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For what must be my fifth assignment to write an assessment and treatment plan for a fictional character, I am now diagnosing and treating one of the heroes of my upcoming novel.
For my final paper in my favorite class so far, the assignment was to write out a course of narrative therapy with a fictional LGBTQ character. We were to include dialogue and explanations of the theoretical basis for what we were doing.
I initially meant to choose Maud, one of the two Victorian lesbian heroines in Sarah Waters' dark, twisty Gothic thriller Fingersmith
. But the Japan trip cut my time short, and I realized that the historical nature and the lack of a recent re-read meant I wouldn't be able to do it justice.
Instead, I went for a character in a contemporary novel which I knew very well, Robertson Davies' The Lyre of Orpheus. (It's the last book in The Cornish Trilogy
, but can be read alone. The character in therapy only appears in the final book.) I counseled Schnak, the inarticulate, eccentric, teenage genius composer.
Cut for being very long (7 pages double-spaced) and for containing spoilers. Though it's not really the sort of book where plot spoilers matter that much.
( Read more )
I initially meant to choose Maud, one of the two Victorian lesbian heroines in Sarah Waters' dark, twisty Gothic thriller Fingersmith
. But the Japan trip cut my time short, and I realized that the historical nature and the lack of a recent re-read meant I wouldn't be able to do it justice.Instead, I went for a character in a contemporary novel which I knew very well, Robertson Davies' The Lyre of Orpheus. (It's the last book in The Cornish Trilogy
, but can be read alone. The character in therapy only appears in the final book.) I counseled Schnak, the inarticulate, eccentric, teenage genius composer. Cut for being very long (7 pages double-spaced) and for containing spoilers. Though it's not really the sort of book where plot spoilers matter that much.
( Read more )
I need recommendations for books which are likely to appeal to an 11-year-old who likes sf, fantasy, and the Alex Rider
series, AND to a 10-year-old who likes mysteries and Lemony Snicket
. To clarify: a single book must appeal to BOTH kids.
On a completely different topic, I double-checked with my Queer Narrative professor, and got an okay to do a fictional therapy session with a queer character from a historical work. He said to just insert myself-as-therapist into their historical context. I am leaning toward one of the heroines in Sarah Waters' Fingersmith
. Lots of issues regarding social narratives, personal "stories," "problem-saturated narratives," queerness, and "madness" there! (I could also counsel them as a couple, but we haven't yet gotten into couple's counseling so I don't feel on firm ground with that.)
series, AND to a 10-year-old who likes mysteries and Lemony Snicket. To clarify: a single book must appeal to BOTH kids. On a completely different topic, I double-checked with my Queer Narrative professor, and got an okay to do a fictional therapy session with a queer character from a historical work. He said to just insert myself-as-therapist into their historical context. I am leaning toward one of the heroines in Sarah Waters' Fingersmith
. Lots of issues regarding social narratives, personal "stories," "problem-saturated narratives," queerness, and "madness" there! (I could also counsel them as a couple, but we haven't yet gotten into couple's counseling so I don't feel on firm ground with that.)For one of my classes (Queer Counseling and Narrative), I need to write a paper in which I do a "first session" counseling an LGBTQ person or couple, then write up a summary of the full course of therapy.
This is not about diagnosis, and the character does not need to have a mental illness. They just need to have some sort of issue or life circumstance which might be helped with therapy.
Can you suggest a character or characters who might be fun to do this with? Criteria:
1. They must be LGBTQ. (They don't have to necessarily explicitly identify that way.)
2. The work they come from must be contemporary (or near-contemporary) realism. No fantasy or sf.
3. Ideally, this will be something I've already read. If not, it should be something comparatively easy to read and obtain.
4. The work must be fiction.
Please give a little bit of detail if you suggest something.
This is not about diagnosis, and the character does not need to have a mental illness. They just need to have some sort of issue or life circumstance which might be helped with therapy.
Can you suggest a character or characters who might be fun to do this with? Criteria:
1. They must be LGBTQ. (They don't have to necessarily explicitly identify that way.)
2. The work they come from must be contemporary (or near-contemporary) realism. No fantasy or sf.
3. Ideally, this will be something I've already read. If not, it should be something comparatively easy to read and obtain.
4. The work must be fiction.
Please give a little bit of detail if you suggest something.
Swordspoint
Presenting Problem: Alec is a white male in his late teens or early twenties, of above-average height and below-average weight. His clothing was shabby, but his hygiene was good. Partially healed, shallow cuts were visible on his wrists when his sleeves fell back. He appeared tense and guarded. His affect was markedly labile, swinging from contempt to brittle wit to open anger to sadness. His reason for coming in was stated to be “idle curiosity.” Upon further questioning, he stated that he had recently been the victim of a kidnapping.
Client reported that the cuts on his wrists were from a suicidal gesture. He went on to recount a history of self-injury and self-destructive acts, sometimes with the intent of suicide, and sometimes as impulsive acts in the heat of emotion. When he feels emotional tension build up unbearably, he either commits a self-destructive act, or provokes someone to attack or insult him so that his lover (a swordsman) will kill the person. Client then feels relief.
Client states that he “can’t do anything right” and that he expects to die violently and young. (Client is not a swordsman himself, so this belief, which predates his kidnapping, is not realistic.) He has attacked his lover, with the knowledge that his lover is a professional killer.
Client periodically (not regularly) uses drugs, and regularly gambles. He denies addiction to either.
He denied suicidal ideation when the question was asked, but said that it could come on at any moment. Client stated that his lover is aware that he is suicidal, and is keeping an eye on him. Client stated that he might also have the impulse to have his lover kill someone at any moment.
Personal History: Client currently lives in Riverside, supported by his lover. He used to attend the University. He became upset when asked how he came to leave it, and refused to state. He also declined to give his surname.
Family Background: Client declined to say anything about his family. From his speech and manner, however, he appears to be upper class and well-educated.
Psychiatric/Treatment History: Client stated that he has had no previous diagnoses or treatment.
Differential Diagnosis: Client states that he has had both depressive and mixed (manic and depressive) episodes. He agrees that he might be having a mixed episode now. He denies recent substance abuse or somatic symptoms, and says that he has never had hallucinations or delusions.
Though client’s relationship with his lover appears to be stable and not marked by idealization and devaluation, he matches other criteria for Borderline Personality Disorder: impulsivity in at least two areas that are potentially self-damaging (drugs, gambling, deliberately provoking violence in others); recurrent suicidal and self-mutilating behavior; affective instability (intense, brief periods of anger, anxiety, or dysphoria); transient, stress-related paranoid ideation; inappropriate, intense anger.
The extreme tension followed by provocation of violence followed by relief and pleasure is similar to the pattern of impulse-control disorders like Intermittent Explosive Disorder and Trichotillomania. Since client typically does not personally commit the violent acts, but achieves relief by witnessing another do so, this is better accounted for as an Impulse Disorder Not Otherwise Stated than by IED.
Rule out Antisocial Personality Disorder. Client is impulsive, exhibits reckless disregard for the safety of self and others, lacks remorse, and is irritable and aggressive. However, there is no evidence of a previous Conduct Disorder, and the antisocial behavior may have been during the course of Mixed Episodes.
Substance use and gambling don't appear to meet criteria for abuse, but client may be minimizing his use.
Rule out PTSD. Client's PTSD-like symptoms predate his kidnapping.
Recommendations:
5150 (involuntary psychiatric hold) for being a danger to himself and others.
An immediate medication consultation.
Individual therapy services to address his Bipolar I Disorder, Impulse Control Disorder, Borderline Personality Disorder, and recent trauma.
Referral to local Narcotics Anonymous Group to address his history of substance use.
Axis I (clinical disorders): Bipolar I, Most Recent Episode Mixed, Recurrent, Without Full Interepisode Recovery, Without Dysthymia, With Rapid Cycling. Currently in a Mild Mixed Episode. Impulse Disorder Not Otherwise Stated (compulsion to provoke others to commit violent acts.)
Axis II (personality disorders and mental retardation): ): Borderline Personality Disorder.
Axis III (general medical conditions): ): None.
Axis IV (psychosocial and environmental problems): ): Domestic violence. Victim of kidnapping. Unsafe neighborhood.
Axis V (GAF: Global Assessment of Functioning): ): 20. Some danger of hurting self or others. (Suicide attempts without clear expectation of death; frequently violent or provoking violence in others.)
Rachel’s note: This was a tough one. I went ahead and diagnosed Bipolar I, but it’s hard to tell from textual evidence whether that’s actually going on, or whether Borderline could account for everything all by itself. I also diagnosed an Impulse Control Disorder, though technically you’re not supposed to if it might be caused by some other condition (like mania), because it was such a significant pattern that I thought it was worth getting its own diagnosis.
I reasoned according to a safety hierarchy, which states that you should err in favor of diagnosing conditions which are dangerous (very bad consequences if you don’t treat them), comparatively easy to treat (potentially very good outcome if you do), and not severely stigmatizing (the diagnosis itself won’t cause severe problems). Bipolar I qualifies on all counts, so I went with it even though I wasn’t positive about it.
Presenting Problem: Alec is a white male in his late teens or early twenties, of above-average height and below-average weight. His clothing was shabby, but his hygiene was good. Partially healed, shallow cuts were visible on his wrists when his sleeves fell back. He appeared tense and guarded. His affect was markedly labile, swinging from contempt to brittle wit to open anger to sadness. His reason for coming in was stated to be “idle curiosity.” Upon further questioning, he stated that he had recently been the victim of a kidnapping.
Client reported that the cuts on his wrists were from a suicidal gesture. He went on to recount a history of self-injury and self-destructive acts, sometimes with the intent of suicide, and sometimes as impulsive acts in the heat of emotion. When he feels emotional tension build up unbearably, he either commits a self-destructive act, or provokes someone to attack or insult him so that his lover (a swordsman) will kill the person. Client then feels relief.
Client states that he “can’t do anything right” and that he expects to die violently and young. (Client is not a swordsman himself, so this belief, which predates his kidnapping, is not realistic.) He has attacked his lover, with the knowledge that his lover is a professional killer.
Client periodically (not regularly) uses drugs, and regularly gambles. He denies addiction to either.
He denied suicidal ideation when the question was asked, but said that it could come on at any moment. Client stated that his lover is aware that he is suicidal, and is keeping an eye on him. Client stated that he might also have the impulse to have his lover kill someone at any moment.
Personal History: Client currently lives in Riverside, supported by his lover. He used to attend the University. He became upset when asked how he came to leave it, and refused to state. He also declined to give his surname.
Family Background: Client declined to say anything about his family. From his speech and manner, however, he appears to be upper class and well-educated.
Psychiatric/Treatment History: Client stated that he has had no previous diagnoses or treatment.
Differential Diagnosis: Client states that he has had both depressive and mixed (manic and depressive) episodes. He agrees that he might be having a mixed episode now. He denies recent substance abuse or somatic symptoms, and says that he has never had hallucinations or delusions.
Though client’s relationship with his lover appears to be stable and not marked by idealization and devaluation, he matches other criteria for Borderline Personality Disorder: impulsivity in at least two areas that are potentially self-damaging (drugs, gambling, deliberately provoking violence in others); recurrent suicidal and self-mutilating behavior; affective instability (intense, brief periods of anger, anxiety, or dysphoria); transient, stress-related paranoid ideation; inappropriate, intense anger.
The extreme tension followed by provocation of violence followed by relief and pleasure is similar to the pattern of impulse-control disorders like Intermittent Explosive Disorder and Trichotillomania. Since client typically does not personally commit the violent acts, but achieves relief by witnessing another do so, this is better accounted for as an Impulse Disorder Not Otherwise Stated than by IED.
Rule out Antisocial Personality Disorder. Client is impulsive, exhibits reckless disregard for the safety of self and others, lacks remorse, and is irritable and aggressive. However, there is no evidence of a previous Conduct Disorder, and the antisocial behavior may have been during the course of Mixed Episodes.
Substance use and gambling don't appear to meet criteria for abuse, but client may be minimizing his use.
Rule out PTSD. Client's PTSD-like symptoms predate his kidnapping.
Recommendations:
5150 (involuntary psychiatric hold) for being a danger to himself and others.
An immediate medication consultation.
Individual therapy services to address his Bipolar I Disorder, Impulse Control Disorder, Borderline Personality Disorder, and recent trauma.
Referral to local Narcotics Anonymous Group to address his history of substance use.
Axis I (clinical disorders): Bipolar I, Most Recent Episode Mixed, Recurrent, Without Full Interepisode Recovery, Without Dysthymia, With Rapid Cycling. Currently in a Mild Mixed Episode. Impulse Disorder Not Otherwise Stated (compulsion to provoke others to commit violent acts.)
Axis II (personality disorders and mental retardation): ): Borderline Personality Disorder.
Axis III (general medical conditions): ): None.
Axis IV (psychosocial and environmental problems): ): Domestic violence. Victim of kidnapping. Unsafe neighborhood.
Axis V (GAF: Global Assessment of Functioning): ): 20. Some danger of hurting self or others. (Suicide attempts without clear expectation of death; frequently violent or provoking violence in others.)
Rachel’s note: This was a tough one. I went ahead and diagnosed Bipolar I, but it’s hard to tell from textual evidence whether that’s actually going on, or whether Borderline could account for everything all by itself. I also diagnosed an Impulse Control Disorder, though technically you’re not supposed to if it might be caused by some other condition (like mania), because it was such a significant pattern that I thought it was worth getting its own diagnosis.
I reasoned according to a safety hierarchy, which states that you should err in favor of diagnosing conditions which are dangerous (very bad consequences if you don’t treat them), comparatively easy to treat (potentially very good outcome if you do), and not severely stigmatizing (the diagnosis itself won’t cause severe problems). Bipolar I qualifies on all counts, so I went with it even though I wasn’t positive about it.
This is purely for study purposes (mine) and entertainment (yours and mine). I cannot actually diagnose any real person.
Young Miles
Presenting Problem: Miles Vorkosigan is a 29-year-old white male who appears older than his reported age. He is of below-average height and weight, and has visible disabilities affecting his legs and back. He wore a military uniform, and his grooming and hygiene were above average (normal for Barrayaran military.) His speech and movements were very energetic, and he appeared restless and fidgety. Upon initial questioning, he appeared cooperative but irritated.
The client relaxed when he was assured that the contents of the meeting were not only confidential but top secret, and was quoted back (by advance permission) Imperial Security Chief Simon Illyan’s comment, “I don’t want to fix him. I just want to know what makes him tick.”
The client then confirmed that he was present due to an experimental pilot program bringing in Betan therapists to assess and, if necessary, treat members of Barrayaran Imperial Security. He rapidly diagnosed himself as “a bit bipolar, hyperactive, split personality, and megalomania,” then laughed when it was pointed out that the last two are not diagnoses.
Client stated that he has a history of depressive episodes and combat-related flashbacks, but neither interferes with his job performance. He stated that he has satisfying relationships with his family, is happy with his work, and has ongoing romantic relationships. Upon closer questioning, he admitted to a suicide attempt as a teenager and frustration over being unmarried. Client denies current suicidal ideation.
Personal History: Serious physical disabilities. Social prejudice due to ableism. Satisfying and very successful military career. High-stress life, but client stated that he enjoys this. Client seems very invested in his secret identity.
Family Background: Good relationship with parents and extended family. History of conflict with deceased grandfather. Recently learned of existence of clone-brother, but clone-brother cut off contact, to client’s regret.
Psychiatric/Treatment History: No previous diagnoses. Client said that he has never been treated for a mental illness, and speculated that he is probably allergic to all psychiatric medications.
Differential Diagnosis: Described manic and hypomanic states to client, and asked if he was having one now. Client stated that he is “always like this” except when he is having a depressive episode. Acquired client’s permission to call his mother, who agreed that client’s baseline met all the clinical criteria for hypomania, except for the existence of a non-hypomanic baseline. Client’s mother described client’s behavior as a child, which met the criteria for Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type. Client and client’s mother stated that the client has never had a manic episode except while under the influence of a substance.
Symptoms of PTSD are concentrated on the reexperiencing and increased arousal axes. Avoidance symptoms are missing, but reexperiencing ones (dreams, flashbacks, psychological distress, and physiological reactivity) are sufficiently intense as to justify the diagnosis.
Rule out Dissociative Identity Disorder. Client’s over-investment in his secret identity is common in military operatives, and there is no amnesia present.
Rule out Narcissistic Personality Disorder. Client’s grandiosity and sense of specialness don’t seem unrealistically inflated given his circumstances, and he shows no more entitlement and arrogance than is common among wealthy, high-status people. Other symptoms are not present.
Recommendations: 1. Individual therapy services to address his PTSD and Major Depressive Disorder. Recommend a cognitive-behavioral approach.
2. A complete medical examination to rule out possible physiological or medication-based causes for his conditions.
3. A medication consultation. NOTE: See extensive list of allergies. Be aware that while the therapist did not diagnose Bipolar II, it could be present in a non-diagnosable form.
4. Individual therapy services from a Jungian perspective to address issues of Persona and Self.
Axis I (clinical disorders): Major Depressive Disorder, Recurrent, With Catatonic Features. Posttraumatic Stress Disorder.Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type.
Axis II (personality disorders and mental retardation): : No diagnosis.
Axis III (general medical conditions): : See attached files.
Axis IV (psychosocial and environmental problems): : High-pressure occupation. Ongoing search for wife.
Axis V (GAF: Global Assessment of Functioning): : 65 (Some distressing symptoms, but generally functioning well.)
Rachel's note: What do you think? Do you need the existence of a non-hypomanic baseline to diagnose Bipolar II? Or should I have gone ahead and diagnosed it anyway? (Or guessed that brief non-hypomanic, non-depressive periods probably existed but had gone unnoticed?)
Young Miles
Presenting Problem: Miles Vorkosigan is a 29-year-old white male who appears older than his reported age. He is of below-average height and weight, and has visible disabilities affecting his legs and back. He wore a military uniform, and his grooming and hygiene were above average (normal for Barrayaran military.) His speech and movements were very energetic, and he appeared restless and fidgety. Upon initial questioning, he appeared cooperative but irritated.
The client relaxed when he was assured that the contents of the meeting were not only confidential but top secret, and was quoted back (by advance permission) Imperial Security Chief Simon Illyan’s comment, “I don’t want to fix him. I just want to know what makes him tick.”
The client then confirmed that he was present due to an experimental pilot program bringing in Betan therapists to assess and, if necessary, treat members of Barrayaran Imperial Security. He rapidly diagnosed himself as “a bit bipolar, hyperactive, split personality, and megalomania,” then laughed when it was pointed out that the last two are not diagnoses.
Client stated that he has a history of depressive episodes and combat-related flashbacks, but neither interferes with his job performance. He stated that he has satisfying relationships with his family, is happy with his work, and has ongoing romantic relationships. Upon closer questioning, he admitted to a suicide attempt as a teenager and frustration over being unmarried. Client denies current suicidal ideation.
Personal History: Serious physical disabilities. Social prejudice due to ableism. Satisfying and very successful military career. High-stress life, but client stated that he enjoys this. Client seems very invested in his secret identity.
Family Background: Good relationship with parents and extended family. History of conflict with deceased grandfather. Recently learned of existence of clone-brother, but clone-brother cut off contact, to client’s regret.
Psychiatric/Treatment History: No previous diagnoses. Client said that he has never been treated for a mental illness, and speculated that he is probably allergic to all psychiatric medications.
Differential Diagnosis: Described manic and hypomanic states to client, and asked if he was having one now. Client stated that he is “always like this” except when he is having a depressive episode. Acquired client’s permission to call his mother, who agreed that client’s baseline met all the clinical criteria for hypomania, except for the existence of a non-hypomanic baseline. Client’s mother described client’s behavior as a child, which met the criteria for Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type. Client and client’s mother stated that the client has never had a manic episode except while under the influence of a substance.
Symptoms of PTSD are concentrated on the reexperiencing and increased arousal axes. Avoidance symptoms are missing, but reexperiencing ones (dreams, flashbacks, psychological distress, and physiological reactivity) are sufficiently intense as to justify the diagnosis.
Rule out Dissociative Identity Disorder. Client’s over-investment in his secret identity is common in military operatives, and there is no amnesia present.
Rule out Narcissistic Personality Disorder. Client’s grandiosity and sense of specialness don’t seem unrealistically inflated given his circumstances, and he shows no more entitlement and arrogance than is common among wealthy, high-status people. Other symptoms are not present.
Recommendations: 1. Individual therapy services to address his PTSD and Major Depressive Disorder. Recommend a cognitive-behavioral approach.
2. A complete medical examination to rule out possible physiological or medication-based causes for his conditions.
3. A medication consultation. NOTE: See extensive list of allergies. Be aware that while the therapist did not diagnose Bipolar II, it could be present in a non-diagnosable form.
4. Individual therapy services from a Jungian perspective to address issues of Persona and Self.
Axis I (clinical disorders): Major Depressive Disorder, Recurrent, With Catatonic Features. Posttraumatic Stress Disorder.Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type.
Axis II (personality disorders and mental retardation): : No diagnosis.
Axis III (general medical conditions): : See attached files.
Axis IV (psychosocial and environmental problems): : High-pressure occupation. Ongoing search for wife.
Axis V (GAF: Global Assessment of Functioning): : 65 (Some distressing symptoms, but generally functioning well.)
Rachel's note: What do you think? Do you need the existence of a non-hypomanic baseline to diagnose Bipolar II? Or should I have gone ahead and diagnosed it anyway? (Or guessed that brief non-hypomanic, non-depressive periods probably existed but had gone unnoticed?)
The Silent Tower: The Windrose Chronicles (Book One)
; The Silicon Mage: The Windrose Chronicles (Book Two)
For the purposes of this exercise, I'm assuming that I know all about magic, other worlds, etc, and take that into consideration when assessing my clients.
Presenting Problem: Antryg Windrose is a slightly disheveled and eccentrically (but not bizarrely) dressed man with somewhat but not markedly tangential speech, and somewhat labile affect. When asked what brought him here today, he states that he is sad and frustrated over his inability to work magic in Los Angeles.
Client denies suicidal ideation, but says he has moderate anxiety over realistic fears of being returned to his home country for execution. Client still takes pleasure in daily life and current relationship, and is employed.
Personal History: Childhood abuse, torture and imprisonment by government, refugee. Client discusses this with insight and appropriate emotion.
Family Background: Client was raised by unrelated abusive man; has no contact with biological family.
Psychiatric/Treatment History: Previous diagnosis of paranoia proved to be incorrect: the client’s seemingly paranoid beliefs were objectively true. Client states cheerfully that “everyone knows he’s mad.” When asked if he believes that he’s mad, he is evasive, then states that he understands why others think he is. Exploration of this point produces several statements of “odd” beliefs regarding magic theory and the likely truth of superstitions. Client has no hallucinations, and possible “delusions” are within the realm of eccentricity.
Differential Diagnosis: Evaluated for depression. Client states that he has no history of mania, major medical condition, substance use, somatic symptoms, symptoms of major depression, or dysthymia. Client agrees that depression and anxiety developed in response to stress.
Consider adjustment disorder with mixed anxious and depressed mood. Rule out on basis of lack of sufficient impairment of social and occupational functioning.
Rule out PTSD (due to trauma history): client states that he has no symptoms of PTSD. Rule out schizophrenia: no symptoms. Rule out paranoid personality disorder: no symptoms. Rule out schizotypal PD: Client is indeed “odd.” But he lacks a pervasive pattern of social and interpersonal deficits due to oddness, is comfortable with close relationships, and is not distressed by being “odd.”
Client appears to be quite well-adjusted and emotionally healthy, especially given his background and circumstances.
Treatment Plan: Therapy for grief over loss of magic. Refer to orthopedist for consultation on injuries to client’s hands.
Axis I (clinical disorders): No diagnosis.
Axis II (personality disorders and mental retardation (note: yes, that is the term for diagnosis)): No diagnosis.
Axis III (general medical conditions): Injuries to hands from torture.
Axis IV (psychosocial and environmental problems): Loss of former career. Exposure to torture and imprisonment. Threat of execution. Refugee.
Axis V (GAF: Global Assessment of Functioning): 80. (Transient and expected reactions to psychosocial stressors.)
(GAF explanation: 100: Buddha. 50: Seriously affected by mental illness. 0: Catatonic or currently randomly shooting passersby.)
ETA: I'm going strictly by the book here. In real life, he probably would have gotten an "adjustment disorder" diagnosis so his treatment would qualify for insurance.
; The Silicon Mage: The Windrose Chronicles (Book Two)For the purposes of this exercise, I'm assuming that I know all about magic, other worlds, etc, and take that into consideration when assessing my clients.
Presenting Problem: Antryg Windrose is a slightly disheveled and eccentrically (but not bizarrely) dressed man with somewhat but not markedly tangential speech, and somewhat labile affect. When asked what brought him here today, he states that he is sad and frustrated over his inability to work magic in Los Angeles.
Client denies suicidal ideation, but says he has moderate anxiety over realistic fears of being returned to his home country for execution. Client still takes pleasure in daily life and current relationship, and is employed.
Personal History: Childhood abuse, torture and imprisonment by government, refugee. Client discusses this with insight and appropriate emotion.
Family Background: Client was raised by unrelated abusive man; has no contact with biological family.
Psychiatric/Treatment History: Previous diagnosis of paranoia proved to be incorrect: the client’s seemingly paranoid beliefs were objectively true. Client states cheerfully that “everyone knows he’s mad.” When asked if he believes that he’s mad, he is evasive, then states that he understands why others think he is. Exploration of this point produces several statements of “odd” beliefs regarding magic theory and the likely truth of superstitions. Client has no hallucinations, and possible “delusions” are within the realm of eccentricity.
Differential Diagnosis: Evaluated for depression. Client states that he has no history of mania, major medical condition, substance use, somatic symptoms, symptoms of major depression, or dysthymia. Client agrees that depression and anxiety developed in response to stress.
Consider adjustment disorder with mixed anxious and depressed mood. Rule out on basis of lack of sufficient impairment of social and occupational functioning.
Rule out PTSD (due to trauma history): client states that he has no symptoms of PTSD. Rule out schizophrenia: no symptoms. Rule out paranoid personality disorder: no symptoms. Rule out schizotypal PD: Client is indeed “odd.” But he lacks a pervasive pattern of social and interpersonal deficits due to oddness, is comfortable with close relationships, and is not distressed by being “odd.”
Client appears to be quite well-adjusted and emotionally healthy, especially given his background and circumstances.
Treatment Plan: Therapy for grief over loss of magic. Refer to orthopedist for consultation on injuries to client’s hands.
Axis I (clinical disorders): No diagnosis.
Axis II (personality disorders and mental retardation (note: yes, that is the term for diagnosis)): No diagnosis.
Axis III (general medical conditions): Injuries to hands from torture.
Axis IV (psychosocial and environmental problems): Loss of former career. Exposure to torture and imprisonment. Threat of execution. Refugee.
Axis V (GAF: Global Assessment of Functioning): 80. (Transient and expected reactions to psychosocial stressors.)
(GAF explanation: 100: Buddha. 50: Seriously affected by mental illness. 0: Catatonic or currently randomly shooting passersby.)
ETA: I'm going strictly by the book here. In real life, he probably would have gotten an "adjustment disorder" diagnosis so his treatment would qualify for insurance.
I am taking a class on Treatment and Assessment. Yes, MFTs can diagnose. (We can't prescribe medication.)
To help familiarize myself with the DSM-IV and the process of diagnosis, terminology, etc, please recommend a fictional character I am familiar with who you think might have a mental illness, and I will attempt to diagnose them according to the DSM-IV criteria, as time permits. It would be helpful to note some incidents or traits which make you think they may need treatment.
For this go-round, please don't throw characters at me who you think might have something obscure, like (checks index) Mixed Receptive-Expressive Language Disorder. The class is currently focusing on mood and anxiety disorders, but I am also reasonably familiar with psychotic, dissociative, and personality disorders from my recent class in Abnormal Psych.
This is purely for study purposes (mine) and entertainment (yours and mine). I cannot actually diagnose any real person.
To help familiarize myself with the DSM-IV and the process of diagnosis, terminology, etc, please recommend a fictional character I am familiar with who you think might have a mental illness, and I will attempt to diagnose them according to the DSM-IV criteria, as time permits. It would be helpful to note some incidents or traits which make you think they may need treatment.
For this go-round, please don't throw characters at me who you think might have something obscure, like (checks index) Mixed Receptive-Expressive Language Disorder. The class is currently focusing on mood and anxiety disorders, but I am also reasonably familiar with psychotic, dissociative, and personality disorders from my recent class in Abnormal Psych.
This is purely for study purposes (mine) and entertainment (yours and mine). I cannot actually diagnose any real person.
.
