1
Wiegand
The Aviator: The Story of Howard Hughes
Michael Wiegand
Longwood University
Pledge _____MSW______
Client and Demographics
The clients name is Howard R. Hughes Jr. He is a Caucasian Male standing at 6,4ft with brown hair and brown eyes.He was born on December 24th, 1905 to his parents Allene Stone Gano and Howard R. Hughes, Sr in Houston, Texas. Both of Howards Parents died before he turned the age of 20. He was born and stayed Methodist throughout his life. He attended private schools throughout his early life then attended California Institute of Technology and Rice University until he dropped out in 1924. Howard Hughes married twice in his lifetime, first to Ella Botts Rice (m. 1925-1929) then to Jean Peters (m. 1957-1971). He was an avid aviator, director, and business owner until the day of his death April 5th 1976
Diagnosis
Mr. Hughes Primary diagnosis was Obsessive-Compulsive Disorder (OCD). Along with OCD Hughes also suffered from Mysophobia (Afraid of germs), Allodynia, and an addiction to codeine (as a result from Allodynia). Most of his symptoms were interrelated and caused him to become reclusive later in life.
Problem List/Background Information
It is believed that Howard gets his OCD and Mysophobia actions and tendencies from his mother. His mother was so afraid of him getting sick that she would check him everyday after he got home to make sure he wasn’t sick, and or getting sick. This caused Hughes to go to the extreme with making sure he would not get sick. He was noted saying to Jean Peters his former wife “No, wait! Honey, you can't move! You can't move, you're safe here! You're in the germ-free zone now, y'understand?” (The Aviator, 2004, Warner Bros. Pictures) This showed a clear-cut example of Mysophobia. As well as showing Mysophobia it showed how it impaired his functioning in daily living as he asked his wife not to move for fear of her getting germs. Other examples of his Mysophobia go from excesses such as writing a manual to his staff on how to open a can of peaches to avoid germs, and only picking up/ touching things with tissues. His Mysophobia easily was induced by his growing OCD.
This is believed to worsen for him later in life especially when he gained more wealth. His wealth influenced his OCD and allowed him to be as particular and as organized as he demanded. An example of theexactness he required was particular with food such as“I want ten chocolate chip cookies. Medium chips. None too close to the outside.”(The Aviator, 2004, Warner Bros. Pictures) This showed how his obsessions would be more than just a thought as he ordered things down to the very placement of them. Throughout his life he displays some of the most extreme and most obvious signs of OCD. Some more signs of his OCD would be he could only eat peas of certain sizes and only with a special fork. He required his staff to open doors with 6-8 tissues and cabinets with 15. His wealth played a huge role in his mental illness because with him being a billionaire he could demand whatever he wanted. At one point he ordered 350 gallons of banana nut ice cream from Baskin Robbins and was noted as only eating that.
Howard Hughes was in a plane crash in 1946 that only worsened all of his behaviors. He is noted as having Allodynia, which caused the slightest touch to be painful for him. That is why he was noted for not wearing clothes in his reclusive lifestyle after. In response to his pain he attempted to cope with codeine. He then grew a dependence on his codeine and also inclined his reclusive lifestyle.
He was well aware of his social status and would often flaunt his extravagance and madness such as “I'm not a paranoid deranged millionaire. Goddamit, I'm a billionaire.”(The Aviator, 2004, Warner Bros. Pictures) This showed a conscious awareness of his issues but proceeded to think his money was the focus versus his issues. He would often resolve business issues with other companies by buying them out or by owning them. This seemed to be an underlying social issue he had that also led to his seclusion.
Treatment Recommendation
Due to his deteriorated condition and extreme decline in health Hughes would need at least a month of inpatient care in a mental health hospital. This is mainly because he is an immediate danger to his self but not to others. His self-danger is mostly due to nourishment and eating habits (refusal to eat certain foods). When admitted to inpatient he would need extreme care because of his instability mentally and physically. After this he would need to receive residential treatment because he would be deemed unfit for home living. This is because we don’t want him to revert back or be in a setting that would cause him to relapse back to his reclusive state. He would require pain medication for his Allodynia and Zoloft for the OCD. This type of treatment would ne necessary until the overseeing Physician deems fit for at home living. This could take from 6 weeks to 9 weeks of therapy.
Types of therapy that would be used would be exposure therapy, cognitive behavioral therapy, and recreation therapy. The exposure therapy would be to get rid of pre-existing cognitions about germs and methods. Used with exposure therapy would be cognitive behavioral therapy from the psychologist. The types of things to expect from these facilities in terms of therapeutic recreation would be expecting lots of release/ stress relief classes. Because the facility he would be at would be more serious and controlled TR programs are going to be more about feeling free and or focusing on expressing oneself.
Client Strengths and Weaknesses
Howard Hughes / Strengths / WeaknessesCognitive / Extremely intelligent, very goal oriented, enjoys putting things together, inventing, creating things. Likes to be constantly engaged in something brain stimulating. / Unfortunately overpowered when it comes to his OCD. Lets OCD interfere with projects, methods, and daily routine.
Physical / Has full body functioning. / Extreme pain all over body due to past plane crash. Lets obsessions become dominant role of physical life. Low nourishment due to past diet habits and extremely underweight.
Emotional / Relatively in control of emotions. (No violent outbursts) / Suffers from loss of parents before the age of 20. Caused issues in later relationships along with other disorders
Spiritual / Methodist. / Does not have a regular spiritual practice.
Social / Able to clearly communicate issues and concerns with individuals. / Reclusiveness in previous years has caused him to socially decline. Needs to be reintroduced to current social standards and how to go about social situations properly.
Goals and Objectives
Goal 1: To increase functional leisure skills
Objective 1.1: The patient will attend one new recreational program per a week throughout the inpatient service.
Objective 1.2: The patient will find two new hobbies, outside of inpatient, to attend after the inpatient service.
Objective 1.3: The patient will identify his or her own valuable leisure skills by the end of the inpatient service as judged by the recreation therapist.
(Melcher, 1999)
Goal 2. To increase social interaction
Objective 2.1: The patient will participate with other peer’sin-group settings actively as judged by the recreation therapy.
Objective 2.2: The patient will attend two group programs per a week throughout the inpatient service.
(Melcher, 1999)
Goal 3. To decrease obsessive compulsive behaviors
Objective 3.1: The patient will only wash hands once for a maximum of 45 seconds after using the restroom.
Objective 3.2: The patient will not repeat tasks/verbal sayings by the end of the inpatient service, as judged by the recreation therapist.
Objective 3.3: The patient will undergo exposure therapy five times a week throughout the inpatient program.
(Melcher, 1999)
Therapeutic Recreation Intervention:
With Recreation Therapy the recommended course of action would be expression therapy (Art therapy, empowerment groups, dance, music, and movement therapy). All should be done along side cognitive behavioral therapy and exposure therapy.This is because we want the individual to take this energy and this focus into different aspects of their life. Research shows that expressive therapies are important for clinical outcomes, reducing stress and anxiety, and overall well-being. (Mcclean, 2016)
To date Howard’s leisure has consisted of aviation and filmography. For HowardHughes specifically a hobby centered on planes or plane modeling would be therapeutic as well since he noted flying was when he would feel away from his issues. He stated, “I want to be remembered for only one thing – my contribution to aviation.”(The Aviator, 2004, Warner Bros. Pictures) This shows just how committed he really is to this passion so it is crucial to incorporate. Incorporating aviation as a hobby into other categories (aviation history, model plane building) would give him a sense of purpose and activity to put his creativity and energy into. It would as well help him overcome his late fear of flying after his accident (Bor & Hubbard, 2006)
Filmography is another passion of Howards, so a film appreciation group and or movie group can prove to be a successful intervention. This if, done correctly, as a group will provide social support as well as helping the Howard understand his illness is something he can work with and overcome (Wedding, Boyd & Niemiec, 2005). As well being a great therapy tool filmography will outlet to his passion for films and movies.
Storytelling would be another possible intervention for OCD, as it would help with socialization and expression. It would also be good for the overall outcomes and well being of Howard. (Weg, 2011)It is recommended that he stay in these programs until his release from residential care.
Evaluation/Program and Client
Program Evaluation
. Observation of OCD interference in daily routine.
. Monitored tracking of goals and objectives being reached before and after programs.
. Survey of effectiveness of programs to participants.
. Adaptations to programs based on needs.
Client Evaluation
. Check to see progress towards goals and if it’s happening in a reasonable time.
. Revise goals based on social expectations and client expectations.
. Client satisfaction should be assessed in correlation to meeting of goals.
Discharge/Aftercare
. If Treatment is effective then the individual should begin traditional outpatient care
. Psychiatrist seeing Howard determines length of traditional outpatient care.
.If an active leisure lifestyle is maintained then no need for a CTRS after discharge.
.Howard should continue an active leisure lifestyle participating in leisure activities once a day for an hour each day.
References
(2016). Retrieved 7 April 2016, from
The aviator. (2004). Warner Bros. Pictures.
(2016). Retrieved 7 April 2016, from
Howard Hughes Biography - life, family, childhood, death, school, mother, information, born, drugs, movie. (2016). Notablebiographies.com. Retrieved 7 April 2016, from
Lawrence, K. (2015). The Eccentric Life of Billionaire Howard Hughes. My First Class Life. Retrieved 7 April 2016, from
How is OCD Treated?. (2014). International OCD Foundation. Retrieved 7 April 2016, from
Bor, R., & Hubbard, T. (2006). Aviation mental health. Aldershot: Ashgate.
Wedding, D., Boyd, M., & Niemiec, R. (2005). Movies and mental illness. Cambridge, MA: Hogrefe & Huber Publishers.
Weg, A. (2011). OCD treatment through storytelling. New York: Oxford University Press.
(2016). Retrieved 7 April 2016, from
Melcher, S. (1999). Introduction to writing goals and objectives. State College, PA: Venture Pub.