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in high school and was recently expelled from Pencey Prep. Currently, the patient is not taking any medications. Results of a mental status examination revealed an emotionally numb, angry individual who 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 touchy subjects 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 and a negative attitude. Speech functions were inappropriate for rate, volume, and fluency. Vocabulary and grammar skills were suggestive of intellectual functioning within the average range. The patient's attitude fluctuated, but was mainly secretive and uncooperative. His mood was melancholy and depressed. Memory functions were descriptive during certain events and detached and unreliable during stressful times. However, during many discussions he was able to show immediate and remote recall of events and factual information. His thought process was scattered, lacking future goals, and disorganized. The patients thought content revealed evidence of delusions, paranoia, and suicidal/homicidal ideation. There was no evidence of perceptual disorder. His level of personal insight appeared unreliable. Social judgment appeared harsh, as evidenced by polite yet bitter interactions with staff and a struggle to form a relationship with other 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 is experiencing flashbacks, poor relationships,self-destructive behavior, hopelessness about the future, trouble sleeping, memory problems, trouble concentrating, and efforts to avoid thinking or 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 thorough analysis has taken place that has proven that Holden Caulfield meets the criteria to be diagnosed with this condition. Candidates of PSTD experience or witness “an event that involved death or serious injury, or the threat of death or serious injury ”(OL). The current clinical presentation appears to represent an acute exacerbation of a chronic psychotic disturbance which had its onset approximately 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 when attending 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 this turtleneck sweater I'd lent him” (170). Witnessing two tragic events occurring to children around
his age level causes fear and anger, leading the patient into a depressing state and an analysis on the 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 young victims. Holden had no control over his brother's disease and could not have done anything to stop 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 in the 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't look where they're going I have to come out from somewhere and catch them...” (172). Holden feels that if he is “the catcher” he can save people from the victimization diseases and bullies put on weaker individuals. It frustrates Holden to know that he cannot defend others. Specifically, he wants to protect the young and innocent, which is who he was before the traumatic events occurred in his life. Holden tells the readers, “I hate fist fights. I don't mind getting hit so much- although I'm not crazy about it, naturally-but what scares me the most in a fist fight is the guy's face. I can't stand looking at the other guy's face, is my trouble” (90). The “yellowness” Holden refers to is his fear to fight back against the people he feels are responsible for harming weaker individuals. He wants to stand 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 images and 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 a connection to his painful memories. He pretends he is shot and has been wounded. Then, he begins having 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 rubbernecks looking at me when I was all gory” (104). His physical reaction to the pain reminds him of James Castles 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
depressed, and at a high stress level, he states, “Anyway, I kept worrying that I was getting pneumonia, with all those hunks of ice in my hair, and that I was going to die” (155). Fear and stress is triggering a flashback to Allie's death. It is apparent that the victim has not mentally moved passed the horrifying moments of his life.
People with similar profiles tend to “try to avoid situations or things that remind them of the
traumatic event or feel a sense of emotional numbness” (OL). In fact, when Mr. Spencer questions Holden's reasons for leaving Elkton Hills, Holden responds by saying, “'Why? Oh, well it's a long story, dire. I mean its pretty complicated.' I didn't feel like going in to the whole thing with him. He wouldn't have understood it anyway. It wasn't up his alley at all” (13). After speculating the patient it is evident that the reason he is avoiding the conversation is because he does not want to speak about James Castle's death. He admits to trying to clear his mind from death during a time that he is exhibiting depression too. Holden says, “Then what I did, I went down near the lagoon and I sort of skipped the quarters and nickel across it, where it wasn't frozen. I don't know why I did it, but I did it. I guess I thought it'd take my mind off getting pneumonia and dying. It didn't though” (156). The patient it currently low on money and at a very high stress level. Therefore, the illness is returning and he is thinking of the tragic deaths. In order to relieve his mind of the painful memories, he copes unhealthily by furthering his money problem, drinking alcohol, and remaining at a cold desolate pond. Holden's struggle to sleep and concentrate are more signals of a mental disease. After a long day, and feelings of restlessness all night, Holden says, “I stayed in the bathroom for about an hour taking a bath and all. Then I got back in bed. It took me quite a while to get to sleep- I wasn't even tired-but I finally I did... I didn't sleep too long” (105). In addition, when lying in bed, Holden states, “Anyway, when I was in bed, I couldn't pray worth a damn. Every time I got started, I kept picturing old Sunny calling me a crumb-bum” (100). During the period of life Holden has spoken about during
his analyzable sessions, his stories have missing peaces and change pace a lot due to his lack of focus. For over a month, the symptoms are causing significant amounts of distress in the patient's life and are interfering with his ability to go about his normal daily tasks(OL). Thus, treatment is necessary. The patients actions confirm that he is currently dealing with a mental illness called Post Traumatic Stress Disorder. I will prescribe the patient an antidepressant to relieve symptoms of depression, stress, and anxiety. The medication will also improve sleep problems and concentration (OL). In addition I am recommending exposure therapy to assist the patient in gaining control of his emotions when reminded of the damaging situation. In addition, individual therapy will help the patient understand his feelings and learn how to think more positively. The medication and psychotherapy will allow the patient to learn proper ways to cope and regain control of his life.
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