University of the Philippines in the Visayas

College of Arts and Sciences

Division of Social Sciences
Miagao, Iloilo

A Major Study on

The Psychological Disorder of Adrian Monk

In Partial Fulfillment of the Requirement

in Abnormal Psychology (Psychology 155)

Submitted to:

Ms. Leah Pradilla

Faculty, Social Science Division

Submitted by:

Jennibeth D. Baculna
BA Political Science-Psychology IV

March 25, 2009

I. History

Adrian Monk is believed to be born in or around the year 1959 so his age now is 50 years old. He
graduated from the University of California Berkeley in the year 1981. In his early age, it was revealed
that in the year 1972 he was already in his 8th grade.

Tracing his family background, his parents were very strict and over-protective, an influence that
is strongly suggested to be a contribution to his disorder. His father is Jack Monk who came originally
from New Hope Pennsylvania and happened to abandoned the Monk family when Adrian was still eight
years old by a mere act of waving goodbye and saying that he would just go to a store and never did
return again. Adrian Monk has one brother named Ambrose, who also experienced another kind if
disorder, known as agoraphobia and acted much strangely as compared to Adrian. Ambrose having an
extreme agoraphobia only left his house three times in the past 10 years. They never heard any news from
their father again until one time, their father left a note to his son Ambrose saying that he was very proud
that after a very long time of staying inside the house, he finally learned to leave the house. The chaos and
emotional instability brought about by their father’s sudden return, to the point of setting an extra plate at
the dinner table and keeping his mail in a filing cabinet in case he comes back.

On the other hand, Adrian’s mother died in 1994 and it was believed that the cause of her death is
cancer. It has been said that his mother raised him to be different from other children because his mother
is thought to be mentally unprepared to be a mother and raise children. Jack Monk returned to San
Francisco in 2006, when he was arrested for running a red light and resisting arrest. He was bailed out by
Adrian, who did not forgive him for leaving at first, but after solving a murder involving Jack’s boss, they
bonded again. Adrian’s father even teaches Adrian how to ride a bike that is, something he was not there
to do when Adrian was a child.

He has a half-brother, whom he was not able to meet personally and mentioned by his father in
the name of Jack, Jr. who happened to live in his father’s basement. Adrian Monk is a legendary former
homicide detective in San Francisco Police Department and hailed as one of the best police officer ever in
the department and turned into a great detective who investigates some serious crimes that are happening
in the place and solved it in an unconventional way although the cases are very puzzling.

He has a wife named Trudy whom he met when he worked before at the University library. The
first time they met was when she borrowed a book and then she was amazed because Adrian did
remember the book quickly as he saw it from the previous day. He got to familiarize the phone number of
Trudy when someone used his back to write a number of his wife. From then on, they have decided to get
married on August 08, 1990. His previous history was that, even, before, he already acted differently but
Trudy still loved him despite of the weirdness of himself and in return, he was also deeply in love with his
wife since she was the only reason that Adrian understands the true meaning of love.

On the snowy time of December 14, 1997, Trudy, his wife has been murdered through a car
bombing accident when she was about to buy a cough medicine for her brother-in-law, Ambrose. Adrian
felt so devastated because of what happened, he could not get over from that situation and made his action
to be more and more strangely each day and he even refused to take his medication to make himself calm
down. As a result, the sudden death of his wife interfered with his job which eventually led to his
suspension in his Department. He devoted those past ten years of his life discovering who is responsible
for the death of his wife. He blamed himself for not being there when his wife needed him most. He later
found out that the man who was the reason behind the death of his wife was identified as the six-fingered
man who hired someone to build the bomb.
II. Description

In describing the client, this part makes him as a real Adrian Monk. Adrian is the man with
misfiring mental process who loves to clean up the mess. Monk is a middle-aged man with a dark, curly
hair, his height is about an average and his ethnicity is not yet determined, he is always well-dressed and
groomed. He wears identical clothing including brand daily. He is ever grieving and innocently paranoid
about everything. His uncontrollable compulsions that identify him are a need to count posts, use wipes
whenever he has touched anything or anyone unfamiliar. Monk is continually obsessed with his phobias
and with the memory of his dead wife Trudy. Uncanny and often effortless observational skill noting
details in a crime scene that everyone else has missed. He can focus when brought out of his internal
world once a week to solve a crime. The ultimate co-dependent, Mr. Monk is convinced he cannot
function without his assistant or psychiatrist. Frequently forgets that he needs money to live and pay his
assistant and psychiatrist. Honest to a fault.

When Monk goes against his own routine and shows the person who cares for others it is very
touching. People who get to know Adrian Monk cannot help but fall in love with the man. He is
endearing because of and in spite of his phobias. He is an irritant that you would sometimes love to
strangle. His feelings are easily hurt. This overly sensitive brooding man makes it impossible not to hurt
his feelings, but he will most likely always forgive you. He is afraid of everything, in a constant state of
grief. The man is convinced he can't go it alone without his assistant and most importantly his
psychiatrist. He was a top police detective who lost his ability to function after the death of his wife, and
now he's working privately, for the police department.

He seems to be a one step forward and two steps back person trying to untangle himself from his
own mental mess by controlling what is around him. He often says, "Here's what happened," before
describing how the crime was committed. Often precedes the previous quote is "I think I just solved the
case." In reference to his observational powers and his obsessive-compulsive disorder, he says "It's a
gift, and a curse." There are also some common phrases that he used most of the time like when
explaining his disorder to exasperated strangers, Monk will often preface his explanation with, "Here's
the thing." He often says, "You'll thank me later," after doing something to fix something that he notices
is out of place. Whenever he zeroes in on a suspect he says, "He's the guy" or in the case of women,
"She's the one." While making an observation on a minor deduction, he occasionally precedes it with,
"Unless I'm wrong--which, you know, I'm not..."

One of his mannerisms is a compulsive need to touch things lightly with his index finger, such as
heat lamps, parking meters, and hat racks. Another is to notice "inconsistencies" in the room by focusing
on sections of a crime scene. He also displays his observation by tilting his head and viewing objects
between his fingers. Another running gag involves an external force causing him difficulty in describing
how a crime was committed. For example, as a result of an earthquake aftershock, he speaks gibberish
from post-traumatic stress. When he went to Mexico, he is dehydrated from having had nothing to drink
for a day and a half and so suffers from a dry mouth and Monk attempts to rap his deductions to a booing
crowd.

III. Diagnosis

There are the symptoms that were exhibited by Adrian Monk in terms of the Clinical
Syndromes/Disorders. First is that he is afraid of hundred of things and it was found out that there are a
total of 312 fears/phobias including fear of germs, needles, dark places, crowds, milk, risk, heights and
enclosed spaces upon which he exhibited in his life. He refused to take some medication in order for
himself to calm down. He speaks in a gibberish manner from post-traumatic stress as a result of the
earthquake aftershock causing him the difficulty on describing how the crime is committed.

Axis I: Clinical Syndromes/Disorders

Axis 1: (300.3) Obsessive-Compulsive Disorder (456)

Adrian suffers from catatonia for three years and he does not like different types of food to touch on his
plate, he also does not like the manner of shaking the hands of other people, riding in an elevator and
airplanes. Furthermore, he needs to be certain that all the hangers in the closet face the same way. Good
thing about him is that, he needs to put things in order and that what makes him as a good detective.
However, his disorder had an effect over his work because he was reluctant to involve himself in a case
that would force him to confront his phobia. He is frightened of life and most of the time decision
paralyzes him. He believes in logic and reason which obviously are needed in his profession. The client
has mannerisms that are recurring. He has this compulsion to touch things lightly with his index finger
like heat lamps, parking meters and hat racks. Monk displays observation by tilting his head and viewing
objects between his fingers and finally he has this excessive devotion to work such that when he has a
crime to solve, it occupies all of his attention.

Axis II: Personality Disorders and Mental Retardation

Axis II: (301.4) Obsessive-Compulsive Personality Disorder (725)

My client has no physical conditions reported.

Axis III: General Medical Conditions

Axis III: None

Monk was seen having problems with the Primary support group classified in his childhood years. First is
that based on his personal history, it was found out that when he was young, his father abandoned him
and that he has a brother who happens to have an extreme agoraphobia. In his early years, he was not
exposed to other people because he was isolated with other children of his age. He also experienced
problems with primary support group with adult that is, the time of (Trudy) his wife’s death, he was left
by his personal nurse Sharon Fleming which caused great distress on his part. In terms of the problems
with primary support group in a Parent-Child relationship, it was initiated that there was a parental
overprotection and strictness on the part of her mother who raised him alone and died on the later part. In
the context of his problems related to social environment I enumerated it into four, first the loss of his
wife, lose of a good friend, Sharon, the need to find the person behind his wife’s death and lastly, Monk
does not believe in coincidence or accident. There are also some occupational problems like the inability
to react appropriately while in duty, he had this strange actions which interferes with his work just like his
ability to investigate cases and interact with his fellow officers and boss and because of this, he was fired
from work. He always yearns to return to the police force. There are other psychological problems found
in him, there was a time that he had an exposure to the disaster particularly, earthquake and the other one
is the parental issue.

Axis IV: Psychosocial and Environmental Problems

Axis IV: Threat of job loss
Monk experienced some serious symptoms or serious impairment in several areas of functioning. He had
this gibberish speech, he simply cannot control his impulses and compulsion which affect his daily tasks
in life. When it comes to his profession, he cannot bring himself to fire his weapon even when someone’s
life is at stake.

Axis V: Global Assessment of Functioning Scale

GAF= 36 (admission)
74 (current)

Diagnostic (DSM-IV)

Axis I: (300.3) Obsessive-Compulsive Disorder

Axis II: (301.4) Obsessive-Compulsive Personality Disorder
Axis III: None
Axis IV: Threat of job loss
Axis V: GAF=74 (current)

IV. Case Formulation

Adrian Monk is a 50 year-old married male, a former detective at San Francisco Police
Department and hailed as one of the best police officers ever who investigate some serious crimes that are
happening in the place and solved it in an unconventional way. He is a very moral man and believed in
justice and goes after crime and criminals wherever they may be. Monk has a diagnosis of having an
Obsessive-Compulsive Disorder. He has this disorder ever since and was heightened and worsened from
the time that his wife got murdered and killed in a bomb incident. It is important to take into
consideration his family background in order to trace back his disorder—his brother suffers from
agoraphobia for almost 10 years, his mother raised him differently from other children for the reason that
she was not mentally prepared to become a mother. It is believed that due to his father’s absence, Adrian
developed his disorder which led to a pathological need for order and self-control. He was involved with
the different people from all walks of life including Sharon who became his personal nurse and willing to
offer assistance upon which on the later part, made Adrian to function as normal as possible. When she
decided to leave together with her son and planned to re-marry her former husband and moved back to
New Jersey, it was another melancholic scene in his life and as a result, Monk once again became unable
to function in everyday works. He finds it difficult to live again knowing that he lost someone all over
again and that he needs to move on with his life without the presence of his personal nurse and thus
continued to pose unique challenges in his everyday life.

He found another comfort with Natalie, a single mother and a bartender who enlists Monk’s help
when her home was damaged. He reminisces those times when Sharon was still there by his side and find
it very similar to the way Natalie acts. Adrian later found out by himself that the more he gets closer to
Natalie and her young daughter, he actually feels certain connection over them.

The disorder caused him to lose his job as a detective in a way that the disorder interfered in his
daily task as a private investigator and it leads Monk to experience the different phobias in his life which
totaled to about 312 fears. He later sought Dr. Kroger, his psychiatrist who helped him all throughout and
aid him to function in everyday life. It is clear that he wanted to seek for help for his present problems
and there is a need to be treated in order for him to go back to his work. Monk himself learned later in his
life that his dead wife, Trudy would have wanted him to try to move on with his life. With the help of his
friends and his own self, he overcomes his own fears and continues to take private cases and he still
interact with his old friends unofficially and he still got a respect over his work.

IV. Treatments

There are various treatments used in treating the Obsessive-Compulsive Disorder. Certain
medications were given to the client which includes antidepressant drug, clomipramine which had an
unanticipated effect of reducing obsessions in depressed people while increasing the amount of serotonin
that is available within the brain and combined it with antipsychotic medication in order for the symptoms
to be effectively controlled. This has been used as a biological treatment combined with behavior
therapy. It is necessary to remind the client to continue with the given medication even if he already feels
a whole lot better because there might be a relapse if he stops taking it. Some medications are gradually
reduced rather than abruptly stopping it in order to avoid withdrawal symptom. The use of cognitive-
behavioral treatment methods in treating the symptoms of the disorder is also relevant as it aims to fix the
harmful patterns of thinking and behavior that often accompany Obsessive-Compulsive Disorder. In
addition to this, my client underwent the ERP or the Exposure and Response Prevention where I, as
Monk’s psychologist help him by gradually exposing him to his feared object and teaching him ways to
cope with his anxiety. This has been the most effective treatment used with the clients having an
Obsessive-Compulsive Disorder as the effect of this is that it retrains the brain which results to
permanently reducing the occurrence of the symptoms of this disorder. The therapy can also extinguish
compulsive behaviors entirely. Behavioral treatment is also considered to be a helpful procedure in
dealing with this kind of disorder particularly the thought stopping in order for my client to reduce his
obsessional thinking along with exposure to situations that provoke the compulsive rituals or obsessions.
There are other clients whom their disorder become too excessive so the only way for them to be treated
is through surgery.

Asides from the medical treatments, one way in treating this disorder is through the help of the
client himself. There are various self-help techniques that might be able to cure or nevertheless lessened
the obsessions and compulsions of a person. The first to take in the self-help process is for the client to
educate himself about the disorder and it is important for an individual to learn from the therapy on their
own and this would challenge and requires him to have commitments and daily practice. Self-treatment is
indeed a very significant idea that goes on a day to day basis. It is also advisable to remain connected with
friends and family so in the case of Adrian Monk, he only had his brother as his family member.
Involving others in the treatment can help guard against setbacks and keep him motivated. Monk’s friends
and Trudy’s families were very supportive to Adrian and despite of the disorder that he has, they still
gave their endless support to him and this could actually be a big help on the part of Adrian for him to go
on as normal as possible with his life. I want to emphasize the idea that many people have this kind of
disorder, Monk is not alone. There are various individuals who happened to experience the same
symptoms and feelings as that of him so it would be better for Adrian to participate in a group whom he
can share some of his experiences and at the same time, learn from those who go through the same thing
as he did.

V. Prognosis

Obsessive-Compulsive Disorder is a long term illness with a severe symptoms followed by times
of improvement. A completely treated person is very unusual but others have improvement over the
course of the treatment.

After 6 years of medication and treatments, diagnosed having some impairment in

communication and major impairment in several areas such as in his work, family relations especially
with his brother, thinking and mood, Adrian Monk finally lives a normal life just like other people. He
knows now how to overcome his obsessions and compulsions which created a beneficial effect not only
on his personal life but towards his social life as well. He returned to his previous work as a homicide
detective at San Francisco Police Department working with other detectives together with his boss in
solving crimes. He is still experiencing some actions that the disorder shows at times, yet he can already
control his obsessions and compulsions over situations and things. Continuing with the therapy plus the
medications, he recovered the disorder completely. If symptoms are present, they are transient and
expectable reactions to psycho-social stressors as a current rating in Global Assessment of Functioning
shows. Adrian Monk may need to stay on some type of treatment program for more additional years to
come or even for life in order for him to fully restrain the disorder from coming back. The condition is
very difficult as it requires emotional effort and serious financial investment yet with the help of Adrian’s
friends and co-workers he able to motivate himself and live a productive life and continued in becoming a
good detective. Together with his brother they now live at one house helping his brother Ambrose cope
with his own disorder. Monk moved on with his life and met a girl who currently inspires him in
whatever he does. Trudy’s family and friends still have their support over Adrian as they considered him
as part of the family.

Overall, Adrian Monk was one of those successful individuals who had made a good response in
dealing with the Obsessive-Compulsive Disorder.