A letter to a patient on the psychiatric inpatient unit

Dear Adam Magician Haven King,

You told me that was your new name, is that still true? You told me that the veins on your arms and legs gave you special powers— the ability to fly, to build massive castles in mere seconds, to be a super hero that fights evil, is that still true? You told me your powers called for a new name, Adam, a strong almost biblical name, is that still true? You told me your best friend was Spider-Man, that’s he’s a really good guy and has been an even better friend when you needed it, is that still true? You told me you are the king of Haven, a castle you built in the sky, a refuge for those seeking shelter from the forces of evil, is this still true? You told me that you get into fights often with other people living on the streets, that these are the evil people who are out to get you, is that still true? You told me that you like being the Haven King, that you like being powerful, that you like being famous, that you are happy, is that still true? You told me you are 25 years old and that you don’t drink alcohol, you don’t do drugs, you only smoke cigarettes, is that still true? You told me that you don’t really know how you ended up in the hospital, you were at Dunkin’ Donuts and all of sudden you were surrounded by police and then brought here. You told me you were upset because we took away your phone, that you’re bored and you want to go to the gym and work out. You told me nothing is wrong with the way you are, you told me that hospitals are for sick people and “I’m not sick,” is that still true? You told me that you’re being held here against your will, and you told me you want to leave. Im glad you were eventually able to leave.

Your father told me your name is John. Your father told me you grew up in another country, and you have an older brother, sister, and mother that loves you. He showed me pictures of your mother hugging you. Your father told me you lived in a big home, went to a prestigious boarding school, and had many friends. He showed me pictures of you and him smiling at the airport your first day in America. He told me that a year later you were betrayed by your closest friends. He told me they took everything from you, leaving you with nothing, no money, no car, no friends. He told me you refused to come back to home, but decided to come to New York on his request because he knew someone who could watch over you. He told me you were working for Uber and had a place to stay. He told me you started talking to him less. He told me you got too many parking tickets and eventually your car was taken away by the bank and police. He told me he couldn’t contact you for weeks. He told me his friend saw you living on the street and then in Dunkin’ Donuts talking to yourself. He told me his friend called the police. He told me he took the next flight he could find to New York. He told me this has never happened before. He told me he wishes he could have been here sooner.

I told you my name is Dr. Jordan Berka. I told you I’ll be the resident psychiatrist taking care of you while you’re admitted to the hospital. I told you the police, your friend, and your father are worried about you. I told you that you’re here in the hospital to be safe, to talk about your experience, to figure out a plan for when you leave. That’s when you told me about yourself. I listened, asked questions, and was curious about your powers, your thoughts, your reality but eventually told you that it all may not be real, I don’t think you believed me.

Was there a better way to tell you? Did it even matter what I said? You did not seem angry when I told you, but you liked me, were you just being nice? I told you what your father had told me, you said all that stuff happened to John, but now your Adam, someone different, someone who had not been hurt, someone strong, someone powerful. I wish I had asked more about how being Adam made you feel, but I was worried about playing into your false sense of reality. I’ve been doing some reading recently and if could speak to you again in those moments I would ask more. I would ask why you chose a biblical name like Adam, I would ask what makes Spider-Man such a good friend, I would ask why the Haven houses, shelters, and cares for refugees, and much more. I don’t think these questions would have made you worse off, maybe it would help you find more meaning in your experience or make connections with what your experiencing. I did tell you I think you are sick and I stand by that. Delusions, hallucinations, disorganized thoughts, withdrawal, agitation are symptoms of a psychotic illness with a proposed basis in deficiencies and excess of neurochemicals in different parts of the brain. I tried my best to explain this to you in terms you would understand, but I don’t think you believed me and I don’t blame you. It may not have been the right time to tell you all that. I wonder was my explanation even helpful? My hope is that it can give meaning and understanding to unfamiliar, strange, and oftentimes scary experiences. My explanation also comes with a proposed treatment— early intervention, medicine, therapy. You agreed to try medication, although Im pretty sure you did not think you needed it. Why? Also are you still taking medication? Does it do the things I claimed it may help with? Are you experiencing any side effects? Are you in therapy? Are you still experiencing these same delusions and hallucinations you came in with?

Adam, or John, whatever you prefer. I have so many questions, but mostly I have hopes. I hope you are doing well. I hope you are happy. I hope you’re able to go on your phone and work out. I hope you feel loved and supported by your family and friends. I hope you found or continue to find meaning in your experience and have the agency to act on it. Lastly, and I know this may sound cruel, but I hope to never see you again on the psychiatric ward.

Sincerely,

Jordan Berka, Psychiatry PGY-2

(The names of the patient were changed to protect his identity)