Clinical Examination Report
New York University
Department of Psychological Issues
Ossenburger Psychiatric/Medical Ward
Statement Of Problem:
Holden Caulfield was at the Ossenburger Institution on December 28th 1953. He was referred by Mr. and Mrs. Caulfield, after he showed up home after days abroad and missing. He was accompanied by older relative D.B. Caulfield. The family wishes to gain information about the client’s mental and behavioral issues. The following is a summary based on the case history form, parent interview, assessment results, and observations obtained before or during the evaluation.
Case History:
The following information was gathered from parent interview and child history form.
Birth History
Medical History
Developmental History
School Performance
Behavioral Issues
Evaluation History
Holden was the second child born to Mrs. Caulfield. He was not diagnosed with any pre-natal problems or defects. Mrs. Caulfield’s pregnancy proceeded with no complications or difficulties. The client was born the usual nine months after being conceived. He reached all motor and verbal milestones within the average time span. No problems were reported until he reached age 12. His younger sibling Allie, diagnosed with leukemia passed away. The client showed disturbing mental issues, and had to be interned at a local hospital for treatment of a broken hand, dislocated in smashing out the windows in his garage. Medical history shows a visit to a local psychiatrist. Further interview shows Holden’s maturity had stopped developing at the same pace as his body. He also had a careless attitude towards education, and the world in general. He was kicked out of various schools, including Elkton Hills, Whooton Academy, and Pencey Prep. The client has developed a wide range of behavioral issues, prone to sudden outbursts of unrealistic fantasies. The individual also keeps a noted distance from society, designating most individuals he meets as phonies. Records show that he was due for an appointment with a psychoanalyst, but never showed up. He has received no medical analyzations up till now.
Behavioral Observations:
When first approached by the physician, Holden asked: “Are you going to psychoanalyze me?” He then started chuckling and muttering under his breath, “Damn phonies!” Throughout the preliminary part of the examination, Holden avoided verbal communication with the clinician. Once engaged in conversation Holden was asked to pick a topic for his discussion. The subject engaged in a series of seemingly random conversations with the clinician, changing topics often. We then asked him what he thought of school. After the first few questions, he replied it was full of phonies, and he hated it. When asked why he failed out of the educational institutions, Holden became quite irritable, avoiding the question, and replying it wasn’t his fault. Throughout the rest of the session, the client made no eye contact with the clinician. Examiners surmise he has difficulty in dealing with his failures. (Examination report ends)
Today, we tested Holden’s societal communication skills. We also tested his ability to adapt to situations. Several individuals were brought in at periodic intervals to engage in conversation with Holden. Test Group A was to engage in short conversations, Test Group B was to engage in slightly extended conversations.
The client was able to sustain a conversation with Test Group A, albeit that he chose unlikely subjects i.e. Ivy League graduates, movie writers/actors, and sex. With Test Group B, Holden sustained a short conversation, but soon degenerated into silence. Notable points are his extense use of profanity.
Results show that Holden has crippled social communication skills.
Examination Day 3:
Today we tested Holden adaptive skills. We composed a short list of questions for him to answer. His first question was what would he do if he was fired from a job he had been in all his life. He replied he didn’t know. As he progressed through the list, it was noted most of his answers showed little or no adaptive skill, in environments such as a new school, or workplace. When he was asked how would he adapt to the loss of an important person in his life, the client nearly broke down, doubled-over and started to mutter, “You’re not dead Allie, you’re not!” Shortly afterward the clinician had to sedate him, as the client attempted to injure him.
Having sufficiently diagnosed his mental state we did a final physical test. We found copious amounts of alcohol in his bloodstream, and damage to his liver. Exams also showed damage to the lungs, and a large susceptibility to lung cancer. The client is possessed of a large amount of bruises, indicating many struggles and physical trauma on the part of Holden. His addictions may be a side effect of mental trauma.
Report and Recommendations:
Holden shows signs of stunted mental growth, including societal and communicative deficiencies, failure to overcome obstacles and failures, lack of adaptive skills. From the amount of bruises present on the subject’s body, he probably has aggression issues. Also, a range of troubling physical problems. The subject has severe liver damage, which will possibly trouble him later on, as well as an increased susceptibility to lung cancer. He is addicted to smoking and drinking, perhaps irrevocably.
The suggestions of this clinic are to intern him in a reformatory program. Most of these problems are no doubt offshoots of unresolved emotions concerning his brother’s death. We would suggest a psychiatrist, or an aid group. He must slowly be introduced back into society, to help deal with his issues, and should also be enrolled into the abovementioned reformatory program as soon as possible. If his addictions are not dealt with, his liver and lung damage will be permanent, perhaps fatal. The client will have to have regular monthly checkups to see if he might be developing lung cancer. As for his liver, he should consider not drinking at all, or at least for a few years. If not, it would be best advised to start looking into transplant options. He should visit a counselor to find the reason behind his fighting, perhaps suppressed anger, or the like. We appreciate your time and patience, we advise to also continue bringing Holden to our institution to monitor his growth and advances.
Alfredo Prieto Giovanni Ferrari
Graduate Clinician Diagnostic Supervisor
