Now that you know something about diagnosis and assessment, let’s review what we know—and what we don’t know—about Rose Mary and Rex Walls, starting with Rex, using the neuropsychosocial approach.
We know that he drank alcohol—regularly and to excess. In fact, he drank so much and so chronically that when he stopped drinking, he developed delirium tremens (also known as the DTs)—withdrawal symptoms marked by hallucinations and shaking. He clearly would have been diagnosed as having alcohol use disorder. (Disorders related to misuse of alcohol and other substances are discussed in Chapter 9.)
We don’t know whether the tall tales he told about himself were delusions or merely attempts to make himself look good in his own eyes and those of other people. Based on Jeannette’s descriptions of her father, it appears that Rex also strove to be the center of attention. This pattern of self-centered behavior suggests that he may have had a personality disorder (specifically, what is known as narcissistic personality disorder, and possibly other personality disorders, discussed in Chapter 14).
What about Rose Mary? Based on Jeannette’s descriptions of her mother’s difficulties. Rose Mary may have suffered from depression. It is possible, though, that certain behaviors instead may have been expressions of anger and resentment about feeling forced to work when her husband was so irresponsible. She was bitter that she hadn’t become a famous artist and blamed her lack of success on her children. In addition, given her own preoccupations with her worth as an artist, even as her children were starving, she may well have had narcissistic personality disorder.
However, again we need to be cautious: No mental health clinician can know with certainty what, if any, specific disorder Rose Mary or Rex Walls may have had. We cannot make a direct clinical assessment of neurological, psychological, or social factors; we can only infer such factors from their daughter’s account, which does not provide the kind of information needed to make an accurate clinical assessment.
Finally, clinicians and researchers diagnosing and assessing patients must keep in mind the possibility that symptoms of a psychological disorder can arise from medical problems. Only after ruling out medical illnesses can a mental health clinician or researcher have confidence in a diagnosis of a psychological disorder.
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