Clinical Psychology

Subjective Distress

We now shift the focus from the perceptions of the
observer to the perceptions of the affected individual.
Here the basic data are not observable deviations of
behavior, but the subjective feelings and sense of
well-being of the individual. Whether a person
feels happy or sad, tranquil or troubled, and fulfilled
or barren are the crucial considerations. If the person
is anxiety-ridden, then he or she is maladjusted
regardless of whether the anxiety seems to produce
overt behaviors that are deviant in some way.
Cynthia and Kwame are obviously two very
different kinds of people. Cynthia’s behavior is, in

a sense, quite conforming. Her ability to cope would

be cause for admiration by many. Yet she is unhappy

and conflicted, and she experiences much anxiety. A

clinical psychologist might not be surprised if she

turned up in the consulting room. Her friends, how-

ever, would likely be shocked were they to learn

that she had sought psychological help.

In contrast, many of Kwame’s friends, associates,

and family members would be gratified if he were to

seek help because most of them have, at one time or

another, described him as sick. But Kwame is not at

odds with himself. He sees nothing wrong with

himself, and he would probably react negatively to

The Case of Cynthia S.

Cynthia has been married for 23 years. Her husband is a

highly successful civil engineer. They have two children,

one in high school and the other in college. There is

nothing in Cynthia’s history to suggest psychological

problems. She is above average in intelligence, and she

completed two years of college before marrying. Her

friends all characterize her as devoted to her family. Of all

her features, those that seem to describe her best include

her strong sense of responsibility and a capacity to get

things done. She has always been a“coper.”She can con-

tinue to function effectively despite a great deal of per-

sonal stress and anxiety. She is a warm person, yet not one

to wear her feelings or her troubles on her sleeve.

She recently enrolled in a night course at the local

community college. In that course, the students were

asked to write an“existential”account of their inner-

most selves. The psychologist who taught the course

was surprised to find the following excerpts in

Cynthia’s account:

“In the morning, I often feel as if I cannot make it

through the day. I frequently experience headaches

and feel that I am getting sick. I am terribly frightened

when I have to meet new people or serve as a hostess

at a party. At times I feel a tremendous sense of sad-

ness; whether this is because of my lack of personal

identity, I don’t know.”

What surprised the instructor was that none of

these expressed feelings were apparent from Cynthia’s

overt behavior. She appeared confident, reasonably

assertive, competent, in good spirits, and outgoing.

The Case of Kwame G.

In the course of a routine screening report for a

promotion, Kwame was interviewed by the per-

sonnel analyst in the accounting company for

which he worked. A number of Kwame’speersin

the office were also questioned about him. In the

course of these interviews, several things were

established.

Kwame was a very self-confident person. He

seemed very sure of his goals and what he needed to

do to achieve them. Although hardly a happy-

go-lucky person, he was certainly content with his

progress so far. He never expressed the anxieties and

uncertainty that seemed typical of so many of his

peers. There was nothing to suggest any internal

distress. Even his enemies conceded that Kwame really

“had it together.”

These enemies started to become quite visible as

the screening process moved along. Not many people in

the office liked Kwame. He tended to use people and

was not above stepping on them now and then to keep

his career moving. He was usually inconsiderate and

frequently downright cruel. He was particularly insensi-

tive to those below him. He loved ethnic humor and

seemed to revel in his prejudices toward minority groups

and those women who intruded into a“man’sworld.”

Even at home, his wife and son could have reported that

they were kept in constant turmoil because of his

insensitive demands for their attention and services.

DIAGNOSIS AND CLASSIFICATION OF PSYCHOLOGICAL PROBLEMS 135