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The Psychiatric Report is the thirtieth and final clue in the Mystery Man Clueline. It can be found by Sam in the lodge's basement, in Chapter 7 of Until Dawn.

Overview[]

A comprehensive report on Josh, elaborating on all his previous experiences with psychiatric treatment and medication.

Transcript[]

Cover Page[]

OCEAN VIEW HOSPITAL
HEALTH AND HAPPINESS

JOSHUA WASHINGTON

FINAL PSYCHIATRIC EVALUATION

05/21/2014

DR. A. HILL

CONFIDENTIAL

Physician History[]

06/11/2006
Jeremy Harris, MD
Whale Point Surgery
Referred on 04/02/2007 after incident at school

04/26/2007
Oliver Purkiss, MD, MPH
Pastoral Wellbeing Center
Referred on 10/19/2009 after incident at school

10/23/2009
Roisi Williams, MD
Santa Buena Medical Center
Referred on 12/09/2008 after disagreement over treatment

01/03/2010
Sarah North, MD, PhD
Cranleigh Hospital
Referred on 11/29/2013 after patient's response to drugs tapered badly

12/19/2013 - Present
Alan Hill, MD, MPH
South-Western Psychiatry
Referred on 03/14/2014 due to potential suicide risk

History of Prescribed Antidepressants[]

Fluoxetine (06/18/2006 - 01/24/2010)

Patient reported that side-effects (headaches, nausea) were becoming too severe, and wanted to change drug.

Duloxetine (02/13/2010 - 11/01/2013)

Patient claimed that the drug was no longer having any effect. Reported that his mood had badly worsened.

Amitriptyline (11/29/2013 - 04/05/2014)

Patient began self-medicating, taking stronger doses.

Phenelzine (04/15/2014 - present)

30mg dose. Twice daily, increasing to three times daily after 2 weeks.

If the patient reports any of the following symptoms, please contact a physician IMMEDIATELY.

Side effects: hypotension, blurred vision, dizziness, insomnia, vomiting, diarrhea, muscle tremors, liver damage (hepatitis),

On withdrawal: nausea, insomnia, nightmares, agitation, hallucinations, paranoia, aggressiveness, slurred speech, ataxia, catatonia, shocks

Summary of Treatment[]

Patient arrived delirious/confused. Strong symptoms of major depressive disorder, related to death/disappearance of sisters.

Placed patient under observation.

ECT was considered, given patient's history of tapering drug effects, but rejected.

CBT, IPT, psychoanalysis, etc, failed to produce any improvement.

New course of drugs was necessary.

Patient moved onto a non-selective MAOI. Rationale being that SSRIs and SNRIs have proven ineffective in the past.

Phenelzine 60mg initially. Higher than average dose was necessary to see reduction of symptoms.

After 2 weeks, patient's symptoms and mood were greatly improved.

Discharged on 16th May after final consultation proved satisfactory.

Dr. Alan Hill

Invoice[]

OCEAN VIEW HOSPITAL

DATE: 05/16/2014

INVOICE #5132

1 Pinnacle Drive
Pacific Road
CA 90187

SHIP TO
Washington Pictures Incorporated
Valley Town
Burbank
CA 90321

QTY. TREATMENT RATE AMOUNT
30 Nights residence (observed) 395 11850.00
1 Phenelzine (200x 15mg) 105.24 105.24
1 Initial Consultation 750 750.00
14 Review Consultation (1 hour) 595 8330.00
7 CBT (1 hour) 745 5215.00

TOTAL: 26250.24
PAYMENTS/CREDITS: 0.00
BALANCE DUE: $26250.24

Location[]

After entering the Psycho's workshop, walk to the desk on your right side and open up the drawer.

Trivia[]

  • This clue can only be found by Sam if she escaped from the Psycho in Chapter 5.
  • Hannah's Diary states Josh went to a hospital.
  • This clue foreshadows the diminishing sanity of Josh, as he starts suffering the same drug withdrawal effects mentioned in the Journal later in the game.
  • The drugs that were prescribed to Josh are all focused around serotonin, a kind of neurotransmitter. Depression can be triggered, if there is a decrease of production of serotonin.
    • Fluoxetine is a SSRI which stands for "selective serotonin re-uptake inhibitor", and this can help increase serotonin in the brain.
    • Duloxetine is a selective serotonin/norepinephrine re-uptake inhibitor.
    • Amitriptyline and Phenelzine are the earliest anti-depressants developed.

Speculation[]

  • It is considered medically dubious and not technically possible to diagnose people you have not personally interacted with. Thus why it is considered gauche for mental health professionals to assert public figures have a mental illness based on their observed behavior from interviews and public events.
    • Fictional characters are an odd caveat to this, as you cannot sit down with them ever but they also can suffer no real life consequences from the practice.
      • Ideally: so long as all persons involved keep self-awareness of their personal biases, such speculation can be comparatively quite harmless and can foster healthy discussions about mental illness.
    • Writers create characters: sometimes with no mental illnesses in mind or as in this case, with specific ones in mind. As writers are rarely doctors, it is not unusual for several other diagnosis to fit as well, if not better than the one the authors intended.
  • The predominant theories being:
  • The drugs that he took were effective, but for his depression only, and never was effective for his suspected second mental illness, Schizophrenia.
    • His main issue was suspected to be Schizophrenia, and thus was never treated: he was treated for the wrong disorder, called Major Depressive Disorder.
  • A less common theory that he was properly diagnosed and the symptoms were the withdrawal symptoms of the above medications.
  • That it was some combination of the two theories.
Clues

Mystery Man Clueline

Wanted Poster · Newspaper Fragment · Answerphone Message · Axe Holder · Cigar Stub (Mike) · Mystical Symbol · Native American Book · Postcard · Cigar Stub (Matt) · Pig Head Note · Threatening Letter · Light from Below · Native American Letter · Cigar Box · Clippings Wall · Business Card · Pig's Head · Hidden Camera · Axe · Faked Newspapers · Lightbulb Catalogue · Batteries and Timers · Dead Pig · Photos of Friends · Hooks and Chains · Video Camera · Dummy in Sam's Clothes · Death Machine Plans · Josh's Cellphone · Remembrance Board · Voice Recording · Psychiatric Report

Twins Clueline

Film Trophy · Beach Photo · Prom Night Photo · Family Portrait · Tattoo Card · Compatibility Test · Tennis Photo · Portrait Photo · Hannah's Glasses Case · Beth's Phone · Hannah's Poster · Beth's Poster · Hannah's Glasses · Hannah's Locket · Marks on Rock · Beth's Cross · Tattoo Photo · Beth's Head · Beth's Watch · Scrawled Journal

1952 Clueline

Mine Danger Map · Old Mask · Administration Notes · Broken Camera · Medical Notes · Clocking-In Cards · Mine Rescue Photo · Old Newspaper · Restraining Chair · Telegram About Miners · Name Tag · Strange Skull · Death Certificate · Clocking-In Machine · Miner Photo · Miner's Family Photo · Romantic Postcard · Journal: Introduction · Journal: Cannibalism · Journal: History · Journal: Combat · Journal: Bite · Makeshift Graveyard · Doctor's Report · Old Film Reel · Suicide Note · Case Study Dossier

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