Adrian Monk, portrayed by actor Tony Shalhoub, is the main character in the USA Network series MONK. Monk is a former homicide detective for the San Francisco Police Department, suffering from an anxiety disorder known as obsessive-compulsive disorder (OCD), as well as numerous phobias. After Monk’s wife was murdered, his disorder worsened leading to his suspension from the police force. When the series opens, Monk works as a private police homicide consultant and undergoes therapy to overcome his anxiety disorder and phobias. He is assisted by a private nurse who helps him cope with his disability on the job.
Part One—Case Study Character Background The episode “Happy Birthday Mr. Monk” shows that Monk, born October, 17, 1959, is a California man of Welsh ancestry. Monk is 50 years old, and was born in Marin County, CA. He stated, “His alma mater is the University of California, Berkley. ” His parents were very strict and authoritarian. Monk’s father Jack Monk abandoned the family when Monk was eight years old. Jack said that he was going to get Chinese food, but he never came back. Ambrose Monk, Monk’s brother, is agoraphobic and afraid to go out in public. Monk’s mom died in 1994.
Because of these childhood family events, Monk is already a very sensitive and fragile person. Mr. Monk dislikes unorganized, rude, dirty, and filthy people. He also dislikes murderers, people who commit evil acts, and criminals on the loose. That is the reason he became a homicide detective. Mr. Monk likes people who help others, such as his physician and Trudy. In addition, he likes organized, clean, and tidy people. Mr. Monk’s strength is that he is a very clever detective. Plus, he has an amazing photographic memory, which helps him catch criminals.
His weakness is that he has many phobias, which affect his performance as a detective. Mr. Monk doesn’t have any friends because of the weird and odd behaviors caused by his OCD. His family consists of his assistants/nurses Sharona, and then Natalie. He also works with people in the homicide department, namely Captain Leland Stottlemeyer and Lieutenant Randy Disher. Stressors/Pathology Mr. Monk does not have any relationships with anyone, mainly because of his odd behaviors. He acts strangely in front people because of his OCD. In the episode “Mr.
Monk Makes A New Friend” he annoys a new friend by calling him too much. Monk explains himself, stating, “I can’t not call him or hear his voice. ” It is very annoying to call a friend every hour. That is one example of how Mr. Monk has difficulty with personal relationships. His wife, Trudy Monk, with whom he had a meaningful relationship, died in a car bomb. Before his wife’s death, Mr. Monk’s OCD symptoms had alleviated. After Trudy was murdered, the OCD symptoms intensified, and those around him could clearly see that he had issues, which affected his job performance and led to his isolation.
When the series begins, Mr. Monk’s condition is somewhat stable, but his lives in an overly organized apartment. The battle Monk faces daily is how to make it through the day with his OCD. He tries to avoid everything that makes him uncomfortable or is viewed as a threat. Mr. Monk stresses over the fact that every room must be neat and tidy. Plus everything must be a multiple of 10; for example he buys a box of eggs, which contains 12 eggs and deliberately throws two eggs away. Mr. Monk doesn’t have any history of this disorder, but his brother was agoraphobic.
Symptoms Other symptoms of OCD manifest themselves typically as ritual behavior such as repetitive hand washing. Mr. Monk needs to wash his hands every time he touches an object or shakes a hand. He becomes obsessed with shapes. For example, his toast has to be a perfect square. Numbers occupy his time. As mentioned above, everything must come in multiples of 10. He has the typical preoccupation with dirt and germs. For example, he can’t stay in an untidy or dirty room; he has to tidy it up. Mr. Monk is terrified of germs, milk, dust, and heights. So what Mr.
Monk does all day is try to stay away from all of these fears. These symptoms never emerged in the series; rather, the viewer is led to believe that Mr. Monk had OCD since he was born. However, the viewer is also informed in conversations with the police sergeant and with Monk’s nurse and therapist that what triggered this disorder was the murder of his wife. Immediately after his wife died, his disorder worsened. Outcome of Case Monk’s treatment was to go to Dr. Charles Kroger for psychotherapy that would aid him to cope with his disorder. In the sessions, Mr.
Monk talks about what he did during the day and the goals he accomplished. The treatment is not entirely effective, but it helps Mr. Monk relax and get all the stress out. In the long term, Mr. Monk cannot overcome his disorder because he cannot imagine that he can be cured. In addition, he is not a risk taker, meaning he could never do anything that would make him uncomfortable. Because of this, there is little hope that he will be able to completely overcome his disorder. This makes sense because his disorder is inherited, and not attributed to environmental causes.
Part Two—Disease Diagnostic Criteria Obsessive Compulsive Disorder (OCD) is a pattern of recurring obsessions and compulsions that are severe enough to be time consuming and interfere with a person’s daily functioning. They must cause marked distress (such as pain or physical harm to the person) or significant impairment. Usually, they take more than one hour of a person’s time. It is important to specify whether or not the patient has poor insight, meaning that the person does not realize that the obsessions or compulsions are unreasonable or excessive.
At some point, the person must realize that their obsessions and compulsions are not reasonable (i. e. , normal). “Obsessions are consistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or stress” (DSM IV-TR, 300. 3). Most common obsessions are about contamination with dirt or germs, repeated doubts, a need to have things in a particular order, horrible impulse, the need to shout obscene words, or sexual impulses. Compulsions are repetitive behaviors which people do to reduce the anxiety or distress of the obsessions.
For example, repeated hand washing is a compulsion, which satisfies the obsession of repeated thoughts of contamination from dirt. For a complete list of Diagnostic Criteria from the DSM IV-TR, see Appendix A. Etiology (Causes) Nearly 1 to 2 percent of the population suffers from OCD. Most of those begin to be afflicted in early adulthood, and it is often preceded by a particularly stressful event such as pregnancy, childbirth, or family conflict. It may be closely associated with depression, with the disorder developing soon after a bout of depression or the depression developing as a result of the disorder.
Men and women are equally affected. A fairly high proportion (as much as 50 percent) do not marry (Baldridge 2001). Although Obsessive-Compulsive Disorder usually begins in adolescence or early adulthood, it may begin in childhood. Modal age at onset is earlier in males than in females: between ages 6 and 15 years for males and between ages 20 and 29 years for females. For the most part, onset is gradual, but acute onset has been noted in some cases. The majority of individuals have a chronic waxing and waning course, with exacerbation of symptoms that may be related to stress.
About 15% show progressive deterioration in occupational and social functioning. About 5% have an episodic course with minimal or no symptoms between episodes (DSM IV-TR, 300. 3) No cause for OCD has been isolated. Four theories exist which try to explain the basis of OCD psychologically: guilt, anxiety, and superstition. 1) The theory of guilt has its origins in Freudian psychoanalysis. Freud believed that patients with OCD developed repetitive rituals, such as hand washing, to replace obsessive thoughts about sex.
The obsessive ritual, then, was seen as a way to replace the guilt of being overwhelmed by forbidden, sexual thoughts. 2) The anxiety hypothesis poses that OCD behaviors develop to reduce anxiety. Many thought or action patterns emerge as a way of escape from stress, such as daydreaming during an exam or cleaning one’s room rather than studying for a test. If the stress is long lasting, then a compulsive behavior may set in. 3) The superstition theory proposes a connection between a chance association and a reinforcer that induces a continuation of that behavior.
In other words, a particular obsessive-compulsive ritual may be reinforced when a positive outcome follows the behavior; anxiety results when the ritual is interrupted. 4) A fourth theory is accepted by those who believe that mental disorders are the result of something physically or physiologically amiss in the sufferer, employing data from brain structure studies, genetics, and biochemistry. Brain chemistry has been found to be altered in those suffering from OCD, along with increased metabolic activity.
In addition, relatives of OCD sufferers are twice as likely as unrelated individuals to develop the same disorder, indicating that the tendency for the behavior could be inheritable (Baldridge 2001). Treatments OCD is one of the most difficult disorders to treat. Treatments usually fall into four categories: psychotherapy, behavioral therapy, drug therapy, and psychosurgery. The goal of psychotherapy in treating OCD is to find and then remove an assumed repression so that the patient can deal honestly and openly with whatever is actually feared.
It is hoped that in dealing with the fear, the compulsions that have developed to replace the fear will lessen. The most effective type of psychotherapy for obsessive-compulsive disorder is behavioral therapy. It can help by desensitizing the patient to the feared object or situation. For example, the therapist will aid the patient in replacing the symptoms of the obsession or compulsion with preventive or replacement actions, such as a non vocal, internal shout of “stop! ” when obsessive thoughts enter the mind or the action of snapping a rubber band on the wrist.
Behavioral therapy may also help by gradually lengthening the time between the stimulus and response. For example, a patient may hold dirt and then gradually lengthen the amount of time after which he or she will wash his or her hands. While behavioral treatment can help to control OCD, it does not “cure” the disorder. Drugs used to treat OCD include antidepressants, tricyclic, monoamine oxidase inhibitors (MAOIs), LDS, and tryptophan. Antidepressants help by reducing depression by correcting the serotonin abnormality in the brain, which may decrease the need for compulsive behavior.
MAOIs may help OCD associated with panic attacks, phobias, and severe anxiety. With drug therapy, it should be noted that when the drugs are stopped, the patient often returns to the obsessive-compulsive behavior. Psychosurgery to reduce OCD is a last resort. The patient would undergo a lobotomy in which the frontal cortex would be separated from the lower brain area in an 8-centimeter square area. A combination of behavioral therapy, psychotherapy and drug therapy is recommended. General Research Behavioral treatments are new ways to deal with the disorder.
For example, someone with an obsession about germs might be asked to practice handling dirt and then not washing his hands for increasing lengths of time. With repeated exposure to the anxiety-provoking object or situation without performing the compulsion, usually the anxiety lessens, and the compulsion weakens its hold. Obsessions can fall into one of five categories: 1. Obsessive doubts, which are persistent doubts that a task has been completed. 2. Obsessive thinking, which is an almost infinite chain of thought, targeting future events.
Obsessive impulses, which are very strong urges to perform certain actions, whether they be trivial or serious, that would likely be harmful to the obsessive person or someone else and that are socially unacceptable. 4. Obsessive fears, which are thoughts that the person has lost control and will act in some way that will cause public embarrassment. 5. Obsessive images, which are continued visual pictures of either a real or an imagined event. (DSM IV-TR, 300. 3) Compulsions on the other hand are repeated, ritualized behaviors.
For example, fearing one has forgotten to turn off an appliance, such as a stove, is a common obsession. It is likely to be accompanied by a compulsion to check repeatedly, perhaps hundreds of times each day, perhaps to see if the appliance has been turned off. Compulsions are repetitive behaviors, the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. In most cases, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation.
For example, those with obsessions about being contaminated may reduce their mental distress by washing their hands until their skin is raw. There is difference between OCD and obsessive-compulsive personality disorder (OCPD). A personality disorder is, on the one hand, a type of mental illness characterized by serious and persistent distortions in the total personality. Every perception, attitude, feeling and behavior is affected. OCD, on the other hand, is an anxiety disorder. Like other anxiety disorders, fear is at its root—fear of a hot appliance burning down the house, for example, or fear of the body being contaminated by germs.
The fear produces an anxiety which can only be alleviated by a ritual, or compulsion, which will reduce the fear. Conclusion— Evaluation of Case In conclusion, Adrian Monk has Obsessive-Compulsive Disorder. He satisfies the following OCD patterns of behavior: 1. Washer, because he is afraid of contamination; 2. Checker, because Mr. Monk repeatedly checks if the door is locked, or whether the oven is turned off. Mr. Monk checks everything a dozen time just to make sure. For example, he checks his oven if it is closed everyday at least twelve times; 3.
Arranger, because he always arranges his utensils based on size and shape and his books based on color. He cannot function in a messy room or disorganized room. In addition, Mr. Monk has other phobias, such as fear of blood and fear of the woods. He is terrified of germs, milk, heights, and spiders. Mr. Monk has a rule that everything he has must come as a multiple of ten. When he buys milk, he gets 10 bottles even though he lives alone and the milk will expire before he has time to drink it all. Monk’s symptoms may improve with therapy, but his OCD will not completely resolve.