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G2TheFunk
For doing a patient intake question – How long and how often…
For doing a patient intake question – How long and how often experiencing current concerns, symptoms, and circumstances: for the following:
Fannie Jones is a 26-year-old single Hispanic female who has lived in the United States her entire life. Her parents were born in Puerto Rico and came to the United States shortly after they were married. Fannie has no children and is employed as an administrative assistant for a major consulting firm. She is, as she says, quite good at her job and is in line for a promotion, which would include free schooling. Fannie presented with an appropriate affect and she was rather nervous in the intake session. She kept on jiggling her right leg and at times she would clench her fists. Fannie is 5’8″ tall and about 30 pounds overweight. She has brown hair, and a fair complexion, and speaks with a slight accent. Fannie was dressed in jeans and a blouse. She also had latex gloves on, which she refused to remove. She did not shake our hand when we first met and she kept a small bottle of antibacterial lotion in her hands.
Fannie reached all of her developmental milestones at their age-appropriate times and reported no history of mental illness in her family. “At least none that is spoken about. My mom has frequent
migraine headaches, but that really doesn’t matter.” Fannie is an only child “but not by choice. My parents wanted another child or two, but my dad had a low sperm count. Eventually, they got older and nothing was happening, so my dad had a vasectomy
to make sure they didn’t get pregnant. I always wanted a little sister to hang with. My mom is upset,
but they have me. (Laughs) My mom says I’m enough for two kids.” Fannie’s mother works as a cook in a large restaurant “and is a dam good cook. That’s why my family has a bit of a weight problem because her meals are so yummy.” Fannie’s father is a police officer who is close to retirement. “My dad ran with the wrong crowd in Puerto Rico, but my grandfather made sure to head off trouble. He laid down the law when he got in trouble and made sure my dad graduated high school. My dad learned a lot of lessons from his father and sees it as his duty to give something back to the community. He likes being seen as a role model. We always worry about him but he has no fears. His faith keeps him safe, he says.”
Fannie began to realize that something was different about her when she was a child. “I liked to always make sure my clothes and toys were lined up in a certain way, and I told my Mom I could not go out or to school unless I was sure. I would check things a lot. I also looked under my bed for dust balls; no dust in my room ever! My parents thought I was just being a neat child, you know, anal. They figured that this was normal since I was a girl, a real girly girl. I was always dressed up, never getting dirty and stuff.” Fannie did well in school, graduating high school with a B-plus/ A-minus average. “I really did well in languages, Spanish of course. I got the medal for Spanish. My parents were really proud of me. I studied a lot. Just because you’re a native speaker does not mean you speak properly. When my grandma heard, she was so happy that I’m keeping up the tradition.”
Fannie told us what brought her in to see us. “I am really afraid of getting AIDS or another disease, so that may be a problem when it omes to meeting a good guy. I’m also afraid that I may say weird things in public and embarrass my family and myself. I’m really afraid of this happening at work, since it might get me fired. Sometimes I don’t go in because of this fear. The arranging thing is really important for me. All of my things at home and at work have to be in the set order before I can continue. It takes awhile but it needs to get done. I also have to be clean always. I takes a long time each day to get to that point. The weird thing is, I know this stuff makes little sense. Everyone does these things, but my mom and friends tell me I do it to excess. The thing is I can’t help myself. It’s like an itch you know you shouldn’t scratch, but you have to, no matter what.” Fannie’s parents got worried as her behaviors continued and got worse. Fannie’s boss was also concerned about her tardiness at work and told her she needed to seek help for her “issues.” “I listened to them and I know these things need to stop. My hands are sore, and I may lose my job, or not move up. And I hate to disappoint my parents. They have no other kids. So I need to stop these thoughts, and hopefully you can help me.”
‘Well, as I got older, things got a lot more complicated. I spent more and more time checking the locks and washing my hands. I even spent a lot of time worrying whether I should do these things again! So a lot of time was spent on this, and they noticed at work and at home. My parents really began to freak. They thought I was bulimic or suicidal because I spent so much time in the bathroom. I was washing my hands, because their soap isn’t strong enough to kill the germs.
I took them awhile, but they finally made the really strong soap that I need. How long do I do these things each day? Well, I spend about 2 hours every day at least washing up and if my hands need more, I’ll be there longer. It is exhausting, so I’m tired a lot.” “I didn’t check the locks as often when I lived at home, but my dad had a gun at home, so there was less of a need. Well, no need to spend a lot of time making sure everything was safe. I still did it a lot anyway, but not as much as in the past. We were safe with his gun. I did often make sure it was put safely away and that the safety was on. I also began to make sure it was loaded before we went to bed. That would take awhile.” “I don’t have much guy time. I work hard and late, since my boss lets me stay late when I’m late arriving. Guys also don’t want to be with me. They see the gloves and think I’ve got leprosy or something. I really don’t have time for guys. Besides, it might eventually lead to intercourse, and sperm is so dirty and germ-filled, I can’t have that.” “As I said, I know a lot of what I do makes no sense and when I do these things, I do them to an extreme. I don’t really know anyone who washes his or her hands like I do. I know it’s weird, but the problem gets worse when I try to control these things. I can’t control them but the few times I’ve tried to, I’ve felt a lot worse. “I want to get better, doc! That’s the first thing. I think something’s either wrong with my brain or my body chemistry.”
Fannie presently does not have a boyfriend “but not by choice. I really miss the company. I was with a neat guy for a while recently, but he left me because he couldn’t deal with my ‘behaviors.’ I had an idea what he meant, but I wasn’t too sure. Since then I’ve been too busy at work and at
home to find the right guy. My dad also doesn’t like me to date outside of the race, but I like to, so that’s a problem.” Fannie’s first sexual experience occurred when she was 18 “and it was not pleasant. It was uncomfortable and messy, and I was miserable afterward. I needed to try it, but since then I haven’t done it much at all. All those germs and dirt.” Fannie told us that her “problems” became much more noticeable when she was a teenager. “I had a normal life, and managed to do everything, but I always had to check for dirt and dust everywhere in the house, in my locker. My mom told me that I would always check the locks on the house to make sure they were closed. I would check the windows to make sure they were shut, and I would always check the stove. She and my dad thought I was being careful so they didn’t do anything. They were happy I acted so safely, especially because our neighborhood had a bit of a crime problem. They thought I was being normal, like anyone who lives in the city.” When Fannie graduated from high school, she took her present job and moved to a studio apartment 10 minutes from her parents. “I wanted to be on my own; I needed privacy. But I was close enough so I saw my folks almost every day, and of course, I wouldn’t miss Sunday dinner! My friends told me that I would always check the locks on the car because I was afraid of someone breaking in and raping me, or jacking the car. That makes sense, right? A young attractive single woman needs to be alert in the city.” “Well, they were worried about me at work. I started to worry about everything in the apartment, and it took me a while before I could leave the house. Everything had to be safe and turned off. I would get to the train and run home because I was sure there was an electrical fire in the kitchen. Then I would check the bathroom for floods, and then I would head out again. Many times I would be in the office building and I would run home to make sure nothing was burning. You do that, don’t you? I mean, not as much, but you do these things.” “They got angry with me at work because I was always coming in late. I just had to be sure. I also had to be clean for work, because of so many germs and bad things there. No one is clean at work. I have these alcohol swabs for my computer. No one touches it except me, and if they sneak in and do it, I’ll wipe everything clean. Co-workers didn’t make much of this, but one day my boss told me she was concerned about my being late all the time. I told her I always stayed late to make up for it, and she told me this was okay. She was also concerned because I was in the bathroom a lot.” What
Fannie’s boss discovered is that Fannie was always washing her hands, something she did a lot at home. “My hands got raw at times because I just could never get them clean enough. I would see a speck of dirt on them, or under a nail, and I’d wash them again. A few times I would use Brillo (steel wool) to make sure they got clean. That hurt, but at least they were clean so I could go out. I found a better soap and used that since the Brillo really slashed up my hands. That company should pay me money; I go through about one bottle a day of that, and I have one in my desk at work. There are so many germs and diseases out there today that one needs to be safe.” We mentioned previously that Fannie came to us wearing latex gloves, and we asked her about that. “Well, I don’t know you, and there are many germs in your office. Counselors like to shake hands and touch you, so I’m being safe. I do this a lot, just to be sure, especially when my hands hurt too much to wash. As I said, can’t be too safe in today’s world, can you? But I will say that not everyone does this.”
Fannie’s mother came in and we asked her about Fannie’s present situation. “My daughter has gotten worse the past few years. She spends more and more time with us because we’re so worried about her. We noticed that Fannie has to check everything in the house and goes nuts when things are not set up a certain way, like at the dinner table. My husband is out a lot so he really doesn’t see a lot of this, but he’s worried also. Fannie’s always washing her hands. The last time she was over, she bled all over the sink because she washed so hard. There was a time when she never changed her clothes because these things like washing took up the whole morning. She’s a sweet, decent woman. What is going on here? Is she possessed? We discovered that Fannie’s mother would always make sure that the table was set the same way and that everything in her house was in the same place before Fannie came over for dinner. “I really feel guilty for what happened to Fannie. No one in my family or Edmundo’s (Fannie’s father) family has any mental
illness, so it must have been something I did during pregnancy. Maybe that’s why we
have only one child, that something is wrong with me. It’s not Fannie’s fault.”
