Assignment task:
35-year-old man referred for a mental health evaluation by the human resources department of a large construction business that had been his employer for two weeks. At his initial job interview, Mr. Carruthers presented as very motivated and provided two carpentry school certifications that indicated a high level of skill and training. Since his employment began, his supervisors had noted frequent arguments, absenteeism, poor workmanship, and multiple errors that might have been dangerous. When confronted, he was reportedly dismissive, indicating that the problem was "cheap wood" and "bad management," and added that if someone got hurt, "it's because of their own stupidity."
When the head of human resources met with him to discuss termination, Mr. Carruthers quickly pointed out that he had both attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder. He said that if not granted an accommodation under the Americans With Disabilities Act, he would sue. He demanded a psychiatric evaluation.
During the mental health evaluation, Mr. Carruthers focused on unfairness at the company and on how he was "a hell of a better carpenter than anyone there could ever be." He claimed that his two marriages had ended because of jealousy. He said that his wives were "always thinking I was with other women," which is why "they both lied to judges and got restraining orders saying I'd hit them." As "payback for the jail time," he refused to pay child support for his two children. He had no interest in seeing either of his two boys because they were "little liars," like their mothers.
Mr. Carruthers said he "must have been smart" because he had been able to make C's in school, despite showing up only half the time. He spent time in juvenile hall at age 14 for stealing "kid stuff, like tennis shoes and wallets that were practically empty." He left school at age 15 after being "framed for stealing a car" by his principal. Mr. Carruthers pointed out these historical facts as evidence that he was able to overcome injustice and adversity.
In regard to substance use, Mr. Carruthers said he smoked marijuana as a teenager and started drinking alcohol on a "regular basis" after he first got married at age 22. He denied that use of either substance was a problem.
Mr. Carruthers concluded the interview by demanding a note from the examiner that he had "bipolar" and "ADHD." He said that he was bipolar because he had "ups and downs" and got "mad real fast." Mr. Carruthers denied other symptoms of mania. He said he got down when disappointed, but he had "a short memory" and "could get out of a funk pretty quick." Mr. Carruthers reported no difficulties in his sleep, mood, or appetite. He learned about ADHD because "both of my boys got it." He concluded the interview with a request for medications, adding that the only ones that worked were stimulants ("any of them") and a specific short-acting benzodiazepine.
On mental status examination, Mr. Carruthers was a casually dressed White man who made reasonable eye contact and was without abnormal movements. His speech was coherent, goal directed, and of normal rate. There was no evidence of any thought disorder or hallucinations. He was preoccupied with blaming others, but these comments appeared to represent overvalued ideas rather than delusions. He was cognitively intact. His insight into his situation was poor.
The head of human resources did a background check during the course of the psychiatric evaluation. Phone calls revealed that Mr. Carruthers had been expelled from two carpentry training programs and that both his graduation certificates had been falsified. He had been fired from his job at one local construction company after a fistfight with his supervisor and from another job after abruptly leaving a job site. A quick review of their records indicated that he had provided them with the same false documentation.
What are the abnormalities in this case?
Abnormalities:
- Specifically looking for how we quantify abnormality bc its subjective
- Take out subjective and make it objective and clinical