Amanda S.was 22 years old when she reluctantly agreed to interrupt her college semester and admit herself for the eighth time to a psychiatric hospital. Her psychologist, Dr. Swenson, and her psychiatrist, Dr. Smythe, believed that neither psychotherapy nor medication was controlling her symptoms and that continuing outpatient treatment would be too risky. Amanda was experiencing brief but terrifying episodes in which she felt that her body was not real.
She sometimes reacted by cutting herself with a knife in order to feel the pain, so she would feel real. During the first part of the admission interview at the hospital, Amanda angrily denied that she had done anything self-destructive. The anger dissolved, however, and she was soon in tears as she recounted her fears that she would fail her midterm examinations and be expelled from college. The admitting psychiatrist also noted that at times Amanda behaved in a flirtatious manner, asking inappropriately personal questions such as whether any of the psychiatrist’s girlfriends were in the hospital.
When she arrived at the inpatient psychiatric unit, Amanda once again became quite angry. She protested loudly, using obscene and abusive language when the nurse searched her luggage for illegal drugs and sharp objects, even though Amanda was very familiar with this routine procedure. These impulsive outbursts of anger were quite characteristic of Amanda. She would often express anger at an intensity level that was out of proportion to the situation. When she became this angry, she would typically do or say something that she later regretted, such as verbally abusing a close friend or breaking a prized possession. In spite of the negative consequences of these actions and Amanda’s ensuing guilt and regret, she was unable to stop losing control of her anger.
The same day Amanda filed a “three-day notice,” a written statement expressing an intention a leave the hospital within 72 hours. Dr. Swenson told Amanda that if she did not agree to remain in the hospital voluntarily, he would initiate legal proceedings for her involuntary commitment on the grounds that she was a threat to herself. Two days later, Amanda retracted the three-day notice, and her anger seemed to subside.
Over the next two weeks, Amanda appeared to be getting along rather well. Despite some complaints of feeling depressed, she was always well dresses and groomed, in contrast to many of the other patients. Except for occasional episodes when she became verbally abusive and slammed doors, Amanda appeared and acted like a staff member. She began to adopt a “therapist” role with the other patients, listening intently to their problems and suggesting solutions. She would often serve as a spokesperson for the more disgruntled patients, expressing their concerns and complaints to the administrators of the treatment unit. With the help of her therapist, Amanda also wrote a contract stating that she would not hurt herself and that she would notify staff member she began to have thoughts of doing so. Since her safety was no longer as big of a concern, she was allowed a number of passes off the unit with other patients and friends.
Amanda became particularly attached to several staff members and arranged one-to-one talks with them as often as possible. She used these talks to flatter and compliment the staff members and tell them that they were one of the few who truly understood her and could help her, and she also complained to them about alleged incompetence and lack of professionalism among other staff members. Some of these staff members Amanda was attached to had trouble confronting Amanda when she broke the rules. For example, when she was late returning from a pass off grounds, it was often overlooked. If she was confronted, especially by someone with whom she felt she had a special relationship, she would feel betrayed and, as if an emotional switch had flipped, would lash out angrily and accuse that person of being “just like the rest of them.”
By the end of the third week of hospitalization, Amanda no longer appeared to be in acute distress, and the staff began to plan for her discharge. At about this time, Amanda began to drop hints in her therapy sessions with Dr. Swenson that she had been withholding some kind of secret. Dr. Swenson `addressed this issue in therapy and encouraged her to be more open and direct if there was something she needed to talk about. She then revealed that since here second day in the hospital, she had been receiving illegal street drugs from two friends who visited her. Besides occasionally using the drugs herself, Amanda had been giving them to other patients on the unit. This situation was quickly brought to the attention of all the other patients on the unit in a meeting called by Dr. Swenson. During the meeting, Amanda protested that the other patients had forced her to bring them drugs and that she actually had no choice in the matter. Dr. Swenson didn’t believe Amanda’s explanation and instead thought that Amanda had found it intolerable to be denied approval and found it impossible to say no.
Soon after this meeting, Amanda experienced another episode of feeling as if she were unreal and cut herself a number of times across her wrists with a soda can she had broken in half. The cuts were deep enough to draw blood but were not life threatening. In contrast to previous incident, she did not try to hide her injuries and several staff members therefore concluded that Amanda was exaggerating the severity of her problems to avoid discharge from the hospital. The members of Amanda’s treatment team then met to decide the best course of action.
Not everyone agreed about Amanda’s motivation for cutting herself. Amanda was undoubtedly self-destructive and possibly suicidal. Therefore, she needed further hospitalization. But she had been sabotaging the treatment of other patients and could not be trusted to refrain from doing so again. With the members of her treatment team split on the question of whether or not Amanda should be allowed to remain in the hospital, designing a coherent treatment program would prove difficult at best.
Article Summary Reports
Title Page – Student Name and Title of Report
Client Background: Describe all of the key background points about the person.
Abnormal Behavior: Describe how and why this behavior is considered abnormal.
DSM Classification: Describe the client’s diagnosis. Go with first choice, then second choice.
Match the symptoms with the diagnosis.
Describe Possible Treatment Plans and Outcomes
Conclusion: What did you learn from this case about abnormal psychology?
Report Format – Typed, single-spaced, up to one page, spelling, grammar check. References included in APA style.
Remember, psychologists, psychiatrists, mental health counselors, and licensed social workers consider behavior abnormal when it meets some combination of the following criteria:
(a) deviant – unusual or statistically infrequent
(b) despised socially – socially unacceptable or in violation of social norms
(c) delusional – fraught with misperceptions or misinterpretations of reality
(d) distressing – associated with states of severe personal distress
(e) dysfunctional – self-defeating or maladaptive or
(f) dangerous – to self or others
