Adrian is a 51 year old widowed male with no children. Adrian shows no signs of physical ailments or other health problems. He does not have a history of drug or alcohol abuse. He presently works for the San Francisco Police Department as a consultant in homicide cases. Adrian obsesses over high levels of order and neatness and, therefore, has trouble functioning in the outside world. He also self-reports an extensive list of phobias. These symptoms were evident in childhood, but seem to have been exacerbated by the death of his wife. His goals are to extinguish the many phobias he suffers from and to experience some level of happiness. Adrian’s social circle consists of a few co-workers who are familiar with his condition.
According to Adrian, his parents were highly strict and very over-protective when he was a child. Adrian’s mother has been deceased since 1994. His father abandoned the family when Adrian was 8 years old, and they have only recently begun communicating again. Mental history of the father and mother are unknown. Adrian’s brother, Ambrose, suffers from agoraphobia. Ambrose has little social contact and fears leaving his home. Relationships with both his father and brother are strained, but otherwise healthy. No other family mental illness is known.
Though not a family member, an important person in Adrian’s life is his assistant. This person assists Adrian in his professional life as well as his personal life. Adrian has had two consecutive assistants that have filled this role for him. This assistant is aware of Adrian’s many phobias and does her best to help him avoid stressful situations. For example, she is responsible for always having anti-bacterial hand wipes available to “protect” Adrian from the germs he fears.
Description of the Problem
The greatest catalyst of Monk’s behaviors seems to be the tragic death of his wife, Trudy, who was murdered in a car bombing. Adrian was previously employed by the SFPD as a homicide detective but received a psychiatric discharge after the murder of his wife. Following his wife’s death, Adrian retreated to his home and refused to leave for three years. With the help of his nurse/assistant, he has reluctantly entered out into the world again, but still suffers from extreme obsessions, compulsions, and fears. Adrian has been unable to solve his wife’s homicide, and this causes great emotional distress to him. He often re-visits and obsesses over the case.
Adrian self-reports that he has 312 phobias and continues to accumulate more as time goes on. These phobias range from common fears such as heights or germs to unordinary fears such as, milk or mushrooms. Adrian also suffers from phobias of dentists, sharp objects, vomiting, ladybugs, glaciers, death, snakes, crowds, fear and small spaces. These fears prohibit him from completing everyday tasks such as driving, shopping, and social interaction.
Adrian’s work as a consultant for the SFPD requires him to visit crime scenes and evaluate evidence. His photographic memory is especially helpful in his line of work. However, his anxiety often prevents him from being able to use his talents. For example, he arrived at a crime scene that had a burnt out bulb in a chandelier and was unable to work until the bulb had been changed. In another instance, he was unable to work because a police officer’s zipper was undone. Adrian is very intent on every aspect of his life being orderly, neat, and clean. He has a habit of cleaning household cleaning appliances, such as vacuums. Balance and symmetry are also important. While working undercover at a bank, he added his own money to every deposit so that the amounts would be whole dollars. He also declined to see a therapist with an amputated arm because he could not get over the asymmetry.
Adrian keeps a meticulous home, with everything in order at all times. He is obsessed with cleaning and cleaning products. He has established certain menus and ways of eating that he also finds organized and acceptable. For example, he will only drink a certain kind of water and cuts his pancakes into squares because he prefers the symmetry. If travel is absolutely necessary, he goes to extreme lengths to pack. Everything must be kept in sealed plastic bags and he will often pack brand new, individually wrapped bedding so he does not have to use something that someone else has used.
The main diagnosis for Mr. Monk appears to be Obsessive Compulsive Disorder (300.3). This disorder is classified in the anxiety disorders. DMS criteria require that either obsessions or compulsions must be present in order to qualify for the disorder. Both do not have to be present. Adrian appears to have both obsessions and compulsions. To qualify for this disorder, the client must exhibit uncontrolled concern about specific ideas and feel compelled to repeat particular acts of series of acts. Adrian’s concern over harmless objects, such as milk, and his compulsion to touch things, such as poles, makes him a candidate for Obsessive Compulsive Disorder.
Other DSM criteria include:
The person has recognized that the obsessions or compulsions are excessive or unreasonable
If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it.
The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.
The disturbance s not due to the direct physiological effects of a substance or general medical condition.
Adrian fits this criterion as well. He is intelligent and sees that his behaviors are unreasonable, but is comforted by them anyway. His grooming and cleaning habits often take excessive amounts of time and go beyond what would reasonably be considered clean. He has no other known physical or mental problems that would cause his behavior. There is no history of substance abuse.
Associated features of OCD that are present in Adrian’s behavior are avoidance of situations where the objects of obsessions are present, frequent doctor visits, and feelings of guilt/responsibility. Adrian also exhibits the associated features of compulsive acts in order to alleviate anxiety, excessive cleansing or grooming practices, and extreme need for symmetrical aligning of objects.
Accuracy of Portrayal
I think the portrayal of Adrian Monk is an accurate description of Obsessive Compulsive Disorder. Someone watching this series would be able to learn about the irrational fears and the difficulties that Adrian has in overcoming them despite how irrational they are. They would be able to see how his behaviors prohibit him from functioning at an optimal level. Another positive aspect of the show is that it shows Adrian as someone with a mental illness, but he is not vilified or seen as inferior. I think this helps promote the idea that having mental illness is not shameful. One possible problem with the show is how his behaviors are usually seen as quirky but still fuional. For someone suffering from OCD in real life, the consequences can be much more detrimental and debilitating. Also, although he is presented as a gloomy character, real OCD can lead to severe depression in the affected individual. Also, he seems to have more phobias than compulsions. Aside from touching poles, he does not exhibit the repetitive behaviors associated with OCD.
Treatment for Adrian could include a prescription for an SSRI medication in order to increase his serotonin production. This could aid in the reduction of depression symptoms, anxiety symptoms, and obsessive-compulsive symptoms. In addition to medication, intense behavioral therapy, specifically exposure therapy with response prevention, is also recommended. This would involve exposing Adrian to the things he fears most (whenever practical and ethical) and compelling him to experience his anxiety until it comes down to a bearable or normal level. In Adrian’s case, however, this would be very time-consuming due to the number of phobias he possesses. Due to Adrian’s difficulty in establishing interpersonal relationships following his wife’s death, grief counseling may also be indicated. Also, his assistant could be included in much of the therapy so that she could be reinforcing appropriate behaviors in his daily life.