Who would study psychology unless they had some issues?!
Chapter 244 - 242: There Is a Problem with This Case Sharing

Chapter 244: Chapter 242: There Is a Problem with This Case Sharing

The emotions conveyed by visuals are very direct.

For some more sensitive students, the heavily spliced images shown on the slides at this moment directly cause extremely subtle physiological responses.

Such as slightly faster breathing, or a slight lump in the throat.

The most sensitive ones have already started to feel a heaviness in the chest.

Nan Zhubin continued:

"Compared to regular depression, ’smiling depression’ poses many new issues for psychological intervention."

"Firstly, ’smiling depression’ is more difficult to detect in everyday life. Many friends, colleagues, classmates, and even family members cannot distinguish the difference between a ’smiling depression’ patient visitor and before. This makes it harder for them to accept the visitor’s real situation, consequently missing the best opportunity for intervention."

Nan Zhubin lowered his voice slightly.

"Secondly, the expressions of someone with ’smiling depression’ cannot be used as regular references during consultations. This can interfere with the consultation process. In severe cases, they may even exhibit stronger language defenses than usual, requiring the intervenor to have better insight and empathy than a regular consultant."

"This brings about the biggest challenge of ’smiling depression’—how to assess if a ’smiling depression’ person has reached ’recovery’ in a psychological sense, or to step back, how to evaluate if they can leave consultations and guardianship to live independently?"

"I will elaborate on these three questions in the case analysis that follows."

Nan Zhubin took a deep breath: "And attempt to answer them."

With the opening remarks complete, Nan Zhubin clicked the laser pointer to move to the next slide.

The image of a crying-smiling face disappeared, allowing many students to sigh in relief.

The main topic began.

First was the introduction of the visitor’s background.

"Visitor C, a sophomore at the time of the first visit, came from a well-off family and was always a ’good student’ and ’good child’. According to the parents’ description, since elementary school, C ranked among the top in the class, although there were occasional fluctuations, they could quickly recover their drive after a reminder. They were obedient, sensible in life, and almost entirely accepted their parents’ suggestions, with interests, dressing styles, and life planning all organized by the parents. Originally intending to study medicine during university, C chose the Chinese Language and Literature program on the parents’ advice."

"According to classmates’ descriptions, the visitor was amiable and helpful. Rarely did they actively participate in class duties or other group activities, primarily focusing on studying. However, they almost never refused when roommates or friends extended invitations."

It appeared to be a very standard background introduction.

Yet those who noted earlier that "all shared information had already been agreed upon by the visitor’s family" also noticed that the content displayed by Nan Zhubin at this moment was all from the observer’s perspective.

No visitor’s complaint was presented, nor was there any consultant’s first impression.

This was very atypical, even to the point of being amateurish.

Some people began whispering to each other.

...

These missing details, Nan Zhubin currently couldn’t present even if he wanted to.

The case he shared was clearly Chen Jie’s, but the files related to Chen Jie had been nearly completely destroyed by Lin Lulin.

What Nan Zhubin presented now was the result of the strenuous memories of Doctor Chen, Cheng Hui, and others.

Luckily, Nan Zhubin’s purpose today was not "case sharing"—or rather, it was not the main purpose.

Nan Zhubin continued to go through on his own: "The initial visit involved using the Symptom Checklist-90 (SCL-90) and the Self-Rating Depression Scale (SDS) to evaluate the visitor’s psychology. The SCL-90 average score was 2.3, and the SDS scored 70."

"According to the self-description, the visitor had symptoms of diminished interest and reduced energy, with additional symptoms of decreased self-esteem and self-confidence, and sleep disturbances. These symptoms persisted for more than two months, resulting in personal distress and negative consequences. Based on the evaluation results, a preliminary assessment was moderate depression."

"After the first visit, the consultant—my mentor, Professor Lin," Nan Zhubin smiled, making a point to mention, "conducted an initial assessment, established a consultation relationship, and set consultation goals. It was ultimately decided to use cognitive-behavioral therapy and medication intervention simultaneously."

"The initial drug intervention was to prescribe 5mg/day Escitalopram and 10mg/day Vortioxetine."

This part, besides the textual descriptions, included some handwritten prescription screenshots.

His storytelling method also increasingly stirred discussions below.

"What’s going on with this case sharing? Does it just end after reporting the scale scores? No interventions took place?"

"Why does it feel as perfunctory as visiting a psychiatric department in a hospital?"

"Colleague, I work in a hospital, you could explain more clearly."

"Ah... what I mean is, while cognitive-behavioral therapy intervention is standard, and the medication intervention is reasonable, where’s the detailed plan?"

"At the very least, provide some verbatim transcripts of conversations? What kind of case sharing is this?"

The professors in the front row slightly frowned at this point.

"Prescribing medications directly during the first meeting? Old Lin... I remember there was a clinic, right, where he is a shareholder?"

"Not sure whether to call him aggressive or conservative."

Even they began whispering softly to each other.

"Looking at this handwriting, it’s definitely Old Lin’s." The one saying this was the Dean of the Psychology College.

He turned to the Principal to explain: "There’s definitely a reason why Old Lin did this, maybe through consultation, he found the visitor’s situation to be more serious than the scale assessments indicated..."

...

The reactions from everyone present were exactly what Nan Zhubin wanted.

However, although the plan was unfolding smoothly, he couldn’t cheer up.

This emotion started spreading with his narration.

The consultants confused by the consultation process felt it but couldn’t empathize yet; their focus remained mostly on the anomalies in the case itself.

At the back row, Xia Tian bit her lip, clenching her fists holding the collar of her clothes, gradually tightening.

[Mr. Nan...]

On stage, Nan Zhubin continued, knowing that what followed was the crux.

"Consultations were set once per week."

"During the second and third weeks, the main goal was helping the visitor learn the principles of cognitive-behavioral therapy, assisting them in identifying automatic thoughts and realizing their own emotions. At the same time, medication dosage increased by 50% starting at the third week."

The slides moved quickly, this part brushed past lightly.

The consultants began discussing more fervently, and the frowns of the professors in the first row deepened.

"Starting in the fourth week, consultation entered the next phase—cognitive reevaluation, challenging automatic thoughts."

"This stage took a long time, spanning weeks five, six, seven, and eight."

"During the fifth week, medication dosage continued to increase, with Escitalopram raised to 10mg/day and Vortioxetine increased to 20mg/day."

This was fairly normal, as the initial period of depression prescription medication is typically at 50% of the standard dosage, gradually increasing over the following two weeks or so.

Yet, Nan Zhubin spoke so briefly, that it made it difficult for those with a medical background present to judge the necessity of such medication intervention.

Because such an increase isn’t always necessary and could suggest finding effective intervention which leads to maintaining or even gradually reducing the dosage.

At this point, their minds were highly active.

Therefore, when Nan Zhubin displayed the next image.

Many people couldn’t help but exclaim in shock or disbelief.