The Twenty by Sam Holland

Author:Sam Holland
Language: eng
Format: epub
Publisher: CROOKED LANE BOOKS

Department of Clinical Psychology—Patient Report

Name of Patient: Catherine Sutton (DOB: 06/05/77, age 18)

Consultation date: November 28, 1995

Catherine has been referred to the Department of Clinical Psychology following admission to hospital after a recent traumatic event. There are no ongoing physical medical diagnoses; she has been receiving treatment solely for malnutrition and dehydration after initial assessment in the Accident and Emergency Department. Catherine is due to be discharged, pending psychiatric and psychological review.

History

Police investigations are ongoing, but detectives from Operation Hursley have disclosed Catherine was found as the sole survivor after a period of forced imprisonment, as well as possible sexual assault and torture. Four other women were killed, and Catherine may have been a witness to these crimes.

Current Situation

Catherine was reluctant to talk at first, avoiding eye contact and attempts at building rapport, sitting in silence for the first two sessions. In the third meeting, Catherine started to open up, talking about her past and disclosing that before her kidnapping, she was homeless, surviving through begging and prostitution. Based on notes from her medical assessment on admission, a drug addiction may have been likely, although Catherine has not confirmed this. She is not showing any signs of withdrawal.

Catherine generally talks with little emotion, with a flat affect, showing signs of psychological numbing. She discussed insomnia and feelings of loneliness, guilt, helplessness, and isolation. She mentioned she has little to live for “now it is over.” When I asked questions directing her to think about her future, she shook her head repeatedly, as if refusing to consider this likelihood.

Contrary to expectation, she was openly hostile toward the police and solicitors when discussing the investigation, growing agitated and angry. She asked about the suspect, but the knowledge that he was in prison only worsened her distress, culminating in a panic attack requiring pharmaceutical intervention. She maintains she will not testify at the trial and will not meet with the CPS.

Clinical Formulation

In my opinion, post-traumatic stress disorder (PTSD) would be the primary diagnosis at this time, with secondary depression (including suicidal ideation) and panic disorder.

Additionally, as the sole surviving victim, Catherine is subject to “survivor syndrome” from having endured the trauma where others have perished. This could result in strong feelings of guilt, shame, anxiety, and social withdrawal, thus compounding her depression.

Risks

Catherine has no support network or family, so nowhere to live on discharge from hospital. Without this support, there is a risk she will end up back on the streets, with a strong likelihood she will take her own life.

In addition, exposing Catherine to further trauma by forcing her to testify at the trial will only compound her anxiety and panic, and is strongly opposed.

Proposed Future Interventions

In the immediate future, Catherine should be put on suicide watch and monitored closely. Admission to a psychiatric bed is advised, where she should be assessed for counseling, cognitive therapy, and appropriate drug treatments.

Given that a social worker is not currently involved, I will also be referring the case to social services.

Dictated, not checked or signed, to avoid delay.

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