Mental Illness and Famous Persons Paper

Mental Illness and Famous Persons Paper

Paper details

1)Select a famous person – living or dead to assess for mental illness – describe the demographics and behaviors of that person – Choose Ernest Hemingway.

2. Using the mental status exam or brief psychiatric scale* – evaluate that person’s mental status with available pertinent information from the literature (use only areas that apply) 20

3. Determine a DSM-IV diagnosis for that person 10

4. Determine 2 nursing diagnoses pertinent for this person’s mental status and nursing care needs . Mental Illness and Famous Persons Paper

5. Identify two nursing interventions for each nursing diagnosis give rational for each 20

6. APA format, 2 references, 2 pages in length, introductory paragraph, conclusion paragraph, proper grammar, etc

Mental Status Examination (MSE) and Psychiatric Diagnosis of a Famous Historical Figure: The Case of Ernest Hemingway

Ernest Miller Hemingway was an American novelist and literary figure in the 20^th century who was born on July 21^st 1899 in Illinois. He was the recipient of the Alfred Nobel Prize for literature in the year 1954 for his literary works. He was also a Pulitzer Prize winner. He died on July 2^nd 1961 after committing suicide. Hemingway was well educated and travelled widely, having stayed in Italy for a considerable amount of time. He worked with the Red Cross during Wold War I. He also stayed in Paris and Cuba, becoming friends with among others revolutionary Fidel Castro and Pablo Picasso. Hemingway suffered from several physical illnesses, including diabetes, liver cirrhosis, and angina pectoris. However, it is his mental illness that led to his death that is the subject of this paper. Hemingway suffered severe depressive episodes but was also elated at times. He suffered from substance use disorder as he was a chronic alcoholic most of his adult life (Metts, 2016). This paper discusses and evaluates Ernest Hemingway’s mental status using the mental status examination (MSE), determines his DSM-5 diagnosis and two nursing diagnoses as well as two appropriate nursing interventions.

Evaluating Ernest Hemingway’s Mental Status Using the MSE

The MSE is an interview between the psychiatric client and the therapist or psychiatrist that follows a particular pattern and involves the psychiatrist questioning the client to obtain an insight into their mental status. It leads to a psychiatric diagnosis and particularly examines the patient’s cognition, emotions, perceptions, appearance, reasoning, insight, and judgement. The MSE is the psychiatric equivalent of history taking and physical examination. It includes both subjective information given by the client and objective observations made by the therapist of psychiatrist (Fernando & Carter, 2015). According to the available literature on Ernest Hemingway, the following would have been his typical MSE findings (Metts, 2016):

Mental Status Examination (MSE)

1. Appearance & Behavior

He appears dishevelled, demonstrates psychomotor agitation and is overactive and restless. He has increased appetite and is friendly and cooperative with piercing eye contact. At other times puts his head down and bends his shoulders reducing the amount of gestures and avoiding eye contact.

1. Speech

He has very rapid and copious speech that is pressured. The rhythm is articulated, the volume is loud, and the content is loquacious (verbose). At other times the speech is not spontaneous/ decreased, slow, dysarthric in rhythm, soft in volume, and impoverished in content.Mental Illness and Famous Persons Paper

• Mood and affect

His is mood is “elated and fantastic”. He is cheerful, euphoric, and elated. At other times his mood is “depressed and anxious”. He shows hopelessness about the future, is suicidal and dysphoric. He has a flat affect that is mood congruent with lability.

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1. Thought process and thought content

He demonstrates flight of ideas with a tangential thought process, word salad and perseveration. Judgement is impaired with grandiose delusions. At other times shows persecutory delusions, suicidal preoccupation and ideas of reference.

1. Cognition

He is easily distracted and demonstrates inattention and low levels of concentration. At other times also demonstrates reduced recall/ low memory.

1. Insight/ Judgement

He shows grossly impaired insight and is surprised why he is being treated as a sick person. At other times, however, he shows variable insight.

• Perception

He demonstrates auditory hallucinations that are mood consistent. At other times, he demonstrates a reduction in normal perceptions.

The DSM-5 Diagnosis for Ernest Hemingway

According to the results of the above MSE, Hemingway’s symptoms and history can be used to arrive at a psychiatric diagnosis based on the diagnostic criteria present in the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013). Hemingway’s MSE reveals that:

• He suffers from periods of abnormally and persistently elevated moods and increased goal-directed activity.
• During the above periods, he shows grandiosity or a high self esteem, insomnia, pressured speech, racing thoughts and flight of ideas, distractibility, psychomotor agitation, and risky behavior.
• His mood disturbance is accompanied by psychotic features (auditory hallucinations and grandiose delusions).
• This mood disturbance occurred even when he was sober and could not be attributed to another condition.Mental Illness and Famous Persons Paper

The MSE has also shown that at other times Mr. Hemingway:

• Has depressed mood.
• Shows a decreased interest in pleasurable activities.
• Has psychomotor retardation, loss of energy, and insomnia.
• Shows lack of concentration.
• Has suicidal ideation.
• Is clinically distressed by the above symptoms.
• Does not have any other condition that can explain the above symptoms. They also occur even when he is not under the influence of alcohol.

According to the DSM-5, therefore, the above observations about Mr. Hemingway show that he fulfils the diagnostic criteria for bipolar I disorder or BPD (Metts, 2016; APA, 2013).

Two Pertinent Nursing Diagnoses and Nursing Interventions for Ernest Hemingway

Ernest Hemingway was first and foremost a risk to himself when he was having a major depressive episode. He was also at risk of getting injured due to his risky behavior at times of a manic episode. Because of this, two of the most pertinent nursing diagnoses for him would be as follows:

1. Risk of physical bodily harm due to suicidal ideation, and
2. Risk of acquiring sexually transmitted infections (STIs) due to risky sexual behavior or sexual indiscretions in a hypomanic episode.

Suicidality is recognized in the DSM-5 as a major characteristic of bipolar disorder. It occurs during the depressive episodes that the patient undergoes (major depressive episode), when the patient feels worthless and full of guilt. At these moments, he may harm himself or actually succeed in killing himself in a suicide attempt. This is what ended up happening in the end in the case of Ernest Miller Hemingway. However, during the polar opposite episode of hypomania/ mania, he would engage in so many indiscretions without giving them much thought or their consequences. These indiscretions include those of a sexual type which present a high risk of contracting STIs.

Two nursing interventions that would help in addressing the above two nursing diagnoses would be (i) to keep the client occupied at all times by giving them company of a task to complete, and (ii) giving the client psychoeducation and counseling with regard to the risks associated with indiscriminate sexual escapades. The rationale for these is that by keeping the patient busy, they will not have time to think about harming themselves. Also, by continuously reminding them of the dangerous of risky sexual behavior, they will be more likely to remember some of that advice and restrain themselves in the spur of the moment. This is despite the fact that their insight and judgement are compromised. Mental Illness and Famous Persons Paper

Conclusion 

Ernest Miller Hemingway was arguably one of the most famous literary figures of the 21^st century. However, despite his fame and fortune he suffered from many physical and mental illnesses. One of the mental illnesses he suffered from and which eventually ended his life was bipolar disorder. He committed suicide at the age of 61 years, during a major depressive episode of his bipolar disorder.

References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Fernando, I., & Carter, G. (2015). A case report using the mental state examination scale (MSES): A tool for measuring change in mental state. Australasian Psychiatry, 24(1), 76-80. http://dx.doi.org/10.1177/1039856215598871

Metts, J.T. (2016). Ernest Hemingway: A comprehensive psychological case study of his life, works, illness, and suicide [Thesis, Ashford University]. ResearchGate. https://www.researchgate.net/publication/313218917_Ernest_Hemingway_A_Comprehensive_Psychological_Case_Study_His_Life_Works_Illness_and_Suicide_Haemochromatosis_Suicide_By_John_T_Metts

Mental Illness and Famous Persons Paper

 

 

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