Sheila Jackson Psychological Disorder

Shameless is a U.S TV show that has quickly gathered a cult-like following. The show focuses on a family, the Gallagher’s, and their fight to survive in the Southside of Chicago. The father is an alcoholic and relies on schemes to make money, forcing the children to learn to fend for themselves and rely on their friends in the neighborhood. One of these friends is a middle aged woman named Sheila Jackson, and it is very clear from the first time her character is introduced that she is definitely abnormal and has trouble functioning. Sheila suffers from Agoraphobia, fear and avoidance of situations which causes a person to feel unsafe. (Durand & Barlow, 2016) In Sheila’s case, her agoraphobia causes her to be unable to leave her home. This causes

Sheila to be unable to leave her home at all, and induces panic attacks when she tries. Sheila’s disorder greatly impacts her ability to function daily, and causes extreme distress in both her and her friends and family. This paper will explore Sheila, her personal history, and how she meets DSM-V criteria for Agoraphobia, and the types of treatments she might encounter as a psychological patient.

Biopsychosocial Assessment
Identifying Information:

Sheila Jackson is a middle aged (date of birth July 16th, 1970), Caucasian female with brown curly hair and blue eyes. She currently resides in the Southside of Chicago, Illinois, where she has lived all of her adult life, although she originated from Naperville, Illinois. Her daughter Karen referred her for psychological assessment.

Family History:

Mrs. Jackson lives in a two story house in the Southside of Chicago with her immediate family. She is married to Eddie Jackson, a clown obsessed, extremely religious postal worker. She also lives with her teenage daughter, Karen. Karen is a troubled teen, who is greatly affected by her mother’s disorder. She lashes out frequently, tattooing her body and skipping school, and is eventually caught by Mr. Jackson having sex in the family home, which drives Mr. Jackson to leave his family and eventually commit suicide by plunging himself into a frozen lake with bricks tied to his feet. Mrs. Jackson is unaware of his death though, and searches for him for months before his body is found. Before his death, both Mr. Jackson and Karen urge Mrs. Jackson to seek psychological help, as her agoraphobia is wreaking havoc on their daily lives.

Along with her immediate family, Mrs. Jackson is extremely close with the Gallagher family that lives down the road. Her daughter is close friends with the children in the family, and Mrs. Jackson eventually is involved romantically with the father, Frank Gallagher. The entire Gallagher family also urges Mrs. Jackson to seek treatment, as they are concerned about her welfare and her ability to live a normal life.

Interpersonal and Romantic History:

As stated above, in the initial seasons of the show, Mrs. Jackson is married to Eddie Jackson. They have been married for 17 years at the start of the show and have one daughter together, Karen. Despite the long marriage, their relationship is tumultuous, and they often have explosive arguments in front of their daughter. Mr. Jackson cannot understand Mrs. Jackson’s condition, and is seen many times calling her crazy and psychotic. Their aggressive arguments cause a huge strain in their relationship, and in their relationship with their daughter. After Mr. Jackson’s suicide, Mrs. Jackson becomes romantically involved with Jody Silverman, a tattoo artist and recovering sex addict that Sheila meets at sex addict anonymous. Although Jody ends up fathering her daughter Karen’s baby, him and Mrs. Jackson briefly date. After this relationship, Mrs. Jackson becomes involved with and later marries Frank Gallagher, although she leaves him in season five.

School/Career History:
Mrs. Jackson graduated with her high school diploma in 1988. She did not pursue higher education. She relies on her partners for income, although in later seasons she gets a job as a part time caretaker of a disabled nun.

Strengths and Resources:
Mrs.

Jackson lives in the southside of Chicago, which can prove to be a very rough neighborhood. They do not view mental illness well, and have likely never encountered a person with a psychological disorder as severe as Mrs. Jackson’s. Despite this, she does have some resources around her to assist her in recovery. The Gallagher family is a major resource for her. They support and love Mrs. Jackson and wants what is best for her, and state multiple times that they will do what they need to do to help her. This also applies to her daughter Karen, another resource who is willing to help Mrs. Jackson get better. She also some internal strengths that will prove to be helpful. Her kindness towards others drives her to seek help because she cannot be there for her friends and family like she should be. Along with this, her willingness to get better will prove to be an

asset.

Symptoms and Diagnosis

Presenting Problem(s):
Mrs. Jackson presents with a severe phobia of leaving the house. When asked about it, she said, “I am unable to leave my house. This leads to a large strain in my relationship with my husband Eddie and my daughter Karen. I am constantly missing school events for her and it is causing her to react negatively towards me.” Her inability to leave the confines of her house is affecting many aspects of her life, including occupation, family, and friendships.

Symptoms:
Mrs. Jackson experiences extreme anxiety when thinking about leaving the house. When she makes any actual attempts to step outdoors, her heart rate increases, her breathing becomes rapid and ragged, and she begins to shake uncontrollably. If she does not return to the house, it escalates into a full panic attack. This causes her to feel very distressed, along with her friends and family. It is also very dysfunctional. She is missing out on life events for her daughter Karen, and it creates a large rift in her marriage. She can’t go grocery shopping or run errands, causing dysfunction in the household.

Potential Diagnosis:
I believe that Mrs. Jackson has a case of Agoraphobia. According to the DSM-V, in order for a person to be diagnosed with this disorder, they must fit all 6 criteria. (American Psychiatric Association, 2013). A person has to have a marked and disproportionate fear when confronted with at least two different situations. In Mrs. Jackson’s case, she fears open spaces, crowded areas, and leaving the confines of her home. A patient must also have an immediate anxiety response when exposed to the stimulus they have a phobia of. In Mrs. Jackson’s case, she has a panic attack during exposure. Mrs. Jackson also recognizes that her fear is disproportionate, the third criteria. Along with this, she displays avoidance behaviors that disrupt normal routines and other aspects of her life. Her symptoms have been recorded for longer than six months, and she has no other underlying condition that can explain her symptoms. Because she fits all six of the criteria, I believe that a diagnosis of Agoraphobia is fitting for Mrs. Jackson, and will allow her to get necessary treatment in order to live a more full and normal life.

Differential Diagnosis:
When looking at Mrs. Jackson’s symptoms, I originally came up with a differential diagnosis of Panic Disorder. After further research and looking at the DSM-V for this disorder, I realized that Mrs. Jackson does not fully fit this diagnosis. Although she does meet most of the criteria, her panic attacks are not unexpected or spontaneous, as stated in the DSM-V. Rather, they are elicited by her exposure to open spaces and leaving her home. Because of this, Panic Disorder does not fit Mrs. Jackson.

Treatment Plan

Evidence Based Practice #1:
My first treatment recommendation for Mrs.

Jackson would be to undergo Cognitive Behavioral Therapy (CBT). CBT is a method of psychotherapy that looks to treat psychological disorders by implementing modifications that change dysfunctional thoughts, emotions, and behavior. (Zalyte, Neverauskas, & Goodall, 2017) CBT is the most commonly used and most effective treatments for Agoraphobia. (Gloster, Wittchen, et al. 2011) In this case, therapist guided exposure during CBT will prove to be Mrs. Jackson’s best option. Self-exposure to their trigger can be difficult for phobia patients, and they will often activate avoidance behaviors which can interfere with their progress through treatment. The presence of a therapist can help to counteract this. (Hahlweg, Fiegenbaum, Frank, Schroeder, & von Witzleben, 2001).The therapist’s role in this case would be to reassure Mrs. Jackson about her safety, and identify safety behaviors that Mrs. Jackson can utilize to ensure that she is secure, such as carrying a cell phone for emergency purposes. The therapist’s feedback can help guide Ms. Jackson and promote more effective behavior by providing modeling and verbal instructions. I would recommend setting up a daily plan that included gradual exposure to the world outside of the home, with small steps being taken until Mrs. Jackson is more comfortable and can make larger and larger advances into the outside world. The therapist’s presence will help keep her accountable, and ensure that she is

actually following her treatment plan and can adjust her daily regime as necessary.

Evidence Based Practice #2:
Along with CBT and therapy guided exposure, I would recommend that Mrs. Jackson be prescribed antidepressants. In a study done by Castro, Sanchez, et al. in 2013, CBT was coupled with antidepressants, while the control group received no medications. (Castro, Sanchez, et al. 2013) The experimental group had a higher success rate and retention rate in CBT, and had longer lasting results. In this case, I would recommend selective serotonin reuptake inhibitors, such as Prozac or Zoloft. These will work to increase serotonin levels in the brain. Standing alone, antidepressants will probably not make that large of a difference, but coupling them with CBT will prove to be effective for Mrs. Jackson.