THE CASE OF ITSUKI
Itsuki Daishi was a 23-year-old engineering student from Japan who was referred to his
university student mental health clinic by a professor who had become concerned about
his irregular class attendance. When they had met to discuss his declining performance,
Mr. Daishi had volunteered to the professor that he was distracted by the “listening
devices” and “thought control machines” that had been placed in his apartment.
While initially wary of talking to the psychiatrist, Mr. Daishi indicated that he was
relieved to finally get a chance to talk in a room that had not yet been bugged. He said
that his problems began 3 months earlier, after he returned from a visit to Japan. He
said his first indication of trouble was when a classmate sneezed and grinned at him in
an odd way. Later that same week, he noticed two strangers lurking suspiciously outside
his apartment.
Mr. Daishi decided that those lurking strangers had installed tiny mind-control devices
throughout his apartment, devices that were intended to weaken his resolve and prepare
him for an onslaught of misinformation from Fox News reporters who intended to
convert him into being a follower of Donald Trump. After weakening his resolve, Mr.
Daishi found himself only able to watch Fox News, and he then found that those
television reporters began to relentlessly comment indirectly and critically about him.
He soon came to the conclusion that they had targeted him because of his “superior
intelligence” and because he would soon become the prime minister of Japan. He
concluded that the Trump Republicans wanted an ally in Tokyo. Mr. Daishi indicated
that he was trying to stay strong, but it was difficult to keep the reporters from putting
ideas into his head.
Mr. Daishi reported that he became increasingly vigilant, fearing that everyone at school
and in his apartment complex was “in on the plot.” He slept little, became withdrawn,
and stopped attending classes, but he did continue to eat and maintain his personal
hygiene.
He denied feeling elated or euphoric. He described his level of energy as “okay” and his
thinking as clear “except when they try to put ideas into my head.” He admitted to
feeling extremely fearful for several hours on one occasion during his recent trip to
Japan. At that time, he had smoked “a lot of pot” and began hearing strange sounds and
believing that his friends were laughing at him. He denied any cannabis consumption
since his return to the United States and denied ever having experimented with any
other substances, saying that he generally would not even drink alcohol. He denied all
other history of auditory or visual hallucinations.
When Mr. Daishi’s uncle, listed as his local guardian, was contacted, he described his
nephew as a healthy, intelligent, and somewhat shy boy without any prior history of any
major psychiatric illness. He described Mr. Daishi’s parents as very loving and
supportive, although his father “might be a little stern.” There was no family history of
any major mental illness.
On examination, Mr. Daishi was well groomed and cooperative, with normal
psychomotor activity. His speech was coherent and goal directed. He described his mood
as “afraid.” The range and mobility of his affective expression were normal. He denied
any ideas of guilt, suicide, or worthlessness. He was convinced that he was being
continuously monitored and that there were “mind control” devices in his apartment. He
denied hallucinations. His cognitive functions were generally within normal limits. He
appeared to have no insight into his beliefs.
On investigation, Mr. Daishi’s laboratory test results were normal, his head computed
tomography scan was unremarkable, and his urine drug screen was negative for any
substances of abuse.
