I have created a semi-fictional case presentation of a psychiatric patient at his intake evaluation.  It reads like many intakes in many a psychiatric chart across the country - but for the twist at the end.  Don’t peek ahead!

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Identifying Characteristics:  Patient is a white male of undetermined sexual orientation, early 30s, homeless, disheveled, thin, mild body odor, no medical insurance.

Presenting Problem:  Patient has grandiose delusions and hears voices.  These voices sometimes bring him comfort, though at times cause him agitation because he feels pressured to live up to their expectations.  Black and white thinking prominent – good/evil, light/dark, right/wrong.  Extremely grandiose to the point of arrogant about his beliefs, yet at times charming, even seductive.  Therapist viewed this as passive hostility and lack of inner control projected outward.

Violence/Homicidality:  History of rages and confrontations with authority figures – from childhood through recent adulthood.  Violent behavior on more than one occasion.  Several arrests for disturbing the peace, willful destruction of property, even attempting to incite a riot.  Minimal jail time.  Patient denied homicidal feelings, but latent rage obvious.  Takes no responsibility for his inappropriate behavior.  Assess further for sociopathic behavior.

Suicidality:  No overt history of suicidal behavior, but lengthy history of knowingly putting himself in harm’s way, and has been assaulted as such more than once.  Appears to elicit extreme hostility in others because of his passively controlling behavior.  Low self-esteem apparent.

Psychiatric Medication:  Claimed he has never taken psychotropic medication.  Psychiatric consultation indicated.  Might do well on an antipsychotic.

Drug/Alcohol History:  Denied history of drug use, but reported moderate alcohol use, with no desire to quit.  Hostile resistance to Alcoholics Anonymous – stated they are “religious hypocrites.”  Drug/alcohol consultation indicated.

Family History:  Raised in intact family, though part of his delusion was that he was somehow “created special” at birth.  Appears to have been isolated, even peculiar, as a child.  Has younger siblings, but spoke little of them.  Alternates between idealization and devaluation/rejection of mother, in borderline fashion.  Does not believe his father to be his biological father, and appears to have delusional ideas of parentage of biological father.  Denied history of abuse as a child, but believes – despite lack of evidence – that unknown others wanted to murder him when he was an infant (self-hatred projected onto others).

Relationships/Children:  Single and no children.  Never married.  Refused to talk about history of romantic relationships, discomfort obvious.  Manipulatively turned questions back on interviewer.  Likely a repressed homosexual.

Work:  Reported some skilled vocational training.  Sporadic work history in youth, but presently rigid refusal to work.  Grandiosely believes that manifesting his delusions is his life’s work.  Panhandles on the street for food.  Unfit for vocational rehab.

Social Life:  Some acquaintances, no friends.  Elitist, hierarchical view of relationships, based on his delusional perceptions of himself.  Views himself as better than most but admits that he is worse than some.  Reports that at times others fall under his sway, though he tends to put down and even mock these people.

Diagnosis:  Schizophrenia, undifferentiated type.  Borderline Personality Disorder.

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(now scroll down the page to see the twist)

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Source of case material:  New Testament, Holy Bible.

Patient’s name:  Jesus Christ.