An Anxious Missionary

There are many cultural and spiritual aspects to this case study which could make for a long post. This post will not delve into those two areas for the sake of brevity.

PRESENTING ISSUE

35-year-old white United States male is receiving counseling in an inpatient psychiatric facility. This missionary had been hospitalized for anxiety.  "I don't know what's wrong with me, I can't stop worrying and shaking.  My insides just feel like they are made of jello."  

RECENT HISTORY

This missionary had been on the mission field  for several years and had much success with the indigenous people in a country in South America.  However, now, he was having anxiety so severe that he had to leave his mission field and seek help.  We discussed his past, his vocation, his mission and he was truly a remarkable man.  We discussed his spiritual life and he noted that he had been cursed by the local "bruja".  She had performed a ceremony to bring down this missionary's influence in the area.   Her home was within view of his office.  He saw her performing her "brujeria" during one of his office conversations with an indigenous friend, his friend remarked with fear, "she is very powerful among the people."

HEALTH HISTORY

Patient states he was in good physical shape outside of his anxiety. He noted that over the last month, he experienced severe insomnia and lost over 30 pounds. Upon admission, his electrolytes were severely out of balance and he was experiencing dysrhythmia as well. He also could hardly keep any food down. He denies a history of the use of alcohol and other drugs. He is currently on anti-anxiety and anti-emitic medication.

PREVIOUS COUNSELING

Patient has had episodic outpatient counseling before moving to South America for anxiety but has not experienced anxiety at this level. No previous psychiatric inpatient admissions are noted.

MENTAL STATUS EXAMINATION

Affect: Anxious

Appearance: appropriate to age, season, occupation

Mood: Anxious

Extreme psychomotor agitation

No apparent psychotic phenomena

No noticeable body odor

Denies suicidal/homicidal/violent ideation and intent

Appears to be of average intelligence

Judgement and insight appears to be adequate

Speech: Rapid, pressured

Sleep: Severe insomnia

Appetite: Lost 30# over the last month, emetic

INITIAL DIAGNOSES

300.02 Generalized Anxiety Disorder

780.52 Insomnia disorder, acute

V62.29 Occupational problem

TREATMENT PLAN

1. Follow the therapeutic milieu of the inpatient facility

2. Comply with the psychiatrist's recommendations

3. Attend and participate in regular group sessions

4. Attend and participate in individual counseling

5. Encourage continued spiritual growth

COURSE OF TREATMENT (approx 15 sessions, inpatient)

1. The patient was very compliant with the following the inpatient schedule

2. The patient took his medication as prescribed.

3. The patient attended and participated in regular group counseling.

4. The patient attended and participated in regular individual counseling with me

5. Patient received regular visits from his Christian friends and hospital chaplain.

DISCHARGE DIAGNOSES

Z03.89 No Diagnosis

CONCLUSION

About two months after his discharge, I received a letter from this missionary.  Evidently, what had happened, when he returned to the mission in South America, he told his friends about his feelings about this bruja and told them he was determined to not let her win this "spiritual battle."  During prayer with his friends, it was revealed to them that they should dig in the dirt of the northwest corner, just outside his office. Several of them and the missionary went outside and started digging. After a bit, they found a talisman buried there. One of the friends, who used to be a brujo, identified the object as something used to curse people. The missionary promptly conducted a service where the talisman was burned in a fire. In his letter, he proceeded to tell me how he felt as if there was "a new freedom" in his life after that.

THOUGHTS

Adlerian theory is a phenomenological counseling theory. This means that the Adlerian counselor accepts the patient's reality. It is unimportant to the Adlerian counselor to have a personal belief in supernaturalism to help this missionary. What was important is that the counselor believes that the patient believes in such. In this instance, the patient had a strong belief in supernatural events; hence, the counselor adopted same. Of interest, this missionary used this saying in his recovery while hospitalized , "We are destroying speculations and every lofty thing raised up against the knowledge of God, and we are taking every thought captive to the obedience of Christ" 2 Corinthians 2:5 NIV (italics and bold are mine). I leave room for the possibility of supernatural events in this case study. I also note that the saying the missionary used sounds very Adlerian as Adler was known for this statement, "chew on a thought like you would chew on a piece of spearmint gum." Adler is considered foundational to the formation of cognitive-behavioral theory (CBT) and mindfulness.

FUN FACT Aaron Beck, one of the founders of CBT, identifies as an Adlerian (see pic below):