Mental Health Social Work


Here in this Mental Health Social Work, an attempt will be made to provide answers to the five questions in relation to the case study of Millie Smile, a 58 year old lady suffering from paranoid schizophrenia.

Mental Health

The answer to Question Occurred In Mental Health Social Work:

Millie Smile, a 58-year-old mother of two children, is suffering from paranoid schizophrenia. She has been admitted to mental homes on several occasions. Even her daughters, Susan and Tina, complain that in their childhood they used to be terrified by the over abusive and unnatural behavior of their mother. During her recent stay in the Elgin Mental Health Centre, the doctors of that very center also confirmed that she is in psychosis. Apart from all these, Millie Smile cannot understand that she is ill. When she was asked whether she is aware that she is suffering from paranoid schizophrenia, in her reply she said that she knows paranoia, but she knows nothing about schizophrenia as it does not make any sense to her. This is not an exceptional case. In the case of every schizophrenic patient Mental Health plays an important role, it is common that the diagnosis of schizophrenia actually bears no significance in his/her life. Paranoid schizophrenia speaks of a subtype of schizophrenia in which the patients like other subtypes of schizophrenia use to stay in a delusion of in an unconscious frame of mind in which they don’t even understand that they are suffering from a psychological disease (O’Leary, 2004). In case of Millie, it is understood that she thinks that she has to stay in mental homes only because she does not have any house of her own and also doesn’t have the money to purchase one for her. It is the feeling of homelessness that captures her mind to such a great extent that she cannot be able to grasp the reality of her present situation. The impact of her past life does not allow her to come out of delusion.

The issue almost becomes a debatable one which encompasses the authenticity of the diagnosis of schizophrenia. Even modern psychiatrists of the world cannot confidently establish the validity of the diagnosis of schizophrenia. By standing at the threshold of the 21st Century, modern science still cannot invent any sort of physiological test which can confirm the availability of schizophrenia in a man’s behavior (Parker & Parker, 2004). So is the case with the invention of an objective test or any other psychometric test which can provide some support to schizophrenic patients. Till now, the diagnosis of schizophrenia has to depend on the specified criteria formulated by the American Psychiatric Association’s DSM-IV-TR Code or World Health Organization’s ICD-10 Code (, 2014). By following the guidelines of the two above mentioned organizations, it is found that the diagnosis of schizophrenia is usually applied in case of a patient who uses to face delusion, hallucinations, and unnatural behavior for more than one month, but less than six months. The diagnosis of schizophrenia cannot even give proper support to behaviors like frequent mood swings. It is found in researchers that almost one percent of the total population of the world suffers from schizophrenia and the number of its victims crosses the milestone of sixty million (, 2014). The most unfortunate fact comes in the form of information that more than half of the patients suffering from schizophrenia are not getting proper chances of diagnosis. Something needs to be done in order to improve the situation for the schizophrenic patients.

An answer to Question No 2:

It is essential to understand the two daughters of Millie, Susan and Tina, learned to cope up with their mother’s illness with the gradual development of their Mental Health. At the time when they were mere infants, the situation was not at all easy for them. The unusual behavior of a schizophrenic patient is almost unbearable for an infant (Brown, n.d.). Their father ignored his responsibility by giving divorce to their mother due to her Mental Health and they had to grow up under the guidance of a woman who was not in her normal state of mind. By following the comments of Allan, Millie’s ex-husband, it is understandable that immediately after the birth of Susan; a kind of post-natal depression was discernible in the behavior of Millie. In an addition to that Allan observed an unusual swing of moods in Millie. At times she was at her best of temperaments when she liked to play with her daughters and found childlike happiness in that. On certain contrasting occasions, she preferred to stay with her low temperaments and used to stay alone. She even remained indifferent to her daughters. On occasions, she even forgot to prepare food or change the diaper of her daughter.

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Her little children had to suffer a lot due to her unusual swing of mood. It is generally observed that the children of a schizophrenic patient often have to suffer a lot due to the illness of their parent (Dobbs, 1986). At that particular age, it was almost impossible for them to understand what was going wrong with their mother. Even when they were at a school going age, staying with their mother did not come on their list of preferences. Instead, they preferred to visit the house of their father Allan and their stepmother Nancy. The tantrum Millie created and the abusive words she had spoken to her daughters were almost unbearable to her little angels. It was the rude and improper behavior of her mother that compelled Tina to make a suicide attempt at an age when she was just standing at the threshold of adolescence.

With the gradual passing of time, when the two sisters, Susan and Tina, became matured enough to understand that their mother is suffering from a psychological ailment, they took the responsibility on their shoulders to provide best possible treatment for their mother so that they can ensure the wellbeing of their mother. Susan has almost posed herself as the carer for Millie and fought her hardest in order to find out a suitable living standard for her mother. She took Millie out of the Elgin Mental Health Centre and provided her ample chances so that her mother can socialize herself with others. The treatment of a schizophrenic patient reveals that it is essential for a schizophrenic patient to remain surrounded by his/her family members, friends and acquaintances (Travis, n.d.). A familiar atmosphere helps him/her to get out of delusions. Thus Susan took her mother for shopping and eating out at a restaurant. These give Millie ample chances to socialize her with the outer world. Social seclusion is not healthy for a schizophrenic patient (LaPera, n.d.). By analysing the need of giving her mother an opportunity to mingle with society, even Tina with her husband Jeff and their two children often came to see Millie and took her to weekend trips with them.

An answer to Question No 3:

In case of Millie, it is easily understandable that her past life has a strong impact on her life and possibly her psychological illness has some connection with her past. Her father died in the Second World War and her mother often remained ill due to an unknown disease. By following the opinions of Millie’s brother, John and her cousin Nancy, it is observed that in her early life, Millie used to be a girl who had an ample sense of love and care for her brother. It was during the adolescent period of her life when she started involving herself in arguments with her parent. Her family members should be careful enough at that particular time so that her unusual behavior could be controlled at a very early stage. Detecting an abnormality in the behavior of an individual at an early stage often helps to restrict major psychological problems that can occur in the future (Reynolds & Farberow, 1981). Even her cousin Nancy was well aware of the fact that Millie, she had confessed in front of her that she only pretended to be normal since her childhood. It was at her meeting with Nancy; Millie disclosed that Johnny Carson, the famous television anchor, had advised her to file a nomination for the Presidential election of USA. It was a clear case of hallucination. In a hallucination, people often get a glimpse of popular figures and even of their dead parents through the figures do not exist in the reality (Venter, 2012). As Nancy was already aware that her sister possesses certain mental illness, she should inform the elders of her family so that they could arrange any medical assistance for Millie.

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It is also clearly understandable that Millie’s ex-husband Allan made the situation worse for Millie. When he knew that his wife’s mental health is not in a proper order, he should take utmost care of her. A schizophrenic patient requires emotional support from his/her nearest and dearest ones (Virkkunen, 1974). It was the revelation of a careless attitude of Allan that he decided to leave Millie in that mental condition and with the responsibility of two kids. It was soon after Allen left her alone that she lost her house and money at the same time. This homelessness and economical bankruptcy gave psychological trouble to Millie even at her later stage of life. In case of schizophrenic patients, it is often observed that they tend to relate discontinuation of a marital relationship with other psychological consequences like the feeling of homelessness, lack of faith in the opposite sex and so on (Zucker, 1958). Due to her mental illness, Millie could not be able to continue her professional life with ease. She found it troublesome to make interaction with her colleagues, neighbours and others. Even the workers of the health care centres could not be able to build up a friendly relationship with her. If those people closely attached to her could reflect a bit more careful attitude towards her, her courses of life could be a different one.

An answer to Question No 4:

In cases of schizophrenia, the incidents of improvement in patients are very scarcely discernible (Bateson et al. 1956). Often the schizophrenic patients find themselves in an absolutely secluded condition where not even their family members are ready to bear the burden of their illness. There is almost no chance left for them to come back in the normal course of life (Endicott & Spitzer, 1978). The case of Millie is an exceptional one. Her family members, especially her daughters, do not let her go to social seclusion. Instead, they fight to the extreme limit to bring Millie back from mental home and find a suitable job of a dishwasher at a cafe for her so that she can get ample chances of bringing her back in the mainstream of life. It is often found in case of schizophrenic patients that a suicidal tendency often grows amongst them (Faris & Dunham, 1939). The similar situation occurs in case of Millie also. Once she tried to commit suicide by cutting her throat and slitting her wrists but was ultimately saved. It is found in researches that suicidal tendency is discernible in case of those individuals who have to spend a major portion of their lives in loneliness (Kapur, 2003). By following the guideline of those researchers, Millie’s daughters try their hardest to give her a social life fully surrounded by her family members, friends, and acquaintances. They use to take her on weekend trips. As Millie loves the children of Tina a lot, the kids also give good company to their grandmother. While talking about the daughters of Millie and their role in bringing back their mother in the normal course of life, it is also essential to mention that not all her family members are supportive enough. Her ex-husband has left her at a moment when she needed his help the most. Her brother and cousin have also shown some indifference towards her.

While discussing the story of Millie’s progress towards a normal life, it is also necessary to note that without a mention to the strong will and determination that Millie reflected, Millie’s story would remain incomplete. The lady has faced a lot of adverse circumstances; still, she showed the courage to get out of those circumstances with ease. The life at the mental homes was a terrible one for her to bear, but with a strong intention to get back to the normal course of life she was able to remove the shackles of the homes and select a life for her own. At the end of the film, it is seen that Millie is quite happy in getting a job in a cafe and she vows to save a certain portion of her income so that she can leave it as a sign of inheritance for her daughters. This temperament in itself shows how strong-willed, she can be.

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The answer to Question No 5:

The film starts on a despairing note but ultimately finishes at a joyous one. This is not a story of absolute helplessness and despair. The film is all about inspiration and changing the outlook of life. Psychological will force can help an individual to attain whatever he/she wants to attain (Weinberger, 1987). The film shows that with the strength of will and hardcore determination, an individual can remove any obstacle and live a normal course of life. Most of the psychiatrists are of the opinion that an individual can handle any adverse situation of his/her life with the availability of great psychological strength (Kaufman et al. 1997). The sad story of Millie ends on a happy note where she finds a normal course of life for her. She gets the opportunity of starting a new inning in her professional life by getting the job of a dishwasher in a cafe. Her long-lasting yearning for a house of her own ultimately gets fulfilled at the end of the film. During her stay in the mental homes, she has lost her friends and acquaintances. At the end of the film, she gets an opportunity to have a reunion with her friends and acquaintances. The ailing Millie of the Elgin Mental Health Centre changes herself into a completely new Millie only with the help of her determination and the support that her daughters provide for her. Without the help of the nearest and dearest ones, it is almost impossible for a schizophrenic patient to improve his/her troubled frame of mind (Robins & Guze, 1970). The film concludes with an inspirational message that schizophrenic patients need not keep secluded from the society. If a schizophrenic patient can be given an opportunity to mingle with the outer world, a major portion of his/her treatment gets completed by that initiative (Sullivan, 1914).


The answers to the questions regarding the diagnosis of schizophrenia, the role of the family members of Millie in extending their hands of support towards her, Susan and Tina’s conception of their mother’s illness and the key elements of her improvement in the concluding part of the film deliver a complete overview of the case study of Millie Smile with success.

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