THEORETICAL FRAMEWORK
LEVEL 7: CATASTROPHIC CRISIS
Case Example
A young bisexual woman in her mid-30s was admitted to a psychiatric hospi- tal following a serious suicide attempt. A number of stressful events had oc- curred over a 3-month period. She began drinking heavily when her partner moved out of her apartment; she had a car accident during a snowstorm; later her car was stolen, and she began “drinking around the clock.” She could not control herself and took a leave of absence from her computer analyst job. She was hospitalized briefly at the local psychiatric hospital. Three weeks after that hospitalization, one evening she was drinking with a man she met at a bar. He drove her home, and they continued drinking in her apartment. The man wanted sex, but she refused, and he forced the situation. After he left the apartment she called a friend to take her to a local hospital, where a rape examination revealed vaginal lacerations. On returning home, the woman continued drinking and, while intoxicated, slashed her wrist with a broken glass. She again called her friend, who took her back to the hospital, where she received 10 sutures; later she was transferred to the psychiatric hospital.
The next day the woman requested discharge against medical advice. She returned to her apartment and went on an extended drinking bout for another 6 weeks, during which she was also very suicidal. About the time she brought a legal suit against one of the male patients and the psychiatric hospital for simple assault, blood tests revealed that she was HIV-positive.
Level 7 has two or more level 3 traumatic crises in combination with level 4, 5, or 6 stressors. Classifying an individual into one of the preceding levels of crisis is dependent upon the nature, duration, and intensity of the stressful life event(s) and one’s perception of being unable to cope and lessen the crisis. Sometimes a crisis is temporary and quickly resolved; at other times it can be life-threatening and extremely difficult to accept and resolve (e.g., having AIDS or a multiple personality disorder, or losing all family members due to a disaster).
In summary, the lack of an up-to-date classification model for determin- ing levels of emotional crises has resulted in a significant gap to advancing the development of crisis theory. The revised and expanded Baldwin (1978) crisis typology is presented to increase communication between therapists and other crisis care providers in clinical assessment, treatment planning, and continuity of health care within a managed care context.
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