New Admission Interview
Bruce Taylor, Interviewer
Dec. 22.
Form 747: Identification and Problem list
Patient: Kringle, Kris, Nicholas St. (Also known as Santa Claus)
Problem List:
1) Possible delusions: (Patient claims he’s the real Santa Claus.) When this doctor doubted the gentleman’s claim, Mr. Claus asked, “Have you been a good little boy?” This doctor then informed Mr. Claus that the question was inappropriate, at which point Mr. Claus said “Ho, Ho, Ho.” Abruptly in the lower pocket of this doctor’s $250 Polo sports jacket there was one (1) lump of coal.
2) Support system: Mr. Claus wanted to have his wife, a little girl named Virginia, and Mssr. Dasher, Dancer, Prancer, Vixen, Comet, Cupid, Donner and Blitzen to visit.
3) Diagnosis: Manic Depression with underlying characterlogical disorder and delusions of grandeur.
4) Disposition: Pt. claims that after he, “...distributes presents throughout the world to good little boys and girls, I’ll return to the North Pole.”
Form DC-10: Record of Valuables and Clothing
1944 United States Navy star chart, Life Pictorial Atlas of The world, Chandler’s Latest Edition of International Air Traffic Routes, Texas Instrument Calculator, labeled, “Don’t Touch, Programmed for Satellite Orbits.” One Sony Walkman with various tapes, Christmas With Lawrence Welk, Bing Crosby Sings White Christmas, Muzakly Yours, The Nutcracker Suite, Twisted Sisters Do Rudolph, one large Thermos of Hot Chocolate, bags of marshmallows, Hershey Kisses and Screaming Yellow Zonkers, Doritos and onion dip, packages of Hostess Twinkies and Ding Dongs plus a zip lock bag labeled, “Sugar ‘n’ Spice ‘n’ Everything Nice” (sent to substance lab for analysis). One bottle of Flea and Tick Off, Heavy Duty. One red, white fur-trimmed Santa Claus suit badly singed, burned and soiled, scuffed boots, blackened and dirty cap with matted fluff of white fiberfill on end.
Form 284-3205: Observation of Patient
Elderly white male, rather chubby and plump, elfin in features and stature with immense beard on chin the color of snow. Pt. has broad face, with cheeks red as roses and nose like a cherry (semi-ripe Bing). Pt. dressed in burned, singed Santa Claus outfit with Adidas sport bag filled with personal articles as previously described. Pt. looks tired and anxious, nervously glancing at clock. Frequently puts finger beside nose and gives abrupt nods of head.
Orientation:
Date: “It’s beginning to look a lot like Christmas.”
Place: “Oh, little town of Bethlehem?” (Pt. smiled sarcastically.)
President: “Ho, ho, ho.”
Assessment: Probably well oriented.
Concerns: “Where’s my sleigh? My reindeer? My bag? I was just on a trial run—”
Assessment: Characterlogical Disorder. Most likely patient is feeling very guilty about something and is atoning for guilt by acting out fantasy of being perfectly good and beneficial because the core personality is seen as evil and terrible. “Santa Claus” is compensatory mechanism/reaction formation to guilt. Insistence about sleigh, reindeer and personal effects simply shows depths of denial.
Form 98109: Harborheights Mental Health Clinical Data
I. Chief Complaint—Patient’s Stated Reason for Seeking Help
Brought in by Seattle Police for wandering around Columbia Center Tower yelling, “Help me! My sleigh and reindeer have crashed into the fifty-first floor!”
II. Present Life Situations
A. Describe Relationships with Significant others
Claims good relationship with wife, a little girl named Virginia, and a particularly good relationship with a Mr. Rudolph.
B. Housing
Pt. claims to “...live at North Pole.”
C. Education: Describe Learning Deficit and/or Strengths
Mistletoe Academy of Packaging Design and Gift Wrapping; Cinderella Electronic Game and Toys; Nutcracker Institute of Advanced Fudge Making and Cookie Design; C.I.A. Intensive Workshop, “Nice People, Naughty People and You”; Peter Pan Academy of Doll Making and Fire Truck Design; Scrooge Institute for the Study of Year-round Christmas Merchandizing; Mr. Claus continued for another twenty minutes. Apparently no formal schooling but seems very bright.
D. Past and Present Employment and Economic Status
Self-Employed.
E. Social and Societal Activities
“Well, me and the elves get together a lot to make lots of toys for the following year. So I guess I’m a family man. Got my reindeer to take care of. I have a busy life. No, I don’t have a car...no roads. No, I don’t go to movies. No. No, TV. I read a lot: A Christmas Carol, The Night Before Christmas. I also like Edgar Allen Poe and Stephen King.”
III. Past History
A. Significant Developmental History (early Family, Childhood and Adolescent Problems)
“I loved my parents. I never drank. No, I was never in jail.” Patient seemed sincere. Pt. seemed lively and quick. This writer knew in a moment that it must be remembered that since patient still claimed to be Santa Claus, it would have to indicate some sort of background psychopathology.
B. Family History
“I don’t remember much about my parents. No sir, I don’t remember anything about cancer, smoking, drinking. I do remember lots of cookies and eggnog. Every day was like Christmas.”
C. Past and Current Medical History—List Major Illness, Operations and hospitalizations.
Pt. claims none.
IV. Review of Systems—Sleep Disturbances Weight Loss, Sexual Problems, etc.
“I get lots of sleep 364 days of the year, but on the twenty-fourth, I stay up all night. What’s today? It isn’t the 24th is it? O Holy Night! Oh, Christ divine! How long does this last? I’ve got my sleigh and eight reindeer on the fifty-first floor of that Darth Vader building...”
Sexual: “Ho, ho, ho.”
V. Mental Status
A. Appearance and Behavior
Unkempt, apprehensive; overall affect is anxiety. At times comforted self by making out lists and checking them twice. Muttered at times, “Gonna find out who’s naughty and nice.”
B. Speech and Communication—Coherence, Pace, Organization.
Obsessional: “When is this going to end? I was just doing a practice run and the smog blinded my reindeer and the loss of ozone must have affected something and I crashed into the building...you have to let me get back to my reindeer and sleigh...I have to get back to the North Pole to get things fixed up so I can get to all the good little boys and girls and give them presents...Please...” Pt. was then informed that he was on a seventy-two hour hold for being gravely disabled. At which point, patient leaped up and yelled, “You can’t do that! I’m Santa Claus and Santa Claus is coming to town! The whole world is expecting me to deliver presents! I’ve got to get my sleigh and reindeer! I’ve got to get out of here!” At that point, Mr. Claus jumped up, shoved all personal effects back in bag and yanked open the door to the admitting office. He was met by fifteen staff people, a set of restraints and after much struggle was wrestled to the ground and carried to his room where he was placed in a waist restraint. Interview terminated.
Subjective: “What am I gonna do? Jingle Bells! It’s Christmas! I have to get my sleigh, my reindeer. Without me, what is Christmas? Think of all the disappointed little girls and boys. How can you do this to me?”
Objective: Tearful. Later on, was quietly smoking pipe the smoke of which encircled his head like a wreath.
Assessment: Deeply rooted delusional system. Obviously sincerely believes in what he’s saying. May mean long term hospitalization. The patients in group therapy, however, were obviously taken by the gentleman, many asking about his reindeer, and what it was like being Santa Claus. Efforts at refocusing the group on more fruitful subjects proved hopeless. Oddly enough, the group therapists all ended up with chunks of coal in their pockets. Most likely cause is some sort of staff hysteria for being out of control of a group. For group to be so taken in by this gentleman means impaired reality functioning.
Plan: Double all pts.’ meds.
B. Tai Lor, M.D.
Attending Psychiatrist
Dec. 23
Subj. “Better watch out! Better not cry! Better watch out I’m telling you why—can’t you see what a mistake you’re making? I’m Santa Claus! What do I have to do to make you see?”
Obj. Intense eye contact.
Asses. In one to one contact, pt’s delusional system remains intact. Pt obviously very well defended against his feelings of unworthiness because of the fear that what he really feels is who he is as a person, (I feel unworthy therefore I am an unworthy person.) Oddly enough, all the patients in spite of massive doses of medication, act as though Mr. Claus is, in fact, Santa. Certainly, at times, his eyes, how they twinkle, and when he laughs his stomach shakes like a bowl full of jelly.
Plan: Further evaluation.
Brucia Talorez, R.N.
Subj. “Hark! the Herald Angels sing! Angels we have heard on high!”
Obj. Pt.’s droll little mouth drawn up like a bow. Finger beside nose, turning head with a jerk.
Asses. Pt. may be hearing voices. Certainly unusual perceptions present. Pt. also claims to know not only when people are sleeping, but knows if they’ve been bad or good. Seems obsessively concerned about this and some of the more paranoid patients seem uneasy around Mr. Claus. May be psychotic elements present. Also, pt. engaging in compulsive giving behavior. When confronted, said, “But that’s what I’m supposed to do.” Pt. secluded in room for thirty minutes.
Plan: Start on Lithium; if delusions persist, begin Thorazine. Monitor compulsive giving behavior; pt. must also learn how to receive.
Bruce Taylor,
Primary Therapist
Sub. “Here comes Santa Claus; here comes Santa Claus,”
Obj. Pt. leading other pts. in singing Christmas carols during community meeting.
Asses. Pt seems to have excellent rapport with other patients. The singing became so affect laden that it became something of a clatter and other staff leaped from their chairs to see what was the matter. Mr. Claus was informed to limit the intensity of his interactions with others.
Plan: Increase pt.’s Lithium
B. Tai Lor, M. D.
Attending.
Dec. 24
Sub. “Oh, ho, ho, ho!”
Obj. Surprised, pleased, good affect. Pt. dressed in cleaned, pressed red Santa Claus suit.
Ass. It was the evening before Christmas, and all through the unit the patients were admiring Mr. Claus’ street clothes when all of a sudden who should appear at the main door but a little girl, age eight, by the name of Virginia, who asked, “Is there a Santa Claus?” (pause) “here?” Visitor handed over to this doctor a sealed envelope. “If he’s here,” visitor said, “these are papers for his release.” As this doctor opened door to let visitor in, abruptly visitor yelled, “Now Dasher! Now, Dancer!” Two immense, well-formed Reindeer charged the door and jammed it open. At that point, Virginia yelled to Mr. Claus, “SANTA BABY! The elves got the sleigh! Let’s go!” Mr. Claus, surrounded by pts., was escorted to the front door and escaped. A few minutes later one of the patients pointed out the window and yelled, “Look!” And what to our therapeutic eyes should appear but an open vehicle pulled by eight reindeer.
Plan: Remove coal from pocket, take suit to dry cleaners.
Bruce Taylor
Primary Therapist.