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longitudinalwaveme · 3 months

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Roscoe Dillon's Psychiatric Assement

I decided to do a psychological evaluation for The Top (Roscoe Dillon), and make it as accurate to a real-world evaluation as was feasible for a guy who's canonically a ghost.

I do not have a doctorate in psychology and cannot diagnose real people, but I am working on my master's in psychology and feel reasonably capable of diagnosing a fictional person who cannot be harmed by my diagnosis if I am wrong.

I tried to be as accurate as possible in my presentation of all conditions included---but feel free to correct me if I made any horrible mistakes.

TW for: Mental health problems; suicide; the Dillon family's horrible ideas about mental health

Iron Heights Penitentiary

1961 Broome Street

Central City, MO

Complete Evaluation: Adam Brooks, M.D.

Date of Exam: 7/31/2019

Time of Exam: 4:45:22 PM

Patient Name: Dillon, Roscoe Neyle

Patient Number: 111044554

History: Roscoe Dillon is a 36-year-old male prisoner of Iron Heights Penitentiary. He is currently unmarried and has no children, but he is in a long-term relationship with a woman named Lisa Snart. He was referred to me by Correctional Officer Robert Morrison after he attempted to hang himself in his cell. This attempt left him unconscious for two days, and it was only after he woke up that I was able to begin the process of evaluation.

Roscoe’s chief complaint was, quote, that “I am a failure, and therefore the tops have turned against me”, and stated that his motivation for his attempted suicide was his belief that he had failed his girlfriend, Lisa, as well as, quote, “my own lofty expectations of myself”. Roscoe also describes and displays symptoms of a mood disorder, with psychotic features, and specifically reported symptoms of depression. While he was unable to provide me with a coherent explanation of how long his symptoms have lasted, Correctional Officer Morrison reports that he has been chronically displaying symptoms since he was incarcerated in Iron Heights Penitentiary nine months ago.

Current Symptoms: Roscoe reports a depressed mood, a loss of pleasure in spinning his tops, problems with his appetite (“I did not realize until recently, but I do not think I have eaten more than a meal a day in quite some time”), difficulty in concentrating, feelings of worthlessness, and a death wish, the latter of which precipitated his attempted suicide. Correctional Officer Morrison also reports that when he is on guard duty, he sees Roscoe sleep only rarely, suggesting a level of insomnia. Roscoe himself was unable to confirm this, but did admit that he thought it was quite likely that he “had not been sleeping well of late”. He attributed this disruption in his sleep to racing, anxious thoughts. Roscoe also reports extreme agitation and a general inability to keep still, which he displayed throughout the evaluation in the form of rocking back and forth in his seat. Also throughout the evaluation, he displayed extremely pressured speech. It was often difficult to understand what he was attempting to say, and this communication barrier seemed to add to his agitation throughout.

Suicidality: Roscoe attempted suicide three days ago, and, while he has not actively attempted suicide since, he has not expressed a desire to live.

Prior Manic/Depressive Episodes: Roscoe has had four prior manic episodes and four prior depressive episodes, three of which involved an attempted suicide. During his first major manic episode, he threatened to blow up half the world with a spinning atomic grenade unless he was made king of the world.

Severity/Complexity: Based on the risk of morbidity without treatment, his personal descriptions and the descriptions of Correctional Officer Morrison of interference with his functioning, his psychotic symptoms, and his recent attempted suicide, Roscoe’s Bipolar Disorder is estimated to be severe.

Associated Signs and Symptoms: In addition to his mood symptoms, Roscoe also displays a number of symptoms of psychosis. He demonstrated mood-congruent delusions of failure, as well as a delusion of passivity, claiming that, quote, “the tops are punishing me for my failures. They are the ones who are making everything spin and spin and spin”. Besides these delusions, Roscoe also reported visual hallucinations, in the form of distorting shapes and colors and the world around him spinning in a fashion that is similar to what might be experienced by an individual with vertigo, and auditory hallucinations, in the form of his father, girlfriend, and girlfriend’s brother talking to him while he was in his cell alone. Furthermore, while Roscoe’s speech was generally organized enough to be comprehensible, he frequently made top puns, and references to rotation and spinning, that had seemingly little relevance to the topics that were being discussed. Roscoe seems to have a degree of insight into his condition, stating that, quote, “I am quite aware that I am mad”, but not to the extent that he recognizes that his delusions of failure and passivity are irrational.

Past Psychiatric History

Withdrawal History: While Roscoe reports a fondness for fine wines, he also claims that he has never experienced serious withdrawal from any substance, and there is no available evidence to contradict this assertion.

Psychiatric Hospitalization: Roscoe was briefly psychiatrically hospitalized after an attempted suicide at the age of seventeen, but was removed after only two weeks. This was done at the behest of his parents and over the protest of at least one of the nurses at the facility. He has also been hospitalized in the prison infirmary for mental health problems twice before, once as the result of a manic episode and once as the result of a depressive episode.

Outpatient Treatment: Roscoe has never received outpatient treatment.

Suicidal/Self Injuries: As previously mentioned, Roscoe has attempted suicide four times. At the age of seventeen, he deliberately overdosed on his parents’ prescription medicine, and was only saved because his mother found his body thirty minutes afterward. At the age of twenty-four, he attempted to jump off of a bridge but was stopped by an off-duty firefighter, who tackled him to the ground before he could actually carry his plans out. At the age of twenty-nine, Roscoe died of a brain hemorrhage induced by the combination of his newly-developed telekinetic powers and the Flash’s super-speed vibrations, but was able to return to life via the possession of several corpse bodies, which he modifies to resemble his own. Due to his unusual manner of existing, his fourth attempted suicide, which he carried out at the age of thirty-two, was actually a completed suicide, in the sense that he deliberately abandoned his host body in order to return to an incorporeal state, and, had he not subsequently possessed a new host body, this psychiatric assessment would never have occurred. While all of this sounds impossible, it has been repeatedly and independently verified by several doctors, police scientist Barry Allen, several other members of the police force, and a coroner, so I am forced to accept the story as true. His most recent suicide attempt occurred two days ago; he attempted to hang himself in his cell with his bedsheets and was only saved by the quick actions of Correctional Officer Morrison. Roscoe does not appear to engage in non-suicidal self injury.

Addiction History: Roscoe vehemently denies any history of substance abuse, and, while it is clear that he drinks a number of alcoholic beverages, there is not sufficient evidence to prove that he has any substance abuse problems.

Psychotropic Medication History: Roscoe has been prescribed lithium by previous doctors, and does take it with at least some regularity when he is not in prison. Due to what I can only assume was an organizational oversight, however, he has not had access to lithium since he arrived at Iron Heights Penitentiary nine months ago (as confirmed by Correctional Officer Morrison).

Other Psychiatric History: Roscoe has been psychologically evaluated twice before whilst incarcerated. He has previously been diagnosed with Bipolar 1 Disorder, which is consistent with his current symptoms, as well as with Autism Spectrum Disorder. These previous psychological evaluations indicate that, when he is not in the midst of a mood episode, Roscoe struggles with social communication and interaction, and evidently has since he was a child. Although he doesn’t seem to understand why, he is aware that he has never had many friends, and he reports, quote, that “I did not like school. The children there made fun of my tops.” He also engages in stereotypies (rocking, hand waving, and especially spinning), particularly when distressed, and has an intense, nearly all-consuming interest in tops. He can monologue about tops for hours on end, and will do so if you allow it. Roscoe is also averse to loud noises and adheres to a variety of strict eating, washing, and dressing routines. In spite of all this, Roscoe insistently denies that he is on the autism spectrum, and will angrily insist that he is, quote, “neither a freak nor retarded” when the topic is brought up around him.

While his severe mood episode likely obscured most of his autistic symptoms, I did notice his rocking in his chair, and I likewise noted that his speech, although rapid and pressured, was also quite stiff (bordering on monotonic) and formal. He insisted on referring to me as “Dr. Adam Brooks” throughout the evaluation. He also only made eye contact once during the evaluation, and the contact he did make was sustained and intense enough that it was clearly not a natural behavior for him. His apparent fascination with tops might also explain the persistent top puns that littered his speech, as well as why he specifically believes that tops, rather than any other object, are punishing him.

Social/Developmental History

Roscoe Dillon is a single, 36-year-old man. He is American, and, although he was born in New York City, he and his family moved to the suburbs of Central City when he was eight years old, and he has lived in the Central/Keystone area ever since. He has a long history of criminal activity. He has been arrested more than four dozen times, most commonly for grand theft and armed robbery, and has been incarcerated on six separate occasions, although he has served out only one complete sentence. He is notorious for escaping from prison, and his repeated deaths also have put an early end to some of his sentences. Currently, he is serving a ten-year sentence for armed robbery, with possibility of parole, but the chances are extremely high that he will escape from prison well before the end of his sentence. I only hope that he doesn’t do so through suicide.

Relationship/Marriage: Roscoe is in a long-term relationship with Lisa Snart. She was once an Olympic-level figure skater who performed for the Futura Ice Company, but became involved in a life of crime shortly after Roscoe’s first death. She is currently incarcerated in the women’s wing of Iron Heights Penitentiary. In spite of this, the two appear to have a mostly functional and healthy romantic relationship. That being said, Roscoe’s intense level of attachment to Lisa is worrying; his primary motivation for attempting suicide was the belief that she would be happier if he was dead, and he also noted that if anything ever happened to her, he would probably kill himself.

Children: Roscoe has no children.

Barriers to Treatment

Emotional: While I have not personally evaluated Roscoe before, other prison psychiatrists who have worked with him state that he is violently opposed to the idea that he might be mentally ill or in need of treatment. This appears to stem from a belief that admitting to mental illness would be tantamount to admitting to being incompetent or a failure. He has also stated that he only takes lithium because Lisa, his girlfriend, asks that he do so. His current psychotic symptoms, which limit his insight, are another potential barrier to treatment, but these will be addressed via the treatment plan.

Environmental: Warden Gregory Wolfe strictly limits the number of patients who are permitted to attend therapy sessions with me. Getting Roscoe approved for therapy will likely prove very difficult.

Family History

Roscoe’s maternal great-uncle, Rufus Neyle, was repeatedly hospitalized for Bipolar 1 disorder. Previous evaluations of Roscoe strongly suggest that the Dillon and Neyle families viewed this as shameful and did everything they could to cover it up.

Roscoe’s maternal aunt, Rachel Dylan (neé Neyle), received outpatient treatment for major depressive disorder. Previous evaluations of Roscoe indicate that Roscoe’s father described his aunt as, quote, “weak” for seeking treatment for her condition.

Roscoe’s first cousin, Ralph Dylan, is known to have been diagnosed with autism spectrum disorder. Previous evaluations of Roscoe strongly suggest that his parents viewed this as an embarrassment; Roscoe evidently claimed that his father once referred to this cousin as, quote, “a retarded freak”; this likely contributes to Roscoe’s vehement denial that he is himself on the autism spectrum.

Roscoe’s paternal grandfather, Roland Dillon, is suspected to have had major depressive disorder. He is also known to have committed suicide at the age of 52. Previous evaluations of Roscoe indicate that his father, Reginald Dillon, perceived this as having brought shame on the family name.

Roscoe’s mother, Rosa Dillon (neé Neyle), is suspected to have anxiety and a potential alcohol abuse disorder. Previous evaluations of Roscoe suggest that she often seemed quite anxious and agitated, and he has stated that she often drank wine to, quote, “calm her nerves”. Roscoe has also claimed that his father did not know of this, or at least refused to admit that he did.

Family psychiatric history is otherwise negative. There is no other history of psychiatric disorders, psychiatric treatment or hospitalization, suicidal behaviors or substance abuse in closely related family members.

Medical History

Adverse Drug Reactions: None known.

Allergies: None known.

Compliance: Roscoe is notorious for non-compliance with medical instructions. While he does take lithium fairly regularly, at his girlfriend’s bequest, he never attends outpatient therapy when not incarcerated, and attempts to avoid therapy while incarcerated as much as he can, even to the point of getting himself sent to solitary confinement rather than having to attend therapy sessions. He seems to despise psychologists and psychiatrists on principle, and is known to make attacks on their professional competency when he disagrees with their assessment of his mental state (which is quite often). As a result, his mental health problems generally go mostly untreated.

Some of this hostility likely stems from the fact that Roscoe’s first psychological evaluation whilst incarcerated came at the hands of Jonathan Crane, a psychologist who was later stripped of his medical license for experimenting on his patients with an unregulated drug of his own invention. This drug, which the newspapers dubbed “Fear Toxin”, was a blend of synthetic cortisol, epinephrine, norepinephrine, indolealkylamines, phenylethylamines, arylcyclohexylamines, serotonin inhibitors, and dopamine enhancers, and was used to induce fear-based hallucinations in its victims. While it cannot be conclusively proven, the evidence seems to suggest that Roscoe was subjected to this drug as a part of the “evaluation” given to him by Crane, and if this assumption is correct, I fear that Roscoe cannot be entirely blamed for his distrust of the psychiatric profession.

Exam: Roscoe Dillon is six feet tall, and, when healthy, weighs around 175 to 180 pounds. When I evaluated him, however, he was badly underweight, weighing only about 147 pounds. His hair and clothes were noticeably disheveled, he had dark circles under his eyes. His body language and his facial features displayed obvious distress and depression. He seemed agitated throughout the evaluation and repeatedly rocked back and forth in his chair. He almost never made eye contact. He exhibited speech that was rapid and pressured—almost to the point of incomprehensibility at times—but which was otherwise properly articulated and generally coherent. His affect was congruent with his mood, and his conversation revealed clear evidence of delusions of failure and passivity, as well as of visual and auditory hallucinations. Except when discussing his specific delusions and hallucinations, his associations were intact, his thinking was logical, and his thought content appeared appropriate. Roscoe’s suicidal intentions were undeniable, given the bruises that were still around his neck from his attempt to hang himself, but he no longer appeared to be actively suicidal. He also denied any specific homicidal ideas or intentions. Roscoe’s cognitive functioning, vocabulary, and fund of knowledge are intact and age-appropriate, and his short-term and long-term memory and ability to abstract are likewise intact. His ability to do arithmetic calculations is not only intact but is bordering on the genius range, which is consistent with his general talent for engineering and inventing. Roscoe is oriented to person, place, time, and situation. Judgment is fair, but is compromised by his psychotic symptoms. Roscoe’s insight into his problems is not completely absent, but is severely limited by his mood episode and psychotic symptoms. There are also signs of autism spectrum disorder, but at present these are largely overwhelmed by his mood and psychotic symptoms.

Diagnoses

F31.5 [296.54] Bipolar 1 Disorder, currently depressive, severe with mood-congruent and mood-incongruent psychotic features.

F84.0 [299.0] Autism Spectrum Disorder, requiring support.

Instructions/Recommendations:

The patient should be confined to the infirmary until further notice, because the patient was very recently actively suicidal, and is still in the midst of a severe depressive episode with psychotic features. I will conduct therapy within the infirmary.

Once the patient has recovered to the point that he is no longer clearly psychotic or a suicide risk, I strongly recommend weekly therapy sessions, even if this is unlikely to take place due to Roscoe’s notorious tendency to avoid therapy at any cost.

Start 600 mg of Lithium, 2 to 3 times/day. Roscoe has Bipolar 1 disorder and a history of suicide attempts; he should have been on lithium from the second he came through the penitentiary doors. I don’t know what oversight caused this, but this problem needs to be resolved now.

Start 3 mg of Risperidone, once a day. This is for the psychotic symptoms.

Notes and Risk Factors:

Global Assessment of Functioning: 12

Risk Factors:

Z62.881 [V15.42] Psychological Abuse in Childhood

While never confirmed, almost every mention of his parents Roscoe has made indicates that his father was demanding, perfectionistic, critical, and verbally abusive when Roscoe did not live up to his expectations.

Z65.1 [V62.5] Imprisonment or Other Incarceration

Serving ten-year sentence for armed robbery (with possibility of parole) in Iron Heights Penitentiary

Z72.881 [V71.01] Adult Antisocial Behavior

1. Roscoe is a career criminal. While he sometimes commits crimes alone, he more often works alongside his girlfriend, Lisa, or in tandem with an organized group of costumed criminals known as “the Rogues”.

Electronically Signed

Adam Brooks, M.D.

On: 7/31/2019, 9:45:24 PM

#flash rogues #flash comics #roscoe dillon #the top #iron heights penitentiary #golden glider #fanfic #tw suicide #tw characters who don't understand mental illness #tw mental illness

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