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EMAIL: M. Kendra

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Guest
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EMAIL: M. Kendra

Well, I've been corresponding with Dr. Kendra for awhile now. I didn't want to post a thread about it since there were others already in contact with her and I wasn't getting anything new. But, now that she thinks Dale is nuts, I may be in a good position with her. I approached her as a psychologist treating a similar case:

Quote:

Ms. Kendra:

An associate of mine believes you may have been treating a patient
with a particularly interesting disorder, similar to a patient I am
treating.
I cannot say too much in my initial email to you (due to obvious
therapist-patient confidentiality issues), but I would be interested in
opening a discussion with you regarding that patient.��Perhaps we
could collaborate together to publish an article, if my suspicions are
correct.
Please contect me via return email if you are interested.��

Warmest Regards,
Jake M. Chambers
Mahkra Mental Health Care��

her first response was somewhat guarded:

Quote:

Dear Dr. Chambers,

I would be interested, depending on my time constraints.��What is your
patient's diagnosis?
-Michelle Kendra

Michelle Kendra, MD
Inpatient & Outpatient Psychiatry
Princeton, NJ Headquarters
Klepsydra Mental Health Facility Network

Quote:

Dr. Kendra:
It is a difficult case, and I don't feel my diagnosis is complete at
this time, but I will give you what I have.��You may notice I am sending
this from a friend's email account and not my account at work (thus the
different screen name); my facility has a very strong confidentiality
restriction and I wouldn't want my network administrator to notice
emails regarding patient diagnosis.��But I must admit I am at a bit of a loss with this case, and worried about it.��I figure that as long as we have
the same goal in the end -- furthering science and better mental health
for all, as well as helping out our patients -- confidentiality becomes
less important, doesn't it?��Perhaps if we do end up sharing information,
we can consider these emails as assisting in the course of treatment.��

At any rate, I have been treating a patient who I will refer to as John
Doe for now.��John suffered from a garden variety bipolar disorder,
occasionally borderline manic-depressive.��He had a strong feeling that
his life was not "turning out as it should."��It was a fairly standard
case, until a certain traumatic incident in his life drastically changed
his psyche.��At first, I thought he was suffering from shock and perhaps
post-traumatic stress disorder, but then he revealed to me the full
depth of his problems.��He believed he had made some sort of a "wish" that was intended to make his life better, and in so doing, had unknowingly ruined his life.��Much like the old stories about Djinns in bottles, the wish supposedly turned on him and caused the tragedy.��Somewhat conveniently, he could not remember the specific details of this wish.��
His obsession with this "wish" is taking over his life at an alarming
rate.��He sees incidents of crime in our city and assumes they are
somehow implicated in his wish.��He has taken to studying numerology
and astrology, perhaps in some sort of attempt to understand his
wish-fantasy or to...maybe reverse it?��I don't know, he is not forthcoming about that subject.��I am a little alarmed by all of it.��It seems to be almost a case of paranoid schizophrenia, as he is convinced that the "world revolves around him," that several events are connected in an attempt to get him, and he is conceptualizing two different versions of himself (the John that made the wish and another John who did not).��Yet, some aspects of that diagnosis do not seem to fit him correctly.��
I am worried about these studies of his.��As his mental condition is worsening, I fear what would happen if he made the jump from astromony to a more sinister subject, such as demonology or satanistic literature.
I know he has made some contacts with dubious "mystical" characters via
email and I hope they do not push him into committing any crimes in an
attempt to reverse his "wish."
At any rate, I was discussing this case with a friend of mine who is also
in the business, and he told me that he knew someone who knew someone (ah, the grapevine) who had told him about a very similar case under your care.��If you do have a patient who is suffering from what I am calling "wish disorder" (for lack of a better term), I would like to try and get any helpful information from you if possible.��I am wondering if maybe they studied the same literature and got this concept from there?��At any rate, let me know if you do have a similar case; it is possible that
your case is very different and I am just overly optimistic.
There are other aspects of my particular case that concern me, although
I do not feel I can discuss them yet due to confidentiality concerns.
Perhaps if we merge our cases into a single course of treatment after
sharing information, I will go into more detail, but suffice it to say
that I have spotted several "real world" aspects of this case that
just...don't add up.��For lack of a better way to put it.
At any rate, I thank you for your time, and apologize if my friend was
wrong and this is just a (somewhat rambling) missive about an unrelated
case.

Warmest Regards,
Jake M. Chambers

Posted: Mon Apr 07, 2003 12:13 pm

Guest
Guest

Of course, after the above, she called me a little bit on my lack of psych knowledge:

Quote:

Dear Dr. Chambers,

I was confused by your description of your patient's case, since, as I'm
sure you know, bipolar and manic-depression are the same thing.��Are you saying that he is possibly Bipolar II because he lacks the full-blown manic episodes?
I'm going to go with that assumption for now; let me know if I've
misinterpreted what you've said.
I believe that consulting colleagues to help patients is protected under
normal confidentiality rules and under HIPAA as well, so while your precautions are admirable, I do not believe that you need to go to such extents as sending this from another e-mail account.
In any case, it sounds like your patient is having a schizoaffective episode
(295.70).��The obsession with the supernatural, the delusions about having caused someone else harm, and the loosening of associations between unrelated crime events and his actions all point me toward this diagnosis.��

I recently discharged a patient with a similar delusion about having made
a "wish" that inadvertently caused his family to be killed.��He had no
prior history of mental illness, however, so I chalked it up to PTSD and
survivor guilt.��I couldn't find another case with that particular delusion in the literature--isn't it interesting that we now have two in a very short
period of time?��I would be interested in comparing notes further; two cases of a previously unreported delusion would make a good case study for publication.

I suggest a combination of Risperdal for the psychosis and Depakote for
mood stabilization.��If the patient tends towards hypomania you might want to prescribe Geodon as well.��If the patient needs an antidepressant, I prefer Wellbutrin, as it doesn't have some of the side effects the other
antidepressants have.

-Michelle Kendra

Quote:

> Dear Dr. Kendra:
>
> I apologize for the previous misstatement; yes, I was referring to
> Bipolar II (more than plain depression, but not fully delusional or
> psychotic) as opposed to full-blown manic-depressive episodes.��Although,
> he occasionally appeared to be bordering on true manic-depressive
> behavior.��He said he sometimes frightened his wife, which was what
> initially led him to my care.��That was the worst of it, before his
> tragic event sparked his new "wish" delusion.
>
> I agree with your diagnosis and course of treatment, although I only
> prescribed the Depakote and Wellbutrin, hoping that stabilizing his moods
> may be sufficient to bring him back to a more connected mental state.��If
> he turns from his current relatively benign studies concerning astrology
> and numerology to something more sinister, I may step up the treatment.
> What did you prescribe for your recently-discharged patient, or did you
> feel his condition stable enough that he could deal with the survivor
> guilt and PTSD on his own?
>
> One of the main things that fascinates me is the shared delusion between
> our cases, one which I hadn't seen before.��I believe your email
> indicated a similar interest.��It may be just coincidence, but I can't
> help but wonder if something in the media or in literature triggered the
> same delusion in each of our cases.��Did your patient indicate any
> particular literature or media he had been studying recently?��Was there
> anything he was particularly concerned with when he was in your facility?
>
> Further, my patient indicated that he remembered absolutely nothing about
> his "wish."��All he knew was that he made one and somehow changed things,
> but that part of his wish was an inability to remember.��I'm not certain
> if he meant that was a specific portion of what he wished for, or if that
> was some sort of consequence or condition of making his wish.��(Of
> course, that also makes it easier for the deluded mind to avoid conjuring
> up possibly incorrect facts surrounding the "wish.")��Did your case
> remember anything about his "wish?"
>
> I suppose a lot of what we are dealing with when we get into the
> specifics may be largely irrelevant in a medical sense.��My old teachers
> would have told me that the essence of the case is that an already
> disordered mind went through a traumatic experience, it sent him into (as
> you correctly, in my opinion, diagnosed) a schizoaffective episode, and
> the rest is just the particulars of how it manifests.��Every case has its
> quirks.��Yet, for some reason, this one stays on my mind, and the fact
> that another one like has happened so close in time makes it all the more
> interesting, if perhaps only for curiousity's sake.
>
> Warmest Regards,
> Jake M. Chambers
> Mahkra Medical Health Care

Posted: Mon Apr 07, 2003 1:14 pm

Guest
Guest

And now, her recent response:

Quote:

Dear Dr. Chambers,
There are more updates with my patient, and unfortunately, he doesn't appear to
be getting better.
Let me give you some more detail about his delusion.��The patient believes that
he was at an amusement park with his family at the same time that the accident
that killed his wife and daughter took place.��He claims that while at the
amusement park, a fortune teller told him something upsetting.��He wanted to
use the day to tell his wife of his financial troubles, including the fact that
he took out a large loan from local loan sharks.��Upon telling his wife this
news, she told him she was going to leave him.��When they returned home, she
packed up some things, took their daughter, and left.��The patient, suicidal,
had a gun to his head when an old man "appeared", pushed the gun away, and told
him he had one wish.��The patient wished for lots of money, and that his wife
and daughter didn't know about his financial situation.��He claims the next
thing he knows he was in the hospital, and was told his wife and daughter were
dead.��There is also something in his story about a six-fingered man.��Looking
back in my notes, I see that it was only the fortune-teller that had six
fingers, although I had thought the magically-appearing man had six fingers as
well.��I have no idea what this could symbolize.
We took a trip out to the place where he insisted the amusement park was, only
to find a cemetery.��Even faced with this hard evidence, he still held fast to
his delusion.��
He has been missing for the past few days, and I believe that he is
dissociative and is wandering around in a fugue state.��I hadn't prescribed any
meds on his discharge, and now I'm regretting that decision.��The patient was
quite insistent that he didn't want any medication, and it didn't seem to make
sense to try to force meds on him that he wasn't going to comply with, anyway.
Now, apparently, his house has blown up.��He had mentioned that he owed money
to loan sharks, but given the rest of his delusion, I didn't put as much faith
in that part of his story as I probably should have.��Now I am quite concerned
that these individuals might have done something to him and/or his house.
Before his disappearance, the patient was insisting that I hypnotize him,
because he believed that would be the key to his recovering his "true" memory.��
Of course, I discouraged him in this, since hypnosis is only going to make him
confabulate some story that conforms to his delusion.��However, it might help
him to cope with some of the feelings that are causing him to dissociate.��Any
second opinions on this?��I hope that the patient will contact me if he's able,
because he wanted to schedule the hypnosis session as soon as possible.��I
might agree, if for no other reason than to get him back in to see me.
I am happy to entertain any treatment suggestions you might have.
-Michelle Kendra
Michelle Kendra, MD
Inpatient & Outpatient Psychiatry
Princeton, NJ Headquarters
Klepsydra Mental Health Facility Network

I'm going to respond to her tonight. Any suggestions?

Posted: Mon Apr 07, 2003 1:16 pm

StarkRavingMad
Decorated

Joined: 23 Mar 2003
Posts: 250

Whoops, hadn't logged in. All of the above are from me.

Posted: Mon Apr 07, 2003 1:18 pm

Tien_Le
Charter Member

Joined: 22 Sep 2002
Posts: 878
Location: corner of no and where

RE: Dr. Kendra correspondence

StarkRavingMad, these are briliant! Dr. Kendra's latest response is an excellent synopsis of the game so far!

Hmm, suggesting treatment is a tricky business. Tread softly.

_________________
consume less; live more

Posted: Mon Apr 07, 2003 1:32 pm

dmax
Unfictologist

Joined: 09 Jan 2003
Posts: 1387
Location: Location: Location!

heh

I like the Arkham reference. Bruce Wayne would be proud.

_________________
That sounds like something HITLER would say!

Posted: Mon Apr 07, 2003 1:43 pm

villard
Boot

Joined: 28 Mar 2003
Posts: 39
Location: Stockholm, Sweden

Not to mention HP Lovecraft (who is now spinning in his grave)

_________________
...the crowd goes wild.

Posted: Mon Apr 07, 2003 1:45 pm

dmax
Unfictologist

Joined: 09 Jan 2003
Posts: 1387
Location: Location: Location!

Remind her that HIPPA doesn't really take effect until April 14th, so she can violate confidentialiaty all she wants till then. Smile

Her note does seem to reinforce something we'd mentioned in passing: Digitalis is NOT the Wish, since the Wish didn't have 6 fingers. I'm figuring it was in that letter as a reminder to us and to prevent confusion.

_________________
That sounds like something HITLER would say!

Posted: Mon Apr 07, 2003 1:48 pm

Guest
Guest

Re: oh

dmax wrote:

I noticed that, too. I remember at one point we thought both Digitalis and The Wish had 6 fingers, but now we know that was just a mistake by Kendra. We also know that Dale was resistant to meds, but really wanted hypnosis. I'm going to work on a return email this evening, suggesting a number of theories and hinting slightly at "Jake Chamber"'s concerns that maybe the wish actually happened to his patient. I'm also going to suggest that Kendra try and track down Dale and definitely hypnotize him (who knows what THAT will turn up!)

Posted: Mon Apr 07, 2003 2:37 pm

butterflyer22
Boot

Joined: 25 Sep 2002
Posts: 37

Treatment options

When considering treatment options you might want to consider if it will help us most to have Dale in out patient care or inpatient care. Not that we know where Dale is or anything. It may be better for Dale to be an inpatient with computer time. Would that protect him from the loan sharks?

Posted: Mon Apr 07, 2003 2:43 pm

RPGgame
Unfettered

Joined: 02 Jan 2003
Posts: 501

[quote="Anonymous"]And now, her recent response:

Quote:

I'm going to respond to her tonight. Any suggestions?

make sure to not mention the name Dale and what are you going to say about your patient. You need a good back story that is similar bun not the exact same thing that they said. Someone else take over I need sleep

Posted: Mon Apr 07, 2003 7:31 pm

StarkRavingMad
Decorated

Joined: 23 Mar 2003
Posts: 250

Here's what I sent back. I had to stop myself from referring to her patient as "Dale" about ten times...

Quote:

Dear Dr. Kendra:

First, I will begin with my patient, before addressing your more interesting case. "John Doe" seems to be responding to the treatment. Although he still insists that his conception of "The Wish" is real, he is now of the opinion that there is nothing he can do to rectify whatever error he belives he has made. His emotional state is becoming more stable as he is now more concerned about moving on with his life than he is with obsessing about the past. I suspect my course of treatment with him may be nearing a close; I see no real reason to continue to attack this delusion about "The Wish" if it allows him to deal with a tragedy and if he is able to move on and live a normal life.

Your patient, on the other hand, seems to be taking a turn for the worse. The main difference I see between our two cases is that (according to your last email) your patient has a very strong recollection of his Wish, while mine has none, but only a general sense that it occurred. It seems to me that your patient is perhaps blaming himself for his family's death. You say it was an accident that killed his family, and he thinks he was somewhere else, but (and I'm speculating here) was this a car accident and was he driving? That could explain the blame he is placing upon himself. Perhaps if that were teamed with a barely conscious "wish" that his family not be around anymore so that he could deal with his money problems, he could then take that wish and make it into the alternate reality in which his wish came true and the death of his family was his fault, and yet not his fault at all since he was tricked by this mysterious man. It would provide an easier reality than that in which the tragedy was truly all his fault and his fault alone.

I'm guessing that the particulars of his story pan out to be in line with his supposed wish. I.e., you said that he wished that he had money and his family didn't know. I'm assuming he got some sort of insurance payoff, so that in his conception his "Wish" came true, but in an evil way? The symbolism of the amusement park being a cemetery isn't lost on me, either. Surely that must represent his life, formerly full of children and fun, and now little more than a burial ground. Maybe by leading you there, his subconscious was trying to show you what his real problem is.

The loan shark portion is more puzzling. I suppose it could be true. I know little about your area and the only "gangsters" I've ever seen have been in the movies. His house blowing up could be evidence of them. Then again, if it is just part of his delusion, maybe he went to the extreme and blew up his own house. Either answer is extremely troubling, to say the least. I would think if you had any way to bring your patient in it would be beneficial to him, either to keep him from causing any more damage, or to protect him from the loanshark, if indeed that person does exist.

There are some portions of your case I don't understand, particularly the symbolism of the six-fingered fortuneteller. Why insert such a strange character into this delusion, when he already had the appearance of the strange man and the wish? It just seems like an extra fact that adds little to his story, and unnecessary to the general delusion. I don't understand the significance, but maybe that just comes from not knowing the facts of the whole case. Had your patient ever said anything about fingers or digits before? And what did this fortuneteller say that was so troubling to your patient? I would be interested in learning more about this fortuneteller, if your patient said any more about that character, as perhaps it signifies some other deeper meaning that we could use to expose the delusion to your patient.

I suppose there are always discrepancies in these types of cases, and so often my curiousity goes unsatisfied. In my case, there are still some things that don't entirely make sense to me. For example, my patient claims to have evidence that he was actually somewhere else when the tragedy that took place happened. It was a receipt with a time on it that couldn't have been correct, given what happened that day and the times noted in official records. I tried to make him see that it was probably just a mistake on the register, but he held fast to his delusion. He also claims to have seen people with "empty eyes" lingering about, and his neighbors agreed with him that strange people have been around his house. I suspect they just have something to do with his exploration of strange mystical websites, perhaps people he messaged or met on them, but it is troubling to me. Anything that furthers his delusions cannot be good.

Finally, as to the subject of hypnotism, I have to think it could only help. It would either reveal to him the truth of what happened, or perhaps reveal more details of his delusion that you could use to help show him that it was false. At any rate, it does not sound like the situation could be much worse than it is currently.

I hope that your patient is located and is in good health. I would appreciate knowing of any developments.

Warmest regards,
Jake M. Chambers
Mahkra Mental Health Care

Posted: Mon Apr 07, 2003 8:18 pm

StarkRavingMad
Decorated

Joined: 23 Mar 2003
Posts: 250

Got an interesting response from her today:

Quote:

Dear Dr. Chambers,

Good news-I heard from my patient today. His message was quite brief, but
assured me he was all right and asked for hypnosis again.

I have had verification of the loan-shark portion of his story; apparently my
patient has been sent threatening e-mails by these individuals. He also has a
more sinister, if that's possible, group after him. They sound very similar to
the "empty eyes" people your patient described. These individuals were
described as having "dead eyes" and at least one of them had a tattoo on his
arm that was the same as graffitti that was found on my patient's house. These
latest confirmations throw a bit of a monkey wrench into my theory about the
nature of his psychosis.

I've been thinking along similar lines to your speculation. If these loan
sharks had indeed threatened his and his family's lives when he didn't pay them
back, then he could legitimately feel that he was responsible for their
deaths. My thoughts now are that the wish-granter is a cover memory for an
encounter with the loan shark enforcers when they gave him a final warning, and
that the amusement park/fortune teller is a cover memory for his initial loan,
i.e., the money opens the world of possibilities to him, the fortune teller is
the person who actually gave him the money but gave him a warning if he didn't
pay it back in time. Maybe the six fingers represent the money-lender's
overabundance? I know, I'm grasping for that one.

I don't know what to make of the cult-figures. They are real, seen by other
people. I think that perhaps Dale had joined a cult, or got on the bad side of
one somehow. If he was in a cult, that might help to explain his dissociation
if they regularly went into altered states during their rituals. In any case,
it doesn't help me try to get him grounded again if threatening tattooed men
with "dead eyes" are asking about him.

Obviously you're in the Lenore Terr/Judy Herman camp regarding recovered memory
and hypnosis. Fair enough. I don't believe the evidence is in your favor, but
we can agree to disagree. Be that as it may, I am going to agree to hypnotize
the patient, partly because I do believe that accessing some of the trauma
regarding the loss of his family will be beneficial to his recovery, but partly
because I admit I'm curious as to what he will come up with. I'm also not sure
he'll come in unless we do this, and he really needs to come see me.

Where is Mahkra located? I'm curious about the reports of the dead/empty eye
people and the fact that they've been seen by others.

-Michelle Kendra

Michelle Kendra, MD
Inpatient & Outpatient Psychiatry
Princeton, NJ Headquarters
Klepsydra Mental Health Facility Network

Posted: Thu Apr 10, 2003 1:18 am

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