Question

Marsha is 16 years old and lives with her two sisters (Jan & Cindy), her mother (Carol), her step-father (Mike), and her three step-brothers (Greg, Peter & Bobby) in Southern California. Her nose was broken when she went to the back to door to tell her brothers that dinner was ready. An errant throw resulted in her getting hit in the face with a football. She was taken to the hospital where she was treated and a bandage was placed on her nose. She was told that she would be just as beautiful as before once her nose healed, yet when the bandage was removed Marsha screamed in horror. To everyone else her nose looked fine, but Marsha saw it as disfigured and disgusting. “I’ll never get the part of Juliet in the school play now!” she sobbed, “and there’s no way that Davey Jones will ever consider singing at our school dance once he sees my ugly nose!” Marsha stopped going out, except to go to the store to get beauty cream for her nose. She wouldn’t even go to school. Her parents didn’t know what to do. They asked the other kids in the family to tell Marsha how beautiful she is, hoping that the encouragement would help her.

            “It’s always ‘Marsha Marsha Marsha’!” thought Jan, “everyone treats her like she’s so beautiful and so wonderful, and they treat me like dirt!” Jan decided the best way to get people to treat her like they treated Marsha was to become beautiful, which to Jan meant she had to lose weight. Though she felt her parents were very controlling, she believed she could at least control whether or not she ate. By the time they noticed Jan wasn’t eating, she had lost a considerable amount of weight.    

            “It doesn’t feel right, Mrs. Brady,” said Alice, the family’s house-keeper, “with Marsha and Jan being so troubled, I don’t think I can enjoy going to The Meat Chopper’s Ball with Sam.” Sam is the local butcher who has been dating Alice for many years. The phone rings and Carol picks up the receiver. “Alice – it’s Sam,” she says as she hands the phone to her. Carol watches as Alice becomes more and more upset as she talks with Sam. “It looks like I don’t have to worry about the ball after all,” said Alice as she hung up the phone, “Sam just broke up with me.” Carol tries to console Alice and suggests that maybe she should take a walk. Alice agrees and puts on her jacket and leaves. Alice never returns. Mike and Carol contact the police and wide-spread manhunt finds nothing. Alice had just disappeared.

            So now things have gone from bad to worse for Carol. On top of everything else, she now finds herself as a stay-at-home mom who actually has to do housework! She is able to manage for a week or so, but then the work just seems to be piling up.   One day when Mike gets home late, she yells, “What took you so long?!? I could use some help around here!” “Honey,” replies Mike, “you know I always get my hair permed on Wednesday night.”   “You’re leaving me to do this while you get your hair done?!?” cries Carol as she collapses onto the sofa. “Carol, what’s wrong? Why are you so stressed?” asks Mike. “Why am I so stressed? Do you know how much work it is to take care of this family? The cooking! The cleaning! The laundry! And on top of that, Marsha thinks she’s ugly and Jan won’t eat!” Mike then decides that all of the family’s problems could be solved if they went on vacation. The next day he makes arrangements for them to go to Hawaii.

            Once they get to Hawaii, Mike suggests they go to the beach. Jan refuses to put on a swimsuit because she believes she is so disgustingly fat. Marsha says, “I could go naked and no one would notice – they’d all be staring at my hideously ugly nose!” So they decided to go for a walk and look for something fun to do.   As they turned the corner they see a sign for Pirate Pauline’s boat tour of the island, and they all decide that a tour would be nice. When they get to Pirate Pauline’s, they see Alice dressed like a sailor and smoking a cigarette. “Alice!! It’s you!!” they yell and they run hug her. “Back off!!” screams Alice, “me name is Pirate Pauline and I sails the salty sea! Argh!” “Well, um, Pauline,” says Carol, “You look just like our old house-keeper, Alice.” “House-keeper! Shiver me timbers!” exclaims Alice, “would a house-keeper have this?” Alice rolls up her sleeve to reveal a tattoo of the skull and crossbones with the phrase, “Momma Didn’t Love Me” tattooed underneath. Little Cindy begins to cry, “Oh Alice, we miss you! Don’t you remember us?” Alice pauses, looks reflectively toward the sky and rubs her chin. She then bends over to look Cindy in the eye as she removes a knife from her pocket. “If yous call me Alice once again I’ll cut out yer spleen!” she threatens. The whole bunch screams as they run back to the hotel. Once they have caught their breath Mike says, “Maybe we should have gone to the Grand Canyon!”   

1. Can Marsha be diagnosed with a disorder? (Explain why or why not) If yes, which disorder? (Be sure to justify your diagnosis)
2. Can Jan be diagnosed with a disorder? (Explain why or why not) If yes, which disorder? (Be sure to justify your diagnosis)
3. Can Carol be diagnosed with a disorder? (Explain why or why not) If yes, which disorder? (Be sure to justify your diagnosis)
4. Can Alice be diagnosed with a disorder? (Explain why or why not) If yes, which disorder? (Be sure to justify your diagnosis)

Answer 1

1. Marsha seems to be suffering from Body dysmorphic disorder . It's a mental health disorder where you can't stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears to be minor, or other people can't see. Here a broken nose has made her believe that she could never look like she was before. Even when the wound is healed Marsha thinks that she doesn't look the same . She thinks she has become ugly and is intensely focused on her appearance. She keeps seeking constant reassurance from her family and friends .She is seen to be embarrassed to go out in to the public. The only time she does go out is to buy beauty cream which she believes will fix her looks. These are all classical symptoms of Body dysmorphic disorder. Cognitive behavioral therapy and medications are the perceived treatments.

2.Jan seems to be suffering from depression. The increasing neglect towards her had led her to question her own beauty .She thinks that to people to start noticing her more, she needed to lose weight. She strongly believed that to get treated like Marsha, she needed to lose weight. She feels that she is invisible to her parents. Though she thinks that her parents are very controlling, she realizes that now as they are more attentive towards Marsha, she can control whether or not she ate. This had made her Anorexic. She began consantly avoiding food to control her weight and by the time her parents noticed it, she had lost a considerable amount of weight. The main way of treating depression is usually medication or talk therapy or a mix of both.

3.Carol seems to have suffer from stress. Being a work mother when the situation in her home has gone sideways ,she was forced to be a a stay-at-home mom. For Carol, this does not bring joy. She hates doing housework as it is evident from having Alice under her employment. She is feeling so much stress from having to deal with both of her daughters going through a rough time, on top of managing a house. This is unfamiliar to her and as it is evident from the passage, absence of her husband's cooperation is making her stress more. She finds herself alone to face all the problems alone and this is taking a toll in her.

4. Alice seems to be suffering from Borderline personality disorder[BPD]. People with BPD is seen to have unstable relationships. It can be seen from the case that, though Alice expects on going to the Ball with Sam, he calls her on the day and breaks up with her. Alice has been in relationship with Sam over seven years and this sudden breakup suggests that things were rocky between them. A person with BPD is also seen to have excessive emotional responses. Alice can be seen to be taking the situation of Marsha and Jan to her heart and feeling depressed. The situation is worsened with her breakup. Alice, on pretense of going for a walk leaves the place without informing anyone about anything. This is an impulsive action which might seem justifiable only to her, which is another sign of BPD. The family meets Alice again at Hawaii where she is unwilling to recognize the family and continue to act up her role as a pirate. The tattoo of the skull and crossbones with the phrase, “Momma Didn’t Love Me” shows that Alice had suffered from childhood neglect and possible abuse which might have led her to develop BPD.