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Down the Rabbit Hole	By : downloadjones300 Category: DC Verse Comics > Batman Views: 3042 -:- Recommendations : 0 -:- Currently Reading : 0
Disclaimer: I do not own the Batman series, nor any of the characters from it. I do not make any money from the writing of this story.

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Arkham Asylum Patient File No. GO78NN2QKE

Name: Unknown
Alias: Joker
Age: Unknown
Height: 5ft 9in
Weight at time of admission: 10st
Weight after admission: 9st 7lb
Marital Status: Unknown
Nearest Relative or Correspondent: Unknown

Physicians Examination

State briefly the mental symptoms of patient: severe psychotic disturbance, bipolar disorder and at least two other possible mental illnesses
When first observed: Unknown
How rapid development:Unknown
Has patient attempted suicide: Unknown
Has patient attempted homicide: Yes
State intellectual level:Highly itellegent
Has patient had previous psychiatric care: Unknown
Alcoholic habits: Patients systems clear from alcohol at time of admission
Drug habits: Patients systems clear from substances at time of admission
Injuries at time of admission: three lacerations to the arm caused by the vigilante, Batman. Became infected after the patient repeatedly pulled the stitches out.

Mental Status Exam

A person who is psychotic is out of touch with reality. People with psychosis may hear “voices” or have strange and illogical ideas. We have yet to determine if the “Joker’s” recent action is the result of his hearing voices as any attempt to question him on the subject has been unsuccessful. However the patient does exhibit other symptoms of a psychotic illness such as getting excited or angry for no apparent reason and chronic insomnia. He seems to have no regard for his own appearance, his clothes whilst custom made are threadbare and unwashed, the choice of patenting and color also adds to the case for a psychotic illness.
The severe facial scaring that the patient possess could also be another indication of a severe psychotic illness but this would only be confirmed if the patient had disfigured himself. At this moment in time the patient is unwilling, or unable, to explain how he came to have such scars. However it is clear that the patient does not see his unmasked face as his true identity. As is procedure when the patient was brought to our facilities, heavily sedated, we removed all his own clothing and make-up off his face. When the patient came around in his cell he became very agitated and distressed, screaming for his “face” to be returned. It was explained to the patient that no items of personal effect were allowed in Arkham, including make-up, which resulted in the patient smashing his own head into the wall four times and fracturing his own skull. After this incident it was agreed upon that to save the patient doing any more damage to himself, he would be given his “face” back.

However when examining the case of the patient further a cross diagnosis of Bipolar disorder must also be taken into account. Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Episodes may be predominantly manic or depressive, with normal mood between episodes. Mood swings may follow each other very closely, within days (rapid cycling), or may be separated by months to years. The “highs” and “lows” may vary in intensity and severity and can co-exist in “mixed” episodes.
The main symptom we have observed in the patient that is conclusive with severe mania is being overtly talkative as the patient switched from one topic to another, almost as if he could not get his thoughts out fast enough. His attention span is often short unless he is engaged in a topic that he is specifically interested in, namely the vigilantly known as Batman. This is mostly due to the patient’s obviously high intellect; he finds it frustrating not to have any stimulation for his mind which then results in boredom and ultimately violence.
Any attempt to discern the patient’s true identity has been meet with fanciful stories, none of which are remotely plausible, and have resulted in the patient becoming angry and violent towards himself and members of staff (see attached Arkham Case File).

Whilst in this “high” state of mania the patient has often been observed to be irritable, angry and have false or inflated ideas about his position or importance in the world. The patient then becomes very elated, and full of grand schemes that shows no regard for any human life, including his own (see police transcript 20FF78).
However it must be understood that this is not a conclusive diagnosis as it has been extremely difficult to analyze the patient due to his violent and disturbing behavior shown towards staff, himself and generally anyone he comes into contact with. Such behavior has led to the patient having to be heavily sedated so as not to cause a threat staff or other patients, this in itself does not help with drying to discern the patient’s deeper psychological problems. The patient has yet to show any of the “low” mood characteristics associated with Bipolar disorder such as; lack of energy, with slowed thinking and movements, feelings of hopelessness, helplessness, sadness, worthlessness, guilt or thoughts of suicide. This could foreshadow that the patient has a complete lack of empathy, neither caring for those around him or even himself.

In review of the diagnosis of schizophrenia and Bipolar Disorder we chose to send the patients case file to Professor Leopold a professor of psychology at Gotham University and Dr. Kinsley, a leading psychiatrist who specialises in the criminally insane. Professor Leopold made the suggestion that the patient could be suffering from Schizoaffective disorder. Schizoaffective disorder is a controversial diagnosis because the symptoms often seem similar to either schizophrenia or manic depression. Some clinicians do not believe there are sufficient differences to justify a separate diagnosis.

The diagnosis is given to someone who experiences symptoms of both a serious mood disorder and schizophrenia at the same time, or within days of each other. Generally, two subtypes of the disorders are recognised: bipolar a schizoaffective, manic or mixed type, also called schizomania and unipolar a schizoaffective, depressed type.

Schizoaffective disorder is characterised by the presence of both of the following:

A serious mood disorder: This may be either bipolar, characterised by extreme swings from depression to elation, or unipolar depression, characterised by a consistently low mood, loss of appetite, sleep disturbance, loss of energy and concentration, despair and/or thoughts of suicide. As confirmed in previous assessment by myself, Professor Leopold also confirmed with my own previous assessment that the patient has yet to show any characteristics of unipolar depression or “lows” compared to the extreme “highs” that have been witnessed. This gives rise to the assumption that the patient has so far been able to curb the flow of thoughts from his mind and will find it increasingly difficult to switch off. The fact that he is suffering from chronic insomnia does not bode well for his health as his brain is never truly at rest, which could lead to heart complications and other stress related illnesses.

Psychotic symptoms: These are similar to those experienced in schizophrenia – such as perceptual disturbances, hallucinations and disordered thinking such as delusions - holding unusual beliefs that suggest a person may be out of touch with reality. Professor Leopold also confirmed that it was impossible to tell at this stage if the patient was suffering from any hallucinations or perceptual disturbances, due to him being so difficult to analyse. It is almost as if his personality shifts to suit his mood, surroundings or people he comes into contact with.

After reviewing the patients case files but having no face to face consultations with the patient, Dr. Kinsley made the suggestion that the patient could also be suffering from Dissociative disorder and more specifically Dissociative amnesia. Dissociative disorders are so-called because they are marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness such as one's personal identity, one's personal history, etc… All of the dissociative disorders are thought to stem from trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience too traumatic to integrate with his conscious self. Dr. Kinsley concludes that this could be the reason why the patient appears unable to answers any questions about his past and personal circumstances, which are often met with hostility, violence and lies.

More specifically Dissociative amnesia is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative amnesia, unlike other types of amnesia, does not result from other medical trauma for example a blow to the head. Dissociative amnesia has several subtypes:

Localized amnesia is present in an individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia.

Selective amnesia happens when a person can recall only small parts of events that took place in a defined period of time. For example, an abuse victim may recall only some parts of the series of events around the abuse.

Generalized amnesia is diagnosed when a person's amnesia encompasses his or her entire life.

Systematized amnesia is characterized by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member.

Dr. Kinsley expressed a keen interest in coming to Arkham to work with the patient and give a more conclusive evaluation but unfortunately further access to the patient in an unmediated state will not be sanctioned at this point as it is deemed to greater risk to both the patient and staff members. After various savage and unprovoked attacks on the patient was placed in a straitjacket, as is procedure, and confined to his cell were he will often screamed for hours on end, smash his head into the floor and try to bite holes in the walls. In response to this we have felt it necessary to place the patient on a course of shock therapy.
A more conclusive evaluation will hopefully be preformed in the coming weeks.

See attached form on patient’s medication, dosage and administrative conditions.

Dr. Jeremiah Arkham
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Down the Rabbit Hole