Abnormal Psychology

In discussing any kind of abnormal psychology, one has to be careful to root this discussion in socio-cultural and economic norms and behaviours. ^[a]The vignette case study leads to an all-embracing ^[b]understanding of what is deemed to be normal and abnormal. This essay will consider the case vignette of Bongani’s current situation as ^[c]well as his history and symptoms. It will provide a principal and differential diagnosis and it will also suggest a course of treatment that will be most appropriate for him as well as, the ethical and legal issues surrounding the treatment. It will make a reasonable comprehensive diagnosis both from DSM-5 and an Indigenous African perspective-critically discussing, comparing and contrasting different ideas.

When looking at ^[d]Bongani’s history as well as his current situation and symptoms it is evident that his principal diagnosis is Major Depressive Disorder (MDD) American Psychiatric Association (2013, p. 160) with mood-congruent psychotic features. When analysing Bongani’s history, it is clear that his parents spilt, and the accompanying traumatic events prior to this split ^[e]and also post-split contributed to his emotional state. The many arguments Bongani witnessed in turn caused anxiety for his mother’s safety. However, his move to Gauteng provided a temporary escape ^[f]as he went on to create good relationships with friends. But ^[g]the trauma re-surfaced with the death of his father. He attended the funeral and again re-focused on his final exams, suppressing much of his latent trauma. He did not show signs of deviant behaviour, behaviour that is socially unacceptable. Bongani maintained social and occupational functioning by finishing school and attending university as well as making friends. His environment before and after the splitting up of his parents caused personal distress but this was not atypical in that he was socially and culturally expected, to feel this way. However his behaviour became abnormal with the death of his father therefore my provisional diagnosis ^[h]would be “Acute Grief^[i]” (Barlow & Durand, 2014, p. 225). “Grief may lead to depression” (Barlow & Durand, 2014, p. 223) but there are other factors involved in Bongani’s case.

Using Bongani’s history and current problems and symptoms it becomes clear that one can separate the principal diagnosis from the provisional diagnosis. The period for MDD is two weeks and five or more of the symptoms have to be present with the patient (American Psychiatric Association, 2013, p. 160) however “The duration of a major depressive episode, if untreated, is approximately 4 to 9 months.” (Barlow & Durand, 2014, p. 215). Bongani’s symptoms have occurred over the past three months. According to (Barlow & Durand, 2014, p. 224) the period of grief ranges from six months to a year. Bongani’s father passed away at the end of the previous year a specific date is not provided^[j]. If one is to assume that the passing happened around November and Bongani had seen a professional the following year, this help would have to have been acquired before the month of October. A diagnosis of Acute Grief would then have been a safe one.

However, Bongani displays more than just Acute Grief behaviour when analysing the symptoms for MDD according to (American Psychiatric Association, 2013, pp. 160-161) Bongani also presents the following symptoms over the past three months low energy, difficulty concentrating, loss of interest in his personal grooming activities, weight loss and feeling “down”. These cover five of the symptoms for MDD as well as a mood-congruent psychotic feature. The psychotic feature is mood-congruent as Bongani expresses signs of guilt about not completing rituals tied to his father’s death. His auditory hallucinations circulate around the theme of him going home, to complete these rituals. (American Psychiatric Association^[k], 2013, p. 186). There is also another notable experiences in the case of MDD Bongani has recently gone through a romantic break up as well as losing a job these experiences fall under stressful life events (Barlow & Durand, 2014, p. 239) “Most people who develop depression report losing a job, getting divorced, having a child, or graduating from school and starting a career.” Losing a job may be harder for Bongani as he has already developed a negative thinking pattern “He feels like fate is against him”. (Acquired from the case vignette). ^[l]In terms of his romantic break up (Barlow & Durand, 2014, p. 240) “…there are some events that are particularly likely to lead to depression. One of them is the breakup of a relationship…” due to the fact that his ex-partner is at the same university as him he may have to encounter her more often then he would like this could lead to feelings of humiliation, loss and social rejection Barlow & Durand (2014, p. 240). In this sense the stress of the breakup has led to his depression.

When analysing symptoms of Grief according to (Barlow & Durand, 2014, p. 225)^[m] the symptoms present in Bongani’s case are a “Steady stream of thoughts or images of the deceased, may be vivid or even entail hallucinatory experiences of seeing or hearing deceased person.” (Barlow & Durand, 2014, p. 225)^[n]Bongani is hearing voices but the case does not stipulate that they belong to his deceased father. “Feeling disconnected from the world or other people…” (Barlow & Durand, 2014, p. 225) Bongani is emotionally detached from his friends there is also strain on his relationship with his grandmother. Feelings of sadness as Bongani’s sad feeling (he refers to as feeling down) is also related to grief although it is not a symptom. There are only two symptoms present for a diagnosis of grief therefore it is a differential diagnosis and not a primary diagnosis. Grief cannot be ignored in this case as the death of his father and the guilt surrounding it may be a very influential in causing MDD.