The fact that Tina hears voices that command her to perform hygienic activities is a first sign of abnormal psychology. Auditory hallucinations are usually referred to as symptoms of schizophrenia, but before setting a diagnosis, Tina’s case must be carefully evaluated by taking into consideration all the information that she provided, included her own believe that her symptoms are a result of a witchcraft performed by her boyfriend for controlling her and the current research in the field of psychopathology.
As Tina confessed that she has used methamphetamines heavily in the past several months, this can be an indication that her symptoms of hearing voices and also her depressive condition that she recently manifests might be the result of this drug abuse. As such, recent research indicates a clear connection between the use of methamphetamine and psychotic symptoms such as paranoia, visual or auditory hallucinations, delusions or mood disturbances (“Methamphetamine: Abuse and Addiction”; Sekine et al., 2006).
Likewise, equally significant, although scientifically biased, in analyzing Tina’s condition and in establishing a diagnosis for her symptoms there must also be considered her believes of witchcraft, as being a potential source of influencing her paranoia (considering the fact that she believes that her boyfriend is performing the auditory hallucinations for controlling her). This is an important aspect to be followed in establishing a diagnosis, considering also the fact that Tina is a Navajo ethnic and Navajo ethnicity is culturally and traditionally influenced by witchcraft beliefs, according to which witch and witches can cause illness, even death and in the past it was believed that witchery was a form of social control (Locke, 2011). This might serve as an explanation for why Tina’s belief, entrenched in the social and traditional culture of Navajo, based on which her boyfriend is performing witchery on her, with the purpose of controlling her. In fact, certain Native Americans do not have a word for “depression”, although they manifest the symptoms of this diagnosis, just as JGH, a 71 year old Native American did, associating his mood disorder with physical pain (“Butcher, Mineka & Hooley, 2011”). Similarly, Tina might associate her depression estate with witchcraft beliefs, as traditionally Navajo, as a Native American group, are unaware of depression, but highly entrenched in witchcraft beliefs.
For establishing a treatment for Tina’s condition there must be considered the previous beliefs and misconceptions about psychopathology. As such, in the antiquity, people who could hear voices, develop a speaking behavior based on religious themes or manifested signs od insanity were considered as being possessed by gods, good or bad, in accordance with their symptoms; this view was later dismantled by Hypocrites, the father of medicine, who, based on scientific research, demonstrated that the mental illnesses were not the acts of deities and demons, but of human brain, able to develop pathologies or to inherit pathologies from family, or to develop them as a result of an injury to the head; the Middle Eve ignored the mental illness and isolated the patients that manifested the symptoms of mental illness to monasteries, although in the first half of the Middle Eve they were treated with prayer, “purified” by priests, send to touch relics or visit holy places and through mild forms of exorcises, which often lead to being accused of witchcraft and being killed for their illness; mental disorders where again perceived with kindness in Europe, when after the French Revolution, Philippe Pinel reformed la Bicetre from Paris, an asylum for mentally ill persons, who treated them like beasts or criminals, holding them in unconceivable filth, making it a shinny place, where patients were no longer held in chains, but allowed to exercise and also had a regular schedule, which miraculously improved their health; later on, in America, Rush founded the moral management as a practice for treating mentally ill patients, which concerned the patients’ social, individual and occupational needs; this, but although effective this method was abandoned towards the second half of nineteenth century, but one echo movement of moral management was the mental hygiene movement, which focused on the well-being of hospitalized patients with mental disorders, based on the biomedical science advances that found that the mental disorders were connected to biological based treatments; the 20th century came with a deinstitutionalization of mental hospitals, with the purpose of providing more human care and integrating mentally disorders patients into regular hospital environment, however, this move caused serious difficulties for mentally ill people who were sent back in their communities, leaving them into a harsh existence of living and begging on the streets most often; more recent scientific advancements indicate that organic factors produce insanity, or that psychopathology is linked to the inner dynamics of unconscious movement (Sigmund Freud’s psychodynamics theory); mesmerism was a current that considered that people were influenced by planets that effected the universal magnetic fluid in the body, treating the patients through hypnosis; the hypnosis sessions emerged into catharsis, a therapy method that investigated the patients when under hypnosis for determining the cause of their illness, by researching the patients’ unconscious; other methods of analyzing and treating the mentally ill patients implied the behavioral perspective (which explains the maladaptive behaviors by applying techniques of free associations and dream analysis), classical conditioning (considered to have a significant role in the personality development both normal and abnormal) or operant conditioning (shaping one’s behavior based on reinforcing a particular activity on the organism for determining the individual to behave in a certain way) (Butcher, Mineka & Hooley, 2011).
Considering these historic approaches on psychopathology, out of which many were misconceptions, the treatment of this patient could potentially be impacted by applying hypnosis for investigating Tina’s unconscious. Likewise, and as she also suggested, the treatment could also imply visiting a medicine man with the problems that Tina manifests, or going to priests for removing the demons that Tina thinks that were sent to possess her by the witchcraft of her boyfriend. This aspect should be regarded from a social constructivism perspective, and the patient directly related to the cultural beliefs and social specificities of her community, which, in Tina’s case, creates an emotional behavior, reflected in her ethnocentric knowledge about her condition (hearing voices is the result of witchcraft), and in her social reality of treating this condition (going to a medicine man is the solution to fight against witchcraft) which must not be neglected as a part of her treatment (Owen, 1995). Therefore, her own belief to see a medicine man for her hearing voices should be encouraged as an additional method to the scientific psychiatric treatment proposed by the counselor.
Tina’s symptoms and her life story (belief to hear voices due to witchcraft, taking methamphetamine, advanced depression and sadness, isolation and paranoia) indicate signs of potential diagnoses: schizophrenia, paranoid type, but it can also indicate trauma, dissociation processes and reactive psychoses (Escher, Romme, Buiks & Van Os, 2002), hallucinogen – induced mood disorder, hallucinogen – induced psychotic disorder with hallucinations, relational problem, substance – induced psychotic disorder with hallucinations (First & Tasman, 2010).
In addition to seeing a medicine man for her auditory hallucinations, Tina’s treatment for schizophrenia should be based on antipsychotic drugs, mostly from the first generation, such as haloperidol, fluphenazine and chlorproamzine (effective also for the patients’ substance-induced psychotic disorder with hallucinations), combined with supportive psychotherapy, either individual or in group (“Schizophrenia”; San, Arranz & Martinez-Raga, 2007) (benefic also for the other identified disorders: trauma, relational problems, depression, isolation).
References
Bucther, J., N., Mineka, S. & Hooley, J., M (2011) Abnormal psychology, 2nd edition. Pearson.
Escher. S., Romme, M., Buiks, A. & Van Os, J. (2002) “Independent course of childhood auditory hallucinations: a sequential 3-year follow-up study”. The British Journal of Psychiatry. Vol. 1818, pp. 10 – 18.
First, M., B. & Tasman, A. (2010) Clinical guide to the diagnosis and treatment of mental disorders. New Jersey, John Wiley & Sons, Ltd.
Methamphetamine: abuse and addiction (n.d.) Retrieved from http://www.drugabuse.gov/publications/research-reports/methamphetamine-abuse-addiction/what-are-long-term-effects-methamphetamine-abuse
Locke, R., F. (2001) The book of Navajo. 6th eds. Los Angeles, Mankind Publishing Company.
Owen, I., R. (1995) “Social constructionism and the theory, practice and research of psychotherapy: a phenomenological psychology manifesto”. Buletin de Psicologia. Vol. 46, pp. 161 – 186.
San, L., Arranz, B. & Martinez-Raga, J. (2007) “Antipsychotic drug treatment of schizophrenic patients with substance abuse disorders”. Eur Addict Res. Vol. 13, pp. 230-234.
Sekine, Y., Ouchi, Y, Takei, N., Yoshikawa, E., Nakamura, K., Futatsubashi, M., Okada, H., Minabe, Y., Suzuki, K.,Iwata, Y., Tsuchiya, K., J., Tsukada, H., Iyo, M., Mori, N. (2006) “Brain Serotonin transporter density and aggression in abstinent methamphetamine abusers”. JAMA Psychiatry, vol. 63, no. 1.
Schizophrenia (DSM-IV- R #295.1–295.3, 295.90) (n.d.) Retrieved from http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Schizophrenia.pdf.
