THREE

* * *

Her name had come up at a conference. He had given a paper on post-modernist psychology and Adams had approached him afterward.

"I've got a case that might fit the bill. Care to hear about it?"

They had talked, and then it had been several hours and they had missed the keynote speech. Schizophrenia, catatonia. A delusional reality of astonishing complexity.

Just your thing, Garrett. We had her aware, for a little while, last month. Then we lost her. Don't know why.

Her name.

It stuck with him because it was almost silly. Who called their daughter "Buffy" anymore?

So he had asked to see her file and Adams had sent it to him. It was a thick thing and he had read it slowly.

#

NAME: Buffy Summers

AGE: 21

DIAGNOSIS: Catatonic Schizophrenia

HISTORY: Illness began when subject was a freshman in high school, with irrational fears of mythological creatures, especially vampires. Was treated at Mayberry Clinic in Los Angeles (attending physician Dr. A. Griffith) and released after symptoms subsided. However, shortly after her release, Buffy suffered a relapse and attempted to set fire to the gymnasium of her school. Following hospitalization, her symptoms of anxiety increased and she began to experience increasingly powerful hallucinations despite antipsychotic therapy, claiming that her parents were getting a divorce and that various types of monsters were threatening the world. After six months Buffy slipped into a catatonic state, from which she periodically emerges in conditions of heightened anxiety, making psychotherapy difficult.

In her catatonic state, Buffy has constructed a powerful fantasy world around herself, in which she is the central character (a "vampire slayer") in an ongoing apocalyptic drama. Included in this fantasy world are a group of friends, lovers, and other acquaintances, populating an imaginary small town in California called "Sunnydale". This reality seems remarkably consistent, so far can be seen from interviews made during her limited periods of awareness. Recent events in this fantasy world include the creation of an imaginary sister named "Dawn" and the death of her mother.

There was a lengthened period of awareness in the Summer of 2001, but it ended in the Fall. According to Buffy, she had "died", but then her friends summoned her back into the Sunnydale reality, resurrecting her to reprise her role as hero.

PROGNOSIS: Not favorable at this time. Neuroleptic drugs have had little long term effect or benefit. A recent change in medication to clozapine produced a brief period of awareness, but it could not be maintained. Patient requires regular supervision but generally remains immobile. Frequent visits by the parents are considered helpful and should be continued.

#

There was more; pages of notes from Adams and others. Interviews, medication reports. Garrett had read this all carefully, then sat back and thought.

It was an interesting case; most schizophrenia patients gave confused accounts, even inconsistent ones, about their hallucinations. But the information here was largely regular; what the therapists had been able to glean about Buffy's imaginary world read almost like a series of novels; each year a new villain would menace her and her friends, and each year she would defeat it. There seemed to be rules to this imaginary world that didn't fit the mold of a schizophrenic delusion; save for the creation of a sister and her own periodic deaths and resurrections, life and death in this fantasy seemed nearly as constant as the real world.

Garrett thought back to his paper.

It is the narrative that we as therapists must consider. For each of us lives our own narrative, and the narratives of our patients frequently contain the seeds of their own healing. It is not up to us to define mental health but rather to help our patients define it for themselves as best they can.

How does Buffy Summers define mental health? he wondered.

It was this question that finally drove him to pick up the phone and make an appointment to see the girl and her parents.