Question

Read the following case study and answer the questions.

Case Study

Mr. Perlman has been a police detective for 27 years when, 8 years before his scheduled retirement, he must have a foot amputated because of the effects of his diabetes. He is put on disability leave, but within 6 months, he has been told he will need to take an early retirement because he continues to suffer disability and may need several toes amputated from his other foot. Mr. Perlman and his wife struggle now with the significant drop in income. (She works in food services at a local hospital). They try not to argue or talk much about money, and Mrs. Perlman expresses empathy for her husband's physical condition. But neither of them has much enthusiasm for the simple things they used to enjoy, like favorite television shows or card games with friends. They have also stopped going out to church or neighborhood events they used to enjoy because it "just feels too hard." Last night, Mrs. Perlman found a note from her husband on her dresser, which said simply, "Sorry. I love you." At first she couldn't find him and called a friend. Eventually they found him sitting in the dark on a chair in the back yard. He was holding a bottle of pills and looked up at her and said, "I'm sorry. I just couldn't do it." She embraced him and wept, but Mr. Perlman did not cry, though he hugged her back. He agreed to come in to the hospital only after Mrs. Perlman and the friend talked to him over coffee until sun-up.

1. During the intake interview, Mrs. Perlman reports no serious incidents of depression in her husband's past that she knows of. Which of the two leading types of stress have contributed to Mr. Perlman's current depression?

2. You note that precipitating factors in Mr. Perlman's case could be described as due to both life events and role strain, but you also see a number of "loss of attachment" factors. Identify clues you have that fit this category, based on his story.

3. After 5 days in the psychiatric ward, Mr. Perlman is doing much better. He is enjoying playing board games again when his wife and best friend visit, and also engages with other patients and the staff both in recreation or relaxation periods, as well as in group therapy. He laughs easier now, as he did before his illness. Today in your therapy session, Mr. Perlman is able to express gratitude that he did not succeed in taking his life. "I guess this means we're all done here, right?" he says. "As long as I stay on these pills for a while after I go home, I think I'll be fine." His wife says she agrees. She smiles and squeezes his hand, and he smiles back at her. When she looks at you, though, she also looks worried.

How would you answer his questions?  and how would you deal with the wife's reaction?

Answer 1

1. The two leading types of stress that have contributed to Mr. Perlman's current depression are :-

- early retirement

- drop in income

2. Loss of attachment factors clues that fit this category :-

- loss of enthusiasm for the simple things they used to enjoy, like favorite television shows or card games with friends.

- they have also stopped going out to church or neighborhood events they used to enjoy.

3. It seems to be a confused response . I would answer his questions after making him express his feelings and thoughts . Will also clarify his wife's reaction by asking her to explain her worries .