Richard Reimer

Character Name: Richard Carl Reimer
Nickname(s): Richard, Rich, Richie
Age: 17
Birthdate: December 7
Gender: Male
Sexual Orientation: Unknown (Behavior suggests pansexual, but Richard doesn't seem aware of his preference aside form the suggestion of others)
Face Claim: Nathaniel Rooklyn



Appearance:

Richard is what most people would term 'average', not being particularly large or short, nor is his build noticeably well muscled or lacking. He is trim, but not in a way that suggests effort has been put into this result. His gaze tends to be distant, though not in a wise or thoughtful way, but rather an indication of his lack of focus on reality, usually occurring when he is either off in his own world, or experiencing a delusion or hallucination. His manner of dress is pretty uninspired, and in fact his skill at putting together an outfit is completely lacking. If not for the foresight of his care takes, there are chances he would wander around not knowing or even being concerned about his clothes matching, or even being an appropriate fit for his body. Fortunately someone has had the wisdom to see to the choosing of his apparel for him. Typically his clothing leans towards darker colors, comfortable nature, and designed to appear loose but not bulky. Even with this being the case, a few articles of clothing seem to have slipped this helpful individual's attention, as he on occasion can be spotted in something that is far too large for him, or perhaps it was a mix up of whose shirt belongs to who. Even with this guidance, he demonstrates a deficiency in being aware of the state of his wears, not noticing on his own if something has worn out, and often either forgetting to button or zip, or in the case of button shirts, mismatching the halves so grossly it is impossible to ignore to the aware observer.

Personality:

For the most part, Richard's personality tends to be fairly consistent, as far as his disposition. For the most part he is docile and complacent. When his attention is achieved, he will do as is requested of him without complaint, and for the most part can be counted on to be honest. Incidents in which he appears to be dishonest are not a matter of him trying to lie or intentionally fabricating a story, but rather, the result of mis-remembered information, or the produce of one of his delusions, hallucinations, or cases where he confused originally purposeful fantasy with reality. While he is often caught up in a fantasy, or one of his less intense delusions, his detachment from others does not seem to extend to a desire to be isolated. In fact, once he has become accustomed to regular time spent with a group or individual, he can become distressed if denied such contact over a period of time. The only case of discrepancy in his behavior under normal circumstances is that he does tend to fluctuate between demonstrating symptoms of flattened affect (ie lack of emotional response and marked appearance of neutrality) and behavior inappropriate given the environment (ie behaving out of sorts with the situation often without obvious signs of provocation, such as giggling or crying without apparent cause). Sometimes his behavior will fall between these two extremes, though moments of stability of expression tends to be rare between his propensity to mode shift and his tenancy to be out of touch, or incorrectly in touch with reality. Unfortunately it has been noted that his complacency, and susceptibility to suggestion often mean that Richard will engage in activities that are potentially dangerous or inappropriate because someone else has suggested he should.

The exception to his usually docile nature occurs when an individual tries to make him see that his delusions or hallucinations are not real. Obvious attempts that are gentle will immediately be met with irritation, and a defensive need to 'prove' he is right. If persisted or if the tactics used by the individual are aggressive or in anyway critical of him, he can swiftly become aggressive and violent. However, even if he remembers the occurrence in question, he usually doesn't appear to remember who was the source or target of his aggression.

Likes:

• Windows
• Fantasy or story based media (ie books, movies, shows ect)
• Images (ie pictures which can be about anything though depictions of violence sometimes upset him)
• Sensory stimuli: regardless of the sense, Richard tends to become engrossed in pleasant sounds, or things that have an interesting feel to them
• soft things
• Straight jackets

Dislikes:

• Being alone
• Depictions of torture
• Padded rooms
• Dead things
• Coffee

Fears:

• Abandonment
• Conspirators(a temporary term sometimes applied to those that are attempting to forcibly convince him that his hallucinations/delusions are not real

Strengths:

• Empathy:he is very good at being able to place himself in another person's situation and understand both how he would feel in that situation and how the other person is likely to feel given their background and disposition
• Writing: his frequent indulgence in complex and often well structured fantasy gives Richard a lot to work with in the writing of fictional prose (while he's present enough to do so.
• Comfortable with Facility Staff: He has become accustomed to the presence of psychiatrist, doctors and other staff present in a mental health facility, and therefore their presence does not cause him stress (unless he is in the middle of a disturbing hallucination/delusion and cannot recognize them for who and what they are). He has come to accept them as just a part of 'normal' life.

Weaknesses:

• Disorders that have brought him to the facility (outlined in detail in final section "Highlights of Patient Files from previous physicians and facilities
• Lack of normal social experiences
• Deficiency in an ability to identify manipulation or deceit in others
  

History:

Due to the nature of his conditions, it is difficult to discern what Richard's past has been from Richard himself. The 'truth' to him can fluctuate in his ability to recall events accurately or even at all, and can even be inconsistent withing specific events themselves (ie what he remembers today about a specific event, may not be the same as what he remembers tomorrow). Still, with information provided by family, former physicians, and staff of previous mental health care facilities, at least a partial outline can be constructed of his past that is known to be true.


Richard is the middle child of five, all of which are still alive, despite what he may at times think. It isn't entirely clear when he first began to experience serious episodes of his current afflictions, as his initial visit to a psychiatrist was prompted, according to records, by inattentiveness and fidgeting in class, as well as a tenancy he was said to have of 'lying'. His parents used to figure that his whimsical and very involved stories were merely a child's imagination, something they say that Richard has always had an abundance of. However, they quickly became frustrated when such 'stories' turned into accounts by their child of things that didn't happen as though they did, or 'lying' about various things. Similar problems were prevalent once he began formal schooling. His teachers describe him as argumentative, as well as not paying attention in class. He would often make noises or speak out with no regard to others students, and would often complain of a teacher 'never saying that' or 'saying this' when it was not the case.


His first physician's prognosis was met with skepticism by his parents, who weren't yet ready to accept that their then seven year old might need to be on medication or to see a doctor regularly. So it was, for a time, that he went without treatment, his parents deciding they only needed to be stricter with him. As Richard only seemed to get worse with this approach they eventually reevaluated their opinion on the matter of getting their son help. For slightly more than four years he was regularly switching prognoses, medications, and even doctors. His parents were impatient with the lack of results and the conflicting information they were receiving about what he might have and what he couldn't possibly have because of his age. Unsurprising as he was diagnosed with varying conditions that later proved to be incorrect, Richard saw mostly no improvement during his courses of treatment. The lack of a consistent doctor caused other symptoms to remain unnoticed or unconfirmed, or written off as a result of one of whatever current medication he was on at the time.

Richard engaged in a serious of troublesome activities and started to become aggressive towards those that tried to keep him from whatever impulsive acts he might have engaged in at the time. His real frustration, however, was when he would come up with some 'crazy' notion of what was going on, and was forcibly told that he was making things up. The frustration quickly escalate to violence, and at the age of 11 Richard was placed in his first facility, one meant for short term care. These final two years saw him in and out of short term care, until one day he became especially violent towards a family member. During this instance his father was forced to physically restrain him, as well as fight the mounting urge to try to stop his behavior in a more aggressive and 'hands on' way. It was then that they decided he couldn't remain in the home any longer. It was only a matter of time before either they hurt him, or he grew to strong for them to safely subdue in the course of his development into manhood.


Shortly after his thirteenth birthday he was admitted to his first long term health care facility. There he remained, and despite the severe decline in his family's involvement in his care, or even in taking intrest in how his case proceeded, he did mellow out. Figuring out his diagnosis more accurately allowed for Richard to be placed on the correct medication, and the regimented schedule and access to those who didn't 'attack' him for the things he knew were real has stabilized his mood considerably, even though he remains unable to function in a 'normal' setting. Recently his original care facility has had to make cut backs to their staff, services, and their patients. He is one of the patients that was referred to The Daniel Grey Psychiatric Hospital, and while it seems that his parents are not yet able or interested in seeing the new place their son will be sent to, they have had no qualms in handing the checks to this other institution.

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Highlights of Patient Files from Previous Physicians and Facilities

Previous Misdiagnoses

• Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Type (Formally classified as Attention Deficit Disorder)
• Oppositional Defiant Disorder
• Antisocial Personality Disorder
• Anorexia: Later disproved as the behavior was revealed to be the result of the suggestion that the patient might be suffering from this eating disorder. The original cause for the lack of nutritional intake was discovered to have been the result of the patient being unaware of his need due to other conditions
• Tenancies to Self-Harm: Later disproved as the infliction of injury to the patient's person were determined to have been accidental, caused during episodes of disturbing hallucinations

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Currently Suspected Conditions

Schizophrenia-undifferentiated type: considered confirmed
Symptoms Observed in Patient:

• Delusions-Bizarre and non-bizarre
• Hallucinations-full sensory, when only auditory often with multiple voices conversing with one another
• Grossly Disorganized Behavior (e.g. dressing inappropriately, crying frequently)
• Negative Symptoms: Blunted Affect (symptom varies in occurrence and duration)

Recommended Treatment:


Anti-psychotic medication, Therapy


Maladaptive daydreaming (compulsive fantasy): considered confirmed


• Discounting episodes caused by delusions, hallucinations, or cases in which the line between fantasy and reality become skewered for the patient, he spends a significant amount of time immersed in fantasy/day dreaming that the patient is aware of and can identify as indulgences in fantasy. During such times the patient may discount varied levels of external stimuli, and can at times demonstrate signs of emotional responses (facial expression, changes in breathing, elation or distress) directly as a result of these fantasies
  
  
• Recommended Management
  Patient should be restricted from fantasy related stimuli which may trigger a stronger desire to engage in this behavior. If the patient is allowed to engage in fantasy related activities it should be monitored to ensure patient safety as well as maintenance of self care. If patient is allowed to engage in fantasy related activities, it is highly recommended the activity not be of a grossly distressing nature, as this may cause an extreme emotional reaction in the patient


Emotionally unstable personality disorder-borderline type: Highly likely pending further observation


Symptoms Present in Patient:



• Marked tendency to act unexpectedly and without consideration of consequences-confirmed
  
• Marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized (typically only when acts are thwarted or criticized, or when others are attempting to convince the patient that delusions/hallucinations being experienced aren't real)
  
• Unstable and capricious (impulsive, whimsical) mood
  
• Disturbances in and uncertainty about self-image, aims, and internal preferences
• excessive efforts to avoid abandonment
  
• Demonstrates impulsive behavior


Recommended treatment

Psychotherapy, Mood stabilizers, Narrow a fore mentioned anti-psychotics to medications also proven to address symptoms specific to patient .

Note:This diagnosis is the most likely to be skewed due to overlapping symptoms and the tenancy for the patient to falsely succumb to outbursts in order to acquire full body restraint, which has proven to be a comfort to the patient during extreme hallucinations. It's recommended that this behavior be addressed and reevaluation take place


Fugue State- formally Dissociative Fugue/psychogenic fegue

- (ie variant of Dissociative Amnesia:Considered Confirmed



Patient exhibits lack of consistency in recall. This varies from complete accurate recall, partial accurate recall, inaccurate recall, and no recall, and can vary in regards to a specific event (real or perceived to be real) over time. The patient has been noted to interchange realities (bizarre and non-bizzarre) with separate memories.

Patient also demonstrates a tenancy to forget delusions/hallucinations/outbursts, especially when the events are particularly intense (though this is not always the case). Most events that are reoccurring, or progressive in nature that focus around trauma sustained by the patient either relate to events supposed to have occurred prior to arrival at long term facility, or to be a variation of such an episode that has been reported to have origins predating admission. This may suggest the presence of real trauma within the patient's past, but given the nature of the patient's disorders it is difficult to confirm this. Regardless, real or not real events are viewed as real by the patient, and is emotionally perceived thusly (when the event in question is able to be recalled).


Fantasy Prone Personality:


While a disposition rather than a disorder, this personality trait observed in the patient is related to a disorder observed in the patient and can offer further insight into behaviors observed, as well as possible courses of treatment or treatments that should be avoided or carefully monitored

Characteristics Note in Patient:


• Excellent hypnotic subject- confirmed
• Having imaginary friends in childhood - unable to confirm with first hand knowledge, suspected given previous physicians and parental testimony
• Fantasizing often as a child
• Having an actual fantasy identity- only in relations to aforementioned condition, does not appear to occur separably to date.
• experiencing imagined sensations as real - confirmed to occure outside of hallucination/delusion driven events
• having vivid sensory perceptions
• Hypnotic hallucinations (waking dreams) -confirmed
• spends over half of waking time fantasizing (excluding time in delusion/hallucination driven state )
• Often confuses or mixes fantasies with real memories


Highly Susceptible to Suggestion:


Patient will typically give in to suggestions made by others without concern for consequences, being manipulated or consideration of personal preference or desire. This excludes being forcibly or aggressively challenged in regards to hallucination/delusion driven events.

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Behavior in Regards to Facility Life

• Medications: Patient will typically take medication without complaint
  
  
• Therapy sessions and activities: Patient will go to sessions without complaint, however the patient may become too engrossed in daydreams/hallucinations/delusions to see to the matter unprompted. So long as the event being experienced is benign, patient can easily be physically lead to the desired destination. Attempts to retrieve the patient from a daydream meets with mixed success. Patient is noted for preferring silence over dishonesty if the patient does not want to share a truthful response, and has not, as of yet, been noted to meaningfully lie to doctors or staff. However the truth that the patient is sure of does not always reconcile with reality given the nature of the patient's disorder
  
  
• Staff: The patient is usually docile and complacent and therefore unlikely to cause difficulty for staff members or doctors. He is not distressed by the presence nor the duties of staff and will not object to either. Patient is however a potential dangerous to self and staff when in a delusional/hallucination driven state. Subduing the patient is recommended, and the patient is noted to physically calm when placed in restraints, even if still in a hallucinatory/delusional state. The state of the patient being dangerous to himself or others occurs with far less frequency then the patient suffers from hallucination/delusion driven events. (in other words, even when in the midst of a hallucination and/or delusion, the patient is usually not a threat)
  
  
• Nutrition: Patient will eat without complaint, and does not seem concerned about food or weight problems. However, patient has been noted to forego eating inadvertently due to being out of touch with reality. Monitoring the patient to ensure basic self care is being attended to.
  
  
• Hygiene: Patient demonstrates regular and successful execution of hygiene related rituals. Difficulty has only arisen on occasions where the patient is so out of touch with reality it does not even occur to him to leave his room for extended periods (if allowed)
  
  
• Dress: Patient demonstrates no intentional rebellion towards restrictions or guidelines in regards to apparel. Patient is however noted to be unaware of the status of his dress and therefore if not kept away from clothing that is deemed inappropriate, may wear said clothing completely unaware of its appearance. Patient is also noted for forgetting to button, zip, tuck in, and/or straighten said clothing or to do so impartially or unsuccessfully. If patient's attention is draw to the problem, he will fix it without complaint.

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Other Problematic Behaviors

• Given patient's susceptibility to suggestion, he has been noted in engaging in dangerous, 'inappropriate', or otherwise discouraged activities upon being invited to do so by others. The patient will not initiate said activities apart from being in a delusional/hallucination driven state. However, he also offers no resistance to the third parties involved.
  
  
• Patient has the potential to become disturbed if hallucinations or delusions he is experiencing are questioned to directly (ie in a way that suggest criticism or doubt ) and may become aggressive or violent with those who forcibly try to alter the patient's perception in the moment. It is sometimes possible to use seemingly honestly posed questions and subtle suggestions to influence the patient's perceptions of the event; however, this is not recommended to be undertaken without due cause given the possibility that the attempt may backfire. Such techniques are best left to licensed psychiatric physicians, and is recommended to take place in a controlled environment

CONGRATULATIONS, Mister, Reimer . After reading
over your application I have come to the conclusion
you should fit in fine at Daniel Grey Psychiatric Hospital. You
may choose your room and set up your schedule, a full day
here at Daniel Grey will start for you on Monday September
16, 2013.