Summary

Subject 2007/Bayona was admitted for observation at the end of March with a diagnosis of acute paranoia, schizophrenia, and shameless, ill-conceived sentimentality. Family records are incomplete, particularly for the 1980s, although there are possible links to a number of earlier landmark cases including 1977/Craven, 1974/Blatty, and 1978/Romero. In light of the unfortunate copycat syndromes reported following these cases, it is recommended that the strictest confidentiality be applied to the present subject. The potential proliferation of similar "disturbances" poses a considerable logistical concern for hospitals both here and abroad; staff are reminded not to allow "clients" to consult their copies of the DSM-IV to minimize the risk of "false positives." Though not as obviously fraudulent as some, the subject nonetheless shows little signs of real distress. Her symptoms are limited to attempts at mimicking other more notably disturbed individuals and the value of further treatment is questionable.

Subject's Personal Statement

"I was an adopted child. Recently, along with my husband and adopted son, I came to take over the orphanage I stayed in as a child. It's a beautiful neo-Gothic mansion full of creaking floorboards, dark woods, eerie knickknacks ... and, of course, dark secrets. I should also mention that my son, Simon, suffers ... suffered ... from HIV; we keep his condition in check with medication. Simon has had a pair of imaginary friends for a long time, but as soon as we arrived in the house we noticed that he seemed to acquire five or six new ones. They were ... are ... children around his age. They'd play games with him. When Simon disappeared, we kept searching for him for months, sticking up posters and keeping track of sightings until we eventually turned to this psychic. That was before we met this creepy woman who had stayed at the orphanage while I was here. I can't think why I wouldn't remember her or her child, considering that he went around with a burlap sack on his head, but I guess age will do that to you, put great big holes in your memory. Anyway, this woman was the mother of Tomás—before he disappeared, Simon had been obsessed with Tomás. I decided to try and communicate with Tomás and the other children directly. They all died in the orphanage, and I thought their spirits might be there. But it wasn't enough. Around this time my husband left me and soon after I discovered what had happened to Simon and I just couldn't take anymore.... I wanted to be with him so much.... where is he? where is my son?"

[NB: Interview terminated when the subject became agitated and required sedation.]

Symptoms

The subject clearly takes pride in her family history. As soon as we had been introduced, she asked if we knew her sponsor at her previous clinic, Dr del Toro. On consultation, Dr del Toro referred me to a number of relevant cases, in particular 2006/Pan. Some disturbing similarities with the present subject began to emerge. The two subjects display similar mannerisms, and their personal statements contain similar elements—ambiguity, a dark house of wood, inclusion of fairy-tale elements, and themes of abandonment stemming from childhood. It is abundantly clear that the subject aspires not only to be like 2006/Pan but to actually become her in some way. Although this imitation can produce the present subject's most lucid moments, paradoxically, it is also responsible for her most painful ones. It is hard not to feel some sympathy, even if skepticism remains about the truth of the subject's disturbance.

The subject revisits other cases even without prompting. Cases referenced during the initial observation period include 2000/Wong, 2001/Amenabar, 2002/Fincher, 2002/Evans, and even 1976/Donner. The influence of the latter on the subject's psyche is particularly evident when she describes watching children from a nearby home. A clear pattern emerges: the subject is not simply familiar with well-publicised and affecting cases; she has integrated elements of her stories into the backbone of the subject's testimony. Junior psychiatrists may find this aspect of the subject interesting as a case study. However, once 2007/Bayona wanders away from these well-rehearsed symptoms, her credibility immediately evaporates.

The subject also shows an unusual desire for her testimony to be seen as literary; specifically, following in the footsteps of traditional ghost stories in the mould of M.R. James, The Turn of the Screw (1898), or Susan Hill's The Woman in Black (1983). However, it should be noted most of these traditional stories (as well as the psychiatric testimony discussed above) are rooted not in affecting visions and events that make you jump but in deeply disturbing relationships and facts about human psychology. A recent example may be found in the work of Joe Hill, son of Dr S King, who needs no introduction to readers of this journal. Hill's novel Heart-Shaped Box (2007) is a detailed psychological study rooted in the cowardice and dishonesty of its primary subject. It is telling that 2007/Bayona cannot achieve the same intensity in her testimony: she is apt to spend a considerable amount of time trying to convey the sinister nature of the deformed child, then suddenly change tack and attempt to paint the episode she is describing in crudely sentimental terms. This, despite the fact that taken at face value her testimony ends with a woman and a boy having to spend the rest of eternity caring for the children who were involved in their deaths.

Further observation is required to reveal whether such shifts are merely emotional manipulation, or whether they indicate sudden religious conversion. In the latter eventuality, we would recommend transferring the subject to the Wright Institute in Innsmouth for further evaluation. Either way, however, they suggest that both the subject's familial claims and her description of her breakdown are tenuous. Professor Clute, in his influential 2006 paper to the American Psychiatric Association, points to cases such as 2002/Nakata and 2001/Amenabar as examples of the pain that a descent into bondage can cause. Unfortunately, 2007/Bayona's testimony amounts to more of a descent into cotton wool.

Suggested Treatment

Considerable time and effort have been devoted to attempting to find some psychological basis for the subject's testimony. However, as yet none has been uncovered. The subject's testimony is powerful considered in isolation, but draws too heavily and too self-consciously from other well-known cases to be a sound basis for diagnosis. Further research would, therefore, likely be of limited value, and the cost of further treatment is difficult to justify.

Dr Harrison is a board member of the American Association for Psychiatric Criticism. Following an unfortunate series of events involving a scalpel, Dr McCalmont has been researching the history of psychiatric criticism. However, he reports that he is eager to return to working with patients.