Reference no: EM133408473
History of Present Illness :
The client is a 53-year-old white male, divorced, living alone, admitted to the hospital in a near-comatose condition because of an overdose of approximately thirty tablets of Valium, 5 mg, combined with alcoholic intoxication. The client was given supportive care and was alert at the time of intake. A heavy drinker for at least 10 years, he has been unemployed from his custodial job for the past three months as a result of showing up late and missing days entirely due to being hungover. He acknowledges feeling increasingly depressed since being fired, and for the past two weeks having insomnia, lack of appetite, and weight loss of eight pounds. He indicates he wanted to die, had been thinking of suicide for the past week, planned the overdose, but had to "get drunk" because "I didn't have the guts [to kill myself]." He is unhappy and frustrated that the attempt failed, stating, "nobody can help me" and "nobody even cares." He denies having any close relationships or caring how others would feel if he completed suicide. He views death as an "escape" and states he feels relieved every time he thinks about it. He denies having any hobbies or interests.
Past Psychiatric History:
One prior psychiatric hospitalization that lasted just under three months following a suicide attempt after his fourth wife left him. Treated with ECT during his hospitalization. He reports that he did experience recovery, but it only lasted for two years. Social History An only child, he reports feeling lonely growing up and having a hard time socializing and making friends. Both of his parents are deceased. His father died by suicide when client was eight years old; his mother died of a heart attack two years ago. He was born and raised in NY and never left that neighborhood. He completed middle school and one year of high school but then dropped out to get a job and help his parents pay for the bills and to "work towards being independent." He has never managed to secure steady employment and feels that he set himself up for failure by leaving school without at least a high school degree. He reports feeling resentful that his parents let him make that decision. He blames them for all of his problems and the fact that his life went off track at such a young age. As resentful as he is, he reports feeling guilty that he never truly forgave them and that they both died before they were able to have a strong relationship. He reported being married and divorced four times. He has no children from any of the marriages, although he has three stepchildren. He has very little contact with any of them. He also reports having no close friends. He explains that he finds it hard to trust people and often thinks about how his parents used him and how he always expects that if they could do that to him, anyone could. When asked to describe himself, he replies, "lonely, guilty, angry, unlovable." He is currently living on Social Security income. He has no savings, retirement account, or other financial resources. He received a bad-conduct discharge from the army after three months for "disobeying an order and punching the officer." He has had no legal problems other than several arrests in the past two years for public intoxication.
- What are your initial reactions to the case?
- How might these reactions impact your ability to engage with this client?
- How might these reactions impact your professional obligation to prevent harm?