I. PERSONAL INFORMATION
AGE: Mid-to-late 40’s
PLACE OF BIRTH: Nazareth, Pennsylvania
BIRTH ORDER: Second of six brothers
DATE OF ADMISSION: 2/18/02
II. PSYCHIATRIC EVALUATION
LOCATION: Delta Institute of Mental Health
CONDUCTED BY: Eleanor Riven MD, Ph.D.
III. GENERAL OBSERVATIONS
Martin was found lying on the sidewalk just outside the chain-link fence that marks the southern boundary of this facility. In the course of the brief discussion that ensued, it became evident that Martin suffers from the delusion that he is a guitar string. On the authority of this therapist, Martin was coaxed gently inside, in the hope that herein he might receive the treatment he so clearly and desperately needs.
2. Physical Description
Martin is approximately thirty-one (31) inches long and 0.04 inches in diameter; more precise measurements as to his exact length have been postponed until his upper extremity has been sufficiently relaxed by hypnosis or massage so as to “uncurl.” He is apparently both bronze-wound and hand-silked, and at the end of his lower extremity is a small metal ring approximately 0.16 inches in diameter. His touch is unforgettable, and the smell that his body leaves on the tips of one’s fingers puts one in mind of subway tokens, old subway tokens, the very same tokens that as a child one might have spread across the floor late on a summer afternoon before one’s mother had returned home from work but after one’s stepfather had departed subsequent to his surprise lunchtime visit, said tokens deployed in various patterns, at times that of a waterfall, at times that of a rainbow, at times that of a tornado as seen from above, arabesques spinning out and away, etc.
Upon first perusal Martin bears no scars or physical deformities. However, a closer inspection reveals that the upper third of his torso is deformed at intervals of decreasing length, the first and longest of which measures 1.35 inches. The deformations themselves are approximately 0.03 inches long, and take the form of a sort of “flattening” of the corporeal structure; in these places his skin is “shinier” than elsewhere.
Equally subtle are the discolorations that occur between the aforementioned deformations. Said discolorations appear to be stains consisting of a mixture of dirt and some sort of light oil, but as Martin’s dedication to personal hygiene is otherwise exemplary, particularly for someone living “on the street,” this seems unlikely.
Unfortunately, Martin is either unwilling or unable to discuss the deformations and discolorations in any detail, other than to say that they are “what’s left of the hands what played (him),” which this therapist takes to mean that they are the result of parental, caretaker or conjugal love or abuse as the case may be.
Martin’s delusion is remarkably consistent and cohesive. Taking care neither to condemn nor to collude in his beliefs, this therapist asked him to explain why he believed that he was a guitar string; instead of answering directly, he insisted that I, this therapist, lodge the aforementioned small metal ring in a wooden notch, wind his upper extremity around a metal peg, stretch him over an ebony bridge, and pluck him firmly. Having of course no such notches, pegs or bridges at hand, and yet seeing no harm in acceding for the moment to his desires insofar as they might be fulfilled within the confines of this facility, I stretched Martin as tightly as possible between the respective backs of two wooden chairs here in our recreation room, securing him in place with the use of large metal clips. I then plucked as requested, a single smooth stroke with my right forefinger.
I was rewarded with our first significant breakthrough, a humming sound, a single prolonged note which, given Martin’s coloring and breadth, one might best assume to have been in the key of ‘A.’ What struck this therapist as of particular interest given its musicological impossibility was the fact that said note appeared to contain the aural characteristics of the minor rather than the major chord in said key. That is, rather than communicating any sort of folk pleasantness, pop mooning or rock aggression, Martin’s note spoke instead to certain dark cramped spaces, and did so in a way that made reference not to clichéd midnight trains bound for Georgia or meeting the devil at the crossroads, but to the at once searing and suffocating sadness that one might experience via, to give a few random examples, the way the light drips from the bare branches of the dogwood in the park across the street as seen from the recreation room’s lone window on a February morning; or, a mother’s insistence on hiding her gin–foolishly, pointlessly, there was no one from whom to hide it–in the laundry hamper; or, the news of one’s stepfather’s death at the prison to which one’s testimony had unwittingly, unwillingly sent him, etc., at which point I noticed that concurrent with the humming sound, Martin was oscillating furiously. Not wishing to risk a full-blown psychotic outbreak, I unstrung him at once, and thereafter the evaluation continued rather more in accordance with current practice, though occasionally interrupted by Snack Time, Pill Time, Arts and Crafts, etc.
Martin’s voice is rough-edged yet mellifluous, and he converses fluidly on all subjects successfully broached. Aside from refusing to respond to certain of my questions on the grounds that the answers were “none of (this therapist’s) damn business,” he was for the most part polite and cordial throughout our interview.
Repeated attempts were made to determine any and all aggravating and detonating factors, the length of time the patient has suffered from the aforementioned delusion, the number of times he has been hospitalized previously, and the number of times he has attempted suicide. Unfortunately, it would appear that none of this information is any of this therapist’s damn business.
V. DIAGNOSTIC APPROXIMATION AND PROGNOSIS
Given the absence of negative symptoms such as affective flattening, alogia or avolition, it is this therapist’s opinion that Martin’s delusion is more likely psychotic than schizophrenic in nature. He may well respond favorably to pharmaceutical and/or psychotherapeutic treatment, and though of course the duration of said treatment cannot be known in advance, once his delusion is under control Martin will in all probability find himself able to fit as easily into society as anyone else–a society, it should be noted, that hardly deserves the manner in which his baritone hum causes diaphanous sheets of the listener’s at once searing and suffocating sadness to float up and away from the listener’s body, said diaphanous sheets drifting out the recreation room’s lone window, across the street, then catching and tearing and hanging in shreds from the bare branches of that dogwood–in a word, catharsis, etc.
Martin presents one of the most interesting cases that this therapist has had the pleasure, though ‘pleasure’ is of course not the word, not exactly, of evaluating in her eighteen years of service here. While it might seem that in Martin’s case there is no potential for danger to himself or others, and that outpatient management rather than hospitalization might thus be the most appropriate course of action, particularly given the exceedingly large and ever-growing number of patients with whom he is presently forced to share the recreation room for hours at a time every morning and every evening, hour after hour of their grasping and babble and drool, it is nonetheless this therapist’s steadfast position that should Martin be returned to “the street” in his current state, he would undoubtedly eventually, and more probably sooner than later, be relegated to one of contemporary urban society’s many many many, if I may, “garbage heaps,” the alleys and storm drains and abandoned buildings wherein gather others similarly cast-off, the psychotic, the schizophrenic and the simply unbearably searingly suffocatingly sad, and if that were to happen, Martin’s current state of delusion might metastasize, perhaps to include complications of a depressive nature to a degree that no seratonin reuptake inhibitors could possibly handle effectively, such that he might someday indeed wonder if there is any point at all in even trying any more, etc., and at that moment may well choose to stretch out on a warm park bench, stare for a time at the sky, close his eyes and slash his wrists. For this reason, though it is well known that involuntary hospitalization may increase distrust, resentment, and the intensity of the patient’s delusional beliefs, this therapist must insist that Martin remain at this facility and under the constant care of a trained professional such as myself for as long as his therapist, this therapist, I, me, deems necessary.
Roy Kesey’s latest books are the short story collection Any Deadly Thing (Dzanc Books 2013) and the novel Pacazo (Dzanc Books 2011/Jonathan Cape 2012). He is the winner of an NEA grant for fiction and a PEN/Heim grant for translation. His short stories, essays, translations and poems have appeared in about a hundred magazines and anthologies, including Best American Short Stories and New Sudden Fiction. He is currently the Writer-in-Residence at Washington College.