56 Alcohol Abuse
Name: Lila Blewitt
Source: Lila: An Inquiry into Morals by Robert M. Pirsig (book, 1991)
Background Information
Lila Blewitt is a Caucasian female and presumed to be middle aged, although her actual age is unknown. She is currently riding on a sailboat with a man she met the previous night in a bar located along side a river on the East Coast. Lila does not have an occupation. In the past, Lila has been a prostitute as well as a waitress. Lila’s mother was critical of her. As a child, when Lila did something good, the mother said nothing; but when she did something bad, her mother mentioned the incident repeatedly. Lila was previously married to a trucker and had a daughter. Her husband and daughter are deceased. Lila’s daughter died by smothering in her blanket, and her husband died in a car accident. She likes to dress very provocatively, but with no originality.
Description of the Problem
Lila has very little direction in life, and her mental processes and conversations are very surface. She dresses overtly sexual, and believes that with enough alcohol, relations with men are reduced to pure biology where they belong. Lila does not moderate her intake of alcohol, and drinks often and to the point of complete intoxication. She takes medication called Empirin whenever she begins to sense a psychotic episode is coming on. These episodes appear to be induced by social stressors, such as disagreements or arguments. Lila also suffers from severe delusions, odd ideations, and catatonia. Lila’s medication was stolen from her purse; she ended up lost in New York City and thought that taking all of her clothes off would be a good idea because then somebody would “see” her and help her. Lila’s social life greatly suffers due to impulsively rapid shifts between seeing individuals as either a rescuing friend, or as an enemy out to get her. Also while she was lost in New York City, Lila ordered three rum and cokes, although she didn’t end up being able to pay for them, and then thought that her childhood pet and dead husband were giving her directions on how to get back to the sailboat she had been riding on. Once back at the sailboat, Lila saw a doll floating in the river and believed it to be a human baby. Also at times, Lila’s speech is highly disorganized, described by the author as “word salad.”
Diagnosis
The diagnosis for Lila that seems to fit appropriately is Schizophrenia, Disorganized Type (295.10) with a comorbidity of alcohol abuse (305.00).
A. To be diagnosed with schizophrenia, two or more of the following characteristics must be present:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms, i.e., affective flattening, alogia, or avolition
Lila displayed all of these characteristics throughout the book.
B. For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-c