Major Depression Case Study: Grief, Diagnosis & Treatment

Client Presentation

The client presents as a well-nourished, well-kempt Caucasian female. She reports that she turned 33 years old two months ago. She is single, employed, and has no children. She exercised daily until approximately five days ago, eats nutritiously, is not a vegetarian, and drinks alcohol — beer or wine — approximately 4–5 times per month, usually wine, consuming as many as two to three glasses when socializing with clients and friends.

The client states that about five days ago she woke up and did not want to get out of bed, so she did not. She called in sick and has not returned to work since. She does not take phone calls from clients or friends. Out of concern, her mother came to her home and brought her to this appointment. The client states, "But I wanted to come. I want help. I know something is not right with me."

During the interview, the client cried uncontrollably. Even as she spoke and answered questions, tears flowed freely. The client looks healthy and physically fit. The only outward signs of distress, aside from the free-flowing tears, are that she arrived at 1 p.m. dressed in clean bedtime lingerie, and throughout the interview she remained lying down on the couch. Though she talked freely and openly about why she was seeking help, she seldom made eye contact with the interviewer.

The client considers herself fortunate, as she is successful in her career as a celebrity agent and earns a six-figure income annually. She states that her studies at Princeton University prepared her for her career; she graduated with an undergraduate degree in accounting and subsequently earned a Master's Degree in Marketing from UCLA. She reports that up until five days ago she led a normal and active career and lifestyle, working a minimum of 60 hours per week. She states that she enjoys her work and finds it only moderately stressful at times, while also maintaining personal interests and socializing with friends outside the celebrity world.

The client reports that she has spent a significant portion of her free time with her parents during her father's prolonged illness. Her father passed away three months ago, and she has been very supportive of her mother since his passing. She reports that she is not currently in a relationship, stating she does not have the time that a successful relationship requires at the present time, and believes she will have more time to devote to one "later."

History and Physical

The client states she sees her gynecologist on a yearly basis and reports no problems. She sees her dentist twice a year for check-ups and cleanings. She sees her family doctor for colds, flu shots, and any other health-related issues throughout the year, though she has not seen her family physician since her flu shot the previous year.

The client reports no family history of alcoholism or drug addiction. She notes that while drugs are present in her work and personal environments, she does not use them because, in her words, "I need to be in control of what I do." Her father's prolonged illness was due to stomach cancer. Her mother and one younger male sibling are reported to be in good health. She reports no family history of mental health problems or other significant health issues aside from her father's cancer.

The client reports that for the past five days she has felt exhausted and has been physically and mentally unable to get out of bed, dress, eat, work, or engage socially. She has had no desire to be in the company of others, including her mother and brother. She states that she has not had suicidal ideations and has not formulated any plan to harm herself. She also states she has no feelings of anger, aggression, or desire to harm another person.

Observations and Precipitating Factors

Throughout the interview, the client cried continuously, dabbing at her tears with tissues. This did not prevent her from talking freely when asked questions. She was a thorough and reliable historian regarding her own health and that of her family. She speaks with hand gestures that emphasize her points and feelings, and she appears highly motivated to resolve whatever she is currently experiencing.

While the client does not know what caused this episode of withdrawal from her professional, social, and family life, she does not regard the loss of her father as a traumatic event, citing the fact that his illness was prolonged and his death expected. During her father's illness, she did not reduce her professional workload, though she often spent less time with clients than she would have otherwise. She increased the time she spent with her father, mother, and brother during his final year of illness, while substantially reducing the time she spent with friends and on social activities. She reports that she never missed her daily workout class during this period.

The client states that her father was her business partner until he fell ill two years ago, at which point she absorbed his responsibilities. Her workload increased from approximately 40 hours per week to 60. During her father's final year, she additionally spent approximately 20 hours per week with her family. Despite this significantly increased burden, her business has continued to thrive.

The interviewer concludes that the client is likely suffering from major depression precipitated by a combination of factors: her father's prolonged illness and eventual death; the assumption of her father's business responsibilities; the pressure to maintain the business's success; and the felt obligation to provide financial and emotional support to her mother and brother. Rather than grieving her father's death, the client has kept him symbolically "alive" by continuing his work and sustaining the family structures he maintained.