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Case Description

I have selected Robin McLaurin Williams as a famous person for current clinical assessment. The case study is partially fictional since the man died in August 2014. Nevertheless, professional considerations motivated my choice. After Mr. Williams’ suicide, many clinical reports, and comprehensive biographic notes became available. Therefore, they constitute the basis for my paper. I follow the categorical approach to identify the set of visible symptoms and classify the disorder. I assume that the patient sought my psychological counseling at the age of 62, i.e., a year before the tragic event.

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Mr. Williams was born in 1951 and grew up in a prosperous Chicago family. His mother had just finished her modeling career and married a successful senior manager of Ford Motor Company. With two elder half-brothers, Robin was the only mutual child of the couple. He grew a lonely and withdrawn boy. His parents’ life was full of social engagements and business trips. As a result, the family’s maid managed Robin’s upbringing. The patient constantly suffered from the deficit of parental love. In addition, his siblings were also reluctant to share company with their youngest brother. Therefore, Robin thought of creative ways to attract the attention of his family. Ingenious comic acts brought him the desired commendation of his parents. His iconic comedian skills developed as an ambient response to the hostile and indifferent environment. In the following years, such unique talent brought him fame and fortune. However, to some extent, it always remained a part of his defensiveness (CBS Chicago, 2014).

Robin was an excellent student throughout his school years. His educational success compensated the troubles he had with his classmates due to excessive weight. The clownish mask helped the shy and diffident boy to cope with bullying and lack of friends. The boy’s adaptive skills perfected as he changed schools following his father’s career shifts. The private school experience in Detroit had a substantial positive effect on the patient’s socialization. The student-centered approach took into account the specifics of Robin’s character, as well as his remarkable intellectual abilities. Active sportsmanship improved his appearance, while his unrivaled eloquence and superb sense of humor helped him in communication with his schoolmates (Jay, 1999).

Robin’s family felt confident about his career in business or politics. However, the boy rebelled against the ordained fate to follow a cherished professional vocation. The patient confessed that it was extremely difficult to resist his father. It was even more challenging to prove the worthiness of his choice. Ever since he embarked upon the acting career, he felt he was trying to justify himself in the eyes of his parents. Exclusive standards he could never meet and misplaced expectations became the burden Robin had to carry through his life. His self-distrust, unease, and nervousness originated from the conflict (Jay, 1999).

High school drama classes discovered his acting and comic talents while the New York City Juilliard School perfected them. His 30-year-long award-winning filming and staging career fascinated millions of fans around the globe. However, it never brought satisfaction to Mr. Williams. Bohemian environment and professional burn-out activated drugs and alcohol abuse. The patient has a 20-year history of addiction, paranoid personality disorder, and obsession (Corliss, 2014). His attempts to fight the vicious habits failed in the long-run. He claims he has been sober and clean for a year already.

Crises in the patient’s personal life triggered relapses. Two divorces, estrangement from his three children, and the death of his best friends, Christopher Reeve, and John Belushi, greatly influenced his unsteady psychological state (Jay, 1999). At the moment, M. Williams resides with his third wife in his California home.

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Clinical History

The client’s chief complaint is about insomnia, lack of appetite, and pessimistic vexations. The problems started two months ago when he faced the diagnoses of an early stage of Parkinson’s disease (CBS Chicago, 2014). Doctors told Mr. Williams that medicine had a limited set of measures to decrease the deterioration of his condition, but nothing would prove a complete cure. He says he feels completely broken as a result of such revelation. He is unwilling to share the news with anyone except his wife. The mild signs of the nervous system disorder are already visible in his posture, facial expression, and slurred speech. He confesses that he had serious trouble making his appointment with me and keeping it. It seems as if he is standing on the verge of the abyss and is about to fall. During the day, he can think of nothing else but checking the gravity of tremor in his hands. Such preoccupation is becoming an obsessive pattern. He believes that his acting and staging career is finished. He cannot focus on his professional activity anymore. Awareness of the inevitability of the adverse consequences took all the happiness out of his life and nothing satisfies him anymore. He does not want his fans and family to see his mental decay. He is paranoid about people’s reaction to his disease. Mr. Williams believes everyone would betray and forget about him. He does not want to live in the shade of his glorious past, as well as die in oblivion. Moreover, Mr. Williams often visualizes his own death. He is alarmed to think there will be no one to attend the funeral by the time he dies. He remarked that it might be better to die sooner to avoid shame. Fear of abandonment and neglect are his two greatest obsessions. He complains about frequent attacks of panic, mental paralysis, and breathing problems. He also reports frequent headaches and stomachaches (Vokes-Dudgeon, 2014).

Since the time Mr. Williams discovered the diagnosis, he lost his appetite for food and sex. His mind provokes him to return to drugs and alcohol. At the same time, he feels guilty for the life, health, and relations he wasted due to his addictions. Nothing seems able to relieve the pessimistic mood. The patient denies recent substance abuse. He has not started any medication yet because he does not believe anything would help his condition.

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Rationale for Diagnosis

Highlighted symptoms explicitly indicate an aggravating mood disorder (Comer, 2013). The pessimistic ideation, performance decrement, lack of energy, lowering concentration, and isolation indicate depression. The patient’s ability to enjoy life is disrupted. Somatic effects include disturbed appetite, insomnia, weight loss, headaches, stomachaches, and reduction of libido. Chronic alcoholism and drug abuse, as well as Parkinson’s disease, exacerbate the depressive episode. Patient’s condition advances the loss of self-esteem, provokes guilt, and results in suicidal thoughts. The gravity and continuance of the patient’s distress allow diagnosing a severe form of the recurrent depressive disorder.

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Treatment Plan

Therapeutic intervention will combine self-help, counseling sessions, and medication. Independent measures will involve significant changes in the patient’s life. I recommend that Mr. Williams should launch a program of early morning exercises. To ensure the stability of such an endeavor, he should hire a personal trainer. Getting accustomed to starting his day in a stimulating life-assuring allows fighting depression in its worst period of the day. The sporting activities should include wrestling and tracks exercise three times a week. Such engagements will remind the patient of his passions in youth and commit him to teamwork. Such an environment will invoke enthusiasm, competitive spirit, as well as create the need for trust, sharing, and mutual support. The schedule is targeted to fight paranoia and isolation. It will hype metabolism, as well as restore appetite and libido. Mr. Williams will overcome suicidal thoughts by creating a list of six close confidants, whom he can call in critical moments and relieve his anxiety (Comer, 2013).

Psychological counseling will involve guided cognitive behavioral therapy. During 20 one-hour talking sessions, the patient will be able to express his mood, ideas, phobias, and feelings. I will help him see the reasons for negative ideation and the way he selectively chooses to develop a depressive thinking pattern. We will critically observe his self-deprecating and suicidal thoughts and mitigate them by addressing a broader vision of his life and achievements. Such an approach will empower Mr. Williams with greater control of his mental and emotional systems. It will give him tools to quench depressive ideation. We will discuss the possibility to add new activities to the patient’s schedule and their positive influence. I will add family sessions to the therapeutic process to advance his reconnection with estranged wife and kids. Reconstruction of the most meaningful relations will give Mr. Williams a substantial motive to work on his recovery goals.

The medication segment will include Citalopram (Celexa) (Kernisan, 2015). The drug is the most studied antidepressant. It has a satisfactory side-effects profile and revealed convincing results in the treatment of elderly patients.

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