An Underlying Instability

MR. HART: I believe this par­tic­u­lar psy­cho­log­i­cal eval­u­a­tion appears as page thir­teen of the clin­i­cal record.

RESPONDENT: Yes, dated 14 April 1967, it reads as follows:

This 20-​​year-​​old, sin­gle SA/​USN with two years active ser­vice was referred by the Naval Ship­yard Dis­pen­sary for eval­u­a­tion of a pos­si­ble schizoid per­son­al­ity. The sub­ject presents a prob­lem with his sex­u­al­ity that he regards as exces­sive. Also, he reports a rather vague prob­lem with adjust­ing to the ship­board environment.

Men­tal sta­tus exam­i­na­tion reveals a well devel­oped, clean cut, blond-​​haired young man who relates in a self-​​effacing man­ner. He does not appear to be anx­ious, but does con­vey the impres­sion of being overly ashamed of him­self. Flow of speech is smooth and thought con­tent is focused on his con­cern about his com­pul­sion for sex. His guilt regard­ing the behav­ior per­sists despite pro­fes­sional reas­sur­ance regard­ing the nor­mal­ity of the behav­ior. He describes dis­tant rela­tion­ships with his peers, indi­cat­ing he has never formed long last­ing or deep-​​seated inter­per­sonal rela­tion­ships. He denies any con­flict with author­ity fig­ures. He has expe­ri­enced some recent impair­ment of sleep and appetite. His think­ing is clear, coher­ent and goal directed. He is capa­ble of spon­tane­ity and appro­pri­ate emo­tional expres­sive­ness. There is no evi­dence of loos­ened asso­ci­a­tions, delu­sions or hal­lu­ci­na­tions. Intel­li­gence is in the high aver­age to supe­rior range; and judg­ment is con­sid­ered essen­tially intact.

A brief review of back­ground his­tory reveals dis­tant rela­tion­ships with peers and lack of per­sis­tence in reach­ing goals. The patient’s nat­ural father suf­fers from schiz­o­phre­nia and has been hos­pi­tal­ized since the patient was three years old. The patient’s step­fa­ther is described as an alco­holic who never estab­lished a mean­ing­ful rela­tion­ship with the patient. The patient’s mother worked fre­quently and he has no warm feel­ings about her. He reports sev­eral episodes of steal­ing minor objects as a child. He pro­gressed through high school mak­ing excel­lent grades, grad­u­at­ing at the age of 18. He briefly attended the Naval Acad­emy, mak­ing excel­lent grades, but dropped out sud­denly for vague, unspec­i­fied rea­sons. He attended another col­lege and dropped out for sim­i­lar rea­sons. He held sev­eral jobs briefly but ter­mi­nated his employ­ment fol­low­ing impul­sive trips out of town. On one such occa­sion he was appre­hended at a girl’s dor­mi­tory. He has dated only occa­sion­ally, usu­ally upon the ini­tia­tive of the girl, and is presently uncom­fort­able in the pres­ence of women.

Impres­sion: No psy­chi­atric diag­no­sis is indi­cated at the present time. There is evi­dence of a basi­cally schizoid per­son­al­ity makeup with some depres­sive features.

Com­ments & rec­om­men­da­tions: The sub­ject is con­sid­ered capa­ble of remain­ing on active duty. There is evi­dence, how­ever, of an under­ly­ing insta­bil­ity, which may require peri­odic reeval­u­a­tion and sup­port­ive ther­apy in the future.

Signed L. Bon­ney LTJG MSC USNR
Clin­i­cal Psychologist