Real-Life Case Study the Research Informant Selected

¶ … Real-Life case study

The research informant selected is a soldier who was deployed in Iraq who is 35 years of age and who was in the army for 15 years. He suffered from drug and alcohol addiction along with post traumatic stress syndrome. At this time he is still battling both of these conditions. When interviewing him, the clear purpose of this project was stated without a doubt, and he was informed of his voluntary participation, along with the fact that he was allowing us to use all the data that he provided. He was reassured of the complete and utter privacy of his responses and how all of his data was going to be kept confidential. For example, he was told that he name was never going to be recorded, none of the researchers would ever have it; instead he was going to be given a number. Furthermore, while his interview was being taped, it was made clear that his image would never be recorded, just his voice.

The purpose of the project was stated as clearly as possible which was: to understand the nuances and factors which contribute to PTSD and to understand why substance abuse is such a common factor with people who struggle with PTSD. Many of the interview questions were taken or adapted from the Clinician Administered PTSD Scale for DSM IV. Before the interview began, the participant was warned that he was going to be asked questions which might make him uncomfortable or asked about some of the more stressful and difficult things that happen to people. He was told that these questions might make him upset and that it was up to him to determine how much he wanted to share. He was also told that if he started to feel uncomfortable he should let us know and we could slow down and talk about his feelings.

The part of the interview which was gathered from the Clinician Administered PTSD Scale for DSM IV was consisted as follows: The participant would be asked to discuss a particularly distressing event and share issues with recurring images, thoughts or perceptions connected to this event. "Have you ever had unwanted memories of (EVENT)? What were they like? What did you remember? (if not clear): Did they ever occur while you were awake, or only in dreams? [exclude if memories were just in dreams] How often have you had these memories in the past month (week)?

0 Never

1 Once or twice

2 Once or twice a week

3 Several times a week

4 Daily or almost every day" (ptsd.va.gov)

For this question and all connected questions like it, the participant answered with a 4: daily or almost every day.

Another line of questioning would revolve around the intensity of these memories: "How much distress or discomfort did these memories cause you? Were you able to put them out of your mind and think about something else? How hard did you have to try? How much did they interfere with your life?" (ptsd.va.gov)

0 None

1 Mild, minimal distress or disruption of activities

2 Moderate, distress clearly present but still manageable, some disruption of activities

3 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities

4 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities

For this question and all others like it, the participant answered with a 4, indicating that he was experiencing extreme distress on a daily basis.

Questions like these will help to gain a clearer sense of what the subject is dealing with on a daily basis and to help determine how painful this subject's memories are and how much interferences they're actually causing. However, some of the interview will also just consist of discussing the specific background of the participant in order to gain perspective on his background characteristics. This person comes had a lower-middle class rural background from a small town in North Carolina. His father left when he was five and his mother was remarried twice. The stepfather that raised him was a truck driver who often wasn't around. His background was different from my own in that he was raised in the country from a slightly lower economic class than my own. My parents remained married and raised us both, whereas his parental situation was more complex. The lifespan development stage that he is at is adulthood. The major stresses and obstacles that he is dealing with are the ones in connection to the PTSD that he suffers from. While he was in Iraq he was kidnapped by enemy forces and he suffers a full gamut of symptoms which are in direct connection to this event. Apparently, experts have found that PTSD symptoms are generally worse when they are triggered directly by another person, thus making his circumstances the most difficult to deal with. This participant also suffers from what is known as flashbacks. "Most PTSD sufferers repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings. They are often triggered by ordinary occurrences, such as a door slamming, a car backfiring, or being in a place that looks like where the trauma took place. A person having a flashback is likely to feel the emotions and physical feelings that occurred when the incident happened despite no longer being in danger" (nih.gov). This is one of the most primal and primary issues that this person deals with. It has caused his quality of life to deteriorate and has made him feel as though he has no control over how he feels or whether or not he feels safe.

One of the major stresses and obstacles that he faces at this time is the fact that he has long used prescription pills and alcohol as the primary coping mechanisms for dealing with the stress, pain and anxiety that he has long been suffering from. This participant feels deeply ashamed about the fact that he relies so heavily on pills, but he continues to use them regardless, creating an added component of shame and unnecessary stress to the mix.

If his life were like a chapter book, this participant would no doubt divide his history as follows: Chapter one: the pain of being abandoned by his father. The added pain of seeing his mother suffer and feel the pain of abandonment as well. Chapter two: feeling the discord of the subsequent two marriages; always wondering if marriage number two was going to work or whether that father was going to end up leaving as well. Chapter three: focuses on acting out a tremendous amount as a child, getting in trouble for smoking, drinking and experimenting with drugs. Chapter four: Enlisting in the army because he had flunked out of high school and had no interest in college. Chapter five: feeling a sense of real belonging and camaraderie among his fellow soldiers; he long felt a sense of power, control and accomplishment when fighting overseas, as he felt like he had finally discovered something he was good at. Chapter six: being kidnapped in Iraq and watching one of his fellow soldiers who was also kidnapped, be tortured to death and killed. Chapter seven: being discharged and sent back to America where he felt like a fish out of water. Finding solace in pills and alcohol, and then ultimately abusing them in an endless downwards spiral.

Thus, in this sense, the participant has a very negative perspective on both the past and the present, feeling that the past is shaping the present in a negative fashion, but that there's nothing he can do about it. Thus, a profound sense of helplessness colors the way he views things. The participant has admitted that the one thing which keeps him moving in life is his dog and the hope that someday he'll see some of his fellow soldiers again. He has lost contact with all his friends and he does not care to contact his family. So much of this soldier's past continues to shape his present and continues to place a bleak outlook on how he views the future. A profound sense of a fear of abandonment continues to impact him: this is a result of the instability which shaped his childhood. This sense of instability translated to an utter sense of worthlessness for this soldier, making him feel as though he didn't matter, and his actions didn't matter, thus pushing him to all sorts of acting out types of behavior as a youth. However, his lack of options after high school pushed him into the army, where he felt the greatest sense of belonging and inclusiveness that he had ever experienced in his life. However, this sense of closeness and stability was shattered through the trauma of combat: essentially, this participant feels like a state of limbo and chaos rules his entire life and he is helpless and out of control and thus unable to experience it.

Literature Review

Based on the data collected in step one, abandonment was a major theme in this participant's life. The literature review thus conducted sought to revolve around this theme.

As we've studied in class, adults who do experience stable childhoods and who are given consistent love and acceptance from the adults in their lives generally are in position to project this into the world and become a contributing member. As Berger explains, "People who do not receive acceptance and affection might stay stuck at that level. They need love but they never feel satisfied or fulfilled by the affection they get. However, adults who do experience abundant love are ready to move to the next level, success and esteem. Their primary psychological need at this stage is to be respected by many people and to be recognized as successful by other members of their profession, community or some other group. They do not abandon their immediate family (spouse, children, and parents); the love of those people is assured. Thus, they are able to seek esteem in the wider world" (Berger, 2009). The participant was never able to get to either of these discussed stages. While the bonds he was able to forge in the army allowed him certain levels of intimacy that he had never experienced before in life, those bonds and ability to give and experience love were quickly shattered by the trauma of being kidnapped and all comparable experiences.

While there hasn't been a tremendous amount written about the connection between abandonment and PTSD, there is still a fair amount of literature which discusses these two aspects. For instance, psychological clinician Pete Walker wrote at length about how abandonment figures into complex PTSD. As Walker describes the way that abandonment depression functions within PTSD, it's easy to understand how it functions within someone like the participant: "This territory is best viewed through unwinding the dynamics of emotional flashbacks. Flashbacks are at the deepest level painful layers of reactions - physiological, emotional, cognitive, and behavioral - to the reemerging despair of the childhood abandonment depression. One very common flashback-scenario occurs as follows: Internal or external perceptions of possible abandonment trigger fear and shame, which then activates panicky Inner Critic cognitions, which in turn launches an adrenalized fight, flight, freeze or fawn trauma response (subsequently referred to as the 4F's). The 4F's correlate respectively with narcissistic, obsessive-compulsive, dissociative or codependent defensive reactions" (Walker, 2013). In this sense it's easy to see how a dual layer of abandonment depression from childhood and from his traumas in Iraq have shaped him into going through such cycles which have undermined his ability to engage in success and forward momentum in his life. While Walker just examines various case studies closely, his research appears to be without variables.