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This is the fifth admission for Holden Caulfield, a sixteen year old, single, white, male,who is a junior in high school and was recently expelled from Pencey Prep. Currently, the patientis not taking any medications.Results of a mental status examination revealed an emotionally numb, angry individualwho shows evidence of excessive distractibility and an inability to track conversation well. The patient was casually dressed and groomed. Orientation was not intact for person, time and place.The patient would zone out and lose focus consistently. Eye contact was not kept on touchysubjects and the patient shook his foot nervously. There was no abnormality of gait, or posture.Signs of deportment were hidden, but seemed present. Mr. Caulfield has pessimistic feelings anda negative attitude. Speech functions were inappropriate for rate, volume, and fluency.Vocabulary and grammar skills were suggestive of intellectual functioning within the averagerange.The patient's attitude fluctuated, but was mainly secretive and uncooperative. His moodwas melancholy and depressed. Memory functions were descriptive during certain events anddetached and unreliable during stressful times. However, during many discussions he was able toshow immediate and remote recall of events and factual information. His thought process wasscattered, lacking future goals, and disorganized. The patients thought content revealed evidenceof delusions, paranoia, and suicidal/homicidal ideation. There was no evidence of perceptualdisorder. His level of personal insight appeared unreliable. Social judgment appeared harsh, asevidenced by polite yet bitter interactions with staff and a struggle to form a relationship withother patients and by uncooperative efforts to achieve treatment goals required for discharge.The patient was admitted due to symptoms of Post Traumatic Stress Disorder (PSTD).The purpose of the current evaluation is to screen for signs of PSTD and clarify the nature of
underlying stress disorder. After speaking with the patient and observing his verbal, behavioral,and symbolic actions, several symptoms have made this diagnosis possible (OL). Caulfield isexperiencing flashbacks, poor relationships,self-destructive behavior, hopelessness about thefuture, trouble sleeping, memory problems, trouble concentrating, and efforts to avoid thinkingor talking about the traumatic event. He appears emotionally numb, irritable, angry, shameful,guilty, easily startled or frightened, and dissatisfied with activities he once enjoyed. A thoroughanalysis has taken place that has proven that Holden Caulfield meets the criteria to be diagnosedwith this condition.Candidates of PSTD experience or witness “an event that involved death or seriousinjury, or the threat of death or serious injury ”(OL). The current clinical presentation appears torepresent an acute exacerbation of a chronic psychotic disturbance which had its onsetapproximately three years ago. The first occurred when the patient was thirteen years old and his brother Allie passed away from Leukemia. The patient's condition was then worsened whenattending Elkton Hills. His peer James Castle was harassed and bullied, leading to his suicide.Holden says “...
and there was old James Castle laying right on the stone steps and all. He was dead,and his teeth, and blood, were all over the place, and nobody would even go near him. He had on thisturtleneck sweater I'd lent him” (170).
Witnessing two tragic events occurring to children aroundhis age level causes fear and anger, leading the patient into a depressing state and an analysis onthe impact of these events are primordial in diagnosing Caulfield.The patient shows a response to the traumatizing event involved fear, horror or a sense of helplessness (OL). In both scenarios, Holden was unable to step in and help both of the youngvictims. Holden had no control over his brother's disease and could not have done anything tostop James Castle's suicide. His inability to interfere has evoked feelings of helplessness. His
desire to assist people similar to the victims is expressed through his desire to be the “catcher inthe rye”. Holden confesses to his sister, Phoebe, “
Anyway, I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody's around -nobody big, I mean - except me. And I'm standing on the edge of some crazy cliff. What I have to do,I have to catch everybody if they start to go over the cliff - I mean if they're running and they don'tlook where they're going I have to come out from somewhere and catch them...” (172). Holden feelsthat if he is “the catcher” he can save people from the victimization diseases and bullies put onweaker individuals. It frustrates Holden to know that he cannot defend others. Specifically, he wantsto protect the young and innocent, which is who he was before the traumatic events occurred in hislife. Holden tells the readers, “I hate fist fights. I don't mind getting hit so much- although I'm notcrazy about it, naturally-but what scares me the most in a fist fight is the guy's face. I can't standlooking at the other guy's face, is my trouble” (90). The “yellowness” Holden refers to is his fear tofight back against the people he feels are responsible for harming weaker individuals. He wants tostand up against the bullies and defend others, and it makes upsets him that he is afraid to.The mentally ill patient “relives experiences of the event, such as having distressing imagesand memories, upsetting dreams, flashbacks or even physical reactions” (OL). After undertaking a punch in the stomach from a pimp named Maurice, Holden is at a high stress level which triggers aconnection to his painful memories. He pretends he is shot and has been wounded. Then, he beginshaving suicidal thoughts. His thoughts are explained when he says, “What I really felt like, though,was committing suicide. I felt like jumping out the window. I probably would've done it, too, if I'd been sure somebody'd cover me up as soon as I landed. I didn't want a bunch of stupid rubberneckslooking at me when I was all gory” (104). His physical reaction to the pain reminds him of JamesCastles situation. In addition, the patient subconsciously is reliving and going back to the sight of James Castle's dead body after his jump out of a window. During another time, Holden drinks, feels
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Holden Caulfield Analysis
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