JANE DOE AND THE GREENS.

Identifying Information:

Jane Doe, Male, aged about 25 years when he was hospitalized had visited to the hospital with his parents and elder sister. On the outside, he had discontinued his under graduation and was working at a local mobile store in the Cape of Bingle, Capital of Dong State which was about 300 km from the village in which the family was staying.

Source of Information:

            Patient’s mother and elder sisters volunteered to inform about the patient. The mother was interviewed about birth history, achieving developmental milestones and negative history of the family. The sister was interviewed about social history, educational history and negative history of the patient.

Collected Information:

Patient’s mother clearly explained that his birth was normal and had achieved developmental milestones at right age. She added to it that he suffered from jaundice about 4 times in the span of 2 years and had been under regular medication. She specified that the patient had no other health issues as a child or as an adolescent other than common cold and fever. When the mother was probed about psychological or psychiatric problems/ illness/ disorders in the family, she reported that her husband’s (patient’s father)’s younger brother committed suicide when he was 18 years old. She also adds to the list, her own father’s elder sister aged about 72 years, who is suffering from Dementia. She was probed about her relationship with the patient and how his behavior was as a child. She acknowledged the facts that she was not having much time to spend with the patient as she had to work in the farm with her husband. She also explained that he was not good at his academics and was not regular to his classes (also because the teachers were not strict in the village). “He studied on his own and cleared his 10^th grade and 12^th grade with great difficulties. He then demanded us to admit him to a college in Cape of Bingle. We had saved some money. He wished to join a course to learn about how to repair smartphones of any brand. This course was for 6 months and the fees were comparatively low. So, we agreed to make him join that course as it would be helpful for his livelihood.” Said the mother.

            She reported that the patient was attending the classes regularly and had completed the course with a certificate which helped him to find a job in any mobile stores as a service person. It was after 2 months, he got recruited as a service advisor in one of the leading brands with a decent pay of 8000 per month. “Jane Doe was depositing 4000 bucks every month to my account and used 4000 for his rent, travel and food. Gradually, the amount reduced and had never deposited money to my account since a year now.” 

She also added to it that he had not come to visit them in the past one year and used to avoid their phone calls.

When probed, she acknowledged that the patient’s roommate had called her to report about weird behavior of her son, after which she, along with her husband and daughter left to meet Jane Doe and brought him to the hospital approximately after 6 months after the illness started. During this span of 6 months, the patient was taken to an astrologer, an occult practitioner, a monk, few temples and had followed the rituals they directed the patient’s caretakers to follow. “They fooled us. One of the doctors in our village minimum facility hospital gave us your contact number and so, we came here.” Reported the patient’s mother.

Information – Reliable.

Patient’s elder sister reported that the patient was having an average childhood with an ambition to support the family financially since a very young age. According to the her, during the patient’s childhood, he had friends of all age groups and had a good relationship with people in the village. She explained that he would get discount on rice and sugar from any shop in the village because, he used to visit those shops to sell the crops the family grew in their farm. When she was probed about the patient’s romantic relationships, she clearly said that he had no such stories. “But, he was interested in a girl from our family. He then lost interest.”

She also reported that he was below average in academics and used to learn mathematics from her. To summarize, her explanation clearly made the therapist understand that there were no problematic behavior or problem situation during his childhood and adolescence.

Information – Reliable.

Presenting complaints/ reasons for hospitalization:

1.     Impulsive anger, violent behavior and pulling hair which resulted in hair loss on the left back part of his head.

2.     Self-harm behavior – slapping himself.

3.     Social withdrawal.

4.     Impaired orientation with reduced sleep and appetite.

5.     Disorganized speech.

6.     Void stares with scared expression on the face.

7.     Low self-hygiene and reduced occupational output.

8.     Scared to spend time alone.

NOTE:  The above-mentioned complaints were observed in the client for 7 months and no medical investigation or treatments were imposed on the patient.

According to the patient:

            “I am fine. They think I am mad. Who doesn’t scold or slap others who call a person mad?”

“I hear a ghost talking to a ghost inside of me. I even see the ghost whenever I am alone. It is trying to kill me and take away my spirit to the world of ghosts.”

“I hear the god inside me asking me to shave my hair as hair is where the ghost stays.”

Adding to this, the patient had lost orientation and his thoughts were tangential. Also, word salad was observed. Judgement was completely impaired and had no insight.

Line of treatment:

·       Reference to psychiatrist for medication.

·       Family therapy for parents and caretakers to make them understand the importance of medication and accepting the patient for his present condition.

·       Psycho educating the client about the importance of medication.

·       Admitting to rehabilitation centre for substance rehabilitation.

·       Hospitalization for 4 days and advising for monthly follow-up.

Etiology/ causes for the present illness: 

Jane Doe acknowledged in the 4^th session (during rounds) that he had been using cannabis/ ganja/ marijuana for 3 years on a daily basis and had stopped it after he watched in the news where an astrologer mentioned his zodiac sign people to not to do drugs after which he stopped it and started going to the temple. Jane Doe claims that a ghost possessed his body when he went to the temple on a new moon day and another ghost followed this ghost for bizarre reasons.

Jane Doe claims that his friends at workplace introduced him to cannabis/ marijuana/ weed, alcohol, cigarettes, tobacco chews, gambling and even black market. Jane Doe accepted that he didn’t like anything other than smoking weed as he believed it to be herbal medicine and claimed everything else to be unhealthy.

Diagnosis:

Schizophrenia (Cannabis Induced Psychosis.)

As explained by Jane Doe, he had been smoking weed for 3 years on a regular basis. As a result of which it had become a pattern of behavior and related bio chemical changes had changed the biological or physiological environment. This made Jane Doe vulnerable to psychological illness which include psychosis, organic depression, etc.

Adding to this, as Jane Doe stopped smoking weed abruptly without tapering it down or using medication to avoid withdrawal symptoms.

1.     Delusion: Delusion is a false, unchangeable concrete belief a person holds, to which he/she has no proper evidences to prove it to be true or normal. For Jane Doe, it is Persecutory delusion which is a belief where a person believes that somebody is spying/ following them. Delusion of black magic is a false, unchangeable, concrete belief towards a phenomenon called black magic with no proper evidences to prove it to the real world.

2.     Hallucination: Hallucination is nothing but the ability to perceive a stimulus in the absence of it. To be more non-technical, people who hallucinate, hears voices that nobody else hears, sees things/ shadows/ people/ animals/ characters which nobody else could see, can smell something which nobody else could smell. Because, these stimuli are not present in real world. For Jane Doe, it is auditory hallucination and visual hallucination. Jane Doe was hearing voices which he claims to be the ghost’s voice. He also claims that he had been seeing a ghost in the corner of any room he lives in.

3.     Negative symptoms: These are a list of behavior or activities the person was exhibiting before the illness started and had been reduced/ stopped after the illness occurred. For Jane Doe, they are, lack of interest in daily activities, reduced occupational output, lack of social and personal relationship, sleep and appetite.

4.     Positive symptoms: These are a list of behavior or activities the person wasn’t exhibiting before the illness occurred and had been showing after the illness occurred. For Jane Doe, they are, anger, verbal aggression and physical aggression and physical fights, self-harm behavior.

Present:

Jane Doe stayed in the rehabilitation centre for a period of 8 months.

“Jane Doe is rehabilitated from his drug use. He has to be under medication for 12 months and should visit the hospital for follow up monthly once.” Reported the chief of the rehabilitation centre Dr. S.M.

Jane Doe, after his discharge, started working in his parents’ farm and stayed with his parents and sister.

I, Ma. Cullinan, his first therapist, met Jane Doe, 1 year after the last meet. Jane Doe could recognize Cullinan and thanked him for helping him overcome his illness. 

“Now, I am proud to be a farmer and the main source of income to my family. I thank Ma. Cullinan, Dr. M and Dr. Phantom for their treatment and guidance. Without you all, I would be dead by now”

-        Jane Doe