Case Study in Alienism: Subject No. 1 – “P”
By Delphine Mercier, Alienist in Training
"The human mind is a fragile machine, prone to fits of violence and poetry, and always at risk of turning inward on itself. In the case of Subject P, I have encountered both the violence and the poetry—and I do not know which frightens me more."
Patient: Male, approximate age 26
Occupation: Laborer
Status: Ongoing outpatient observation
Location: Personal referral; subject approached voluntarily
Initial Presentation
Subject "P" arrived of his own accord. This fact alone sets him apart from many patients I have observed in recent years, who are usually referred by clergy, constables, or kin. There was no coercion. No outburst. He claimed he "wished to understand himself better," and believed I might offer clarity. He is a man of few academic experiences, lacking formal schooling, but he speaks clearly, even eloquently at times, and with more self-awareness than most of his station.
He presents as physically healthy, hardened by manual labor, though there is a tension in his posture, a coiled readiness that never seems to abate. Even seated, he watches the door. I would describe him as a man who looks like he might run—but in truth, I believe he is always preparing to strike.
Session Observations
Session 1:
P spoke openly of his childhood: parents now deceased, siblings distant, former lovers estranged. He spoke of loneliness without sentimentality. When I inquired about early sources of joy, he recalled drawing as a child—animals, figures, faces. I suggested we resume this activity as part of his therapy, to redirect his outbursts into a medium of expression. He agreed without resistance, and even seemed eager.
He treated me with respect throughout—never deferential, but earnest. He does not extend this courtesy to others, as I later learned.
Session 2:
He returned with several drawings. Each was filled with kinetic energy, some beautifully rendered, others more frantic. One showed a hand around a throat—not the moment of murder, but the tension just before. Another depicted a man holding his own head in his hands, weeping.
He confessed that the acts he commits—fights, injuries, destruction—come without warning. He claimed to feel remorse afterward, even grief. But he also said, plainly, "It never stops me the next time."
I attempted light physical redirection (a comforting touch to the shoulder). He neither recoiled nor responded. It was as though my presence was real to him, but my body was not.
Session 3:
I asked directly: "Do you regret hurting others?"
He smiled, but there was no pleasure in it. “I hurt them,” he said, “so I won’t hurt you.”
I did not know how to respond. I still don’t.
Session 4:
I encountered P outside the city walls, purely by chance. He greeted me with the same calm composure, asked if I was "sleeping well." The question felt misplaced, too intimate, though not overtly inappropriate.
What followed was less ambiguous: he warned me not to share what he had told me, not with the constabulary, not with clergy. “If you do,” he said, “I’ll bring the world down on you. But I won’t enjoy it.”
He looked genuinely sorry to say it. That, somehow, was worse.
Session 5: (Ongoing)
Incomplete. Notes deferred.
Provisional Assessment
Subject P displays traits consistent with a choleric imbalance, accompanied by impulse disinhibition and latent sadistic impulses. His affect does not match clinical definitions of psychosis—he does not hallucinate, nor does he express delusional beliefs. He is not insane, at least not in the legal or spiritual sense. He simply cannot—or will not—cease his destructive behavior.
He exhibits a kind of internal coherence. He understands the nature of his actions and even articulates his guilt, yet he remains untethered to the consequences. There may be a trauma buried in early life, but he denies any direct abuse. He speaks with a curious blend of fatalism and restraint, as if violence is both his curse and his ward.
Clinical Note
I attempt to maintain distance. I write down everything he says. I review the patterns. I build a profile. This is what I am training to do.
But there is something about him that resists reduction.
He does not haunt me like a ghost. He clings to the edges of my waking mind. When I sleep, I find myself searching for him in crowds, wondering if he is behind me when I pass windows. I fear he is becoming a permanent resident in my thoughts.
I do not believe he will harm me. I believe he is trying not to. That may be the most frightening detail of all.
“There is nothing unnatural about him. That is the horror.”