Name: Camille C.

Sinday Date: February 4, 2022

Block: Block DDD

Instructions: Answers must be handwritten. Write legibly. Upload this activity in the

MOLE.

The Aviator
Overview
The movie depicts the earlier years of film producer, industrialist, and aviator Howard
Hughes before he became less able to function with obsessive–compulsive disorder in
late life. The movie depicts Hughes’s obsessions involving perfectionism in his film-
making and need for order concerning his food and cleanliness of his environment.
Several scenes illustrate that food could not be touching on the plate and beverages
needed to be served in unopened containers. He was so obsessed with perfection in his
films that he spent millions over budget to create what he considered the perfect movie,
only to insist on re-shooting the entire film as a “talkie.” Despite his fame, Hughes
demonstrates an obvious uneasiness in crowds and before the cameras. As the movie
progresses, Hughes’s OCD worsens to the point where it interferes with daily functioning
by jeopardizing business dealings, delaying completion of aeronautical projects, and
destroying personal relationships. In private, phobias and compulsions threaten him with
self-imposed solitary confinement.
Client name: Howard Hughes
Psychiatric diagnosis: Obsessive–Compulsive Disorder (OCD) with absent
insight/delusional beliefs

*For the criteria supporting this diagnosis, please refer to the Diagnostic and Statistical
Manual of Mental Disorders, 5th edition, by the American Psychiatric Association, and/or
your Wolters Kluwer mental-health nursing textbook.

Date:      February 4, 2022

Your name: Camille C. Sinday

Name of the client you are assessing: Howard Hughes

Name of the movie: The Aviator

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What is the chief complaint? (Why, in his/her “own words,” would the client say he or she
being assessed?)

Response:
     Always anxious, and chronically ill – this is how Howard Hughes recognizes
himself. “Sometimes it feels like I’m losing my mind,” he said, expressing his
dissatisfaction Throughout Howard Hughes’ life, there’s always been a constant sense of
discontentment, uneasiness, and anxiety. Handwashing, cleanliness, and orderliness
are all obsessive-compulsive behaviors that he has. During social engagements and
public appearances, he experiences a great amount of stress that hinders him to put up
a good interaction. To make matters worse, Hughes is also averse to being among other
people thinking that he might acquire diseases from them. As much as possible, he
prefers to stay at his place to limit contact whether it is for work or for personal reasons.

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Based on the above information and a close viewing of the movie, what questions would
you raise during history taking? What are some possible answers?
You might base your questions on the:
● History of your client’s present (and presenting) illness.
● Past psychiatric history, its treatment, and treatment outcomes.
● Psychosocial history.
● Past significant medical history.

Response:

1. History of your client’s present (and presenting) illness.

 If you could recall, at exactly when did this pattern of behavior begin?
This behavior started when I was very young. I was 8 years old when my mother would
give me a bath and teaches me how to spell “quarantine”.
 Exactly how long has this been going on?
This behavior started when I was very young. I was 8 years old when my mother would
give me a bath and teaches me how to spell “quarantine”.
 In addition to cleanliness and order, what other concerns do you have?
I set my clothes on fire and overly spend my money on things I want.
 Are you (Mr. Hughes) aware of any obsessive thoughts or compulsive actions?
Yes, I am.
 What could possibly be the factors that trigger this behavior?
Facing public audiences.

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  Do you have coping strategies? What are they?
I spell the word “quarantine” and isolate myself inside my cinema room.
 How frequent and for how long does he participate in ritualistic activities?
As long as it contents me.

2. Past psychiatric history, its treatment, and treatment outcomes.

 OCD, or any other anxiety disorder, has Mr. Hughes ever been treat for this in the
past?
No.
 How was the treatment? What was the result of the treatment?
I didn’t go under treatment.
 Do you know about what his drinking patterns and drug habits are?
No.
 Has he ever been depressed?
He could be.
 Did he ever consider causing harm to himself or to others?
No, he hasn’t.
 Has he been sleeping well?
Not much.

3. Psychosocial history

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 Is Mr. Hughes close to anyone? Any close friends?
Yes, he is friends with a few of his workmates and have been associated with several ladies.
 How often does Mr. Hughes see other people?
He always sees people as he works almost every day of his life.
 How is his relationship with his peers?
He can be distant to people he’s not close with.
 How is it living with anxiety?
Every day is a challenge.
 What does Mr. Hughes do for entertainment?
He flies his planes, meet girls, and play golf.
 Is there a history of anxiety disorder in his family?
Her Mom quite manifested being obsessive with cleanliness.

4. Past significant medical history

 Did he ever have any condition that may have contributed to his anxiety
symptoms?
None.
 Has Mr. Hughes ever experienced any physical issues as a result of his ritualistic
behaviors?
He once wounded himself for overly washing his hands.
 Has his health ever been harmed as a result of his anxiety?
Not as I recalled.
 Has he ever been admitted to the hospital because of an infection or other illness?
He has never.
 Has he undergone surgery or ever been hospitalized?
No.
 Is Mr. Hughes on any sort of medication? What exactly are they?
He hasn’t been on medication.

What observations do you have about the client’s behavior?

Response:
     
Mr. Hughes appears to isolate himself from others on purpose. Instead of usual
dates done publicly, Mr. Hughes prefers to take his dates to solo activities such as
golfing and flying. Mr. Hughes can’t help but think of his growing anxiousness
when under a lot of pressure, manifesting psychosis on a regular basis. Moreover,
Mr. Hughes appears to be having a disturbed thinking process as manifested in
his repetitious speaking patterns. He also showed peculiar behaviors after his
relationship with actress Kate Hepburn ended. Hughes set his clothes on fire as if
purging himself of the emotional pain he suffered. It was also highlighted in the
movie how he then began a ritual of wearing only tennis sneaker shoes. As a
result of the immense stress he’s gone through, he shut himself alone and sat

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fixated in his cinema room, seeing no one, wearing no clothing, surrounded with
lots of tissues, neither bathed nor cut his hair and nails for weeks, and continually
watching movies.

Hughes seems to like to have control over lots of things. Those people with whom
he appears to have the most effective relationships are those with whom he is
solid and steadfast. Hughes’ 2 female friends, however, refused to tolerate his
attempts to exert authority over them. In each of these 2 situations, control and
predictability are present despite the fact that they were set in place by others. Mr.
Hughes appears to be doing well with these partnerships.

In your opinion, is the diagnosis discussed above accurate?

Response:

YES.
     

What requirements does the client meet that support this diagnosis, based on DSM-5
criteria?

Response:
     
Excessively carrying his own soap in the pocket is one of his repetitive behaviors.
Hand washing, specific meal rituals such as the milk being served with the cap on the
bottle, the vegetable not touching the meat, opening a bag of chips with his right hand at
a certain angle, and the specificities of his 10 medium-sized chocolate chip cookies not
too close to the outside.

Obsessive thoughts: Mr. Hughes’ obsessions are twofold. Whether be in his works in
film or aviation, he demands precision and pristineness. Clean tablecloths, no smoking,
not touching the doorknob after washing his hands, avoiding to greet his peers with a
handshake, specific with the covering of his planes, and, later in the film, quarantining off
areas of his residence as germ-free zones are all examples of cleanliness. Moreover, he
also insisted on picking up objects using tissues to isolate himself from germs. He would
point out dust, stains, or other flaws in people’s clothing and insist that they would have
to clean it up.

What treatment plan would you outline?

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Response:

To sensitize to frightening situations:

- cognitive therapy should be used
- education about OCD must be done
- build tolerance of the obsession’s object
- teach coping skills which include relaxation techniques (meditation, muscle relaxation,
visualization, and deep breathing exercises) – relaxation methods help in the assistance of
reducing anxious responses and afford response prevention (assisting in the delay or avoidance
of performing rituals); and
- problem-solving skills.

Medication management:
- SSRIs, benzodiazepines, Buspirone, beta-blockers, and TCAs are some of the medications
available for OCD treatment.

     

With what expected outcomes?

Response:

Howard will:

- demonstrate effective techniques for relaxation.

- show how to apply and practice adaptive coping mechanisms.
- display a decrease in the occurrence and severity of anxiety.
- talk to someone else about his feelings.
- demonstrate how to apply behavioral treatment approaches effectively.
- illustrate how to apply problem-solving approaches effectively.
- show improvement in interpersonal interactions.

     

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