This report is filed on behalf of the patient (name, admission data and vital information on Form MH331-7A) presently remanded to this facility.

Intake Synopsis

A male, age twenty-four, with a probable history of alcohol abuse and stimulant abuse was detained for observation (72-hour hold - resisting arrest, drunk and disorderly, possession and use of a controlled substance). Approximately forty (40) monaxadrine 75mg were discovered in patient's boot. Patient smelled of liquor and presented symptoms consistent with amphetamine psychosis.
Patient was lucid (though intoxicated), aware of his surroundings and greatly agitated. Both wrists had suffered contusions as a result of combativeness while in handcuffs. Patient was uncooperative in the extreme, exhibiting paranoid delusions about the events leading up to his arrival at the facility and the purpose for which he had been brought here.

As patient was obsessed with leaving the facility and could not maintain a coherent dialogue, he was placed in a safe room. Persistent violent behavior necessitated the use of five-point restraints.

Patient identity has been positively confirmed, despite the absence of a wallet or any contact information, business cards, etc. Next-of-kin have not been located to date. Attempts to contact persons identified by patient as his girlfriend, employer and landlord were unsuccessful. Under emergency custodial guidelines, patient was designated as a ward of the facility.

Initial Psychiatric Exam
(ten hours after admission)

(In order to convey the unusual nature of the patient's delusions more clearly, less formal language will be used.)

Since patient is unwilling to communicate for more than a few seconds at a time and is often incoherent, the views he expressed were learned over many exams and have been rewritten as a narrative here for convenience. Unless attributed to the examiner, all statements and perceptions are the patient's, and should be weighed accordingly.

Patient was startled when the examiner entered the room, and claimed he could not see the examiner. He could hear the examiner's voice, and see a clipboard and pen brought into the exam room by the examiner - but stated the objects were moving as if by "magic" and not by any method he could discern. This belief is maintained with unwavering consistency (below).

The prior evening, patient was "just passing through" after getting lost on a highway unfamiliar to him, and had stopped at a gas station. His purchases allegedly consisted of gasoline, cigarettes and coffee - and not alcohol, despite the strong odor of whiskey on his breath and clothing, and a blood-alcohol concentration of .16 (per Breathalzyer, twenty-six minutes after being taken into custody).
Within seconds after leaving the gas station, the passenger-side door of the patient's car opened unexpectedly and several black leather ("biker") gloves flew in. They seized control of the steering wheel and foot pedals and overpowered him, handcuffing his hands behind his back. They produced a pint bottle of whiskey and a bag of pills, forced him to consume several "shots" of liquor and at least six tablets (probably monaxadrine), and covered his eyes. They then drove the car in a rapid and reckless manner, employing many turns and manuevers to confuse patient's sense of direction. They forced him to smoke several of his cigarettes.
He did not have an explanation for the strength, animation or perceptive abilities of the apparently "empty" gloves (e.g. containing his muscular frame, moving through the air steadily and freely, "seeing" in order to drive the car), or for the disappearance of his wallet. Finally, they brought him to the facility and parked his car in a storage shed or barn, where it would not be seen, and dragged him into the ward.
(It goes without saying that the facility staff has worked closely and at great length with local public safety personnel.)

After the disembodied gloves closed the safe room door, they stripped off his clothing and took it through a "secret" door which had opened in the wall behind him (roughly opposite to the room's only door). At least a dozen large black gloves of silk or nylon (acetate, also known as "bridal satin", and lycra / "spandex") entered from the compartment, carrying extremely thick leather cuffs and straps. The cloth gloves subdued and anchored him without difficulty, "real smoothly," as the leather gloves had earlier. Then the overhead lights dimmed, and he spent several minutes yelling and attempting to break free. He had no idea how or why he was admitted.
Then, patient claims, the gloves began to molest, stimulate and tickle him with great vigor. This occurred continuously, with uncountable "smoke breaks", for a minimum of nine hours. He was not allowed to sleep because of this overwhelming ecstatic assault.

Several latex gloves were first noticed as they cleaned up voided bodily wastes. They and the leather gloves subsequently palpated his entire body with creams and oils. When first allowed to catch his breath, patient noticed the arrival of dry satin gloves, bringing the total number in his vicinity to "around thirty". One brought a pillow, and several were carrying large tool boxes, which were set down near him and opened.
These were later discovered to contain food of a high-carbohydrate nature such as chocolate and "energy bars", water, whiskey, cigarettes, large unlabelled bottles of tablets and capsules, and apparatus such as feathers, feather dusters, brushes, handheld electric shoe polishers, straps and rope, genital restraining devices, penile masturbatory devices, "cock rings", vibrators, clamps, various other sadomasochistic paraphenalia such as crops and hoods, and a variety of lotions and oils.
He reports he was given water through no action on the part of the gloves, i.e. the water bottle "floated up" and opened, and was insistent that he drink from it. (Patient can offer no mechanism by which this occurs, and accepts the "reality" of the magically animated objects due to the adroitness and efficacy he observed.) When he saw a pack of cigarettes floating to him, opening in midair, he refused to cooperate. The gloves resumed stroking his feet and sides for several minutes in order to force him to smoke.
Patient claimed he had smoked almost two packs (x20/per) of cigarettes since arrival (10 hours prior), despite his hands being continuously restrained. The pack, lighter, matches, etc. are said to service him with clearly forceful insistence. The preeminent brand of cigarettes (Camel Filter 100's) is different than what he purchased at the gas station (generic brand, unfiltered), and the Zippo lighter (matte black, with a lasso or lariat being swung by a "cowboy glove") is unfamiliar to him.
Patient believes the objects are being manipulated by a sentient, immaterial force and has used singular terms such as "ghost", "comedian", "sadistic fuck", "puppeteer" and "shaman". But during the irregular snatches of dialogue with the examiner, he generally refers to this tormentor as "they", because of the dozens of gloves and freely moving objects used on him.
Spot checks were made through the door-viewport at least every 30 minutes. In a few instances, patient was lying still and panting for breath as if recuperating from great exertion. But the majority of spot checks revealed the patient laughing maniacally, with tears streaming down his cheeks, heavily perspiring and sexually aroused. After the first few hours, his struggles diminished almost completely. A wide variety of loudly deranged noises were generated by the patient, as if he was enduring a heavy onslaught of sadistic tickling. His voice was reduced to a whisper by morning.
Patient steadfastly insisted he was naked, still in restraints, and chain-smoking throughout the exam. He believed his chest and the surrounding area were covered with cigarette ash and a veritable puddle of sweat. Residues of semen, petroleum jelly and emoillents were said to be clearly present, and he demanded the collection of samples to confirm this (naturally, the examiner declined).
Within three minutes, patient had concluded the examiner and his kidnapper were one and the same. The pen was said to be "doodling" on the clipboard's paper, or sketching cartoons of his plight, or making lists of extreme and invasive activities to which he would be subjected. He withdrew from therapeutic dialogue, alternately raging and pleading for his release, then becoming uncommunicative.

Subsequent Symptomology

Without exception, the patient has displayed consistent pseudoreactive behaviors since being admitted. His first hours in the ward were described as "just an introduction" to even more grueling and arousing provocation. Subsequent exams followed much the same pattern as the initial one, though recently patient has declined to respond to any of the examiner's questions and conversational gambits.
Spot checks reveal no new information and have never caught patient "out of character". During a typical episode (third shift, beginning 51st hour after admission) he was observed to whoop and howl uproariously, shuddering and squirming, finally ejaculating and then laughing even harder - a "session" which lasted nearly 110 minutes before his next "smoke break".

Since the first psychiatric exam, patient reports or claims:

• - He has been held for "something like" two weeks, rather than 72 hours.
• No clothing has been allowed since he was admitted.
• He has been restrained by his wrists and ankles every waking moment since his arrival - or, upon awakening, is immediately restrained again if he was not already bound.
• The restraints prevent him from rising or changing his body position, much less going to his assigned bed. He has not seen any part of the ward or grounds since his arrival, except a direct path from where his car is "stashed" to the safe room.
• Racks and suspension devices are often assembled, attached to brackets and hardware that are clearly visible on the ceiling and walls, and he is transferred to them for extended periods in order to provide access to all surfaces of his body. At other times he is restrained in a prone position on the floor and stimulated for interminably long sessions.
• The drug regimen is drastically increasing his susceptability, sensitivity and ticklishness. (Lafrinex 300mg/q.i.d. is apparently blamed for an extraordinarily augmented response. "Tingling in extremities" is a rare side effect, <1%, per current PDR.) Stimulants are force-fed daily in order to prolong the fondling sessions.
• He is allowed to sleep for unusually long intervals, in order to fully "recharge" for the next session.
• Meals provided by staff and left inside the door (in order to encourage him to move, spurred by hunger to at least crawl a few yards) are brought to him where he lay. Other than an animated spoon, the food is carried from tray to his mouth by the usual undetectable means.
• Roughly one meal in four is "normal," i.e. a heated, well-balanced menu. The others consist of an excessive quantity of unusual foods such as canned gelatin, garbanzo beans, cake frosting, menudo, or pickled eggs. He is required to "clean his plate," or else the palpation resumes promptly and is even more severe. Scheduled meals are supplemented by a large volume of vitamin-enriched snacks, candy and other junk food.
• Immediately after the end of a psychiatric exam, the lights are dimmed and the toolboxes are brought back out, and the molestation resumes. This causes him to look forward to the interviews and desire that they stretch on for hours, even though they are a "mindfuck" and provide no discernible benefit. An extreme session of tactile manipulation inevitably follows, during which he is continually "taunted" by the observing clinician.
  This has reinforced his belief that the exam represents a mockery of the healing process and a false promise of help or release. The examiner "sets him up" for hours of delirium, and the immediate start of the session (and its severity) reinforces his helplessness. "They" are thought to be "rubbing his face in it," i.e. his vulnerability and incarceration, and "they" or "them" always includes the "gloves" who captured him as well as the magical examiner that is thought to put them to use.
• He can describe the appearance, movements and abilities of the inanimate objects, from the cigarette lighter to a customized anal/testicular "spreader", in vivid and exhaustive detail.
• Almost every waking minute is spent eating, smoking, "catching [his] breath"... or undergoing delirious tickling and other torments. Often he is made to smoke while "slower" palpation is occurring.
• Three "jailhouse tattoos" have been applied to his arms and chest while he slept. Two cannot be seen, due to the cuffs keeping his arms outstretched, but the tattoo over his right breast represents "animated feathers and a padlock".
• The toolboxes are replenished with new supplies as needed. Changes in brands occur intermittently (unfiltered Camel cigarettes, nutrient bars, and rum being substituted for whiskey).
• Of particular concern is the outside appearance of the toolboxes over time. His name has been painted on the lid of each box, and cartoonish sketches of him in the throes of hysteria are also painted in white ink. Whiskey labels, portions of cigarette packs, condom and lotion packaging, etc. have been glued all over the exterior surfaces.
• Due to the drug regimen and the increasing familiarity with his more sensitive areas which is being gained by his tormentor, patient is pessimistic about ever achieving short-term goals of "getting numb" (unresponsive to tactile stimulation) or "passing out" (syncope) when desired.
• He has no comprehension of the "official" reason he is in the facility.
• The patient exhibits a morbid fear of being kept in the safe room and stimulated with increasing efficacy for "months and months".

Pharmacological Regimen

Attached

Interim Diagnosis

The patient's chronic paranoia appears to have been initiated by inordinate consumption of amphetamines (adaptive tolerance). Withdrawal and detoxification have not resulted in any perceived abatement of his phenomenal ordeal - and patient has maintained that the gloves are still imposing large doses of stimulants and other unidentified drugs upon him. The persistence and intensity of his fantasies are more typical of organic schizophrenia, but standard conversational therapy and drug options have not been of benefit.
The magic gloves and feathers, exacting their severe and ecstatic punishment, are manifestations of deeply internalized, morbid guilt.
Exceptionally sublimated narcissism is indicated by the belief in continuous restraints and locked doors.
The "secret passage" from which the tormentors emerge, with a full arsenal of implements and supplies, is suggestive of the birth canal as well as subconscious anxiety about early sexual experiences. Similarly, latent homosexual desires are symbolized by the reports of anal penetration, the inclusion of condoms and male "sex toys", and by the large, powerful "hands" (cf. father/grandfather/uncles) that have full and relentless control of patient's tethered body, reducing him to the passive role of a toy.
The constant and extremely graphic (realistic) presence of tobacco, alcohol and stimulants, forced upon the patient, is an allegorical desire to regress into a subordinate and obedient role in the presence of familiar males (brothers, cousins) in order to repeat adolescent bonding rituals. This is often observed in patients who are increasingly dependent on stimulants in order to combat disappointment and a fear of boredom in their lives, though few develop hallucinations of novelty and pleasurable excitement to the consummate extent seen here.

Treatment Summary

Several modalities have been attempted, without result.
Antipsychotic medications do not degrade the solidity of the delusions.
A review of published literature has not suggested any promising techniques. Unfortunately, case histories which include fantasies of intense erotogenic tickling are nonexistent.
Obviously, the antidelusional pharmaceuticals require more than seventy-two (72) hours to take effect. Until blood serum levels are optimal, or at least detectable, their usefulness cannot be ascertained. Tevixstin, for example, is a highly respected long-term agent with initial results in placebo (or margin-of-error) ranges.
Hasputane, approved by the FDA last month, is a psychotomimetic derived from a common mushroom with newly discovered similarities to mescal (= mescaline) that induces hallucinations. But a study at Johns Hopkins in which fractional doses were administered to nonfunctional psychotic patients found a paradoxical effect, which might assist this patient to reintegrate with his environment.

Conclusion

Due to an open-ended private grant that supplements the state's reimbursements, and the present lack of any other chronic patients, this facility is able to pursue a methodical long-term course of treatment. Patient offers a highly intriguing educational opportunity, and facility staff is committed to providing continuous and highly responsive care.
Our lockdown ward for non-acute cases is unoccupied (four-bed, freestanding, services fully contained, remodeled two years ago and highly secured to eliminate flight risk). Due to patient's conspiracy-seeking paranoiac state, isolation is preferable until his trust and a more cooperative attitude are obtained. Any potential benefit of interacting with others is questionable at this time since patient is thoroughly convinced he is restrained and confined to the sick room, isolated from the world.
However, if directed, patient will be transported even if the drug regimen is incomplete. The next nearest licensed facility is in Shayton (nearly six hours away, by car), which is closer than the north State hospital (due to the rebuilding of Highway 733 and very congested detours around it, eight hours of travel time should be anticipated). As such a transfer would require the use of sedatives and restraints, at this time it would confirm patient's fantasies in a potent and debilitating manner and is strongly contraindicated.
Examining patient at this facility would be preferable, if Board staff workload permits. The customary advance notice would be necessary and appreciated. (Since it is understood that supervising diagnosticians are no longer assigned to the nearest District office, please be forewarned that it is not feasible to reach this facility in one day from your headquarters. Accommodations can be found in Mt. Low, two hours' drive to the northwest.)
In light of the recent memo concerning substantial Board staff reductions, it is realized that a length of time will elapse before this report is read. Since the backlog exceeds the interval by which the subsequent report would be due, this Petition for Extended Care (Form MH9-11, "Indigent", attached) is also the first regularly scheduled summary, per the paperwork-reduction guidelines.

Unless expicit direction is received to the contrary, the next progress report for this patient will be submitted one hundred and eighty (180) days from this date.