“The defendant added he was possibly drugged and someone inserted an unknown object in his rectum,” the report says. “Although the defendant is not certain the victim is responsible for this, the defendant made a statement indicating he needed to hurt whoever hurt him and was prompted to purchase the knife at a Target store near Miami International Airport.”

Ah yes, the good ol’ transphobic psychosis combo (it’s actually more common than you’d think, mental illness can showcase some hidden inner prejudices that people normally mask better in some pretty ugly ways). Those biases are really deeply interwoven into our society and they often worm their way right into those that are already psychologically vulnerable, then they wind up featuring strongly in delusions and hallucinations.

It can also be genuinely trauma related, a lot of my patients have been bouncing between the street, correctional and psychiatric institutions, and shelters, any one of which a sexual assault can and is often even likely to happen in. Traumas are another thing that frequently pop up in people’s hallucinations and delusions.

One time we had a newly admitted patient literally covering their clenched butt with their hands while waddling down the hall and looking around suspiciously. It was kind of humorous to watch but in that dark, sad way that hospital shit gets sometimes.