CASE STUDY 6
Running head: CASE STUDY 1
Case Study
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Case Study of Mary Tyrone’s Morphine Addiction in the film Long Day’s Journey into Night by Jeanie Hackett
Introduction
The paper focuses on the chosen character named Mary Tyrone, in the Film Long Day’s Journey into the Night. Mary, a fifty-four-year-old mother of two, is married to James Tyrone. Perhaps, the film depicts the psychological impediments that Mary undergoes in her struggles with morphine addiction. The fundamental objective of the paper is to develop conceptualization based on the chosen character, Mary. The case conceptualization of this character will be established from the diathesis/stress model that takes into consideration the precipitating factors (stressors), predisposing factors, as well as the perpetuating factors. Other aspects that would be considered include resiliency factors. The conceptualization based on these factors will encompass the three fundamental domains of the bio-psycho-social model. Therefore, through a proper evaluation of the character, a treatment plan for the character will be established.
Presenting problem
Mary’s present problem is her addiction to morphine which has resulted in the family disintegration. Morphine addiction results in both psychological and physical dependence which renders the body non-functional in the absence of the drug (Minozzi et al. 2013). Its symptoms can be portrayed as immediate side effects on an individual health, personality and lifestyle change. Physical symptoms include bloodshot or glazed eyes. When coming for lunch after work Jamie notices her mother has used morphine by the looks on her eye. Abrupt weight changes; this is clear in the film where Mary claims to have increased in weight which is not true. Changes in personality; Mary has developed a tendency of blaming her husband and sons. For instance, she withdraws from her family as she thinks they are the cause of her suffering. For example, she comes to the point of rejecting Jamie as she claims to be the cause of her son’s death. She claims that Jamie killed her son out of jealousy thus keeps away from her. She also blames them for her loneliness. Another physical symptom is the inability to sleep. Mary is unable to sleep but claims it’s because of her husband snoring and her worry about Edmund. Loss of appetite. At lunchtime, Mary claims to have no appetite (Davison et al., 2014).
Under psychological symptoms, it is marked by a change in the overall attitude of personality this characterized by impairment in personality functioning and the existence of a pathological personality trait (Davison et al., 2014). Under pathological personality trait the patient exhibit antagonism which is marked by chronic dishonesty and hostility. Mary kept on lying to herself about the past and could not hide her anger from her family. Additionally, she lied to Jamie of not consuming morphine. Another trait is disinhibition which is marked by irresponsibility. Mary was inadequate in her role as a wife and a mother. In the film, Mary claims that…”All I wanted was to be a wife”… this indicates a sense of regret portraying that she wasn’t performing her roles as a wife.
Historical Background and Observation of the character
To understand Mary’s condition of morphine addiction, it is crucial to base it on her historical background and current observation. This is well illustrated when using the biopsychosocial model. This model suggests that for any disorder to occur there are complex interactions involved which include biological, psychosocial, socio-environmental and socio-cultural factors, i.e., hereditary, environmental or social factors (Davison et al., 2014). Mary’s condition was as a result of these three factors. Mary could not withhold psychological stressors arising from his husband and children. For instance, she experienced loneliness as her husband preferred the company of the bar room rather than hers. Additionally, her fellow convent friend found her unworthy as part of them due to her choice of getting married.
Perhaps life events could have linked Mary to certain specific patterns of depressive symptoms, e.g., angry outburst; in the film, while taking lunch, Mary angrily outburst to James how he took her to Dr. Hardy and how he is the cause of her current condition…”I hate doctors!” this suggests that she was carrying a genetic diathesis for depression (Davison et al., 2014). Another feature that may have resulted to her condition is psychopathology, i.e., arising from childhood experiences, development of behavioral competences and coping techniques, stressors encountered in adulthood, and cultural influences. For instance, in the film, Mary claim that her father died of consumption. This portrays that perhaps she got her consumption habit of morphine from his father. In her adulthood Mary is under stress of loneliness, she claim that she even doesn’t have friends that can visit him while his husband goes to the barroom and her sons have boys to mingle with. To cope with this challenges Mary turns to morphine.
Another risk factor that could have resulted in Mary’s morphine addiction is social-cultural variables. Research by National Longitudinal Survey of Children and Youth (NLSCY) showed that patients with addiction were prevalent most to caregivers with consumption issues (Davison et al., 2014). Perhaps following her father’s consumption, Mary found it easy to consume in turn her addiction. Another risk factor is psychological variables which comprise of the effect of the drug on mood, the role of cognition, and the situation in which a tension-reducing effect occurs. For instance, in the film, after having a confrontation with Edmund about how everyone was spying on her Mary rushes to the spare room to use morphine. In this case, she uses morphine to control mood and reduce the tension that is already building between her and Edmund.
Mary claims that her entire life has been a miserable journey into the fog of hope and dream. She uses the fog symbolically to represent how she tries to hide from the reality (Davison et al., 2014). Mary uses morphine to move into her idealized past and to overcome the torment of her current life which allow her to relieve the event in her mind. In the entire movie, Mary is portrayed as a tortured individual incapable of gathering sufficient drive to overcome her drug use.
Diagnostic Case Formulation Based On the Diathesis Model
Mary Tyrone, a 54-year-old is a wife to James Tyrone and a mother to three sons, i.e., Jamie, Edmond and the deceased Eugene. Her condition was likely caused by (origin) both etiological vulnerabilities which consist of nature and chronological factors, i.e., the predisposing, precipitating and perpetuating factor (Minozziet al., 2013). Mary developed mechanism schemas which were activated by precipitants worsening her condition. In the film, her morphine addiction is marked by Edmund birth, Edmund sickness, the death of Eugene, and loneliness. This marked her lack motivation and had self-depreciating ideas. Perhaps, it could also have resulted from the fact that her father used to consume in spite of having tuberculosis. Mary joins her family to go for lunch but finds Edmund holding a glass “do you want to kill him…don’t you remember my father; he wouldn’t stop after he was stricken…there is no comparison…” To overcome this problem, Mary turns to using morphine which has rendered her an addict.
Mary’s condition can be explained by use of a cognitive behavioral case conceptualization which comprises of three components, i.e., a hypothesis that encompasses mechanism that results to the problem, origin of the mechanism, and the precipitants responsible in activating the mechanism hence cause the problem (Mumma, 2011).CBT dictates how the role cognitions play in behavior change. This portrays the importance of both behavior and cognitive approaches to comprehending and assisting patients. Mary understood how her consumption of morphine had an impact on both her health and family but could not let go. This indicates that Mary was the cause of all her problems. The information garnered from the assessment is used in the development of a formulation which marks the hypothesis of the causative agent of the patient’s illness and which is used as the basis for intervention. In CBT, the psychotherapist repeatedly carries assessment phase to ensure that the process of treatment is flowing on smoothly. However, CBT focuses more on the formulation phase.
Cognitive behavioral therapist depends on a number of controlled studied in the process of her formulation, which may include a mechanism that results to the prevalent symptoms, epidemiological findings, and randomized controlled trials (Mumma, 2011). Similarly, the therapist relies on data from the case at hand, i.e., Mary’s present addiction. This enables the therapist to a testing formulation hypothesis. For instance use of a self-report measure of symptoms of anxiety, or depression to track the progress of the patient during the treatment session. In CBT patients are requested to arrive early for their therapy session in order to accomplish all the measures used to monitor their progress which is then given to the therapist.
Treatment
Generally, addiction treatment should enable an individual to stop using the drug, stay drug-free and be fruitful for her family and the society. Basing on the biopsychosocial model, illness behavior and health are considered as a product of genes, i.e., regarding biological; lifestyle or stress when viewed as behavioral factors, and family relationships or social support in terms of social condition (Davison et al., 2014). For instance, Marys’ morphine addiction was attributed to both biological, psychological and social state. The prescription of morphine by the cheap doctor to relieve pain during birth acted as a biological contributor to her health. Despite acting on her pain morphine worked on her brain making her shut reality of how the present things were and hence thinking only on her past. She used to seek to find refuge on morphine even when it was not a case of pain which ended up becoming part of her life.
The most effective treatment strategy to curb Mary’s morphine addiction is the cognitive behavioral therapy (CBT) (Davison et al., 2014). Studies have indicated that cognitive and behavioral treatment is the most effective psychological treatment for clients with addiction. Cognitive behavioral therapy allows psychotherapist and the clients with addiction to understand the origin, current status, and maintenance of the problem towards recovery. For instance, a feeling of being worthless being replaced with a feeling of being worthy. CBT is marked by a dialogue between the patient and the psychotherapist which entail three steps. These processes aim at ensuring that the patient recovers. This includes first; the psychotherapist reinforces the patient’s effort at self-instruction. Secondly, the psychotherapist builds on the patient’s initial self-instruction and led her into challenging the notion that perfection is the only way to appease others. Lastly, the therapist assists the patient in generating alternatives to perfection or doing right.
CBT can further be grouped into one, aversion therapy; the client with addiction is made nauseous while looking at the drug. Second is contingency-management therapy; this entails educating clients with addiction and those around them on ways of reinforcing the inconsistent use of drugs. For instance, use of Antabuse and avoiding situations linked to past use of drugs a condition called behavioral self-control training.
Other forms of treatment include individual therapy; which is marked by the ability of the client with addiction to learn and apply both the general and recovery techniques on her situation. This method offers the patient with a safe and confidential context in which the patient can sort out every sensitive and personal problem. Another method is providing genuine counseling; this is essential when there is a need to facilitate a therapeutic relationship (Miller, 2014).
To facilitate effective treatment, treatment plan needs to be developed by the psychotherapist. Treatment plan shows the progress of the patient during therapeutic interventions (Miller, 2014). It offers information regarding the patient’s behavioral strengths, problem areas, employment status, financial, spiritual, medical, relationship, addiction recovery, and sexuality. All this are essential and gives an overview of how to conduct therapy. However, in the course of carrying out therapy session, psychotherapist encounter various challenges. One of the significant challenges is the creation of a conducive relationship when conducting a cognitive behavioral therapy with a client with addiction.
Apparently, most client tends not to open up their problem due to fear of rejection or being judged. It is mandatory to ensure that a good relationship prevails between the psychotherapist and the patient for a smooth therapy session (Miller, 2014). For instance, always avoid involving the patient’s member immediately and instead focus on the patient. Addition one should be empathetic and be encouraging while listening keenly to the patient. Give a safe judgment-free attitude that will aid in easing discomfort. Because you know the ugliness of drug, in some instances one might be overwhelmed by a range of emotions, but this should be a blockade in creating a healthy relationship.
Conclusion
In a nutshell, when considering the causative agent of substance abuse and dependence disorder, it is crucial to know that this condition is generally a developmental process. First, the person must first show a positive attitude towards the drug, experimentation, regular use, heavy use and later becoming physically depended on it. This is directly linked with a diathesis-stress paradigm which links biological, psychological, and environmental factors. Different disorders are transmitted via different diathesis, for instance in biology it is through genetically transmitted diathesis while in psychological it’s via cognitive set. In the film Long Journey into Night, Mary’s condition was as a result of psychological and environmental factors.
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