PSYCHIATRIC EVALUATION

NAME: Sandor Clegane

ALIAS (if applicable): the Hound, Dog

CHIEF COMPLAINT:

“Killing is the sweetest thing there is.”

ADMISSION ASSESSMENT

Patient presents today as aggressive and irritable for his initial psychological assessment, and this clinician attempted to gain insight to the patient’s chief complaint. Unfortunately, he is uncooperative, stating, “I’m the terror here!” Extra personnel were brought in and put on standby should the patient’s anger/anxiety become exacerbated to the point that restraint and seclusion would be necessary before the end of this assessment.

CURRENT STATUS

Sandor Clegane’s appearance is disheveled and generally untidy – although it is obvious that the patient is dirty, this clinician questions whether some of the grime is blood, and whether is it the patient’s or from another person. Patient is very tall and large, and it is apparent that he uses his mass to intimidate others. Eyesight will be assessed by the medical staff, as the left side of his face and head are covered in a large scar resulting from severe burns. It is unknown at this time whether any skin discoloration is due to his unwashed appearance, or whether bruising has occurred. Any contusions or blood (whether his own or another’s) present on his person is indicative of a recent brawl, supporting actions taken to subdue any sudden and violent outburst.

Sandor also answers to being called the “Hound,” although it should be noted that he grimaces or sneers when addressed as such – the nickname stems from the three dogs adorning the Clegane sigil, but this clinician feels that the patient calls to mind an “obedient dog” when referred to by this name.

PATIENT HISTORY

Sandor Clegane has one sibling, an older brother named Gregor (AKA “the Mountain That Rides,” or simply, “the Mountain”). This brother is the reason for the extensive scarring across the left side of Sandor’s face and head, as Gregor pushed his younger brother’s head into a fire when they were children (the scars were later played off, as his father would explain that Sandor’s bed caught fire when others would inquire). It is unknown, and the patient is unwilling to elaborate on, the implication of neglect at the hands of his parents for not addressing the abusive and homicidal behavior of his brother, Gregor. This physical and emotional abuse has led the patient to be highly distrustful, societally disconnected, and incredibly fearful of fire.

Sandor’s time in King’s Landing was spent as a bodyguard for Joffrey when he was Prince, then he replaced Barristan Selmy in the Kingsguard following the death of Robert Barathron, elevating Joffrey to the position of the King. Although he took Selmy’s place, he refused to be knighted. When questioned about his refusal, Sandor responded, “I am no knight. I spit on them and their vows. My brother is a knight.” (A simple inquiry revealed the truth in this statement, as his brother was known as Ser Gregor Clegane.) It is evident that Sandor thinks deeply when he assesses others, since he sees the nuance in titles and the decisions of those around him – for example, he sees society’s idea of knighthood as a mockery (since no one, in his mind, has the values typically associated with a knight), and the very fact that the inflictor of his worst pain and suffering is a knight only serves to solidify his deduction.

Before Joffrey became King, Sandor served as his personal bodyguard – he was constantly referred to as “the Hound” and “Dog,” especially when called upon to perform a certain task. The diagnosis of antisocial personality disorder is not aligned with following rules, particularly regarding being a bodyguard, but “obeying” this position allowed Sandor free reign to kill and abuse as Joffrey saw necessary. A singular event stands out, particularly among the Stark family, when Sandor was ordered to kill a very young boy named Mykah (AKA “the butcher’s boy”). This boy, a friend of Sansa Stark’s sister, Arya, was accused by Joffrey of assault; it was Sandor that was ordered to hunt down the child. He did, and still feels no remorse for the murder of a defenseless child, which supports a diagnosis of antisocial personality disorder. He also claims to have killed for the first time when he was 12 years old (an anonymous man during Robert’s Rebellion), in further support of the aforementioned diagnosis.

As a member of the Kingsguard for King Joffrey Baratheon, Sandor frequently found himself in the presence of teenager Sansa Stark. This is significant because, while they were both at King’s Landing for Joffrey’s reign, Sansa was constantly abused; however, it is relevant to note that Sandor was not only omitted from the abuse inflicted upon her, but offered her a certain degree of comfort and tried to save her. Any indication of an antisocial personality is questioned here in his actions towards this abused girl, as it is evidence of the patient showing empathy for another person. On the other hand, the patient has experienced extensive abuse himself, and may be merely projecting onto the Stark girl – in this case, a diagnosis of antisocial personality disorder wouldn’t be ruled out, as he would view the situation selfishly inasmuch as he is saving himself.

The patient was heavily involved in Stannis’ invasion of King’s Landing, the Battle of the Blackwater, until the use of wildfire on the water and the ships moved ashore into the midst of the action. Sandor’s history of abuse via burning has created an excessive fear of fire, which was demonstrated when it drove him to abandon the battle and the King. Although he doesn’t report flashbacks or nightmares, he manifests a high emotional response when confronted with the substance itself, indicative of the diagnosis of post-traumatic stress disorder (PTSD).

Following a run-in with the Brotherhood Without Banners, Sandor took Sansa’s younger sister, Arya, as his “prisoner.” The term is used loosely, since (much like Sansa) he did not dole out any abuse or mistreatment, and Arya had nowhere else to go. Although empathy is implied, this clinician feels that Sandor saw Arya more as a peer, and less as a victim. Just as Sansa Stark represented the child that was Sandor, Arya Stark represented what he was to become – he saw the girl knock out a merchant to make their travel smoother, and he saw her use his own knife to kill a man she had just met (to avenge her brother’s death, but to Sandor one doesn’t need a reason to kill). Therefore, his antisocial personality is perpetuated. Moreover, his desire to keep Arya alive and unhurt lies in the fact that he expects a hefty ransom to be paid for a living, unscathed Stark.

RISK ASSESSMENT

Sandor scored highest on the assault/violent risk assessment, taking into account his unpredictable behavior and history of assault. He also verbalized threats throughout this assessment. This contributes to his high risk for elopement. In all, the patient’s violent history and desire to leave the facility makes him an extremely precarious patient – he will need 24-hour visual surveillance and several staff members that are able to restrain a person of his size and ability. Expect the patient to test the doors.

The patient scored zero on the sexual acting out risk assessment – he has no history of sexual abuse or assault. When confronted by a peer (simply identified as Bronn) in the past about sexuality, Sandor only redirected the conversation to homicide.

He scored moderately on the withdrawal symptoms assessment – even though the patient drinks heavily, he reportedly has never showed signs of withdrawal during times of “draught.”

STRENGTHS

The patient has very few strengths, but among them he possesses an average intelligence (which could be better or worse than this clinician estimates, but the patient is very terse and unrevealing) and good physical health overall. This clinician believes that the patient could be capable of independent living, if the patient would be willing to cease his roving and marauding activities and settle down in one area. He also possesses vocational skills which could be put to good use, if he would allow it.

PLAN

-Psychotherapy for behavior modification in regards to antisocial personality disorder

-One-on-one therapy with the aim of acquiring healthier coping mechanisms

-Psychopharmacology therapy to stabilize mood

-Anger management

-Education regarding substance abuse and child abuse (victim-centered)

-Group-based therapy to address impulsivity, interpersonal difficulties, and re-offending

-Follow detoxification protocol for withdrawal prophylaxis

DIAGNOSES

Axis I PTSD, child abuse/neglect

Axis II Antisocial personality disorder

Axis III Extensive head and facial scarring

Axis IV Social, occupational, legal, primary support

Axis V 45