Shape of Snakes

Psychiatric report on

Mrs. M. Ranelagh-dated 1979

Queen Victoria Hospital

Hong Kong

Dept. of Psychiatry

A consultation was requested for Mrs. M. Ranelagh of 12 Greenhough Lane, Pokfulam, Hong Kong, by her general practitioner, Dr. J. Tang, querying postpartum depression after the birth of her son, Luke (DOB 20.10.79). According to her husband, she has been suffering from depression for some time. She refuses all medication. Mrs. Ranelagh had a two-hour consultation with Dr. Joseph Elias on December 19, 1979.

(The following extracts are taken from Dr. Elias's report, which was released to Mrs. Ranelagh in February 1999.)

...Mrs. Ranelagh was a difficult patient. She insisted on making it clear from the outset that her only reason for attending was to prove once and for all that she wasn't suffering from depression. She was uncooperative and angry. She expressed considerable hostility toward "men in authority" and "people who throw their weight about," and referred to "coercion," "bullying" and "intimidation" on a number of occasions. When I suggested to her that, far from persuading me to give her a clean bill of health, such statements were leading me to question the existence of a paranoid disorder, she agreed to cooperate.

...She admits to feelings of emotional turmoil following various events that happened at the end of last year and the beginning of this in London. She refused to discuss these in any detail for fear of confirming my suspicion of paranoia, however, she touched on three-two of a highly personal nature-to explain her "anger." She produced a number of newspaper clippings as evidence that the first incident had occurred-the death of a black woman-but was unable to support her other allegations. Without independent confirmation, I cannot say whether the subsequent incidents a) happened or b) are a construct to validate her sense of injustice re the black woman's death.

...The main focuses of her resentment are her husband (resident with her in Hong Kong) and mother (resident in England), whom, for various reasons, she feels betrayed her. This has resulted in a "coldness" toward them, which she "needs time to overcome." She describes her pregnancy as "ill-conceived"-(pun intentional?)-pointing to the difficulties of starting a new life abroad while carrying a baby to term. She talks lovingly about the child, calling it "my baby," while blaming her husband for "exposing her to an unplanned pregnancy." She retains a close bond with her father (resident in England), whom she contacts regularly by telephone and who is her only confidant. In addition, she listed a number of related problems: a dislike of being touched; feelings of insecurity when alone in her house; an obsession with hygiene; dislike of certain sounds-i.e. doorbells, London accents, rats scratching(?).

...I advised her against forging alliances-particularly with her father, who is "conducting some research" for her-which her husband will almost certainly see as betrayal if he finds out. I also pointed to the potential danger of making an ally of her son as he matures. She concurred on both counts, but remains adamant that her marriage will end tomorrow if she forces another confrontation with her husband. This is not what she wants. She rejected my offer of a joint session with herself and Mr. Ranelagh, as she believes that neither of them would be able to talk honestly without causing the immediate separation referred to above. Her feelings for her husband are confused. She seems to retain a close bond with him despite her resentment and believes her decision earlier this year to stay in the marriage was the right one. Nevertheless she is intent on punishing him for sins of "omission and commission."

...Mrs. Ranelagh presents herself as an intelligent, self-aware woman who is trying to come to terms with some extremely unpleasant, and as yet unresolved, issues in her life. Once satisfied that she had persuaded me she was not a "depressive"-a view I encouraged-she talked at length about her intention to seek "closure," although she is clearly ambivalent about what sort of closure she wants. In simple terms, she prefers the more anodyne description of "justice" for her black friend to the rather more accurate one of "revenge" for herself.

...When I warned her that prolonged internalized anger, be it well-founded or capricious, could lead to the sort of paranoid disorder-persecutory, delusional, phobic-that she was so determined to dissociate herself from, she said the damage had already been done. "I'm between a rock and a hard place, Dr. Elias. I'm a coward if I give in and a neurotic bitch if I fight back."

...In conclusion, I can find no evidence of depression in this patient. She is obsessive and extremely manipulative, but is also well in command of herself. I found her rather frightening...