Psychosocial recovery in patients with affective disorders- case report
Ema N.Gruber, Happy family NGO, Croatia
Affecive disorders are psychiatric diseases with multiple aspects, including biological,
behavioral, social and psychological factors. Most common affective disorders are major
depressive disorder, bipolar disorders and anxiety disorders. The effects of these
disorders, such as difficulties in interpersonal relationships and an increased susceptibility
to substance abuse- are major concerns for parents, physicians and the community.
Affective disorders can result in symptoms ranging from the mild and inconvenient to the
severe and life threatening leading to suicide in 15 % od those cases. Major depressive
disorder also known as monopolar or unipolar depression is severe, common psychiatric
illness, causes prolonged periods of emotional, menatl and physical exhaustion with a
considerable risk of self destructive behavior and suicide. Major studies have identified
major depressive disorder as one of the leading causes of work disability and premature
death, representing an increasingly worldwide health and economic concern.
Bipolar affective diseases are divided into type I and iI, cyclothimiac and hypomania
disorder. Peope with bipolar diseases experience periods of mainc (hyperexcitable)
episodes alternating with periods of deep depression.
This is a case report of M.K, the patient who has major depressive disorder.
When he was hospitalized, he experienced periods of few weeks of symptoms that
included sadness, emotional heaviness, feelings of worthlessness, hopelessness, guilt,
anguish, fear, loss of interest for normal dality activities, social withdrawal, inabilits to feel
pleasure, physical apathy, difficulty in concentrating and recurrent thoughts about death.
He had changes in sleeping pattern with insomnia durign the night and hypersomnia
durign the day, chronic fatigue and feeling of being physically drained and immobile. He
also had irritability and mood swings, loss of appetite and profound despair, isolated
himself in bed.
He had all the risk factors in developing the disorder, he participated in the Croatian war
from 1991-1995 as a soldier, he lost his job 4 years ago and since than is unemployed
without social welfare, he had a drinking problems after the war and in 2008. his wife left
him and took his two daughters away. He came to the hospital with major depressive
disorder asking for help.
The treatment in hospital included psychotherapy and drugs and psychotherapy which is
important in helping to cope with guilt, low self esteem, and inadequate behavioral patterns
once the neurochemistry is stablized. The treatment team that treated him was consisted
of the psychiatrst, nurses, social worker and occupational therapist. Additional community
resources was available in a form of a support groups for people and his family provided
by Happy family NGO.
During the hospital treatment we started with his rehabilitation proces tailored to the
individual patients needs in ordered to facilitate the process of recovery from illness to as
normal a condition as possible. The purpose of his rehabilitation is to restore his physical,
sensory and mental capabilities that were lost due to illness. Rehabilitation was
addressed to the patients phyisical, psychological and environmental needs.
In this case we achieved the process by modifying the patients physical and social
environment in the way that he was engaged in the theatre group as a part of the
rehabilitation program of the Happy family NGO and the name of the play they performed
was “The house of the hedgehog- there is no place like home for mentally ill person”. This
was adaptation of the children play that has long tradition in our country, but now the
hedgehog was mentally ill person fighting for the right to live at his home.
Originaly, our NGO Happy family was running this project for 2 years. During the 2009. we
performed that play in numerous places, different psychiatry hospitals, congressess and
events, and in 2009 I presented this at the Gamian conference. Than, since the impact of
the project was huge, during the 2010. the theatre group went to present the play to the
elementary scholls, especially to the countes that were destroyed by the war 20 years
ago- Glina, Petrinja Jabukovac, Popovača. That was the year when this patient played the
main role in the theatre play and went on a tour.
The main idea with this specific theatre play was to pass the message to the
children in elementary schools that it is possible for a mentally ill person to live with
his illness at his home, in the community.
So he went on playing the role of the hedgehog- home fighter and in one elementary
school that we visited he managed to see his daughter, after a year that they were
separated. She didnt wont to see him and now she was so proud on him, they started a
better relationship that continued even after the tour. We asked if she also wonts to be part
of the play and she become an actress as well. Played the hadgehogs daughter what she
actually was so the experience was good for her as well. This great moments of bringing
father and daughter together were the reason why we volonteer in our NGO so we were all
proud and happy with the way things worked out for them. Even his ex wife was happy
since he was working, doing usefull things, socializing with people and his daughter, wasnt
drinking alcohol and his treatment for depression was going well.
What was achieved in play for this particular patient, as part as his rehabilitation aims and
goals: He manage to learn how to: (1) find alternatives to problems, (2) reduce feelings of
isolation, (3) develop new coping skills and patterns, (4) broaden the range of expression
of feelings, (5) experience positive interactions, and (8) develop social relationships.
In this case report- psychosocial recovery in patient with affective disorders was performed
by using psychodrama therapy in order to use a person's creativity and spontaneity to
reach his or her highest human potential.
By closely approximating life situations in a structured environment, the patient was able to
recreate the exact scenes in a way which allows both insight in his problems and an
opportunity to practice new life skills in order to deal with his life tasks.
The play was an opportunity for patient to practice new and more appropriate behaviors,
and evaluate its effectiveness within the supportive atmosphere of the group. Because the
dimension of action is present, play was often empowering in a way that exceeds the more
traditional verbal therapies that wasnt helpfull in his case.
With its perspective on the social network in which an individual lives, it promoted mutual
support and understanding and helped with his inclusion to society.