Emmanuel "Manny" Daines

D.O.B: 05/26/1973
AGE: 39
GENDER: M
STREET ADDRESS: Mercy Behavioral Health
TOWN/CITY: Pittsburgh
STATE: PA
HEIGHT: 5'9"
WEIGHT: 155 lbs
ETHNICITY: Caucasian
DISTINGUISHING MARKS: Manny has some scars on his inner arms and elbows, signs of his former heroin abuse.

Do you have any ongoing medical issues for which you require treatment or medication?:

Manny receives melotonin supplements as needed for the occasional bout of insomnia.

Are you aware of any allergies? If so, please list allergy, age of onset and any medications or treatments you require or recieve:

Patient has no allergies.

Have you had any surgeries or invasive procedures in the past? If yes, please list reason and approximate age of procedure:

Tonsillectomy at 7 years old.

Do you take any medications or supplements daily? Do you follow any treatment plans? Please list medications or treatments, and reasons below:

They make me go to therapy, one-on-one and group sessions, as if it's ever helped in the past.

We currently have Manny on a daily regimen of Clozaril. He takes one 12.5 mg pill with breakfast each morning.

Do you use tobacco, consume alcohol, or use any other drugs including street drugs and/or prescription medications not prescribed to you? If yes, please list number of packs a day, number of drinks a day, and/or drugs consumed below:

I would give my left nut for a fix, but heroin is frowned upon in these circles.

Manny smokes up to half a pack of cigarettes per day. We have helped him cut down on the pack a day habit he had when he first came to us last October.


Please describe, to the best of your ability, your emotional and mental state of wellbeing:

I don't feel anything. I'm dead inside.

Manny's attitude for the past several months can only be described as apathetic and lacking in initiative. He is socially withdrawn and not particularly forthcoming in therapy sessions unless prodded, and even then he doesn't say much, giving us little insight into his current mental state. Emotional outbursts are infrequent, but are usually angry and resentful in response to some perceived slight or suspicion when they do occur. Manny has confronted several of the other patients here about talking behind his back when in fact they have done no such thing. He is capable of taking care of himself and interacting with others in an acceptable fashion but continues to express minimal interest in doing so. At his worst, Manny is suspicious, paranoid, and hostile. At his best, he is responsive, relaxed, and curious. His mood is unstable, unpredictable, and fluctuates often, but mostly he is quiet and keeps to himself.

Have you been diagnosed with any psychiatric or psychological ailments? Please list any diagnoses below, and the treatments or medications prescribed to you. Please include name of medications, dosage, and number of doses per day:

I'm crazy, haven't you heard? I have nothing to offer society, I'm ugly, I'm a monster, everyone wishes I was dead. I don't know why they don't kill me instead of continue to pass me from nuthouse to nuthouse. What's the point?

Current diagnosis is one of Residual Schizophrenia with a History of Substance Abuse. Symptoms of depression have recently been noted, but no suicidal thoughts or intent have manifested as of yet. Manny has been in and out of various mental health facilities in the Southern Pennsylvania and Maryland areas since the age of 15, when he was first diagnosed with Paranoid Schizophrenia. A variety of treatments and medications have been tried on him over the years, but because Manny has a history of refusing to take medications over an extended period of time, it is hard to determine just how effective those treatments might have been. Typically, he is cooperative for several months up to a year into a treatment program before he suddenly decides that the staff is trying to harm him and he will no longer take prescribed medications. Since early adolescence, he has operated under the delusion that others believe him to be a hideous monster or beast of some sort and want him put down. He has reported hearing laughter, whispers, taunts, and death threats directed at his person, though we believe these to be nothing more than hallucinations, as no one else can back up his claims. During times of outpatient care, in addition to going off his prescribed medications, Manny has resorted to hard drug abuse to blot out the voices, particularly heroin. He has alternated between snorting it and administering it intravenously, hence the scars from track marks on his arms.

Have you ever been hospitalised or referred to regular outpatient care due to these ailments or associated incidents? If so, please note where, and at roughly what age:

As previously mentioned, Manny has been in and out of various mental health facilies and psychiatric hospitals since the age of 15, with periods of outpatient care in between. Before coming to us here at Mercy, Manny spent five years as a patient at Baltimore Behavioral Health - the first two years as an inpatient and another two years as an outpatient before voluntarily readmitting himself for inpatient care for another year prior to transfer.

How have these ailments affected you and your life? Are there any major life instances you feel have been directly affected by these ailments, such as suicide attempts, criminal activities, etc?:

I don't have a life. My "ailments" have all but guaranteed that. I was dealt the short end of the stick at birth and taunted with a promising childhood until all hope was ripped out from under my feet at the very same time my life should have been starting.

It is my belief that the schizophrenia, and Manny's inability to cope with it, is what led to his dalliance with drugs. His first period of outpatient care was at age 19, during which time he shared an apartment with a friend. This friend introduced to him to a multitude of drugs, but none of them had the same affect on him that heroin did. For as long as the high lasted, the voices went away and Manny could feel normal for a time. Unfortunately, it wasn't long until he first overdosed at age 20 and was promptly mandated by his social worker at the time to return to inpatient care. His second overdose, which led to his stint at Baltimore Behavioral, happened at the age of 33.

What is your social life like? Do you have many friends or relationships? How are your family relationships?:

I don't keep in touch with my family. They all hate me and wish I was dead. Likewise I don't have any friends and have never had a romantic relationship.

Manny has difficulty trusting others. He only gets along with one or two gentlemen on the ward, and even then, I wouldn't call them friends. They smoke cigarettes in the courtyard and occasionally spend mealtimes together, but they don't speak much, and when they do, it's typically about their experiences with drugs. Manny's mother and father have expressed interest in communicating with him, but he refuses to speak to them on the phone and doesn't answer their letters. He does not believe me when I tell him that they genuinely care for his well being and wish to see him.

As far as intimate relationships are concerned, Manny insists that he doesn't believe in love and is only interested in getting close to another human being if there is something in it for him, namely sex or drugs. He isn't too preoccupied with the former these days, but admits that he has sold his body for heroin in the past.

Do you believe your life circumstances have contributed to any ailments? If so, what circumstances, and why do you feel they have contributed?:

No. I used to be normal. Now I'm not.

Manny had a relatively normal childhood, with no early indicators that he would go on to develop this debilitating illness later in life. When he was first diagnosed with Paranoid Schizophrenia, a look down his family tree revealed that his paternal grandfather had also been diagnosed with the illness in his youth, so the condition appears to be merely hereditary. His life choices after being diagnosed have not helped him rehabilitate, but I have hope that he can find a form of treatment that finally works for him and enables him to live out the remainder of his life in peace and normalcy, without feeling the need to rely on illicit substances.

If you could change one past event that has happened to you, what would it be, and why?:

I would have never have been born. It would be so much easier that way, wouldn't it?

Do you wish to rehabilitate from your ailment(s)? If so, how do you feel this would best be accomplished?:

I do, but I don't know how. I don't think I can. I'm not strong enough and I'm not sure anyone else really wants me to get better.

Manny wishes to rehabilitate, but lacks the motivation or willpower to do so. He simply doesn't believe it is possible for him to live a normal life. It is a hope of mine that someone at Hallowsgate has the ability to change his mind and help him see things from a different perspective, something I have unfortunately failed to do despite my best efforts.


Where did you grow up? Please list the location(s) and describe what it was like growing up there:

I spent my early years in Harrisburg, PA before moving to Mt. Lebanon, a suburb of Pittsburgh. Southern Pennsylvania is a boring place, but when I was a healthy, happy child, it was adequate. The small city vibe of Harrisburg was sufficient to fill my imaginative brain with all sorts of stories and ideas, and Pittsburg was even more exciting. My father took me to football games, and we were close enough to both Baltimore and Washington, DC to take several day trips throughout my youth. I can't remember those days very well anymore.

What was your family life like? Did you spend much time with your parents? Do you have any siblings? If so, what are your relationships like?:

Manny did not have any siblings growing up. He does not speak often of his childhood, claiming he can't remember details, but says that his parents were pleasant enough from what he can recall. I think he remembers more than he lets on, but that it pains him to do so, seeing as how his life took such a dramatic turn in his teenage years. He doesn't like to remember the days when he was "normal" because he doesn't believe he can ever have that kind of life again. I have spoken with Manny's parents at length; they are wonderful people and give me every indication that they were attentive and loving parents. His mother, Julia, was an event planner and his father, Daniel, owned a bakery in Pittsburgh. Both had plenty of free time to spend with Manny. He spent a couple of hours with a babysitter every day after school, but the family always sat down to dinner together. Manny's grandparents were active in his life, except for his paternal grandfather, who passed away two years before he was born. Manny didn't know much about him, including that he was afflicted with schizophrenia. That he learned shortly after his own diagnosis.

What was school like? Did you have any problems? Did you enjoy school? What were your grades like?:

I was bright and had a promising future ahead of me, or so I thought. It doesn't matter now and I don't want to talk about it.

Manny was indeed a bright young man. He did well in school, got along with his teachers, and only had a few conflicts with students who bullied him for being short and skinny. He becomes visibly agitated when I attempt to discuss this with him. In the year leading up to his diagnosis, Manny's grades faltered when he became increasingly preoccupied with others' opinions of him. He became obsessed with the idea that the other students were afraid of him because he was ugly, and that the older boys in particular were plotting harm against him.

Did you engage in any extracurricular activities, such as academic, artistic, or sporting clubs?:

Prior to diagnosis, Manny was part of the chemistry club and met with a weekly creative writing group after school. He was never particularly athletic, but was allowed to ride a bike to school after the age of 10, which he says he enjoyed.

What was work like? Did you have any problems? Did you enjoy your work? What were your coworker relationships like?:

Manny has never held down a job. His parents have been remotely assisting him with medical bills for the treatments he's been receiving over the course of the past 14 years, and have assisted him financially with rent, bills, and grocery money during times of outpatient care, sending checks to a post office box in his name.

Have you ever been convicted of a crime or misdemeanour? If yes, please explain, list conviction, and list any sentences associated with convictions:

No.

Lastly, please tell us about yourself. How do you feel about yourself and what you have done with your life? If you have committed crimes, how do you feel about those now? What are your hopes for the future?:

I don't care. I want to get well but I know I won't. I just want a fix, and maybe a warm body to sleep next to from time to time, as long as they don't expect me to love them and don't run from me screaming.

Deep down, I know that Manny regrets the fact that he hasn't done more with his life, but he feels so helpless that he doesn't think he can turn it around and have a better future. He never asked for this, after all, and understandably sees himself as a victim. I hope that by sending him to a smaller, more specialized facility like Hallowsgate, he can get the kind of care that inspires him to work toward having the kind of life that he deserves. There is a remarkable human being somewhere in there and I wish he could learn to see that and give himself a chance.


What are they not telling us? What secrets do they have to hide? What back story are we not hearing? This is where you can tell us all the things your character wouldn't put on an application, or others don't know.:

Nothing of note.

Your Nickname: Zillah
Your Chatango Screen Name: zephyr13
Your Character's Playby: Johnny Depp

Date: 06/09/2012
Attending: Dr. Alexander Farthing
Session: Individual Therapy

Therapy Notes: Introductory meeting with Mr. Daines progressed without incident. Connections were able to be established with the patient, and communication was easy and amiable. Primarily, discussion consisted of the topic of trust, therapist availability, and medications. Mr. Daines has not reported any problems with his current prescription of 12.5mg Clozaril, once daily with morning meal, so I believe this should be continued. He continues to suffer with insomnia as a result of the medication however, so I am recommending 5mgs diazepam before lights out, to assist with restful sleep.

Additional: Given that the diazepam will be controlled by the attending staff each evening, I do not believe that this prescription would conflict with Mr. Daines' history of substance abuse.

Follow-Up: Follow-up date to be set for later this week. Goal will be to further establish a connection and lines of cumminication and trust.

Precription: 12.5mgs Clozaril, once daily, with breakfast.
Attending: Dr. Alexander Farthing
Additional: N/A

Precription: 5mgs Diazepam, once daily, before bed.
Attending: Dr. Alexander Farthing
Additional: N/A

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Date: 09/07/2012
Attending: Dr. Cyril Darling
Session With: Dr. Sean Whelan
Session: Group Therapy

Therapy Notes: Today's group therapy was an drawing activity. I started the patients off with bright colors, giving them each their own set. My goal for this session was to see what they would do if only given "happy" crayons. After they'd been drawing for a while I asked them to share what they'd drawn and then I introduced more colors. The second set were the dark colors; black, brown, and various earth or jewel tones. What I wanted to see now was how the addition of the darker colors effected what the patients drew. They had the option to start a new picture or to add on to the first one.

Manny entered with Malachi, something I expected, and he took a seat beside the younger man. I asked everyone to give their name he did answer. He seemed a little put off by the activity at first but he did begin to draw when given the time. I only caught glimpses of what was on the page but it seemed to be a family. Manny left the table shortly after his picture was done to follow Malachi to the corner of the room and remained there for the rest of the session. He seemed to be trying to comfort the distressed young man and from what I could was succeeding on some level.

When the session ended and Malachi once again became upset Manny asked if they could take some of the crayons with them to allow him to continue to draw. I allowed it, telling them to head down to the recreation room and continue drawing there. I sent an orderly after them with extra paper.

Additional: Manny definitely seemed to have formed a bond with Malachi and, while it seemed to be good for them, I feel that it should be monitored carefully and handled in the same fashion. They have the potential to feed each others' disorders, something we want to avoid, but at the same time I haven't seen anyone keep Malachi so calm before.

Follow-Up: I recommend keeping an eye on them but keeping distance. If things appear to be unhealthy for them only then should staff step in.

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Date: July 13, 2012
Attending: Dr. Cyril Darling

Notes: After a group therapy session with Dr. Sean Whelan, Emmanuel Daines and Malachi Craul were to be sent to the recreational room with art supplies, as Malachi was not ready to stop coloring. When their absence became noticed, staff was sent on the look out for the duo, in which I monitored the halls. After a while, I overheard Manny and Malachi down an abandoned hallway (Children’s Ward), distressed. Upon my arrival, Malachi was several distressed, curled into a ball onto the floor.

I proceeded to pick up Malachi, informing Manny that I was going to get them out of the situation and back to the safety of their dorm. Manny was distressed and clearly frightened, however, manageable. After some coercion, I was able to get Manny to walk with me while I carried Malachi out. He informed me not to look at the “dead” children, however there was no one in the wards but Manny and Malachi. I informed him that I would not, and I reassured him multiple times that he was safe.

I am rather proud of Manny, and his ability to cope. He responds well to compliments, in telling him he is brave. I told him he must be brave for Malachi, that Malachi needed him. He would not leave with me unless I had Malachi. However I had no intentions of leaving the younger man in the hallway. Manny was very brave.

-Dr. Finn McAlister

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Patient: Emmanuel Daines
Date: 31/07/2012
General Topic: Self-Image and the Perceptions of Peers
Therapist: Dr. G. Bjorgen MD

Pre-Therapy Notes: Emmanuel Daines has a noted and consistent history of Paranoid Scizophrenia, which appears for a time at least to have been responding to medication and therapy. More recent notes show a decline in his mental status however, and I would caution more observation on the nature of his association with his roommate, whose condition may be exacerbating Emmanuel's case. I would also consider exploring further medication options and more intensive individual therapy to address current mental status.

Behavioural Observations: Mr. Daines did not look happy to be joining the group therapy session today, and appears more withdrawn and oppositional. I would note this as a perhaps furthering of schizophrenic behaviours which should be addressed with his therapist.

Therapy Report: Mr. Daines was much disturbed by the topic of today's session, and did not appear reassured when I informed him there were no wrong answers. I might suggest the application of a mild sedative by mouth prior to group therapy sessions should this reaction to group settings become more prevalent. When the topic came around to Mr. Daines, I asked him what he thought other people thought of him and if this influenced how he viewed himself. As I expected, he elaborated that people thought he was a freak, and crazy, and that he in turn supposed it was true. I countered by asking him if he thought other people's perceptions were always correct. He answered negatively, but posited that when he could see the hate and disdain on their faces, he felt their opinions of him must have some merit. As he was tense already, I did not push the subject, and moved on to Ezekiel Tadesko, who had spoken out of turn already.

Additional: Suggest addressing medication and inclusion of a benzodiazepine, as well as monitoring the relationship between Mr. Daines and his roommate, and considering lessening their interactions on a daily basis and providing other distractions instead.

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Date: 29/09/2012
Attending: Dr. Cyril Darling
Session With: Amelia Bowman
Session: Group Therapy

Therapy Notes: Today I had the patients making paper decorations for Halloween. I provided the paper pre-cut as well as glue sticks and silly eyes if they wished to give them faces. I wanted to give them an activity that they would see the results of in a couple weeks decorating the hospital for the holiday.

Manny seemed in low spirits when he arrived to the session, not saying anything as he walked in. I did notice that he seemed put off by the sight of the art supplies. When he was asked to give his name and something about himself he said that he was a paranoid schizophrenic and not a child. Given Manny's condition I got the feeling he'd been in a lot of craft activities. At first he didn't seem interested in the activity at first but when Juliette asked him to make her a pumpkin. He did participate in the activity after that, making the pumpkin promised. As the discussion turned to Hallowsgate being haunted Manny became increasingly more upset, mentioning the Children's Ward and how it was unsafe. I attempted to reassure him that there was nothing out there and that it was only unsafe because it was old, but this seemed to upset him more. I admit I shouldn't have called him out like I did, but it was intended to keep the others from becoming upset as well. Manny crushed the pumpkin he'd been making out of anger and I called the session after Drake's outburst, asking Manny to stay behind. I radioed for Dr. Darling to come down to the room to discuss the topic with him.

Additional: As Manny didn't respond well to the craft I will not be having him in such activities in the future. Instead I will attempt to find something a little more suitable for him, as he feels like his disorder causes him to be treated like a child. Dr. Darling is meeting with him to discuss his feelings about Hallowsgate being haunted but I am concerned that he his delusions are getting worse. If he is seeing children it might call for an increase in medication and therapy.

Follow-Up: Evaluation by Dr. Darling, no future craft activities.

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Date:October 20, 2012
Attending: Dr. Cyril Darling
Session With: Dr. Finn McAlister
Session: Group Therapy

Therapy Notes: The intention for this session was to introduce the idea of the subconscious and how our minds tend to cover up things we wish to repress from our memory. I instructed the group to introduce themselves and state one thing they enjoyed about Hallowsgate Hospital. I then lead into an imagination exercise:

Quote :

You are walking down a road.... As you are walking, you see a house. Look at it. Notice its details.... Walk towards it. What do you notice about it?.... You start to walk around the house, looking at it as you walk.... Now you are halfway around. Notice the details of the house as you continue to walk around it.... Now you come back to where you were when you started.... As you walked around the house, you noticed a way to get in. Now go into the house.... What do you see?.... Explore the house, what's inside?.... As you were exploring, you noticed a secret door leading to a secret room. Go inside that room. What do you see?.... Now leave the secret room and go back into the main part of the house.... Now leave the house. As you are walking away from it, you look back at it one more time....what do you see?"

I proceeded to ask each patient what they imagined. Emmanuel Daines imagined:

Quote :

The house is made of stone, crawling with ivy. There's a chimney, and all the windows are broken. The yard's overgrown, a rusted lawnmower out front. Inside it's dirty, filthy. There are forgotten child's toys lying in dust, and the remains of a fire in an old fireplace. The embers are smoldering... it's as if someone's just been there. In the kitchen, there's still some lukewarm tea in a kettle on the stove. The secret room is... beautiful, actually. I didn't expect that. There's a big four poster bed, a crackling fire in another fireplace. Everything's made out of silk and velvet, except for the leather armchair next to the fire. There's a chilled bottle of wine on a stand next to it, and an empty glass. I don't want to leave... but when I do, the house looks the same, only the grass has been cut and the broken windows have been replaced. I don't really know what that says about me.

The next question, I gave my take on Manny’s house, and stated that I felt he wished to enter a place and come out better than when he went in. And I believed that he is well on the way to doing just that. This seemed to lift his spirits only slightly, and I asked how he believed he was making progress, and he stated that he is meeting people and getting fresh air.

Additional: I believe it is doing Manny well to meet and talk to various people. Encourage him when you can, and if you must criticize him, do it in a constructive way.

Follow-Up: Monitor his relationship with others, ensure he gets fresh air, and encourage him often.

---

Quote :

Manny,

Your father and I are worried sick about you. Why didn't you write us - or at least call us - to let us know you were transferring facilities? I can't believe you've been at this Hallowsgate for over three months now and we haven't known about it. We thought it was odd when we stopped receiving communications from Mercy, and that there were no bills coming in for your treatment, but we've both been so busy with work we didn't think to question it much.

Manny, I know you're sick, but I wish you would write me back sometime. Just a line or two to let me know you're doing okay would be all the reassurance a concerned mother needs. I know that your condition makes it hard for you to trust your father or myself, but please believe me when I say we still love you, we've always loved you, and we just want you to get better, for your own sake.

Have you met a nice young woman there, at Hallowsgate? I always hoped you would meet someone who could help you, even just a friend (and not like those shameful junkie friends you used to hang around with - they were nothing but trouble and only made things worse for you). I still have hope that you can put institutionalization behind you for good and settle down with someone sweet someday, maybe even have a family. Your father and I would love grandchildren before we're too old to enjoy them, and we're nearing retirement age now. Still, the both of us remain too energetic not to work. Life is good, but we miss you.

Anyway, I found a couple old photographs of you that I thought you'd like to have. Maybe they'll remind you of better days, though I know they weren't the best. I've also sent a carton of Marlboros - do you still smoke those? I guess you do now. Please write me back if you can, Manny. It would be so good to hear from you. We love you.

Love,
Your Mother