Intellectually, this man is functioning within the
“bright normal”range of intelligence, but at a consid-
erably lower level than previous assessment has indi-
cated. In normal circumstances, he thinks carefully and
logically (though unimaginatively), and is capable of
sustained intellectual efforts. At the present time, he is
easily distracted by intense inner experiences. Strong
affect and mental images of unpleasant recent events
appear to intrude on his problem-solving efforts and
reduce his cognitive efficiency. Thus, his concentration
and memory are somewhat impaired; recognizing this,
he makes halting and ineffective efforts to overcome
and compensate. These efforts produce increased phys-
ical tension, which may account for his somatic symp-
toms. It is likely that his reality testing is somewhat
impaired under conditions of high stress, especially the
stress of perceived threats to his sense of competence or
to the welfare of others; under these conditions, his
cognitive controls may be insufficient to prevent his
becoming overwhelmed by internal or external stimuli.
There is no evidence of a thought disorder, and it is
likely that he can return to premorbid levels of func-
tioning if he receives appropriate treatment.
Mr. Ramirez’s mood is normally bland, almost stoic,
with mild expression of emotions appropriate to the sit-
uation. He rarely exhibits anger, and, indeed, generally
manages his affective experiences so as to avoid arous-
ing strong feelings in himself. He is, however, capable of
great emotional intensity, the expression of which he
views as weakness, both in himself and in others. His
greatest fear is the loss of self-control, since he believes
such control to be the prime means of attaining satis-
faction in life. Typically, he maintains control over his
emotions by avoidance, withdrawal, and denial—even at
home, where he feels less need to protect himself. He
attempts to prevent both his wife and his children from
expressing intense or prolonged affect, both positive
and negative. He is experienced by others as emotionally
insulated, but not cold or threatening.
Currently, he is reacting with unusual intensity to
mild stimuli, and there are indications that he is
experiencing acute dysphoria, with barely suppressed
rage and frustration. It is apparent that his normal
controls over affect are becoming less effective,
though he continues to deny either the existence of
strong emotion or his own inability to contain it. Since,
as a police officer, he must work in daily contact with
situations that are bound to elicit unpleasant emo-
tions, and since he will never be able to completely
protect his family from all harm, it is likely that his
emotions will intensify and that his control will weaken
further. A breakdown of control may manifest itself in
more severe somatic complaints or in hostile and
aggressive action, or in both. It is clear that Mr.
Ramirez’s current method of dealing with recently
encountered stresses is increasingly ineffective.
Mr. Ramirez is generally conforming and conven-
tional, with a need for structure and a strong sense of
morality, loyalty, and responsibility to others. He per-
forms best, and experiences a strong sense of compe-
tence and self-confidence, in situations where both
role and task are clear. He has a need to be—and to be
seen as—strong, effective, and in control. To this end,
he is planful, vigilant, persistent, and determined, set-
ting goals for himself and pursuing them in an orga-
nized manner. When difficulties arise, he tackles them
immediately, directly, and actively, and is impatient
with ambiguous resolutions to problems. On the other
hand, he demonstrates a lack of flexibility and a ten-
dency to be dogmatic and domineering, especially with
those he views as inferior or in need of his protection.
Because of his confidence and competence, others tend
to trust, rely on, and respect him, but they find him
emotionally distant and hard to know. Because of
these attitudes and behaviors, Mr. Ramirez is, in gen-
eral, a highly competent police officer.
In his personal life, both his single-minded pursuit
of goals and his refusal to acknowledge intense affect
make for a rather joyless and dogged existence. His
need to avoid appearing vulnerable and his tendency
to enjoy solitary pursuits keep him from an active social
life, and he experiences considerable discomfort in
what appear to him to be purposeless social occasions.
Only in his most intimate relationships is he able to
relax to some degree—for example, when playing with
his children. He has a strong sense of the importance of
family, and generally adheres to a traditional view of
the male’s role as provider and protector. Thus, the
recent attack on his wife was experienced by Mr.
Ramirez as a severe and multifaceted threat, calling for
immediate action. Because he had no control over the
situation and has no way to control future, similar
situations, Mr. Ramirez feels helpless and vulnerable to
a degree that is extremely difficult for him to tolerate.
Diagnostic Impressions
This man’s premorbid functioning is likely to have been
characterized by mild social phobia, a tendency to
restrict affective experiences and expression, and a
somewhat rigid personality structure. However, it is
likely that he was generally effective in daily living,
with stable work and personal relationships. Recent
changes in his affect, behavior, and cognitive func-
tioning appear directly related to several severe(Continued)CLINICAL JUDGMENT 305