“I don’t know.”

Dr. Brace sat in silence, an attempt to intimidate me into saying more. I stared at the exposed parts of the floor, counting the tiles. Thirty-two.

The clock on the wall ticked, drawing my attention like a baby crying out for its mother.

“I’m going to prescribe you an antidepressant, something to make you feel a little better.”

It wasn’t a suggestion. This strange man, whom I had just met, knew what was best for me.

“And let’s set up an appointment for you with a psychologist.”

mental status examination

Grace on a one-to-one presented as a somewhat seductively dressed 18-year-old. Her affect was clearly anxious. Her mood, she described as depressed. When symptoms of depression are reviewed, indeed she describes significant mixed insomnia, tendency to be withdrawn and show little interest. She has significant feelings of tiredness and low energy. She feels that her concentration is poor and she is unable to relax, with excessive worrying or nervousness. She describes classic anxiety symptoms of a panic type with panic attacks occurring approximately once or twice a week. She has been prescribed Ativan to be taken on a permanent basis.

Client did spend a period of time partying when she came to university (i.e. drinking alcohol). She drinks a lot and has not moderated this by her own report. She smokes marijuana daily. She has done so for the last couple of years.

Client denies suicidal ideation or intent. She does, however, cut herself and has done so over the past four or five months. These are relatively superficial and I examined some superficial scarring on her forearms today. She claims she doesn’t know why she does this.

diagnostic formulation
Axis 1 (Major Mental Illness):

1. Generalized anxiety disorder
2. Major depressive episodes

Axis 2 (Personality Features):
Significant borderline tendencies.

Chapter 21

Whenever my siblings and I misbehaved, my parents would threaten to lock us in “the ratty closet.”

The closet in my and Annabelle’s bedroom was connected to the attic. It had a sanded-down brown door with an iron latch that secured from the outside. It wasn’t used for anything other than the storage of old toys we had outgrown, and my mother’s sculpting tools. I had never been inside—I’d never even opened it—but I imagined it was inhabited by hideous monsters.

I’d bar the closet before bed, pushing our toy kitchenette against it, and lie awake listening to the sounds of nails scratching and scuttling along the floor above.

One night, after listening to the scratching for hours, I heard a thump and the weight of something shifting, falling, dragging its claws against the walls.

After a few moments of silence, it began pushing against the door. The plastic kitchenette squeaked as the latch creaked. I rose from my bed, moving toward the closet. Annabelle was still sleeping soundly, her soft breathing steady. I knew I had to protect her. I had to kill whatever was in there.

I grabbed a toy pot, my fingertips pulsating. I slid the kitchenette aside as the noise continued. Scratching, thumping, the closet door shifting. I inhaled deeply, my lungs filling, and held on to my breath as I reached for the latch, unhooking it slowly.