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Nick is a tall, bearded, muscular man of twenty five. His physician…
Nick is a tall, bearded, muscular man of twenty five. His physician refers him for psychiatric evaluation, and he arrives there dressed in a white suit with a rose in his lapel. He greets the psychiatrist with “Aren’t roses beautiful at this time of year?!” When asked why he has come for an evaluation, he says he’s done it to please his family “who seemed worried” about him. He has also recently read a book on psychotherapy, and hopes that “maybe there is someone very special who can understand me. I’d make the most incredible patient.”
During the interview Nick pulls out a set of newspaper clippings, his resume, photos of himself and a novelty shop dollar bill with his picture in place of George Washington’s. He says that he felt rejected by his parents, but overcame this to become popular. He mentions a friendship with an actor for whom he’d done publicity. Once, he says, he arrived at a celebrity party pretending to be the not-yet-well-known actor, and soon after decided he was wasting his talents promoting others and should go into acting himself. He says that soon his actor friend “will want to be president of my fan club”.
At one point in the interview, Nick says “I should write letters to God – he’d love them!”. When asked about his love life, he says he has no lover, because “people are just superficial” and “only interested in sex”. Recently, he did have a relationship, but he became disenchanted when he realized his lover was “ugly” and “an embarrassing dresser”. Nick says he owns over 100 neckties and about 40 suits, and is proud of how much he spends on “putting himself together”. He says “One day, the mindless, happy people who have ignored me will be lining up to see my movies!”
Nick’s father was an emotionally distant alcoholic who was rarely around and apparently had many affairs. Nick reports his mother was “like a friend”. She was chronically depressed about her husband’s infidelity, and relied on her son for support, often kissing him on the lips, until he was 18, when she began an affair of her own. Nick reports feeling rejected and contemplating suicide at that time. As the interview ends, Nick requests a referral to a psychiatrist who would offer him free treatment, seeing no reason to pay someone who “would be getting as much out of the sessions” as he would.
What is the diagnosis and treatment?
