In your role as a behavioral clinician, it is imperative you understand and be able to analyze the etiologies of psychological disorders as you work with justice-involved individuals. Identifying the cause of a psychological disease or abnormal condition, whether intrinsic, extrinsic, or idiopathic, provides you with a basis for diagnosing the root cause of the disorder.

Choose one of the following case studies for the Week 3 Summative Assessment:

Sam: 

Sam is a 25-year-old African American who is incarcerated for robbing a jewelry store. He reported that he was “framed” for this offense. Sam reported that he was engaged in a “spiritual battle” against demonic spirits who told him to shoot himself. During the interview, he stated that he had “telepathic skills,” meaning that he heard voices inside his head with whom he had conversations. He felt disappointed he was unable to complete his suicide and asked the staff to call the FBI but declined to explain the reason for his request. The voices gave him “hypnotic commands” and also had the power to “increase his own serotonin.” He did not believe that the voices were part of any illness but just telepathic communications with demonic beings. He reported how voices controlled him: “They enjoyed controlling me. They keep me from having complete thoughts. I find myself not realizing what I am trying to do; they make me feel “gyroscopic,” having heartburn, and they have the ability to nullify my medications.” The patient indicated that he had difficulties maintaining his train of thought: “Voices keep me from having complete thoughts very often, and they block my thoughts, keep me from doing things, and get me scared.” The voices were in total control of his future, and suicide was his only option: “I am not able to control my future enough to make things not happen.” Sam first consulted a psychiatrist when he was 17 and reported paranoid thinking. He started to hear voices at 21.

Anna:

Anna had a long history of severe mental illness dating back more than 20 years. During her first depressive episode, she had killed her baby while suffering psychotic symptoms. She also made two serious suicide attempts. Anna has been divorced twice and now lives alone in a council house. She has an adult daughter who is deaf and severely handicapped. Prior to her last arrest, her daughter lived at home, and she cared for her with help from local social services. Her daughter was placed in residential care when Anna was incarcerated. In view of the previous infanticide, social services had always monitored the situation with regard to risk factors for her daughter’s safety; however, this was less of an issue now that she was an adult. Anna’s illness history is characterized mainly by depressive episodes with psychotic features. She had experienced episodes of paranoid thoughts when she believed her neighbors knew all about the past and she was reluctant to go out because she felt persecuted. Anna felt extreme guilt at having killed her child. When psychotic, she would shout that she was evil and deserved to be punished. It seemed that the guilt had affected her considerably to manifest in a negative self-concept. Even when well, Anna never spontaneously talked about herself in a positive manner at all.

Continuing in your role as an intern with the psychological treatment center for a local correctional facility, assume your supervisor has asked you to prepare an analysis of the etiologies of the disorder development for the client.