Case Study
Katniss Everdeen
Haley Moore
Introduction
Katniss Everdeen is a married, 20-year-old female, residing in the 12th district of Panem. Everdeen is married to Peeta Mellark. Mellark is a 20-year-old male also living in district 12. Mellark has recently been diagnosed with Posttraumatic Stress Disorder and is the reason Mrs. Everdeen has agreed to therapy. Katniss is described to be in good physical health, however, is described to have ‘unstable’ mental health. Everdeen is presented today with suicidal thoughts, tendencies, and actions as well as nightmares of overwhelming memories of traumatic experiences and social isolation. Everdeen is here with Husband, Mellark.
Everdeen and spouse Mellark were the victors of the 74th annual Hunger Games, as well as participants in the QuarterQuell. During the 74th games, Everdeen witness the murder of countless friends. Including a 12-year old female tribute of district eleven. Everdeen described herself as one of the only reasons her husband Peeta Mellark made it out of the games. She vividly remembers finding him on the doorstep of death and nursing him back to health. Mellark and Everdeen became ‘star-crossed lovers’ at the beginning of the games, their feelings for one another only increased during this time of rehabilitation for Mellark. Everdeen’s first suicide attempt was at the end of the 74th games when she and Mellark where both found victors. Not willing to leave or kill her opponent and lover Peeta Mellark, Everdeen and Mellark both threatened to eat poisonous berries. Before the suicide could commence both were named victors by President Snow. She and Mellark where evaluated and seen to be of good health after the games, however, both were visually traumatized. Everdeen says she still has traumatizing nightmares and hallucinations about what occurred within the 74th games.
Everdeen recapped returning to the games again with Mellark in the QuarterQuell Everdeen was taken to district 13 by rescuers during the games. Mellark, however, was captured and taken to the capitol where Everdeen states he was “brainwashed to believe she was the Enemy”. Mellark is rescued after being tortured and brought to District 13, where Everdeen says she attempted to rekindle her relationship with her fiancé, only to be strangled by Mellark. Mellark says this is where his symptoms of PTSD are the most evident in his daily life. Everdeen was hospitalized but was deemed okay after rehabilitation. Everdeen says the nightmares of watching Rue pierced to death by an arrow, and of her now husband attempting to kill her have left her traumatized and unable to sleep at nights. The nightmares have been occurring for the past 8 months.
Everdeen does not blame Mellark for what occurred. Everdeen also witnessed the murder of her sister Primrose Everdeen on capitol grounds by a bomb. She also states that she witnessed the killing of her friend Finnik, and mass destruction -equivalent to 90% of her hometown being killed or taken prisoner.
Everdeen says she again attempted suicide at the execution of Panem’s President Snow. Everdeen was charged with killing President Alma Coin rather than Snow. Everdeen attempted to commit suicide by taking a Nightlock pill. Mellark stopped the attempt. In solitary confinement, Everdeen says she attempted suicide twice more, once by starvation and once by an overdose of Antipsychotics. Everdeen was unsuccessful all three times. She was released on Mental Insanity at the time of the crime and sent to live in the rubble of District 12 at the victors' circle. Mellark is the reason she has come to the office today. Mellark says she refuses to be around people, and will not talk about the traumatic circumstances that have occurred within the last 4-5 years. Instead sleeping for long periods of time and being in solitary confinement.
Based on the presented symptoms it seems that Everdeen has gone through very stressful and extremely traumatic experiences. Her willingness to come to therapy, however, provides a ray of hope that the problems could be worked on. Her sleeping issues, hypervigilance as well as hallucinations can all be analyzed and traced back to certain mental health disorders.
Diagnosis
Based on the symptoms presented today, the events that Everdeen has undergone, both in the Hunger Games and the Revolution have lead to what I believe to be Post Traumatic Stress Disorder [PTSD] in combination with Major Depressive Disorder [MDD].
Post Traumatic Stress Disorder is a Mental Health Disorder where individuals may experience: agitation, irritability, hostility, hypervigilance, self-destructive behavior and suicidal tendencies, or social isolation. Patients may also experience, insomnia, nightmares, emotional detachment, loss of interest or pleasure in activities, guilt, flashbacks, fear, severe anxiety and loneliness.
In Mrs. Everdeen's case her suicidal thoughts and actions, social isolation, insomnia, nightmares as well as feelings of social detachment and emotional detachment are all key symptoms of PTSD. With PTSD the individual must have had these behavioral symptoms for longer than a month, However from what Mr. Mellark, past doctors visits, and the events that she has described to me, it is my belief that these symptoms have occurred longer than the one month window.
Cause of PTSD
Based today on the symptoms and past experiences that Everdeen has encountered it makes sense as to the cause for PTSD. To be diagnosed with PTSD the patient must have met the criteria of five groups.
Trauma – Clinically speaking, traumatic events can be described as involving the direct experiencing or witnessing of actual death, threatened death, or a serious injury. Everdeen witnessed the death of multiple individuals both in and out of the arena used for the games. Everdeen has also been on the brink of death herself due to the hands of the one she should be able to trust most, Mellark. Everdeen has also described countless times when her own life has been threatened. Like many war veterans and Law Enforcement officers, Everdeen has known multiple people that she has killed. That personal relationship can add on to the amount of trauma that Everdeen has succumbed.
Nightmares/Flashbacks – While Everdeen did not describe any type of flashback, the event of re-experiencing can happen in numerous ways. Everdeen described a dissociative flashback of when she killed a fellow tribute in the 74th Hunger Games. Everdeen described hunting with Gale prior to the victors' tour, where while hunting she remembered when she killed Marvel, the tribute that killed Rue. Everdeen has also described a marked variation in her pulse and respiratory rates. Saying she would become tearful, and unable to establish what is real versus what is not.
Avoidance- For many patients and individuals after traumatic events it is typical for them to avoid reminders of the trauma. Unlike most, however, Everdeen has been found to be staying inside and away from common civilization. Mellark stating that she refuses to go out and hunt, rather staying inside laying in the dark in her room, or on the couch always away from windows.
Negative Mood, Thoughts or Actions – Trauma can negatively alter a patient's mood and thoughts. Mellark has described a change in her behavioral patterns, no longer being positive and upbeat. Everdeen’s trauma may have resulted in her persistent negative emotion as well as her constant state of fear. Everdeen’s suicidal actions also deem her negative mood and thoughts.
Arousal and Reactivity – Many patients with PTSD also mark their experiences with alterations in arousal and reactivity that may be associated with their trauma. Everdeen has talked about her increasingly irritable and angry outbursts that use to not occur. Everdeen described herself as a normal 15 year old before the games and the revelation. Saying she would mainly stay to herself and her family. Everdeen’s most recent outburst was described by her over exaggerated reaction to the finding of her sister's cat on the kitchen sink 3 weeks ago. Her sister died in a bombing at the Capital. Everdeen also explained difficulties falling asleep currently as well as when she was living in District 13.
Based on Everdeen’s presenting symptoms as well as those not presented by her but by other reports, it is of my opinion that with proper counseling as well as the use of Selective Serotonin Reuptake Inhibitors and possibly a Sleeping Prescription Everdeen can return to her life. It is my opinion that the results of the events of the past five to six years will always remain with her. However learning to cope with these feelings, working through the nightmares, and reintegrating back into society will help Everdeen’s Mental Health. Her resilience will also be helpful.
Treatment Plan
For most patients suffering from some form of PTSD, the combination of a type of therapy and treatment with medications will provide the best results. The goal for treatment with Mrs. Everdeen is to reduce her symptoms and allow for her to return to a normal life. While this may take time, Everdeen has displayed resilience and motivation and it is my belief that she will get better.
With her presented symptoms I recommend 12 one hour session with a licensed psychotherapist, preferably myself. I recommend that 6 of these sessions are Cognitive Therapy, while another 6 be Equine Therapy. Everdeen has expressed interest in nature and the outdoors, therefore Equine Therapy will allow her to lean on her passions.
I also recommend a dosage of Selective Serotonin Reuptake Inhibitors, to be taken once daily, or as needed for the symptoms of depression.
The Patient has agreed to these methods of treatment. I plan to see the patient in the office next Wednesday morning at 9 am.