The Anomaly of Contemporary Psychopathological Double-Binds
A Case Study
The following excerpts are from Dr. Andre Nowzick’s most recent work in the field of psychology.
Considered by his peers to be his most substantial work to date, Dr. Nowzick presents a case study illustrating the life of Peace Corps Volunteer Miguel Arturo Garcia in The Anomaly of Contemporary Psychopathological Double-Binds: A Case Study. Dr. Nowzick’s exploration into the mind of his most unique patient grants us a look into what it means to be simultaneously diagnosed as suffering from panic disorders with agoraphobia and crippling histrionic personality disorder ; resulting in what experts now refer to as a psychopathological double-bind. The observations obtained are complex and contradictory, and not easily explained in terms of exclusively quantitative perspectives on behavioral change and cognitive-behavioral models of any panic disorders known to the common man.
Please be warned of super-duper complex terminology as this was written by true genius. If at any point there is doubt in the credibility of Dr. Nowzick’s research, simply recognize it is a consequence of the inability to comprehend its multifaceted vernacular. In other words, you are dumb and the author is right. No question.
After thirty-seven years’ experience working with extreme cases of anxiety disorders found in Peace Corps volunteers, I’ve never come acrost a subject quite like Miguel Arturo Garcia. Mr. Garcia’s situation is the most interesting vector of cultural polarity: his illness being situated between two elements of contemporary culture, one being romantic and virtuous, the other vicious and tragic. Even after spending three months with my last patient, George, who was situated in the Bukuvu region of Africa and who endures a psychosis in which the patient has delusions of being a wild animal , I’ve never quite had an opportunity to observe a condition as parapsychological as Miguel’s. Yes, he’s of more unsound mind than real life Tarzan.
Having never before suffered any acute onset of somnambulism, comorbidities, spontaneous daytime panic attacks, definitive self-defeating behavior, dramatic emotionality, childlike dependency, sphenopalatine ganglioneuralgia hypersensitivity , transient diaphragmatic spasms , nocturnal enuresis, orthostatic hypotensions, or constitutional vulnerability to dysregulation of brainstem alerting systems, Miguel’s spontaneous condition arose several days after completing his pre-service training. It seems the only concerning medical situations Miguel Garcia suffered from before service were a brief period in which he couldn’t hear from his left ear after inserting a cotton Q-tip too far when he was seventeen and his onychocryptosis .
For the most part, Miguel has led a normal life up until the point of arrival in his site of Monte Plata, Monte Plata. Miguel is a 6’2’’, 235 lbs. , 24 year old male of Mexican descent. Residing in Aurora, Illinois for the majority of his existence, he describes his inhabitation as a Chicago local because, “It’s just easier, OK?” One’s initial impression of him is that of a rather charming, outgoing, and entertaining person who is often flirtatious and places a great deal of emphasis on his joke telling predilection. A fellow volunteer from his cohort described him as, “…Ok, I guess. His weird obsession with defending the WWE as real entertainment kinda freaks me out sometimes, but besides that he’s a chill guy.” Considering he has an impressive 1,300 friends on Facebook, I would believe Miguel used to be quite popularious among his peers.
Unfortunately, everything is not well in paradise. Recent activity has members of his community concerned about his well-being. Peace Corps medical staff contracted my help when they found spikes in electro-dermal and heart rate measures of autonomic activation. I later found an abnormal combination of criteria for agoraphobia with panic attacks and symptoms of histrionic personality disorder. Striking differences in Miguel’s lab results showed higher tonic levels of skin conductance  and heart rate elevations after a test situation outside the laboratory. My research in this paper, which I wrote and which I researched myself, describes reactivity to various types of stimuli, recovery, habituation, and unprompted variability. Thus, introducing quite possibly my most sententious work to date.
 Patient #420: Simply referred to as George for anonymity’s sake. My last book describes George as suffering from depression that deteriorated over a seventeen month period into a frank psychosis at which he imagined himself a gorilla. George is a rare case of clinical lycanthropy that resulted from an immaculate consummate integration process gone wrong within his community in an African jungle. A documentary on this research can be found here for the lexiconically challenged.
 Previously recognized as brain freeze.
 An impressive track record considering he’s been in a total of two physical altercations in his lifetime. Neither of which he truly won nor lost.
 A disgustingly prominent ingrown pinky toenail. Sensitive to his foot’s appearance, Miguel refuses to remove his socks while wearing sandals in public.
 With a BMI of 27 kg/m² he is considered overweight, to which he responds with: “Nah, I’m just the right amount of thicc.”
 He’s unusually tan now.
Symptomatology began five days after arriving to site in Monte Plata when Miguel inaugurated a pathological inability to leave his room. Members of his coop and host family concerned themselves with Miguel’s situation after he was spending days of upwards to 18 hours in bed in what was described as a turbulent vegetative state. I began my prospective experimentation with a series of interviews and observations:
Dr. N: Miguel, why do you feel you stay locked in your room for so long when at home in site?
Miguel: Dr. Nowzick… is that Japanese?
Dr. N: No, answer the questions please.
Miguel: That must have sucked during high school, to have a name like Nowzick.
Dr. N: …
Miguel: If I was there I would have been like, “To the principal’s office, Mr. No Dick!”
Dr. N: Forget about my last name. From now on call me Andre instead.
Miguel: Ok, Dr. Dre. That rhymes. Look dude, I don’t really know what to tell you. Going outside really sucks and I hate it. I can’t so much as step off my front porch before I’m undergoing drenching sweats and instantly getting feelings of inadequacy. I just get so tired all the time and on top of that it seems like everybody is always staring and watching my every move. Sometimes I even feel dizzy for no reason and strangely enough I lose sight in my left eye. Like, why? Fuck that, I rather stay in bed where it’s chill.
Dr. N: Most volunteers feel this way when they first arrive to site. Don’t you think it’s a bit excessive to stay in bed for hours at a time?
Miguel: Have you ever watched Law and Order dude? That shit is long! I start off like, ‘Ok I’m gonna watch some Law and Order today, but only one episode!’ Next thing I know I’m four episodes deep and my morning is over! At that point, I might as well just keep watching until I finish the series. Plus, its not like I have anybody to see.
Dr N: What about your friends?
Miguel: My friends are a bunch of old dudes that play dominoes and talk about the weather all day. They’re not even cool. I get yelled at for the dumbest shit like not being able to shuffle right. Hanging out with them only gives me anxiety. One time I could have swore my partner was force choking me after I ruined his chances at a capicua. He was like, staring at me really hard and I couldn’t breathe. Dude was a brujo or something.
Dr. N: And what do you do for food? Or the need to use the bathroom?
Miguel: Breh, I barely eat here. I always feel sick, and the only time I ever really need to use the toilet is when I have explosive diarrhea. Otherwise I’m always constipated and what I feel might be a big duke is really just a fart. Why risk it ya’know? Besides, if I ever really have to pee I just stand on my bed and do it out my window. Its pretty refreshing.
Dr. N: Are you referring to embracing the outside world through your window as a refreshing experience?
Miguel: What? I don’t know man, but the wind on my balls feels good. I told you, I just hate leaving my room.
Dr. N: Noted.
Progress after Miguel’s three month in-service training (IST) continued to deteriorate. Miguel quickly developed dysthymic behavior with a chronic volatile low mood and low self-confidence. “When we first met, he seemed to radiate enjoyment of life, especially when discussing the evolution of R. Kelly’s musical career,” mentioned another fellow volunteer of cohort 17–01. During my later sessions with Miguel, he would egregiously complain of various issues like having to un-tuck his mosquitero to turn the light on, going to the super market when they run out of his favorite snack , drinking when his bottled water was too warm, not getting his preferred seat on the guagua , sitting through TV commercials that last longer than he’d like, or blowing through his stipend money too quickly .
“When we first met, he seemed to radiate enjoyment of life…”
Considering his reason for joining the Peace Corps , I found his stories designed to elicit unnecessary sympathy and compassion. An exaggeration, if you will. Further questioning and observation revealed a pernicious internal struggle materializing within him:
Dr. N: How do you feel about your service now that your 3 month IST is over?
Miguel: “Dr. Dre, nobody in my site knows me! The few people that do, don’t understand me. I’ve got all this knowledge to give them, but I’m never allowed the opportunity to show it. I’m really fucking up here.”
Dr. N: Maybe you could fix that by visiting some members of your community more often?
Miguel: BRO, I HATE GOING OUTSIDE!
Tensions at home with his host family only worsened his condition. Miguel would say, “I don’t understand what my host mom wants from me! All I want to do is please her, but that’s as achievable as getting Drake and Meek Mills on the same track again.” Although severe, the sentiment Miguel expressed is not entirely uncommon within other Dominican Republic volunteers. The complicated relationship between resident Peace Corps Volunteer and host mother can be referred to as the Doña Satisfaction Paradox.
Doña Satisfaction Paradoxes (DSPs) are a series of scenarios that are self-contradictory and at times absurd, but in reality express possible truth. A DSP is summarized using the following six, commonly shouted phrases:
1. Necesitas comer más! (Eat more)
2. Tu comes mucho, no comas tanto! (You eat too much. Eat less)
3. Sal de la casa más! (Leave the house more often)
4. Tu sales mucho! (You leave too much)
5. Tienes que dormir más! (You need more sleep)
6. Tu duermes demasiado! (You sleep too much)
Miguel concluded our interview on the subject with: “You don’t understand, I need these people to like me. Otherwise, what am I even doing?”
A troubling dilemma indeed.
 Queso Blanco flacored Lay’s.
 Right behind the driver’s seat for easy access to the door.
 As he is easily convinced to spend money on trips with fellow volunteers.
 To ignite and nurture diverse, ethical, cultural worldliness that advances the human condition.
My initial diagnosis for Miguel Garcia was a classic case of Axis I Agoraphobia with mild panic disorder. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), Agoraphobia (DSM-V 300.22, F40.00) is an anxiety disorder characterized by a fear of certain environments and situations. Best known as a fear of open spaces, agoraphobia is, in fact a much broader condition, and can apply to individuals who struggle with scenarios such as leaving the house, standing in line, or using public transportation. Observations with Miguel demonstrated symptoms parallel to those found in agoraphobia patients, such as:
- Becoming isolated or detached
- Feeling alone
- Being afraid of losing control in public
- Avoiding places of dense populations
- Refusing to leave the house
- Heightened sense of paranoia in public
- Racing heart/palpitations
- Excessive sweating
- Trouble breathing or a feeling of choking
- Chest pain or pressure
- Lightheadedness or dizziness
- Upset stomach pains or diarrhea
- Excessive flatulence
- Fear of dying
Months of further perceptive surveillance on the subject revealed contradictory and complex complications in Miguel’s fragile state of mind: a pervasive pattern of excessive emotionality and attention seeking. Hard to believe at first, I couldn’t negate the presence of the diagnostic criteria for Axis II Histrionic Personality Disorder (DSM V 301.50). It wasn’t enough for the man to suffer from agoraphobia, but the effects of HPD were the icing on top of the fluffy cake. Miguel thusly indicated five (or more) of the following symptoms for HPD:
- Is uncomfortable in situations in which he is not the center of attention
- Interaction with others is often characterized by inappropriate sexually related behavior or allusions to sexual references
- Displays of rapidly shifting and shallow expression of emotions
- Consistently using physical appearance to draw attention to self
- Has a style of speech that is excessively impressionistic and lacking in detail
- Shows of self-dramatization, theatrically, and exaggerated expression of emotion
- Is suggestible, i.e., easily influenced by others or different circumstances
- Considers relationships to be more intimate than they actually are
Whether the problem at hand is a true personal psychopathology, or merely marginalization by a political definition of ‘psychopathology’, nevertheless, we have ourselves a double-bind. Webster’s dictionary defines a double-bind as a psychological predicament in which a person receives from a single source of conflicting messages that allow no appropriate response to be made. Miguel’s HPD obligates him to reach out into the market place to satisfy his overwhelming compulsion to befriend the members of his community, but such is his fear of the very same marketplace that he cannot under any circumstance, leave home.
A situation of this magnitude is unheard of in the field of psychology to this point. The time spent with Miguel has been both a blessing and a curse. On one hand, I’ve had the opportunity to expand the known boundaries of psychology into a new era of discovery within the field. On the other, I painfully sympathize with the insufferable condition Miguel Garcia finds himself in. One thing is certain: our work together has only just begun. May the psychology Gods sway the odds in our favor.
May the psychology Gods sway the odds in our favor.
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About the Author
Andre Nowzick, PhD
Dr. Andre Nowzick is considered to be the Peace Corps’ leading expert in cognitive-behavioral models of anxiety disorders whose work has significantly contributed to theories concerning psychological problems as a set of exposures to diverse socio-cultural practices found from returning and current Peace Corps Volunteers’ service.
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