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PHILADELPHIA STATE HOSPITAL

Southhamptong Road & Roosevelt Boulevard

Philadelphia, Pennsylvania 19114

Group Therapy Progress Note

Members present: Lily XXXX, XXXX Keller, Sylar XXXX, and KaiXX XXXX

The four new members to the unit attended a group therapy session to orient them to th ehospital and provide a place for them to discuss what brought them to Byberry. Topics discusses included methods of earning privileges, prohibited items, levels of restriction, and eventually turned to a shared delusion between all four of the new members.

Lily XXXX was quiet throughout the session and primarily only responded when she was directly asked a question. She was open about her suicide attempt but vauge on the details of what happened before or after she jumped. She apeared uncomfortable when another group member asked whether she reached "the other side" or had "a near death experience." However, she became significantly more engaged and animated after the other group members started to discuss the faceless man, as though relieved she could finally share these experiences with another person who understood.

XXXX Keller was almost impossible to keep focused throughout the session. He frequently shifted his focus from the physical and legal difficulties that led to his hospitalization to the parties he had thrown throught the decades. Confrontation from myself and the other group members did not dissuade him of the fact that he was not alive in the '60's or '70's. Rather that becoming more animated and engaged when discussing the faceless man, XXXX Keller grew quiet and disengaged, to the point where he only acknowledged that he had seen this figure as well and subsequently stopped talking.

Sylar XXXX was brought to the session in a straightjacket and his feet were shackled to the chair while one of the orderlies remained in the room throughout. He was calm and cooperative and open about the fact that he was brought to the hospital after the court found him not guilty by reason of insanity. He was all the more open about his crime, which incolved setting fire to an apartment building in XXXXXX, Pennsylvania that led to the deaths of multiple residents. When asked what led to him setting the fire, he provided symptoms in line with pyromania, describing the urge to set fires, with an increased rise in stress until he gave into the impulse and started the blaze. His response to the discussion of the faceless man was amusement, as he continued to insist that his father would not only release him from this hospital at any day now, but that his father would never, ever allow the faceless man to harm him in any way, shape, or form.

KaiXX XXXX spent the majority of the session drawing on a piece of paper one of the orderlies had given to her earlier that morning. She described her self-harm as "necessary" but would not elaborate with any degree of sprcificity, only saying that it was "an offering." when asked what the offering was for, she stated that it would "keep the tall man away." At the end of the session, I requested to look at her paper to see what she had been drawing. She had captured the likeness of each and every group member and person in the room, myself and the orderly included. Each one of us had been harmed in some way, with the image of Lily held underwater in what appeared to be a bathtub, the image of XXXX missing his arms and legs as through they had been ripped off, the image of Sylar trapped in a burning building and laughing, and the image of KaiXX strung up on a fence with what appeared to be barbed wire. The image of myself unsurpringly involved a loss of the skin on my body, as though I had been flayed, and the orderly was stabbed through with a variety of weapons, akin to 'Wound Man.'

I did not ask her about these drawings. I fear I should have.

Arkady Calder, Ph.D, XX/XX

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