The file folder read, in thick black type:
"Psychiatric patient #P3439864, Harold (a minor; last name withheld)."
"This patient has been in our care for seven years now," the middle-aged psychiatrist casually mentioned, thumbing through the thick sheaf of notes in the folder. He nodded greetings to colleagues passing by as he guided the newly-hired young doctor down the long, clean-tiled halls of the sanitarium.
"Unfortunately, he shows no signs of getting better; if anything, his psychosis continues to deteriorate." The old doctor paused, preparing to recite a case history well rehearsed in his mind. "His difficulties began in childhood. His parents were killed in a car accident during his infancy -- he was in the vehicle, though too young to remember. He was sent to live with an aunt and uncle. And a cousin about his own age. Bit of a strained situation, I'm afraid. They were reluctant to take him in based on his mother's history of mental health issues. And, naturally, they strongly favoured their own child over him."
"What ended him up in here?" the young doctor asked.
"At the age of ten, he experienced an episode whilst on a family visit the zoo. We have a very specific record of the incident. He noticed a python
cage with a sign reading 'raised in captivity.' That seems to have triggered the psychotic break
. He had a very strong hallucination
, first that he was conversing with the snake
, and then that he caused the glass to disappear, allowing the snake out of the exhibit and causing his cousin to fall into it."
"Did any of that happen? The snake escaping, I mean, not the causation, obviously."
"No. No, the snake never got out of the case. The cousin never fell in."
"But the patient was convinced that these things had happened?"
"Yes. And shortly thereafter he began experiencing delusions that he was being sent important letter
s, and that these letters were being intercepted by his uncle."
"What were the letters about? In his mind, I mean."
The old doctor chuckled lightly for a moment. "Invitations to attend a school of wizardry. On his eleventh birthday, they took him to visit a lighthouse
, and he entered into a catatonic state. That prompted his uncle to call to have him committed here. Some of the staff went to collect him, and he immediately awoke from his catatonia
, but had clearly lost the ability to distinguish reality from fantasy. And, well, he's been here ever since, spinning the most remarkable tales. In his delusion, he is wealthy, powerful, and popular. A star athlete in a sport which we gather is something like cricket
. Oh, and," the older man raised a studied eyebrow, "he imagines having magical fights with troll
s and werewolves
"Has he developed a paranoid focus to his delusion?"
"Very good, doctor, you've read your textbook
s. Indeed, he's had a typical progression of his psychosis, by which he's invented a grand enemy
, an evil force behind every obstacle which he imagines himself to be faced with. Actually, early on the patient fixated on another of our senior staff psychiatrists. Dr. Volder. Mort Volder."
"Why did he choose Dr. Volder as his focus?"
"We think because he was the only member of the staff on leave when the patient was admitted. He met the rest of us, but the orderly who showed him around -- big Scottish fellow, one of the ones who went to pick him up from the lighthouse -- well he was fairly new, and couldn't remember Volder's name. The patient took that as an indication that there was something hidden and sinister about my vacationing colleague."
The young doctor shook his head in amazement. "Quite an imagination, there."
"Oh yes. Clever, too. He's escaped from the building more than once, but never left the grounds. He just ends up spending the night in the woods, and come morning, he has fantastic stories of magic creatures there."
The pair came to Dr. Volder's office, where the older doctor introduced the younger.
Dr. Volder joined the conversation without missing a beat. "The patient sees me as the source of his disconsternation. In his fantasy, he's built me up to be the cause of his parents' death. So we're going to try something new tomorrow, a radical confrontation therapy. That's what you're here to observe. We, and a number of the staff, are going to role-play his fantasy with, allow him to believe that he's actually casting spells and whatnot, in a climactic final battle with the alter ego he's projected onto me. Naturally, this battle will culminate in my defeat by his 'magic' -- we hope that will be enough to finally snap him out of his delusion."
The other doctor pointed to some red flags in the file. "He's had a few instances of violence under the delusion that he's fighting a villain
. He has, I suppose due to the initial snake incident, a fixation on there being especially evil snakes which he must destroy."
The young doctor flipped to the tabs. There was a choking incident, and an occasion where he stabbed an orderly with a knife he'd managed to hide in his hat
. More mundane episodes of violence, kicking and punching, had seen an increase in recent months.
The older doctor continued, "if tomorrow's effort fails.... well, he'll need to be lobotomized
The young doctor nodded, understanding the gravity of the situation. Meanwhile, the older doctor beckoned a young nurse who was passing by.
"Ah, Ginny. We'll need you on hand when we deal with Harry tomorrow. He's got a soft spot for you."