◆ SpookStack

. : promptly instituted. _ ETIOLOGY Not fully determined. The stress of ‘the patient's recent life situation is undoubtedly an important factor. Other contributing factors, including organic brain disease chronic or acute, should be explored. PROGNOSIS For the present acute psychotic reaction, fair, if proper treatment is RECOMMENDATION . Immediate psychiatric hospitalization, study, and treatment, Close observation. Suicidal-precautions. ‘ DISCUSSION The possibility that the patient is malingering, or feigning mental fliness, was carefully.considered. In my opinion this is not true of this individua! at this time. First, I doubt that someone unfamiliar with teehnical psychiatry could play the part of a paranoid delusional psychotic person with such accuracy, consistency, ‘and typical detail. Second, it places Mr. Ruby at cross purposes with his attorneys, who have repeatedly encouraged him to believe that he-has an excellent chance for successful appeal and that at a new trial he would ‘not _ only be saved from the death penalty but that a much more sympathetic under - standing of him would emerge. Third, I don't believe he wants tq go to a mental ‘hospital at. all, degpite his attorneys' belief that he should; he actually prefers the jail, where he says “they know me"; that this is inconsistent with his fears of murderous police is itself characteristic of his delusional state.- Finally, he violently rejects the idea that he is mentally il] now, or that he is suffering from ‘abnormal thoughts and feelings; the true malingerer usually grasps eagerly at such an explanation. . The unexpected discovery that this individual has developed ‘an acute paychotic reaction naturally requires. me to postpone consideration of the speciai xe aes ches