Case study: Erectile dysfunction from torture by Laleh Yaghoubi The following is a case study of a male client, Mubilajeh, suffering from a sexual disorder (impotence). Erectile disorder, the inability to have an erection or maintain one, is currently the most common sexual disorder among men (Hyde 468). One result of erectile disorder is that the man cannot engage in sexual intercourse. For many men, including this individual, psychological reactions to erectile disorder may be severe: embarrassment, depression, and anxiety. The client was diagnosed and given an assessment with the goal of determining the factors. Through a process of discovery, the client's history finally revealed that the impotence was actually a result of Posttraumatic Stress Disorder (PTSD) caused by a past experience. People with PTSD fear re-experiencing a traumatic event and sometimes are unable to remember certain aspects (Barlow 138). However, through psychoanalytic therapy, this client illustrates a successful recovery. Patient This section presents a brief patient assessment, including a case history of the client considered in the study. Mubilajeh, thin proportioned and nearly seven feet tall, is a thirty-year-old African male originally from Nigeria. He is a peaceful and proud African man. He has been married to his wife, Zhane, for nine years, and they hope to have children very soon. At the age of fourteen, Mubilajeh's father passed away, which left his mother alone to raise six children. Mubilajeh was the oldest of the six children. After his father's death, Mubilajeh felt obligated as "man of the house" to financially support his family. These difficult times forced him to quit school, and he found a full-time job at a neighborhood library. Mubilajeh had always been an excellent student in school; he especially missed writing his creative stories. Mubilajeh found his job extremely boring; therefore, he kept himself occupied reading anything he found interesting in the library to pass time. Mubilajeh returned back to school when his brothers were old enough to work and help financially support the rest of the family. This allowed all three of them to work and attend school. Mubilajeh eagerly continued and completed his education at a local university. In Nigeria, Mubilajeh became a well-known professional writer and an engineer. He later published a very controversial story that stirred considerable political debate. The Nigerian government felt the story could provide a cause for starting a revolution and threatened Mubilajeh, so he and his wife escaped to the United States. They moved to Philadelphia approximately four years ago and live in a one-bedroom apartment a mile from Mubilajeh's place of employment. Mubilajeh is a hard-working janitor in the emergency services department at St. John's hospital.
Symptoms and Diagnosis This section presents a description of the Mubilajeh's problems and their diagnosis. His complaints presented a list of symptoms associated with a particular kind of sexual disorder, erectile dysfunction (impotence). This has been a very embarrassing and stressful problem for him and has put a strain on his relationship with his wife, Zhane. Zhane has been sympathetic but she is very worried about him. Mubilajeh was feeling sharp pains in his lower back and proceeded to see a doctor at his place of work. During his medical office examination, the attending physician, Dr. Dahl, noticed twenty enormous burn scars all over Mubilajeh's back. Though healed through time, the scars still felt rough like the bark of a tree. Dr. Dahl asked Mubilajeh, "How did you get those?" However, Mubilajeh didn't want to talk about it. 'We don't have to talk about it, but I am rather concerned about that possible hernia," replied Dr. Dahl. After x-rays and further tests Dr. Dahl revisited with Mubilajeh and determined that surgery was urgently necessary. After Mubilajeh's surgery, Dr. Dahl reported the successful results to Zhane. Dr. Dahl, concerned about further possible problems with Mubilajeh's health, asked Zhane how Mubilajeh got the severe scars on his back. Zhane explained that due to the controversial story that Mubilajeh published, a group of soldiers came to their house and captured him. That same night, the soldiers returned and raped Zhane. After several weeks the soldiers released Mubilajeh. Barely alive, he finally returned home. He had broken bones, severe burns, and bruises. Zhane explained that she never told Mubilajeh of her rape by the soldiers. Also, Zhane volunteered to share that she and Mubilajeh had been experiencing intimacy problems. During his routine patient check-up, Dr. Dahl consulted with Mubilajeh about the information Zhane had shared with him. Mubilajeh confessed that he had been experiencing impotency. During a standard room check/preparation one day, Nurse Elliot walked in and found Mubilajeh in the comer of an examination room. The room was in disarray. Mubilajeh had blood all over his hands and shirt. Nurse Elliot not only found surgical scissors in his hands, but also saw Zhane lying unconscious on the floor in front of him. Security was called and Mubilajeh was arrested. When Zhane finally became conscious from her coma, she explained that after shamefully confessing to Mubilajeh of her rape, she repeatedly struck herself with the surgical scissors. Mubilajeh was only trying to stop her. "He felt responsible for what happened to me. I felt ashamed, like I could never please him again," stated Zhane. Mubilajeh was temporarily released. Due to illegal entry into the United States , the immigration office demanded to hear Mubilajeh's whole story in court. Otherwise, Mubilajeh and his wife would be forced to leave the country. However, Mubilajeh could not remember anything from the incident. It was diagnosed that Mubilajeh was suffering from a posttraumatic stress disorder. Plan This section presents the treatment plan that was used for dealing with the client's problem. Also, this section will describe the results and outcome of how that process was applied. This plan took into consideration the severity of Mubilajeh's disorder with regard to his resistance to treatment.
COMPONENTS [Type of Therapy Chosen ] From a psychological point of view, most clinicians agree that victims of PTSD should face the original trauma in order to develop effective coping procedures and thus overcome the debilitating effects of the disorder. In psychoanalytic therapy, reliving emotional trauma to relieve emotional suffering is called catharsis (Barlow 144). The trick, of course, is in arranging the re-exposure so that it will be therapeutic rather than traumatic once again. A traumatic event is difficult to recreate, and very few therapists want to try. Therefore, imaginal exposure, in which the content of the trauma and the emotions involved with it are worked through systematically, may be used. Another complication is that trauma victims often repress their memories of the event. This happens automatically and unconsciously. On occasion, with treatment, the memories flood back and the patient very dramatically relives the episode. Although this may be very frightening to both patient and therapist, it is therapeutic if handled appropriately.
APPLICATION [of Therapy to This Patient] Given Mubilajeh's resistance to seek professional help, Dr. Dahl attempted to find another strategy for treatment. Mubilajeh was still reluctant to seek psychological therapy, but he was beginning to feel more comfortable discussing his problems with Dr. Dahl. As a result, Dr. Dahl spontaneously decided to share a personal experience with Mubilajeh in which he suffered memory loss caused by PTSD from a traumatic incident. He explained the gruesome details of a viscous attack. "Afterwards, all I could think of was 'why didn't I do anything?"' explained Dr. Dahl. "You can't . . .you can't do anything. You're helpless," replied Mubilajeh. All of a sudden, Mubilajeh remembered what happened to him. He recalled his eyes tightly blindfolded, the unbearable smell of smoke, the excruciating pain of being hung by his hands, and the metal irons burning into his skin. He hopelessly wondered if he would ever taste Zhane's sweet lips again or smell the scent of her perfume.
Results/Outcome
This section presents the results of the treatment plan used in the study. After hearing all of the details, the courts agreed to allow Mubilajeh and Zhane to remain in the United States . Due to the psychoanalytic therapy process used by Dr. Dahl, our diagnosis of Mubilajeh's PTSD showed itself to be valid. Dr. Dahl's strategy was successful and Mubilajeh was able to remember the details of his traumatic experience. Cognitive, Behavioral and Couple Therapy later used in the treatment process also provided successful results. Mubilajeh learned to overcome the fear and horror of his past traumatic experience. The anxiety caused by these emotions was gradually overcome, as was the sexual disorder.
Conclusion
The author hopes that the case study presented here has communicated some of the issues and concerns associated with Posttraumatic Stress Disorder. The author also hopes to show the damaging effects that patients may suffer as a result of this disorder. Such individuals are often doubly handicapped. Our hypothesis that Mubilajeh's sexual disorder was actually a result of PTSD caused by a past experience proved to be valid. Mubilajeh was not only suffering from severe psychological problems caused by PTSD, but psychological problems from his sexual disorder as well. With a helpful, caring doctor and a therapeutic treatment program he was able successfully recover.
References
Barlow, D., & Durand, M. (1999). Abnormal Psychology: Anxiety Disorders (pp. 138-144). New York: State University of New York. Hyde, J., & DeLarnater, I. (1997). Understanding Human Sexuality: Sexual Disorders (pp. 468-49 1). Madison: University of Wisconsin.