Lady Macbeth is a white, Scottish lady of middle age and upper class background and social status. She is married to the Thane of Cawdor and Glamis, Lord Macbeth, and currently has no need for a job and remains a housewife. She was admitted due to the express referral of her husband, Macbeth, who insisted that she needed immediate psychoanalysis and potentially medication. I have taken the chance to interview her, on the request from her husband, so I may judge for myself the severity of the situation at hand.
After a conversation with Macbeth, it seems to be that Lady Macbeth is suffering from psychopathic tendencies and is in dire need of help. According to Macbeth, she has already committed infanticide and has plans for regicide; he recommends (with complete discretion) that she is to be locked away immediately. She may simply suffer from underlying depressive disorders but the true cause is yet to be found. The preliminary results were reported in the patient’s progress notes on 12/06/12. The current report will supplement and elaborate upon those preliminary findings Examinee Background Information
Lady Macbeth lives with her husband and servants in a castle in Northern Scotland. She is believed to be between the ages of 35-42 yet she has not been willing to elaborate upon the accuracy of these facts. Lady Macbeth leads a mainly solitary life, as her husband is pre-occupied with his active role in the Scottish Army. Due to reports from staff and workers, she very rarely interacts with her staff, except for at meal times and when she needs assistance, this information resounds very strongly of the possibility of an underlying depressive disorder due to her reclusive habits.
In her early life as a wife she bore a child which was reported to have died at the age of six and a half months due to an accident with one of the family’s hounds. However, Lord Macbeth has allowed me to gain access, unheard of previously, to an eye-witness account who is sworn to having seen Lady Macbeth, in a moment of rage, dashing the suckling babe’s head against the bedpost before collapsing on the floor in weeping wreck. If this testimony is true, then it is very likely that these findings will mean she has need of immediate counselling and medication.
Previous medical reports show that a month after the alleged death of the Macbeth’s baby, prescription for anti-depressant drugs had been taken out. However, the success of this early prescription is not known as Lady Macbeth repeatedly needed monthly prescription, states the local pharmacist’s records. The anti-depressant administered was of a very high dosage and Lady Macbeth no doubt suffered from delusional visions from the drugs and might well have formed an addiction to them due to the continued need.
A conversation with Lady Macbeth’s chamber maid discloses that a week previously, she went hurriedly to the main chamber because she heard Lady Macbeth shouting, but when nearing the door, it turns out that she was shouting to what seemed to be herself. The topic of the conversation included such comments as “ unsex me here” and “ fill me, from the crown to the toe, top-full of direst cruelty! ” Whether another person was in the room was not certain but this evidence clearly points towards Lady Macbeth having contact with supernatural beings, maybe witches.
Mental Status Evaluation Results of mental status examination revealed an alert, intelligent individual who showed strong signs of superficial charm. Lady Macbeth comes across as a woman who has a grandiose self-worth, with little time or attention for the needs of others. However, Lady Macbeth lacked evidence of excessive distractibility and followed the conversation well, indicating her high intellect. Punctuality seems to be important to Lady Macbeth yet impulsivity to action was also very evident. There was no abnormality of gait, posture or deportment.
Vocabulary and grammar skills were suggestive of intellectual functioning within the highest range. Memory functions were grossly intact with respect to immediate and remote recall of events and factual information. There was no evidence of perceptual disorder. Social judgment appeared poor, as evidenced by a lack of appropriate interactions with staff and other patients on the ward and by disruptive efforts to treatment goals required for discharge. Pathological lying was shown throughout the examination in the most extreme form; these were deceitful, unscrupulous, manipulative, and dishonest behaviour.
Only on rare occasions were cases of these traits were uncovered due to the layer of superficial charm that Lady Macbeth has imposed upon herself. This point’s towards the possibility of Lady Macbeth being a psychopath instead of having an underlying depressive disorder. Summary of Evaluation Results of psychological evaluation reveal an extended history of alcohol abuse and a psychotic disorder characterized primarily by disturbance of thought content. Due to the extended need for anti-depressant drugs, it would suggest that Lady Macbeth might suffer from a depressive disorder.
However, the repeated need for the drugs, four years after the initial prescription would indicate that an addiction has occurred. The current clinical presentation appears to represent a chronic psychotic disturbance which had its onset approximately four years ago (the death of her child). She lacks sufficient motivation to go without medication which would break her out of her seclusion after a relatively brief period of withdrawal. I recommend that efforts to establish a new anti-depressant program are undertaken and that attempts to establish trusting relationships between Lady Macbeth and her spouse are taken.
Individual therapy will be more productive than group sessions due to her reclusive nature. I believe that initial efforts for group therapy would be wasted on her. Once her guardedness has been relaxed, it will likely be beneficial to explore psychosocial issues present at the time Lady Macbeth lost her child. Psychoanalysis will be conducted at a later date to assure Lady Macbeth’s sanity but medication will not be needed for fear of creating yet another addiction problem for the future.