These are the TIPS that correspond with Higurashi no Naku Koro ni episode 24.

Lunch Take-out List 1Edit

Attn: Kuroda Mental Clinic

Going straight to the point, it is assumed that this is an acute case of post-traumatic stress disorder. The patient is subject to tremendous stress following her parents' sudden divorce and being subjected to choose to live with one or the other.

Furthermore, the patient firmly believes that she herself was responsible for her parents' divorce, which further promotes her state of self-mutilation. The patient's largest shock stems from sense of betrayal from her own household which she believed was an absolute safe haven. Henceforth, there is a high possibility that the patient will observe psychological defense measures to protect her family.

(For example, she may feel high disdain for any person of the opposite sex approaching her father. She might feel uncomfortable in having other people in her home. Or, she may conduct absurd behavior in order to keep people away from her home. There have been reported cases where the patient would unconsciously bring and pile garbage for the latter example.)

It is highly important that the patient hold daily household communication with her father. By deepening the communication between the patient and her father, it will strengthen their family bond and loosen up her anxiety.

Since the patient only shows signs of acute syndrome in this case, there is a very good chance that she will immediately recover within three months with her father's support and proper medication.

However, it is not uncommon for a patient who seemed to have recovered to have a sudden re-occurrence (flashback) even after ten years.

The father is still young, and there is still a chance for him to re-marry. But, the prospect of her father re-marrying may cause the patient to have sudden flashbacks of her turmoil. This may instigate psychological defense behaviors along with elevated stimuli.

Please explain this part very thoroughly with the father in order to maintain the recovery process and mental care of the patient. Should the father have decided to undergo a second marriage, it is recommended at the minimum that he should hold off in telling the patient until she has reached the capable age of living independently.

Also, the patient's psychosomatic self-mutilation behavior, more commonly known as delusional parasitism seems to have its own attributes to culture-bound syndrome.

The patient seems to observe the superstitious curse from her home village, which she strongly believes that this was the cause of her parents' divorce. This is thought to be a part of her subconscious defense mechanism, where the mind tries to shove her self-proclaimed fault to her village curse in order to reduce her psychological pain.

If such a strong belief can induce such symptoms such as self-mutilation, then there might be cases similar to these recorded previously. Perhaps prior medical files that document similar culture-bound syndromes may be available at a large medical institution near her local area. It will then be possible to provide better and accurate mental care for the patient by obtaining these case files.

These B5-sized letters were written on the back of the paper used for writing memos.

The blank side of these letters were written with the following memo:

1 Chuuka-don (Chop Suey Bowl), 3 Shanghai-style Gomoku Yakisoba (Chow Mein), 1 large Cha-han (fried rice)

Lunch Take-out List 2Edit

Furthermore, it is important that we take caution concerning her father.

Bearing in mind that she has taken a considerable mental blow by experiencing her father’s divorce, by trying too hard to be cordial to the patient, there is a strong possibility that she may erupt with induced delusional disorder.

As the first step in mental care, one should listen to the patient’s story carefully, and not unsparingly deny them is the basics of the basics, but especially concerning with family, it may be difficult to not respond with some sympathy.

Additionally, the symptoms of delusional parasitism are widely known, and at times, it is not uncommon for that hysteria to spread entirely throughout a single community.

(Thus, even with the complaints from several people, it does not necessarily prove the existence of any parasite. Consequently, it is frequent that the outcries to the Health Care Centers for the extermination of these harmful pests are compromised with nothing but mass delusional statements.)

Nevertheless with this case, the consistency to the details of these delusions are unusually extreme, in the worst case, by labeling this treatment for parasitic care, may result the patients to abnormally seek and mutually harm each other fatally, or possibly allow each other to race to suicidal tendencies with their pessimism views.

Moreover, this induced delusional disorder, otherwise known as shared psychotic disorder*, shows a particularly strong possibility of influencing a convivial companion.

People coming in contact with the patient, must make the patient understand that she is still presently under medical treatment, and take care to caution her to not be influenced by these delusions.

Likewise, individuals who are likely to be influenced include family members and possibly a close person such as a boyfriend are to be noted.

Lunch Take-out List 3Edit

The danger of culture-bound syndrome lies in the fact that it can easily trigger delusional mis-identification syndromes.

That is to say, in the current case, every time the patient sees something trivial, she will try to interpret it as being a "curse".

And it is believed that as a result of the accumulation of these events in an understandable form, a delusional system is created, ultimately leading to paranoia.

Furthermore, the patient is also exhibiting slight signs of personality disorder. Of course, it is at a very slight level, and has no hindrance whatsoever on the patient's normal life.

It is not uncommon for even healthy individuals to have primary delusions in their daily lives. However, since the delusion contents are nonsensical, they are usually ignored by the individual automatically without recognition.

And yet, there exist cases where these events would accumulate despite their in-comprehensiveness. This is said to be largely dependent on the natural characteristics of the individual, and it is believed that the patient shows a relatively strong characteristic in this area.

Now then, I believe that Dr. Kuroda is very much aware that primary delusions are categorized into 3 different kinds of cases.

Delusional mood is the feeling of impending crisis without basis.
Delusional intuition is the feeling of a sense of duty or goal without basis.
Delusional perception is the feeling of a baseless cause against a baseless target.

In the patient's case, it is believed that these incomprehensible delusions accumulate, acting out simultaneously with the culture-bound syndrome, inducing delusional mis-identification syndromes, and ultimately causes incomprehensible delusions to become understandable by interpreting them as a "curse".

The comprehensible delusional system then induces understandable secondary delusions, further strengthening the patient's delusional system with the passage of time.

(The delusional parasitism mentioned earlier can be considered as a secondary delusion)

A common point in all paranoia patients lies in the fact that even after an outbreak, they would still appear perfectly normal, with no changes in their personality.

The patients would also be unaware of their own ailments, and due to their personal interpretations of the delusional system, there are many cases where a patient would arm him or herself logically, making it extremely difficult for a 3rd party to point out that he or she is having a delusion.

Furthermore, although it may depend on the tendency of the delusions, there are also cases where a persecutory delusion would turn into a pursuit delusion or conspiracy delusion, causing the patient to create an imaginary enemy and take up anti-social behaviors.

(For example, there are cases where believers of a religious cult would respond to the cult founder's paranoid visions as a group, shifting the group into a conspiracy delusion, causing them to take up anti-social behaviors in the name of self-defense. Although no such cases have been reported in Japan yet, it may become possible in the near future)

Luckily, as of now, the patient hasn't reached such a serious condition.
With proper treatments, she should easily be able to make a full recovery.

Please make sure that her father also understands that this is not an unusual case, but something caused by the accumulation of a number of innocent factors that anyone could have.

The patient can be treated only by deepening her bond with her father, but as long as she has her bond with her father, she can definitely be treated.

For the above reasons, if the patient is to return back to her hometown, I strongly suggest that the patient continue to receive guidance from specialized medical institutions even after returning.

Please excuse me for writing such a long article.
I wish to thank you for reading this until the very end.

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