HUGO - Chapter 2

Josie

This has just been one long, incredibly frustrating day. Murphy’s Law strikes again—everything that can go wrong, will go wrong. Wednesdays through Fridays are usually dedicated to research and teaching, but today I got preoccupied with my clinical work. I’m worried about one of my long-term patients. I’m afraid he’s slipping into a new psychotic episode, so I spent over two hours this morning consulting with the psychiatrist and nurse practitioner at our clinic. We discussed potential changes to his treatment plan and even considered adjusting his medication. The problem is, Franklin has never been the most reliable when it comes to taking his meds or showing up for appointments. It’s been a struggle to find the right combination of antipsychotics and therapy that works for him, and we’re all hesitant to make any major changes now. But if Franklin is truly on the brink of a relapse, we might not have a choice. I’ll talk with him about the options on Monday, but I’m not optimistic—he’s likely going to be resistant to any changes. And that was just my first issue of the day!

I’ve been working on a grant proposal to fund a large new research project, but my colleague, Dr. Dorothy McDermott, is going out of her way to undermine me. She has been sending me the wrong information about deadlines and grant requirements, keeps badmouthing me to Peter, our department head, and she has even been trying to influence the grant committee who has to review all of the applications. All in very subtle ways, of course, so I can’t really call her out on anything directly. It’s becoming increasingly annoying.

The reason behind her behavior isn’t hard to figure out. A tenured position will be opening up in our department at the end of the year, and Dorothy and I are both vying for it. She knows that if I secure this grant, I’ll be in a stronger position for the role—especially since her last two proposals were rejected and she’s running low on graduate students. I, on the other hand, have no such concerns. I currently have eight graduate students under my supervision, more than anyone else in the department, and fortunately, most of their projects are progressing well. Although one of my graduate students, Nia, has been underperforming lately, so I make a mental note to schedule a meeting with her to discuss it.

On top of it all, I suspect one of my college students has been plagiarizing his master’s thesis. I was reading it right before I came here today and it looked a little too familiar to me, but I have to look into it more closely before I can be sure.

However, right now I have a more pleasant task ahead of me. This undergraduate class about psychosis is one of my favorite courses to teach. I know that some of my colleagues hate their teaching obligations, because it takes so much time away from their research, but personally I don’t mind it at all. I’ve always enjoyed teaching. I love my job, and what’s more fun to be paid to talk about something you love?

‘Good afternoon, everybody,’ I greet my students brightly as soon as I walk in.

I’m met with a couple of lukewarm mumbled greetings from the students in the front rows. The students who are still standing quickly make their way to their seats while I start up my presentation. When I’m ready to begin, I look up at my audience. I notice a few students are still looking at their phones and starting up their laptops. My eyes linger for a second on a mountain of a man, who is doing neither of those things. His hands are folded on the desk in front of him and he’s leaning slightly forward. His eyes are focused on the screen behind me, and he seems to read the information there with great interest.

I don’t remember seeing him in class last week, even though he’d be pretty hard to overlook. Not just because of his size, but also because he doesn’t seem to fit the usual demographic of my students. This man is a little older and a little overdressed, in his well-fitting navy blue dress shirt. I wonder if he’s an actual student, or perhaps some sort of education inspector doing an unannounced assessment of my teaching skills. That makes sense, I realize, if they’re already gathering information to decide who gets the tenured position at my department. If that’s the case, then let him inspect away. I’m good at what I do and my classes have consistently been receiving high evaluations since I moved here two years ago, so I’m not worried about it.

‘I know that you all have a deep and loving connection with your phones, so let’s try to conduct an experiment together. Perhaps we can let absence make your hearts grow fonder by focusing on me for the next two hours,’ I open with a joke to catch the attention of the last few students who are still on their phones.

I hear a couple of chuckles, but most of the students indeed put their phones away.

‘Today, we are discussing different psychotic profiles,’ I continue, pulling up my first slide. ‘Our diagnostic manual identifies a few different psychotic disorders, and they all come with their own specific set of symptoms and criteria. This is not the most interesting lecture of the course,’ I warn honestly, followed by an emphatic look through the hall, ‘but this information will be heavily featured on your exam. So let’s see if we can get through the afternoon together, shall we?’

Although I generally enjoy teaching this class, this particular lecture is one of my least favorites. I mostly spend the time describing the various diagnoses and explaining how they are distinguishable from one another, but I do my best to make it as engaging as possible. Thankfully, my students seem interested and actively engaged. They ask insightful questions, which I always take as a good sign, and they’re especially enthusiastic about the short videos I’ve included in the lecture. Over the years, I’ve recorded videos of patients with different diagnoses, all with their explicit permission, to share their personal experiences with my psychology students. I’ve found that the theoretical content comes to life much more effectively when students can see real examples from patients who have lived through these symptoms and diagnoses.

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‘Dr. Chastain? I still don’t really understand how schizophrenia and schizophreniform disorder are different from each other,’ one of my students asks with a frown. He flips through a pocket edition of the diagnostic manual in front of him. ‘They seem to list the exact same symptoms and criteria?’

‘That’s very perceptive of you. You’re absolutely right,’ I reply. I’m leaning against the desk, facing the students as I answer their final questions at the end of the lecture. ‘Schizophrenia and schizophreniform disorder have the same criteria, with just one real exception. Anyone?’

I glance around the room and raise my eyebrows expectantly, crossing my arms and my ankles. A few students look at each other hesitantly, but eventually one of them raises her hand.

‘It’s the duration, right?’ she asks, as if she is not completely sure.

‘Exactly,’ I nod approvingly, smiling at her. ‘Schizophrenia can only be diagnosed when symptoms have persisted for at least six months. Schizophreniform is diagnosed when symptoms last between one and six months. Schizophreniform disorder could be seen as a precursor for schizophrenia. You can remember it as schizophrenia-light, if you will. But only for your exams, of course,’ I add with a wink. ‘Our medical system does not acknowledge this as an actual diagnosis.’

I’m rewarded with a few chuckles from my audience.

‘So, schizophreniform disorder can turn into schizophrenia?’ the student who posed the initial question asks to be sure.

‘After the six month threshold of persistent symptoms has been reached, yes,’ I confirm.

‘But what do these diagnoses mean treatment-wise? All these diagnoses are different, but there’s also a lot of overlap when it comes to the symptoms they list,’ another girl says with a wrinkle in her forehead. ‘I mean, people with these diagnoses still all suffer from psychosis, right? So how do the specific diagnoses affect how you treat these patients?’

‘Only to a certain extent,’ I admit. ‘There are treatment guidelines, but even when you see ten people in a row who are diagnosed with, for example, schizophrenia, they can still all present with vastly different symptoms. In the end, you always treat the individual patient, and not their diagnosis.’

The student posing the question nods at me satisfied, as if that was exactly what she wanted to hear. I hold back a smile. I always enjoy questions from critical thinkers. I try to encourage it in any way I can.

‘We’re going to discuss the different ways of treating psychosis during the second half of this course. So, we’ll get into that in much more detail later,’ I promise. ‘Are there any more questions about today’s lecture?’

I glance around the hall, but most of the students are either shaking their heads or staring blankly at me. Then, the tall newcomer in the back hesitantly raises his hand.

‘Yes?’ I look at him inquisitively.

‘I was wondering how people can become psychotic? Like, what causes them to have a psychosis in the first place?’ the man asks me. I notice that he has a deep and pleasant voice, but that doesn’t make his question any more relevant to this specific lecture.

‘That’s a very good and interesting question,’ I say, ‘but the onset of psychosis was already discussed last week, during the first lecture of this class. I’ve uploaded my presentation from last week to the digital course platform, so I recommend you review those slides and then reach out if any further questions remain unanswered.’

I stand up, scanning the room as I give a final nod toward my students. ‘That’s it for today, everyone. In the next two lectures, we’ll take a deep dive into the different symptoms of psychosis and how they can present clinically. And I promise, by the time I’m finished, all of you will have experienced a hallucination yourself,’ I add with a mischievous smirk.

‘Are you bringing LSD or shrooms, professor?’ one of the students yells jokingly.

‘Come to class and find out,’ I laugh, wiggling my eyebrows at him, which causes another round of laughter. ‘I’ll see you all next week!’

It’s actually a perfectly safe visual hallucination, induced by a strobe video, but now they have something to speculate on until my next lecture. I turn around and start gathering my things, hearing the low hum of students chatting as they file out of the classroom. Several mumble a quick greeting as they pass, and I offer them a friendly nod and smile in return. But then one person stops in front of me.

‘Excuse me, Dr. Chastain?’

I glance up to see the older man from before standing there. Or older… I’m guessing we’re probably about the same age, but my students likely consider anyone over thirty to be ancient. Up close, the man looks even bigger. At six feet tall, I’m not used to looking up to people, but this giant of a man is definitely towering over me. He has a full head of short, black hair and stormy gray eyes that exude a serious and observant expression.

‘What can I do for you, mister…?’

‘Just Hugo,’ he says, extending his hand.

I stand up straight and shake it briefly. ‘What can I do for you, Hugo?’

‘I wanted to apologize for asking you the question. I only just joined your class today, and I didn’t know the cause of psychosis was already discussed in an earlier lecture,’ he says apologetically.

‘You should never apologize for asking a question,’ I say sternly. ‘That’s what education is for. Just look through the slides of last week's lecture first. I think that most of the information you seek will be in there. You can access them through the university’s online platform where you’re registered for this course. And if you still have questions after reviewing them, just come see me after class next week, okay?’

‘Right…’ Hugo puts his hands in his pockets and glances at me hesitantly.

‘Is there a problem?’ I ask, frowning.

‘No, not at all,’ Hugo replies quickly, though he seems a bit nervous. ‘I, uh… I’m just new at this university. I don’t have access to the online platform yet. Is there another way I could get those slides?’

I shut down the computer and toss my bag over my shoulder, ready for this day to be over. I’m looking forward to plopping down on my couch with a glass of wine.

‘Sure,’ I sigh, but then smile at him. ‘Either email me, and I’ll send them to you, or just drop by my office on the second floor of this building tomorrow with a USB drive. I’ll be reviewing my grad students’ papers there all day.’