Episode 23 — Chapter 27
In my professional judgment, this patient is suffering from paranoid schizophrenia with delusions of grandeur combined with an extraordinarily rare time displacement syndrome. His delusion is impervious to external, irrefutable, contrary evidence. He believes that his enemies have created some elaborate fantasy world to keep him confined for their own nefarious purposes.
The patient’s delusion is classic grandiosity. He believes himself to be one of the greatest baseball players of all time. He expects everyone he meets to recognize him. He claims to have performed the lead role in a stage play over a century ago. The delusion is undoubtedly a consequence of severe frontal lobe injury sustained in a near-fatal hit-and-run accident.
I believe it would be unsafe for the patient to be released at this time. He has no money, no known home, no known next-of-kin, no known vocational experience. His only claim of an occupation is as a famous deceased baseball player. Patient exhibits anger, anxiety, paranoia, temper and depression. I believe he poses an immediate danger to himself and others if he is not committed. If he were released, it is my professional judgment that he would be unable to care for his own health and safety, which would lead, more likely than not, to an imminent life-threatening crisis.
After completing the first draft of his supporting declaration, Dr. Cantril downloaded the Petition for Commitment Order from the Georgia Mental Health website and began filling in the details and checking appropriate boxes. For delusional patients, the form indicated that the MacArthur-Maudsley Delusions Assessment Schedule had to be completed and submitted. He located the schedule online and scanned through it. There were seven dimensions that had to be assessed. During the next thirty minutes, he went through the form. It was clear that for a commitment order, a high score on the “action” and “negative affect” dimensions was important; there needed to be a substantial risk that the patient would act on his delusions and act violently. Although Mr. Cobb had not exhibited any overtly violent behavior, Dr. Cantril reasoned that it was more likely than not that the patient might react aggressively or even violently if released into the general public.
Dr. Cantril spent the next hour editing his declaration and insuring that every question had been answered and every box checked on the submission forms. He then printed out the documents and signed his declaration. Minutes later, he delivered the file to the Legal Department, instructing the receptionist that the matter was urgent and needed to be processed before the patient was released.
Savannah booked a room at the Hilton for two nights before postponing her return trip to St. Louis. In her hotel room later that evening, she spent several hours researching Cobb online—the amount of material regarding him was staggering. Most articles painted Cobb as a racist with a trigger temper, who played dirty on the diamond and used every trick in the book to gain an advantage. A portrait emerged of a paranoid, psychotic perfectionist, who made enemies everywhere he went. But he was also universally acknowledged as the greatest player of the dead-ball era.
Savannah fixated on the photographs. She accessed archival pages from the Detroit Free Press, which contained frequent photographs and sketches of Cobb. He seemed to be in the news nearly every day during the baseball season. The likeness was uncanny; there was little doubt that the patient was a dead-ringer for Cobb. But she needed more in her article than just a physical similarity.
Savannah needed to conduct an actual interview!