Chapter 1. John
1.1 Introduction
Patient: John
Written by Brooke L. Whisenhunt, Ph.D.
Missouri State University
(c) 2013 Worth Publishers
1.2 Presenting Complaint
John is a 20 year-old male college student who lives with a roommate in an apartment off-campus. Over the past 3 weeks, John felt like he had experienced a complete personality transplant. He had never really considered himself to be a creative or original person, but all of the sudden he began to have so many ideas about ways he could improve his life, new projects he could tackle, and plans for bettering his future. For example, he decided that he wanted to start a new online business buying and selling items on E-Bay. He spent over a thousand dollars one night purchasing old guitars on E-bay that he believed he could refurbish and resell for a profit. While he had always enjoyed playing the guitar as a hobby, he had never actually done any refurbishing work and didn’t own any tools. He didn’t have the cash to pay for the guitars which meant he had to put all of the purchases on the credit card he received from his parents. He planned to refurbish the instruments and resell them in order to pay his parents back before they ever got the credit card bill. However, before the instruments began arriving in the mail, he also enrolled in a program to become an online advertising salesman. He saw an infomercial one night describing the program that promised thousands of dollars nearly overnight. He had to pay another $1500 for the packet of marketing materials (which again went on the credit card) but he knew it was a “sure thing.” He did not tell his parents about any of the credit card purchases because he firmly believed he would have the money (plus a hefty profit) well before their bill was due.
John’s ideas were coming so rapidly that he had a hard time getting all of the words out quickly enough when talking to his friends. He felt as if everyone else was moving in slow motion and often found that he was impatient with other people. He had so much energy that he rarely felt tired. When he did try to sleep, his mind would continue racing and he would ultimately sleep only 2-3 hours each night. But each morning, he would feel energized and ready to tackle new projects. He tried to attend his classes during the day, but he found it was impossible to concentrate during the lecture. He couldn’t sit still and his racing thoughts made him feel like he was wasting time that he could spend working on his other projects. He was unconcerned about his grades, telling his friends that he was sure he could ace the tests, and that he didn’t need to attend class or complete the assignments. His friends were incredulous but he believed they were just jealous of his quick learning skills.
Although John felt as if his thoughts and ideas were crystal clear, his friends and family began to respond to him with confusion and concern. He expected that his roommate Calvin would be impressed with his E-bay scheme and was disappointed when Calvin kept pointing out all the problems with his plan. When he spoke to his parents on the phone, they began reacting strangely and kept asking “is everything OK with you?” At one point, they even asked him if he had been using drugs. He felt misunderstood and couldn’t fathom why his friends and family couldn’t recognize that he was simply seeing the world with more clarity than ever before.
He became a social butterfly and sought opportunities to attend parties as much as possible. He drank heavily at parties despite having rarely consumed alcohol previously. One night, Calvin found him in a separate room at a party with a crowd of people who were known drug users. His friend tried to get him to leave the party with him, at which point John became very angry and had to be physically restrained. When he finally arrived home in the early morning hours, he discovered that his parents were sitting on his living room couch. Calvin was also there and looked up apologetically at John, and said “I’m really sorry, man, but something is definitely going on with you and I just thought I needed to let your parents know so that we can get you some help.” His parents said that they were also worried and that they had made an appointment with his primary care physician back home. They had already packed a bag and told him that they were planning to drive him home that day. He was frustrated and a little angry, but he didn’t feel like he had any choice but to get in the car with them for what he was sure would be a giant waste of time.
John’s parents described the “old John” as a fairly quiet and even-tempered person. He was a careful decision-maker and rarely acted spontaneously or impulsively. In fact, his mother had always been a little concerned that he seemed too uptight and worried about minor things. When he was 17 years old, his girlfriend broke up with him after a year-long relationship. He did not want the relationship to end and spent weeks trying to get his girlfriend back. When she began dating another guy, he had a difficult time coping. He stopped hanging out with his friends, and he always had an excuse to say “no” when invited to any events or parties. He lost his appetite and as a result, lost 15 pounds over a 2 month period. His parents became very worried about him but he refused to consider seeing a physician or a counselor. After about 3 months, he started to feel slightly better. He slowly began venturing out again and his parents noticed that he was laughing and smiling once more. They were very relieved and ultimately attributed his difficulties to the break-up.
1.3 Social/Family History
John was the oldest of 3 children. He has a sister, 4 years younger and a brother 7 years younger than him. Both of his siblings still live at home. His parents married after dating in college. Both of his parents are college-educated. His father works in the banking industry and his mother has a part-time position as an accountant. John was an “accidental” pregnancy and was born only 1 year after his parents were married. His parents reported that they were not quite ready to become parents when he was born, as they had hoped to establish their careers more fully before starting a family. His mother had just started a Master’s degree program when she discovered that she was pregnant and she ultimately quit the program and took a part-time job to help contribute financially. To some degree, his mother had always regretted not being able to complete her education but she was very devoted to her children. When looking back on John’s early childhood, his parents reported that they were under a lot of stress at that time due to a combination of factors. John’s maternal grandfather had a long history of psychiatric problems, and during that time period there was an escalation of problems that resulted in his hospitalization. John’s grandfather had been diagnosed with bipolar disorder in his 30’s and occasionally had stopped taking his medication which typically led to a decline in functioning. Dealing with the grandfather’s issues combined with having an unexpected newborn baby and the financial pressures of early careers, his parents reported that those early years of John’s life were not particularly happy ones for the family.
After several years, their stress levels improved and they decided that they were ready to have more children. His mother reported that she had always felt somewhat guilty about John’s early childhood, particularly when she compared the way she felt during her other 2 children’s early years. . She also wondered if John’s reserved nature and tendency to be somewhat melancholy was due to the stress of his early childhood years.
In school, John was generally an A/B student. He was the kind of student who often went under the radar and tried to avoid being the center of attention. He was very conscientious about doing school assignments and rarely missed a day of school. He had a small but close group of friends throughout elementary and high school. He was generally hesitant when it came to asking girls on dates, but he was talked into a double-date at age 16 and ended up having a great time. He and the girl dated for just over a year when she suddenly broke off the relationship. He became desperate to get back together and he started leaving her multiple voicemails and text messages every day. Within 2 weeks, he heard from a friend that his ex-girlfriend had been seen out with another guy from their school. He felt hurt and betrayed and he was even more hesitant to date following the break-up. During the first 2 years of college, he went on dates only a handful of times.
John described his relationship with his parents as very close. He typically called them at least once a week from college. Because of his recent habits of staying out late, skipping classes, and becoming engrossed in his latest “project,” his contact with his parents had become sporadic. When his parents spoke with John, they stated “he sounded like a totally different person” which contributed to their mounting concern about his well-being. The night they received the call from his roommate, they immediately jumped in the car and made the 2-hour drive to John’s college.