Clinical Assessment: Holden Caulfield

My friend Steve who teaches English in a Pittsburgh High School asked me several years ago to read Catcher in the Rye from a clinical perspective. I presented the following assessment to his students to give them a psychological profile of Holden Caufield's character. The process was fascinating and increased my appreciation for J. D. Sallinger's classic novel. Of course this is a highly speculative assessment and I hope it provokes some debate.

Psychosocial History

Family:
Patient is a 17 year old male, the 2nd of four children from a wealthy family in NYC. His younger brother Allie died at the age of 10 on July 18, 1946 from Leukemia when Holden was age 13.  An older brother named DB is a screenwriter and lives in Hollywood. The younger sister Pheobe is now age 10 and lives at home with both parents in an apartment in NYC. Father is a successful corporate attorney whom Holden describes as "touchy" and his mother is a homemaker whom he describes as "nervous" and "hysterical."


Substance Use:
Holden admits to being a heavy smoker. Prior to intake, he had an episode where he became severely intoxicated from drinking scotch. He admits to drinking whenever he can convince a waiter to serve him even though he is underage. "I can drink all night and not even show it," he says.


Socio-Economic:
Holden lives with a wealthy family in NYC and has attended several of the most exclusive boarding schools in the country, most recently, Prencey Prep in Augerstown, PA. Expelled in December due to poor academic performance, he was failing 4 subjects with the exception of English in which he excels. Holden was also expelled from three prior boarding schools for similar reasons, saying, "I didn't exactly flunk out or anything. I just quit, sort of." Prior to his most recent expulsion, he described an incident where he lost the fencing team's equipment, resulting in significant social ostracization. This may have triggered traumatic memories about an incident that occurred when he attended Elkton Hills, when a fellow student committed suicide after being shunned by classmates. Holden was a witness to this young man's death.

Concerning his family's wealth in comparison to others, Holden states that he feels guilty.

Tending to view others with suspicion and disdain, Holden says most people are "phonies." He often has a hard time seeing the good in others, and that he has a low opinion of himself at times saying, "I'm a moron."

Prior to leaving school, he reports starting a physical fight with his roommate over a girl. The roommate gave Holden a bit of a thrashing.

As for his religious beliefs, he describes himself as a "sort of atheist."


Psychiatric:
Holden describes several incidents in the past month that appear to be instances of derealization. He reports, "I felt like I was sort of disappearing."

He says he often acts as if he's 13 years old, about the age when his younger brother Allie died, and imagines talking with him, idealizing this brother as “50 times as intelligent” as himself and the “nicest member of the family.” He considers himself the "only dumb one in the family,” and idealizes all of his siblings. Holden had an emotional breakdown the night his brother died, breaking all the windows in the garage, resulting in a brief hospital stay to treat his wounds. His parents wanted him to receive psychoanalysis at that time but did not follow through. Thinking about his brother's baseball mitt gives Holden pleasure and he wrote a composition about it for his roommate. However, the roommate rejected the paper and Holden tore it up out of anger.

Because "everything always stayed right where it was," Holden likes museums, suggesting a possible struggle with accepting the significant changes in his life. "Certain things they should stay the way they are,” he says. “You ought to be about to stick them in one of those big glass cases and just leave them alone."

Saying he doesn't see much point to the way most people live their lives, Holden shows signs of low motivation and despair. He often fantasizes about running away to a place where no one knows him, where he won't have to interact with people. Ironically, he seems very interested in engaging people in conversation and can become quite animated, even fixated on certain ideas. Friends and family often say he speaks too loudly, that he says the same things over and over, and that he has a very negative outlook on life. He continually says things are very depressing and terrible.

He reports decreased appetite.

Often lying to relieve boredom, Holden says, "once I get started, I can go on for hours if I feel like it." He admits to being very sarcastic. It’s difficult for him to find pleasure in activities saying "almost every time somebody gives me a present, it ends up making me sad." To him, Christmas "didn't seem like anything was coming." He admits to frequent crying spells over the past several weeks. He reports that he never cares too much when he loses something and says his younger sister told him "you don't like anything." When pressed by her to think of something he liked, he talked about the classmate at Elkton Hills who committed suicide and his deceased brother Allie.

Occasionally engaging in compulsive actions, he calls it a nervous habit when he turns the cold water on and off repeatedly when in the bathroom. However, this may be more indicative of restlessness and impulsivity. He admits to engaging in attention-getting behavior saying, "I'm an exhibitionist,” reporting that he will often do things "all of a sudden -- for no good reason" when the mood strikes him. He admits to lighting matches as another nervous habit.

Obsessed about certain ideas or people, he says this often annoys others. He seems particularly obsessed about a former girlfriend named Jane Gallagher, that his roommate dating her made him so nervous he nearly went crazy. Concerning his anxieties, he says, "when I really worry about something, I don't just fool around. I even have to go to the bathroom when I worry about something. Only I don't go. I'm too worried to go. I don't want to interrupt my worrying to go." He says he could hardly keep his voice from shaking when speaking with his roommate about Jane.

Incidentally, Jane was the only other person he ever showed his brother Allie's baseball mitt too.

He admits to suicidal thoughts saying, "I felt so lonesome, all of a sudden. I almost wished I was dead" or other times wanting to commit suicide. He denies any serious intent or plans.

A week prior to intake, and prior to returning home from Pencey, Holden left school without telling anyone and spent several days in NYC. During this time he rarely slept, did a lot of drinking and engaged in potentially self-destructive behavior. For example, he hired a prostitute though he did not follow through on engaging in high risk sexual behavior. However, he was nearly assaulted by the prostitute’s employer over a dispute about payment.

He says he has trouble concentrating when depressed, saying he talks "sort of loudly" to his deceased brother Allie when he gets really depressed. He says he hates everything, "living in New York and all. Taxicabs, and Madison Avenue buses, with the drivers and all always yelling at you..." Others tell him he "shouts" when he complains about these things though this seems to puzzle him. It appears that Holden shows signs of significant irritability and possible mood instability, perhaps the beginnings of mania. He says peers complain that he jumps from one subject to the next. A college friend recently accused him of being fixated on immature and inane thoughts. This same friend told Holden to keep his voice down, suggesting pressured speech, and recommended Holden see a psychoanalyst to deal with the patterns of his mind.



Medical:
Holden is 6' 2" and prematurely grey on the right side of his head suggesting exposure to significant stressors in his life, most notably the death of his younger brother and the suicide of a classmate. He grew 6 1/2 inches in the past year and nearly contracted TB. Other than this, he appears to be healthy. Prior to intake he describes symptoms of insomnia and panic like symptoms, diarrhea and nearly passing out.



Strengths/Weaknesses

Strengths:
Capable of Independence, Expressive/Articulate, Intelligent, Physically Healthy, Supportive Family

Weaknesses:
Defensive, Distrustful, Impulsive, Not Motivated to Change, Poor Judgment, Very Narrow Interests

Diagnosis:

Axis I

296.20    Major Depressive Disorder, Single Episode, Unspecified
V62.82   Bereavement
300.02    Generalized Anxiety Disorder
296.90    Mood Disorder NOS
314.9      Attention Deficit/Hyperactivity Disorder NOS
313.81    Oppositional Defiant Disorder
V62.3     Academic Problem

Axis II

301.4    Obsessive-Compulsive Personality Disorder

Axis III

No diagnosis

Axis IV
Educational Deficit: School Suspension, Family Conflict: Death of Loved One, Relationship Conflict: Peer Group Conflict


Axis V
Global Assessment of Functioning (GAF) Current:     50    Prior: 60

Presenting Problems:

Primary: 

Depression

Secondary: 

Anxiety
Attention Deficit/Hyperactivity Disorder (ADHD)
Academic Underachievement
Low Self-Esteem
Mania/Hypomania
Posttraumatic Stress Disorder (PTSD)
Suicidal Ideation/Attempt
Grief/Loss Unresolved
Chemical Dependence

Primary Treatment Provider:  

Charles E. Cote, LCSW