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Is Her Diagnosis Major Depression Or Sexual Repression?: a Non-Western Fijian Female Clinical Single Case Study

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Is Her Diagnosis Major Depression Or Sexual Repression?: a Non-Western Fijian Female Clinical Single Case Study JURNAL PSIKOLOGI 1999, No. 1, 1 - 8 IS HER DIAGNOSIS MAJOR DEPRESSION OR SEXUAL REPRESSION?: A NON-WESTERN FIJIAN FEMALE CLINICAL SINGLE CASE STUDY Leo Marai View metadata, citation and similar papers at core.ac.uk University of Gadjah Mada brought to you by CORE provided by Jurnal Psikologi ABSTRACT This article presents a case of a 25-year-old non-western Fijian working class woman who became severely depressed following a love relationship problem. During six months of cognitive-behavioral treatment involving two 1 hour weekly session specifically applying Beck, Rush, Shaw, and Emery (1979) standard cognitive therapy resulted in no treatment gain. This indicates the inefficacy of such intervention, thus being attributed to differential clinical diagnosis of the syndrome. After termination of therapy, a further in-dept case analysis and review of the patient revealed the importance of sexual repression as possible underlying syndrome, thus suggesting Freud’s psychoanalytic conceptualization of this problem as a possible explanation of her many depressive and anxious symptoms. A prospective suggestion on possible psychoanalytic treatment is advocated for in such future case of similar nature. The problems of classification of mental disorders in Diagnostic Statistical Manual (DSM), clinical diagnosis, clinical judgment, and therapeutic bias, are briefly highlighted and discussed with some concluding suggestions. Keywords: Diagnosis Major Depression or Sexual Repression The issue of clinical diagnosis of Nevertheless, there is a general consensus various psychological disorders has been in the literature that depression and anxiety. an area of controversy in clinical Exist concomitantly in clinical case psychology and psychiatry. For instance, (Watson, Clark & Carey, 1988; Watson & the diagnosis of depression and anxiety has Kendall, 1989). These debates are usually stimulated a lot of intense debates because centered on theoretical issues and treatment some clinicians claim that both syndromes outcomes. In order to demonstrate the are similar while others view them as correct diagnosis of a particular distinct entities (e.g., Akiskal, 1990; psychological disorder, the outcome of the Dobson, 1985; Stravakaki & Vargo, 1986). intervention or treatment has been utilized ISSN : 0215 - 8884 2 LEO MARAI as one major criterion in assessing the PRESENTING CONCERN AND therapeutic effectiveness. In simplicity, if HISTORY OF AFFECTIVE the treatment is successfully demonstrated DISORDER than this can be attributed to proper Prior to clinical intervention, the patient diagnosis. On the other hand, when the had no personal and family history of treatment is ineffective than the diagnosis emotional or psychiatric disorder. Further is assumed to be incorrect. evaluation through her mother confirmed In what follows, I present a comprehen- the foregoing information. sive single clinical case study of diagnosis A year and two months before visiting of major depressive disorder in a female the clinic, she was admitted to hospital patient, thus showing the appropriate when she collapsed in the washroom of her diagnosis based on self-reported symptom work place. She recalled collapsing as a measures with well defined psychometric result of severe continuous abdominal pain properties derived from Beck’s cognitive concentrated around gaenacological area of theory of depression and anxiety. Similarly, her body. When admitted to the intensive the Diagnostic Statistical Manual for care unit of the hospital, she was when then Mental Disorders III Revised edition diagnosed of ovarian cyst. Surgery was (DSM-III-R) diagnostic criteria for major performed immediately and her left ovary depressive disorder concomitantly confir- was removed (this medical data was med the diagnosis of this syndrome. confirmed via patent’s record in the Subsequently, I show the inefficacy of hospital through the consent of the patient). cognitive therapy because of differential diagnosis and thus suggest a possible Subsequently, after ovarian cyst diagnosis of sexual repression from removal and her discharged from hospital, psychoanalytic theory of Sigmund Freud as she continued to experience the same a causal explanation of the patient’s major intensity of pain around her gaenacological depressive episode with anxiety symptoms. is. Specifically, the pain is normally associated and experienced during her menstrual cycle. However, the pain is so PATIENT’S BACKGROUND intense that many times it proves difficult The patient, Miss Betty Z is a single for her to walk. Although analgesic and indigenous non-western Fijian, who was anti-biotic drugs that were prescribed by self-referred for therapy. At the time of her doctor and taken by her, the pain initial evaluation at the clinic, she was 25 persisted from month to month. The patient years old, and employed as a public at various times further consulted various relation officer in a financial institution. gaenacological doctors as well as receiving She is the only daughter in the family, and acupuncture treatment, but there were no a graduate from a local university. She success obtained from these treatments. lives with her mother and described her as Since after the surgery, this episode of pain authoritative and domineering. Her father lasted for 14 months, and that was the time died when she was 20 years old while she came for psychological intervention. studying at the university. ISSN : 0215 - 8884 IS HER DIAGNOSIS MAJOR DEPRESSION OR SEXUAL REPRESSION? 3 Before the history of developing pain, COGNITIVE AND BEHAVIORAL patient Betty Z had a first boy friend that EVALUATION was a foreigner on contract attachment Because of the unsuccessful treatment working in Suva city. After months of their of her pain and associated depressive and intense love relationship, the boy friend left anxious symptoms noted by her medical for his country after his contract has doctor, Miss Betty Z was advised to consult expired. During the period of their a clinical psychologist or psychiatrist. At relationship, the patient admitted falling intake, the patient’s symptoms included deeply in love with her boy friend. Their depressed mood, anhedonia, insomnia relationship did not result in sexual (difficulty in falling asleep), diurnal intercourse, but sex foreplay was exercised. variation of mood (night worst) loss of These involve kissing, sucking the breast, appetite, loss of weight, and being anxious and touching sexual organs of each other. at times. In terms of quantitative measures, The patient recalled having no orgasm. the Beck Depressions Inventory (Beck, According to the patient, this was her first Ward, Mendelson, Mock & Erbaugh, 1961) sexual experience. Nevertheless, sexual score was 30, Hopelessness Scale (Beck, intercourse was not entertained because the Weissman, Lester & Trexler, 1974) score patient comes from a Protestant religious was 15, and Beck Anxiety Inventory (Beck, group, and also a strong cultural back- Epstein, Brown & Steer, 1988) score was ground that prohibits and condemns sex 13. before marriage. These scores were consistent with Initially when she came for psycho- severely depressed mood thus qualifying logical intervention, she complained of her for a major depressive disorder missing her boy friend and expressed diagnosis. The DSM-III-R diagnosis was as longing ness to be with him soon. The follow: patient could not develop another love relationship because she loved her boy Axis I : Major depressive disorder friend so much. Another factor influencing (296.23) her present status quo was of culture Axis II : No diagnosis related morality and that is, her immediate Axis III : Physical condition: Pain family knew her present relationship and to venture into another one is seen as Axis IV : Psychosocial stressors: Broke up immoral. In compounding the problem, her with the boy friend family boy friend promised to send an airline pressure ticket so that she can travel to his travel to Axis V : Current GAF = 70; Best GAF his country, get married, and live there. past year = 68 This was not forthcoming as expected, and as result, the patient began to develop severe pain in her gaenacological area as TREATMENT well as depression and anxiety symptoms. Treatment consisted of cognitive- She felt uncertain about her future. behavioral therapy specifically utilizing standard cognitive therapy for depression ISSN : 0215 - 8884 4 LEO MARAI (Beck, Rush, Shaw & Emery, 1979). One In countering anxiety, progressive- hour weekly sessions were held twice muscular relaxation exercise training was weekly. The treatment lasted for a total of taught to the patient. After mastering it, she 48 sessions (6 months). utilized the technique to prevent anxiety in situations that normally precipitate her anxious symptoms. Cognitive Content The patient exhibited cognitive content Treatment Outcome symptoms typical of depression, including such negative thought as: “I am a looser”, As can be seen in Figure 1, treatment “there is no future for me”, I am always was unsuccessful, although the symptoms wrong when I do something good”’ “I am decreased slightly after intervention; there not interested in anything I do these days”, were increases there after from session to “things just won’t work out the way I want session. As a result of continuous failure in them to.” These negative thinking treatment gain, after six months, the characterized her depressed mood. therapy was terminated on ethical grounds, and the patient was referred to another psychotherapist
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