R.F. was a 25 year-old male who had recently been fired from his job as an assistant at a local bookstore. Before he took on this job, he was in college for about a year. However, he dropped out of school at the beginning of his sophomore year.
He was accompanied by his best friend from high school when he first came to our clinic three weeks ago. On his first visit, R.F. was experiencing a delusion of grandeur. He repeatedly verbalized his belief, to no one in particular, that he was the “Ooda-Buddha” and only he was “enlightened enough to save all sentient beings from their suffering”. The receptionist of the clinic also noted that he took several magazines from the magazine rack and began to whack them against the walls and sometimes his thighs. R.F.’s failure in basic self-care was also evident from his unkempt appearance during the past three consultations: he was always barefooted and wore the same baseball cap, black T-shirt, and old boxers. It was also obvious that he had not showered and brushed his teeth for at least three days.
His best friend said that R.F. had been “acting really weird” for the past six to seven months. In addition to the delusion of grandeur that he often experienced, R.F. himself mentioned that he was afraid to go to sleep at night because he was positive that the gods of other religion would break into his room, sneak up behind him, and then strangle him. He also thinks that every church he had ever walked past was a menacing sign – a signal that his doomsday was impending. Often, R.F. would be having conversations with no one in particular. His speech was neither cohesive nor logical. For e.g. when one of the clinicians asked him whether he felt nervous or tense recently, he answered the following: “I hate the garden when I try to eat but that doesn’t mean I am good. Come to me.” On another occasion, when asked who “Ooda-Buddha” was, R.F. replied, “Johnny Tony Mary Hairy Wali Hali”.
According to his best friend, R.F. sometimes “wailed like a bawling baby” without provocation or apparent reason. Once, during a seemingly enjoyable lunch at McDonald’s, R.F. gave an acute scream and started crying for a full ten minutes. On other days, he “giggled his way up and down the cereal aisle while pointing to random items on the store racks” when they were at the grocery store. During the second consultation, R.F. exhibited an obvious shift in emotions. He entered the room giggling but when he sat down opposite the clinician, he sobbed continuously. He also went into “periods of rigidity”, where his upper torso would stiffen suddenly and he resisted any pressure to move. These bizarre symptoms – disorganized speech, abrupt shifts in emotions, absence of goal-directed acts, and rigid motor behaviours – occurred quite frequently when R.F. was still working at the bookstore. These “crazy” and “eccentric” behaviours drove customers away and thus R.F. was fired by the store manager.
R.F.’s parents abandoned him and his elder brother when he was 17. His brother moved to the United States after falling in love with an American woman five years ago. He had been living alone in a run-down quarter in the inner slums of the city ever since. His best friend said that for the past eight years that he had known R.F., the latter worked very hard to make ends meet. After graduating from high school, R.F. deferred his college studies in order to earn money for university tuition. When he was 22, he held three part-time jobs simultaneously. He made just enough to get by, and for the past few years had been doing “pretty alright, but not fantastic”. He also mentioned that R.F. never really had many close friends when they were in high school and college. However, R.F. did get involve in a serious romantic relationship with a 30 year-old female whom he had met at the bookstore. R.F. was deeply in love with her, but she broke it off a year ago, citing reasons of incompatibility. R.F.’s best friend could tell that R.F. was devastated, but the latter kept to himself and refused to talk to anyone about his heartbreak. When questioned about R.F.’s family history, his best friend said R.F. once mentioned that two of his maternal uncles were institutionalized when they were about 35 and 40 respectively. He was not sure why they were institutionalized, but he recalled how R.F mocked cruelly at them – saying that his uncles were crazy and he couldn’t fathom how people could actually believe in such things as “the aliens are coming to plant messages from God” into their heads.
Currently, R.F. is unemployed and lives alone. His best friend stays two blocks away from him and tries his best to drop by to care for R.F. everyday e.g. cleaning the house, bringing meals, etc after he knocks off from work as a car mechanic. However, he said that while he is genuinely concerned about R.F., he is starting to feel drained and exasperated, and doesn’t know how much longer he can hold out.
