Biopsychosocial Assessment of Howard - Research Paper Example

Case Vignette: Howard s affiliation Case Vignette: Howard Introduction The model of Bio psychosocial is an approach which s that several factors like behaviours and emotions which forms the psychological factor, biological factor and social factors like cultural and environmental play a major role in the state of a human individual in relation to illness or disease. The health of an individual is essentially well understood in the when a combination of factors like mental state, biological and social are considered rather than solely on biological terms. Constructs that are spiritual in nature have been proposed to also be considered as an effect of disease or illness on an individual (Engel, 1977). This model has moved away from the traditional model of medicine which stated that every disease or illness can be identified by means of underlying change of the body from normality like pathogen, injury or genetic factors. It is a widely used model in the field of medicine and sociology (Sarno & John, 1998). The Bio psychosocial Assessment Howard a male aged 32 years is diagnosed with a post-traumatic stress disorder and depression. Howard is torn between his wife and military service. Howard’s wife wants Howard to leave the military. Howard’s wife considers the military to be tiring because of the constant movement. Howard disputes this and insists on going on with military service for at least 20 years, which is the minimum in order to be eligible for pension. Howard puts much importance on this apart from the love of military service. Leaving the military would be traumatic for Howard after a lengthy period of time. By using the Bio psychosocial analysis, we can first look at the origin of the Post-traumatic stress disorder and depression which is the social factor. The social factor which contributes to this illness originates first from the military service that Howard is involved in. The social factor as a contributor to Howard’s illness can be understood by first understanding the military culture. According to Burke (2004), ‘‘military culture is made and made for a purpose. Any cultural practices that cannot be justified as directly or indirectly serving the mission of service and protection cannot be tolerated’’ (p. 23). This culture is hard to exit and this culture is embedded in every service member. Every branch of the military has its own culture defined by mission, values history, traditions and practices. In general terms, the culture of the military differs from the United States larger society in that it adopts a paternalistic culture with a strict code of discipline. The military is characterized with ‘‘long career pipelines and lock step paths’’ (Lawrence, 2006, p. 219). This long career paths are ensured by the requirement that in order for a service man to be entitled to a pension, they must have served for 20 years in the military. The interdependency and focus on the group culture of the military sets it aside in comparison to the business sector. This may not have been understood by Howard’s wife. Howard was confused about what would happen in relation to being able to provide for the family. Howard may have felt there was no other way through which this could have being achieved. The military was the only option according in Howard’s view. The military culture id deeply ingrained into the mind of Howard that he expects everyone in the house to follow strictly through with their duties like it happens with the military. This caused conflict in Howard’s family. The social interaction in Howard’s family is deteriorated and this was among the contributory factors to Howard’s illness and diagnosis. The refusal by Howard to talk about the problems facing him is characteristic of the military culture. Howard believes that a soldier should be able to handle anything for they are trained to do so. Using the Bio psychosocial analysis, the social factor in form of culture that Howard is accustomed in the military can be said to contribute heavily to the diagnosis of depression and Post Traumatic Stress Disorder. The psychological aspect of Bio psychosocial analysis can be identified though the emotions, behaviors and thoughts of Howard. The dilemma of Howard brings a flurry of emotions which causes Howard to break down in tears in front of a therapist. Emotions of Howard are a contributing factor to his illness. This can be identified by when Howard is torn between family and military service. Howard is emotionally attached to his family although in the choice between family and military service, Howard chooses military service. Howard chooses to suppress his emotions ‘like a soldier’ in order to facilitate return to military service. The behavior of Howard is characteristic of military culture, where they are trained to handle everything by their own. This behavior contributes in a way to Howard’s illness and diagnosis of depression and Post Traumatic Stress Disorder. Howard’s behavior towards his family causes stress points in the family. The other cause of Howard’s diagnosis can be attributed to his undertaking of his military duties. The Post Traumatic Stress Disorder is defined by the Diagnostic and Statistical Manual of mental disorders as a group of symptoms brought about by an individual having experienced borne witness to an event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of others” (Criterion A, p. 467). This illness is characterized by experiencing again those horrid memories, high vigilance, avoidance, high emotional outbursts, hostility and anger. Howard’s emotional outbursts are a characteristic of this diagnosis. This can mean that during Howard’s execution of military duties could have encountered something that caused trauma. This is seen by Howard’s dealings with his family where they are characterized with these outbursts of emotions. The violence in domestic relationships of military service men may be as a result of the trauma experienced in the war zone. Howard’s family is experiencing violence in form of emotions. A good illustration of this is when Maguen, et al (2010) discovered that self-reports from military service men returning home from war-zone were characteristic of anger and strife in domestic relationships. Howard’s domestic relationship seemed to be experiencing such strife. There were disagreements in the family of Howard relating to his military service and deployment. Howard was deployed to Iraq and may have experienced trauma from what he experienced during his service there. This may include witnessing death of other service men and of Iraqis and taking part in such incident. Maguen, et al was able to link such trauma to violence in homes of these servicemen. Winkle and Safer (2011) in their research paper “Killing Versus Witnessing in Combat Trauma and Reports of PTSD Symptoms and Domestic Violence,” conducted a study on the link between trauma and domestic violence. They concluded that killing in war accounted mainly for differences in Post-Traumatic Stress Disorder symptoms. In Howard’s case, a change was seen after returning from his second deployment. This change included anger outbursts which were as a result of domestic strife. Evidence Based Intervention Clinical case management includes a number of intervention plans. The prior case management involves five assessments which are; monitoring, linking, advocacy and planning. The actual case of clinical management has a number of components surrounding the very delicate client engaging process which can be a long term relationship. Before any assessment of Post-Traumatic Stress Disorder, there must be a determination of whether there is imminent threat of death or to bodily integrity or is there is a risk to others. In the case of Howard, Howard was not yet really a big risk to his family and himself but was in the process. There were characteristics of outbursts witnesses by the family in this regards. Such outbursts may have eventually led to violence. The determination of mental stability is important; individuals who may have experienced trauma in the case of Howard may still be in a state of crisis which is characterized by non-response to questions from the clinician (Briere & Scott, 2006, 39). This is important in order to mitigate on any dangers that may be waiting to happen as a result of Trauma. If there may be an imminent danger to self or to other, steps should be taken by the clinician handling the case appropriately. This measure may be inclusive of referral to the proper authorities or proper better facilities depending on the extent of the trauma. Howard may not have come to such an extent but proper management of Post-Traumatic Stress Disorder in its initial stages is critical. Howard was clearly in a state of crises; which was characterized with non-response of questions by the clinician. Howard when questioned about his family chose to remain quiet and be overcome with emotions. The first step by a clinician dealing with such a case would be to determine a client’s metal stability (Briere & Scott, 2006). If the client’s mental state is found to be destabilized, proper interventions have to be employed by the clinician which may include reassurance reduction of stimuli leading to such instability (Briere & Scott, 2006). Howard was mentally unstable which was evidenced with his breaking down when a question was asked regarding his family. Trauma survivors may externally appear stable but occasionally their behaviours are characterised with emotional outbursts (Briere & Scott, 2006). Howard was occasionally having anger outbursts towards his family. After stability of the client, the other components of assessment can be initiated (Briere & Scott, 2006). After the determination of client’s mental stability and the clinician is satisfied, then the extent of trauma exposure should be determined. This is achieved through querying about the traumatic events by starting with trauma nature and characteristics (Briere & Scott, 2006). Individuals with trauma may not want to volunteer information of trauma events and will not tell unless asked directly. This may be due to embarrassment or fear of not wanting to relive that traumatic experience (Read & Fraser, 1998). This is seen in Howard where the therapist asks about a question about his wife and hesitates before breaking down in tears. This he considers it being an embarrassment because Howard believes that a soldier should be able to handle such problems During assessment of trauma, set guidelines should be followed to make the client comfortable and free to speak about the trauma. These guidelines include establishment of a level of guidance, asking questions which are non-judgemental, becoming comfortable when talking about the traumatic events and repetition of assessments if necessary (Briere & Scott, 2006). In evaluation of trauma results, the evaluation is divided into two according to Briere & Scott (2006). These are process response and activation response (P. 44). Process response is obtained by observation of the client behaviour during assessment and activation response is obtained by the way sudden outbursts of emotions emanating from trauma. Activation response is essential in quantifying severity of trauma and degree to which the stimuli activates response from trauma. In the case of Howard both evaluation methods would have been applied. Process response would have been obtained by observing the way Howard was acting and his behaviour. In regards to activation stimuli, it would have been obtained by the extent of emotions that Howard showed when asked certain questions touching on his wife. Originally, the therapist’s initial intention is not to induce activation, but to be alert in case it shows up. In the case of Howard, activation came inform of break down in tears when the subject o his wife was botched. Avoidance responses are observed when there was expected a response to a specific stimulus and there was none. This can be attributed to under- activation (p. 45). In combination with other sources of information like from caregivers, the data obtained provides a basis for diagnosis by the clinician. Symptoms of Post-Traumatic stress must be clearly identified which include; relieving experiences, avoidance symptoms and hyper arousal symptoms (p. 53). In the case of Howard, diagnosis of Post-Traumatic Stress Disorder was done and such symptoms would have been present. The Clinician Administered Post-traumatic stress disorder scale (CAPS) (Blake, et al, 1995) is the standard of measurement for Post-Traumatic Stress Disorder. There are other standards of measuring Trauma depending on the level and extent. In the case of Howard, CAPS would have done the diagnosis. Trauma evaluation is but part of the work where also the health assessment of the client is also done. In regards to the use of spiritual aspect of the Bio psychosocial analysis can be used. The spiritual solutions can be part of the healing process and experiences for the mental patients. This can be done in corroboration of mental health workers. Competent clinicians respect religious beliefs of every individual and should avoid judgmental evaluations of the clients in regards to religion and whose beliefs differ from theirs. In a multicultural society, tolerance should be practiced in such a multilingual multicultural society by the clinicians. . References Benedek, D. M., & Wynn, G. H. (2011). Clinical manual for management of PTSD. Washington D.C: American Psychiatric Pub. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8, 75–90. Bachman, J. G., Segal, D. R., Freedman-Doan, P., & O’Malley, P. M. (2000). Who chooses military service? Correlates of propensity and enlistment in the U.S. armed forces. Military Psychology, 12(1), 1–30. Engel, George L. (1977). The need for a new medical model: A challenge for biomedicine. Science 196:129–136. 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