Campana, Kevin Harvey F.

Case Analysis – Psych 201

I. Theoretical background and Rationale

As personality theories offer provide explanatory framework on the person’s pattern of thinking,
feeling, and behaving, it would help us to organize information about the case Philip and
understand the series of events leading to his current situation.

Psychodynamic Theory

Psychodynamic emphasizes the major role of unconscious and the processes beneath the
surface of awareness in determining individual’s behavior. The id, which contains basic
biological drives such as sexual and aggressive desires, is hidden in the unconscious. The
superego, on the other hand, exerts control over seeking of this instincts as it is bounded by
societal prohibitions and conscience. These two structures are powerful forces in the
individual’s inner world which influences the third structure which is the person’s sole source of
communication in the with the reality and the structure that gives the individual the mental
powers to adapt to the realities of the external world, the ego.

In a psychologically healthy individual, id fulfills its basic biological drive by ego’s ability to
navigate to external world as long as it confines with the limitations set by superego. However,
this is not easy for ego since it is facing is a constant struggle in reconciling the blind, irrational
claims of the id to seek gratification of needs without regard of what is possible and proper and
the superego which strives blindly and unrealistically towards perfection. In the event that
sexual and aggressive desires are so strong, we use defense mechanisms to prevent us to
recognize the existence of these desires.

In addition to this, the theory also emphasized that childhood experience, most especially
traumas, has a huge factor for the person to develop a healthy mental state. Early attachment
relationship to individual’s primary caregiver has an effect on person’s vulnerability to mental
illness. Thus, there is a high chance that unresolved conflicts and childhood patterns of behavior
Another factor is sociocultural factor which shapes and influences of how an individual deal
with will resurface in their significant relationships. anxiety and conflict in relation with others.
As a result, these factors, most especially an individual’s relation with self and others during
their childhood significantly affect someone’s capacity to bear, reflect on and integrate any
mental experience including the painful ones in their adulthood.

To integrate these concepts in our case, Philip grew up in a dysfunctional family and a product
of incestual relationship which exposes him to traumatic experiences during his childhood. The
situation he had lived where his grandfather, who is also his father, isolated him to the outside
world for eight years to avoid the scandal. His father ignored him and his mother has very little
time on him which made him closer to animals than human beings since he doesn’t go to school
or church where he can build social interaction which is very vital during these formative years.
As he moved to his aunt, traumatic experience continues as he entered school where he was
bullied by group of boys, sexual abuse by his cousin and severely punished by his teachers.
These experiences made Philip felt abandoned and ashamed most of the time.
Cognitive Theory

As the psychodynamic theory focuses on the powerful internal forces that defines an
individual’s personality, the cognitive theory focuses on the influence of cognitive (mental)
process of an individual as a cause of a healthy or unhealthy mental state. In general, it is not
the situation and events that affects our behavior and emotion, rather, it is the way we perceive
or think about these events does.

It is important to note that individual’s set of core beliefs about self and others can predict their
future interpretation, behavior and affective responses to life events. Further, parenting styles
and early caregiver bonding are foundation to the development of these core beliefs. Thus,
securely attached children with supportive and affectionate relationship with these early
caregivers can learn self-efficacy, emotional understanding, and self-regulatory skills. In contrast,
children who lacks emotional support considered themselves isolated, vulnerable and
unworthy.

In the case of Philip, the adults around him, especially his mother and grandfather, can be
considered as his early caregivers. Unfortunately, the trauma and abuse he experienced are a
clear indication that he lacks emotional support which leads him to develop maladaptive
concept of self and low self-efficacy which is needed in surviving adult life most especially when
he migrated to UK. Also, the decision of Philip to isolate himself and carrying arms whenever he
left
his apartment is an indicator that he perceived that no one can’t be trusted and they are
planning to torture and kill him.

II. Diagnosis and justification

Delusion which is heavy influenced by fear is the most significant symptom in Philip’s condition.
This is due to his belief that his cousin and the new employee belonged to an international
crime organization that had some sort of connection with Malta which were instructed by the
parish priest of his village to kill him slowly and make him suffer tremendously in the process.

Indicators of pathology

Let’s examine the indicators of pathology to determine if Philip’s delusion will subject him to a
mental illness. First, this delusion causes him discomfort as he claims to feel magnetic waves
which have caused him palpitation (distress). Second, this is not a culturally expected behavior
because the conspiracy he is insisting does not have any solid evidences (deviances). The
patient’s delusion also affects to perform his functions at work on the counter in his cousin’s
take-away restaurant and causes major impairment in his current significant relationship [with
his cousin] (dysfunction). Then, his possession of two offensive weapons and the incident where
he hit a nursing assistant exposes himself and others to harm and danger (dangerousness). On
the other hand, during the interview, no abnormal movements were observed (dysregulation).
Family history is also a factor since there is a history of disabling mental illness. As a result, we
can conclude that Philip is suffering from a mental disorder.

Now, let’s consider the other symptoms existing to determine the possible diagnosis to Philip.
Psychotic symptoms are noticeable to our client as there is a present of odd, unusual feeling,
thoughts and behaviors, there is a persistent delusion and there is absence or luck of
functioning. In this case, two or more psychotic symptoms with continuous disturbance is an
indicator of either schizophreniform disorder or schizophrenia. However, psychotic symptoms
are also present in other illness. With this, we must first rule them out.

Examining other mental disorders/illness

First, delusion is reportedly present to some substance abuse patients. But, since there is no
indication that Philip has a history of Substance use we cannot consider this condition. Next,
persistently depressed mood, manic episodes and suicidal thoughts is not present in the given
information. In the DSM-V, psychotic symptoms in Major Depressive disorder are episodic which
happens when major depression episode occurs. As such, we can rule out depressive and
bipolar disorders. In the criteria of schizotypal personality disorder, distorted perceptions,
improper interpretation of events and constant doubts about others are signs and symptoms of
this condition. However, intense degree of delusion, which is present with Philip’s current case
don’t usually experience by individuals diagnosed with schizotypal.

Diagnosis

We will be using the duration of the symptoms to determine the final diagnosis to our patient
since this the main difference between schizophreniform disorder (continuous disturbance
between 1 month to 6 months) and schizophrenia (continuous disturbance for at least 6
months). In the given information, the only indicator in relation with the duration is that over
previous months, Philip made a numerous report to the police regarding his belief that an
organized crime groups wanted him dead but before that, he spent many months of formal
admission to hospital where he is already claiming that he is experiencing magnetic waves
attack. These data implicate that the psychotic symptoms are occurring for at least six months.
In conclusion, Philip is possibly suffering from schizophrenia.

III. Hypothesis on origins, triggers, and maintaining factors

From the beginning, Philip is repeatedly exposure to series of trauma and abuse with little to no
access to emotional support from people around him. Psychodynamic theory emphasizes the
importance of childhood experience to an individual’s future psychological state. Further, Philip
grew up in an environment where he deserved to be isolated and hidden. In relation to this, it is
consistent that he is always being told to hide away when the man in black visited, which is the
parish priest. Since then, that man in black has a reputation of someone who disliked him and
will put harm on him.

In addition to this unfortunate events is that almost all of the people he meets, he experiences
abuse, whether emotional, physical and even sexual, and treated him badly. Some of these
events is when he is subject to “friendly bullying” by his cousin and his sexual abuse.

In the cognition theory, these exposure led him to a belief that all people are not worthy to be
trusted because interaction to them will lead him to pain and problem. He thought that being
isolated is the only way to be safe and meeting someone is a way for him to be hurt. Another
way to explain this is the behavioral theory where repeated exposure to a certain event will
result to conditioning.

Another thing is the way he grew up where he has no formal schooling and during his
childhood, he is abundant with what he needed especially food since they have a farm. During
his late childhood, even when he is with his aunt, his savings are coming from her. Thus, he is
not prepared for employment which makes him difficult to fulfill the skills required for his job. In
the gene-dispositional theory, where biological bases is an important factor, his family history of
mental illness is another origin of this condition.

Given these factors, all events where social interaction is needed becomes a difficult situation
for him. This paranoia led him to a persistent delusion that all people are connected with one
goal: to do harm and slowly kill him. So for him, the only way to be safe is not to trust no one
and to be in complete isolation. Thus, psychotic symptoms functioned as a “defense” to the
unbearable aspect of Philip’s reality.