My case report on Smeagol

Okay, for those of you who have been so anxiously waiting, here it is at last (huh? whatever). I wrote a case report on Smeagol for my abnormal psych class this quarter. I had to diagnose him with something from DSM. He ended up with schizotypal personality disorder. We had to do a made up case report--it was supposed to be totally made up, where we made up the person and their history and so forth, but they said it was fine to use a fictional character from literature. It was fun. It's kind of long. Enjoy.

Sméagol: A Case Study involving Schizotypal Personality Disorder
Benjamin Ady
University of Washington, Seattle

Presenting Problems

Sméagol is a 562 year old male who comes from a large and wealthy family among the Stoor people (Tolkien, 1965b, Appendix B). He was arrested and prosecuted for stalking and was sentenced to two years probation. One of the conditions of his parole was evaluation and therapy at a private mental health clinic. During his intake appointment, Sméagol presented as an emaciated (BMI of 18.1), pale, figure who seemed to be fixated on an item which had been stolen from him, a ring which he called “my precious”. Furthermore, he appeared to have two distinct personalities, switching back and forth between them sometimes rapidly, as well as having conversations between these two identities, and referring to himself as “we” or “us”. He also exhibited a great dislike for and even fear of light of any sort, as well as some delusional thinking. Sméagol constantly expressed throughout the interview a great suspicion of the therapist and of people in general.

(Read more...)


Course and Psychosocial History

Sméagol claims to have been given a ring as a gift from his friend Déagol for his 20th birthday. He believes this ring makes the wearer invisible. Sméagol’s symptoms began soon after his acquisition of this ring. He claims to have used to it to learn people’s secrets, and became a gatherer and trader in gossip and hurtful information. He withdrew more and more from the life of his family and community, becoming something of an outcast. Finally, he was expelled from the community, which did not displease him. It was during this time as well that his dislike of light, especially the light of the sun, began.

After this Sméagol wandered alone until he finally became a solitary hermit living in the vast unexplored underground system of tunnels and caverns known to exist under the Misty Mountains. He eschewed, and continues to eschew, any and all social relationships.

Sméagol says that it was also after the acquisition of “my precious” that he began to experience himself as two personalities. “Gollum”, an unkind name which his community and family began calling him, was the dominant personality who increasingly hated and wanted to hurt other people. Gollum is also the personality that is most fixated on the ring which he says was stolen from him. “Sméagol”, on the other hand, was his original name and appears to be afraid of Gollum and under Gollum’s control.

He has been separated from his family of origin for centuries, yet it is clear that his early experiences have affected him greatly. As a bright child in a large and influential family, there were high expectations placed on Sméagol. His grandmother was the matriarch of a large extended family, and was believed to have great wisdom and spiritual power (Tolkien, 1965a, book I, chap. 2). After his acquisition of the ring, however, Sméagol found himself increasingly disliking his family and people in general, and avoiding them or taking actions to minimize or destroy relationship.

Having lived alone as a hermit for hundreds of years, Sméagol has no social support. His only relationships were those that were lost when he was expelled from his family of origin. He also seems fixated on Bilbo and Frodo Baggins, whom he claims stole and still have his ring.

Sméagol knows of no history of mental illness within his family. He has no documented medical history, and apparently has not seen a doctor in hundreds of years. There is no known record of previous mental health evaluation or treatment.


Diagnosis

Sméagol’s diagnosis is schizotypal personality disorder. His ongoing lack of any participation in, desire for, and anxiety over, any social relationships or interactions, his magical thinking about “my precious” (invisibility), his odd manner of speaking, his two distinct personalities, his paranoid ideation, his anxiety over interacting with the therapist, and his ideas of reference regarding the ring and himself all meet criteria for this disorder (Durand and Barlow, 2006, p. 442). Most of these characteristics developed during early adulthood and have persisted throughout Sméagol’s life. While both paranoid and schizoid personality disorders were considered, neither diagnosis accounted for the full range of Sméagol’s cognitive distortions and his eccentricities. Sméagol’s behavior is too clearly odd to meet criteria for delusional disorder, and his symptoms are not severe enough to warrant a diagnosis of schizophrenia. Although he does have 2 distinct personalities, he does not have the inability to remember important personal information required for a diagnosis of dissociative identity disorder. Sméagol does not appear to be depressed or have a history of depression and thus does not meet criteria for mood disorder. His emaciated state is due to lack of food availability, and not to anorexia.


Cultural Context

As a person living within the varied cultures of Middle Earth, some of Sméagol’s ideas and behaviors are bound to strike therapists in the 21st century western paradigm as odd. Nevertheless, even within his own culture, Sméagol’s ideas and behaviors are remarkably unusual and have caused him enormous social impairment over the years. The Hobbitish peoples are known to be trusting, highly social, lovers of open spaces and the sun, and generally unconcerned with the larger world. So even from his cultural paradigm within Middle Earth Sméagol clearly meets criteria for the diagnosis of schizotypal personality disorder.


Treatment

We recommend Sméagol be referred to a psychiatrist to be prescribed fluoxetine, which was found to be somewhat effective for schizotypal personality disorder by Markovitz, Calabrese, Schulz, and Meltzer (1991). We recommend continuing cognitive behavioral psychotherapy with the specific goals in mind of helping Sméagol to integrate his two personalities, and to reduce his fixation on the ring and his inappropriate stalking behavior towards Frodo Baggins.


References

Durand, D. M., & Barlow, D. H. (2006). Essentials of abnormal psychology (4th ed.). Australia: Thomson Wadsworth.

Markovitz, P. J., Calabrese, J. R., Schulz, S. C., & Meltzer, H. Y. (1991). Fluoxetine in the treatment of borderline and schizotypal personality disorders.
American Journal of Psychiatry, 148, 1064-1067.

Tolkien, J. R. R. (1965a). The fellowship of the ring. New York: Ballantine Books.

Tolkien, J. R. R. (1965b). The return of the king. New York: Ballantine Books.