Mental Health Case Study Scenarios

Case Studies

Case Study I

Tina is a 17-year-old high school junior who resides with her parents and 14-year-old brother. Tina’s mother is concerned about her daughter’s recent 22-pound weight loss. Tina counts calories and exercises each morning and evening. Despite her weight loss and low-average size, Tina says that she is “fat” and she weighs herself several times a day. Tina has always felt close to her family, especially to her mother. She is an excellent student, active in cheerleading and works a part-time job. Tina’s mom tells her that she looks too thin, but Tina still believes she needs to lose more weight. Tina quickly is offended and reacts defensively. When Tina’s father encourages her to eat more, she argues with him during dinner. Tina’s brother teams up with Dad, sometimes calling Tina names. On several occasions, Tina has left the table and locked herself in her bedroom. Tina’s parents are unsure if she is showing some ordinary teenage rebellion or if she is developing an eating disorder. Until now, Tina has never given them any problems.

Case Study II

Robert is a 45-year-old married man with two adult children. He has been employed as a metallurgical engineer in a local steel mill for 20 years. Robert married his high school sweetheart. He describes their relationship as “typical.” They eat meals and attend family gatherings together but do little else as a couple. Robert spends his spare time reading, playing golf and watching TV. For the last two months, Robert has felt blue and his appetite has decreased. Because he has not been sleeping well, Robert drinks more at night. Sometimes he feels like life is hardly worth living. Robert has tried to “snap himself” out of this sour mood but nothing seems to work.

Case Study III

Martha is a 52-year-old divorced woman with three grown children. Her oldest child, Heather, is married with a good career and is expecting her first baby. Martha’s middle child, Scott, is single. He has a teaching degree and a history of drug and alcohol abuse. Carter is Martha’s youngest child. He lives at home and commutes to a local university where he is a senior. Martha works as a legal secretary and lives on a tight budget. She is considering returning to college, and maybe even dating, now that her children are older. But Martha is afraid to make a decision that she may regret. In fact, when Martha makes plans to return to school or to join an online dating site, she feels so anxious that she sometimes experiences panic attacks. Martha can’t decide if she should let her life remain status quo or if she should work through her fears holding out hope for a more fulfilling life. Martha asked her family doctor for something for anxiety, but he suggested that she call a counselor.

Assessments and Recommendations

WWC therapists encounter scenarios similar to those above every day. In fact, they welcome individuals and families with these kinds of concerns and help them to discover positive solutions.

Regarding the counseling cases cited above, WWC therapists would assess the following areas:

  1. Family history of depression and anxiety – For example, in Case Study II, if lack of sleep and decreased appetite affected Robert’s functioning, his therapist would encourage him to exercise. If Robert’s symptoms persisted, his therapist may refer him to a doctor for a medication evaluation. On the other hand, in Case Study I, Tina’s therapist may refer her to our dietitian for nutritional counseling. At WWC, we evaluate nutritional and exercise regimens and help clients to make better health choices in order to improve brain and physiological functioning.
  2. Cognitions or how a person thinks – Tina’s thinking about her eating has become obsessive. Whereas, in Case Study III, Martha’s thinking may be too focused on the future and her fears. Clients can learn to modify unhealthy ways of thinking to reduce anxiety.
  3. Expression of feelings – This is one of the important initial benefits of counseling as therapists encourage clients to talk about their thoughts and express their feelings. Because Robert may not talk about his feelings, he may have a decreased awareness of probable causes of his depressive feelings. Tina’s attention has become so focused on food that she is possibly shutting out her feelings about maturation.
  4. Relationships and support systems – Positive relationships and social supports promote good mental health. Tina’s family relationships are becoming strained in Case Study I. Too much attention on her food consumption during meal time could be encouraging Tina’s anorexic behavior. Robert needs to take a more serious look at his relationship with his wife since it is probably not as “typical” as he believes. More importantly, improvement in his marital relationship would help to relieve his depressive symptoms. Martha is probably affected by her two older children “leaving the nest” and the prospect of her youngest son leaving home after graduation. Martha’s hesitancy to find a love relationship may have something to do with fear or uneasiness in a past relationship. All these possibilities would be explored in therapy sessions.
  5. Past and current stress levels – An accumulation of stressful life problems often builds up over time and can result in psychological problems that may affect an individual’s ability to function well at work, school or home.
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Five Case Studies

 

Case Study #1

Subject Name: Robert

Sex, Age and Marital Status: Male, 19, single

Occupation: College Student, summer lifeguard

Personal Background: Upper middle class family, parents never divorced, 1 brother and 1 sister. Raised in and remains active in L.D.S. church.

The Incident:

Robert has worked for 3 summers as a lifeguard at the Desert Shores Community Association Lagoon Pool, and is now lifeguard supervisor. The Lagoon, as it is known, is a naturally shaped, concrete lined and sand covered swimming pool designed to look like a tropical lagoon. It is irregular in shape, surrounded by palm trees and includes a beach around the swimming area as well as a large picnic and recreation area that will accommodate a large crowd of members.

On Sunday of Memorial Day Weekend, 1998 there were approximately 1,500+ members at the Lagoon, enjoying a picnic and family swimming. As described by Robert, there were so many people in the lagoon you could barely see the water. With 3 lifeguard stands, and several lifeguards on duty and rotating time on the stands, plus those not on the stands working the crowd, Robert felt that even though things were busy they were under control. At the appropriate time Robert approached a stand to relieve another guard, Tyler. Robert climbed up into the stand, sat down, began scanning the water and crowd, and immediately saw a child floating face up about a foot beneath the surface of the water. He jumped from the stand, entered the water, pulled the child out and observed that her skin was white, her lips blue, her eyes rolled back in her head. There was no respiration and no pulse. He immediately began CPR, thinking to himself: "She’s dead" and "what if she’s dead" and other thoughts about the consequences of a drowning. He worked on the child for what he estimated to be 3 minutes with no response, then the child coughed but failed to breath. He continued working and after about another 30 seconds the child began to cough, cry and breath. Her color began to return as the paramedics arrived and took the child away to be checked at the hospital. The parents had been standing at Robert’s side the entire time he was working on resuscitating the child. The hospital reported there was no brain damage and no broken ribs (common as a result of CPR).

Response to Event:

I interviewed Robert approximately 7 weeks after the event occurred. At the time of contact he indicated a willingness to discuss the event and an appointment was made for the following day for a interview. Using a standard interview outline, containing questions considered pertinent to the diagnosis of P.T.S.D., an informal, conversational interview of approximately one hour in length was held. In the course of that interview the following occurrences, symptomatic of P.T.S.D., were revealed:

1) Nightmares about the event in which the rescue effort was unsuccessful were experienced; the first occurred on the third night after the event, the second on the following night. Both were extremely violent and traumatic;

2) Numerous spontaneous daytime flashbacks/daydreams with a pattern similar to the nightmares were experienced. These were numerous and recurring during the subsequent week. Less violent cued responses to event familiar stimuli, including elevated heart beat, continued for another 2 to 3 weeks.

3) Some sense of detachment and estrangement occurred, though subject was not consciously aware of it until the interview. At the interview the subject realized he had not had sex with his girlfriend since the incident occurred, whereas prior to the incident they had engaged in sex about once a week. But, there was also a greater closeness with parents involving much greater daily communications.

4) Some sense of hypervigilance in the workplace and in non-working circumstances.

5) In the course of the interview it became clear Robert was to some extent blaming himself for the near drowning. He has not yet realized that he was not in a position to observe the victim at the time she actually went under water and that it was his assumption of active lifeguarding when he relieved Tyler that actually resulted in the saving of the child.

Follow-up Activities:

There was no suggestion by anyone involved with Robert in the workplace or among his family or among all those he came in contact with as a result of the event, that he might benefit from any type of counseling. In fact, no one, including the employer, even debriefed him and asked him to recount the event. And no one, including closest family, asked him to recount his personal reactions and experience. Rather than asking about his feelings, or the event, the general inquiry was "Are you doing ok?" or something similar. Other interviews revolved around the human interest aspects of the event as a newsworthy item but paid no attention to any trauma he experienced. At the close of the interview, after I thanked him for his time, he thanked me for listening to him.

Summary:

Robert experienced a traumatic event with a happy ending; the victim did not drown. Nevertheless, for a full month after the event he experienced active symptoms that upset him and upset his life and work and social habits. His lack of sexual activity continued even longer than a month. By DSM-IV standards it is questionable if he actually developed P.T.S.D., in as much as active symptoms appear to have continued barely 4 weeks. It is more likely he only experienced many of the diagnostic symptoms of the disorder.

 

 

Case Study #2

Subject Name: John

Sex, Age and Marital Status: Male, 27, married (age 24, single, at time of incident)

Occupation: Landscape Contractor/Supervisor

Personal Background: Upper middle class family, lost biological father in accident as toddler, mother remarried happily, parents never divorced, brothers and sisters. Raised in L.D.S. church but left the church a number of years ago.

The Incident:

September 16, 1995, Salt Lake City, Utah.

John had known Allan Evans since boyhood, though being 2 years older they were not good friends in public school. John was a leader in High School, president of the student body and an athlete. His younger life was marred by the tragic death of his father in an explosion when he was a toddler, though his mother remarried happily and ultimately relocated to the town where John grew up. His stepfather, who he considers his father, is a loving and sacrificing man, caring deeply for his family, and his mother is described as a very loving person as well. Attending State University John’s life was, at times, a bit confused, his desire for social normalcy conflicting with his Mormon upbringing. His desires for social normalcy prevailed at this time, and neither he nor his wife are active in the L.D.S. faith today. But, confusion brings strife; he experienced arrest and serious penalty for D.U.I. as well as for writing bad checks. Finally, in an effort to extricate himself and set himself on a new track, he accepted a job, with his parents’ blessing, with Club Med and over a 2 year period worked in the Caribbean and Mexico. During his college years his acquaintance with Allan Evans blossomed into an all encompassing and truly great friendship. The two became true bosom buddies, doing everything together, going everywhere together, and sharing together the burden of John’s problems. But, at no time did Allan share his burdens with John; Allan was, and had been since childhood, subject to profound depression and had, at age 10, made his first attempt at suicide. He was, unknown to John, seriously manic-depressive, had over the years been in thus far unproductive psychotherapy and had been prescribed various anti-depressants, the final prescription being for Zoloft which he never took. At the time John left his home town to work at Club Med he and Allan remained in close contact and when John visited home in the fall of 1994, prior to transferring to a Club Med in Mexico, Allan asked John to see if he could get him a job. When John arrived at the Club Med in Mexico and told the staff about Allan -- his good looks, his charm, his athletic ability, his rock climbing skills which could be utilized in the resort’s recreation program -- they told John they’d hire Allan and within a week Allan was in Mexico and at work. During the ensuing months the friendship grew stronger and now included the friendship of John’s then fianc�e, and future wife, Karen. The three became inseparable, doing everything together. As described by John, his bond with Allan seems as strong a relationship of platonic love as I’ve ever encountered. But, life in paradise was to come to an end. In the spring of 1995 all 3, John, Karen, and Allan, returned to the states to resume a life a bit less fantasy filled. After visiting at home, John and Karen settled in Salt Lake City, John working for a landscaping company, Karen for Nordstrom department stores. And, after a summer at home, working as a greenskeeper at a local private golf club, Allan moved to Salt Lake City on Labor Day weekend, joining the same company John was working for and living with John and Karen as their roommate in their 2 bedroom apartment. The good life continued briefly, but it appeared to be a good healthy young adult life; partying but not to excess, evenings on the town having too much to drink sometimes, and working hard at their jobs during the day. But it all came to an end the night of September 15th. There was a bar-b-q at the home of John and Allan’s boss. A good, fun time. Following that, there was a visit to a bar -- more drinks and a few games of pool. Everyone was having fun, Allan was playing host, but by about 2:00 a.m. John knew he needed to go home. He’d had too much to drink. So he and Karen left -- Allan said he’d catch a ride with someone else; and he did. At home, John and Karen went to bed -- they were out like lights. John said he sleeps incredibly soundly. Karen, awaking at some point to go to the bathroom, notices Allan’s bedroom light is on; good, he made it home! She goes back to bed. Morning: John and Karen awake, share a few thoughts, and John gets up, followed by Karen. She heads to the kitchen to make coffee. John, seeing Allan’s light still on through his cracked door, goes to peek in. He finds Allan lying on the floor beyond the bed, ghostly white, blood pooled around his head; dead. Shock. He turns, goes to the kitchen, Karen is working with the coffee, John says: Allan is dead. Karen, not seeing John, says: Don’t joke, this isn’t funny. But then she turns and sees him and knows things are bad and John is not joking. The Dance has ended (Arata/Brooks, 1989).

Response to Event:

John was interviewed nearly 3 years after the event. His memories and emotions are vivid and raw:

Shock, disbelief, semi-hysterical feelings, a call to 911. Question from 911: Are you sure he’s dead? A return to the bedroom, and for the first time spotting the gun in Allan’s lap. 911 dispatches help immediately upon hearing of the presence of a gun. Arrival of an emergency crew from only 4 blocks away -- John hears the sirens as they approach. A good, compassionate crew, though fears on John’s part they might blame him. What if they think he shot Allan? The body is removed within about 30 minutes, John and Karen are questioned, tell what they know. The authorities ask them not to contact anyone until they can contact Allan’s family. He tells the emergency crew he wants to be with his mommy. John calls his sister anyway. He needs to talk to someone. Conversations with a coroner’s assistant ensue; also a call to a cleaning company to clean up the brains and blood; an $800 quote. Next step: Get home to be near Allan’s family and his own. What if Allan’s family blame him? What if they hold him responsible for Allan’s death? A mostly wordless drive home (6.5 hours), some clarity of thought -- "I can handle this," -- a brief telephone conversation with an uncle as they pass through an Idaho town. Arrival in the home town on Saturday evening. His parents come out to greet them: "John, you look good." John is internally outraged: "Don’t tell me you’re glad to see me and I look good. Tell me how sorry you are for me. Make me feel something other than the horror I feel about my best friend, a man I loved as much or more than any brother, blowing his brains out and leaving me behind to find him and deal with this. Then, the necessary visit to Allan’s parents home; the fear of blame, but Allan’s father greets John with love and concern: "John, I want you to know we don’t blame you for any of this." Relief, but then enormous emotional chaos when Allan’s father tells John he wants him to be the one to contact the boys’ mutual friends, fraternity brothers, etc. John consents and spends several hours on the phone, then spends several hours meeting and talking to friends and acquaintances

Follow-up Activities:

John experiences constant reminders on a daily basis, even now 3 years later. Triggered by sounds, songs, situations of familiarity they are strongly emotional and result in feelings of detachment as well as emotional response through crying. Never a day passes without an incident of some sort. There were strong nightmares at first, now occasional nightmares, but Allan’s presence in dreams that are not unpleasant also occurs with some regularity. Initially there were intense sleep disturbances, but they are lesser now, though still exist. Mental images are incredibly strong and fear of disaster lurks behind every event. Cues easily set traumatic memories in motion. While there was some temporary loss of appetite, normalcy returned. But today John feels strongly he has a significant stomach ulcer as a result of the ongoing traumatic stress. There is a strong sense of wanting to be done with this, and a fear of consequences, including thoughts of suicide, if he doesn’t get over this, but he welcomed opportunity to talk with me. While there is no desire to return to the location of the event, his memories are vivid and include exceptional detail.

Among the residual emotions are a strong sense of feelings of estrangement from people who won’t recognize the severity of his emotions or the magnitude of the event. But he feels stronger than ever feelings of love and closeness to his wife, Karen, who shared the actual event and shared for a time some of the friendship. Included in his feelings is a real, and repeatedly vocalized, fear of taking his own life in response to being unable to get past this. Persistent sleep problems aggravate his emotions, and his temperament which is by nature solid and easy going could drift to volatility without great self control.

John remains close with his parents even though his immediate response was that his parents didn’t respond properly to him at the immediate time of the event. They said he looked good and were glad he was all right which was nice but, in his opinion, not appropriate considering what he had just experienced. There is no real change in his relationship with his parents; he loves them very much though appears confused a bit. John is closer now than ever to his wife Karen, discusses how they rely on each other for ongoing support.

His friends were open about the incident at the time; curious and loving. But John had already left college and many of the old relationships were dwindling at that time so no real change with most. There was anger, which persists to now, at some who failed to respond appropriately to the incident and John’s feelings.

 

Allan’s parents told John they were going to sort of "adopt" him in Allan’s absence. John said it seemed strange to have them say that, but now he now talks with them as he never did when Allan was alive. When Allan was alive they were Allan’s parents and he viewed them as such and had no closeness with them at all.

 

Summary:

John is a strong, intelligent, clear thinking and well spoken young man who has experienced a personal horror no one should have to experience. He is, without question, suffering chronic P.T.S.D. at an intense level. His love for his wife is a godsend and I’d love to meet her at some time. I feel deep concern for him, though, and feel an intense need to help him find assistance for both himself and Karen. He describes a relationship with Karen that concerns me in only one respect: His dependence on her, and her possible reciprocal dependence, may be more burden than either of them is equipped to bear. The same horrors faced and lived together need to be exorcised from their daily lives through the intervention of a third party on whom they can unload. It is incredible to me that my conversation with him was the first thorough emotional debriefing he has had since the suicide, and that no one, including Allan’s father who is a mental health professional, or another Psychiatrist who was involved in helping John and Karen extricate themselves from the lease on the apartment where the suicide occurred, intervened with some level of force urging them to seek therapeutic help.

 

 

Case Study #3

Subject Name: Martha

Sex, Age and Marital Status: Female, 20 (at time of event, 60 now) , married

Occupation: Rancher

Personal Background: Upper middle class family, of pioneer, self sufficient stock, parents divorced, limited involvement in Episcopal church

The Incident:

Martha had married Bill over 5 years before the incident. They were, at the time, a happy and settled young couple. With ample landholdings passed to Bill by his maternal family, they were financially secure and Bill, with his military service and college behind him, had settled in to be a Montana rancher for the rest of his life. The oldest child, Alan, came without surprise and was welcomed with thoughts of several more children to come. The next child Rick was welcomed equally enthusiastically and he was followed shortly by a daughter, Kay.

Martha was busy. There was a lot to do on a ranch and the demands of ranch life, coupled with those of mothering 3 small children, were just about enough to wear her down at times. It was morning, time to get going, time to load the 3 children into the truck and go to town. As Martha was readying baby Kay for the trip, Alan and Rick loaded themselves into the truck. Working away, somewhat preoccupied, Martha suddenly started, concerned with an oversight on her part. She and Bill were hunters and there was still a rifle hanging in the truck. Better tell the boys to keep their hands off. A quick adjustment to the diaper, grabbing Kay, Martha heads for the door, pushing it open and simultaneously beginning a call to the boys: Hands off the gun. It’s not a toy. But she’s interrupted: She sees Rick pointing the gun at Alan, playing, and then in a deadly game, Rick pulls the trigger.

Response to Event:

Shock, disbelief: "This isn’t real. We’re always so careful with guns. This can’t possibly be happening. Only idiots leave guns where children can reach them." An overwhelming anguish engulfs Martha -- an inability to respond to the horror witnessed.

Follow-up Activities:

This event which occurred over 40 years ago evokes such strong memories and responses Martha has difficulty recounting them. She will, she says, ultimately work her way through the entire event with me, from beginning to end. She hasn’t done that with anyone else before, only in her own mind. The process is one of going very slowly and allowing for a lot of breathing time. She says she’ll recount it all, from beginning to end. But what she hasn’t realized yet, is that at this point there is no end: There has been no closure yet.

Summary:

The death of one’s own child is perhaps the second most emotionally traumatic event that can be experienced, falling just after the death of one’s spouse (presuming a happy marriage). I am unable to locate source materials that rank the witnessing by a parent of the death of one’s child as the result of the sudden and violent accidental actions of another of one’s children. The impact of the event on Martha, Bill, Rick, Kay, and the final child to be born in the future, Carl, remains to be explored. In jumping ahead, one significant fact has been discovered: At no time has any person, in any capacity, suggested any kind of counseling. And, the interview to this point, is revealing symptoms of chronic P.T.S.D.

 

 

Case Study #4

Subject Name: Tim

Sex, Age and Marital Status: Male, 17, single

Occupation: High School Junior

Personal Background: Middle class Hispanic family, member of Roman Catholic Church, attends church though not regularly

The Incident:

It is the last week of school, the day has been fun -- no real classroom work, no assignments to be dealt with at night, a winding down of the activities of the past year. The morning has, in fact, been sort of boring with little to engage the interest of the young men who are such good friends. But, all in all, life is good and the summer stretches ahead. There’ll be a little work, and the freedom from responsibility of school and the ensuing play time is eagerly anticipated. Tim’s good friend, Ron, has it good. His family has done well, well enough in fact for Ron to be driving a late model convertible. Yes, he paid for some of it, but mostly the car came to him from loving parents.

But, the morning is dragging. This school has no lunch period. School begins at 7 a.m. and releases at just after 1 p.m. But, the boys are hungry, thirsty and restless. Let’s escape briefly during the 10 minute nutrition break; the school’s offering of snacks does not tempt: A daring foray to the nearest 7-11 to grab some junk food, returning before getting caught during the schools nutrition break seems like a fun and exciting adventure. The signal indicates dismissal for the nutrition break and the three race for Ron’s car. Last one there is a loser! Into the car, a quick exit from the parking lot, and then a mad race down the street to the main artery that leads to the 7-11. Entry onto the main street, floor the gas pedal. Let’s go! And then, something happens. Ron loses control of the car, it veers to the right from the road, hits a sign, a post, and in an attempt to correct and prevent more damage, Ron overcorrects, the car rolls and then it is over. Silence broken by creaking sounds, hissing sounds, dripping sounds, whirring sounds.

But, most of these details are remembered later, through a haze. Most of the actual physical events of the accident are a jumble of thoughts. Tim lost consciousness at some point in the accident. The aftermath: Ron lies dead; Tim and the other passenger are injured but will recover.

Response to Event:

Tim simply would not talk much about the event at this point. He has been advised, by his family’s attorney to have no detailed discussion beyond the actual event with me. Legal action against Ron’s family’s insurance carrier is pending. I am asking the attorney to reconsider. Tim has not been counseled. The attorney is seeking damages based on lingering physical symptoms, the emotional symptoms being, at this time, immaterial to that case (see footnote, page 8; Harvard Mental Health Letter, July 1996, p. 4) . I have, in discussion with Tim’s family, explained P.T.S.D. and its ramifications and believe, based on their guarded responses, that Tim is suffering P.T.S.D. at some level. While my discussions with Tim and his family are not intended, in any way, to further a lawsuit seeking damages as a result of the accident, it may be greed, and the attorney’s interest in potential gain through a P.T.S.D. diagnosis, that will ultimately get Tim some therapeutic help.

Follow-up Activities:

This event which occurred only 3 months ago is far from closed. Tim, and hundreds of other young people, experience extraordinarily traumatic accidents with an incidence that is mind boggling. And yet, to date, no one has suggested counseling: no priest, no school counselor, no physician, not even the lawyer prior to my introduction to the scene.

Summary:

I intend to stay in touch with Tim’s family and hope to complete this study. And, I hope Tim will receive some counseling. He appears eager to talk with me but is, at present, constrained from doing so.

 

 

Case Study #5

Subject Name: Lisa

Sex, Age and Marital Status: Female, 30, married happily, one child, age 2

Occupation: Homemaker

Personal Background: from a middle class family with whom she maintains close contact, has 1 brother, no church involvement

The Incident:

Lisa’s first pregnancy was uneventful and the baby boy arrived without incident. Lisa and her husband were delighted. Life was good, Aaron’s job was a good one, and they had no financial or other worries. More children would be in order soon. Before Aaron junior’s first birthday there was good news: Lisa was pregnant again, the baby would come in the fall. The pregnancy proceeded without notable incident. There was one scare: A little blood spotting on Lisa’s underwear. But, upon examination the doctor declared everything ok and the pregnancy continued. Due in December, by November Lisa was ready. She was heavy set already, and the burden of the pregnancy was wearing on her. That plus chasing around a toddler.

Then, unexpectedly, there were early and unexpected contractions. But, the contractions didn’t feel normal. There was, Lisa sensed, something not quite right. She was hospitalized and examination revealed a fetus in distress. Something was definitely wrong. After 24 hours delay a decision to induce and force the delivery. The delivery was not good, and the results of the delivery devastating: A baby boy, suffering mongolism, brain dead but with, at birth, a heartbeat. Life support was begun. But, within 24 hours reality prevailed: Lisa and Aaron sadly agreed to disconnect life support and the baby died within minutes. There is a great sense of loss, a mourning for this child that was given a name. A full funeral is conducted at a funeral parlor with the family and close friends attending. Lisa and Aaron decide that this child will not be slighted: They take the body back to the mid-west for burial in a family plot. Now life can continue.

Several months pass. Lisa’s physician declares her healthy and fully recovered and Lisa and Aaron decide to once again let nature take its course. Perhaps she’ll become pregnant again.

Success, another pregnancy is confirmed. But, within 3 weeks there are problems: Spotting of blood again. Absolute emotional panic ensues. How can this be happening again? Is everything ok? Am I going to lose this baby too? A rush to the doctor who confirms her worst fears: The fetus has died. Within 48 hours Lisa’s body spontaneously expels the dead fetus.

Then the most devastating revelation: Lisa and Aaron have an Rh incompatibility problem. The doctors are aware of it. At any sign of troubles Rhogam has been administered to Lisa to assure she is not sensitized. Sensitization inevitably results in the near impossibility to bear more children. But, at some point, subsequent to Aaron junior’s birth, probably during the pregnancy with the full term Mongoloid child, there was a rupture, however small, that allowed mixing of fetal and maternal blood, and resulted in her sensitization. It may be impossible for Lisa to bear additional children.

Response to Event:

Anger, grief, disbelief and the search for a medical procedure to assist in the successful delivery of another child. Intra-uterine blood transfusions can be done, and have been successful. But there is uncertainty and there are absolutely no guarantees of success. The pregnancy might be aborted through the transfusion process, or the transfusion might produce a damaged baby. Sleeplessness, dreams, hallucinations of death of her other child, edginess, overprotectiveness, and a myriad of P.T.S.D. symptoms begin to emerge. And this event occurred only 3 weeks ago, in late July 1998.

The event which occurred is ongoing, the reality of the recent miscarriage still being assimilated, and the uncertainty about her childbearing future being a major preoccupation. Lisa is suffering, though how long the suffering will continue is uncertain. But, one things that is certain is that to date, no one has suggested counseling: there is no clergy in Lisa’s life, her parents are deeply moved by her plight but are unequipped to assist her, and the person who should be concerned with her mental condition, her physician, hasn’t said a word to her about her psychological condition. His concerns are entirely physiological in nature.

Summary:

I have regular contact with Lisa and Aaron and I will be able to follow their progress through this event. I intend, if I perceive continuing problems, to encourage Lisa, and probably Aaron, to seek counseling from some source.

 

 

 

Summary Note

As my research on this subject progressed and in particular as I discovered that among my five case studies there had been no effort at, or direction to, counseling, I made an earnest effort to determine if there was, in the public domain, any method of support readily available to individuals exposed to individual traumatic events who are suffering from P.T.S.D. The answer to my question, at this time, is no. I would like to be proved wrong, but a search of every source I have been able to access (U.N.L.V. Library, Las Vegas-Clark County Library System, various Internet search engines) has revealed only one organized support group dealing with victims of Post Traumatic Stress Disorder. That organization, in its infancy, is based in British Columbia, Canada. The State of Nevada Mental Hygiene Division provides some limited crisis intervention services and also provides counseling on a group and individual basis on a case by case basis but when quizzed about P.T.S.D. sufferers had no readily available suggestions for treatment. There are no support groups devoted to the victims.

But, a return to, and review of, the statistics of traumatic incident, and the probable correlation between those statistics and the development of P.T.S.D. cases, raises a serious question: With so many minds at stake, and so much potential and actual counter-productive social dysfunction resulting from the disorder, shouldn’t there, at a minimum, be a readily available volunteer support group for sufferers of P.T.S.D.? And shouldn’t public employees, particularly police officers and emergency medical technicians, who are frequently first on the scene of serious accidents be encouraged to offer, out of simple human compassion and concern, a referral card directing the potential P.T.S.D. victim to a source of help? Shouldn’t physicians, recognizing that traumatic incident has occurred, even though P.T.S.D. may not be present at the time of the occurrence, be aware of the need for assistance? Shouldn’t they at least suggest seeking counseling? Recognizing the passage from history of the years of generous government funding to provide even marginally adequate public mental health services, is there not great logic in seeking and assisting in the establishment of voluntary support groups?

Perhaps continued study and better education about and understanding of P.T.S.D. within the general public is needed. Given that study, and a more complete presentation to the public of a clear picture of the problems and needs of sufferers and potential sufferers, perhaps a nationwide network of volunteer support groups, comparable to Alcoholics Anonymous or Compassionate Friends will emerge. I hope so and I intend to work to that end.

 

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Last changed: September 13, 2002

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