Expert answer:Consider Sally and put yourself in the place of he
Answer & Explanation:Consider Sally and put yourself in the place of her mental health provider.Research the common modalities for treatment for Schizophrenia and other psychotic disorders.Then, approach your conceptualization of Sally’s illness from a bio-psychosocial perspective, and discuss what your revised treatment recommendations would be for her.For example, would her treatment consist of medications alone, If yes why? and if not, why not? Would you likely be her only mental health provider? What barriers may exist to her success in getting and staying well? You are not limited to these three items and can expand upon this as neededmeet_sally.docxmeet_sally.docx
meet_sally.docx
meet_sally.docx
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Meet Sally
Sally did not start life with the best roll of the dice. In spite of
physicians’ warnings, Sally’s mother persisted in her twopack-a-day smoking habit, even while she was carrying Sally.
Also, during her fifth month of pregnancy, Sally mother
suffered a severe bout of the flu. Additionally, there is reason
to believe Sally may have inherited some vulnerability to
schizophrenia. Her maternal grandfather had always been
known in the family as an “eccentric”, but people less fond of
him preferred to call him “crazy or “nuts” He had developed
a number of unique religious beliefs and also was known in
the community for having placed unusual mechanisms on
the roofs of his barns, supposedly to bring in
“electromagnetic energy” to help his livestock grow. Farming
in those days did not demand the organizational and
financial skills that it does today, so it provided plenty of
room for odd and/or person-avoidant behaviors. He was
never brought to the attention of any mental health
professionals – indeed, he thoughtthey were “nuts.”
In general, Sally was slow to develop. She both walked and
talked late, but at the same time was an active child. She was
never formally diagnosed as “hyperactive” but she clearly
was above average on this dimension.
Sally’s parents had a marriage filled with conflict, even
separating for almost 10 months when Sally was 2 years old.
But they did reunite, to enter into what would best be
termed a long-term conflict-habituated marriage. They were
both devoted to Sally, especially since after two miscarriages
after Sally’s birth they were advised not to have any more
children. Sally’s father traveled quite a bit because of his
position as a sales coordinator for a farm machinery
company. When he was home, he played with Sally a lot. But
he could be quite critical if he thought she was not behaving
(and later achieving) at the level he thought she should be.
Her mother, on the other hand developed an intense, almost
symbiotic relationship with Sally.
Sally was of above-average intelligence. However, in spite of
her mother’s intense coaching and Sally’s withdrawal into
studying (and fantasy behavior), she was only average or
lower in most subjects. It was always as if her thought
processes were, as one teacher put it, “just a bit off center.”
Sally did have an occasional friend. But her mother’s
overprotection and Sally’s occasional odd behaviors and
thought processes kept her out of the flow of activities, and
she never made long-term, deep friendships. In fact, when it
appeared that Sally had a possibility of having a deep
friendship, her mother’s intrusions became more
pronounced, and the promise of that relationship was
destroyed. Essentially, Sally was a quiet and mildly shy child.
Also, because she did not have the feedback inherent in
friendships and an active social life, she developed even
more odd interests and mannerisms. These in turn served to
further distance her socially.
Upon graduation from high school, Sally was allowed to
board at a nearby college. However, the stress of being in
new surroundings was too much for her. She started talking
to herself, and her assigned roommate quickly managed to
be moved to another room. One afternoon the dorm
counselor found Sally in her room sitting in a chair, staring at
the floor. Sally was unresponsive, and her limbs could be
moved about and would then stay in place, almost as if she
were a plastic doll.
Sally was in a withdrawn catatonic state, marked by a
condition referred to as “waxy flexibility.” She was
hospitalized and improved fairly rapidly. She tried to return
to school but became more and more reclusive, now often
skipping classes. Her mother brought her back home “to
take care of her,” and Sally degenerated even further, at one
point showing a pattern of almost total unresponsive
behavior, interrupted occasionally by periods of giggling and
rocking behavior, traditionally termed a hebephrenic pattern.
Finally, Sally’s father insisted that Sally return to the hospital.
She did, but when she showed some improvement, her
mother again brought her home and did not continue the
recommended outpatient treatment. Sally was able to get a
part-time job as a clerk in a nearby store that did a lowvolume business, which did not place great demands on her.
She spent almost all of her free time at home, doing some
jobs around the house and spending the rest of the time in
her room. About this time, her father suffered a fatal heart
attack, making Sally’s mother even more dependent on her
daughter. Sally had now taken to wandering about on her
way home from work, possibly as a defense against the
intensity of her mother’s needs. Her behaviors were also
becoming more bizarre. One day the police found her
walking in the shallows of a pond in the town park,
muttering to herself. They took her to the local hospital, and
she was then transferred to a nearby hospital.
Sally’s mother subverted any real treatment at the time of
Sally’s first two hospitalizations. Thus, Sally was not
effectively treated until late in the process of her disorder –
not an uncommon occurrence with schizophrenics. In her
third hospitalization, Sally was immediately put on
pharmacotherapy – in this case, Thorazine. She was included
in an inpatient therapy group and talked to her psychiatrist
for a half-hour or so about twice a week.
Fairly rapid improvement was seen in Sally’s more obvious
symptoms, such as talking constantly to herself, sometimes
in an obvious response to voices she heard. However, some
of her “negative” symptoms – specifically, her disturbances in
attention and thinking – remained. Eventually, she was
released back to her mother’s care, which meant that in spite
of attempts to deal with her large overlay of social deficits
through outpatient therapy procedures, Sally made little
progress.
There were several relapses; indeed the relapses began to be
more common. The symptoms were now many and varied,
although not always so flamboyant as in some of the earliest
episodes, thus now earning her the diagnosis of
Undifferentiated Schizophrenia. At the last contact with her
therapists, Sally was in the hospital. The prognosis for any
substantial cure was poor, and it is probably that she will
continue the pattern of going in and out of hospitals and
aftercare.
Meet Sally
Sally did not start life with the best roll of the dice. In spite of
physicians’ warnings, Sally’s mother persisted in her twopack-a-day smoking habit, even while she was carrying Sally.
Also, during her fifth month of pregnancy, Sally mother
suffered a severe bout of the flu. Additionally, there is reason
to believe Sally may have inherited some vulnerability to
schizophrenia. Her maternal grandfather had always been
known in the family as an “eccentric”, but people less fond of
him preferred to call him “crazy or “nuts” He had developed
a number of unique religious beliefs and also was known in
the community for having placed unusual mechanisms on
the roofs of his barns, supposedly to bring in
“electromagnetic energy” to help his livestock grow. Farming
in those days did not demand the organizational and
financial skills that it does today, so it provided plenty of
room for odd and/or person-avoidant behaviors. He was
never brought to the attention of any mental health
professionals – indeed, he thoughtthey were “nuts.”
In general, Sally was slow to develop. She both walked and
talked late, but at the same time was an active child. She was
never formally diagnosed as “hyperactive” but she clearly
was above average on this dimension.
Sally’s parents had a marriage filled with conflict, even
separating for almost 10 months when Sally was 2 years old.
But they did reunite, to enter into what would best be
termed a long-term conflict-habituated marriage. They were
both devoted to Sally, especially since after two miscarriages
after Sally’s birth they were advised not to have any more
children. Sally’s father traveled quite a bit because of his
position as a sales coordinator for a farm machinery
company. When he was home, he played with Sally a lot. But
he could be quite critical if he thought she was not behaving
(and later achieving) at the level he thought she should be.
Her mother, on the other hand developed an intense, almost
symbiotic relationship with Sally.
Sally was of above-average intelligence. However, in spite of
her mother’s intense coaching and Sally’s withdrawal into
studying (and fantasy behavior), she was only average or
lower in most subjects. It was always as if her thought
processes were, as one teacher put it, “just a bit off center.”
Sally did have an occasional friend. But her mother’s
overprotection and Sally’s occasional odd behaviors and
thought processes kept her out of the flow of activities, and
she never made long-term, deep friendships. In fact, when it
appeared that Sally had a possibility of having a deep
friendship, her mother’s intrusions became more
pronounced, and the promise of that relationship was
destroyed. Essentially, Sally was a quiet and mildly shy child.
Also, because she did not have the feedback inherent in
friendships and an active social life, she developed even
more odd interests and mannerisms. These in turn served to
further distance her socially.
Upon graduation from high school, Sally was allowed to
board at a nearby college. However, the stress of being in
new surroundings was too much for her. She started talking
to herself, and her assigned roommate quickly managed to
be moved to another room. One afternoon the dorm
counselor found Sally in her room sitting in a chair, staring at
the floor. Sally was unresponsive, and her limbs could be
moved about and would then stay in place, almost as if she
were a plastic doll.
Sally was in a withdrawn catatonic state, marked by a
condition referred to as “waxy flexibility.” She was
hospitalized and improved fairly rapidly. She tried to return
to school but became more and more reclusive, now often
skipping classes. Her mother brought her back home “to
take care of her,” and Sally degenerated even further, at one
point showing a pattern of almost total unresponsive
behavior, interrupted occasionally by periods of giggling and
rocking behavior, traditionally termed a hebephrenic pattern.
Finally, Sally’s father insisted that Sally return to the hospital.
She did, but when she showed some improvement, her
mother again brought her home and did not continue the
recommended outpatient treatment. Sally was able to get a
part-time job as a clerk in a nearby store that did a lowvolume business, which did not place great demands on her.
She spent almost all of her free time at home, doing some
jobs around the house and spending the rest of the time in
her room. About this time, her father suffered a fatal heart
attack, making Sally’s mother even more dependent on her
daughter. Sally had now taken to wandering about on her
way home from work, possibly as a defense against the
intensity of her mother’s needs. Her behaviors were also
becoming more bizarre. One day the police found her
walking in the shallows of a pond in the town park,
muttering to herself. They took her to the local hospital, and
she was then transferred to a nearby hospital.
Sally’s mother subverted any real treatment at the time of
Sally’s first two hospitalizations. Thus, Sally was not
effectively treated until late in the process of her disorder –
not an uncommon occurrence with schizophrenics. In her
third hospitalization, Sally was immediately put on
pharmacotherapy – in this case, Thorazine. She was included
in an inpatient therapy group and talked to her psychiatrist
for a half-hour or so about twice a week.
Fairly rapid improvement was seen in Sally’s more obvious
symptoms, such as talking constantly to herself, sometimes
in an obvious response to voices she heard. However, some
of her “negative” symptoms – specifically, her disturbances in
attention and thinking – remained. Eventually, she was
released back to her mother’s care, which meant that in spite
of attempts to deal with her large overlay of social deficits
through outpatient therapy procedures, Sally made little
progress.
There were several relapses; indeed the relapses began to be
more common. The symptoms were now many and varied,
although not always so flamboyant as in some of the earliest
episodes, thus now earning her the diagnosis of
Undifferentiated Schizophrenia. At the last contact with her
therapists, Sally was in the hospital. The prognosis for any
substantial cure was poor, and it is probably that she will
continue the pattern of going in and out of hospitals and
aftercare.
…
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