The Psychiatrist's Note is found in Silent Hill: Downpour, in the "Mirror, Mirror" sidequest house in the Port District after the quest's completion. It will appear on the floor near the broken mirror. The note is in relation to a young Caucasian woman diagnosed with obsessive compulsive disorder whom is forced to conduct mundane, repetitive rituals in her own home because she believes that the "people in the mirrors" will cause her physical harm if she doesn't.
This is very similar to the events of Silent Hill: Origins where the "people in the mirrors" told Helen Grady to kill her son, Travis Grady, as they convinced her that he was "The Devil". These "mirrors" were a reference to the Otherworld.
SILENT HILL PSYCHIATRIC HEALTH CENTER
Patient Name: Malone, D. A.
Patient DOB: 03/04/76
The patient is a young caucasian woman, age 20, of good physical health with no abnormalities in her medical or mental health history. She initially came to my office after a recommendation from her family doctor, complaining of insomnia, exhaustion, and depression. Subject recently lost a sibling (older sister) but refuses to divulge further details.
After further interviews, I have diagnosed the patient as suffering from acute Obsessive Compulsive Disorder. Patient described recurring nightmares, anxiety, fits of anger, and panic attacks stemming from the irrational belief that if she does not conduct mundane, repetitive rituals around her home, "the people in the mirror" will cause her physical harm.
Sending recommendation to the patient's GP that she is suffering from OCD with possible schizophrenia, advising further tests and possible antipsychotic medication.
Dr. Ari Richmond
Silent Hill Psychiatry & Family Counseling