Case 10 - Thomas F.

Thomas F. was brought to therapy by his wife, who reported that he was having "crazy ideas about her." Tom maintained that his ideas were not crazy and insisted that his wife was having affairs with at least two men, both family friends.

Tom, forty-seven, and Carmen, forty-two, had married three years ago after a courtship of five year's duration. This was the second marriage for both. Tom had three children from his first marriage; these children lived out of the country with their mother. Carmen's only child from her first marriage had been killed in an accident when he was ten years old. Since they had lost the children from their first marriages, Tom and Carmen hoped that they would be able to have children together and reported being extremely happy when Tom, Jr., was born almost a year ago. However, their son brought considerable stress into their lives.

Tom and Carmen had met at the computer firm where both worked, Tom as a programmer and Carmen as administrative assistant. They were together almost constantly, both at work and at home. However, when their son was born, Carmen took a position at a local hospital, working nights in the admissions room, so that someone would always be available to care for their son. Tom was home with him during the evenings and nights, and Carmen was with the child during the day. They saw very little of each other, and nearly all of their energy was focused on parenting. Both had few friends or outside interests to give them support. They had bought a new house, and added debts prevented them form going out frequently, as they had when they were dating. In addition, Tom's mother had cancer, and Tom and Carmen were trying to spend as much time as possible helping her.

About two months ago, Tom began to express suspicions about how Carmen was spending her daytime at home. She assured him that she was too exhausted to do much more than care for Tommy, maintain the house, and try to get some sleep. However, tom's accusations grew worse, and he insisted that Carmen was having sexual relationships with at least two men in his absence. During this time, he continued his job as a programmer; and, except for several days in which he had left work precipitously in an effort to catch Carmen with her purported lovers, his performance at work had been unaffected. There was no prior history of mental disorder in either Tom or any of his first-degree relatives.

An excellent review of Psych movies

You can find an extensive collection of psychology related films at

http://www.psychmovies.com

While your there, participate in a brief survey of your favorite and worst psych films.

Popular Films With a Theme of Psychological Disorder

A Beautiful Mind
Agnes of God
Amadeus
As Good as it Gets
Awakenings
Benny and Joon
Birdy
Blue Sky
Clean and Sober
Don Juan de Marco
Eating
Eqqus
Fight Club
Frances
Good Will Hunting
I Never Promised you a Rose Garden
I’m Dancing as Fast as I Can
Inside Moves
Interiors
King of Hearts
Madness of King George
Mosquito Coast
Mr. Jones
Nell
One Flew Over the Cuckoo’s Nest
Ordinary People
Prince of Tides
Rainman
Slingblade
Sophie’s Choice
Sybil
The Dream Team
The Shining
The Snake Pit
The Three Faces of Eve
The Fisherking
Thelma and Louise
Truly, Madly, Deeply
Unstrung Heroes
What about Bob
What’s Eating Gilbert Grape
When a Man Loves a Women
Who's afraid of Virginia Woolf?
Whose Life is it Anyway?
Women Under the Influence
Ya Ya Sisterhood

Major Case Study – Movie Review

Purpose: The purpose of this assignment is to observe an individual(s) who is struggling with abnormality. The story may be fiction or non-fiction. To potentially receive a high grade, the focus of your paper will be on the individual, not on the plot or theme of the movie. In some rare cases, the focus of the movie review paper may be on a faulty mental health or family "system."

1. Focus on the individual:

A. What do you observe about the person, their thoughts, feelings, behaviors?
B. According to the definition(s) presented in both lecture and the texts, is this person acting abnormal?
What are their difficulties?
C. Is a diagnosis given in the film? Is it correct? How was it made? How would you alter the diagnosis?
What do you think the diagnosis is?
D. What are the primary, predisposing, or precipitating causes of their disturbance?
E. How does their history relate to the disturbance?
F. Take a particular model of causality (e.g. biological, psychodynamic) and apply it to this case.

2. Focus on the environment:

A. Are there any environmental influences that you believe are influential to the person's disturbance?
(e.g. the era, the institution, the dysfunctional family, the therapist's practice)
B. Does the movie accurately portray the person? Or, do you believe the case is distorted by
"Hollywood"
C. How do others respond to this person? Focus on both mental health professionals and family
members.
D. If treatment was given, was it helpful, harmful?
E. What do you believe would have helped the person improve/change?

3. Do A Client Map

These are just some questions to ask yourself. Be creative. Each movie, each story is different and should provide a different focus to your paper. Work from your own experience and current
knowledge base. Do not feel that you have to do "research." To potentially receive a high grade, you should not simply answer the above questions, but rather address your main character with these prompting questions in your mind.

Remember to write clearly and in a well-organized manner.

Case 9 - More Than a Five-Fingered-Discount

"Fifteen years!" It was how long Winona had been shoplifting, but from the expression on her tear-streaked face, it might have been the length of her sentence.

Winona was 27, and this was her second arrest, if you didn't count the one as a juvenile. Three years earlier, she had been arrested, booked, and released on her own recognizance for walking out of a boutique with a silk blouse worth $150. Fortunately for her, two weeks later the shop fell victim to the recession; the owner, otherwise preoccupied, did not follow through with the prosecution. Badly frightened, she had resisted the temptation to shoplift for several months afterward.

Winona was married and had a four-year-old daughter. Her husband worked as a musician. After her previous arrest, he had threatened to divorce her and obtain custody of their child if she did it again. She worked an actress prior to being a homemaker. A conviction could doom her return to work.

"I don't know why I do it. I've asked myself that question a thousand times." Aside from stealing, Winona considered herself a pretty normal person. She had lots of friends and no enemies; most of the time she was quite happy. In every other respect she was law-abiding; she wouldn't even let her husband cheat when he prepared their taxes.

The first time Winona had ever stolen from a store was when she was six or seven, but that was on a dare from two school friends. When her mother found the candy she had taken from the convenience store, she had gone with Winona and made her return it to the store manager. It was years before she was tempted to steal again.

In junior high, she noticed that periodically a certain tension would build up inside her. it felt as if something deep within her pelvis itched and she couldn't scratch it. For several days she would feel increasingly restless, but with an excited sense of anticipation. Finally she would dart into whatever store she happened to be passing, whisk some article under her coat or into her handbag, and walk out, flooded with relief. For a time it seemed to be associated with her menstrual periods, but by the time she was 17, these episodes had becomoe completely random events.

"I don't know why I do it," Winona said again. "Of course, I don't like being caught. but I deserve to be. I've ruined my life and the lives of my family. Its not as if i needed another compact - I must have 15 of them at home."

Case 8 - The Case of George W.

George w., a thirty-six-year-old white male, was referred for therapy by the courts. Following his third conviction for driving while intoxicated, George had been sentenced to a six-month stay in a work-release program. Therapy was required as part of his participation in that program.

George began using alcohol when he was fourteen years old and had been drinking excessively since that time. His father, his maternal grandfather, and two of his three brothers all abused alcohol. George had been married to his second wife for two years and had a one-year-old child. his first marriage had ended in divorce four years earlier, partly because his wife would no longer tolerate George's drinking. He had maintained contact with his two children from that marriage.

George was employed as a supervisor for a construction firm. He had been with the same company for over ten years and had a good work record. He consumed little alcohol during the day, but on most evenings he would begin drinking beer as soon as he returned home from work, and he also drank on most weekends. He had tried to stop drinking on his own repeatedly and had been alcohol free for six months when he married his present wife. However, he stated that financial difficulties associated with the birth of their child led him to resume drinking. George reported frequent weekend episodes of binge drinking and occasional blackouts. He said that his wife was unhappy about his drinking and expressed disappointment that they never went out; but sincee she was always absorbed in caring for the baby, he did not believe going out mattered any more to her than it did to him.

George reported some mild depression and stated that he was very shy and never felt comfortable around people. Alcohol had helped him feel more self-confident, so that he was able to establish relationships with a group of male peers who also drank to excess. The possibility of an underlying avoidant personality disorder was considered. Otherwise, George's difficulties all seemed related to his alcohol use.

Case 7 - The Misdirected Gentleman

Henry McWilliams had been born in London. Dressed in his short grey pants, white shirt, and school tie, he rode the London underground every day to his exclusive school. One day, when he was nine, he saw a man rubbing up against a woman on the Underground.

Henry was small when he was nine, and even in the crowded subway car he has an excellent eye-level view. The woman (she was an adult, though Henry had no idea how old) was a bit overweight and dressed in a tight-fitting mini-skirt. She was facing away from the man, who allowed the weight of the crowd surging through the doors top press him up against her. The man tugged at his crtoch, and then, as the train began to move, rubbed himself against her.

"I never saw her face, but I could tell she didn't like it," said Henry. "She tried to push him away, she tried to move, but there was no place for either of them to go. Then the train stopped and he ran out the door."

Henry the adult, age 24, had now referred himself for treatment. He had moved with his parents to the United States when he was 15. Since his graduation from high school, he had worked as a messenger for a large legal firm. Many days he spent on the subway in his official capacity. He guessed that he had rubbed against 200 women in five years. He was seeking help at the insistance of one of the partners in his law firm, who the week before had happened to ride the same train and watched him in action.

When Henry was in need, he would go into the men's room and put on a condom so as not to stain his trousers. Then he would roam up and down the outskirts of a crowd on a subway platform until he found a woman who interested him. This would be someone who was youngish but not young ("They're less likely to scream."), and well-rounded enough to stretch tight the material of her skirt or slacks. He especially liked it if the material was leather. He would board after she did, and if she did not turn around, would rub his erection up and down against her buttocks as the train began to roll.

"I'm very sensitive, so it doesn't take much pressure." Sometimes the woman didn't even seem to realize what was going on, or maybe she didn't want to admit it, even to herself. He usually climaxed within a minute. Then he would bolt out the door at the next stop. In the event that he was interrupted, he would hang out around the platform until he spotted another woman in another crowd.

"It helps if I imagine that we're married or engaged," he explained. "I'll pretend that she's wearing my ring, and I've come home for a quickie."

Case 6 - Melvin B.

Melvin B. a sixty-two-year-old black male, was referred for therapy by his physician. He had been diagnoses as having gastric ulcers

Case 5 - The Case of the Quiet Zombie

An eleven-year-old girl asked her mother to take her to a psychiatrist because she feared she might be "going crazy." Several times during the last two months she has awakened confused about where she is until she realizes she is on the living room couch or in her little sister's bed, even though she went to bed in her own room. When she recently woke up in her older brother's bedroom, she became very concerned and felt quite guilty about it.

Her younger sister says that she has seen the patient walking during the night, looking like a "zombie," that she didn't answer when she called her, and that the patient has done that several times, but usually goes back to her bed.

The patient fears she may have "amnesia" because she has no memory of anything happening during the night.

There is no history of seizures or of similar episodes during the day. An electroencephalogram and physical examination prove normal. The patient's mental status is unremarkable except for some anxiety about her symptoms and the usual early adolescent concerns. School and family functioning are excellent.

Child Case - Baby Susan

Susan was admitted to the hospital at age 6 months by an aunt for evaluation of failure to gain weight. She had been born into an impoverished family after an unplanned, uncomplicated pregnancy. During the first four months of life, she gained weight steadily. Regurgitation was noted during the fifth month, and increased in severity to the point where she was regurgitating at every feeding.

After each feeding, Susan would engage in one of two behaviors:

1) She would open her mouth, elevate her tongue, and rapidly thrust it backward and forward, after which milk would appear at the back of her mouth and slowly trickle out; or

2) She would vigorously suck her thumb and place fingers in her mouth, following which milk would slowly flow out of the corner of her mouth.

In the past two months, Susan had been cared for by a number of people, including her aunt and paternal grandmother. Her parents were making a marginal marital adjustment. Nevertheless, Susan often smiled and was responsive to all of her caregivers.