Case Study

 Name: Mrs. Leslie Tilman Gender: female Age: 32 years old T- 97.6 P- 97 R 22 149/98 Ht 5’3 Wt 245lbs Background: Recently had her first child two months ago. Currently married; stay at home mother after working in retail for 5 years. Grew up with both parents, one sister in Omaha, NE. Completed education through bachelor’s level, studying physics. Previous employment included research science as well as high school substitute teaching for 5 years prior to birth. No previous suicidal gestures; has uncle who committed suicide via GSW. She denied drugs/alcohol; uncle was opioid abuser. Hx of HTN-prescribed labetalol 100mg twice daily, admits to missing doses due to forgetting. No legal hx. Allergies: codeine 

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 Mrs. Tilman, your husband is extremely worried about you. 
MRS. TILMAN Yes, I know that. 
 Does coming her bother you? 
 TILMAN Yes. Yes it does. I’ve never been to a shrink before. I don’t think I need to be here now. 
 I’d like to ask you a few questions if that’s ok. 
TILMAN Yeah, that should be fine. 
Sleep? 
TILMAN I can’t sleep much. But that’s to be expected. 
How so? 
MRS. TILMAN The baby. It cries a lot. 
 And what wakes you? 
\MRS. TILMAN Well I’m usually already awake. 
\\You have trouble sleeping? 
\MRS. TILMAN Just falling asleep. Especially after the baby cries. 
\What’s the baby’s name? 
\ TILMAN Jessica. 
\ Beautiful name. How old is she? 
\TILMAN Two months. 
\ How has your appetite been lately? 
\\MRS. TILMAN I don’t know. It’s not big, but I want to lose weight after the pregnancy. 
\ You aren’t comfortable with the way you look? 
\MRS. TILMAN I’m terrible. Alright. I look terrible, I feel terrible. My body is bloated. I have lines on my face, bags. I look disgusting. 
\ What do you do to lose weight? 
\MRS. TILMAN Well, I want to run, but… I don’t get out much. 
\ Why? 
\MRS. TILMAN Cause I’m stuck at home. I have to take care of the baby, all day long. I guess I should just get used to it. This is my life now all day long, stuck at home with the kid. 
\MRS. TILMAN Who could afford one? Especially with having to pay for the kid. 
\ Have you said any of this to your husband? 
\MRS. TILMAN To Rick? 
\DR. GREY Uh huh. 
\MRS. TILMAN No. I couldn’t. He’d be so disappointed in me. How could I even tell him that I felt this way. That I wanted out. He comes home from work and… he plays with Jessica. This perfect family. 
\ How has your relationship been? 
\MRS. TILMAN Not good. 
\What’s happened since Jessica was born? 
\ILMAN It’s not added much. I mean it is my fault. I can’t stop crying. All the time. [she cries] Sometimes I don’t even know who the baby is. And I yell a lot. Things just upset me. Everything and anything he does lately just upsets me. 
\For instance? 
\MRS. TILMAN Well… Well the other day he came home and changed her diaper but he threw the dirty diaper in the wrong trash can and he didn’t tie it up in the bag the way he was supposed to. 
\ And that upset you? 
\MRS. TILMAN Yeah. And I told him, and I was yelling so he started yelling. So yeah. That’s our marriage right now. 
\ Have you been sexually active since Jessica was born? 
\MRS. TILMAN No. Not really. I have no drive or desire. Rick keeps wanting to but I just… I push him away. 
\ And how is your social life? 
\MRS. TILMAN Non-existent. I haven’t seen my friends in forever. They came over to see the baby but that’s about it. I might as well get used to it. I can’t go out anymore. She’s too young for a baby sitter, and even then we couldn’t afford one. I had to quit my job. 
\ Were you forced to quit? 
\MRS. TILMAN No. They gave me maternity leave, but… but I figured this is never going to end. I might as well leave now. 
\ Do you do anything for yourself? Something to relax, something creative? 
\MRS. TILMAN No. I tried writing. I liked writing but… I don’t know, I… nothing moves me. 
\ You can’t write now? 
\MRS. TILMAN I have no inspiration, and it’s not fun. I know I’m going to be interrupted soon anyway. Before Jessica, I could write for hours a night. I hated anyone disturbing me. [she cries] Now I can’t have twenty minutes. And you can’t tell a baby to hold on with wanting her lunch. For an hour. When she’s hungry, she’s hungry. 
\ Do you regret having a child? 
\MRS. TILMAN No. I… I’m just not sure. I’m not sure, okay. 
\ Are you happy? Does anything give you pleasure? 
\MRS. TILMAN [Shakes her head] No. [she cries]. Look, please, I… I know I’m a mother now. I. [sigh] I don’t know how to put this, I feel terrible. [Cries harder]. I don’t want to be a bad mother. I love my daughter. But I don’t know… I don’t know why I say these things. It’s just really difficult… and Rick, I see Rick and he has this look. It’s this look, its like I know what you’re thinking. It’s like he’s judging me. It’s like he knows I’m not normal. I mean, what’s wrong with me? Sometimes I can’t even hold my own child, I… I, she’s crying and I can’t… I can’t touch her. And when I give her milk it disgusts me. I don’t know what to do. I don’t know what’s wrong with me. I don’t know what’s wrong with me. [She reaches for a tissue] 
\Mrs. Tilman, do you have thoughts of suicide or death? 
\[she shakes her head yes] 
\Have you acted upon them? 
\MRS. TILMAN [she shakes her head no] No. I couldn’t. I couldn’t do that to Rick or Jessica. And then I feel guilty again. It’s this… this endless cycle. I’m not happy and I want to get out and if I get out, then I would just… I would just… just ruin everyone and that makes me more unhappy. 
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