Posted by Rich (188.8.131.52) on October 18, 2002 at 05:48:02:
In Reply to: Case study - Mr. Simpson posted by Jan den Breejen (184.108.40.206) on October 18, 2002 at 00:37:05:
> What would be the likely type of:
> Mr. Simpson
Mr Simpson seems to be a good example of Millon's Insular Paranoid, with its combination of paranoia and the withdrawal of the avoidant. He shows the social anxiety of the avoidant-people are making fun of him. This report shows his delusions of reference-he is the hub of the TV networks, and his personal isolation from other people.... Rich
> Mr. Simpson is a 44-year-old, single, unemployed, white man brought to the emergency room by the police for striking an elderly woman in his apartment building. His chief complaint is, "That damn bitch. She and the rest of them deserved more than that for what they put me though."
> The patient has been continuously ill since age 22. During his first year of law school, he gradually became more and more convinced that his classmates were making fun of him. He noticed that they would snort and sneeze whenever he entered the classroom. When a girl he was dating broke off the relationship with him, he believed that she had been "replaced" by a look-alike. He called the police and asked for their help to solve the "kindapping." His academic perormance in school delcined dramatically, and he was asked to leave and seek psychiatric care.
> Mr. Simpson got a job as an investment counselor at a bank, which he held for 7 months. However, he was getting an increasing number of distracting "signals" from co-workers, and he became more and more suspicious and withdrawn. It was at this time that he first reporated hearing voices. He was eventually fired, and soon thereafter was hospitalized for the first time, at age 24. He has not worked since.
> Mr. Simpson has been hospitalized 12 times, the longest stay being 8 months. However, in the last 5 years he has been hospitalized only once, for 3 weeks. During the hospitalizations he has received various antipsychotic drugs. Although optpatient medication has been prescribed, he usuallys stops taking it shortly after leaving the hospital. Aside form twice-yearly lunch meetings with his uncle and his contacts with mental health workers, he is totally isolated socially. He lives on his own and manages his own financial affairs, including a modest inheritance. He read the Wall Street Journal daily. He cooks and cleans for hmself.
> Mr. Simpson maintains that his apartment is the center of a large communication system that involves all the major television networks, his neighbors, and apparently hundreds of "actors" in his neighborhood. Thre are secret cameras in his apartment that carefully monitor all his activities. When he is watching TV, many of his minor actions (e.g., going to the bathroom) are soon direclty commented on by the announcer. Whenever he goes outside, the "actors" have all been warned to keep him under surveillance. Everyone on the street watches him. His neighbors operate two different "machines"; one is responsible for all of his voices, except the "joker." He is not certain who controls this voice, which "visits" him only occasionally and is very funny. The other voices, which he hears many tmes each day, are generated by this machine, which he sometimes thinks is directly run by the neighbor whom he attacked. For example, when he is going over his investments, these "harassing" voices constantly tell him which stocks to buy. The other machines he calls "the dream machine." This machine puts erotic dreams into his head, usually of "black women."
> Mr. Simpson describes other unusual experiences. For example, he recently went to a shoe store 30 miles from this house in the hope of getting some shoes that wouldn't be "altered." However, he soon found out that, like the rest of the shoes he buys, special nails had been put into the bottom of the shoes to annoy him. He was amazed that his decision concerning which shoe store to go to must have been known to his "harassers" before he himself knew it, so that they had time to get the altered shoes made up especially for him. He realized that great effort and "millions of dollars" are inovlved in keeping him under survelliance. He sometimes thinks this is all part of a large experiment to discover the secret of his "superior intelligence."
> At the interview, Mr. Simpson is well-groomed and his speech is coherent and goal-directed. His affect is, at most, only mildly blunted. He was initially very angry at being brought in by the police. After several psychotic symptoms, he was transferred to a long-stay facility with a plan to arrange a structured living situation for him.
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