Existential Terror and Breakfast: Clinician's Notes - revfitz.com

Existential Terror and Breakfast: Clinician’s Notes

Epiphanies taste better with toast.


Note: The names and references of the prescription drugs in this record have been redacted to ensure the rights and privacy of their respected corporation. This clinical note taking software is a product of [redacted]…©, (“Clarity for you”™).

Clinician: Clarisa T. Queen, PhD.

Patient: Malcolm Steadman

Date and Time: [redacted]

Location: Main Office

Participants: Client only


Purpose of Evaluation:

Establish Malcolm’s mental health state and establish treatment plan.


F41.0-Panic Disorder

F41.1-Generalized Anxiety Disorder

F10.20-Alcohol Use Disorder, Moderate

F33.0-Major Depressive Disorder, Recurrent episode, Mild

Past Psychiatric History:

Was held for a five day observational period after contacting Suicide Prevention and expressing odd behavior.

Clinician’s Notes:

Malcolm’s general appearance was appropriate. His dress was appropriate, and his hygiene clean. During the initial greeting his motor activity was that of agitation and his mood appeared to be anxious. This is the only scheduled meeting Malcolm has kept since his time in observation. He has missed two others. His demeanor was very polite and apologetic as he expressed missing said meetings due to job hunting.

I informed Mr. Steadman that food was not allowed in my office, but that I would waive the rule just this once as he brought in a bialy and is out of work. Mr. Steadman was amicable to this.

I disagree with the initial evaluations that Malcolm suffers from being Bi-Polar. Though a depression state was noticeable in him, nothing during my interview suggests that he suffers from the manic side of it. To the contrary, I believe that Malcolm suffers from Panic Disorder and that his current medication [redacted]…©, “Clarity for you”™ does not align with his needs (at no fault to [redacted]…©, “Clarity for you”™, of course). Malcolm apologized at this.

Malcolm Steadman has been substituting professional therapy with talking to his cable company’s customer service line. This suggest that the passive barrier of the phone between him and his would-be therapists not only acts as a calming factor to him, but also allows Malcolm to disown his problems and not take responsibility for them. It was this habit that eventually led Malcolm to dial the prevention hotline when customer service was no longer an option or an outlet.

Though unemployment, coupled with social isolation and moderate alcohol abuse accounts for his state of depression, there are other factors of Malcolm’s behavior I find difficult to explain. Malcolm has self expressed his panic attacks as being induced by an “Existential Terror”, an antagonist that he referred to throughout the interview as “being fully capable to sneak up on you like the most proficient of predators when you least suspect it and is triggered by the slightest or minuscule philosophical dread”. Though he refers to his “Existential Terrors” with personified verbiage, I do not believe Mr. Steadman to be delusional.

After making himself comfortable, Malcolm described the panic attacks in greater detail. They occur often (at least weekly it seems, if not more) and they vary in degree of intensity. These panic attacks have greatly affected his livelihood as according to Malcolm, they have made him late for appointments and have even caused him to lose his previous job. On that occasion it seems that Malcolm was meditating on the obvious correlation between giraffe mortality rate and chocolate (something I will not go into detail as this is common knowledge learned in grade school) when the subject of mortality itself became his main fixture. It was then that Malcolm felt paralyzed with fear.

Malcolm has an obsession with mortality and our greater place in the universe.

Aside from his unorthodox means of talking to customer service representatives, Malcolm has also been self medicating his problems with alcohol. This was a subject of embarrassment for Mr. Steadman (though I am beginning to suspect that all subjects are embarrassing for him) and he expressed regret upon spending much of his savings on intoxication prior to his time at observation. I have recommended seeking out AA or other alcohol abuse programs. Mr. Steadman claims that he has not drank since that incident.

The closest our conversation ever came to being contentious was while discussing his refusal to take [redacted]…©, “Clarity for you”™. Though I believe this prescription to be wrong for him now, given his new diagnosis ([redacted]…©, “Clarity for all”™ would likely do him better) his unwillingness to take [redacted]…©, “Clarity for you”™ was concerning. It is Malcolm’s concern that one of the stated side effects (suicidal thoughts) was not something he suffered from now and does not want to be at risk of said side effects if he takes his prescription. He was very vehement that suicidal thoughts was the very thing [redacted]…©, “Clarity for you”™ is meant to prevent and not cause. It was then that I explained to Malcolm that treating his symptoms can be a long and experimental process. I assured him that if said thoughts were troubling him I would be more than happy to change the dosage or even try a different drug that works for him. Malcolm seemed amicable to this.

Malcolm does not appear to be suicidal to me, nor do I believe him to be suicidal in the past.

I have prescribed Malcolm to take [redacted]…©, “Clarity for all”™ (the Prescribed Frequency of Treatment: once a day or as needed). Other treatment strategies include: Cognitive Reframing, Relaxation/Deep Breathing, and Psycho-Education. I do not believe that he needs Preventative Services at this time.

Mr. Steadman is due for a followup therapy session in a week’s time. He assured me that he would cut down on his alcohol usage and call me if needed.

He left his bialy at my office uneaten.

Clarisa T. Queen, PhD.



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Rev. Fitz
M.P. Fitzgerald (Rev. Fitz) is an author, illustrator, and amateur Mad Scientist who lives in Seattle.

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