106 CHAPTER 3
he drank so much and so chronically that when he stopped drinking he developed
delirium tremens (also known as the DTs)—withdrawal symptoms marked by
hallucinations and shaking. He clearly would have been diagnosed as having alcohol
dependence (disorders related to the abuse of and dependence on alcohol and other
substances are discussed in Chapter 9).
We don’t know whether the tall tales he told about himself were delusions or
merely attempts to make himself look good in his own eyes and those of other
people. Based on Jeannette’s descriptions of her father, it appears that Rex also
strove to be the center of attention. This pattern of self-centered behavior suggests
that he may have had a personality disorder (specifi cally, what is known as nar-
cissistic personality disorder, discussed in Chapter 13). Several other personal-
ity disorders might also be appropriate diagnoses, including paranoid personality
disorder, given his frequent statements about the FBI and unions being after him
or against him, and antisocial personality disorder, given his frequent disregard
for the rights and safety of others—including his wife and children—and his
clear violation of the law (at one time he created and carried out a scheme to
defraud banks). Given his long history of drinking, though, it is hard to sort out
how much of his behavior arose from the effects of alcohol dependence and how
much might have been caused by an underlying personality disorder. However, the
vast majority of people who abuse or are dependent on alcohol do not develop
Rex’s other problems—and thus it’s not likely that his alcoholism can account for
these other problems.
What about Rose Mary? Based on Jeannette’s descriptions of her mother’s
diffi culties with work—her lack of motivation to work despite the family’s dire
circumstances, her diffi culty getting out of bed in the morning in order to get
to work, and her inability to complete her school-related paperwork with-
out assistance—Rose Mary may have suffered from depression. It is possible,
though, that these behaviors instead may have been expressions of anger and
resentment about feeling forced to work when her husband was so irresponsible.
She was bitter that she hadn’t become a famous artist and blamed her lack of
success on her children. In addition, given her own preoccupations with her
worth as an artist, even as her children were starving, she may well have had
narcissistic personality disorder.
However, again we need to be cautious: No mental health clinician can know
with certainty what, if any, specifi c disorder Rose Mary or Rex Walls may have
had. We cannot make a direct clinical assessment of neurological, psychological,
or social factors; we can only infer such factors from their daughter’s account,
which does not provide the kind of information needed to make an accurate
clinical assessment.
Clinicians and researchers diagnosing and assessing patients should keep in
mind the possibility that symptoms of a psychological disorder can arise from
medical problems. These medical problems can range from a brain tumor, stroke,
or hormone imbalance to a condition like anemia, the symptoms of which may
overlap with those of depression. For Rose Mary and Rex Walls, it’s possible
that malnutrition (and for Rex, the effects of chronic heavy drinking) adversely
affected their psychological functioning. Therefore, patients should obtain ap-
propriate medical evaluations to ensure that their psychological symptoms are
not caused by a medical problem. Only after ruling out medical illnesses can the
mental health clinician or researcher have confi dence in a diagnosis of a psycho-
logical disorder.