The Last Tour Essay


This paper describes the mental illness and its causes, the stages of its development how it impacts the patients behaviors and the procedure of its treatment prescriptions. All these are discussed in relation to the patient within the case study known as the last tour. The paper gives a concise summary of the current clinical situation; the current diagnoses using DSM-IV-RT the historical cause of the illness, the problems encountered in the process are also described.

The initial mental health counseling assessment is often used in the treatment of the mental illness. It is used in formulating the initial tentative diagnosis. The diagnoses can sometimes be changed to address the changes that occur with the individual’s presentation and functioning. The data gathered after the diagnosis process is what is usually used in administering any treatment. This has been applied to the last tour story victim, which describes the life of a marine combat who was wholeheartedly committed to his job but finally got post traumatic stress which led to the interference of his mental health. This caused him to indulge in some chaotic activities which eventually led to his death (Messina, 2008).

Present Description
The triggers associated with recent symptoms include the victim making rush decisions. Instead of simply shaking people’s hands the patient bear-hugs people and claim that he has the ability still to serve at the highest ranks within the government. The patient further tries to reverse the Toyota out of the tree branches where it was wedged after the crash. The patient got easily upset when asked stupid questions, like whether he killed anybody. The patient is not well taken care of since he still drinks and smokes cigarettes at will. The other care deficit is that they are still allowed to drive a car at night in spite of their condition. This problem has caused some mental opaqueness in the patient. The patient suffered a condition described as ‘hyper-vigilance’ which is caused by battle fatigue. The patient was admitted through primary care, where the major symptoms were recognized and the physician assistant prescribed the antidepressants Zoloft and trazodone used to control P.T.S.D (Finnegan, 2008)

First, thorough psychosocial history is done and the mental status examined. In this case, the patient was found to be out of his mind after he had the test. After the test, the Multiaxial Diagnosis is developed using the DSM-TR-IV. The presented problem is described and all the specific symptoms verified to justify the diagnosis and the duration estimated. Secondly, the client’s mental health history is checked, whether the patient had been hospitalized before for psychiatric conditions or not. It was found that he had been hospitalized in Marine Corps War fighting laboratory at Quantico, and Bethesda Naval Hospital. He had not been involved in family therapy when young. Thirdly, determination is done on whether the client had undergone any psychotropic medications, it was found that he used the antidepressants Zoloft and trazodone, given to him by assistant physician in War fighting Lab. Fourth, the client’s relevant overall health history is reviewed, this includes things like the current physical health, the patient is examined for any past or present cause accounting for his current mental health complaint.

Then the client’s family background is reviewed to identify any psychosocial stressors, substance abuse that might not have been successfully treated. The clients social history is reviewed, his performance in school, interaction at the community level. Fifth, review of the client’s vocational history, his level of commitment to the current Job is done. It was found that the client really loved his job and was committed to it and the length of tenure on past jobs, the client’s whole life was chaotic and tormented. Then the client’s strengths are identified and the liabilities the client has brought to the therapy. He suffered visual and audible hallucinations that were as a result of overmedication. Finally the client is rated based on the mental health status exam (Finnegan, 2008)

Past Description
The illness of the patient was caused by his hard work at the Marine Corps which interfered with his brain causing him post-traumatic stress disorder including emotional problems. He suffered a problem known as psychosis where he could fight his way through walls. Also included is his combat flashback, the task that involved him in searching Baghdad both on foot and mechanized patrols. This trauma they said worsened through his habit of drinking. There damage is done in three degrees with time. The damage range from standard combat stress which can be treated within few days rest and full stress damage (Finnegan, 2008).

The Problems
Comparison and Contrast of the Patients Presentation
By the use of DSM IV-R diagnosis some of the general Post-Trauma Stress Disorder symptoms expected from the patient are the level of damage which ranges from standard war stress. This symptom can get treatment within a short time rest, that is, a few days. In full blown complex P.T.S.D, is very difficult to be get treatment or cure. P.S.T.D is a psychic wound which can be crippling, incurable in its innumerable complications. There is an expectation of U.S soldiers suffering from depression either at present or in future. Another symptom which the soldiers suffer from is stigma which is attached to P.T.S.D and majority of the victims don’t seek any treatment. These symptoms were similar to what Twiggs was suffering from though in the beginning he did not clearly announce his P.T.S.D. This clearly shows that from the DSMIV-R Twiggs was suffering from P.T.S.D (Finnegan, 2008).

After this sergeant major apprehended the symptoms, he was sent to the physician who gave him some prescriptions which he could use to control P.T.S.D. The medications were meant for evaluating and adjusting but Twiggs had dull effect instead. He took the prescriptions, the antidepressants Zoloft and trazadone and mixed them with alcohol. In his marriage, sadness, anger, drinking and flashbacks took charge of their marriage. Twiggs had guns all over his house, others which he placed between the mattresses and bow springs. He also pushed his family away because his symptoms kept on recurring and he could behave fascinatingly (Finnegan, 2008).

There were cases of suicide in the military and this was evident with the Twiggs brothers. The suicide cases were high among veterans as well as active duty military. Travis who was in the Marine Corps discovered that he was suffering from Post-Trauma Stress Disorder and felt so bereft since he thought that he could not go back to the marine after all the devotion he had made to his work. Kellee saw her husband on given days he was sad, acted like mad people, he was depressed and often felt as if they he was weak and not worthy of being in the marine. He could sweat every night and shake uncontrollably. The presentation of the patient in relate to the DSM criteria for the diagnosis indicates that there are high chances of Post-Trauma Stress Disorder in the marines which can either be cured at an early stage or can even kill after it gets to a critical stage of sickness. Most of the patients who suffer from P.T.S.D are the soldiers from the military (Finnegan, 2008).

Nursing problems
The most glaring nursing problem with my patient is post traumatic stress disorder (PTSD). My patient who was once a marine soldier, a veteran of combat suffers from serious bouts of combat flashbacks more so when my patient drinks heavily. According to the wife of my patient, my patient had been behaving abnormally prior to his departure two days ago. Besides, the wife seems surprised that my patient is actually admitted here in Arizona. The implication is that my patient had been suffering from PTSD for a long time probably for all his life as a soldier. Usually there are several types of PTSD which could range from combat stress to full-PTSD which could quite difficult to treat (Finnegan, 2008).

            The other nursing problem that my patient suffers from is anxiety and depression. The implication here is that combat flashbacks have made my patient to suffer from depression (Finnegan, 2008). This is usually manifested in such characteristics as lack of sleep, memory loss as well as lack of composure and heavy drinking among other characteristics. For instance, despite the fact that my patient had patient loves movies, he cannot be in a position to watch a movie since the tyre and gunshots would remind him of the previous experiences as a soldier. The patient has equally been diagnosed with attempted suicide.

            The nursing interventions with regards to the PTSD as well as anxiety and depression include the prescription of antidepressants such as Zoloft and Trazodone as well as antipsychotic. The other nursing intervention would be counseling sessions as well as therapies as well as a reduction in the medication. However, the unfortunate bit is that my patient did not fully recover from the disorder. Instead the psychosis continued as more and more medication was being prescribed on him. The implication is that these prescriptions did not help much but only contributed towards overmedication of my patient (Finnegan, 2008).

Hypothetical Evaluation
It is said that nearly twenty percent of those who served in the Marine Corps were suffering from P.T.S.D. or from a major depression. The suicide rate among veterans and active-duty military personnel could be rising as well. The work that the solders do at the Marine Corps affect them indirectly and therefore it affects their brain. In the story the two brothers whereby one was a solder, says that he was the strongest man and totally devoted in the Marine Corps. It can be clearly seen that people liked him. For example, Kellee’s landlady, Pamela said that she is not a big fan of military but she really liked Travis because he had a wide streak of goodness. He seemed to be a little over the others in terms of physical energy because he would work out in the basement at 3 a.m. for a couple of hours before he could go to work. He was a highly trained marine, a marital-arts instructor, weapons expert, and a skilled combat tracker (Finnegan, 2008).

However during this time of being a solder he faced many problems. He developed a Post-traumatic disorder which led to him having developing emotional problems that led them to try and find comfort in cigarettes. This made his mind getting out of order and made him to start behaving oddly. The client at this time had emotional problems that led to him getting an accident a car crash. This is clearly seen where it is said the brothers behaved oddly after the crash, they tried to reverse the Toyota out of the tree branches where it was wedged but could gain no traction (Finnegan, 2008).

The other problem that the client had is that he had problems with the Law this is seen where it is said that after the last rangers left, while the dusk was falling, the twigs brothers approached two tourists, who had stopped their rental car to admire the view A.38 revolver was displayed and the twigs brothers got into the car and drove away. It was due to their emotional problems that had been caused by P.T.S.D. The Travis’s wife explained about their state and said that Travis had been out of his mind the last time she saw him (Finnegan, 2008).

The client made his brother to get into trouble with the law and to both of them being killed, because he is the one who influenced his brother to do everything that he was doing. It is clearly seen when the wife of the soldier says that his brother was not a fighter but might have done it in order to impress his brother. The reasons that made the client to behave like this were his emotional stress and his P.T.S.D, which caused damages to his brain, and made it to run out of order (Finnegan, 2008).

The case study A Reporter At Large, The Last Tour, A decorated marine’s war within By William Finnegan is a story about a marine who had committed suicide and the brother. Mr. Travis Twiggs was a Marine Corps staff sergeant who was stationed in Quantico, Virginia. His brother was William Twiggs and his wife was Kellee Twiggs. He had two daughters, America and Ireland. He struggled with post-traumatic stress disorder. In January, 2008, he wrote an article titled PTSD: The War Within in the Marine Corps Gazette about his struggle with post-traumatic stress disorder and he publicly acknowledged that he had emotional problems. He then worked in a new unit, the Wounded Warrior Regiment. In this unit, he spread the word about treating and preventing P.T.S.D. and he later met President Bush at the White House in the late April. He then tried to drive into the Grand Canyon three weeks later. A few days before their death, Travis and William had disappeared. Travis’s wife Kellee explained that Travis had gone out of his mind the last time she saw him (Finnegan, 2008).

In the present clinical situation, there are triggers associated with recent symptoms of the patient.  This is because the victim making rush decisions. For example, the patient tries to reverse the Toyota out of the tree branches where it was wedged after the crash. The historical clinical situation of the patient shows that his illness was caused by his dedication of work at the Marine Corps. His hard work had caused him post-traumatic stress disorder including emotional problems. His wife explained how he was out of his mind the few days before his death. The patient had so many problems such as the nursing problem like post traumatic stress disorder and the symptoms related to it (Finnegan, 2008).

In the final analysis, the issue of PTSD is s very serious disorder which can cause several problems more so if the PTSD is a complex one like the one patient was undergoing. In this case a radical decision should have been made such as sending the patient to some program of PTSD probably in New Jersey. In New Jersey, probably the patient could have been given a personal cognitive therapy which could have succeeded. The implication here is that this could probably have been more effective as opposed to being put in much medication which of course was ineffective (Finnegan, 2008). What is meant here is that currently there are available many effective programs which can be put in place to assist victims of PTSD top fully recover but only if the program is identified as early as possible.

Finnegan, W. (2008, September 29).  A Reporter At Large: The Last Tour, A decorated marine’s war within. New York: The New Yorker. Retrieved October 28th, 2008, from

Messina, J. (2008). Initial Mental Health Counseling Assessment Using the DSM IV-TR C6432 Diagnosis of Pathology retrieved October 28th, 2008, from