Alicia is a 28 year old female that has been referred for outpatient services after being admitted into an acute psychiatric ward for 5 days. Alicia complains of persistent numbness on the right side of her body, extending from her face down to her leg. Twice, Alicia was admitted into the hospital from the emergency room with a visible amount of paralysis on the right side of her face. After numerous tests, ruling out Bell’s Palsy and Parkinson’s disease, Alicia was sent home. Alicia now complains that aside from the numbness in her body that she is now feeling considerable shortness in breath and chest aches.
There is a history of heart disease, stroke and heart attacks on the maternal side of her family and recently, Alicia’s father had heart surgery. Since she was a child, her mother states, Alicia was a very sensitive person, very emotional and compassionate. Alicia often felt sorry for others that were less fortunate and ill. Mother reports that Alicia was often stricken with colds, fevers and pneumonia as a child and that she suffered socially, always being kept indoors and protected from bacteria and other germs. Alicia tends to be very shy, withdrawn and socially inept.
Alicia has never dated and reports that she has no long term relationships with anyone other than her parents and immediate family. Alicia states she wishes she could mingle and find companions her age. Parents report that Alicia is very delicate and they demand that she be seen at least twice a week. Mother reports and supports Alicia in saying that there must be a medical reason for all her illnesses and complaints. Alicia becomes severely emotional when confronted with the number of negative tests that have been done. She will seclude herself and not eat, shower or speak with anyone and after a while turn from tearful to angry. No one believes me but there is something seriously wrong with me” she cries during her hospital assessment. Alicia’s parents demand that they be a part of her individual treatment and demand that they are a part of every treatment decision that is made. “She is not capable of making her own decisions” her father reports. “She is very gullible, sensitive and extremely delicate”, mother states. When asked if she wants to return to inpatient care, Alicia looks to parents for their input. Alicia rarely answers any questions directed at her without parental guidance. 2. CASE STUDY: DAVID
David is a 13 year old boy who has recently been admitted to a juvenile detention facility in San Luis Obispo, California. Police reports indicate that he and another boy were arrested for breaking and entering into a private residence. He has also been charged with assaulting police officers at the time of the arrest. David grew up in an upper middle class section of San Luis Obispo. David’s father, Oliver, is a professor at a small college, and his mother, Sharon, is a dentist who works for a large health care group. David has an older sister, Sarah, who is 15 years old.
Their family has had no prior contact with law enforcement agencies. Even as a small child, David seemed unable to restrain himself. He would bound around the house, crashing into walls and objects, frequently breaking items or destroying house plants. These activities became more pronounced just after meals and when he was angry or disappointed. David seemed to require very little sleep, and he would quickly become bored with most activities. However, he would spend long hours playing computer games, and also enjoyed playing with the family dog, Jessie.
David entered a period of low mood at the age of 11 when Jessie died. David’s parents say that David has always been an insecure child. David was slow to complete toilet training, and his parents admit that they gently teased him about his frequent “accidents” which continued until he was 8 or 9 years old. David seems unable to compete with his precocious older sister, who has been very successful both socially and academically. Although Sarah takes David’s side in front of her parents, David reports that she teases him when they are alone.
Sharon took a leave of absence for the first three years of David’s life. She then returned to work on a part-time basis and enrolled David in a high quality day care center. David seemed to thrive in this environment and would look forward to his twice weekly visits. Just before his fourth birthday, however, David grew ill and had to be withdrawn from the school for more than a month. Afterward, David seemed highly anxious about returning to the center. Indeed, each time he did go to the center, he was highly agitated; at the school’s request, his parents withdrew him from the program.
For the next year until he began school, Sharon and Oliver arranged their schedule so that one or the other of them was available to take care of him. At the age of 6 years, David’s parents enrolled him in a private Montessori school, and with the help of the school psychologist, David made a fairly smooth transition. David developed few friends at school; most children seemed put off by his high level of energy and incessant talking. In spite of his social isolation, however, David seemed to enjoy learning very much, and did well in school through the fourth grade.
Testing indicated an IQ score of 126. He scores particularly high on verbal abilities, though much lower on mathematics. Unfortunately, David did not get along with his fifth grade teacher, who was fairly inflexible in his approach. David’s grades dropped dramatically, and since then, he has steadfastly refused to put forth an effort at school. About this time, David began stealing small amounts of money from his mother’s purse. When his mother confronted him about it, he denied it. But afterward, he continued stealing the money and made little effort to conceal his actions.
David entered puberty at the age of 11, and at that time, his mischievous behaviors became more destructive. He frequently got in fights with classmates, and would verbally assault teachers. He was suspended from school for defacing the school walls with obscenities. David explained himself by telling his parents that he was unable to control his actions. In turn, his parents disciplined him by preventing him from playing with his computer games for a month. Separately, each parent admits to allowing David to occasionally play with the games during this punishment period.
In middle school, David began associating with the older boys in school. His parents suspect that he may have tried smoking cigarettes and may have experimented with sniffing glue. He was suspended from school for fighting in the lunch room and repeatedly threatening smaller children. He is frequently truant from school, and his parents have caught him sneaking out of the house late at night. After his arrest for breaking and entering, David began to cry and told his parents that he felt badly for what he had done. He added that he was unable to control himself.
David is reluctantly undergoing psychiatric evaluation at the juvenile detention facility. 3. CASE STUDY: LAMANDA Lamanda is a 22 year old woman who has recently graduated from Ohio State University with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Lamanda was born in Detroit, Michigan. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store.
Lamanda reports that she was a shy, unattractive child, but that in general her early childhood was “pretty happy. ” Lamanda says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She says she feels especially close to her mother, though she typically approaches her father “when I have a big problem. ” When Lamanda was 14, her family moved to Royal Oak, a working class suburb outside of Detroit. At about this time, Lamanda began to blossom intellectually.
Her grades were consistently very good, and she was a member of the National Honor Society. She says she remembers this as the happiest period of her life. Lamanda also bloomed physically. She became popular with boys, although she reports frequent anxiety when she was unsure of how to deal with their advances. Lamanda was especially distressed by some strong sexual advances from her 47 year old softball coach during her sophomore year of high school. Lamanda insists, however, that this “incident” is in the past and that she has not thought about it for years.
Throughout high school, Lamanda concealed her mixed heritage from her classmates by not inviting friends over to her home. She admits that she is embarrassed by this, and she suspects that her parents realized what she was doing. She now insists that “I am not black or white, I am me. ” During her junior year of high school, Lamanda had her first serious boyfriend, Morris Silverstein, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. She describes the sex as “good, considering our age. Morris was accepting of Lamanda’s ethnic heritage, and became good friends with Lamanda’s father. Like many young people, Lamanda seldom discussed sexual or romantic issues with her parents, preferring to keep her parents out of her personal life. Morris broke up with Lamanda during her freshman year of college explaining that he wanted to be able to date other people. Lamanda says she coped with the break up “pretty well” and she and Morris have remained good friends. In college, Lamanda has dated sporadically and she acknowledges some bisexual experimentation. Lamanda says that she prefers heterosexual relationships, however.
She has been dating Brett for more than a year, but she says that he seems to be less committed to the relationship than he used to be. Although he seems to be making an effort to be supportive, Lamanda reports that he tries to be positive but always ends up criticizing her. Although Lamanda appears to be a natural athlete, she leads a relatively sedentary lifestyle. She was the star pitcher for her high school softball team, although she quit abruptly during her junior year. Last year, she joined a recreational softball league, but she quit after only a few weeks, explaining that she was just not enjoying herself.
Lamanda does not like her job at the restaurant, but seems unwilling to look for other employment. She says that she feels “very jittery” whenever she gets ready for work, and she uses any excuse to take days off. She also refuses to associate with fellow employees, and reports getting very anxious when she was given a surprise birthday party. Lamanda works the evening shift, and she often does not get home until 3am. In turn, she routinely sleeps in until 1 or 2 in the afternoon. Recently, she has lost interest in cleaning her house and seldom cooks for herself.
She also attends less to her personal grooming. She now avoids seeing both Morris and her parents, fearing that that they will disapprove of her. She also says she has lost interest in further education. About two months ago, Lamanda became friends with a social worker who frequents the restaurant. After a protracted conversation, he recommended that she seek professional assistance. 4. CASE STUDY: BEN Ben was born and raised in Siloam Springs, Arkansas. His father, who died when Ben was 18, was a janitor at a local department store. His mother was a homemaker.
Neither of his parents finished high school, and Ben was born when they were only 17 years old. Ben is 52 years old and has been working as a driver for a postal company for the past 22 years. He reports that he likes his job and enjoys interacting with people. Ben was an only child, and he explains that he got a lot of attention. He says that that he loved his parents very much, “but they were kinda weird. ” He adds that “They were like me. Just different, ya know? ” Ben said that his aunt, his father’s sister, has been institutionalized on several occasions. Ben has been unmarried his entire life.
He reports “I liked the girls OK and all that” but he never developed permanent relationships. Ben reports that he has always been “nervous with the girls and such” and he avoids making any significant social overtures with women. He meets his sexual needs matter of factly by visiting a prostitute on a regular basis. He reports that their sexual encounters are highly regimented. He refuses to elaborate on this point, stating that his mother taught him to “never talk about dirty things”. Ben reports that he also directed a lot of his energy into long walks. Every evening, he would go for a walk, sometimes lasting up to 5 hours.
His neighbors were often concerned seeing him walking alone late at night and the police have been called on several occasions. Recently, however, Ben has lost interest in the walks, explaining that the streets are too dangerous. Ben has attended church on a regular basis throughout his life. He has been involved in a number of community activities; people seem to appreciate his involvement, though they find him a bit odd. During the past two years, coworkers have noticed a gradual change in Ben. While he always seemed a bit unusual, during the past few years, his social interactions seem confused and inappropriate.
He sometimes smiles when he is angry, and often seems distressed and agitated when everyone else is laughing. A coworker who befriended him reports that Ben may be using hallucinogenic drugs. Ben denies this, however. Although coworkers have described a gradual decline, one dramatic event seems to have exacerbated his condition. Ben was scheduled to make a routine delivery, but instead of taking the box into the store, he handed it to a pedestrian who happened to be on the street. As he handed it to her, he explained “This is a gift from Jesus — please keep it with you always. The puzzled pedestrian reported the incident to Ben’s supervisor. The following day, Ben was unable to clearly recall the incident, and had no explanation for it. Although his actions were highly unusual, it was an isolated incident and his supervisors let him off with a warning. Unfortunately, the error became known around the station, and coworkers teased him for several weeks. Ben explains that this error weakened his low self image, and undercut his confidence in his ability to perform his job. Ever since this event, Ben has become very careful to avoid making mistakes.
He routinely double-checks all of his deliveries, sometimes running back into stores to confirm that he has delivered the correct box. He admitted that he sometimes hears celebrity voices telling him that he is making an error. Ben spends his spare time in solitary behaviors including watching television (he watches a lot of Court TV and builds plastic military models). During the past six months, Ben also admits to carefully checking all of the locks on his house at night. Although Ben lives in a comfortable neighborhood, he points out that all of the young people in the area dislike him and they may be planning to break into his house.
He also disconnects his phone at night to avoid potential threatening phone calls. Finally, Ben has recently begun insisting that he is suffering from cirrhosis of the liver. Although medical tests have proven negative, he insists that he can feel the organ rotting inside of him. This thought seems to have developed after he watched a television program on the side effects of alcoholism. At the urging of his supervisor, Ben has voluntarily sought help from his employer’s human resources department. 5. CASE STUDY: ALEXANDRIA
Alexandria is a 31 year old female, born and raised in Chippewa Falls, Wisconsin. Alexandria married when she was 18 years old, to a soldier that was stationed in Illinois and had her first child at 19. Alexandria currently has 3 children ages 12, 10 and 8, all girls. Alexandria’s husband sought professional help for Alexandria when he noticed her “obsession” with cleanliness and complained that “Alexandria is a wonderful wife and mother but she doesn’t have much time for anything else but to do daily chores and quite frankly, I’m worried”.
Alexandria states she has a regular daily schedule that she follows from the moment she wakes up till she goes to sleep. Everyday she wakes at 6:30 A. M. and will begin preparing for the day. She wakes to take the family’s 4 dogs for a walk around the block, returns at 6:45 A. M. , begins making breakfast, wakes girls at 7 A. M. , prepares them for school and walks them to school to have them in by 8 A. M. When she returns, she has scheduled chores and errands that are scheduled to the hour on the hour.
Alexandria manages to make lunch that her husband comes home to during the work day and also prepares dinner nightly at the same time. Alexandria states that she is in bed by 10 P. M. every night, without fail and prior to going to sleep; she has a nightly regiment that she does to prepare. Both Alexandria and her husband state that they have not had sexual relations since their youngest daughter turned 5 and that it is beginning to take a toll on their relationship. Alexandria reports that she tries to “fit’ lovemaking into her schedule but finds it impossible at times.
She also reports that she has no desire to have relations with her husband and states, “I don’t even have a sex drive, is that normal? ” Friends and family report to Alexandria’s husband that Alexandria displays the “perfect wife syndrome” therefore he rarely saw any “real” problems with her behavior until recently. Alexandria’s husband reports that he was called by his Platoon Sgt. twice to have his wife seen for professional help because school officials called stating Alexandria was walking aimlessly around the school and on several occasions, would sit in the quadrant within he classrooms crying. A few times, the girls would call him at work crying, stating “momma is real mad, she said we didn’t finish on time and we didn’t clean it right. ” Alexandria’s husband began to notice an obsession of cleanliness and schedule that if it did not occur the way she wanted it to, she would become extremely emotional, either angry or sad. Alexandria states that she is accustomed to working her daily schedule and does not “handle it well” if the schedule isn’t followed exactly how it should be. 6. CASE STUDY: THOMAS
Thomas is a 16 year old, Hispanic male, which has been in and out of residential treatment since he was 12 years old. Thomas was originally sent to treatment after his mother passed and he was 10 years old. Thomas was living with his maternal grandmother as he never knew his father until he was 9 years old and after his mother passed away, his father began to state that Thomas was not biologically his son. Thomas is reported as “usually being a very sweet boy with a big heart, very understanding and loyal to the people he loves and cares about”.
Thomas has been involved with gangs and does not admit to being a gang member but has three tattoos; one on his neck, wrist and right hand knuckles. Thomas was recently charged with aggravated assault towards a household member when he attacked his “father” with a baseball bat. Thomas reports that he was with his friends and when he returned home, his “father” stated that he was 2 minutes late and began calling him names, yelling and pushing Thomas in front of his friends. Thomas states this angered him and so he pushed “father’ back, grabbed a baseball bat and began hitting him so he would stay away from him.
This is not the first time that Thomas claims his “father” mistreats him, but the court continues to recognize the “father” as a custodial parent regardless of his statements that Thomas is not biologically his. Thomas has been exhibiting anger, depression and stating homicidal ideation. “I want to kill my father, he’s an asshole”. Thomas reports that father is receiving SSI checks from state for Thomas because of his past Bipolar diagnosis, but that he never sees the money or gets anything he needs or wants. Thomas reports that he buys new shoes, clothes and other necessities because he sells marijuana and meth.
There is no history of use although grandmother reports that Thomas acts strange and she has her suspicions. Grandmother also reports that Thomas wakes up in the middle of the night screaming and cursing but denies nightmares or being afraid of anything the next day. Thomas shows very little interest in age appropriate activities and has been talking about having a “bad” childhood and not wanting to live much longer. Thomas says, “I don’t want to grow old. There’s nothing to look forward to. My dad doesn’t want me, my mom is gone and my grandparents are trying to get rid of me. ” 7.
CASE STUDY: JESSICA Jessica is a 16 year old Caucasian female that was adopted when she was 2 years old by her maternal great aunt. Jessica has received therapy since she was 5 years old for traumatic memories of abuse, both physical and sexual. Aunt, Leona, reports that she and Jessica have always been very close while she was growing up and states that Jessica was always very bright. Jessica is an “A” student and displays a great potential to be in the top 10 percent of her class. Jessica enjoys music, dance and drama; in fact, Jessica won first place in improvisation and acting for the school.
Jessica reads often and her articulation and expression well exceeds her level of maturity. Leona states that Jessica has been to the medical doctor 7 times within the past 6 months for outrageous claims of illness and pain, in which numerous tests have been done and there appears to be nothing medically wrong with her. Jessica also displays a sudden amount of paranoia, thinking that “everyone” is talking about her and wants her to fail at all her dreams and aspirations. Leona also reports that Jessica has begun showing very odd behaviors that she normally would never display such as: talking back, ebelliousness towards rules, ignoring her responsibilities and obligations, wanting to get tattoos and piercings and staying out late to include “ditching’ school. Leona also reports that she is concerned that Jessica is being sexually promiscuous and that she ran away two weeks prior to coming to treatment, to meet a boy that she met over the internet. After meeting the boy for the first time, Jessica claims that she is in love and the boy understands her and wants her for who she is. Jessica reports different circumstances then her Aunt does.
Jessica claims that Leona wants to treat her like she is a baby or how she did when she was younger and does not want her to grow up. Jessica claims that Leona wants to maintain control over her life and cannot see that she is intelligent enough to take control of her own life and make good decisions. Jessica reports that the boy she met knows her better than anyone else and she gave him her virginity because he said he loved her and she truly believes it. When asked questions regarding the circumstances, Jessica becomes very emotional, cries, yells and becomes defensive.
Jessica’s moods are erratic and overdramatized. Leona sought Jessica inpatient care when during the interview; Jessica stated she was feeling very upset and asked to go to the restroom. At that time, Jessica crawled out of the restroom window and was found at a gas station, by police, asking for money claiming she had been abandoned by her family. Jessica cries constantly and asks to be sent to a foster family or emancipated from her Aunt to live on her own. When asked how she intends to support herself, Jessica cries and states, “I don’t know but I’ll figure it out”, and becomes extremely emotional.
She has a tendency to hyperventilate, perspire profusely and turn pale. On occasion she states the room seems to get smaller, stuffier and she says she feels like she is dying. 8. CASE STUDY: MARTY Marty is a 43 year old male, born in Alamogordo, New Mexico. Marty grew up in a close knit environment and was an only child. Marty and his parents moved twice in his life from Ruidoso, NM to Abilene, TX then back to Alamogordo, each time because his father’s job would transfer him. Marty has had one job since he was 18 years old and states that he has good work ethic because of his father.
Marty’s father died 5 years ago and since then, Marty has taken the role of provider for his mother. Marty has never moved out of his parent’s home and only graduated to the guest house 7 years earlier. Marty’s father, Tom, helped Marty fix up the guest house and told him that it was time he became a man and made his own way. Marty was responsible for paying monthly rent, utilities and doing chores around the yard as part of his agreement to be a tenant for his parents. When his father died, Marty moved out of the guest house and back into the home.
Marty reports that just recently he met a young woman that he has taken an active interest in but states that he has difficulty speaking to her and does not know how to approach her. Marty reports that Clara, the young lady, is very successful, owns her own home and has a college degree. Clara’s family lives in another city and Clara moved to Alamogordo after she graduated to work as a contractor through the Air Force. She represents power, stability, independence and many things that Marty says he has never seen before.
Marty reports that since he has met Clara, he realizes that women can be independent and strong and he defies and resents his mother for being weak and dependent. Marty has fear of rejection so he admires Clara in secret. Marty seeks professional help and guidance as he states his resentment towards his mother has him thinking terrible and vindictive thoughts towards his mother. Marty reports that 2 years ago, his mother was diagnosed with osteoarthritis and she has constant pain.
She often tells Marty that she wants him to meet a woman and settle down because she feels she will not survive much longer but every time he makes plans, she “ruins” them by telling him she needs him to stay home and help her. Marty states he has ill thoughts of abandoning her in the home, not buying her groceries, disconnecting the phone so she cannot call for help and leaving her to struggle to see if she will do anything to help herself. “ I don’t want to hurt my mother but sometimes I think that’s the only way she will actually ever do anything to help herself”, he says. Marty is beginning to have uicidal and homicidal thoughts and more than anything, has lost interest in everything. Marty has not shown up for work in 2 weeks and his supervisor is threatening to fire him now. 9. CASE STUDY: SHYAN Shyan is a 29 year old Caucasian female that was born and raised in Balmorhea, TX. with a population of 513. She is an only child. Shyan’s father was the town Sherriff and previous to that he was the Chief of Police and a police officer in two other small towns, Avery, TX. and Beckville, TX. Shyan was accepted to a university in Albuquerque, NM with a full scholarship when she turned 18 and she moved without her parents support or “blessing”.
Shyan graduated from college with a Masters in Social Sciences and works as a therapist at a residential treatment facility, with adolescent girls. During a session with a 15 year old patient, Shyan is reminded of a childhood incident and experiences an emotional break. Shyan recalls an incident where she was abused by a female childhood babysitter and was forced to watch pornography and engage in sexual touching and petting. Since this incident, Shyan never spoke of it or told her parents. “We lived in a small town and everyone knew eachother. I didn’t want the drama, the embarrassment or any problems.
That’s why I didn’t stick around”. Shyan stated that she was 7 years old when it happened and denies any threats or recurrent episodes with the babysitter. Shyan stated, “I didn’t really remember the whole incident really until I started working with my client”. Apparently, the client is a young girl that states she was sexually molested by the daughter of her mother’s friend when she was 6 years old and when she turned 12, the older girl came over for a Christmas party and tried to kiss and fondle the girl. Shyan states now that she remembers the incident, she is sure there is more to it then what she remembers.
Shyan reports that she has been estranged from her parents for many years and also finds that she tends to engage in relationships with men that are unsuccessful, substance abusers and “poor lovers”. Since remembering the incident, Shyan reports that she has trouble remembering events that occurred the day when the incident occurred, a few details and not much of the time she lived in the small town until they moved again. Because of this, she has been experiencing moments of depression, anger and self-blame. Shyan states she wants to feel whole again, remember what happened and put it behind her.
Shyan also reports she wants to discontinue using Prozac. The most important is, she wants to rebuild her relationship with her parents and find fulfilling relationships. 10. CASE STUDY: ROGER Roger is a 19 year old, Caucasian male, with a history of erratic behaviors. Roger’s mother states that she feels that Roger is a very strong individual with much determination and handles himself under great stress and difficult situations. Roger, on the other hand, tends to become extremely anxious in difficult situations. He will perspire profusely, forget what he was going to say or do and sometimes becomes verbally aggressive.
Roger has a history, as a child, of making up elaborate stories. For example, when Roger was 8 years old, he overheard his parents discussing a job opportunity in another city and state and what a possible move might look like. The next day, teachers called Roger’s father inquiring about this new move stating that Roger had gone to school and stated he would not be able to complete his class assignments because he would be moving soon as his father was a high profile government employee. Roger’s father is actually a foreman in a construction company.
Roger also, at one point, told fellow classmates and teachers that he had been diagnosed with a brain tumor after visiting the doctor to check a bump on his forehead that he received in a game of golf. Roger is being brought to therapy by his father who states that he has become concerned with Roger’s preoccupation to be a rock star. “He’s very illogical and he believes that he is going to be famous but I don’t know where he gets it from. I also notice that he talks to himself a lot and he breaks into a dance out of nowhere like he’s hearing music but I don’t know where from”.
Roger’s father also states that Roger stated he saw God in the bathroom mirror when he got out of the shower and the mirror was fogged. Roger’s behavior seems to have changed dramatically in the past few months, according to his parents and appears to be getting worse with time. Roger’s parents fear that Roger might hurt himself or someone else because he can’t differentiate between reality and imagination. Roger used his mother’s credit card to book a flight to Hollywood for American Idol tryouts and mother states, “I’m just glad the airport called to verify when he arrived packed and ready to go, whether or not he was an authorized user.
God knows what would have happened to him if he was able to get on the plane and go! ” Roger has no idea why his parents have brought him to care and state, “my parents are so over protective. They don’t want to let me go. I worry about them because they need me to survive. If I wasn’t at home, they wouldn’t remember to pay their bills, clean or care for themselves. They are so dependent on me. I just want to be able to spread my wings and fly. ” 11. CASE STUDY: BRAD Brad is a 45 year old male that is currently serving in the U. S. Army as a Sergeant Major.
Brad has recently returned from Afghanistan on his fourth tour of 18 months and has been referred by a military liaison for evaluation. Since Brad returned from deployment, co-workers and family members have seen a significant difference in his personality and behavior. Brad injured his back and his left knee while deployed and was given pain killers to alleviate the pain when he returned. Brad’s wife, Gina, states that Brad had been taking the pain medication as prescribed but noticed that he has gradually increased the dosage and amount and also has been drinking heavily.
Brad was confronted at work by his Commanding Officer for being intoxicated or under the influence on the job. Gina reports that Brad seems detached, emotionless, no affect and disinterested in previously enjoyed activities. “He doesn’t talk about his deployment, he never has, but something bad must have happened this time around because he never behaved this way last few deployments. He came back the second time and he was okay, I guess, but then the third time required more effort on his and my part to get back in routine”. Gina states that Brad is short tempered, has little patience for their children and 2 grandchildren.
At times, Gina states that Brad wakes in the middle of the night in cold sweats and screaming or yelling but when she wakes him, he does not remember. “I think I am losing my mind” Brad says as he states that often times he sees things happening around him like it was a movie. “I see people and have conversations with guys I know aren’t here anymore”. Brad is experiencing flashbacks or abreactions according to the psychologist that saw him at the military medical center. At times, Brad states he experiences a state of “shock” or paralysis like he was back in a combat situation and he wonders if he did the right thing.
Brad refuses to open up to his wife and recognizes that his marriage is failing. Gina confirms that during simple arguments or disagreements that Brad will suggest that she leave him, be happy, and start over with someone new. Brad desperately wants to regain his “old self” but states he feels he may never be the same again. Brad pretends to himself and others that he is fine and demands that his Commanding Officer send him back out to “theatre” or back into the field with his unit. Brad states he has grown accustomed to the daily routine, anxiety and stress and wants to die in battle rather than reintegrate into civilian life.
His unit is opting that Brad be medically separated from the Army. 12. CASE STUDY: JOLEEN Joleen is a 14 year old, African-American girl that has been in and out of residential and inpatient, acute care for the past 6 years. Joleen has several difficulties at home, school and with her siblings. Joleen was brought to care by her mother and step-father as they fear she is a danger to herself and others. Joleen recently ran away from home and went missing for 10 hours. Mother, Theresa, reports that Joleen becomes verbally aggressive with her and her siblings and twice, has pushed her mother up against a wall.
Joleen is about 68 inches tall and weighs about 246. There is a history of Diabetes and Hypoglycemia in the family and mother insists that Joleen has neither but must be on a special diet eliminating sugar, carbs and fats. At home, mother has placed locks on kitchen cabinets and the refrigerator to keep Joleen from snacking and “stealing” food during the night. Mother denies that there is anything organically wrong with Joleen although her last intelligence test revealed that she was borderline mentally retarded (MR) and this test was taken when she was 8 years old.
When speaking to Joleen, she states that she did not run away but that she went to the nearby corner store because she was mad at her mother. “I didn’t want to do my chores so I just went to the store and I asked a man for some money to buy a coke and some chips. After I ate them I went to my grandma’s house and stayed there for a little while then I went to my friend’s house. Then I went home. When I was walking home, I saw the police at my house and I thought my mom called the police on me because I pushed her so I was pissed. ”
Joleen reports that she has problems at school because other children tell her she is an ogre and that she is ugly and dumb. “They don’t know what they are talking about because I have a lot of boyfriends”. When asked what she thinks a boyfriend is, Joleen replies, “a boy that is a friend, duh”. Joleen denies any sexual relations or physical touching with boys but states, “well I have one boyfriend I wanna kiss and that’s the Jonas brothers. They are all my boyfriends”. Joleen states that when she grows up she wants to be a mother and a wife.
Joleen has some difficulties engaging in conversations with others because of her level of understanding and her inability to stay focused. She is very forgetful and tends to lose interest easily. 13. CASE STUDY: DEMETRIUS Demetrius is a 32 year old male, homosexual and the youngest of 3 brothers. He has been in and out of treatment since he was 19 years old, after “coming out of the closet” to family and friends. When Demetrius was 10 years old it was discovered that he had been sexually molested by his older brother, the middle child, Shawn, since he was 6 years old.
Shawn, 11 years old at the time, began molesting Demetrius by touching his genitals, then with digital penetration which eventually led to oral and penal penetration. Demetrius, being a young child, knew that the sexual acts he was engaging in with his brother was wrong but he recalled being too afraid to tell his parents for fear of humiliation and embarrassment. Demetrius stated, “My brother and I were close and I really didn’t have a lot of friends to play with so I knew that if I told on my brother, that he would get into serious trouble and something bad would happen to him, leaving me alone”.
Demetrius shared rooms with his brother Shawn until his mother walked in on the boys having sexually intercourse and decided to move Shawn into a separate bedroom. It was about this time, that the eldest brother, Mark, turned 18 and moved out of the home. Demetrius states that his parents put him in a room next to theirs and placed alarms on the door to sound if he opened his room in the middle of the night and to alert them if Shawn had entered the room. Demetrius states his window was nailed from the inside.
One important factor that bothered Demetrius about the molestation was that his parents never called authorities but soon after the discovery, tried to engage the boys in therapy and family therapy. “My parents were big time church goers and we were forced to learn scriptures and so forth so it really hurt my family when I came out of the closet. I do blame my brother though that I am gay because I don’t think I would have been if he hadn’t done what he did”. Demetrius is seeking help to deal with feelings of inadequacy and anxiety. “I sometimes wish I had never been born.
I think of ways to hurt myself. I find partners that will hurt me sexually and I don’t know why. I don’t go home for family gatherings because even though my brother and I worked through some of what happened I still get angry, I hate him but then I wonder what it would have been like if we continued. ” Demetrius was arrested for public indecency 2 years ago and has numerous complaints against him from individuals at nightclubs and social gatherings, that he rubs up against them and touches people inappropriately in crowds, particularly men. I started doing drag shows at a small gay nightclub and I really like it”. Demetrius states that he sometimes uses large doses of ecstasy and one night he found himself roaming around downtown in a dress and heels asking strangers to rape him. “I think if I just OD on something and never wake up tomorrow, it would be a better world”. Demetrius reports that since the molestation that he has had recurrent problems with bowels and experiences constipation and enuresis.
Demetrius acknowledges that he has had some successes in the past year with singing and playing the piano at a lounge. He states he was asked to sing and play the piano full-time and even asked by a local band to join them. He states he always loved music as he was part of the church choir but since he disclosed his homosexuality, he refuses to go back to church. “It was humiliating when all this happened with my brother and I because my mom like announced it to everyone at church and asked everyone to pray for us. I was younger but I know it had to hard on my brother.
Can you imagine standing in front of a whole congregation and having your mother tell them pray for my sons because they have been fornicating with one another? It was awful! I couldn’t get any friends, especially girlfriends and there were a lot of older boys that used to tell me things like, I’ll give you 5 bucks for a blow job. Sometimes I did it and sometimes I didn’t. Didn’t matter, they thought I was trash anyways. ” 14. CASE STUDY: ANNA Anna is a 21 year old, Caucasian female from Los Alamos, NM. Anna comes to care after being found playing “tag” with cars on the highway.
She appears pale, emaciated, withdrawn and psychotic. Spectators claim that Anna ran out from the side of the road and was laughing hysterically and running after cars and touching them. She was attempting to punch windows and knock off mirrors of passing cars. She is extremely slender, almost anorexic but the deputy attending states it took 3 large grown men to hold her down and get her off the road. Deputy reports that Anna lives alone in an apartment with minimal furnishings and stated he found only coke, chips and candy in her refrigerator.
Anna’s mother lives on the other side of town and is a foster parent, with Anna being her only child. Anna’s mother, Laverne, states that she lost control of Anna when she was about 15 and when she turned 17, she let the young girl move out and live on social security she received from her father’s death. Laverne admits that she rarely checks on Anna and states that ever since Anna was a young child she often ate only chips, plain baked potatoes, water or coke and nothing else because she feared that everything was poisoned. Anna reports that she hears voices. “They make me laugh, they’re funny”.
Anna denies any visual hallucinations but is obviously unnerved, unable to stay still and asks to sleep. Anna walks a short distance, lays down and goes to sleep. Anna refuses to eat and states she only wants Cheetos and a baked potato. Anna states she has never had a menstrual cycle and does not know what puberty is. Laverne does not know where or how her daughter has been surviving for the past two years or so. She claims that Anna took medications when she was younger but cannot recall the names of the medications now or what they were for. Laverne states she knows one medication is for asthma.
Anna reports that she hates her mother then cries and says she loves her and misses her and wants to go home. She complains of headaches, feeling tired, thirsty and then she becomes extremely hyperactive and aggressive. During her bouts of aggressiveness she appears to be swinging her arms and trying to hit someone or something that is not visible to anyone else in the room. Anna is considered an adult and Laverne never took her for any type of psychological testing or assessment as a child; therefore Anna can sign herself in and out of treatment as she pleases and can refuse treatment.
She, however, poses a threat to herself and the community. There appears to be several issues that are preventing Anna from functioning normally and will require some cooperation on her part or at least direct observation. 15. CASE STUDY: MARK Mark is a 23 year old male with a history of aggression and violence. Mark has a tendency to physically attack others without provocation. This 23-year-old male suffered a closed head injury at age 17 in which he landed on his head due to a pole-vaulting accident at a high school track meet.
Since the fall, he suffered from bipolar disorder (rapid-cycling mood swings), seizures (2-3 per day), daily headaches, daily neck and back pain, and sleep disorder (he would often be awake for 24-36 straight hours before finally going to sleep and then often would sleep for 24 or more hours). He was taking Tegretol for bipolar disorder and pain medication for headaches. During this patient’s upper cervical exam, an upper neck injury was found, most likely stemming from the pole-vaulting accident.
The injury was compromising this patient’s brain and spinal cord function. After five months of upper cervical care, all mood swings, headaches, seizures, pain, and sleep trouble were corrected, and all medications were discontinued. Six months later Mark seeks treatment as he is beginning to experience fluctuating mood swings that he cannot seem to control and states that he gets into moods of extreme excitability and feels like he can do anything. “Sometimes when I get in this mood I will go without sleeping all together and just say up all night.
I get crazy ideas to do all kinds of things and I scare my roommate who tells me about it later and I don’t remember doing any of those things but if I do, I just can’t help it”. Mark reports that he is not only having these bouts extreme hyperactivity, but he is also experiencing bouts of extreme sadness and feelings of hopelessness. “I can’t get out of bed on these days and I get the worst thoughts about life and people”. Mark is not socializing during his depression episodes but then finds himself to be the daredevil and life of the party during his hyper times. 16.
CASE STUDY: TERRI Terri is a 45 year old housewife, caregiver, mother and business woman. Terri always felt that perhaps she was not as good as other people were, therefore she kept to herself mostly, and avoided most all social interactions. She’s been married for the past ten years to a wonderful man and she also has become the caregiver of her 84 year old mother, who had Alzheimer’s Disease, by moving the mother into her own home. Terri’s 23 year old daughter lives next door with Terri’s three year old granddaughter, who spends a lot of time at her Grandma’s home.
Terri also works from home by maintaining and designing web sites for businesses and also by her Ebay business that she runs, all from her pc at home. Terri has had problems with her blood pressure going high at times and has been treated for this and for depression. About a year ago, Terri became very depressed and cried a lot about almost anything at any time. That was when the doctor prescribed Celexa for her. She ended up going off of it because of the sleep interruptions and the drowsiness and crabbiness during the days.
With Celexa, she found herself in a don’t care mood most the time and her work suffered from this. A few weeks ago, the depression got very worse, Terri cried and slept every free moment just trying to escape the sadness. If she wasn’t sad, she was extremely angry with most everyone for various reasons. At times she would think of how other people were mistreating her and doing her wrong. She thought the world was unfair and rude and she began to react by withdrawing even more into her own shell. A few days ago, Terri’s blood pressure was checked by a health nurse and found to be at 156 over 104.
The next morning, Terri checked into the doctor’s office to get her blood pressure pills re-prescribed. When she told him that she had discontinued the Celexa, he questioned her about the reasons for this. After asking her if she had experienced any outstanding experiences lately, such as being promiscuous or wild rides in her car, Terri looked at him blankly and said she had not. She did admit to having started many many projects and not completing any of them due to lack of continuing interest. She also confessed to having many mood swings, such as extremely angry, sad, happy or mainly extremely depressed most of the time.
The doctor told her he believes her to have a Bipolar disorder and that he recommends she visit a psychiatrist. Terri felt insulted and questioned him about this. He then announced that perhaps they could just try medication first and see if it helps. He prescribed Wellbutrin for her and she has been on it for the past 4 days now. Terri has experienced some stimulation from the new medication such as more energy, but then a crashing down to tears and depression, and then anger again. Terri wonders if she is going to get better and if the medication is adding to her problems.
Today is the fourth day though, and she is feeling better and not being depressed much today. Just a little tired. Quite a giant switch from yesterday, when she woke up and requested to go fishing in the rain, or to another town for the day, or downtown to visit every coffee shop in the area, or just to go anywhere different for awhile. Her husband refused to ok any of this. Terri ended up crying most of the day and feeling anger mixed in with the depression so bad that she cleaned her bedroom and threw out many of her own clothes. She felt a driving need to burn off the anger.
Afterwards, she did not talk very much at all and refused to eat also. By the evening, she just felt resigned and tired. But then in late evening, she decided to go miles out of the way to eat at a fish camp and take her mom along. Her husband agreed to this. Afterwards, she decided to visit her sister whom she has not corresponded with for over three years. She later came home in a happier mood and slept well. Terri has called her mother’s caseworker and her mother will be trying a trial stay at the nursing home soon, in order for Terri to get some rest.
She may then decide to leave her mother there if it works out. She wishes she had told the doctor of her other phobias also. She is afraid to drive the car and go anywhere alone in it. She refuses to meet strangers to discuss business and has suffered financially from this. She even has a problem talking to strangers over the telephone Terri is a 45 year old housewife, caregiver, mother and business woman. Terri always felt that perhaps she was not as good as other people were, therefore she kept to herself mostly, and avoided most all social interactions.
She’s been married for the past ten years to a wonderful man and she also has become the caregiver of her 84 year old mother, who had Alzheimer’s Disease, by moving the mother into her own home. Terri’s 23 year old daughter lives next door with Terri’s three year old granddaughter, who spends a lot of time at her Grandma’s home. Terri also works from home by maintaining and designing web sites for businesses and also by her Ebay business that she runs, all from her pc at home. Terri has had problems with her blood pressure going high at times and has been treated for this and for depression.
About a year ago, Terri became very depressed and cried a lot about almost anything at any time. That was when the doctor prescribed Celexa for her. She ended up going off of it because of the sleep interruptions and the drowsiness and crabbiness during the days. With Celexa, she found herself in a don’t care mood most the time and her work suffered from this. A few weeks ago, the depression got very worse, Terri cried and slept every free moment just trying to escape the sadness. If she wasn’t sad, she was extremely angry with most everyone for various reasons.
At times she would think of how other people were mistreating her and doing her wrong. She thought the world was unfair and rude and she began to react by withdrawing even more into her own shell. A few days ago, Terri’s blood pressure was checked by a health nurse and found to be at 156 over 104. The next morning, Terri checked into the doctor’s office to get her blood pressure pills re-prescribed. When she told him that she had discontinued the Celexa, he questioned her about the reasons for this.
After asking her if she had experienced any outstanding experiences lately, such as being promiscuous or wild rides in her car, Terri looked at him blankly and said she had not. She did admit to having started many many projects and not completing any of them due to lack of continuing interest. She also confessed to having many mood swings, such as extremely angry, sad, happy or mainly extremely depressed most of the time. The doctor told her he believes her to have a Bipolar disorder and that he recommends she visit a psychiatrist.
Terri felt insulted and questioned him about this. He then announced that perhaps they could just try medication first and see if it helps. He prescribed Wellbutrin for her and she has been on it for the past 4 days now. Terri has experienced some stimulation from the new medication such as more energy, but then a crashing down to tears and depression, and then anger again. Terri wonders if she is going to get better and if the medication is adding to her problems. Today is the fourth day though, and she is feeling better and not being depressed much today. Just a little tired.
Quite a giant switch from yesterday, when she woke up and requested to go fishing in the rain, or to another town for the day, or downtown to visit every coffee shop in the area, or just to go anywhere different for awhile. Her husband refused to ok any of this. Terri ended up crying most of the day and feeling anger mixed in with the depression so bad that she cleaned her bedroom and threw out many of her own clothes. She felt a driving need to burn off the anger. Afterwards, she did not talk very much at all and refused to eat also. By the evening, she just felt resigned and tired.
But then in late evening, she decided to go miles out of the way to eat at a fish camp and take her mom along. Her husband agreed to this. Afterwards, she decided to visit her sister whom she has not corresponded with for over three years. She later came home in a happier mood and slept well. Terri has called her mother’s caseworker and her mother will be trying a trial stay at the nursing home soon, in order for Terri to get some rest. She may then decide to leave her mother there if it works out. She wishes she had told the doctor of her other phobias also. She is afraid to drive the car and go anywhere alone in it.
She refuses to meet strangers to discuss business and has suffered financially from this. She even has a problem talking to strangers over the telephone 17. CASE STUDY: JACK Jack is a 27 year old man diagnosed with schizophrenia. He has been referred to Top Quality Rehabilitation (TQP) to provide supported employment services. Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small videocameras in the returned tapes to catch him making mistakes.
Jack became increasingly agitated at work, particularly during busy times, and began “talking strangely” to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had “surveilance photos of him that were being reviewed by the CIA”. After about a year Jack quit his job one night, yelling at his boss that he couldn’t take the constant abuse of being watched by all the TV screens in the store and even in his own home. Jack lived with his parents at that time. He became increasingly confused and agitated.
His parent took him to the hospital where he was admitted. He was given Thorazine by his psychiatrist, this is a very powerful psychotropic medication. However, he had painful twisting and contractions of his muscles. He was switched to Haldol and had fewer side effects. From time to time Jack stopped taking his Haldol, and the voices and concerns over being watched became stronger. During the past 7 years Jack was hospitalized 5 times. He applied for and now receives SSI, and with the assistance of a case manager has moved into his own apartment.
He is now a member of a psychosocial “clubhouse” for people with mental illness. He attends the clubhouse 3 times a week. He answers the phone, and helps write the clubhouse newsletter. He has a few friends at the clubhouse, but he has never had a girlfriend. Jack told his case manager he would like to get a job so he can earn more money and maybe buy a car. Jack is very worried about looking for a job. He doesn’t know how to explain his disorder to a potential employer, and he is afraid of becoming overwhelmed. He likes movies and would like to work with them in some manner. 18.
CASE STUDY: DAL Dal is an attractive young woman, 26 years old, but seems to be unable to maintain a stable sense of self-worth and self-esteem. Her confidence in her ability to “hold on to men” is at a low ebb, having just parted ways with “the love of her life”. In the last year alone she confesses to having had six “serious relationships”. Why did they end? “Irreconcilable differences”. The commencement of each affair was “a dream come true” and the men were all and one “Prince Charming”. But then she invariably found herself in the stormy throes of violent fights over seeming trifles.
She tried to “hang on there”, but the more she invested in the relationships, the more distant and “vicious” her partners became. Finally, they abandoned her, claiming that they are being “suffocated by her clinging and drama queen antics. ” Is she truly a drama queen? She shrugs and then becomes visibly irritated, her speech slurred and her posture almost violent: “No one f***s with me. I stand my ground, you get my meaning? ” She admits that she physically assaulted three of her last six paramours, hurled things at them, and, amidst uncontrollable rage attacks and temper tantrums, even threatened to kill them.
What made her so angry? She can’t remember now, but it must have been something really big because, by nature, she is calm and composed. As she recounts these sad exploits, she alternates between boastful swagger and self-chastising, biting criticism of her own traits and conduct. Her affect swings wildly, in the confines of a single therapy session, between exuberant and fantastic optimism and unbridled gloom. One minute she can conquer the world, careless and “free at last” (“It’s their loss. I would have made the perfect wife had they known ow to treat me right”) – the next instant, she hyperventilates with unsuppressed anxiety, bordering on a panic attack (“I am not getting younger, you know – who would want me when I am forty and penniless? “) Dal likes to “live dangerously, on the edge. ” She does drugs occasionally – “not a habit, just for recreation”, she assures me. She is a shopaholic and often finds herself mired in debts. She went through three personal bankruptcies in her short life and blames the credit card companies for doling out their wares “like so many pushers. She also binges on food, especially when she is stressed or depressed which seems to occur quite often. She sought therapy because she is having intrusive thoughts about killing herself. Her suicidal ideation often manifests in minor acts of self-injury and self-mutilation (she shows me a pair of pale, patched wrists, more scratched than slashed). Prior to such self-destructive acts, she sometimes hears derisive and contemptuous voices but she know that “they are not real”, just reactions to the stress of being the target of persecution and vilification by her former mates.
