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May 31, 2023
Instructions: This assignment requires 5-6-page report (typed, double-spaced, one-inch margins). You will be required to cite any sources used within the text of your report (see APA Publication Manual). Due dates for these assignments are listed below in the course outline. Students can submit assignments early for proofing and are also encouraged to utilize campus resources including the Writing Lab. The report is worth 50 points. Rubric is provided.

 

By the time he was admitted to the hospital, George Lawler was talking a mile a minute. He harangued the other patients and ward staff, declaring that he was the coach of the U.S. Olympic track team and offering to hold tryouts for the other patients in the hospital. His movements were rapid and somewhat erratic as he paced the halls of the ward and explored every room. At the slightest provocation, he flew into a rage. When an attendant blocked his entrance to the nursing station, he threatened to report her to the president of the Olympic committee. He had not slept for 3 nights. His face was covered with a stubbly growth of beard, and his hair was scattered in various directions. His eyes were sunken and bloodshot, but they still gleamed with an intense excitement. His life had taken a drastic change over the past 2 weeks. George was 35 years old, married, and the father of two young children. He worked at a small junior college where he taught physical education and coached both the men’s and women’s track teams. Until his breakdown, the teams had been having an outstanding season. They were undefeated in dual competition and heavy favorites to win the conference championship. The campus was following their accomplishments closely because it had been many years since one of the school teams had won a championship. In fact, track was the only sport in which the school had a winning record that season. This was not the first time that George had experienced psychological problems. His first serious episode had occurred during his junior year in college. It did not seem to be triggered by any particular incident; in fact, things had been going well. George was playing defensive back on the university football team. He was in good academic standing and fairly popular with the other students. Nevertheless, during the spring semester, George found that he was losing interest in everything. It was not surprising that he did not look forward to classes or studying. He had never been an outstanding student. But he noticed that he no longer enjoyed going out with his friends. They said he seemed depressed all the time. George said he just did not care anymore. He began avoiding his girlfriend, and when they were together, he found fault with almost everything she did. Most of his time was spent in his apartment in front of the television. It did not seem to matter what program he watched because his concentration was seriously impaired. He kept the TV on as a kind of distraction, not as entertainment. When he did not show up for spring football practice, the coach called him to his office for a long talk. George told his coach that he did not have the energy to play football. In fact, he did not feel he could make it through the easiest set of drills. He did not care about the team or about his future in sports. Recognizing that George’s problem was more than a simple lack of motivation, the coach persuaded him to visit a friend of his—a psychiatrist at the student health clinic. George began taking medication and attending individual counseling sessions. Within several weeks, he was back to his normal level of functioning, and treatment was discontinued. George had also experienced periods of unusual ambition and energy. As a student, he had frequently spent several days cramming for exams at the end of a semester. Many of his friends took amphetamines to stay awake, but George seemed able to summon endless, internal reserves of energy. At the time, these episodes went relatively unnoticed. George’s temporary tendency toward excess verbosity, his lack of need for sleep, and his ambitious goals did not seem pathological. In fact, his energetic intervals were productive, and his behavioral excesses were probably adaptive in the competitive university environment. There had been two subsequent episodes of depression with symptoms that were similar to those of the first episode. The most recent incident had occurred 8 months prior to his current hospitalization. It was September, 2 weeks after the start of the fall semester. George had been worried about his job and the team all summer. Who would replace his star sprinter who had transferred to the state university? Would his high jumper get hurt during the football season? Could they improve on last year’s winning record? Over the past month, these concerns had become constant and consuming. George was having trouble getting to sleep; he was also waking up in the middle of the night for no apparent reason. He felt tired all the time. His wife and children noticed that he was always brooding and seemed preoccupied. Then came the bad news. First, the athletic department told him that he would not get an increase in travel funds, which he had expected. Then he learned that one of his assistant coaches was taking a leave of absence to finish working on her degree. Neither of these events would have a drastic effect on the upcoming season, but George took them to be disasters. His mood changed from one of tension and anxiety to severe depression. Over several days, George became more and more lethargic until he was almost completely unresponsive. His speech was slow and, when he did say more than a word or two, he spoke in a dull monotone. Refusing to get out of bed, he alternated between long hours of sleep and staring vacuously at the ceiling. He called the athletic director and quit his job, pointing to minor incidents as evidence of his own incompetence. He believed, for example, that the assistant coach had quit because of a brief argument that he had had with her 6 months earlier. In fact, they had a positive relationship, and she had always planned to return to school at one time or another. She was leaving earlier than she had expected for personal reasons. George seemed to be blaming himself for everything. He apologized profusely to his wife and children for failing them as a husband and father. His despair seemed genuine. Suicide appeared to be the only reasonable solution. He threatened to end it all if his family would only leave him alone. George’s wife, Cheryl, called the psychiatrist. Before he called and quit his job, George was clearly losing control over his own behavior. An incident occurred on the day of the conference meet, illustrates the dramatic quality of his disturbance. While the men’s team was dressing in the locker room prior to taking the field, George paced rapidly up and down the aisles, gesturing emphatically and talking at length about specific events and the virtues of winning. When the men were all in uniform, George gathered them around his own locker. Without Cheryl’s knowledge, he had removed a ceremonial sword from their fire place mantel and brought it with him that morning. He drew the sword from his locker and leaped up on a bench in the midst of the men. Swinging the sword above his head, he began chanting the school’s fight song. The athletes joined in, and he led them out onto the field screaming and shaking their fists in the air. A reporter for the school newspaper later described the incident as the most inspirational pregame performance he had ever seen in a locker room. Without question, the team was driven to an exceptional emotional peak, and it did go on to win the meet by a huge margin. In fact, George was later given the school’s annual coaching award. His behavior prior to the meet was specifically cited as an example of his outstanding leadership qualities. Unfortunately, the action was also another manifestation of psychopathology.

Social History

In most respects, George’s childhood was unremarkable. He grew up in a small, midwestern town where his father taught history and coached the high school football team. He had one older brother and two younger sisters. All of the children were fair-to-average students and very athletic. George loved all sports and excelled at most. When he accepted a football scholarship to the state university, everyone expected him to go on to play professional ball. He was always popular with his peers. They looked to him for leadership, and he seemed to enjoy the role. He and his friends were mischievous but were never serious discipline problems. Although some of his friends began drinking alcohol during high school, George always refused to join them. His father had been a heavy drinker, and he did not want to follow the same path. After several years of problem drinking, George’s father had joined Alcoholics Anonymous and remained sober. Everyone agreed that the change in his behavior was remarkable. George’s uncle (his mother’s brother) had also experienced serious adjustment problems. This uncle was several years older than George’s mother, and the principal incidents occurred before George was born. George was therefore uncertain of the details, but he had been told that his uncle was hospitalized twice following periods of rather wild behavior similar to George’s current behavior. Although the uncle had been assigned a diagnosis of “acute schizophrenic reaction,” contemporary diagnostic criteria would require a different diagnosis.

 

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