Waheed is a 47-year-old male from Pakistan. Trained as a structural engineer, Waheed has worked hard for the past fifteen years to build a future for his wife and two sons, aged 8 and 5, whom he says he loves very much. Waheed is actively involved in parenting his sons, taking them to swimming classes on Saturday mornings and attending school functions wherever possible. Exercise is something the family has enjoyed together, with long bike rides on weekends.
Prior to the Global Financial Crisis, Waheed had obtained approval from his bank to construct a large home in a town near to his current home. Halfway through construction, the GFC hit and the bank informed Waheed that he would receive no further instalments on his loan. Waheed was left with a half-built house which, the bank stated, he could sell. However the sale value on an unfinished home was over $300,000 less than the value of the completed home, and Waheed had invested his entire savings of $350,000 into the house. Cultural influences of Waheed’s upbringing and religion make him hesitant to “fight” the bank, yet over the past eighteen months Waheed had become lethargic, unable to sleep and then has nightmares when he does sleep; he also shows no interest in his work or home life.
Waheed has told his wife that he feels guilty for losing their savings, and believes he is useless at providing for his family. For the past nine weeks Waheed has remained at home and been unable to muster the energy to go after new work projects. His wife, a doctor, has managed to cover the daily expenses of the family through her income, but is concerned that he barely speaks anymore; instead Waheed sits at his desk either staring at the wall or browsing the newspaper from his city in Pakistan online. Waheed presented for diagnosis only on insistence from his wife, as he has long believed that mental illness is a sign of weakness.
- Axis I: Major Depressive Episode. Waheed has exhibited five of the conditions in Table 1 1 for more than two weeks, being specifically: markedly diminished interest or pleasure in activities, insomnia, fatigue, feelings of worthlessness and a diminished ability to concentrate.
- Axis II: Not applicable. No personality disorder or mental retardation was noted.
- Axis III: Client is in good health with no known medical conditions.
- Axis IV: Since the bank’s withdrawal of funds, Waheed has become increasingly unable to tender for new projects, and has not worked at all for nine weeks.
- Axis V: Global Assessment of Functioning score = 45. This score at the lower end of the middle range highlights Waheed’s longer-term inability to work or to relate socially to his family.
Treatment of Waheed’s condition will necessarily be multifaceted. Initially, Waheed may benefit from the biological treatment of antidepressant medication prescribed by a psychiatrist, and a schedule of visits with a psychologist. For Waheed to agree to these visits, education on the idea of mental illness as a physical issue may be helpful. Psychological intervention should include cognitive-behavioural therapy to assist Waheed in addressing his feelings of guilt at losing the family’s savings, and his fear of looking for future jobs. As well, it has been reported that physical exercise may be as helpful as medication in overcoming depression.
Therefore it is recommended that Waheed return to his practice of bike riding with his family (also a social intervention) and engage a personal trainer who can create a personal exercise plan that suits Waheed’s lifestyle. Particularly, working with a personal trainer will give Waheed an opportunity to achieve goals in his fitness regime, which may assist in restoring Waheed’s faith in himself to achieve goals in the area of business. A final recommendation would be for Waheed’s wife to support him by arranging regular informal social occasions with family and friends, beginning with just once a week, to help Waheed see that he is acceptable to others and valuable in their lives; this will assist Waheed in rebuilding his self-esteem.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994:320 7.
“Exercise rivals medication in treatment of depression.”(NEWSBRIEFS)(Brief article). (2007-12-01). In Mind, Mood & Memory. 3 (12), 2(1). Belvoir Media Group, LLC.