Running head: Clinical Depression Gonzalez1

Nursing Management of a Patient with Clinical Depression

Jocelyn Gonzalez

Dr. Smith

Period 2- English 11

30 May 2017
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Nursing Management of a Patient with Clinical Depression

Holden Caulfield, a 16 year old male with personal struggles indicates he has clinical

depression. He seems to demonstrate bad habits such as smoking and drinking quite frequently,

using inappropriate language, lack of sleep, as well frequent mention of his suicidal thoughts. It

is apparent that Mr. Caulfield has not received adequate diagnoses therefore, has been analyzed

quite thoroughly. Through a thorough examination it has been discovered that the major impacts

in why he has developed clinical depression are: his low self esteem, the death of his brother

Allie Caulfield, and his parents unawareness to the support Mr. Caulfield needs. It is quite

transparent that he has a low self esteem in the way he considers himself to be the dumb one in

the family which has therefore, resulted to his dismissal at Pencey Prep, the private school in

which he was attending. As well at the age of 13, Mr. Caulfield experienced the death of his

younger brother Allie, who he cared for dearly. As a result to the death, Mr. Caulfield’s parents

have not allowed him to grieve properly and instead sent him away to different school, therefore

not helping Mr. Caulfield mental health. Therefore, as a nurse, the focus will be mainly on his

self esteem, coping with the loss of his brother, and gain a greater connection towards his

parents.

Pathophysiology

The symptoms of clinical depression, according to ​WebMD​, include fatigue, low self

esteem, unable to stay focused, insomnia, disinterest in everyday activities, and frequent thoughts

of suicide, however these symptoms are not limited to. It usual to be diagnosed of clinical

depression when these symptoms occur every single day for 2 weeks straight. The major trigger

for clinical depression are loss of a love one possibly through a death, feeling of loneliness,
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major life changes, abuse either sexual/emotional/physical, or personal conflict. It is quite

conspicuous that Mr. Caulfield trigger stems from his brother’s death in which can appear

dramatic in the sense Mr. Caulfield was only 13 years old and his younger brother dies of

leukemia which quite possibly is the start of harmful action such as breaking many windows

from his garage, resulting to his hospitalization.

History

Holden Caulfield, a 16 year old male, has recently been diagnosed with clinical

depression due to the many comments of depression and death. As well, through his action

which are deemed dangerous such as heavy smoking and drinking that can affect his body

negatively. These are not the only actions in which demonstrate his depression it can be seen

frequently, such as the insomnia he experienced therefore results to his bad habits of alcohol

abuse. Another example includes: crying without a conscious reason, isolation toward people due

to their “phoniness,” poor academic habits such as Mr. Caulfield frequent dismissal of schools,

and his low self esteem.

Nursing Physical Assessment

Mr. Caulfield is described to have a low self esteem which is noticeable when he either

compares his intelligence to his siblings or fulminate about Stradlater’s own looks which results

to having negative feelings towards him. “Like Stradlater. All these handsome guys are the same.

When they’re done combing their goddam hair, they beat it on you. When I finally got down off

the radiator and went out to the hat-check room, I was crying and all. I don’t know why, but I

was. I guess it was because I was feeling do damned depressed and lonesome” (Salinger 153).
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Mr. Caulfield does not state the reason for his depression however, with the previous mention of

Stradlater it is evident that he is comparing attractive male youths to himself resulting to bringing

himself down. The results of low self esteem eventually made cry and made him feel lonesome

in the way he is not able to receive reassurance from others. The negative impact of the situation

results for Mr. Caulfield disliking others who he feels perceive themselves to be better therefore

he grows a hatred toward his own perception of them and does not realize in reality he does not

need to be comparing himself to others for he has his own good qualities, however with no push

was ever taken for him to follow the path of self-love he therefore feels lonesome.

The greatest stem of Mr. Caulfield depression come from the death of his younger

brother, Allie. “I was only thirteen, and they were going to have me psychoanalyzed and all,

because I broke all the window in the garage” (Salinger 39). After he had discovered the death of

Allie, Mr. Caulfield could not cope with the loss therefore, instead of talking to someone about

how he felt he became destructive. It is quite possibly that this is Mr. Caulfield first uproar from

known incidents. This portrays the dangers in which Mr. Caulfield can pose to himself as well as

others in the sense of not being able to control his emotions therefore resulting the physical

violence.

Though it is Allie’s death in which began the start for Mr. Caulfield depression the

greatest impact in which grew toward the loss he felt from the tragic event was the support that

his parent did not help provide for him when he needed it the most. “Boy, I felt miserable. I felt

so depressed, you can’t imagine. What I did, I started talking, sort of out loud, to Allie” (Salinger

98). Due to the loneliness Mr. Caulfield experience through dealing with the loss of his brother

his parents did not demonstrate a method of support for him. Instead of helping the 13 year old
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child at the time, his parents would send him away therefore, make him feel as though he could

not share his pain with others. Which advanced his depression therefore affecting his mental,

physical and emotional state. Such can be seen when he is sometimes seen talking to Allie

outloud for he feels as though there is not one to talk to when he is feeling lonesome and

depressed.

Nursing Diagnosis & Patient Goal

The goal set for Mr. Caulfield is to have him address his major problem which is heal

from the death of his brother, Allie. According to ​Teens Health, ​the most effective ways of

healing through a death of a loved one is: let your emotions be expressed and released, talk about

it when you can, preserve memories, and join a support group. Therefore these are the essential

means for Mr. Caulfield to overcome the barrier of his depression and move forward for his

future and not to fall into the abyss of feeling lonely and helpless. The greatest change that is

expected for Mr. Caulfield is to bring light to his feelings and not hold them back for they must

be heard by expressing himself to others will he be able to lift the weight that he may be feel on

his chest.

Nursing Interventions

It is decided that he will be going through therapy every three times a week. The first two

session will include cognitive behavioral therapy and interpersonal therapy as for the third

therapy session it will be a family therapy. Through the family therapy, “parents are taught to

identify the symptoms, how to approach a depressed child, how to help him, information about

mood disorders, interpersonal skills, stress reduction, medication and medication side effects.

The effect of various stressor in a child's life is also examined in the context of different
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environments such as school, home, community” (Sokolova 1). As a result to the family therapy,

Mr. Caulfield’s parents will gain a greater understanding on their son and his feeling which help

bring together the bond they had prior to the death of Allie.

Evaluation

After the meaningful session Mr. Caulfield had gone through there are few changes that

are seen. Though Mr. Caulfield experiences moments in which he feels like giving up, the great

support group has helped lead him to the bright side of things. The great change that is seen is his

the ability of being able to acknowledge that is not alone and by making that great breakthrough

in the last few months of therapy. By realizing he is not alone he has been able to open up to the

therapist as well a bit to his parents and peers. Though at times it appears instead of opening up

he backtracks and begins to show signs of initial symptoms of his clinical depression it is not

permanent and always overcomes them as a result, it is noticeable that he is gaining a positive

effect from all the therapy sessions.

Recommendations

Holden Caulfield is clearly suffering from clinical depression, grieving the loss of his

brother and needs some direction in healing by following the right path by doing so will help

improve his health. Psychotherapies the ​National Institute of Mental Health ​are best suitable for

adolescent, “include ‘cognitive behavioral therapy,’ which helps people learn new ways of

thinking and behaving, and ‘interpersonal therapy,’ which helps people understand and work

through troubled personal relationships.” As well family therapy will be continued to further

improve his relationship with his parents therefore improve his mental health. Through this Mr.

Caulfield will be able to cope with the loss of his brother for his life to be able to surpass through
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this traumatic event in his life. As well it is recommend Mr. Caulfield does an internship as a

student aid for he seems to turn to teachers quite frequently and by doing so it well help him

develop a positive relationship as well help push forward his career purpose of similar to being a

protector he will feel more at ease with his life and motivated in school. If he is motivated it will

be easier for him to make positive relationships and fit into social situations.
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Works Cited

“5 Ways to Cope When a Loved One Dies.” ​TeensHealth​, 28 May 2017.

“Antidepressant Medications for Children and Adolescents: Information for Parents and

Caregivers.” ​NIH, ​28 May 2017.

“Major Depression (Clinical Depression).” ​WebMD, ​23 May 2017.

Salinger, J.D. ​The Catcher in the Rye​. New York Boston London: Little, Brown and Company,

May 1991. Print

Sokolova, Irina. “Depression in Children: What Causes It and How We Can Help.” ​Rochester

Institute of Technology, ​28 May 2017.