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CASE STUDY 2

Case Study of Mary Tyrone’s Morphine Addiction in the film Long Day’s Journey into Night by

Jeanie Hackett

Introduction

The paper focuses on the chosen character named Mary Tyrone, in the Film Long Day’s Journey

into the Night. Mary, a fifty-four-year-old mother of two, is married to James Tyrone. Perhaps,

the film depicts the psychological impediments that Mary undergoes in her struggles with

morphine addiction. The fundamental objective of the paper is to develop conceptualization

based on the chosen character, Mary. The case conceptualization of this character will be

established from the diathesis/stress model that takes into consideration the precipitating factors

(stressors), predisposing factors, as well as the perpetuating factors. Other aspects that would be

considered include resiliency factors. The conceptualization based on these factors will

encompass the three fundamental domains of the bio-psycho-social model. Therefore, through a

proper evaluation of the character, a treatment plan for the character will be established.

Presenting problem

Mary’s present problem is her addiction to morphine which has resulted in the family

disintegration. Morphine addiction results in both psychological and physical dependence which

renders the body non-functional in the absence of the drug (Minozzi et al. 2013). Its symptoms

can be portrayed as immediate side effects on an individual health, personality and lifestyle

change. Physical symptoms include bloodshot or glazed eyes. When coming for lunch after work

Jamie notices her mother has used morphine by the looks on her eye. Abrupt weight changes;

this is clear in the film where Mary claims to have increased in weight which is not true.

Changes in personality; Mary has developed a tendency of blaming her husband and sons. For

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instance, she withdraws from her family as she thinks they are the cause of her suffering. For

example, she comes to the point of rejecting Jamie as she claims to be the cause of her son's

death. She claims that Jamie killed her son out of jealousy thus keeps away from her. She also

blames them for her loneliness. Another physical symptom is the inability to sleep. Mary is

unable to sleep but claims it’s because of her husband snoring and her worry about Edmund.

Loss of appetite. At lunchtime, Mary claims to have no appetite (Davison et al., 2014).

Under psychological symptoms, it is marked by a change in the overall attitude of

personality this characterized by impairment in personality functioning and the existence of a

pathological personality trait (Davison et al., 2014). Under pathological personality trait the

patient exhibit antagonism which is marked by chronic dishonesty and hostility. Mary kept on

lying to herself about the past and could not hide her anger from her family. Additionally, she

lied to Jamie of not consuming morphine. Another trait is disinhibition which is marked by

irresponsibility. Mary was inadequate in her role as a wife and a mother. In the film, Mary claims

that…"All I wanted was to be a wife (Gray, 2017)"… this indicates a sense of regret portraying

that she wasn’t performing her roles as a wife.

Historical Background and Observation of the character

To understand Mary's condition of morphine addiction, it is crucial to base it on her

historical background and current observation. This is well illustrated when using the

biopsychosocial model. This model suggests that for any disorder to occur there are complex

interactions involved which include biological, psychosocial, socio-environmental and socio-

cultural factors, i.e., hereditary, environmental or social factors (Davison et al., 2014). Mary's

condition was as a result of these three factors. Mary could not withhold psychological stressors

arising from his husband and children. For instance, she experienced loneliness as her husband

CASE STUDY 4

preferred the company of the bar room rather than hers. Additionally, her fellow convent friend

found her unworthy as part of them due to her choice of getting married.

Perhaps life events could have linked Mary to certain specific patterns of depressive

symptoms, e.g., angry outburst; in the film, while taking lunch, Mary angrily outburst to James

how he took her to Dr. Hardy and how he is the cause of her current condition…”I hate doctors!”

(Gray, 2017) this suggests that she was carrying a genetic diathesis for depression. Another

feature that may have resulted to her condition is psychopathology, i.e., arising from childhood

experiences, development of behavioral competences and coping techniques, stressors

encountered in adulthood, and cultural influences (Davison et al., 2014). For instance, in the

film, Mary claim that her father died of consumption. This portrays that perhaps she got her

consumption habit of morphine from his father. In her adulthood Mary is under stress of

loneliness, she claim that she even doesn't have friends that can visit him while his husband goes

to the barroom and her sons have boys to mingle with. To cope with this challenges Mary turns

to morphine.

Another risk factor that could have resulted in Mary's morphine addiction is social-

cultural variables. Research by National Longitudinal Survey of Children and Youth (NLSCY)

showed that patients with addiction were prevalent most to caregivers with consumption issues

(Davison et al., 2014). Perhaps following her father's consumption, Mary found it easy to

consume in turn her addiction. Another risk factor is psychological variables which comprise of

the effect of the drug on mood, the role of cognition, and the situation in which a tension-

reducing effect occurs. For instance, in the film, after having a confrontation with Edmund about

how everyone was spying on her Mary rushes to the spare room to use morphine (Gray, 2017).

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In this case, she uses morphine to control mood and reduce the tension that is already building

between her and Edmund.

Mary claims that her entire life has been a miserable journey into the fog of hope and

dream. She uses the fog symbolically to represent how she tries to hide from the reality (Davison

et al., 2014). Mary uses morphine to move into her idealized past and to overcome the torment of

her current life which allow her to relieve the event in her mind. In the entire movie, Mary is

portrayed as a tortured individual incapable of gathering sufficient drive to overcome her drug

use.

Diagnostic Case Formulation Based On the Diathesis Model

Mary Tyrone, a 54-year-old is a wife to James Tyrone and a mother to three sons, i.e.,

Jamie, Edmond and the deceased Eugene. Her condition was likely caused by (origin) both

etiological vulnerabilities which consist of nature and chronological factors, i.e., the

predisposing, precipitating and perpetuating factor (Minozziet al., 2013). Mary developed

mechanism schemas which were activated by precipitants worsening her condition. In the film,

her morphine addiction is marked by Edmund birth, Edmund sickness, the death of Eugene, and

loneliness. This marked her lack motivation and had self-depreciating ideas. Perhaps, it could

also have resulted from the fact that her father used to consume in spite of having tuberculosis.

Mary joins her family to go for lunch but finds Edmund holding a glass “do you want to kill

him…don’t you remember my father; he wouldn't stop after he was stricken…there is no

comparison…(Gray, 2017)" To overcome this problem, Mary turns to using morphine which has

rendered her an addict.

CASE STUDY 6

Mary’s condition can be explained by use of a cognitive behavioral case

conceptualization which comprises of three components, i.e., a hypothesis that encompasses

mechanism that results to the problem, origin of the mechanism, and the precipitants responsible

in activating the mechanism hence cause the problem (Mumma, 2011).CBT dictates how the role

cognitions play in behavior change. This portrays the importance of both behavior and cognitive

approaches to comprehending and assisting patients. Mary understood how her consumption of

morphine had an impact on both her health and family but could not let go. This indicates that

Mary was the cause of all her problems. The information garnered from the assessment is used in

the development of a formulation which marks the hypothesis of the causative agent of the

patient's illness and which is used as the basis for intervention. In CBT, the psychotherapist

repeatedly carries assessment phase to ensure that the process of treatment is flowing on

smoothly. However, CBT focuses more on the formulation phase.

Cognitive behavioral therapist depends on a number of controlled studied in the process

of her formulation, which may include a mechanism that results to the prevalent symptoms,

epidemiological findings, and randomized controlled trials (Mumma, 2011). Similarly, the

therapist relies on data from the case at hand, i.e., Mary's present addiction. This enables the

therapist to a testing formulation hypothesis. For instance use of a self-report measure of

symptoms of anxiety, or depression to track the progress of the patient during the treatment

session. In CBT patients are requested to arrive early for their therapy session in order to

accomplish all the measures used to monitor their progress which is then given to the therapist.

Treatment

Generally, addiction treatment should enable an individual to stop using the drug, stay

drug-free and be fruitful for her family and the society. Basing on the biopsychosocial model,

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illness behavior and health are considered as a product of genes, i.e., regarding biological;

lifestyle or stress when viewed as behavioral factors, and family relationships or social support in

terms of social condition (Davison et al., 2014). For instance, Marys' morphine addiction was

attributed to both biological, psychological and social state. The prescription of morphine by the

cheap doctor to relieve pain during birth acted as a biological contributor to her health. Despite

acting on her pain morphine worked on her brain making her shut reality of how the present

things were and hence thinking only on her past. She used to seek to find refuge on morphine

even when it was not a case of pain which ended up becoming part of her life.

The most effective treatment strategy to curb Mary’s morphine addiction is the cognitive

behavioral therapy (CBT) (Davison et al., 2014). Studies have indicated that cognitive and

behavioral treatment is the most effective psychological treatment for clients with addiction.

Cognitive behavioral therapy allows psychotherapist and the clients with addiction to understand

the origin, current status, and maintenance of the problem towards recovery. For instance, a

feeling of being worthless being replaced with a feeling of being worthy. CBT is marked by a

dialogue between the patient and the psychotherapist which entail three steps. These processes

aim at ensuring that the patient recovers. This includes first; the psychotherapist reinforces the

patient's effort at self-instruction. Secondly, the psychotherapist builds on the patient's initial

self-instruction and led her into challenging the notion that perfection is the only way to appease

others. Lastly, the therapist assists the patient in generating alternatives to perfection or doing

right.

CBT can further be grouped into one, aversion therapy; the client with addiction is made

nauseous while looking at the drug. Second is contingency-management therapy; this entails

educating clients with addiction and those around them on ways of reinforcing the inconsistent

CASE STUDY 8

use of drugs. For instance, use of Antabuse and avoiding situations linked to past use of drugs a

condition called behavioral self-control training.

Other forms of treatment include individual therapy; which is marked by the ability of the

client with addiction to learn and apply both the general and recovery techniques on her

situation. This method offers the patient with a safe and confidential context in which the patient

can sort out every sensitive and personal problem. Another method is providing genuine

counseling; this is essential when there is a need to facilitate a therapeutic relationship (Miller,

2014).

To facilitate effective treatment, treatment plan needs to be developed by the

psychotherapist. Treatment plan shows the progress of the patient during therapeutic

interventions (Miller, 2014). It offers information regarding the patient's behavioral strengths,

problem areas, employment status, financial, spiritual, medical, relationship, addiction recovery,

and sexuality. All this are essential and gives an overview of how to conduct therapy. However,

in the course of carrying out therapy session, psychotherapist encounter various challenges. One

of the significant challenges is the creation of a conducive relationship when conducting a

cognitive behavioral therapy with a client with addiction.

Apparently, most client tends not to open up their problem due to fear of rejection or

being judged. It is mandatory to ensure that a good relationship prevails between the

psychotherapist and the patient for a smooth therapy session (Miller, 2014). For instance, always

avoid involving the patient's member immediately and instead focus on the patient. Addition one

should be empathetic and be encouraging while listening keenly to the patient. Give a safe

judgment-free attitude that will aid in easing discomfort. Because you know the ugliness of drug,

CASE STUDY 9

in some instances one might be overwhelmed by a range of emotions, but this should be a

blockade in creating a healthy relationship.

Conclusion

In a nutshell, when considering the causative agent of substance abuse and dependence disorder,

it is crucial to know that this condition is generally a developmental process. First, the person

must first show a positive attitude towards the drug, experimentation, regular use, heavy use and

later becoming physically depended on it. This is directly linked with a diathesis-stress paradigm

which links biological, psychological, and environmental factors. Different disorders are

transmitted via different diathesis, for instance in biology it is through genetically transmitted

diathesis while in psychological it’s via cognitive set. In the film Long Journey into Night,

Mary’s condition was as a result of psychological and environmental factors.

CASE STUDY 10

References

Bart, G. (2012). Maintenance Medication for Opiate Addiction: The Foundation of Recovery.

Journal of Addictive Diseases, 31(3), 207-225.

http://dx.doi.org/10.1080/10550887.2012.694598

Davison, G., Blankstein, K., Flett, G., & Neale, J. (2014). Abnormal psychology (pp. 66-397).

Gray, J. L. (2017). Long Day's Journey into Night by Jeanie Hackett. Eugene O'Neill Review,

38(1), 156-159.

Manocchio, T., & Petitt, W. (2015). The Tyrone Family. In Families under Stress (pp. 112-138).

Routledge.

Miller, G. (2014). Individual Therapy. Learning the language of addiction counseling (pp. 103

109). Hoboken, New Jersey: Wiley.

Minozzi, S., Amato, L., & Davoli, M. (2013). Development of dependence following treatment

With opioid analgesics for pain relief. Addiction, 108(4), 688-698.

http://dx.doi.org/10.1111/j.1360-0443.2012.04005.x

Mumma, G. (2011). Validity Issues in Cognitive-Behavioral Case Formulation. European

Journal of Psychological Assessment, 27(1), 29-49. http://dx.doi.org/10.1027/1015-

5759/a000054

Spears, C., Hedeker, D., Li, L., Wu, C., Anderson, N., & Houchins, S. et al. (2017). Mechanisms

CASE STUDY 11

underlying mindfulness-based addiction treatment versus cognitive behavioral therapy

and usual care for smoking cessation. Journal of Consulting and Clinical

Psychology, 85(11), 1029-1040. http://dx.doi.org/10.1037/ccp0000229

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