Does My Uncle Scrooge Need Help?

A Psychological Evaluation of Ebenezer Scrooge

Scrooge
Imagine the following – you have a very crabby and very wealthy uncle.  One day he says he saw ghosts.  Not one ghost, but four ghosts.  Now he’s a changed man.  What would you do?

You might very well take your uncle to a psychologist.

This psychological analysis was done in November of 2005 by Karen Eveland, a student at Texas A&M University Kingsville for an abnormal psychology class.  Her professor is Dr. William E. Kelly.


Psychological Evaluation
Date: January 15, 1844
Patient: Ebenezer Scrooge
Tests Administered: Clinical Interview
Psychologist: Karen Eveland

Personal Data: Ebenezer Scrooge is an approximately 50-year-old Caucasian male. He is single and has never been married. Mr. Scrooge lives alone. He owns his own business. Mr. Scrooge’s closest living relative is his nephew, Fred.

Scrooge

Presenting Problems: Mr. Scrooge states that he has no complaints, however he has agreed to meet today in order to satisfy the concerns of his nephew Fred.

Fred states that he is concerned about Mr. Scrooge’s mental state. He claims Mr. Scrooge has been unusually active and emotional, and that he has been giving away his money in large sums. Although Fred admits that Mr. Scrooge’s heightened generosity is somewhat of a pleasant change; he is concerned that Mr. Scrooge may not be mentally competent. At this time, Fred is requesting that Mr. Scrooge be evaluated for mental competency to determine if he is in need of a guardian.

History: Mr. Scrooge and his nephew participated in providing details about Mr. Scrooge’s life history.

Mr. Scrooge reports that he spent most of his childhood in boarding school. He was often isolated and forgotten by his family. He felt and still believes that his father did not care much for him. He states the only relative that paid much attention to him was his sister, Fan. She was the mother of Fred, and is now deceased. Mr. Scrooge states that he had few close friends during his childhood. During young adulthood, Mr. Scrooge was engaged to be married. However, when his bride-to-be expressed concerns about Mr. Scrooge’s obsession with money, the wedding was called off. After the wedding was called off, Mr. Scrooge, states he turned his focus completely to his business and did not attempt to make any friends or to maintain any other relationships. He does state that he had one friend, Jacob Marley, who was also his business partner. Jacob Marley is now deceased and Mr. Scrooge reports having no other close friends until very recently.

Fred states that in the past he has attempted to visit Mr. Scrooge frequently, but that he generally found him inhospitable. Further Fred, states that the last seven years or so, Mr. Scrooge has worked late on a daily basis, isolating, and depriving himself and his sole employee of even adequate heating at his place of business.

Approximately two weeks ago, on Christmas Eve, Mr. Scrooge claims that he was visited by his deceased friend, Mr. Marley as well as by three other spirits. Mr. Scrooge states that initially he thought his vision of Mr. Marley was a hallucination brought on by indigestion, however, he now believes the event to be have been real. He states that Mr. Marley warned him about being punished in the after life and told him to change his ways before it was too late. Mr. Scrooge states that after Mr. Marley departed, he saw three other spirits who transported him through time and space to view Christmases in the past, present and future. He says two of the spirits actually spoke with him and warned him about living his life selfishly. Mr. Scrooge says that the last spirit did not speak but did take him to visit his own grave. Mr. Scrooge states that upon awakening Christmas morning and finding himself still alive, he determined to change his ways. He says that his sudden generosity is a result of this determination. He also claims that he is happier then he has ever been in his life, and that each new day brings him more joy. Mr. Scrooge is insistent that the experiences with his deceased friend and the three spirits were real.

a christmas carol

Mr. Scrooge states that he has never used any drugs and that he drinks alcoholic beverages rarely. Fred, Mr. Scrooge’s nephew, confirms this information.

Current Status: Mr. Scrooge appears to be coherent. He is able to identify place, time, and people. He reports no other delusions or hallucinations, with the exception of the events he reports took place on Christmas Eve.

Diagnostic Considerations: Mr. Scrooge appears to be coherent and stable. Initial impressions of Mr. Scrooge’s symptoms indicate a possibility of Bipolar disorder. These symptoms include sudden onset of extreme mood fluctuations, racing thoughts, increased social activity, and a decreased need for sleep. However, these symptoms are balanced with intermittent periods of deep thought and reflection occurring several times within the same day. Mr. Scrooge is able to remain calm and collected for long periods of time. He also reports no symptoms of depression. Therefore, he does not meet the criteria for Bipolar, hypomania, or cyclothymia.

Due to the sudden onset of Mr. Scrooge’s psychotic like symptoms (hallucinations and delusions) and the extremely short duration of these symptoms (one night), Mr. Scrooge does not meet criteria for Schizophrenia or Schizophreniform. Although Mr. Scrooge’s thinking is somewhat symptomatic of delusional thinking, in that he maintains that the hallucinations he experienced on Christmas eve were real, he otherwise displays no other indications of irrational thought.

Mr. Scrooge appears to have suffered from Brief Psychotic Disorder, without marked stressors. The hallucinations and delusions he experienced two weeks ago evidence this. The fact that he maintains the reality of the events does not necessarily indicate deluded thinking, since the trauma from experiencing delusions and hallucinations of the magnitude reported by Mr. Scrooge could be enough to convince him of their reality. It is common for people to believe such hallucinations are real when the only alternative explanation is for them to accept that they were temporarily psychotic. To accept the notion of psychosis is extremely frightening and it is sometimes easier for some to believe the event really happened.

It is quite possible that Mr. Scrooge did suffer from some type of food poisoning, which in turn caused him to hallucinate. However, after this much time has elapsed it would be very difficult to investigate this hypothesis.

It seems more likely that Mr. Scrooge experienced a brief psychotic episode. Although undiagnosed, Mr. Scrooge appears to have suffered from obsessive-compulsive personality disorder in the past, as evidenced by his hoarding money and extreme work history. People who suffer from personality disorders are more at risk to experience a brief psychotic disorder than the general population. It is impossible to diagnose Mr. Scrooge with this disorder however, since he has no current symptoms.

As for Mr. Scrooge’s current mental state, he appears to be competent. Although he is giving away large sums of his money and is very emotional, he is able to mentally assess the risks of his behavior. Mr. Scrooge does not appear to be a danger to himself or others.

Scrooge

Notes:
Axis I – Clinical Disorders: Brief Psychotic Episode (December 24, 1843)
Axis II – Personality Disorders: Possible history obsessive compulsive personality disorder (rule out)
Axis III – General Medical Condition: Deferred
Axis IV – Psychosocial and Environmental Problems: Stress related to holidays, lack of friends and family support system, and what appears to have been a brief psychotic episode.
Axis V – Global Assessment of Functioning: Highest level of functioning in past year: 75; present functioning: 75

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