Patient Case Report

Patient Case Report

Author’s Name

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Patient Case Report

Background

Sometimes people tend to be extroverts, but the level differs from one person to the other. John (34-year-old man) shows a high level of individualism in the way he loves to stay without any interference. He stays away from the city, arguing that the place is dirty and polluted, and does not keep friends. Many people around him think he lacks humor, but this does not appear to affect him at all. John locks himself in his bedroom when he is not working, which worries his mother, who thinks the man would be better off when he marries and maintains a family. The analysis shows how John’s introversive nature pushes him to seclude himself from the rest, which causes him much loneliness. Considering that John suffers from a psychological problem, the report proposes the use of social cognitive behavioral therapy and psychodynamic therapy, which embrace approaches that would help John overcome his challenges. It is necessary to find suitable solutions to John’s increased seclusions and loneliness to avoid the adverse effects he might experiences and to save the society from equally adverse repercussions. Introversion may be beneficial to John in some ways, but he needs to seek assistance on how he may increase his socialization with others to lead a healthy and progressive life. 

Assessment

The analysis does not highlight why John chooses to behave the way he does, which leaves the reader to speculate the reasons for such conduct. The man does not suffer from any adverse health condition that would make him seclude himself and has a job, which further leaves one wondering why he behaves like a person who has much stress. It is difficult to explain why John displays introversive behaviors and isolates himself, yet such a lifestyle is typical among older people usually above 55 years or those who experience threatening social conditions (Singer, 2018). A qualitative study to explore isolation and loneliness among adults (28-60 years) reveals that older people face seclusion either some of the time or always. The study further informs that adults aged 28-45 years could become lonely or seclude themselves from others due to several demographic factors, including low academic level, little income, lack of relatives, poor health, and rural living, among other factors (Singer, 2018). John’s case, however, is quite different because he lives away from the city by choice, and quits school to avoid too much interaction. Indeed, the character is embedded in his trait, and the concerned persons should find suitable intervention approaches to help the first-born child in the family. 

A suitable way to describe John would be to say that he is an introvert who pays much interest in his mental state, a situation that drives him to isolation and loneliness. John’s behaviors depict that of a loner because he tends to be more reflective and reserved. John, for example, does not want to visit his cousin in Glasgow anymore as he believes the city is not as clean as he wants. Evaluators such as Khalil (2016) and Suliman (2015) argue that introverts like John tend to gain more energy through personal reflection and become suppressed when they interact with others. Such people find pleasure when they engage in solitary activities such as meditating, and when they stay alone rather than spending time in large groups. Such a person prefers to focus on particular attention at a time, and usually observe situations keenly before taking part.

It is vital not to mistake introversion for shyness because many usually use the two interchangeably, yet that should not be the case. Introspection is a person’s choice, whereas shyness emanates from some form of distress (Suliman, 2015). Introverts generally prefer solitary to communal activities, but do not necessarily fear social indulgence in the same way as shy people. The misconception many people have about introverts results in a situation where many talents and energy go to waste (Suliman, 2015). Looking at John’s case, it is apparent he prefers to stay alone, but this does not mean that he ultimately wants to isolate. He even becomes annoyed when his family members choose to move away when they become mature enough to start their own families. 

Formulation

Loneliness and introversive behaviors are global human emotions that are both unique and complex to each person. The condition has no common cause, which makes the prevention and treatment approaches of the potentially harmful state of mind to differ considerably. Hans Eysenck’s theory informs that such behaviors are a result of underlying differences in brain functioning and psychology (Cacioppo et al., 2015). Eysenck employed the ascending reticular activation framework to evaluate the nature of extraverts and introverts and ruled that whereas outgoing individuals indulge in social activities and seek excitement in an attempt to heighten their arousal level, introverts like John happen to stay away from social events as a way of suppressing such stimulations. 

The loneliness John experiences is one that does not merely need the presence of others as it would happen when a discrepancy occurs between a person’s preferred and real social conditions. Usually, the variance would lead to negative thoughts of being alone, and the distress of being socially isolated makes one uncomfortable. John’s situation, however, appears to be innate because he does not need the comfort of others whom he can trust, share ideas with, and prosper together. Instead, he chooses to lock himself in the bedroom and avoids going to church or to visit his brothers and sister who left home and are all now married residing in towns nearby. John’s seclusion, loneliness, and increased introversive behaviors, therefore, suggest that he might be suffering from a psychological condition that may only get better through proper intervention methods. 

Interventions

The interventions to help people suffering from mental and psychological problems took a new turn in 1978 when the Task Panel published the Perspectives onPsychological Science report. The publication emphasized the essence of offering healthcare and reducing the pain of those suffering from emotional problems, including isolation and loneliness (Cacioppo et al., 2015). Nearly 40 years later, practitioners in the medical field have developed several intervention approaches to address the increased psychological problems many people face today. 

A practical approach to helping John is using the social-cognitive behavioral therapy (CBT) framework, which focuses on educating affected persons on how to identify the negative thoughts that they have about themselves and others. CBT is appropriate in this case because it helps to uncover the negative perceptions affected persons have about social interactions, and to regard the thoughts as being possibly wrong that needs to be rectified rather than embraced (Cacioppo et al., 2015). CBT implies that it is possible to overcome introversive behavior and loneliness by aiming to transform maladaptive social cognitions and perceptions such as false perceptions, irrational and dysfunctional beliefs, and self-defeating ideas. CBT usually yields the anticipated results when a qualified therapist takes over the process, and when the affected person agrees to comply with the guidance. 

An advantage with the social cognitive approach is it relies on a model that helps the victim understand and overcome their situation. The model allows victims know that they do not voluntarily become secluded and lonely; instead, they find themselves on one end of the spectrum of social connections. Social CBT lets the affected persons know that the perception that they are separate from others heightens their desire for self-preservation (Cacioppo et al., 2015). The model encourages the affected persons to understand the source of their irrational and dysfunctional thoughts and to know how this affects their interpersonal interactions with others. Even though more investigations are still required, available information shows that interventions created to adjust maladaptive social cognition may be worth trying. 

Other than social CBT, psychodynamic therapy may help John and others who have similar problems overcome their tribulations. The process brings together a therapist and a client who displays psychological-related disorders, particularly those who find it difficult to maintain social and personal relationships (Jakobsen et al., 2011). Psychodynamic therapy may help John understand how past or earlier emotions tamper with current behaviors, affinities, and decision-making. The approach would be more helpful to John if he understands the origins of his social hurdles but is not able to overcome the problem without assistance (Jakobsen et al., 2011). The advantage with the psychological intervention mechanism is it shall help the patient know how to resolve and analyze his present issues and transform their behaviors in current relationships through rigorous examination and scrutiny of earlier emotions and experiences. 

Evaluation

Handling John’s case in a clinical setting would require the application of both psychobiological and pharmaceutical approaches associated with loneliness and inappropriate social behaviors. Increased evidence suggests that combining psychological interventions with short-term pharmacological treatment provides the best outcome for people suffering from the effects of isolation and loneliness (Cacioppo et al., 2015). John would have to go through CBT, psychodynamic therapy, as well as take several drugs that would help ease the effects of loneliness, including unconstructive thoughts. Physicians and therapists usually recommend fluoxetine for patients experiencing loneliness and isolation (Cacioppo et al., 2015). The antidepressant has many effects on the body, including but not limited to, regulating the behavioral impact of seclusion, fear reactions, and anxiety-like behaviors. Oxytocin is another functional medicine for social isolation because of its capabilities to promote social affiliation and togetherness. The drug helps buffer the behavioral and neural defects that cause social isolation and regulates anxiety. Cacioppo et al. (2015) even feel that using pharmacological treatment may work well for individuals who do not prefer other psychological interventions such as social CBT and could yield consistent improvement. Addressing John’s case in a clinical setting, therefore, will require an application of both mental and pharmacological treatment to achieve the best results. 

Implications

Human beings are social creatures, and their psychological, biological, and social systems work best when they thrive in collaborative environments. It is common in many societies to witness scenarios where social networks lessen as people grow older, resulting in many cases of loneliness and isolation (Cacioppo et al., 2015). Unfortunately, keeping to oneself and failing to address the issue might have adverse effects on the individual as well as on the society, which requires the affected persons to seek intervention as soon as possible. 

John’s behaviors should worry him because of the adverse effects he is likely to encounter if he does not change. The increased seclusion, loneliness, and introversion he displays could cause severe health effects. People live as social species whereby their social networks, including their communities, tribes, and families, enable them to thrive and survive (Singer, 2018). The condition where people must interact or socialize with others is embedded in the evolutionary transformation of physiologic and behavioral mechanisms such as the genetic, neural, and hormonal functions that promote social interactions (Singer, 2018). Human beings differ in their behaviors because the biological and psychological structure of most people pushes them to prefer social networks to isolation. Since loneliness and social isolation are likely to occur in adulthood, many scholars now pay attention to the possible health effects on individuals. Many researchers in this area agree it is challenging to identify and study the health effects of loneliness and isolation, especially in situations where a person lives with particular pre-existing health conditions such as depression and immobility (Cacioppo et al., 2015). Nonetheless, several studies of social isolation show a connection with poor health. Individuals who isolate themselves either due to introversion or other factors stand a high risk of becoming obese or smokers, and may even develop lifestyle diseases such as high blood pressure (Cacioppo et al., 2015). John may get valuable insight from the revelation that increased loneliness, isolation, and introvert behavior could have adverse health effects, and consider changing how he interacts with people. 

Studies by several researchers confirm introversion and seclusion could cause poor health on the victim. Singer (2018), for example, monitored the total mortality rate in a group of men (30-35 years) for whom social interactions were open to the investigators. The surveyors followed 32,624 healthy male participants and realized that 511 deaths occurred during the period (Singer, 2018). The study discovered unmarried men, those with fewer than five friends or relatives, and those who do not belong to any social or religious organizations had higher (90%) risk of succumbing to cardiovascular disease (CVD), and more than twice the risk of death from suicide or accident, as well as the double threat of experiencing fatal or non-fatal stroke (Singer, 2018). The findings from Singer’s study provide valuable insight to people like John because they become aware of the importance of social interaction on their health. 

John’s behavior can have other adverse effects on him apart from the health issues that put his wellbeing at considerable risk. John, for example, may destroy the efficiency and quality of sleep, so that it is less nourishing, both psychologically and physically (Singer, 2018). John may wake up several times at night and could have difficulties going back to bed. Prolonged lack of sleep may affect his cognitive ability, which can affect his response and reasoning mechanisms. John must work towards addressing the issue as fast as possible because continued seclusion and introversive behaviors could worsen his relationship with others, including his close relatives. Already, John dropped out of school and hardly associates with friends at work and at home. 

 John should consider changing his behaviors because the lifestyle could have adverse effects on society at large. Members of the community usually develop sympathy for individuals who exhibit seclusion and high levels of introversion. They feel sorry for such individuals and wish they get an intervention to overcome their tribulations. The increased solitude and loneliness, which may cause psychological problems cost the U.S. government up to $7 billion in extra health costs every year. The government incurs a lot of cost building and furnishing hospitals and spends a lot of money acquiring additional drugs for people suffering from isolation-related ailments such as isolation, arthritis, hypertension, diabetes, and heart disease (Khalil, 2016). Today, many countries, including the U.S., invest a lot of money in finding appropriate medication for people suffering from loneliness. Whereas such a development may be a reaction to the greater isolation, which fuels a broad range of disorders the money put into the production of such drugs could help to improve other areas such as infrastructure and education if people could avoid practices that could push them to isolation (Khalil, 2016). The deaths that occur from loneliness related ailments also affect society because of the pain and agony people experience when they lose their loved ones. 

Even though John’s character has many adverse effects, it is vital to consider some of the benefits that come with such a personality. People should remember that not every person who isolates themselves are lonely, and who show loneliness would keep away from others. Khalil (2016) brings to light how society tends to be biased against people who keep to themselves, and how the teachings in school that people should be sociable make introverts appear less significant. Khalil (2016) argues that such perceptions are wrong because people like John can encounter specific individual and social benefits. 

Research Forward

An evident gap in research on people’s behavior is many scholars fail to emphasize the strengths of people who keep to themselves, such as John. Most researchers on social practices put more emphasis on the benefits of interacting with others, thus creating a one-sided impression that extroverts have all the joy, and their attention-seeking personalities often give them the chance to gain promotion, credit, and fame (Coplan & Bowker, 2014). Whereas scholars put little focus on magnifying the merits of an introvert, future investigators should highlight more on the areas in which introversion helps a person. The researchers should expound on the aspect that while many are quick in judging introverts for their minimum indulgence, they are hardly accused of being disruptive, excessively demanding, and intolerable (Coplan & Bowker, 2014). Future researchers should come up with more findings on how introverts respect their space, and that of others as well, and how they are mostly independent. Future investigators should expound on how people like John, who prefer to isolate themselves, happen to be original and creative (Coplan & Bowker, 2014). They should make people know the benefits of not adopting the values of the group and what is widespread, and how having personal preferences that have an insignificant influence on contemporary issues may benefit a person. John is an excellent example of a person who does not give in to what many think is right when he prefers to stay away from the city where many perceive to have a lot of opportunities. 

References

Cacioppo, S., et al. (2015). Lonliness: Clinical import and interventions.

            Perspectives on Psychological Science, 10(2), 238-249.

Coplan, R., & Bowker, J. (2014). The handbook of solitude: Psychological perspectives on

            social isolation, social withdrawal, and being alone. Hoboken: Wiley-Blackwell.

Jakobsen, J., et al. (2011).The effect of interpersonal psychotherapy and other psychodynamic

            therapies versus ‘treatment as usual’ in patients with major depressive disorder. PLos

            ONE, 6(4), 1-9.

Khalil, R. (2016). Influence of extroversion and introversion on decision making ability.

            International Journal of Research in Medicine Sciences, 4(5), 1534-1538.

Lee, E., et al. (2018). High prevalence and adverse health effects of loneliness in community-

            dwelling adults across the lifespan: Role of wisdom as a protective factor.  International

            Psychogeriatric, doi: 10.1017/S1041610218002120

Singer, C. (2018). Health effects of social isolation and loneliness. Journal of Aging Life Care.

            Retrieved from https://www.aginglifecarejournal.org/health-effects-of-social-isolation-

            and-loneliness/

Suliman, F. (2015). The role of extrovert and introvert personality in second language

            acquisition. IOSR Journal Of Humanities And Social Science, 20(2), 109-114.