The Fishbowl

[Content Warning: Mental Health, Suicide / Self-harm, ED's, Explicit Language, Sensitive Content]

CASE RECORD FOLDER

Facility: Riveredge Hospital, Forest Park, Illinois

Date of Application: 11/26/1990

Name of Admittee: Elaine M. Purcell

Last 4 Digits SSN: 3487

Date of Birth: 09/13/1972

Place of Birth: LA, California

Marital Status: Single

Address: 4th Ave, Maywood, Illinois, US

Status at Admission: VOLUNTARY Date Admitted: 11/26/1990

Diagnostic Impression at Admission: Restless and anxious; dissociative state with hyperfixation of surroundings and objects.

Established Diagnosis/ Mental Disorder/s:

Generalised Anxiety Manic Depressive Disorder OCD

Riveredge Hospital

INTEROFFICE MEMORANDUM

To Record Room Date Nov 23rd, 1990

Dr. Jane Amber

From

Dr. Richard Chandler

SUBJECT Elaine Purcell

Elaine Purcell was examined in my care on November 23rd, 1990. Following my extensive evaluation, I have referred her to Riveredge Hospital. My decision was based on:

Her soporific demeanour, imbalanced circadian rhythm, disquietude and hopelessness.

Severe depression and manic impulsive / compulsive decisions affecting general wellbeing.

Immersion in fantasy, withdrawal and isolation.

History of depression, anxiety, and OCD.

No current health-care plan, employment, nor active therapy.

The patient has been seen by Dr. Schmidt Pierson for ECT treatment 04/17/1987 (age 14yrs), and again on 21/11/1988 (age 15yrs), results attached in file.

ETIOLOGY

Did you experience episodes of intense productivity followed by exhaustion?

☐ Yes ☐ No

Have you ever felt detached from your body or surroundings?

☐ Yes ☐ No

Do you perform mental rituals, like silent praying or counting, to reduce anxiety?

☐ Yes ☐ No

Do you feel the need to check things, such as taps, stoves, or doors, repeatedly?

☐ Yes ☐ No

Do you have repetitive, disturbing thoughts, images, or impulses that keep coming into your mind?

☐ Yes ☐ No

Do you have forbidden thoughts or images regarding sexual acts?

☐ Yes ☐ No

Do you feel others misunderstand or misinterpret your intentions?

☐ Yes ☐ No

Do you have persistent fears of harming yourself or others, even though you don’t want to?

☐ Yes ☐ No

Did you have difficulty maintaining friendships?

☐ Yes ☐ No

Do you believe you are currently ill?

☐ Yes

☐ No

☐ Unsure

Nov 30th, 1990

Diary entry,

I don’t know, maybe life’s too crazy for someone like me. That’s why, if I didn’t come here, I’d really become crazy, too, like the rest of them. It is easy to slip into the space of another world: the child’s mind, the insane, the crippled, the chronically ill, the dying, and perhaps the skeletons of who we used to be. I often feel like a fish swimming in circles of dull routine, but here they really do swim in slow-moving circles, lapping a film of turbid walls and rooms that meld into more rooms of the same opacity. There’s a typecast for places like this, where the crazy people live and only ever get crazier. They treat us like we’re a threat to the world when we become a threat to ourselves. We wonder if we should ever be let back outside; maybe that’s how they keep their business, a scheme of population control. They took my shoelaces when I arrived, also my earrings and my lepidolite necklace, which my mom gave me. My roommate, Carol, says to hide our jewellery from the staff, because she swore that once Nurse Rita was wearing her mother’s pearl earrings. But Carol is crazy.

PSYCHOLOGICAL EXAMINATION REPORT

Name: Elaine M. Purcell

Age: 18 years and 3 months

Sex: Female

Date of Evaluation: 12/03/1990

Riveredge Hospital Psychologist: Dr. Jane Amber

Reason for Referral: Patient has voluntarily admitted herself with concerns of persistent anxiety, intrusive thoughts and impulsive behaviour, self-isolation and manic depressive mood swings. Referred by Dr Richard Chandler, the patient has a history of Generalised Anxiety, Manic Depressive Disorder, and OCD.

Assessment Report: Patient presented with elevated anxiety and appeared to be preoccupied with perceived safety risks to others and inanimate objects. Patient was observed to have intrusive thoughts imposing fear of the compromised safety of her apartment, her belongings, and her family cat and fish. During the session, the patient abruptly stood to turn off the wall outlet, despite no device being connected, stating that the electrical currents could initiate a fire.

Patient was observed repeatedly plucking her eyebrow hairs with her fingers during conversation, appearing to be habitual anxiety-driven behaviour. A foam stressball was offered as a redirection technique.

Patient described she “feels like tuna in a can.”

Doctor’s notes: Patient was cooperative, mildly irritable and restless. Thought process appears linear but ruminative with limited insight and fair judgement; no delusions observed. Preoccupation with safety themes noted. Patient endorses ego-dynostic intrusive thoughts of self-harm imagery without associated intent or behavioural planning. Thought content appears consistent with obsessive rumination rather than active suicidal ideation.

Dec 23rd, 1990

Diary entry,

This cold winter gloom seeps deep into my bones, in all our bones, we’re all too thin; like sardines tucked into a frigid tin bed. Some of the girls here have asked if I want to be a part of the ward’s Secret Santa. I said “Why not,” and drew Jean’s name from the pillowcase; I don’t know much about her. Carol says Jean tries to kill herself at least once a month and often spends most of her time in the fishbowl, which is wardtalk for the high-observation unit. I don’t have any commissary yet, but Joyce is nice enough to lend me some of hers. She tells me she plans to run away and will have no use for it anyway. I tell this to Carol later, and she laughs sardonically, and says, “She’ll be back by curfew.” Carol also tells me that Jean likes music and her headphones were stolen, so I used Joyce’s commissary money to buy new ones. I think she will enjoy listening to music again.

RIVEREDGE HOSPITAL — INCIDENT REPORT

Date: 12/25/1990

Time: 14:25

Unit/Ward: Female Acute Care, Recreational Room

Reporting Staff: Nurse Angela Simpson

Patient(s) Involved: Jean Choung, Joyce Marland, Carol Whippett, Elaine Purcell

Witness(s) to Incident: Nurse Pamela Hart, Nurse Rita De la Fuente

Description of Incident: At approximately 14:25, staff were alerted by patient Carol Whippett, who reported in distress “Jean is dead again!” Upon arrival in Jean Choung’s room, the patient was observed unconscious on the floor with headphone cords around her neck.

Patients Joyce Marland, Carol Whippett, and Elaine Purcell were present and became visibly distressed during the incident and verbally agitated towards one another. Subsequently, Joyce and Carol became physically aggressive. Staff intervened to separate patients and de-escalate the situation, taking Joyce and Carol to seclusion, while Jean was transferred to medical. Elaine displayed signs of anxious dissociation; staff took her to her room and stayed to monitor her safety.

Immediate Actions Taken:

Jean Choung was removed and placed in observation (1:1).

Headphone cords and other potential ligature items removed from patient access.

Follow-Up / Recommendations:

Psychiatric review requested for Jean Choung to assess ongoing suicide risk and treatment plan.

Staff to review safety protocols regarding patient access potential hazard items.

Monitor all involved patients for anxiety or agitation during recreational periods.

Dec 29th, 1990

Diary entry,

It wasn’t my fault. I didn’t hurt Jean. Joyce blamed me, but it wasn’t me; it was Carol. She came back today, and she was pissed off, squealing like a paranoid pig. She accused me of stealing her things, which I didn’t, and she began rummaging through my things even when I told her to stop. She wouldn’t listen. So I let her have her tantrum and left her alone in the room to yell at nothing but her own insecurities. I heard tonight that she requested a new roommate.

RIVEREDGE HOSPITAL — PROGRESS REPORT

Date: 01/26/1991 Name: Purcell, Elaine M.

Riveredge Psychologist: Dr. Jane Amber

Progress Report: 3 Months

The patient has been doing extremely well adjusting within the facility over the past three months, with participation in group and individual activities, except for the incident following the release of Joyce Marland and Carol Whippett from seclusion.

Incident Summary: During the incident, Elaine Purcell and Carol Whippett were observed engaging in verbal aggression. Elaine reported that Carol had gone through her personal belongings after Carol alleged that Elaine had taken her jewellery. When staff arrived, Carol was observed handling Elaine’s belongings when Elaine pushed Carol. Both patients were placed in seclusion for two days. Following Elaine’s release from her first time in seclusion, she was quiet and withdrawn; spending the subsequent two days primarily in her room.

Reporting Staff: Nurse Angela Simpson

Doctor’s Notes: Continue to supervise Elaine, including individual (1:1) and group psychology sessions.

Review and adjust medication as indicated.

Monitor interactions with peers for aggression and conflict.

RIVEREDGE HOSPITAL — CBT TRANSCRIPT

Session Speaker: Dr. Jane Amber

Date: 01/01/1991

Individual Session (Excerpt)

Dr. Amber: Do you remember pushing Carol, Elaine?

Elaine: I remember telling her to stop going through my things, they’re my things, not hers. I don’t want her to touch my things.

Dr. Amber: You’re right, they are your things. What are you worried about when she touches your things?

Elaine: They’re my things. She might break them, or, I don’t know, just something might happen that I might miss until it’s too late. (00.30) I don’t like being called a liar. I didn’t steal her jewellery.

Dr. Amber: I believe you, Elaine…What did you feel in the moment she was going through your things?

Elaine: I felt upset, and she was moving things around that I had arranged specifically how they’re supposed to be. She doesn’t understand, she never does, she’s always in my space and she’s too close. My things need to stay where they are.

Dr. Amber: What happens if your things are moved from where they’re supposed to be?

Elaine: (00.45) U:m—I don’t know—euh, (00.11) something bad. I just don’t like people touching my things.

Dr. Amber: When you say “something bad,” do you mean something could happen to the objects, or something could happen to you?

Elaine: (00.18) Both, I guess…like if I leave socks on a cord then a fire will start and everything will burn.

Dr. Amber: That’s quite a scary thought. That must be very overwhelming. Have you ever left a sock on a cord to see what would happen?

Elaine: No.

Dr. Amber: Perhaps that’s something we can work on in our next session, it’s called exposure therapy…. Does that sound like something you’d like to try?

Elaine: (00.45) I’d like to not be so controlled by the thoughts.

Dr. Amber: I want to help you achieve that goal… (00.45) Is there anything else about what happened with Carol that you want me to understand?

Elaine: (00.33) I didn’t steal her jewellery.

Feb 16th, 1991

Diary entry,

Carol’s transfer was approved. I don’t feel bad for her, Joyce says she’s in here for borderline personality disorder, saying, “the bitch has major mood swings.” I heard she slashed her ex-boyfriend’s tires and set his car on fire after he broke up with her. Talk about crazy. My new roommate’s name is Dottie. She’s quiet and keeps to herself, but when Joyce and Barb come into our room, she hovers—I think she does this because she feels left out—until Joyce tells her to “Get lost.” Dottie is little and insecure. I understand her need to be seen; it seems like she has already become a ghost here, lost within the current of this Styrofoam fishbowl. She has big, doughy, blue eyes, which I think are quite pretty, but her hair is soft and dull, much like her. She has been here for a while, but not as long as Joyce. She really wants to be a mother. She keeps a stuffed brown bear wrapped in a soft flannel baby blanket; she coddles and carries it everywhere. It’s sad, in a way. I never want to be a mother; that weight is not mine to hold, like it is Dottie’s.

April 4th, 1991

Diary entry,

We girls stick together without really being together. Just like a prison, in this place, there are girls who’re allies and girls who dob on us to the nurses for ‘inappropriate behaviour.’ Joyce tattles on Barb for stealing food from the kitchen and hiding it under her bed. Barb’s room always stinks like sour, rotten chicken, and we saw maggots crawling across her floor while she read an Entertainment Weekly magazine, lounged in her fuzzy pink slippers and bright, glossy Bonne Bell lip smacker balm. Joyce says Barb loves bulimia, though Barb denies it; her teeth are yellowing, her breath stinks, and her eyes bulge out of their sockets unnaturally. Joyce isn’t a bad person; she is just misunderstood. She watched her mother kill herself when she was a little girl. She says she doesn’t remember it, but her eyes are giant, glazed with deceptive sorrow. Joyce gets cigarette privileges; she has been here the longest. She shares a cigarette with Barb and me until Dottie comes and asks us to put the cigarettes out, saying, “The smoke will hurt the baby.” Joyce tells her to get her head out of her ass, which I think is harsher than she needs to be, but Dottie leaves, and we laugh about it. I tell Joyce that she was rude, and she calls me a pussy and says, “She’ll get over it.” I tell her Dottie isn’t like that, and then Joyce becomes defensive and mean, like she does when she’s challenged, and I’m pissed off she can be so carelessly callous. We’re not talking now.

Fishbowl

Swimming in this curious mind of mine,

inside glass of solitude and brine.

Endless, I fear this turn will sore

my eyes a sight they’ve many seen before.

Waters sway heavier against the spine,

a thousand eyes lurking midst the salty swine.

Fearful, the weight of the breathless

floats silent over rose-coloured trenches.

Dancing around and round in turpentine,

tuna in a can of sweetened wine;

Waiting, for the courage to leap

out of this fishbowl to the wondrous sea.

— By Elaine Purcell

05/22/1991

Sep 10th, 1991

Diary entry,

Joyce ran away again. She is an animal, feral from the taste of freedom; always dragged back kicking and screaming; only dead fish let the current take them. She is sent straight to seclusion for three days, and then she comes out like nothing ever happened, smoking cigarettes and goading Nurse Angie, until she inevitably tries again the next month. I don’t want to sound selfish, I want her to be happy, but I hope she comes back for my birthday. I suppose it is difficult for a fish to stay in its bowl once it knows what the ocean looks like.

Sep 13th, 1991

Diary entry,

It’s my birthday today, and I am nineteen. I was given a cupcake at lunch; it had strawberry frosting with sprinkles. I heard the nurses ring the police station to put out an “APB” this morning, and then just after lunch, I heard Joyce screaming profanities at the nurses who dragged her back in. It’s hilarious to hear what she comes up with: “You thundercunt!” and another of my favourites, “Pussmonkey!” She asked to see me before they sent her to seclusion, at which Nurse Angie allowed her five minutes. She told me she went to see her brother, and then she slipped a tissue in my palm discreetly, telling me it was her mother’s, and then told me to open it in my ward away from the nurses and crazy Carol. It’s a brooch, a copper Northern Cardinal. It’s beautiful, and I’ll keep it in my socks for safekeeping.

RIVEREDGE HOSPITAL — DISCHARGE FORM

Patient Name: Elaine M. Purcell

Date of Birth: 09/13/1972

Admission Date: 11/26/1990

Discharge Date: 06/18/1993

Admitting Physician: Dr. Richard Chandler

Attending Psychiatrist: Dr. Jane Amber

DISCHARGE SUMMARY

Formal Diagnosis:

Generalised Anxiety Disorder, Obsessive-Compulsive Disorder — currently in partial remission. Patient demonstrates residual compulsive behaviours and intrusive thoughts, particularly around personal space and objects. Patient is functioning passive-dependent.

Follow-Up Recommendations:

Outpatient psychotherapy: 1-2 sessions per week.

Psychiatric follow-up with Dr. Amber or primary psychiatrist in 2 weeks.

Continue medication regimen and monitor for obsessive thoughts or compulsive behaviours.

Prepared by: Dr. Jane Amber, PsyD

Date: 06/18/1993

Oak Park Natural Pet & Fish

Pet Supply Store

23 N Harlem Ave,

Oak Park, IL 60302, United States

Tax Invoice / Receipt

Goldfish $8.92

Sub Total $8.92

Rounding -$0.02

TOTAL $8.90

06/20/1993 11:21:36 AM

1015 S 4th Ave, Maywood, IL

60153, United States

Nov 11th, 1993

Dear Joyce,

I don’t miss the hospital, but I miss the feeling of floating. I write about my time there, not professionally, but maybe I’ll publish something someday. I work at a library, it’s quiet, and I find the work really calming. I know you’d call me a pussy for it. I have been seeing this guy, Todd, who’s lovely, and he has asked me to move in with him. I said I would, my place is a sea of cardboard and clutter. I really hope you are discharged soon, try to get better, and listen to them even though I know you don’t want to.

See you on the outside,

Elaine

Dec 22nd, 1993

Diary entry,

Joyce killed herself today. Angie called me to tell me about the funeral. I can’t help but think this seals the chapter of Riveredge for good. I know that Joyce and her mother are together now. I suppose some fish do make it to the ocean. For the first time, Joyce is probably really, truly happy. I’m happy for her, even if her happiness is my sadness. I wear her mother’s brooch every day now. Things are getting serious with Todd and me, and if I ever do have a daughter, I’ll name her Joyce.