Crisis Intervention Case Study

Excerpt from Case Study :


Crisis Intervention

What about Bob?:

A psychological overview

"I have...problems" the patient Bob Wylie whines, in his first session with his psychiatrist in the film What about Bob? The film details the near-traumatizing experience of the psychiatrist in treating Bob over the course of the film. Bob is a white, middle-class, middle-aged divorced man who has multiple phobias and is also highly manipulative in terms of how he interacts with the psychiatrist's family. Bob's lack of social connections in terms of friends and family become particularly manifest in the film as he strives to be 'adopted' by his therapist, whom he follows (stalks) when the therapist is on vacation. Bob is afraid of most social interactions (yet is pathetically needy), is germ-o-phobic (he is afraid to touch anything directly) and is a hypochondriac (he fears everything from having a heart attack to having his organs explode unexpectedly).

The crisis Bob experiences during the film is immediately touched off by his divorce, which he seems unable to explain in a coherent fashion (he blames it on his difference of opinion with his wife on the subject of Neil Diamond). However, clearly his crisis has long-standing, deeper roots that a single relationship. In a more conventional therapeutic setting (in other words, when being seen by a more competent therapist than his on-screen psychologist) Bob would be diagnosed as having a personality disorder, rather than a mood disorder such as depression.

According to the DSM, a personality disorder is an appropriate diagnosis when a patient exhibits "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas," namely of cognition or "ways of perceiving and interpreting self, other people, and events;" affectivity, "the range, intensity, lability, and appropriateness of emotional response;" "interpersonal functioning;" and "impulse control" (Personality disorder, 2011, Behave Net). Bob clearly displays deficits in all of these areas, as is manifested by the fact that he 'follows' his therapist on vacation. Bob's hysterical fears of abandonment, sickness, and contamination deviate markedly from the expectations of a culture that expects him to be able to tolerate separation from loved ones for short periods of time and to eventually 'pick up the pieces' emotionally, after a divorce. Bob's emotions regarding abandonment are overly intense, as manifested by the fact that he follows his therapist on vacation. And his actions regarding germs and potentially life-threatening illnesses are also extreme and unrealistic. Everyone fears sickness to some degree, but allowing such fears to limit or to control social interactions are not 'normal.'

The fact that Bob's obsessions and feelings about others interfere with normal interpersonal functioning are manifest in the fact that he has no friends and his troubles holding down a job or staying in a marriage. Even his therapist is frustrated by his patient's neediness. Bob is also unable to show any appropriate methods of impulse control at all. He follows his therapist as if the need to depend upon the man is an itch he cannot help but scratch, just as he fakes various illnesses, both as a means of gaining attention but also because he genuinely believes that if he does not have medical attention all of the time, he will die.

Regarding Bob's formal diagnosis, the film is unclear. His therapist is so desperate to be free of Bob, he checks Bob into a psychiatric unit. However, Bob is quickly released, and his humor ("Roses are red, violets are blue...I'm a schizophrenic, and so am I") cause the staff at the hospital to think Bob has no problems at all. Although Bob's thinking may be maladapted and maladjusted, he is not disassociated from reality like a schizophrenic who hears voices.

Bob's hypochondria and obsessions with cleanliness clearly show signs of obsessive-compulsive behaviors. However, he lacks the perfectionism and obsession with numbers that is characteristic of this particular illness. Also, obsessive-compulsive personalities tend to be excessively devoted to work, miserly, and perfectionist in nature, and show little need for the help of others (OCD, 2011, Behave Net). In contrast, Bob is very open about his near-pathetic neediness (he is so needy that even the therapist's children befriend him out of sympathy). Bob shows a majority of clinical symptoms associated with Borderline Personality Disorder, a disorder that is marked by a near-hysterical fear of abandonment. Bob's worries about his health seem to be a…

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