A Case Report of Major Depressive Disorder

Movie Name: Dear Zindagi

Character (Patient): Kaira

Submitted by:

 Javeria Noor 030  Umer Rehman 036

 Zarish Javed 053  Ajer Atiq 004

 Eisha Isar 019

Submitted to: Sir Aqeel

BS PSYCHOLOGY 6A
CASE REPORT

I. Summary
Kaira is a 25-year-old woman who is very ambitious and career-driven. She was a
budding cinematographer who wished to work on and direct her own films in an
independent manner. She came into therapy with the complaint of sleeplessness.
Kaira’s problem of sleep disturbance started when she had to make a rather tough
decision about working on her dream project that involved the person that she was
romantically inclined towards but was no longer on good terms with, or letting go of
this project so she would not have to interact with him.
Along with sleeplessness, she has been experiencing anger outbursts, irritability,
frustration, feelings of sadness and hopelessness as well as difficulty in making
important decisions. These symptoms have been appearing for a couple of days now,
more precisely ever since she moved from Mumbai to Goa.
On the basis of DSM-V criteria, the client was diagnosed with major depressive
disorder with moderate level of severity.

II. Demographic details:

 Name: Kaira

 Gender: Female

 Age:25 years

 Education: Course in cinematography or Film Study

 Occupation: Cinematographer

 Marital status: Single (three breakups)

 No of siblings:Two

 Birth order:First born

 Head of family: Father

 Father occupation: Businessman

 Mother occupation: House wife

 Religion: Hindu

 Residence: Mumbai and Goa

 Source of referral: Her friend who was “gay” and taking sessions by his
psychologist

III. Presenting Complaints

Clients’s verbatim:
I have not been able to sleep for several weeks at this point. That is the main reason
why I have come here today. I have tried medication among other options, but nothing
has worked so far. I have recently moved from Mumbai to Goa which I understand is
a major change, however, that is not a problem for me because I like to move as
opposed to being in one place, I enjoy traveling a lot. My only concern is this sleeping
problem.
If you must know, I am romantically inclined towards this person who I thought felt
the same way about me, however, I recently found out that he got engaged to someone
else. My main problem now is my profession and the fact that a dream project of mine
is linked with both him and his fiancée, which further complicates the situation. I am
worried because I am unable to figure out how to deal with the situation. There are
times when I feel like I should go ahead with the project as it would be unwise to miss
out on such a great opportunity. However, at other times I feel like I should step away
for the sake of my self-respect.

IV. Symptoms

Kaira has been experiencing the following symptoms for a while now, precisely since
the time that she moved to Goa from Mumbai:

 Sleep disturbance (insomnia)

 Anger Outbursts
 Irritability or frustration
 Recurrent feelings of hopelessness, sadness or emptiness
 Difficulty in making decisions

V. Histroy of Present Illness:

Kaira suffers from insomnia due to her dissatisfaction of life and she spends her
nights sleepless. Her heart and mind are at constant war. She have lived alone in a
cosmopolitan city and have had trouble with your landlord because she is an
unmarried woman living all by herself. The society aunties and uncles go haw when
she move around in short clothes. Her relatives keep nagging her with rishtas. They
doubt her so, she have a feeling that no one in the world understands her and she is
burdened with all the problems. She feel everything goes wrong only with her! She is
guilty of being in too many relationships making her hopeless. Kaira tries to blame
others for her problems. She has a pretentious attitude and no care for what is
happening around her and/or to the ones whom she possibly cares about. Kaira also
pretends to be a humanitarian trying to pull herself together. Yet, she derives pleasure
and closure from broken relationships by barging into supermarkets and randomly
breaking pickle jars. She say “ I am too tired to express love to anyone”. That’s why
she hate couples who get mushy in public.She gets angry when anyone ask “If you're
in an unconventional profession, why don't you settle down and get a job?” Kaira's
effort a lot to act normal. She struggle of her character when she screams and is
struggling to feel normal due to society pressure.

VI. Previous Treatment:

No previous treatment has been taken.
VII. History:

 Family History and Childhood History:

Kaira's parents shift abroad to establish their business overseas. Her mother was
unable to take care of the two children, so they decided to leave Kaira in India with
her grandparents. Little Kaira starts writing letters to her mother but after learning the
truth she stops writing them. Later on, Kaira opens up and breaks down while
explaining how traumatic it was for her when she learn the truth and she still lives
with it. She concludes by saying that she fears getting rejected or abandoned.

 Academic History:
She failed in second standard because Kaira’s parents left her with her grandparents
which affected her childhood. Kaira gets afraid of abandonment because she does not
want to undergo the same situations once again.
Once, Kaira lashes out at a family get-together when the constant taunts of her
relatives and parents poke her mental peace. In the monologue, she asks her parents
and family members why it is important to have a kid when as a parent one cannot
take care of the child. It's better to end their so-called responsibility rather than
making the child go through a series of traumatic experiences, she adds.

 Social History:
She is most comfortable when with her three best friends, Fatima, Jackie and Ganju.
After his breakup with Rumi, Kaira reunites with her younger brother, Kiddo, who is
the only other person besides her best friends that she is closest to. Matters with her
family come to a head when Kaira has an outburst at a family get-together where she
confronts her parents about them abandoning her for years at her grandparents' house.
Moreover, her landlord then turns her out of her apartment because the building
association wants to rent apartments only to married couples. All this plus
dissatisfaction with her prospects at work serves as a catalyst for Kaira's shift to Goa.

 Relationship History:
She faces many problems in her relationships. She never allowed anyone for the
marriage, she left Raghu, Sid, and Rumi because she had a fear that they will leave
her.
Kaira’s cheats on her boyfriend, Sid, with a colleague, Raghu, who loves her but
whom she keeps at arm’s length. Later, she meets a musician, Rumi, and falls in love
with him, but they break up before anything serious can happen when she realizes
they may not be the right fit for each other. During therapy , Kaira meets her ex-
boyfriend Raghuvendra, who tries to understand Kaira's point of view. Kaira also tries
to explain to him what she is going through but ends up asking him to get out. Later,
she can't understand why it was difficult to tell Raghuvendra.

According to client, she develop Thanatophobia. This fear to feel safe you have to be
fearless, fear of losing someone (Thantophobia), and fear of one can leave us. She
rejected many guys and goes through mental trauma and insomnia.

 Medical history:
No past medical history.
 Pre-morbid Personality:
She is an aspiring cinematographer at the start of her career who is independent and
more competent. She tries to cope with her personal and professional lives and
maintains a balance. She wishes to direct her own films.

 Psychiatric History:
Insomnia and family pressure to find a husband drive Kaira to suffer from anxiety and
possible depression.

VIII. Assessment:
Informal Assessment

 Clinical Interview:
Kaira was assessed by clinical interview. It took 45 minutes for the session. Her
therapist of Dr Jehangir Khan, presented a glamourised version of therapy and
missed out on the value of professional boundaries which is the foundation of a
therapeutic relationship. He holds sessions on the beach while cycling with Kaira
and then on a ferry seems to provide mixed messages. While he doesn't seem
flirtatious, he seems to be definitely leading Kaira on. When Kaira talks about her
childhood, her turbulent relationship with parents, he announces his interpretation
rather than helping her process her own emotions and jumps in too quickly to tell
her that she must try and look at her parents differently. More than the therapist’s
interpretation, the client coming to see their own experience in a different light is
where therapy begins.
The most problematic part was the ending, Jehangir Khan cancels the session at
the last minute without informing Kaira, and then in the next session announces
that the following session will be their last session. It was both odd and
unprofessional that it’s not taken into consideration that a client who is struggling
with abandonment, may not be prepared for abruptly terminating her therapy
sessions or to handle future life situations. It seems as pure power could be
dangerous and in conflict with how psychotherapy operates.

 Behaviour Observation:
Kaira sat on a couch normally. She started touching things randomly and dropped a
few things. She seemed very impatient as she kept changing her seat. Kaira even tried
to leave the room because she couldn’t wait anymore. The session started as Kaira
asked for water while cracking a joke in a very serious manner. Kaira seemed
responsive to all the questions. At first, Kaira was thinking a lot before speaking and
her speech was disorganized. She didn’t maintain much eye contact and kept
repeating words. She also seemed uneasy while answering questions and touched her
face few times.

 Mental Status Examination:

In Mental Status Examination, the appearance, behaviour, attitude, mood, affect,
speech, thought content, thought process, judgement and insight of the client are
observed.
  Appearance:
Kaira, a 25-year-old female, appeared young. She seemed slim with normal height. In
the first session, she was wearing a trouser, with a casual shirt and had a little makeup
on. Her hairs were all wavy and tied with a high pony-tail. She wore glasses, nail
polish and few accessories like band, bracelets and a necklace. Kaira carried a bag
with her. In her next sessions, she was again in a casual dressing with the same
hairstyle and same accessories. She seemed to give more facial expressions in this
session. Talking about the next session, she was dressed so casually in a top with
ripped jeans. She sat too comfortably with one foot on the couch. In her ending
sessions, she dressed more properly in a semi-formal way.
 Behaviour:
Kaira couldn’t maintain long eye contacts. She showed gestures while talking and had
a good sitting posture. In one session, she was moving her foot and playing with her
lips for some time.
 Attitude:
Kaira was very responsive towards every question. At first, she seemed very impatient
but later she easily cooperated.
 Affect:
Throughout the sessions, Kaira’s affect was appropriate with respect to her speech
content. Her emotions and expressions were suitable with what she was saying.
 Mood:
Kaira reported that she couldn’t sleep and feels as if things are messed up. Due to
which, she seemed tired, restless and unhappy.
 Speech:
Kaira’s speech was of normal rate and volume. Her articulation of words was clear.
- Fluency:
The speech fluency of the client was normal. At first when she just started to speak up
about the problem, she seemed to take pauses while speaking but then it was back to
normal.
- Repetition:
Sometimes she repeated words while talking during the session.
- Comprehension:
The words spoken by Kaira were clear and well understood.
 Thought process:
Kaira’s thought process seemed to have loose association at the beginning but then
she was giving relevant answers afterwards. She seemed to pay close attention to the
questions and discussions.
 Thought Content:
Kaira was mostly talking about her sleep problem, her profession and her love life.
She was concerned that society will judge her every action.
 Cognition:
Kaira was confident and well-oriented. Her memory seemed fine as she remembered
everything about her past and present. She was quick and clear while answering to the
questions about her problems. Her cognition was fine.
 Perception:
Kaira faced no perceptual disturbances.
 Insight:
Kaira seemed open and had insight related to the problem she was facing. She was
very accepting and had good insight.
 Judgment and Problem-Solving:
Kaira’s judgment seemed well just like any other normal person. She was quick in
making conclusions of her problems as well as solving them. For example, in the
session she interpreted her dream with the help of the therapist.

IX. Clinical Therapy Sessions:

Kaira received treatment in the form of clinical therapy. She went for regular therapy
sessions with her psychologist/therapist to resolve the problematic behaviors, feelings,
thoughts and habits that were contributing towards her deteriorating mental health.
Dr Jehangir Khan is a charming clever clinical psychologist whose in-depth analysis
of dreams makes him the modern day ‘Sigmund Freud’. The theories of Sigmund
Freud relating to the ‘subconscious’ through dream analysis are cleverly illustrated
with the ‘brain doctor’ helping Kaira figure out that her suppressed childhood traumas
of abandonment maybe the underlying cause for her fear of commitment.
The therapy sessions involved unconventional techniques or aspects such as
conducting the sessions at different locations and in different scenarios such as during
a bicycle ride or at the beach, to break the monotonous cycle of sessions held at the
psychologist’s office or clinic as per normal.

X. Further Therapeutic Recommendations:

Psychodynamic or Psychoanalytic Therapy
It can be further recommended that Kaira may begin with psychodynamic or
psychoanalytic therapy. This form of therapy places a focus on the cause of
depression being unresolved conflicts from the childhood. Hence, it would be
appropriate to practice with Kaira so that she can become more aware of her full
range of emotions, including the contradictory and troubling ones, and so she can put
her feelings into a useful perspective.
This approach can help her understand how her fear of abandonment, which comes
from her experience of being abandoned as a child by her parents, is something that is
affecting her relationships as well because before she can fully commit to a
relationship, she chooses to leave or take a step back before the other person can do
so.

XI. Diagnosis:
DSM-IV-TR Diagnosis:

X 296.32 Major Depressive Episode, Recurrent Episode, Moderate, with

1 specifier anxious distress (p.194)
X V71.09 No Diagnosis
2
X 307.42 Primary Insomnia
3
X Society pressure, Toxic parenting, Relationship problems, Work Stress
4
X GAF=65(Current)
5

Dsm-5 Diagnosis:

296.22 Bipolar I Disorder, current episode manic, moderate severity, with

 anxious distress

XII. Referneces:

 https://fsharetv.co/movie/dear-zindagi-episode-1-tt5946128
 https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

 American Psychiatric Association (2013). The Diagnostic and Statistical

Mannual of Mental Disorders, (5th ed). Arlington, VA: Author.