Sequel:
Patient Name: Joshua Atkins
Age: 53
Seven months ago, Mr Atkins went through a period of acute psychological stress resulting from the traumatic death of his daughter, Miss Rebecca Atkins, age 21. It would appear that the extreme stress triggered an abnormal grief response which, untreated, developed into a severe psychotic break and dissociative identity disorder. Unable to process his loss, Mr Atkins began displaying abnormal behaviour, wearing items of Rebecca’s clothing, sleeping in her bed, even utilising her social media to contact her friends, claiming to be her. When this was referred to police, Mr Atkins was questioned and, according to police reports, appeared agitated and confused at the time, claiming to have no knowledge of Rebecca’s passing and, indeed, insisting that he was her.
Why the police did not escalate this to mental health services at the time, I do not know. Mr Atkins’ mental state deteriorated over subsequent weeks, resulting in him submitting himself for a large swathe of cosmetic surgical procedures, including liposuction and liposculpting, full body laser hair removal, follicle transplantation, facial feminisation and reconstruction, breast and buttock implants, tracheal shave, finally culminating in a total sexual reassignment vaginoplasty. Rebecca’s ex-fiance, who has reviewed the images of Joshua’s altered body at length, assures me that the surgical transformation is quite accurate and complete.
After recuperation, Joshua returned home to live out the life of his daughter. This went unnoticed until his arrival at Rebecca’s place of work some weeks later, whereupon her ex-employer called the police and Mr Atkins was, finally, referred to our care.
Physically, Mr Atkins has the appearance of a young, well-kempt brunette woman of approximate 20 years of age. He is pleasantly confused, chatty, co-operative with care staff, and coherent enough to pass himself off as a woman, such that on multiple occasions he has successfully absconded from the ward by simply requesting a porter to open a door to allow him to leave, which they did, believing him to be a visitor or nurse. In demeanor, he does not appear depressed - indeed his persona is bubbly and energetic, showing a friendly interest in the ward staff and often saying ‘she would like to become a nurse one day’. He is capable of conducting all Activities of Daily Living, dressing himself fashionably in the spare clothing the nurses have provided, cooking, cleaning, and washing himself.
I do not believe Mr Atkins is faking his condition in any way. On analysis, I believe he truly believes himself to be his own daughter, a psychological defence mechanism to the frozen grief he is experiencing. This is evidenced by the occasions in which Mr Atkins enters a lucid period, becoming fully cognizant of what has transpired and who he is, clutching his face and breasts in extreme agitation, uttering ‘oh my god, what have I done?’. These episodes typically last only a few minutes before the false persona reasserts. For his own comfort, I have administered a mild sedative. This has reduced these lucid periods to almost zero.
Clearly Mr Atkins is not in his right mind. However, in many ways, he is cogent and shows the capacity to rationally make judgements about his treatment and incarceration here, which 'she' strenuously objects to. Moreover, I do not believe he is any immediate danger to himself. It is therefore becoming legally untenable to confine him here on a long-term basis.
In the meantime, Rebecca’s ex-fiance has offered to house Mr Atkins and oversee his care, administering his daily sedative and reporting to us any worsening of behaviour, and has even kindly provided Mr Atkins with his daughter's engagement ring, which has proven a source of great comfort during his stay here.