Humanities Homework Help

1. Review the two cases below.
2. Using the Multipath Model explain the causes of each patient’s mental disorder.

Case Summary #1

Robin Henderson is a 30-year-old married Caucasian woman with no children

who lives in a middle-class urban area with her husband. Robin was referred to a

clinical psychologist by her psychiatrist. The psychiatrist has been treating Robin

for more than 18 months with primarily anti-depressant medication. During this

time, Robin has been hospitalized at least 10 times (one hospitalization lasted 6

months) for treatment of suicidal ideation (and one near lethal attempt) and

numerous instances of suicidal gestures, including at least 10 instances of drinking

Clorox bleach and self-inflicting multiple cuts and burns. Robin was accompanied by her husband to the first meeting with the clinical psychologist. Her husband stated that both he and the patient’s family considered Robin “too dangerous” to be outside a hospital setting. Consequently, he and her family were seriously discussing the possibility of long-term inpatient care. However, Robin expressed a strong preference for outpatient treatment, although no therapist had agreed to accept Robin as an outpatient client. The clinical psychologist agreed to accept Robin into therapy, as long as she was committed to working toward behavioral change and stay in treatment for at least 1 year. This agreement also included Robin contracting for safety- agreeing she would not attempt suicide.

Clinical History

Robin was raised as an only child. Both her father (who worked as a salesman)

and her mother had a history of alcohol abuse and depression. Robin disclosed in

therapy that she had experienced severe physical abuse by her mother throughout

childhood. When Robin was 5, her father began sexually abusing her. Although

the sexual abuse had been non-violent for the first several years, her father’s sexual

advances became physically abusive when Robin was about 12 years-old. This

abuse continued through Robin’s first years of high school.

Beginning at age 14, Robin began having difficulties with alcohol abuse and

bulimia nervosa. In fact, Robin met her husband at an A.A (Alcoholics

Anonymous) meeting while she was attending college. Robin continued to display

binge-drinking behavior at an intermittent frequency and often engaged in

restricted food intake with consequent eating binges. Despite these behaviors,

Robin was able to function well in work and school settings, until the age of 27.

She had earned her college degree and completed 2 years of medical school.

However, during her second year of medical school, a classmate that Robin barely

knew committed suicide. Robin reported that when she heard of the suicide, she

decided to kill herself as well. Robin displayed very little insight as to why the

situation had provoked her inclination to kill herself. Within weeks, Robin

dropped out of medical school and became severely depressed and actively

suicidal.

A certain chain of events seemed to precede Robin’s suicidal behavior. This chain

began with an interpersonal encounter, usually with her husband, which caused

Robin to feel threatened, criticized or unloved (usually with no clear or objective

basis for this perception. These feelings were followed by urges to either selfmutilate or kill herself. Robin’s decision to self-mutilate or attempt suicide were

often done out of spite- accompanied by the thought, “I’ll show you.” Robin’s selfinjurious behaviors appeared to be attention-seeking. Once Robin burned her leg

very deeply and filled the area with dirt to convince the doctor that she needed

medical attention- she required reconstructive surgery. Although she had been able to function competently in school and at work, Robin’s interpersonal behavior was erratic and unstable; she would quickly and without reason, fluctuate from one extreme to the other. Robin’s behavior was very inconsistent- she would behave appropriately at times, well mannered and reasonable and at other times she seemed irrational and enraged, often verbally berating her friends. Afterwards she would become worried that she had permanently alienated them. Robin would frantically do something kind for her friends in an attempt to bring them emotionally closer to her. When friends or family tried to distance themselves from her, Robin would threaten suicide to keep them from leaving her.

During the course of treatment, Robin’s husband reported that he could not take

her suicidal and erratic behavior any longer. Robin’s husband filed for divorce

shortly after her treatment began. Robin began binge drinking and taking illegal

pain medication. Robin reported suicidal ideation and feeling of worthlessness.

Robin displayed signs of improvement during therapy, but this ended in her 14

month of treatment when she committed suicide by consuming an overdose of

prescription medication and alcohol.

Case Summary #2

At the time of his admission to the psychiatric hospital, Carl Landau was a 19-

year-old single African American male. Carl was a college freshman majoring in

philosophy who had withdrawn from school because of his incapacitating

symptoms and behaviors. He had an 8-year history of emotional and behavioral

problems that had become increasingly severe, including excessive washing and

showering; ceremonial rituals for dressing and studying; compulsive placement of

any objects he handled; grotesque hissing, coughing, and head tossing while

eating; and shuffling and wiping his feet while walking.

These behaviors interfered with every aspect of his daily functioning. Carl had

steadily deteriorated over the past 2 years. He had isolated himself from his friends

and family, refused meals, and neglected his personal appearance. His hair was

very long, as he had refused to have it cut in 5 years. He had never shaved or

trimmed hi beard. When Carl walked, he shuffled and took small steps on his toes

while continually looking back, checking and rechecking. On occasion, he would

run in place. Carl had withdrawn his left arm completely from his shirt sleeve, as if

it was injured and his shirt was a sling.

Seven weeks prior to his admission to the hospital, Carl’s behaviors had become so

time-consuming and debilitating that he refused to engage in any personal hygiene

for fear that grooming and cleaning would interfere with his studying. Although

Carl had previously showered almost continuously, at this time he did not shower

at all. He stopped washing his hair, brushing his teeth and changing his clothes.

He left his bedroom infrequently, and he had begun defecating on paper towels

and urinating in paper cups while in his bedroom, he would store the waste in the

corner of his closet. His eating habits degenerated from eating with the family, to

eating in the adjacent room, to eating in his room. In the 2 months prior to his

admission, Carl had lost 20 pounds and would only eat late at night, when others

were asleep. He felt eating was “barbaric” and his eating rituals consisted of

hissing noises, coughs and hacks, and severe head tossing. His food intake had

been narrowed to peanut butter, or a combination of ice cream, sugar, cocoa and

mayonnaise. Carl did not eat several foods (e.g., cola, beef, and butter) because he

felt they contained diseases and germs that were poisonous. In addition, he was

preoccupied with the placement of objects. Excessive time was spent ensuring

that wastebaskets and curtains were in the proper places. These preoccupations

had progressed to tilting of wastebaskets and twisting of curtains, which Carl

periodically checked throughout the day. These behaviors were associated with

distressing thoughts that he could not get out of his mind, unless he engaged in

these actions.

Carl reported that some of his rituals while eating were attempts to reduce the

probability of being contaminated or poisoned. For example, the loud hissing

sounds and coughing before he out the food in his mouth were part of his attempts

to exhale all of the air from his system, thereby allowing the food that he

swallowed to enter an air-free and sterile environment (his stomach) Carl realized

that this was not rational, but was strongly driven by the idea of reducing any

chance of contamination. This belief also motivated Carl to stop showering and

using the bathroom. Carl feared that he may nick himself while shaving, which

would allow contaminants (that might kill him) to enter his body.

The placements of objects in a certain way (waste basket, curtains, shirt sleeve)

were all methods to protect him and his family from some future catastrophe such

as contracting AIDS. The ore Carl tried to dismiss these thoughts or resist

engaging in a problem behavior, the more distressing his thoughts became.

Clinical History

Carl was raised in a very caring family consisting of himself, a younger brother, his

mother, and his father who was a minister at a local church. Carl was quiet and

withdrawn and only had a few friends. Nevertheless, he did very well in school

and was functioning reasonably well until the seventh grade, when he became the

object of jokes and ridicule by a group of students in his class. Under their

constant harassment, Carl began experiencing emotional distress, and many of his

problem behaviors emerged. Although he performed very well academically

throughout high school, Carl began to deteriorate to the point that he often

missed school and went from having few friends to no friends. Increasingly, Carl

started withdrawing to his bedroom to engage in problem behaviors described

previously. This marked deterioration in Carl’s behavior prompted his parents to bring him into treatment.