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H-3.1: CASE STUDY #2

I. “N” was a displaced person, living in a small apartment in Phoenix. He had left his country to find the happiness and wealth that had eluded him there and in several other countries in which he had temporarily settled. He believed the United States would become his adopted home. English was not “N’s” original language. He spoke English well, some French and some German. His job as a cab driver afforded him sufficient income to furnish a 3-room apartment with some of the trappings of his original culture. Something was missing. He found himself feeling more than alone; he was lonely. He knew where other displaced people from his country often congregated for food and companionship but did not make use of this knowledge. He worked long hours and was physically weary at the end of his workday but was unable to sleep soundly and usually awoke unrefreshed. Disruptions in his country of origin had scattered his family, and his connections to kin had been disrupted even before he left. He found it difficult to trust people he came in contact with both on and off the job. He was wary of passengers that used his cab, always expecting the worst from them. His appetite had deserted him within the past few months and he ate meals at erratic times, sometimes missing one meal or more. He always ate alone. His connection to an organized faith had been severed while still in his country of origin. He did not make efforts to reestablish it in Phoenix.

“N’s” sleep, what there was of it, was often troubled by unsettling dreams. People from his past often populated them and were often physically harmed or damaged before the dream had ended. The dreams did not have a nightmare quality but were negative and unsettling. Lately, in an effort to sleep soundly, “N” had purchased sleeping pills from another cabbie that he knew slightly. He found some relief with them, but over time was in need of more pills on any given evening to fall asleep. His mood with passengers would sometimes turn cold and distant, more so than his usual manner of formal politeness. He noticed this on occasion and considered it peculiar since he knew none of them well enough to dislike them.

II. “N” now found it difficult to get more than four hours sleep per night. It reminded him of the same difficulty he had as a child. At that time his parents split up and for a time he was unsure where he would be living. Relatives had always been present during much of his childhood. However, with limited job opportunities and a weak economy, they had all moved away in order to seek employment. He could remember the uncertainty and loneliness he experienced at that time in his childhood.

He had heard of doctors who had settled here from his country who were said to be helpful, but had not sought them out. One or two other cab drivers, also from his country, had consulted with them and had expressed satisfaction with the results. He had heard people on help-oriented radio and television programs speaking of help received from one practitioner or another, or one therapy or another, but was not sure he could be helped.

III. Over time, his difficulty in sleeping soundly, lack of appetite, and general malaise made it difficult for him to complete his shift. He also found himself unable to take advantage of overtime opportunities that often became available. He had several close calls on the road and became frightened he would cause an accident through inattention. He saw a doctor recommended by one of the cabbies he worked with. The doctor knew of a mental health agency that he had good experiences with and set an intake appointment with one of their assessment staff for the following week.