23 Mar 2015
In most cases psychologists draw their diagnostics by conducting an interview with their clients like the one conducted by Louise on Margaret. This is based on the fact that understanding ones problem from the horse's mouth is easier. There are various factors that may be deduced from such an assessment. For example Louise was able to identify many changes that her client has undergone and the difficulty she faces in dealing with them.
There are also social factors that can not be understood otherwise that impact greatly on many people with psychological disturbances. It was also as a result of this assessment that the client reported her recent memory loss that shows her awareness of her abnormal conditions. Therefore this assessment was meant to determine what ails Margaret and thereafter draw some useful therapies to help her go back to normalcy.
In her conclusion Louise drew some conclusions concerning Margaret's condition. Margaret reported some changes in her menstrual periods. She noticed a change in her moods which has partly contributed to her moodiness although this could be as a result of hormonal imbalance due to menopause considering Margaret's age. Further, Louise underlined Margaret's dealing with her son being away and her inaccessible daughter as she is too much preoccupied with her child. Margaret is diagnosed to be struggling with this change of life hence her condition.
Louise also drew from Margaret that she has become frequently forgetful and she is aware of it. She is also aware of her change of mood and reaction towards her daughter which she does not want her to discover. This could be attributed to her general feeling of anger and loss thus; she has lost interest in life.
This show of self awareness is depicted when Louise asked her about her anger towards her daughter. She burst to tears because Louise had discovered her true feelings towards her daughter which she was concealing. The reactions portrayed by Margaret during the assessment are the best example of another dimension of Margaret's psychological assessment. Margaret portrays anger and sadness following her relation with her daughter. She believe that her daughter rushed into marriage and she is now less concerned about her. It was also concluded that due to pervasive anxiety she loses sleep, overeat, over drink, has spasmodic moods and memory distractions. As a result of this she has gained extra weight that she sees as part of her problem.
In the Margaret's assessment, psychological testing is vital because it would test her take on her condition. For example whether she appreciates change or to whom does she hold responsible for her condition. Self proclamation is important as it is out of such discussions that a professional draws conclusions on how to handle the situation. This is called mental status evaluation in which the coherence in thought is assessed. Due to her history of her family, she could be judged as having depression. Margaret's father is reported to have died when she was three and this led to her mother being away from home most of the times. That could be the reason for her unconscious suppressed desire not to separate from her children.
Physical screening for Margaret is necessary in order to diagnose various possible complications that may be evident as a result of the signs and symptoms she narrated. There are several problems that could be confirmed in the course of medical examination. Medical testing could rule out her biological hormonal imbalance following the previous hormonal test done to the patient.
Considering her age and the frequent premenstrual moodiness, it is logical to rule out hormonal imbalances related to menopause. Possible complications for Margaret's case include memory lapse due to memory losses witnessed and neurological malfunction. Physical examination may also be useful in confirming the reason for her overweight and the increased appetite that has devastated her sex life.
Case study two: Lillian
Case two illustrates Lillian's defense in life where she draws confidence in herself by her personality disorder. Her defense of splitting is her major preoccupation in dealing with her situation. Right from the onset, she complains and enquires as to why her life is being made difficult by what she refers to as some idiot. What follows is a description of how other people have blocked her way always. Her description of the event that unfolded in the coffee line proves that she is the problem but her weaknesses are evident on her mistreatment and blame on others. This way according to her, she is not the problem, the problem is from without.
Lillian is also very sensitive on matters of gender discrimination as she cites that her former boss treated her badly because she was a woman. She resorts to finding solution in the workers union. This is a commonsensical issue but she doesn't care anyway because she is not the problem. Her problem is proved further by the fact that she currently does a housekeeping job even after college education. Before this, she has gone down the stairs and lost six jobs in ten years. Her social life is limited to her drinking friends, unstable lasting sexual relationships with men she meets at the bar. She uses her drugs to soothe her nerves. This is helpful because it would be worse if she reduces herself to depression due to self blame. This is necessary from her point of view because she feels better about herself when she does so.
Lillian's constant anger in borderline personality disorder may be natural or inborn. History proves that Lillian even before her father died she would conflict with her mother where her father sided with her. This proves that she could have natural tendency to have bouts of anger. Her father could have been that kind as demonstrated by his support and siding with her in her row with her mother. If her father did not see any cause of hunger in her daughter both could have something shared.
There is also a possibility that Lillian's condition could be as a result of disappointment and many failures in life. Lillian has had a string of disappointment in her employment. She losses jobs and has plummeted to a position of a housekeeper. This could turn her to anger. In her social life, we are also told that she feels guilty often but her defense is her unconscious transfer of that blame to a second person's act. This way she is elated and soothed that she is clean. Therefore there is a possibility that Lillian's anger could be both as result of some existential factors and inborn.
Lillian border line personality disorder was depended on taking very many other factors constant. It was only drawn from her blame on others and dominance of anger fluctuations from hope to disappointments in relationships, workplace conflicts, drug use and lack of self appraisal. It never considered that this could be an inborn condition. There could also be a possibility that her condition is worsened by her drug use however mild. Differential analysis could therefore ignore some important parameters influencing some situation.
Her antisocial personality disorder was ruled regardless of her self blame sometimes. She has failed to relate well with people at work, friends and even her mother because of this condition. This leads her to blaming everyone for some cause. For instance she feels her mother favors her siblings; she thinks her boss at work hates her because she is a woman and generally feels victimized by other people's acts. Lillian justified her misbehavior as drug use as a response to the stress caused by other people who she finds as a problem.
Lillian's anxiety disorder is born of her desire to expect too much from others. She expected too much of a laxity from her boss that she had to be sacked. she expects too much from her mum and also from the society especially from the union representative and thus it is hard to avoid disappointments and disillusionments
Case study three: Jim
In Case three we are introduced to Jim and his situation that requires psychotherapy. A very good example of a vegetative sign of depression is his inability to sleep which is consistent. This is accompanied by his extreme feeling of despair and anxiety. Sigmund Freud, an expert in the field of psychoanalysis would analyze depression as anger turned against self. This can apply to Jim because he is blaming himself for ruining his girlfriend's life when he abandoned her.
There is also the issue of body and mind struggle. Normally the two entities coordinate harmoniously to produce the normalcy in life. However, his case is different with all the depression. His mind contemplates suicide in order to punish himself and as a result he has shed off much of his weight. Jim's body and mind, as result of this struggle and depression are now enemies.
Another struggle between his mind and body is seen whenever he comes up with a painting. He literally ends up destroying it. There is a contest and infighting of his mind and body and thus he poses the biggest danger to himself more than to anyone else. It is for this chief reason that the clinical findings prescribes that protective hospitalization is required until medication and psychotherapy work on him.
A mood congruent delusion is a state where by some one is inconsistent in their usual mood that affects the reinterpretation of things in another way. For example Jim is not consistent in his former behavior when he started looking at himself as a destroyer. His way of perception changed as a result of his depression and self blame. He has conceptualized a world of depressed thoughts and thought patterns that are confirming his melancholy.
Actually all what Jim ails from is anger. He is for sure angered at himself for ruining his girlfriend's life. That is why he has had relentless attacks of himself resulting to depressed behavior, thought processes and mood fluctuation. There is some evidence of concealed anger in Jim. One reason he can conceal this is because he may have loved his girlfriend so much that hurting her would devastate him too.
Secondly he sees himself as selfish when he turned down her request. He might have deep seated regrets as to why life let him meet a girl who did not understand him when he presented his case. He may conceal this because first he has himself to blame and has made out his decision though unconsciously to punish himself. This leads him to spend most time fantasizing his physical health and contemplating suicide. His dreams at night would reveal his concealed fears and desires as it is theorized by Sigmund Freud in his interpretation of dreams.
From the onset, Jim was judge for himself and he declared his guilt and assigned himself punishments. He no longer finds need or pleasure in company. He spends time smoking cigarettes and thinking about his death. As a result of this self guilt, he has declined eating thus lost a good deal of weight. He has also undertaken unconscious self punishment of neglecting his hygiene and general normal life as he has imprisoned himself in bed where he buys a lot of time to think about his worthlessness and pain.
Another punishment he has subjected himself to is to destroy his creativity's products. Whenever he does a work he destroys it at the end of the day. There is also psychological punishment where his conscious is always tormented by nightmares of some gruesome women attacking him and that reduces him to crying like a child. This can be associated by his suppressed desire to punish himself and whenever this happens Jim feels that his selflessness deserved punishment.
Case four: Janet
In the forth case, the precipitating stressor event that might have kicked of Janet schizophrenic episode can be noted from the history his parent gave. There was a time when she is reported to have scratched her wrist with a razor in an act that is termed as self destructing. Then there was her being separated from her family members who used to care and support her. There are other factors that are noted in her history to have been repressed causes. She is reported that from the time she was young the girl had been shy, socially awkward and sensitive. This historic evidence shows that she has had that condition but under the cause and understanding of her family members, it had been contained. Moreover when she was seven years she had gone slowed school. The family undertook a therapy that was corrective to the situation.
In her adolescent she frequently argued with her mother although this can be attributed to hormonal changes that are experiences by many adolescents, the argument reportedly resulted to self harm. She was more provocative and worrisome although this behavior just popped in and disappeared later. Another behavior was that Jane would behave eccentrically as engaging in complex rituals to trigger her sleep. Sometimes she would not want to be seen eating, a clear indication of her psychosocial malfunctioning
Another factor that may have triggered her condition may be was her roommates and new environment. She was, on joining college, introduced to an environment which she was not probably used to. She was then left to be controlled by her long encased schizophrenia. Janet's primary delusion is her attempt to rescue herself from some inner dangers and fears. Her delusion interprets her parents and nurses as threat geared towards sabotaging her idealized salvation which is to be actualized through Dr. M. It started earlier when she would quarrel with her mother. At this age it did not come out clearly as at those formative stages her condition would retreat.
Her confidence and overexcitement in justifying her condition is rife with evidence that she is no longer self sensitive. She fantasizes with Dr M whom she has assumed as a sole hope in bringing about salvation in the world. Her delusion has reduced the world to herself. To her, the world is under attack by same threatening unknown and can be saved only when her desire to unite with Dr. M come to a reality. This is her ultimate optimism and desire to be saved or reserved.
Her delusion and hallucination fit together so that she misinterprets real life as attack. This can be traced back from when she was young. She could not understand her mother and they would pick quarrels that sometimes resorted to self destruction. The world she has been living is therefore not the real world. Her hallucinations are evident in the way she interprets Dr.M. She has conceived a Dr. M who is being blocked to reach her, even after she was instructed by a voice to merge with him and save the world.
The mistaken sensory perceptions and the way she interprets reality as a threat makes the two to fit together to produce a kind of Janet we see.
Her hospitalization saves her and others because she is a danger to others and her self. She has a terrifying intrinsic experiences described as command hallucinations. These hallucinations instruct her to do anything to herself and others. When she perceives everyone as a danger there is a possibility that she can attack anyone under the influence of her delusions. This can also be because her reality is faulty and her judging reality is misleading.
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