Northeast Lighthouse Institution
SUBJECT: B-73684. Staff refers to subject as “Be”
EXAMINER: Robert Kendrick, Ph.D.
REASON FOR REFERRAL: Subject has been institutionalized at NLI since early childhood (“as long as I can remember”) due to infectious disease quarantine. Staff professional, Dr. Barry Seagal, has requested this examination due to subject’s recent change in mood and possible homicidal ideation.
1. Clinical history
2. Mental status examination
Subject is a ? year-old white male who has been a resident of this institution for over 30 years. (Age is estimated in mid thirties as subject does not know his age.) He is interviewed via telephone connection through plexiglass window. He stands about 5 feet 8 inches tall and weighs 145. He was thin in his stature. He wore long brown hair, unkempt, jeans, and a pull-over tee shirt on which is written “I am God” in marker. He does not appear to be in any acute distress.
Subject reports no history of any physical or psychological maladies. Indeed, his lifelong medical record provided for review is completely unremarkable, even for normal childhood illness such as measles, mumps, chicken pox, etc. He reports never being sick. Only remarkable feature is the aforementioned infectious virus. No successful treatment. Clinical trials ceased years ago with lifelong quarantine being unanimously agreed upon by examining staff. FAMILY HISTORY:
This examiner was provided with no family history, and subject was non-contributory in this area as well. VOCATIONAL HISTORY:
None. Subject lives in quarantine.
DESCRIPTION OF ACTIVITIES OF DAILY LIVING:
Subject reports that every day is the same. As noted, he is institutionalized. He awakens at 4:00 AM and retires around midnight. His mornings are spent watching television (“I watch TV until dinner time”). His evenings are spent writing. (It is noted that subject repeatedly showed this examiner a stack of pages he claimed contained “new ideas,
social solutions, and medical cures.”) He relates he spends perhaps an hour total eating meals that are delivered three times a day via a “meal duct.” Subject related no interaction with others—including NLI staff—for several
years. He denies any specific exercise regimen. He states that writing, reading and television are his only hobbies. MENTAL STATUS EXMINATION:
In evaluation of subject, he was noted to be cooperative but with underlying hostility. He was sarcastic at times. Affect was broad. He was oriented times four. He denied any vegetative or psychological features of depression. He denied crying spells, headaches, confusion, or any physical maladies. He denied suicidal ideation, but when asked about homicidal ideation, he gave a wry smile before answering “no.” His speech was soft. His stream of thought appeared logical, clear and coherent. However, this examiner was impressed by subject’s bizarre thoughts, narcissistic tendencies and delusions of grandeur. For example, subject believes he has world-altering gifts to give to humanity. Yet, at the same time, he was quite arrogant and condescending when speaking of people. He expressed an understandably strong wish to leave the institution but became quite guarded when asked what he would do if released. His insight into functioning was limited by an inflated ego. His attention span was balanced. State of consciousness clear save for his aforementioned inflated notion of self. Cognitive functioning is estimated in the high average range of intellectual abilities. Memory was intact. His earliest memory is being brought here in a plastic cage. He doesn’t know how old he was when that happened. No memory of mother or father or life outside NLI.
DIAGNOSTIC IMPRESSION DSM IV:
AXIS I: Schizoaffective disorder w/psychotic features.
Personality disorder w/antisocial traits
AXIS II: Deferred.
Subject has no history of psychiatric illness. However, today’s evaluation revealed strong narcissistic, anti-
social, and potentially hostile characteristics. He has been isolated from human contact his entire life and seems to bear a great deal of hostility towards people. However, in bizarre contradiction, subject relates that he has discovered many solutions—medical, political, scientific, etc.—which he deeply wishes to share with humanity. He is bitter that his disease and necessary quarantine precludes any such possibility. It is strongly recommended that a psychological course of action be instituted for this subject consisting of, but not limited to, psychotherapy, pharmacological intervention, and quarterly psychiatric and/or psychological evaluations.
Thank you for allowing me to participate in the evaluation of this subject.
Robert Kendrick, Ph.D.