Use the Case Study Response Guide to format your assignment. In Section 4 of the response guide, address each of the following:

What diagnostic possibilities does Bill’s case present?
What have you read in the case history so far that presents these possibilities for you?
What kind of questions you might ask to evaluate each diagnostic possibility? You must consider at least two—but no more than three—diagnostic possibilities and develop a series of questions to interview for each possibility.
What possible answers would lead you toward or away from each of your possibilities?

Bill is a middle-aged, married, Caucasian male who has two grown children. Bill’s father passed away when Bill was in college, and this loss still pains him. He held his father in extremely high regard and at times referred to him as “brilliant,” even though his father did not graduate from high school. His father worked at a skilled trade until he suffered a fatal illness in his late 40s or early 50s. Bill laments the loss of his father and, in particular, the guidance he thought his father could have provided during turbulent times in Bill’s life.
According to the pattern of alcohol use that Bill describes, it is likely that Bill’s father had a serious drinking problem, if he was not actually an alcoholic. Bill’s mother, who is also deceased, is described by Bill as a strong woman and the matriarch of the family. While Bill states that he had much respect for her, it seems that his respect was also tinged with fear of her disapproval. She never accepted or understood why Bill chose the college he did and why he had an interest in an Army career.
Bill states that his mother never used alcohol. He describes her as a very critical and judgmental person. His family of origin was devout in their religious beliefs, and this appears to play a significant role in Bill’s life. He is close to his siblings, but they do not talk often, and he feels guilt for not initiating calls to them. His hesitation to call them is due in part to a fear that they will reject him. It is for this reason that he also tries to keep conversations with them at a superficial level. His extended family includes people who have achieved at the highest levels of government and their professions.
Bill graduated from a prestigious college and embarked on a military career, which was his lifelong ambition. A “vindictive” superior officer who gave him poor performance evaluations cut Bill’s career short. It turns out that Bill may have had much more of a role in this than he is aware of or initially admits. He acknowledges a lengthy period of indecision and marginal adherence to military standards at the beginning of his career, but relates that he eventually got over that “down time.” Nonetheless, Bill developed the persona of hero in both military matters and civilian jobs, and to this day, he compares himself with heroic figures from antiquity and sees himself on the verge of doing something great, “if,” he says, “I can ever get over this serious case of the blues I’ve been experiencing for the past months.” He indicates that he has felt this way, “empty, really,” nearly all day every day for at least two to three months. As he says this he appears tearful. He relates that there was no particular incident or event that started him feeling this way. “It just came over me,” he says.
He reports that he has, in fact, lost interest in any kind of work or activities over the last months, and finds joy in literally nothing. He has no energy and reports that others have been asking him why he’s so plodding and slow about everything lately. He has great difficulty getting out of bed in the morning and constantly thinks about suicide. While he feared death as a young man, he now says he would welcome it. He has been on Prozac “and things” for years and questions whether it is working.
Bill is awash in guilt. He feels guilt for things he has done and for things he has not done. He has a disarming smile that belies the pain he feels and keeps people from prying into his life. He has one or two drinks of Jack Daniels, neat, each night. Psychotherapy is difficult with him because of the chronic nature of his problems and his fear of alienating people who are close to him. He seems to genuinely believe that his expectations of other people are fair and reasonable, but he is so disappointed in “everything” that he doesn’t know what there is to live for.
Bill places unrealistic importance on the support available from his nuclear family. Yet, he says he is cautious around them because if he says or does the wrong thing, they might leave him or tell him to leave. He is, he adds, feeling pretty worthless and guilty about ridiculous little things he’s done and said to his family. He knows he has been emotionally “fragile” the last few months; in particular, he has found himself increasingly irritable. He expresses anger at his adult children because they do not appear as devoted to him as he was and still is to his late father. However, Bill keeps this anger to himself for fear of rejection. He has also recently experienced conflict with his wife of many years. It is not possible for her to meet his expectations for support, so he becomes angry with her, but withholds the expression of his anger for fear of alienating her.

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