Psychology Consultation:

Patient is a 24 year old female of Rohirric descent. Pt admitted to Houses of Healing on March 15, 3019, transferred by foot from the fields of Pelennor, where she sustained a left radial/ulnar fracture. She initially presented as unconscious and unresponsive, with poor respiratory effort. Saturation levels improved quickly to within normal limits and pt aroused to administration of a tincture of athelas. Pt currently presents with symptoms of sustained depressed mood and low frustration tolerance. Consultation requested to assess for possible mood disorder and make recommendations for treatment.

Behavioral observations:

Pt was alert and oriented to person, place, time and purpose. Mood was irritable, with a restricted range and poor regulation of affect. Thought processes were generally clear and logical, though assessment was restricted by the premature termination of the interview. Verbalizations were notable for disinhibited and provocative content. Energy level appeared good, if the force and accuracy of the thrown chamberpot can be judged to be a valid indicator of her physical condition.

Relevant history:

History was obtained from the medical record and staff of the Houses of Healing secondary to pt's lack of cooperation. Of note, pt's elder brother has recently departed for the Black Gates of Mordor and her maternal uncle was recently deceased in the military action in which she sustained her injuries and so were not available for interview.

Pt is the younger of a sibship of two, with a brother the elder by 4 years. Family history notable for repeated traumatic losses and possible history of depression with passive suicidal ideation, if not intent. Father deceased in 3002 secondary to injuries sustained when ambushed by orcs, having pursued them "in hot anger, unwarily and with few men." Mother deceased soon after, of unknown causes. Most recently, pt's maternal uncle reported to have exhibited symptoms of a lengthy depressive episode, apparently in remission at the time of his death, including a chronic amotivational state, low energy level, low responsiveness, irritability, social withdrawal, and chronically poor hygiene. Pt's occupation given as dry nursemaid and Shieldmaiden, of unknown duration. Education level attainment high relative to age and cultural cohorts.

Per the medical record, pt reported to have engaged in subterfuge allowing her to ride with the Rohirrim into war against the expressed wishes of her guardian and with the intent of seeking death. Pt's behavior strongly suggestive of passive suicidal intent, with a plan of extreme lethality, upon which she has acted with some success.  Pt noted to exhibit other symptoms of a depressive episode such as chronic dysphoric mood for more than 2 weeks, irritability/poor frustration tolerance, low self-esteem, feelings of hopelessness/helplessness, anhedonia and a preoccupation with death.

Collateral interview performed with Lord Faramir, acting Steward of Gondor. Please refer to the transcript below for its content.

[[begin recording]]

Examiner: Hi, thank you for agreeing to see me. I'm afraid, of those left in the city, you know her the best. It would be helpful if I could ask you a few questions.

Faramir: Any I can answer that may help her.

Examiner: To start off with, how did you come to meet Lady Eowyn?

Faramir: Soon after the Captains left the City she was brought to me by the Warden. The hours of waiting seemed difficult for her and she chafed at the restriction to her bed.

Examiner: How did she seem to you, then?

Faramir: Lovely.

Examiner: Uhm… I think I was wondering a bit more about how her mood was at the time.

Faramir: Oh. Of course. Ah. I do believe she appeared somewhat despondent. Though, it would certainly be understandable.

Examiner: What was it that she was doing that made you know that, that she was despondent?

Faramir: She said that she envied those who had found death in battle and well, you see, I had lost my own mother when I was 5 or 6 years of age, quite young, and the lady seemed both sad and fair. Reminded me of her, I suppose.

Examiner: Your mother.

Faramir: Who?

Examiner: I'm sorry, the lady reminds you of your mother?

Faramir: Yes. In fact, I sent for a mantle that I remember her wearing, my mother, that is, and I think I shall give it to the Lady Eowyn.

Examiner: Ah.

[[Scribbling is heard in the background. Later review of the clinical file revealed the following note, "Pt's paramour lost his mother, father remains, at key point in his psychosocial development - pt attracts men with unresolved Oedipal issues? "]]

Faramir: And I could certainly understand her sadness. I had just lost my own father. One minute he was there, haranguing at me for being a wizard's pupil and not a proper son to his father or captain to his lord and the next he is lost to the Houses of Silence.

Examiner: I'm so sorry to hear that. I'm sure you miss him.

[[Scribbling is heard. Note from the clinical file: "Father now deceased, re-emergence of Oedipal issue, only now, pt's paramour wins and achieves the mother-object now that father is "out of the way"? Impact on pt's self-esteem to be mere mother-substitute in paramour's repetition-compulsion of acting out inability to 'make mother happy' enough to 'stay' with him?"]]

Faramir: Indeed I do. Though, it is no secret he preferred Boromir.

[[Scribbling stops]]

Examiner: Boromir?

Faramir: Yes, my elder brother, ever my protector and cherished by my father and the people of Gondor.

[[silence]]

Examiner: And, I take it he's, uhm. . .

Faramir: Dead?

Examiner: Dead, yes.

Faramir: Yes. All that came home of him was the Horn of Gondor that washed ashore.

Examiner: I'm so sorry.

Faramir: And even that was cloven in twain.

Examiner: You look. . . sad. . . when you say that.

[[Sound of sniffling and rustling of cloth.]]

Faramir: I told myself I wouldn't cry.

Examiner: That's okay. Here.

[[silence in which more rustling is heard and then the sound of a nose being blown.]]

Faramir: Do you have a bucket for waste?

Examiner: Uh. . . yeah. . . Here's one.

[lengthy sigh and then more silence]]

Faramir: I think I would grieve less if my father's end had not come in despair. And fire! Why fire? Such a painful end. I cannot think what it must have been like for him.

Examiner: How awful! That must be such a burden for you, to think he suffered in the end.

Faramir: Yes! And to have chosen it! Ah, father.

[[silence]]

Examiner: It's hard to make peace with something like that.

Faramir: Indeed! I hardly know what to think. My father was a good man and served Gondor to the best of his abilities for many years. We had our disagreements, that is sure, but he loved me as best he could. To think that he shall be known for his last moment of despair and that he would have taken me with him had it not been for the perian!

[[silence]]

Examiner: I'm sorry. What did you say? Wait, let's go back to that.

Faramir: What?

Examiner: Uhm. Back to what you were saying about your father.

Faramir: Which part?

[[silence]]

Examiner: Uhm. . . never mind. I think that's enough to give me a pretty good idea of what I need to know. I'm sorry the interview brought up some painful memories for you and I do appreciate your willingness to help.

Faramir: Do not worry yourself over it. It is nothing to me if it can help the lady. I would see her happy, if I could.

[[sound of scraping of a chair and footsteps]]

Examiner: Of course. Thank you, again.

Faramir: You are welcome. Please let me know if there is anything else I can do.

[[sound of door closing, silence, and then creak of chair]]

[Muttered voice of the examiner]: How do these people find each other?

[[end recording]]

Impressions:

Pt exhibits symptoms consistent with the exacerbation of a long-standing subclinical mood disorder. She currently meets criteria for a Major Depressive Disorder – Moderate Severity. Positive for passive suicidal ideation and intent, upon which she has a history of acting with high lethality. Pt continues to be at high risk.

Recommendations:

Please institute precautions according to suicide prevention protocol, including restriction of access to strings, sharp objects, swords, razors, ropes, lords of the nazgul, and angst-ridden men who enjoy taking walks along walls of lethal height.

Thank you for this most interesting consult.