Attn: Kuroda Mental Clinic
Going straight to the point, it is assumed that this is an acute case of
post-traumatic stress disorder. The patient is subject to tremendous stress following her parents' sudden divorce and being subjected to choose to live with one or the other.
Furthermore, the patient firmly believes that she herself was responsible for her parents' divorce, which further promotes her state of self-mutilation. The patient's largest shock stems from sense of betrayal from her own household which she believed was an absolute safe haven. Henceforth, there is a high possibility that the patient will observe psychological defense measures to protect her family.
(For example, she may feel high disdain for any person of the opposite sex approaching her father. She might feel uncomfortable in having other people in her home. Or, she may conduct absurd behavior in order to keep people away from her home. There have been reported cases where a patient would unconsciously bring and pile garbage for the latter example.)
It is highly important that the patient hold daily household communication with her father. By deepening the communication between the patient and her father, it will strengthen their family bond and loosen up her anxiety.
Since the patient only shows signs of acute syndrome in this case, there is a very good chance that she will immediately recover within three months with her father's support and proper medication.
However, it is not uncommon for a patient who seemed to have recovered to have a sudden reoccurrence (flashback) even after ten years.
The father is still young, and there is still a chance for him to re-marry. But, the prospect of her father re-marrying may cause the patient to have sudden flashbacks of her turmoil. This may instigate psychological defense behaviors along with elevated stimuli.
Please explain this part very thoroughly with the father in order to maintain the recovery process and mental care of the patient. Should the father have decided to undergo a second marriage, it is recommended at the minimum that he should hold off in telling the patient until she has reached the capable age of living independently.
Also, the patient's psychosomatic self-mutilation behavior, more commonly known as
delusional parasitosis seems to have its own attributes to
culture-bound syndrome.
The patient seems to observe the superstitious curse from her home village, which she strongly believes that this was the cause of her parents' divorce. This is thought to be a part of her subconscious defense mechanism, where the mind tries to shove her self-proclaimed fault to her village curse in order to reduce her psychological pain.
If such a strong belief can induce such symptoms such as self-mutilation, then there might be cases similar to these recorded previously. Perhaps prior medical files that document similar
culture-bound syndromes may be available at a large medical institution near her local area. It will then be possible to provide better and accurate mental care for the patient by obtaining these case files.
*These B5-sized letters were written on the back of the paper used for writing memos.
The blank side of these letters were written with the following memo:
1 Chuuka-don (Chop Suey Bowl), 3 Shanghai-style Gomoku Yakisoba (Chow Mein), 1 large Cha-han (fried rice)