PSY

The Case of Estelle Estelle is a 19-year-old Hispanic woman who was raised in Puerto Rico but came to the United States as a 14-year-old. She was raised as a Catholic and remains very devout, attending church on a regular basis and observing all of the holidays. She is 5‟5” tall, weighs 148 pounds and is pleased with how she looks. Estelle wore slacks, high-heeled shoes and a long-sleeved shirt to her first visit. This was typical attire for her no matter what the weather. Estelle made fair eye contact and seemed very intense during the sessions. She rarely smiled and seemed on the verge of tears at times but she never really cried during the sessions. She wore a fair amount of eye shadow and lipstick and carried a CD player. She spoke with a slight accent and sat with a defensive posture throughout the earlier sessions. Estelle is a freshman at a community college and has no idea what to major in or what to do with her life. She presently works at a hair salon. Estelle described her reasons for coming to the clinic. “It was a bad day at the salon. My boss yelled at me because a color treatment went bad on a regular. Somehow I used the wrong mix and it came out too reddish. I was yelled at and sent home for the rest of the day. Of course my dad happened to come home early and he found me and yelled at me and asked if I was fired. I mouthed off at him and was sent to my room with no dinner. My mom as usual sided with him and further grounded me for the weekend. Can you believe stuff like this for a 19-year old? Anyway, I decided not to go in the next day so I stayed home and did a lot of thinking. I was tired of the abuse, tired of not finding the right guy, tired of my life. You know how they say I was sick and tired of being sick and tired of all of this cr**? I was.” Estelle then decided to do something about these feelings. In the past she cut herself on her arms and legs but had no intention of doing major damage or of taking her life. This time she wanted to do something more dramatic. “I wanted to do something but I was not sure if I wanted to kill myself. I figured if I really hurt myself the pain would vanish and my family would finally apologize for the way they treat me. So I went to the kitchen and found some Drano. I swallowed it and it did hurt like nobody‟s business. I freaked out and called 911 immediately, since I realized something was really wrong here. They arrived quickly with an ambulance and took me to the hospital to pump my stomach.” The paramedics told Estelle not to make herself vomit. Drano, if vomited back up, could cause as much damage coming up as it did going down. Her parents arrived at the hospital and were beside themselves with worry and remorse. Estelle told us this was the first time she saw her father crying. “For once they had nothing mean to say to me. My dad wanted to know what went wrong and how, and what they could do to fix it.” The hospital kept her for a longer period of time, made a complete evaluation and placed her in group and individual therapy. “I told work I was sick and would be out for awhile and they

understood completely. The incident of my messing up a client‟s color was not mentioned. It was wild. All of a sudden everyone couldn‟t be nicer to me and they felt sorry for me.” Once Estelle was discharged she went home and returned to work Estelle has two older sisters, 24 and 21, and one older brother, 27. Estelle is the youngest. “I‟m often treated like the baby. Everyone always watches out for me.” Her mother recently returned to work as a secretary for a large company; her father has worked for the past 5 years as a superintendent in a large apartment building. Estelle still lives at home; her other siblings are all out of the house. “But you need to know that they all live very close to my family and to me, no more than 20 minutes away. We believe in being close, sometimes too close.” Estelle had an unremarkable childhood, reaching all of her developmental milestone at the age-appropriate times. She had her first sexual experience at age 16 with a man who was 10 years older. “I made a mistake and realize it now. It‟s okay to have sex when you love someone even if you are not married to him. He never loved me; he lied to me to get me into bed. I felt like a jerk.” In school Estelle‟s grades ranged from C+ to B-. She graduated with a C+ average “because I have this tendency to think in Spanish while I‟m trying to speak English, and I get confused. My writing is not good. We also do not speak English at home. But that‟s not really an excuse. I was not the best student. I didn‟t take school seriously.” She could not decide whether to go on to college or not, but her family convinced her to go. Her siblings were all either employed or home taking care of their children, but none of them had a college degree. Estelle “would be the first; I also was not really ready to go out and work full time right now.” Estelle eventually took a job in a hair salon. “I do nails and hair. I went to beauty school and I‟m a trained beautician so they let me do the cutting and coloring. It‟s actually a lot of fun and I made some contacts through the shop. For example, there was Harry…..” Harry was an agent for a local modeling company who told Estelle that she had “the look” to be a professional model. She signed a limited contract and did some work for local newspapers and advertising circulars. Harry promised that she would graduate to bigger and better things. Whether or not this was true, Estelle finally felt good bout herself and decided that she was good enough to get a college degree. “I never really liked myself. My dad would always tell me I was a nothing, and that I would not amount to anything, that I would end up pregnant at a young age because I didn‟t take school seriously. No, he never really beat me. He hit

me a few times but he always apologized afterwards for that. He was just mean to me, verbally abusive, and that really hurt. No matter what I did I could never win with him. After hearing this cr** for so many months I just snapped.” Thus, at age 14 Estelle cut her wrists and arms repeatedly and waited in the bathroom for her parents to come home that evening. When they arrived “Wooo, were they surprised! I felt like I made my dad pay for all the abuse. Now look at your little girl with her arms all sliced up. What do you think of that?” Her parents immediately called the police, and they took her to the emergency room of the local hospital. Her arms were treated (All of the cuts were superficial. They would leave scars but no permanent damage was done) and she was kept 72 hours for observation. Once it was determined that she was not a threat to herself she was discharged. “It was odd because they really did not do too much to me. They asked me a bunch of questions and told me that I would be staying there for awhile. The only thing they kept asking me was „Did I really want to off myself? I told them heck no! I just wanted my family to realize how much they would miss me if I DID really do it. But you can guess what happened next.” Can you? When they arrived home from the hospital Estelle expected her family to be upset. Her entire family was there and they all screamed at her, telling her that she was an idiot, especially after everything her family had done for her. “The worst was my dad. He sent me to my room right before a family dinner; that really hurt. He also hit me …only once…in the face and I got a black eye. He was really mad at me, telling me how scared he was and how my little „trick‟ cost him a fortune. Things just seemed to get worse after that for me.” Estelle began withdrawing from everyone and would periodically cut herself, again not with the intent to kill herself. “I wanted to hurt myself. I don‟t really know why. It was like I couldn‟t stop.” She then showed us her legs. “You see, I needed to stop with the arms because it was too obvious. I switched to my legs because it‟s easier to wear long pants in the summer. The cuts are not too deep, just enough to burn and hurt.” Estelle‟s grades also began to drop in school. She experimented with alcohol and cocaine and began to have strange mood swings. “I would just have these emotional outbursts for no reason, no matter who was there or what they said.” Estelle was about to turn 16 and had been seeing her boyfriend for 8 months. Her parents were furious and forbade him from entering their house. Right after Estelle had intercourse with this man she dropped him and “went crazy with guys. I would have many short relationships but real intense. We‟d have sex the first date, see each other as often as we could and then after a month or so I would dump him and move on to the next. The pattern stayed the same, never longer then two months for any guy. And always sex, no matter what I felt. I would have sex, fall in love, and then get sick of them so fast I‟d dump them. This was causing me trouble though.”

Her parents were called into school because her grades were getting too low. The guidance counselor blamed it on home problems and Estelle being boy crazy. Drug usage was never discussed. Estelle‟s parent‟s severely restricted her behavior, forbade her from seeing any more boys, and required her to stay at home on the weekends until her grades came back up. “My grades eventually got better but I really hated my parents now. They were trying to ruin my life.” Estelle graduated high school and went to beauty school as soon as she could, never really having the intention to continue her education. She still lived at home and still suffered from the verbal abuse of her father. She was also seeing guys as often as she could, and the volatility of these relationships did not change. Finally, one day she had enough, which led to her swallowing Drano and eventually to see us. Estelle reported no history of mental illness in her family, and also reported no history of drug or alcohol abuse. She emphatically stated that she was clean and that she only “experimented” with cocaine and alcohol and never got in trouble because of her usage. All the drug screens performed at the hospital came up negative, so Estelle was being truthful here. Investigation into the hospital‟s case notes also confirmed the absence of mental illness in her immediate family. What did arise in the ninth session was the fact that her maternal great-grandmother was hospitalized for the treatment of “depression I think, but I think, but I‟m not so sure. Hispanics tend not to talk about these things. It‟s kept in the family, but I think something went on there.” Estelle told us that when she was a young child she never seemed to get much attention except when she did something wrong. Her school projects were never displayed at home, and she was sure her family favored her brother. He was the oldest, and her father was especially close to him and was very proud he was male so he could “lead” the family once her father passed on. In many cultures and societies women are seen as not being equals to men. They do not get as much attention and they are not expected to be successful career-wise.