SOWK 7371 – Case Study Jonathan Jonathan is a 24-year-old US Army veteran who at

SOWK 7371 – Case Study
Jonathan
Jonathan is a 24-year-old US Army veteran who attends community college. He presented at the
emergency room (ER) with his girlfriend and sister. Upon evaluation, the LCSW noted that he is tall,
slim, and well-groomed with glasses. He speaks softly, with an increased latency of speech. His affect is
blunted except when he becomes anxious while discussing his symptoms. Jonathan stated that he came
to the ER at his sister’s request. He has had a migraine for the past several days, which feels like “sharp,
shooting” sensations in various bilateral locations in his head. He also describes a “ringing” sensation”
along the midline of his brain that seems to worsen when he thinks about his vices. For the last 2½
months he’s been experiencing “hallucinations of a spiritual nature.”
Jonathan identified his vices as being “alcohol, cigarettes, disrespecting my parents, girls.” He denied
guilt, anxiety, or preoccupation about any of his military duties during his tour in Iraq, but he had joined
an evangelical church 4 months earlier in the context of being “riddled with guilt” about “all the things
I’ve done.” Three months earlier, he began “hearing voices trying to make me feel guilty” most days. The
last auditory hallucination was two days ago. During the last few months, he began noticing that
strangers are commenting on his past sins.
Jonathan believes that his migraines and guilt might be due to alcohol withdrawal. He had been drinking
three or four cans of beer most days of the week for several years until he “quit” 4 months earlier after
joining the church. He still drank “a beer or two” every other week but felt guilty afterward. He denied
any alcohol withdrawal symptoms such as tremors and sweats. He smoked cannabis up to twice
monthly for years but quit completely when he joined the church. He denied using other illicit drugs
except for one uneventful use of cocaine 3 years earlier. He sleeps well except on occasional nights
when he could only sleep a few hours because he had to finish an academic assignment. Jonathan
denied depressive, manic, or psychotic symptoms and violent ideation. He denied post-traumatic stress
disorder symptoms. Regarding stressors, he felt overwhelmed by his current responsibilities, which
includes attending school and almost every day church activities. He was a straight A student at the start
of the school year but he is now receiving Bs and Cs.
In separate interviews, Jonathan’s sister and girlfriend both stated that Jonathon had been increasingly
isolating himself and quiet. Previously, he used to be fun and outgoing. He also had never been
especially religious. His sister believes that the church he has become involved with is “brain washing”
him. His girlfriend however said that when she attended a church service with Jonathon, some of the
congregation members told her they have occasionally talked to new members who felt guilt over their
prior behaviors, but no one who had ever hallucinated before. They expressed that they were all
worried about him.