“Crime of the Ancient Mariner” by Brian Lance, with Illustrations by Christina Sun
NAVAL MEDICAL CENTER
FIRM LAND, COUNTREE
EPTE OUTPATIENT MEDICAL BOARD
NAME: THE ANCIENT MARINER
INTRODUCTION: This is an ancient left-hand-dominant male, LTJG/USN/AD, with service on the sea, first presented for psychiatric evaluation at NAVMEDCEN in his own countree upon grounding the pilot’s boat. Attention is invited to the Limited Duty Boards.
HISTORY OF PRESENT ILLNESS: The Mariner describes lifelong feelings of dysphoria, and fascination with suicide and depression, beginning during childhood, persisting through early adolescence and throughout his days on the sea, and gradually becoming more severe. He describes social isolation from friends and family, and “did only speak to break the silence of the sea! And in dreams assured were of the Spirit that plagued us so.”
The Mariner notes making a decision to end his life with daily thoughts of suicide. He describes self-destructive behaviors to include “a hellish thing. And it woke’n woe, for all averred I had killed the bird that made the breeze to blow. I bit my arm, I sucked the blood.” He would drink to the point of blacking out on a nightly basis.
The Mariner was placed on Limited Duty by the Hermit with a diagnosis of Adjustment Disorder and recommended for Administrative Separation, which the Mariner supported as he expressed a desire to get out of that silent sea. Despite being on Limited Duty, he experienced inability to focus and concentrate on problems at work and could not recall conversations, nor shapes of men, nor beast. He states: “The ice was all between.”
The Mariner continued to have thoughts of suicide, and reported thoughts of shooting himself with his own cross-bow. He feels hopeless throughout the day for most weeks and states: “seven days, seven nights I saw that curse, and yet I could not die.”
The Mariner feels ashamed. His enjoyable outside interests have declined. His overall mood is as “white as leprosy. The nightmare life-in-death was she, who thicks man’s blood with cold. A weary time! A weary time!” He was started on Zoloft, which caused bruxism, and was switched to Lexapro, which had fewer side effects. He was referred to and screened at Naval Medical Center Firm Land PIOP. Hesitant to engage in group therapy treatment, he declined treatment. He was re-screened and attended the second time, completing PIOP. The history was not consistent with hypomania, mania, substance-induced mood disorder or psychosis. But a weary time! A weary time!
PAST PSYCHIATRIC HISTORY: The Mariner has engaged in psychotropic medication management. He was treated with Zoloft, Ambien, Celexa, Wellbutrin, Lexapro and Abilify. He was also seen by a Lonesome Spirit from the South Pole for individual therapy every other week, but stopped going, stating: “every tongue through utter drought was withered at the root; we could not speak, no more than if we been choked by soot.”
The Mariner was referred to the Spectre-Woman and her Death-mate for testing for diagnostic clarification with the following results: “The Mariner’s pattern of responding on the MMPI-2-RF, MCMI-III, and the SIMS is consistent with significant over-reporting or marked exaggeration of psychiatric, somatic, cognitive and neurological problems. Therefore, the test data are not sufficiently reliable or valid to support diagnostic hypothesis, and similarly, the interview data may not be completely accurate. Personality traits suggested by the MCMI are of questionable validity. The Devil knows how to row.”
The Mariner endorsed suicidal thoughts throughout his life and once placed a loaded cross-bow in his mouth. He denies previous inpatient psychiatric hospitalizations or psychotropic medication use prior to seeing the Hermit. He was screened by SARP and diagnosed with Alcohol Abuse. He was referred to Level I, which he completed. Out of the sea came he!
PSYCHOLOGICAL/FAMILY HISTORY: The Mariner is an only child, alone, alone, all, all alone on a wide wide sea! He grew up below the kirk, below the hill, below the lighthouse. He describes his father as a good father who took him boating as a child. He denies a history of sexual, physical, or emotional trauma, but ’twas sad as sad could be.
The Mariner went to sea after high school. After serving on the sea, he was discharged. The bright-eyed Mariner graduated from University. He became a commissioned officer in a ship with his glittering eye. And now the storm BLAST came, and he was tyrannous and strong. He struck with his o’ertaking wings. And now came both mist and snow, and it grew wondrous cold.
SUBSTANCE USE: The Mariner would consume alcoholic drinks on that silent sea, but acknowledges concerns about his previous heavier alcohol use and in this context reports feeling as though he was unable to control/stop drinking, feeling guilt over his alcohol use, regretting drinking to the point of memory loss, and failing to meet his social/interpersonal obligations as a result of alcohol consumption, stating “what evil looks had I from old and young.” Instead of the cross, the Albatross about his neck was hung.
Since, the Mariner has abstained from alcohol. A weary time! A weary time!
PAST MEDICAL HISTORY: None.
MEDICAL STATUS EXAMINATION: The Mariner, whose eye is bright, whose beard with age is hoar, is alert and oriented in all spheres. He is very thin, long and lank and brown in appearance as is the ribbed sea-sand, with intermittent eye contact, and skinny hand, so brown. He has a strange power of speech, spontaneous with a slow rate, normal rhythm, monotone, and soft volume. Some mild psychomotoric slowing is noted. His mood is frustrated, somewhat dysphoric and irritable.
TREATMENT COURSE: The Mariner reports that he has been under the care of two different psychiatric providers for depressive symptoms prior to initiation of treatment with the Wedding-Guest.
There was a ship! And the Mariner was an officer on it at sea, but currently passing, like night, from land to land while on Limited Duty. He reports he has been on multiple medications, most recent Lexapro and Wellbutrin and Abilify. He reported continued bruxism with Wellbutrin, which was discontinued and side effects left him free. He has completed PIOP, which he may’st hear the merry din. He has been involved in individual therapy with the Lonesome Spirit from the South Pole, which he reports is “sometimes sweeter than the marriage feast, sometimes wrenched with a woeful agony.” He reports despite medications continuing to feel what he describes as nor breath nor motion; as idle as a painted ship upon a painted ocean, as sad as sad could be. He finds himself being a catastrophic thinker and is frustrated with the uncertainty of his future.
FINDINGS: After an adequate period of observation, evaluation and treatment, a seraph-band reviewed the available records and current findings. This seraph-band, each waved his hand: It was a heavenly sight! This seraph-band, each waved his hand, no voice did they impart — No voice; but oh! the silence sank and they agree that the Mariner suffers from a condition that precludes his rendering any further useful service to ships on the sea.
The Mariner’s claimed conditions to the countree were reviewed and no further changes are recommended to God himself.
Axis I: Major depressive disorder, single episode, moderate, Alcohol Abuse
Axis II: Deferred.
Axis III: Recently diagnosed heart as dry as dust.
Axis IV: The sky and the sea, and the sea and the sky
Axis V: GAF of 5.
RECOMMENDED MEDICATIONS: Continued psychopharmacological medication is advised. The level of medication required does not plague the Mariner so as to fling the blood into his head and fall down in a swound. The Mariner takes the prescribed medications appropriately and can be expected to do so upon discharge.
RECOMMENDATIONS: Following a review of the clinical findings, the seraph-band is of the opinion that the Mariner suffers from a condition that existed prior to service and is considered to have been aggravated by a period on the sea. The seraph-band recommends that the Mariner’s case be forwarded to God himself for disposition.
DISPOSITION: The seraph-band is further of the opinion that the man hath penance done, and this has not restored the Mariner to a duty status, nor restored his glittering eye. At the present time, the Mariner is considered fully competent to be discharged from the sea, does not constitute a danger to self or others, and is not likely to become a public charge; and penance more will do.
MENTAL COMPETENCY: The seraph-band is of the opinion that the Mariner is mentally capable of handling his own financial affairs.
DISCIPLINARY STATUS: There is no known disciplinary action, investigation or processing for an administrative discharge pending. The Albatross fell off, and sank like lead into the sea.
FIRST VOICE (P)
LCDR MC USN
SECOND VOICE (P)
LCDR MC USN