE gives her a new box.

Dr. MARSIELLE: “Here you go, Flandre.”

Patient 6651508 takes the box without notice and takes the black crayon.  Patient colors until the page is filled in.  Patient places paper on table and slides it to Dr. MARSIELLE.  (See attachments 4A.a-4A.b)

Dr. MARSIELLE:  “Good.  That’s good, Flandre.  What is it?”

Patient 6651508 makes no response.

Dr. MARSIELLE: “That’s alright, we can talk about it another time if you would prefer that.  We’re going to take you back to your room now, okay?”

Patient 6651508 makes no response.

End transcript.

Attachment 2B

The following transcript documents the second attempt to diagnose and treat Patient 6651508 through psychotherapy, using juvenile accommodation 16A.

11:30, 12/10/1988

Dr. MARSIELLE: “Hello again, Flandre.  I wanted to follow up on yesterday’s talk.  Could you tell me what this is?”

Dr. MARSIELLE gives Patient 6651508 her drawing.  Patient does not look at the picture and does not respond.

Dr. MARSIELLE: “Flandre?”

Patient 6651508 does not respond.

Dr. MARSIELLE: “It’s alright, if you don’t want to talk about it.  Would you rather just draw another picture today?”  Pause.  “I’ll just leave these here then.”

Dr. MARSIELLE leaves paper and a box of crayons on the table.  After 3 minutes and 28 seconds, Patient 6651508 opens the box and removes black crayon.  Patient 6651508 begins filling the page in.  Patient flips paper over when done with the first side.  When crayon is used up, patient extends her hand for another box.  When finished, patient places picture on table and slides it to Dr. MARSIELLE.  (see attachments 4B.a-4B.b)

Dr. MARSIELLE: “You drew the exact same thing yesterday, Flandre.  Do you want to tell me what it means?”

Patient 6651508 does not respond.

Dr. MARSILLE: “That’s alright, Flandre.  That’s alright.  We can do this again tomorrow, okay?  Let’s go back to your room now.”

Patient 6651508 does not respond.

End transcript

Attachment 2C

The following transcript documents the third attempt to diagnose and treat Patient 6651508 through psychotherapy, using juvenile accommodation 16A.

11:30, 12/11/1988

Dr. MARSIELLE: “Hello, Flandre, it’s me again.  Do you want to talk about what you drew yet?”

Patient 6651508 does not respond.

Dr. MARSIELLE: “That’s alright, Flandre.  You don’t have to talk yet if it makes you feel uncomfortable.  Why don’t you draw another picture?  But, since you’ve drawn the same thing twice already, why don’t you try drawing something new today, okay?”

Patient 6651508 takes the crayons and paper and proceeds to draw five figures of varying heights.  She is a considerably skilled artist.  Despite the figures all clearly being human females, Dr. DOWNES states that there is something extremely unsettling about the image, and the figures have a strongly inhuman air to them.  At the farthest left is red-headed woman in a beret.  Her eyes have been removed, leaving still-bleeding sockets.  Despite this, she smiles.  Beside her is a purple haired woman in a nightgown.  She has no eyes.  Next is another red-headed woman in a vest and skirt.  Her face is covered.  Second from the right is a young woman in a French maid’s uniform.  Her eyes are hollow, and she holds a bloodied knife.  At the farthest right is a winged teenaged girl.  She has mouths for eyes. (See attachment 4C.a)

Dr. MARSIELLE: “Who are these people, Flandre?  Are they your friends?

Patient 6651508 continues drawing and makes no response.

Dr. MARSIELLE: “Are they your family?  Do you know them?”

Patient 6651508 does not respond and continues drawing.  When finished, patient slides the paper and crayons across table to Dr. MARSIELLE.

Dr. MARSIELLE: “That’s very good, Flandre.  Can you explain who these people are?”

Patient 6651508 does not respond.

Dr. MARSIELLE: “Flandre, could you tell me who these women are?”

Patient 6651508 does not respond.

Dr. MARSIELLE: “Flandre?  Could you just tell me what made you draw this, Flandre?”

Patient 6651508 does not respond.

Dr. MARSIELLE: “Will you tell me why you drew this picture, Flandre?”  Pause “Flandre?”

Patient 6651508 rises and walks to Dr. MARSIELLE.  Patient whispers to Dr. MARSIELLE for several minutes and returns to her seat.  The two stare at each other for nearly 17 minutes.

Dr. MARSIELLE: “Okay, Flandre, you’re going back to your room now.”

End transcript.

Attachment 2D

The following transcript documents the fourth attempt to diagnose and treat Patient 6651508 through psychotherapy, using incidental approach 1A-1C.

12:45, 12/12/1988

Dr. DOWNES: “Hello, Flandre.  My name is Dr. Nigel Downes.  Dr. Marseille couldn’t make it today, so I’ll be taking her place for today.  Is that alright?”

Patient 6651508 does not respond.

Dr. DOWNES: “Flandre?”

Patient 6651508 does not respond.

Dr. DOWNES: “Alright then, Flandre.  You don’t have to say anything.  Just listen.”

Patient 6651508 does not respond.

Dr. DOWNES: “So, if we could begin, could you tell me when and where you found the metal rods?”

Patient 6651508 whispers.

Dr. DOWNES: “I’m sorry, Flandre, I didn’t quite catch that.  Could you say it again more loudly?”

Patient 6651508 whispers.

Dr. DOWNES: “Did you say ‘wings,’ Flandre?  Wings?”

Patient 6651508 whispers.

Dr. DOWNES: “What do you mean ‘wings?’”

Patient 6651508 does not respond.

Dr. DOWNES: “Do you mean those rods were wings?”

Patient 6651508 nods.

Dr. DOWNES: “Why did you stick the wings in your back then, Flandre?”

Patient 6651508: “I wanted to fly.”