Psychological evaluation Essay

Psychological evaluation

Reason for Referral:

            The first clinical interview for Ms. Williams, the patient is young, just 17-years old, a single and white Puritan female who works as a household help or female companion almost throughout her life to other Puritan families. She has no records of formal education. The patient is undergoing psychological evaluation for symptoms of possible borderline personality disorder. This evaluation aims to explain why the patient is exhibiting such conduct that clearly puts the people around her in jeopardy. Her behaviour of outright lying and inflicting emotional and psychological pain to others and even to the point that deaths have occurred due to her malicious intent is an indication that the patient herself is suffering from a disorder for which reasons are to be clarified in this report.

Procedures:

Clinical Interview: see appendix

Case History/Background Information:

22 March 1675 – The patient was born is second eldest to the Williams family. Her family showered attentions more to the eldest since the child is male. She is soon followed by other siblings.
1683 – The patient is 8 years old; is separated from her family at a young age of 8 years old when the Williams family died of an unknown disease. The uncle is a Reverend in Salem, Massachusetts, who is in need of a companion for his daughter.

January 1685 – The patient is 10 years old; gets into a verbal fight with other boys in the town as she is smirked and chided as being worth nothing but to be a slave girl. Possible beginning for the patient to develop inferiority complex about her physical features and sexuality.

April 1685- The patient is found of bullying other Puritan little girls in her community. She is reprimanded and punished by her uncle as he finds out that a neighbour’s dog is found to be dead after the neighbour’s daughter gets into a fight with the patient. The reverend locks her up in the attic for two days without supper.

December 1686 – The patient is 11 years old; she becomes a leader of some sort for the town’s female bullies who targets on pretty girls and young boys.

1689 – The patient is 14 years old; sent to be employed with John Proctor and his wife who have no children.

August 1689 – The patient is 14 years old; realizes she is physically attracted to John Proctor. She follows his wife willingly but scorns him for developing such feelings for him. She ignores Mr. Proctor.
17 September 1689 – The patient is 14 years old; gets into an argument with Mr. Proctor over her bad manners. Mr. Proctor threatens that he will fire her if she continues with her ill manners.
02 February 1690 – Elizabeth Proctor leaves the house to visit her relatives in the next town.
03 February 1690 – The patient and Mr. Proctor are left behind. The patient suffers from sexual advances made by Mr. Proctor. In the end, Mr Proctor avoids her after the advances.
05 February 1690 – The patient suffers from nervousness over the incident with Mr. Proctor; she confronts him over what happened and he admits that he likes her. Mr. Proctor and the patient sleep together for the first time.
February 1690 – July 1691 – The patient when she was 15 to 16 years old, continues with her sexual affair with Mr. Proctor. On July, they were discovered by Mrs. Proctor and the wife ridicules her by throwing words such as “soiled hypocrite” “an unwanted whore” and “Satan’s bitch” to her. She is driven from the Proctor home and sent back to her uncle.
July 1691 – May 1692- Rumours circulate that the patient “is soiled” meaning is not a virgin anymore as Mrs. Proctor refuses to attend their Parish since some people there are actually sinned. The patient exhibits more negative and unruly behaviour with foul language and extreme bullying on young girls and yet manages to earn the good graces of the townsfolk with her impeccable behaviour.
18 June 1692 – The patient and other girls from the town goes into the forest to perform a ritual to “kill off” Mrs. Proctor for ruining the patient’s character.
19 June 1692 – Girls who are known to be within the patient’s circle suddenly falls sick. The reverend’s daughter, Betty Parris, is the most severe case as she gets extremely sick.
21 June 1692 – The patient spreads stories that people in their town are doing witchcraft. This ensues chaos in the entire town as person after person gets accused, thrown into trial and imprisoned.
24 June 1692 – Twelve townsfolk gets hanged after being proven guilty of witchcraft. Five others remain on trial including Mr. Proctor and his wife.
25 June 1692 – The entire town awaits the proceedings as one of the most reputable man, Mr. Proctor is accused of witchcraft by the patient. His wife is also imprisoned and on trial.
28 June 1692 – Mr. Proctor goes on trial for witchcraft. He denies this and instead admits to his affair with the patient. The patient denies this even when one of the girls, Mary Warren admits to making up the whole fiasco with the witches and rituals. The patient’s uncle, suggests that she undergoes clinical treatment and evaluation to help her resolve her issues.
Behavioural Observations:

            The patient is pale, wan and yet physically attractive. Although there are deep circles around her eyes and a haunted look in them, there is a strong determination set in her jaw as if she is set against something or someone. She does not fidget or even looks anxious. She is confident and strong in her element. However, the patient looks withdrawn from her surroundings and even angry as she frowns momentarily over the objects around the interview room. She is controlled in her expressions and actions, sometimes, even too controlled. The patient also manifests contradicting sides during the interview—she would be very docile and sweet and then vehement and violent in her choice of words and expression of them.

            The patient also obviously looks down on the people in her community most especially those belonging to the Parish and of men. This must arise from the fact that she has suffered tremendously in men’s hands or that her expectations about the Parish is not met. She has high confidence in herself and thinks of herself as a person of great importance to the point that she has no sense of affinity with her family members, girls her age and her friends. The patient’s mood shifts tremendously with the topic of the interview from being very whimsical with the subject of Mr. Proctor and then very vehement with the subject of Mrs. Proctor.

Diagnosis:

            The patient suffers from a psychiatric disorder, specifically on the borderline personality disorder as she seeks to have dual personalities in front of the majority of the town and to that of the people who knows her affair with Mr. Proctor. Her malicious intentions of spreading lies would have been on the normal on the average scale of people who have suffered loss of a loved one, but the involvement of twelve lives would prove the severity of her alarming character. The fact that the patient does not feel any remorse, sadness or grief over the conclusion of her affair with Mr. Proctor is an indication that she may have extreme emotions bottled up inside of her. Moreover, her inability to nonchalantly accuse other people to save her reputation, even if lives are already at stake, is evidence that she has issues with emotional control.

            According to Heffner, borderline personality disorders would have the symptoms of “unstable relationships” with other people, “inconsistent moods, and significant impulsivity” which the patient so clearly all has. Although the patient does not have tendencies of inflicting harm to herself, she has great tendencies of inflicting great harm to other people by means of physically eliminating them.

Treatment Plan:

            According to Heffner, treatment is long term and has to be a continuous process both for the patient and for therapist who specializes in treating such disorders. The symptoms for this disorder have been present for a long time as with the case of the patient, already starting with her childhood and had a increase of bottled up emotions with her that eventually lead to the outburst of her emotions. Heffner further suggests the following treatment plan:

Insight oriented therapy can be helpful but research is showing an increased support for a cognitive-behavioural approach.  In other words, the individual’s thoughts and actions are monitored both by the self and therapist and specific behaviours are counted and a plan is made to gradually reduce those thoughts and behaviours that are seen as negative.

But Westenberg presents a different case as the patient’s disorder can also be diagnosed as being an obsessive-compulsive disorder (OCD) that stems from her ability to have such “persistent, often irrational, and seemingly uncontrollable thoughts” (Heffner). Westenberg states that “obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by recurrent persistent thoughts (obsessions) and/or repetitive compulsory behaviours (compulsions)”. If Westenberg is correct in this, then it means that medical treatment can be done in this particular patient’s case.

Prognosis:

            This will depend on the patient’s ability to admit that she has a disorder and that she needs to be treated

Appendix

Q: What’s your name and how did you get it?

Patient (P): My name is Abigail Williams. I think my momma gave it to me. I don’t really know.

Q: How many are in your family? What number are you?

P: We’re about 6 but I live with my uncle. I am second to oldest.

Q: If you could be an animal, what would you be, and why?

P: I wanna be swan, something beautiful. What are beautiful animals? Mermaids are animals too right? If that’s an animal, I want to be a mermaid.

Q: If you could travel anywhere in the world, where would you go?

P: Somewhere I can be away from my uncle and the people here. I don’t want to Puritan no more. People here are too fake. They really do things but pretend they’re all do gooders.

Q: What do you most like to do for fun?

P: I like going to the forest with them other girls. Also, I like going out with boys. I mean, I am girl. That’s normal right? Of course I want to be with em boys. Well, actually, I just like one boy. Know John? Yeah, I like that boy. Well, he isn’t a boy exactly. He’s a man. Well, a married man exactly. See what I mean about people here being hypocrites? They think that man is good but he’s sinned as the devil himself.

Q: In one word, what is the most important thing to you and why?

P: Myself. Who wouldn’t consider herself important? Do you think you’re not important to yourself?

Q: Who was the most influential person/people in your life and what did you learn from them?

P: My uncle is a good person, he raised me well and good. But that man I was talking about—John? He made me feel special. He made me feel like I am not just a black slave made to be ordered around. Know his wife? That bitch isn’t fit for him. If he wants her then why would he be with me? That bitch should die along with those other witches. She’s like that—a bitch witch.

Q: If I were to walk into the place where you live, what would I see hanging on the walls, placed on the tables, or shelves?

P: I don’t have any place on my own, what you talking about? I live with my uncle or whoever wants to hire me. I used to work with the Proctors but they fired me because of John’s bitch of a wife.

(Questions were taken from http://courses.wcupa.edu/ttreadwe/courses/02courses/interview.doc.)

Works Cited

Miller, Arthur. The Crucible. Oxford: Heinemann Educational Publishers, 1992. Print.

Heffner, Christopher. “Boderline Personality Disorders”. Psychiatric Disorders. Web. AllPsychOnline. 06 May 2010.

Westenberg, H.G.M. “The Role of Dopamine in Anxiety Disorders: Focus on Obsessive-Compulsive Disorder”. European Frontiers in Third Series Neuropharmacology.Web.Medea Communications.06 May 2010.