Case Study: Possible Bipolar Diagnosis: Miranda

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SAMPLE EXCERPT:

[. . .] "Just because I'm an Asian girl they expect me to be smarter than everyone else. Well, I'm not smart, I can't help it."

To evaluate the mental health of Miranda requires several cultural factors to be taken into consideration when contextualizing her situation. Given their first-generation immigrant status, Miranda's parents may be more likely to interpret their daughter's behavior as disobedience and defiance rather than a mental health issue, given that viewing such actions through a psychoanalytic lens is not part of their tradition. However, the fact that both Miranda's mother and brother have shown signs of mental illness in the past indicates that Miranda's issues may have a biological basis. Her parents are not receptive to the idea of treating their daughter with medications for a psychological condition despite the fact that most mental health practitioners concur that some form of pharmaceutical treatment is necessary in addressing the needs of patients exhibiting bipolarity, which is the diagnosis suggested by Miranda's pediatrician (Duffy et al. 1998). Should the evaluative process indeed result in a bipolar diagnosis, ensuring that Miranda receives appropriate psychopharmacological intervention may prove challenging, given her parents are even somewhat reluctant to allow that there may be a need for therapeutic counseling. But it is also possible that Miranda's symptoms may be linked to using drugs although Miranda has never admitted to using any form of illegal substance or alcohol.

Because of Miranda's age, there are concerns that normal adolescent rebellion may be interpreted as a mental illness. It is not unusual for adolescents to experience a search for identity at Miranda's age within American culture. Because Miranda's parents grew up in China, they may be uncomfortable with the extreme individualism tolerated by American culture. In America it is considered normal for teens to engage in a certain amount of limit-testing that may not be acceptable in other cultures. Additionally, mental illness as a whole is more stigmatized in Chinese culture, which may make Miranda's parents more reluctant to acknowledge that their daughter may have a mental health issue and are more eager to view her issues as self-willed (Alonso et al. 2008, cited by Unite for Sight website).

Ethical concerns which naturally arise when treating Miranda are attached to her age. Treating Miranda from a therapist's perspective requires a certain level of trust and confidentiality that might not be seen as acceptable when viewed through her parents' Chinese-American worldview which does not accept a rigid and individualistic division between parent and child. According to the 2014 ACA Code of Ethics as well as being culturally sensitive to the family as a whole and not imposing individualistic dictates upon the parents in terms of precisely how they should raise their child, even when treating minors "counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf" (A2C & A2D). The need for effective counseling of Miranda and ensuring honesty must be balanced out with her parents' rights and cultural worldview. For example, if Miranda were to be found in engaging in risky behavior, ideally Miranda would be persuaded to discuss this with her parents vs. The therapist automatically 'telling' on Miranda (unless Miranda appeared to be at considerable physical risk). Similarly, Miranda's need for treatment should be acknowledged by the therapist. If making a recommendation for a particular medication for Miranda, the therapist should be prepared to answer her parents' concerns and explain why bipolarity (if such a diagnosis is warranted) requires more than 'discipline' to quell Miranda's behaviors.

References

2014 ACA Code of Ethics. (2014). ACA. Retrieved from:

http://www.counseling.org/resources/aca-code-of-ethics.pdf

Alonso, J. (et al. 2008). Association of perceived stigma and mood and anxiety disorders: Results

from the World Mental Health Surveys. Acta Psychiatr Scand, 118: 305-314. Excerpted

at Unite for Sight website at http://www.uniteforsight.org/mental-health/module7#_ftn13

DSM: Mood disorders. (2014). National Institute of Mental Health. Retrieved from:

http://www.ncbi.nlm.nih.gov/books/NBK64063/

Duffy, A., Martin, A., Kutcher, S., Fusee, C., & Grof, P. (1998). Psychiatric symptoms and syndromes among adolescent children of parents with lithium-responsive or lithium-nonresponsive bipolar disorder. The American Journal of Psychiatry, 155(3), 431-3. [END OF PREVIEW]

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Possible Bipolar Diagnosis: Miranda.  (2014, May 26).  Retrieved April 22, 2019, from https://www.essaytown.com/subjects/paper/possible-bipolar-diagnosis-case-study/4201893

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"Possible Bipolar Diagnosis: Miranda."  26 May 2014.  Web.  22 April 2019. <https://www.essaytown.com/subjects/paper/possible-bipolar-diagnosis-case-study/4201893>.

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"Possible Bipolar Diagnosis: Miranda."  Essaytown.com.  May 26, 2014.  Accessed April 22, 2019.
https://www.essaytown.com/subjects/paper/possible-bipolar-diagnosis-case-study/4201893.