Jane Doe and the wrong therapist.

         Jane Doe, aged about 20 years was on his wheelchair when he was brought to the hospital. Unhygienic, long – untrimmed beard, flat affect – neck bent down and tapping his left foot to the peddle of the wheelchair. Maybe Jane Doe was irritated or angry for being in the hospital. He was admitted after the formalities. His father was a small-scale business owner and mother was having her own store where she sold antique jewels. Jane Doe had discontinued his engineering course from Bingle Institute of Engineering, Bingle. 

         Jane Doe’s father reported that Jane Doe had been in depression during his final year and so, he quit his studies. He took medications for 3 months and was fine after that. He had been working in our factory to learn about the business. “He was better before. Now, he has become worse. I guess it’s a relapse.” Said Jane Doe’s father. 

         Jane Doe’s mother cried while explaining about his behavior during childhood. Being inattentive, not following the instructions, going against the wish of their parents, verbal and physical aggression in the school, truancy and low academic performance. She added to it that Jane Doe was not interested in studying engineering. “He never wanted to study engineering. He wanted to do interior designing course or architecture. His father forced him to take up and so he agreed to it half minded.” She then broke the news about his relationship breakup that happened when Jane Doe was in his 7^thsemester/ 4^th year as a result of which he was depressed. “Jane Doe was taken to a psychiatrist. He completed the course of medication. He was better till 2 weeks after the psychiatrist asked us to stopped the medication. He started worrying more and more. His sleep reduced, he skipped his breakfasts almost every day. He was then taken to Nomads’ Counselling Centre in Bingle City. Google says that the therapists there are good. But after he went to take counselling there, his mental health became more worse. We are here now.” she completed in a breath. 

         Jane Doe was kept under observation for 2 days. He was then brought to talk to the counselling psychologist who gathered the information from his parents. Jane Doe was initially uncomfortable talking to Cullinan but, was gradually feeling comfortable sharing. Jane Doe initially talked about his sadness and his present situation which is making him feel depressed. He added to it saying – “what on this planet is permanent, sir? We all are temporary. What is the point in taking these medications? What is the point in talking about what happened in the past and what I am doing in the present when the future is so uncertain?”

Now, Jane Doe is working in his father’s office, has a good social relationship and has worked on his relationship with his parents. Jane Doe is expected to fly to Titanium City in a couple of weeks to receive an award for his achievements as a young entrepreneur. His parents are happy for his achievements too.

         But why was the relapse? What was the reason behind Jane Doe’s severe depression and racing negative thoughts? The answer to this is – meeting the wrong therapist.

         When Jane Doe’s sadness overtook him even after he completed the course of medication for the first time, he was taken to a counsellor. This counsellor though – was not a professional counsellor. She had no proper certificates nor the minimum eligibility criteria to call herself a counselling psychologist. All she had was a 3 months diploma course in basic counselling skills from Nomad Academy, Bingle. Also, she had another diploma in understanding children’s behavior. She had then started practicing counselling. When Jane Doe was into depression – 1^st phase, he met this counsellor who – at the right time put these words in the mind of Jane Doe which became his belief: “what on this planet is permanent, sir? We all are temporary. What is the point in taking these medications? What is the point in talking about what happened in the past and what I am doing in the present when the future is so uncertain?”

The way Jane Doe perceived it might be different from what the counsellor actually meant. A right therapist would understand or probe to understand what the client or patient has understood from each session. 

WHAT WE SAY, HOW WE SAY, WHEN WE SAY, WHAT WE MEANT, WHAT THEY UNDERSTOOD AND HOW IT CHANGES A PERSON’S LIFE MATTERS A LOT.

-            CULLINAN

Young Jane Doe Problems

 This story talks about Jane Doe, a 27 years old male – a C.A to understand if he actually has a solution to his problems. During the first session, Jane Doe’s thoughts were showing a red flag. He had been sliding towards depression and had developed alcohol as a coping mechanism. As the sessions continued, it was understood that the unresolved conflicts during childhood and pent up emotions are the reason behind why Jane Doe had to go through this phase of life.

 Every person has unresolved issues. But not every unresolved issue leads to pathology. When it is triggered by an external factor or stimulus, it becomes pathology. To conclude, every person is vulnerable. All you need to do is to take care of your mental health, physiological health and spiritual health.

Identifying Information:

 Jane Doe, Male, aged about 27 years, walks to the Counselling Centre with a list of complaints. On the outside, he had completed his CA and had his own firm with more than 15 people working in his organization.

Presenting complaints/ reasons for the visit:

1. Reduced sleep and appetite. (Since about a year)

2. Frequent nightmares. (3 to 4 scenarios repeated about 5 times in the past 6 months.)

3. Palpitation/ racing heartbeat, short breath, stiffness in facial muscles. (Since about a year)

4. Pain in forehead region and headache complaints were frequent. (Since about 6 months)

5. Scared about the future. (Since about 4 months)

6. Usually feeling sad or anxious all day every day. (Since about 2 months)

7. Increased alcohol use. (Since about 6 months)

Informant:

 Jane Doe comes up and talks about the issues all by himself. He explains that he has been in this state from the last 6 months. Jane Doe acknowledged that his friend forced him to take therapy instead of worrying about his issues over alcohol. Therapist thus directs Jane Doe to meet him weekly once for 7 sessions to which Jane Doe said “yes”.

Story of Jane Doe:

 Jane Doe is the last son to the parents who worked in their won farm. Jane Doe has a brother and a sister. Brother is staying abroad with his wife and a child whereas the sister is staying in her husband’s home with 2 children. Jane Doe shared and still shares a good relationship with his mother, sister and brother. When he was questioned about how his relationship with his father is, Jane Doe explained that he passed away 11 years ago due to excessive alcohol consumption which resulted in leaver scleroses. When probed, Jane Doe explains about his disturbed relationship with his father because of his habits of drinking, violence against mother, himself and the sister (brother had left to Bingle to study). Jane Doe explains that his father was doubting on his wife and always used to claim that she had affairs with other men and this was the reason why the fights began. “It used to end after my mom started bleeding.” Said Jane Doe. He adds to it saying “I was locked in the room and I could hear my mom crying and my dad hitting her with a block of wood or a plastic pipe or rubber tube. I could even see it through the window (Cries). I couldn’t save her. (cries).” Jane Doe’s then class teacher talks to his mother and takes care of him in her house when he was in his 8th grade. Jane Doe explains that he was always an academic achiever and had been in top 10 list.

After completing his 10th grade, Jane Doe shifts to Bingle City to Study 11th,12th and further, staying at his brother’s place. This is again Jane Doe – “I was happy on one side for staying away from my dad, so that I can study peacefully and achieve something great. But, at the same time, I was feeling worried and anxious thinking about the way my dad would be treating my mom. I even thought that my mother would be no more to see my achievements and would either be killed by my father or would commit suicide because of my father.”

Jane Doe continues explaining that it was difficult for him to concentrate on his studies and used to call his neighbor or teacher who cared him for 3 years, to understand about the present situation. He praises his neighbor saying that they were patient and was talking to him and explaining him about how things were. Jane Doe then explained that his father died in a minimum facility hospital after 3 days of hospitalization. He was pronounced dead 4 months prior to Jane Doe’s 12th grade exams. Jane Doe – “His death is something that made my mom’s life peaceful. I was liberated from my anxiety and worries. I was so revealed and so was my sister. My brother was not so much affected because he was in the hostel ever since his childhood and had been detached from the family.” He adds to it that he could concentrate on academics better after the death. He explained that the mother and sister were staying in the farm house. By this time, the farm had started minting money and had a great turnover. Jane Doe calls these “The Golden Days”. He then started studying in B.Com. during which his sister got married. Jane Doe proudly said that he was one among the university toppers.  He then continued with his masters (M.Com.) during which his brother got married. Few months after which the first nephew was born.

“I used to go to my village weekly once to see my mom, my sister, my brother in law and my nephew happy. I still do it. But, because of the present issues, I have not gone there since a couple of months.” Said Jane Doe. 

 Jane Doe, after completing his masters in commerce, had appeared for C.A examination and had cleared it in the 3rd attempt. He explains that he had the potential and caliber to do it. Jane Doe then worked under a CA for a couple of years after which he started his own firm and is a successful entrepreneur.

 He explains another incident which has an impact on his beliefs. This is the Verbatim.

Jane Doe – “There is another incident that makes me scared about the future.”

Cullinan – “What is that about?”

Jane Doe – “It was on my nephew’s second birthday, an incident happened which I can never forget. (Paused). We were celebrating his 2nd year birthday in our farmhouse. We had invited more than 200 people and almost all of them showed up. We had organized a cocktail party and dinner. Everything was going fine and smooth till late evening. Right before the bartender opened the bottles, my nephew fainted due to a THI (Traumatic Head Injury) after which we rushed her to the hospital and first aid was given. We reached home in an hour and saw only two people waiting for us to say Bye and everybody left without having food and drinks. It was all my sponsor for the party. We all felt so bad after this. We decided not to plan or organize any such parties in the future.”

 These were the exact words Jane Doe talked to me during the therapy. He further explained that he had started withdrawing from parties and meeting friends. He explains that he drinks with one of his close friends in his house. “My house has a small bar. I invite my friend. We drink, we eat and we talk about random things. When I talked about my issues to him, he instructed me to meet you in person and gave your phone number.”

 This was jane Doe prior to his visit to CCC. During the process of interrogation, Jane Doe opened up saying that he has been in physical relationship with 4 women who he met on Facebook, Tinder and Bumble. He also added to it that it was not a relationship and was a casual thing. He calls it “friends with benefits.”

Jane Doe claims that he has never been into any problems or conflicts because of these kinds of relationships.

“My mother is now forcing me to get married and she has already started searching for a girl. This makes me feel more anxious.” He said. He added to it that he is well settled financially, socially and is physically stable. He complained that he had been feeling emotionally unstable – which is making him reject every girl his mother suggests. Jane Doe acknowledged that this behavior made him feel guilty. To overcome this feeling, Jane Doe chose alcoholism as a coping mechanism. He acknowledged that he has never been to meet the girls he has been in a relationship with – in the past 4 months and claimed that it might be one among the reasons behind why he has been rejecting every girl his mother is suggesting him. He continued explaining about his friends who are married and are not happy – claiming that to be one of the reasons for his anxiety. While Jane Doe was thinking about the reasons for his problems, his anxiety increased as a result of which he had become verbally more expressive.

Cullinan then made him relax on the couch and let him free to speak after mild relaxation. Jane Doe, while talking to Cullinan, suddenly pauses while explaining about his brother’s marital relationship issues, he questioned Cullinan about the probable reasons behind why he is facing these issues. 

WE AS THERAPISTS USUALLY DON’T BE DIRECT IN OUR APPROACH – AT LEAST NOT DIRECTIVE WHEN IT COMES TO PROVIDING INSIGHT TO PATIENTS WITH TRAUMATIC AND UNPLEASENT PAST LIFE EXPERIENCE.

Jane Doe was probed. He then understood that he was scared because, he believed that celebration leads to tragic ending. He also became aware of his belief that he doesn’t believe in women that much.

It was clear that Jane Doe’s present situation was because of his childhood experience where his father was abusive towards his mother, where the father was alcoholic and was abusive towards Jane Doe himself. His parents’ marital relationship was the only example he has – either to follow or to reject (either as a positive role model or a negative role model). Jane Doe, as he was powerless as a child, had no freedom to express his experienced emotions. Adding to it, presently, it is clear from Jane Doe’s words that his conscious belief is that he might become like his father. To cope with this stressful situation, he is taking a flight from stimulus that makes him respond according to his beliefs. Adding to this, the nephew’s birthday incident that wasn’t successful because of a disaster has an impact on Jane Doe’s belief. 

“Celebrations will always have a tragic ending” – Jane Doe’s exact words. To overcome this, Jane Doe, as mentioned above, takes a flight from the stimulus that puts him in the celebration scenario. 

These beliefs were gradually resolved by imposing psychotherapy on Jane Doe for 4 sessions.

 It has been 8 months after termination, I read a message from Jane Doe which read – 

“Dear Cullinan,

I am Jane Doe. Hope you remember me. I am all well now. thank you for helping me out. I need a 10 minutes appointment to meet you and invite you to my marriage. Please inbox the time and date so that I can come with my fiancé. 

Yours truly,

Jane Doe”

Sketch by @Chiyaan Bala

Prof. Dr. Jane Doe – the mathematics professor

Identifying information:
Prof. Dr. Jane Doe, male, aged about 47 years was brought to the hospital with the complaints mentioned below. His wife, aged about 42 years and son aged about 13 years had been devastated observing the patient’s behavior. On the outside, the patient had been working as a guide and a senior professor, mathematics department at Bingle University. Jane Doe was awarded as one of the best professors of the decade.

Presenting complaints/ reasons for hospitalization:
Aggressive behavior.
Disturbed and reduced sleep and appetite.
Low occupational and academic output.
Disorganized and repetitive speech.
Irritated almost all day – every day.
Affect and mood observed to be abnormally sad, irritated, frustrated and scared.
Ticks.
Crying inappropriately when alone.

NOTE:  The above-mentioned complaints were observed in the patient in the past 2 months and no medical investigation or treatments were imposed on the patient.

Information collected:
Patient’s wife explained about the patient’s abnormal behavior since a couple of months. She clearly explained that Jane Doe was not sleeping at night and was constantly forcing her to wake up and turn the alarm off. She added to it that he destroyed all the clocks in the house. “When I asked him the reason, he said that he was hearing the alarm tone continuously.”
She adds to it that she had never seen him behave in this way any day before. When probed about negative history of the patient and his family, it was understood that his younger brother had committed suicide during his late adolescence. She also adds details about Jane Doe’s father’s alcoholism and violent behaviors which led to chronic mental illness to which he had denied to take treatment. According to the wife, Jane Doe is always an emotional person and takes things too seriously and worry about everything. To make the psychologist understand it better, she gave an incident as an example: “Jane Doe, my son and I were boating in the lake – the Golden Inn resort. My son was feeding the fishes in the pond while Jane Doe was teaching him tricks to make fishes come to the surface. During this process of feeding the fishes, Jane Doe, by mistake dropped the plastic bag that had nothing inside. It was a 2 inch / 2-inch pen drive cover which didn’t even have the pen drive. He worried about it and was feeling guilty for 3 days.”
She adds to it that Jane Doe is presently not meeting any of his co-workers, students or research supervisors on purpose and she explained that Jane Doe claimed that they take away his ideas and thoughts to become successful.
Patient’s son explained that Jane Doe was helping him with his studies and was the source of motivation. He acknowledged that Jane Doe was not giving his health a priority since the day he has been observing Jane Doe. “My dad always worked on his math for his next paper. He had never slept/ rested properly since ages. We once had a conversation where he started sobbing like a small kid. The reason was – his thesis was purposefully being rejected and he was being targeted by the university people and his batchmates. He claimed them to be jealous and that has an impact on his career and research.” Said Jane Doe’s son.

Information collected are reliable.

Source of information:
 Patient’s wife and son were interrogated to understand the patient’s history.

According to the patient:
“I am like this because my research supervisors, university director and my batchmates gave me a lot of mental tortures. They get to know what I think and they write the research papers. They think that I dint know about this.”

Line of treatment:
Reference to psychiatrist for medication.
Family therapy for parents and caretakers to make them understand the importance of medication and accepting the patient for his present condition.
Psycho educating the client about the importance of medication.
Hospitalization for 4 days and advising for monthly follow-up.

Diagnosis:

Schizophrenia.
According to Prof. Dr. Jane Doe, he had been under extreme pressure with respect to his occupation and academics. He acknowledged that he had been pressurizing himself to achieve another Ph.D. which was having a lot of competition. He adds to it that this competition was extremely unhealthy and had a negative impact on his psychological health. He continued saying that it was after Jane Doe’s research supervisor threw his paper works in his face and asked him to quit the research even if his works were intact. Jane Doe acknowledged – “I couldn’t sleep the whole night and the incident that happened that afternoon is still fresh in mind and I am not able to concentrate on my studies or work.”
Hallucination: Hallucination is nothing but the ability to perceive a stimulus in the absence of it. To be more non-technical, people who hallucinate, hears voices that nobody else hears, sees things/ shadows/ people/ animals/ characters which nobody else could see, can smell something which nobody else could smell. Because, these stimuli are not present in real world. For Prof. Dr. Jane Doe, it is auditory hallucination. He complains hearing alarm noise.
Delusion: Delusion is a false, unchangeable concrete belief a person holds, to which he/she has no proper evidences to prove it to be true or normal. For Prof. Dr. Jane Doe, it is delusion of thought withdrawal where the patient believes that his seniors and co-workers are withdrawing thoughts from his mind as a result of which they are progressing in their research and he is here without progressing.
Positive symptoms: Excessive inappropriate talking and social interaction. Sadness and crying inappropriately.
Negative symptoms: For Prof. Dr. Jane Doe, they are, lack of interest in daily activities, reduced occupational output, lack of social and personal relationship, sleep and appetite.

Etiology/ causes for the present illness: It was observed and understood clearly from the history of the patient that he had been vulnerable to psychological illness because of genetic conditions. The risk factors that made Prof. Dr. Jane Doe more vulnerable were the constant occupational pressure and academic pressure (as he was working on his second research paper.)
 It is clearly understood from Jane Doe’s son’s information that the incident that triggered a psychotic vibration was when Jane Doe’s paper work were thrown away by his research supervisor who criticized and humiliated him in front of his batchmates and juniors. Jane Doe had been spending sleepless nights since the day he had started working on his second research. This resulted in a disturbance in his vital functioning which include blood pressure, thyroid stimulation hormones, other hormones and biochemical equilibrium was disturbed. Triggering factor triggered excessive worrying which resulted in degeneration of brain cells, auditory hallucination, positive and negative symptoms.

Present:
It has been 2 years since his illness has occurred. Client is not responding to any medication or any therapies. It is observed that the client has gained complete insight about his present illness and is ready to take treatment but the medication and psychotherapy has been showing no effects on the client. He was later sent to take up a brain MRI and reports read that his brain cells were degenerating as a result of which he has been facing biochemical imbalance which resulted in psychosis. Prof. Dr. Jane Doe has been in a mental health care centre where he has been under surveillance and constant care. His family visits him monthly once and spends a week’s time with him.