Today I delve into the world of diagnosis. I have to write up a mental status exam on Mrs. Z, a fictional woman whose son, a high school sophomore, died of an overdose. Though she has no history of mental health problems, she is currently in crisis. Her family has brought her to me in the ER in hopes that I can help her. Here’s the case:
1. Her husband and teen daughters found her in the son’s bedroom, holding his body, the night after he died; the husband and daughters hadn’t been home. When the ambulance arrived to take her son’s body away, she had to be pried from him.
2. She stayed in his room all night praying (not abnormal), unaware of anything going on around her, and remained in a daze for the following 4 days.
3. She wouldn’t eat, bathe, or visit with the clergy who came to speak to her during that time.
4. She refused to go to her son’s funeral because she insisted he wasn’t dead; he was sitting by God’s right hand waiting for the ordained moment to return to earth.
5. When attempts to get through to her did occasionally work, she screamed that she wanted to die.
6. She began to have nightmares in which her son’s rigid body gestured for her to join him, and she began to believe that maybe it was God’s will that she die soon, too. She was convinced that some abdominal pain she was experiencing, which extended up to her heart, was a sign of fatal cancer.
Her family has brought her to me, literally having to drag her in. She’s too upset to talk, she moans and screams and beats her head with her fists when asked simple questions like her name and age. She can’t sit still, pacing up and down the hall.
Now I have to write up a mental status exam on her. Once I figure out how, that is. It shouldn’t be hard because the prof gave us samples to work from. Although I’d like to be reading (something other than textbooks) or watching television, at the same time I’m mentally salivating and happily rubbing my hands together. This is the sort of case I can sink my teeth into!
We’ll be using this case for different assignments throughout the semester. Now you have the details and can roll along with me as I falter and develop. By the end of this course, I might have you looking at the people around you, diagnosing them with various psychopathologies.
Of course, you’ve probably been doing that already.