Case Conceptualization: 38-year Old Husband with Depression and Anxiety

Case Conceptualization: 38-year Old Husband with Depression and Anxiety
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Depression: Case Conceptualization
Background Amos is a 38 years old husband who presents for a follow-up in the outpatient clinic. He seeks to address what he describes as depression. “Often,” says Amos, “I get moments of anxiety, and it just ruins my day.” Amos lives in Annapolis with his current girlfriend. The girlfriend runs a salon and spa business in Annapolis. They have been together for two years, and they have plans to get married. They have one child, a 1-year-old boy, but Amos is not the biological father. However, Amos is yet to divorce his first wife officially. He has two children with his wife, who lives in North Carolina and works as a State Attorney’s office secretary. Amos has not seen the two children for four years because of a restraining order filed by the wife. Amos also has another child, a 17-year-old girl whose mother died on her birth. Her name was Ana. The daughter lives with her grandparents (Anas’ parents) in Bethesda. The patient has not seen this daughter because he is not on good terms with Ana’s parents, who blame him for their daughter’s death. Amos’ parents passed on in a gruesome road accident when he was in grade 1. After that, he lived in six different foster homes before he turned 18. Amos does not have siblings. However, he is close with his distant cousin. The two are entrepreneurs who run a small chain of laundromats in Annapolis and Baltimore. He says he does not have many friends, even from college. He graduated with bachelor’s degrees in business management and computer science. Since the onset of the Pandemic, Amos’s business has hit rock bottom. With his cousin, he closed down six laundromat stores and let go of 26 employees. There are currently only two stores open, and Amos is worried because they are not showing signs of recovery. Amos says his anxiety comes from persistent worry about the future; his business is collapsing. He feels bad he cannot support his children and may never see them until they are 18 because of the current court orders and his estranged relationship with Ana’s parents. After filing a court order, Ana’s parents took the daughter as her legal guardian. At the time, Amos had been accused of money laundering and drug trafficking later dismissed due to lack of evidence. Amos maintains that he was a victim and not a conspirator of the local crime syndicate. Further, Amos feels like he is losing control of his mind and his future. Recently, he has experienced difficulties in concentration. He is increasingly isolated because he does not fancy other people’s company; he is increasingly losing his temper, as evidenced by the smashing of utensils with minimal irritation. Other anxieties and stress triggers include the desire to see his children, the worry that he is getting broke, and an uncertain future. Additionally, Amos reports experiencing major depressive disorder, which includes feeling sad on some days, poor concentration, feelings of hopelessness and worthlessness/guilt, frequent thoughts of death, poor appetite and sleep, no motivation or energy to do activities, and overall fatigue. However, the patient denies having suicidal thoughts. “I mean…I know I will get to see my children… and bond with them; when they turn 18…I have many reasons not to attempt my life,” Amos explains. The patient, however, still holds bitter memories of his experience in foster homes. He was bullied by other children because of his small size, was beaten and abused in at least three foster homes, and experienced domestic violence with one foster family. Session Overview Amos reported that he always feels anxious about the future. When asked why that is, Amos stated, “I don’t know…I guess I feel like I am losing control. I have worked hard, my cousin and I. We started from nothing. But now all that seems to be faltering away, and I feel like I may not see my children again…you know. The youngest is six years old.” Amos reported that he does not have many friends. Letting go of some of his loyal employees contributed to this. “Work used to occupy me,” he says. “Running around the city on my motorbike and interacting with the employees in all our store; that is what kept me going…now I cannot do that…”. When asked about his relationship with his cousin, the patient says, “Kim is a fantastic and loyal guy. He knows his business and knows how to deliver. But I feel he is losing it too. We are tight. I interact with his family, and sometimes, I play with his children. But they often remind me of mine. As a result, I find myself resisting. Lately, I don’t visit his family often. He complains about that. But I feel he is facing problems similar to mine. Our laundry business…that was our ticket from poverty. I love him, though, and he loves me…I think.” When asked who his social support is, Amos reports that Kim is the closest family and friend. Amos reported that he has been trying to read self-care books to try and put his mind straight despite the current pressure. “I have read Mark Mason, Gary Bishop, James Allen, and James Clear…I think the books have kept me out of trouble.” However, the books have not helped with the increasing feeling of anxiety, stress, and depression. He quit smoking and alcohol three years ago to stay clean and earn a right to see and interact with his children. Recently, however, he has resumed drinking. This is partly why he is keeping distance from his very religious cousin and strictly against any form of substance abuse. He also quit working out because he did not find it enjoyable anymore. He reports being gaining weight tremendously. “In the past year, I have gained about 13 pounds,” he says. According to the patient, inadequacy and failure are the core things that eat him up. He could not keep his family. “I let Ana down,” he says. According to Amos, on the day of the delivery of his 17 years old daughter, the same day Ana passed on, he was not present because he was out at a party in Baltimore. He also thinks that the same problem could be affecting his business. He assumes that he has a habit of destroying good things. “My family, my business, my relationships…. sometimes I feel that I did not deserve any of that,” he adds. The patient reported that he has been experiencing worsening depression and anxiety. The patient reported that she has been trying to be more self-aware regarding his anxiety by not avoiding it but instead addressing it. However, he feels like he is losing control to that end too. The patient also reported a persistent headache, especially at night. He has tried different painkillers but has not gone to a health facility to determine the underlying issue. He argues that his headaches are punishment for the pain he has caused his family and the people around him. “I am an isolated figure,” he says. “I like being alone…but I yearn for connections. When I get these connections, I ruin them. I am bad like that. With his current girlfriend, he feels he is stonewalling her on pertinent issues. He is afraid of losing her, so he tends to pretend that things are okay at work. Nevertheless, she is noticing changes and asking questions which only depresses Amos more. “She is right to ask questions,” Amos says. “But I cannot answer them. It is not easy. I don’t know why.” Asked about his childhood, Amos says he does not like to remember it. Asked why, he says, “It is a part of my life that I wish I could erase.” His childhood was full of tragedies. He lost his parents in a car accident while he was in grade 1. He lived with abusive foster families and foster siblings. “The only time I enjoyed life in my youth was in college…at least there, I was free, and people were a little friendly. They did not care much whether you are black, tiny, talkative, or quiet”. At one of the foster homes, when he was 12 years old, Amos was forced to stop a fight between his foster parents. He did this by firing a weapon they had left on the table on the roof of the house. He says thinking about his past brings him anxiety and nausea. “If given a chance,” he says, I will punish those who made my life hell.” He holds a long list of about 25 names. He describes his foster father as “angry” and constantly “agitated” by the tinniest of things. The foster mother was always on the “edge” when the father was around. The foster father is the first on his list. Last on his list is his 17-year-old daughter’s grandmother. Vulnerabilities This patient is more vulnerable to experiencing anxiety and depression symptoms than other individuals due to past trauma and current socio-economic circumstances. The impact of his experience in foster homes makes it difficult for him to trust anybody, including his estranged wife. The experience has also contributed to his temper issues as he is increasingly smashing things at the slig...