Angela Case

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					Case Study

When she was thirteen, Angela attempted suicide. Her method of attempted suicide
was prescription drugs. Many students who attempt suicide have mood disorders,
substance abuse problems, etc.) and require psychiatric placement before entry into
special education. Angela, a 14-year old adolescent has been placed in a self-contained
classroom at her high school. Angela is the only female enrolled in her class of twelve
students. Angela has a history of school anxiety and school phobia. (

Angela has a large extended family, with her older brother and two sisters still living at
home, even though they are both out of high school. Angela’s father is a laborer in the
cotton fields, and her mother stays home to take care of the family. More information
about her family is provided in the narrative below.

Since third grade, Angela’s school attendance has been erratic, with an average of thirty
absences per year, and frequent tardies. Her school records indicate that the frequency
of absences increased over the course of each year, with the most absences and
tardies occurring in the spring. As part of her psycho-educational evaluation, the school
psychologist, Ms. Sandoval, conducted a Child Behavior Checklist (CBCL). The
responses from Angela’s mother, two of her teachers, and Angela herself, indicated that
she exhibits shyness, guilt, anxiety and tension. In addition, Ms. Sandoval administered
the Wechsler Intelligence Scale for Children (WISC) and the Woodcock-Johnson
Achievement Test. The results of the WISC indicate that Angela has a full-scale IQ of
109, with a verbal IQ of 94 and a performance IQ of 121. The Woodcock-Johnson
Achievement Test shows a Broad reading score of 82, a Broad Writing score of 74 and
a Broad Math score of 90.

Angela’s academic history has been generally poor, with consistently below average
grades across content areas. She is currently taking core classes in English, General
Math, General Physical Science and World History in a self-contained classroom.
Angela is also taking Child Development and Nutrition as electives. She has two or
three good friends, but generally has difficulty building and maintaining relationships
among her peers and teachers. Angela is currently taking Wellbutrin for depression,
which has been very effective in maintaining her emotional stability. However, she
continues to have difficulty in school.

Angela's fear is not exclusively due to her fear of school, but also because she "fears"
what may happen at home if she isn't there to help
maintain the household.

Angela speaks of her love for her parents and how she is "afraid" that her father might
die from alcoholism, a heart condition,
or excessive nose bleeds. She also worries that her mother might have an emotional
breakdown due to the continual problems in the home. Angela explains that
she had attempted suicide because she thought that would be "one less problem for my

Angela's earliest memories consist of "always being depressed.”

In the historical profile below, Angela speaks of her own anxiety, depression, loneliness,
family distress, and the events leading to her eventual suicide attempt noted at the
beginning of the case study.

Angela's Words

Even in second, first, and kinder, I would get depression real easy. In third grade, I had
trouble doing all my work. I couldn't concentrate and I would
just be right there [in the classroom] trying to concentrate on my work. I wouldn't be
working because I couldn't concentrate. I would tell the teachers
and they would help me but they wouldn't give me the help I needed, in my work or how
I felt. I would go to the nurse all day. I would go to the nurse
and [say] I was sick. I wanted to go home because I couldn't concentrate and they
would tell me that I wasn't sick, that I didn't have a fever. I would
tell them, "Please call my mom. Call my mom, because I don't want to be here today."
From third grade on, I didn't want to go to school. I started noticing
that I was worrying more about a lot of things. [When] I'd go to the bathroom, I was
worried that someone was going to be right there, because I would
hear rumors that in the bathrooms there were some spirits. I would be real scared. So
when I would go [to] the bathroom, if I would hear something, I would
just run, run out of the bathroom. I would be scared. At recess, I wouldn't like to go
outside. I would tell my teachers if I could stay in the classroom
and finish my work. All those kids, they were playing and they felt happy. They really
meant it. They were enjoying themselves. When I would be outside,
I couldn't enjoy myself. I'd always be worrying and sad and I didn't know what was going
to happen, and I would think about lunch, "What am I going to
do? What if I forget my [lunch] ticket?"

[I] was just shy first through fifth, but in sixth grade it really [started] when I didn't want to
go to school. I didn't want to go to school no more and people wanted to beat me up.
There were like six girls in a gang that wanted to beat me and my friend up and we
didn't understand why... My friend, I would say that she was conceited, but I would still
hang out with her because she was my friend. They wanted to beat me and her up.
They would go to us and they were all telling us, "Well come on. Let's throw down." I
would look at them and just walk away. I didn't want to get into any trouble so I would
just walk away and they said that they were going to beat me up after school. They
were going to get me [at] the bus. I told my teacher that day--when the girls threatened
me—I asked my teacher if I could go to the bus 5 minutes earlier. Well, he let me go 5
minutes earlier, but that time I forgot that I had to go get a nurse's slip for my
[emergency] information. I went and the nurse had to make copies and it took like five
minutes to make three or two copies. When I was done, the bell rang. [The nurse] gave
me the papers. I went out the building, running out the building. I just ran to [the] bus.
That day I went home. I was all nervous. I told my mom that they [the girls] wanted to
beat me up.

[My mom] said why didn't I tell her sooner and that she was going to talk to my teacher.
I didn't want her to talk to my teacher or my principal because they were going to think
that I was a tattletale. I would just tell my mom, "Mom, don't go. Don't go, mom." I never
brought it up [again] because then she would go. Two days later one of the girls that
wanted to beat me up, she came to me and she talked to me and [said] that she wasn't
the one that wanted to beat me up. It was the other girls. We became friends, her and
another girl from that group.

In school, I wouldn't go to school for like three days out of the week or more. I missed
school. I wouldn't want to go to school and I would go to the nurse with a headache.
When I passed to seventh grade, I went to Dove Middle School, and I didn't like it over
there. I only went for two weeks. There were a lot of kids there, a lot of kids in my
classroom. I would just be. I was shy. I never ever talked at all. Never. Not even to my
teachers. They would just be looking at me as if I was a stuck-up and that I didn't want
to talk to any of them. I would be scared every time I would walk down the hall. I'd be
looking around and all that stuff. I'd get real nervous when I'd see a lot of kids. I would
always be worrying about my dad, my mom, my sisters... I couldn’t concentrate on my
work and I would look up and try not to cry. Tears would just roll down my eyes. That's
when my mom started noticing that I didn't want to go to school. Every morning I'd wake
up crying and I didn't want to go to school. My mom took me to a M.D. or something, a
Ph.D. I think he's a doctor and we talked. [It was in] seventh grade that I was just there
[at home]. I wouldn't go out no-where. I wouldn't. I wouldn't like to get out. I would
always have the curtains closed. I would like to be in the dark and all this stuff as if I
wasn't even there. All day [I] wouldn't be watching T.V. or anything.
I would stay in my room with the radio on, like never come out of my house. I'd stay like
that for like three weeks or more and I wouldn't want to go out. I wouldn't want to go

[It was in] third grade, that's when my brother [started] drinking more, getting coke,
marijuana, all this stuff. He would come home and beat his girlfriend. Then she'd go
with her grandma. Her grandma's like two houses away from our house. He would start
beating up on her. One day he got his girlfriend and he turned the table and everything
on the table fell down. He broke a chair and all this stuff. He messed up the bathroom.
My mom didn't know what to do, so she called the police and the police came and they
handcuffed him in the back and they threw him on the floor. He hit himself on the head.
My mom saw all that and she said, "Oh, no never mind, just leave him and go. Get the
handcuffs off him." Me, my sister, and the kids watched everything. I was worried
that my mom might get so emotionally depressed and sad and decide that she couldn't
do nothing about it. She would just like go crazy, because of all the
problems she had in the house...
My dad, he was, he is an alcoholic. He bleeds from his nose, because they give him this
pill to make his blood thin so that the blood can go through his heart. He has a heart
problem. He bleeds. He bleeds and bleeds and bleeds and bleeds for like three months.
We had to [take] him to the hospital like every week. They would put these sticks all the
way up [his nose], and two strings would come out. They finally burned his face [veins in
his nose]. The day before yesterday, he started bleeding and bleeding again.
Yesterday, all I could do is think of my dad and what happened to my dad. I couldn't
concentrate, but even though I couldn't concentrate, I still did my work.

[I thought] that he was going to die and that my mom, too, that she would have a heart
attack or something. She has a lot of problems. She has to take care of my nieces and
nephews. They're always at my house. Always. They're from 8 years to 2 years. They
get on my nerves. There's a boy named Javier, my nephew. He's four. Pablo, he's 8
years old. We have our cousin, Patty, she's 2 years old. For every little thing they cry.
Every little thing. I could understand Javier and Patty. They have a mom that abuses
them because she has a lot of problems with her boyfriend. He beats her up and she
takes it out on the kids. I would always see her beating them up because I would stay
with her to like take care of the kids so they wouldn't get like all scared of her.

The worst that I've seen was when ... my sister she sat down and started crying
because her [boyfriend] started to beat her up. I didn't know what to do. I didn't know
what to do. Her boyfriend left her a black eye and everything. He just left and I was just
watching [my sister] and she would be crying and Patty and Javier would start crying.
They saw everything. She told them, "Shut up, alright, just shut up. You're the ones who
make things like that." She got Javier by the neck and she swung him against the couch
and he hit himself on the wooden bar. He was just crying and crying, and I wanted to
get up and like get her and tell her to stop hitting them. My [other} sister she wouldn't let
me, she just said, "Sit down, sit down." I've never seen her hit Patty because she's a
girl. Javier, she takes it out on Javier a lot.

Don, my brother, he's a drug addict. He has Pablo and Carmen, my other niece and
nephew. My brother, he's 29 already and he gives my mom problems because he'll go
to work and then the next two days he won't. He'll just be laying around the house...
He'd be with his girlfriend. Nobody likes her from our family. When [Don] gets checks,
he says, "That's my check" and all this stuff and he wastes it on things, on her, clothes
for her, nothing for the kids, and Pablo gets all upset.

[Pablo] has a temper. He has a temper like his dad and if you tell him, "Pablo sit down."
He won't. I go, "Pablo, I'm going to call your dad." [He'd say], "So, call him, I don't care."
Last time, he made his mom and his dad get in a fight. Pablo and Carmen had spent the
whole day with [the parents] on Saturday… They [the parents] came and brought them
home like at 10:00 pm and it was time for Don and his girlfriend to go out dancing or
whatever. Pablo didn't want to stay. He was crying, "No, mom, don't leave me here” and
all this stuff. Don was waiting in the car and Pablo was hugging his mom, holding her,
and just wouldn't let go. My mom came and said, "Pablo you've been all day with them.
Let them go where they want to go now." He was just crying and all this, and
my mom got him and took him away from her. Pablo punched my mom and slapped
her, and all this stuff, and I got him, and I go, "Pablo." I got him by the
shoulders real hard and I sat him down, "Pablo stay here. Your dad's going to come and
he's going to hit you. You already know. Pablo, stay here." Don came and got real mad
at him and got him by the neck and was choking him. My mom got in and got a brush
and hit [Don] to let him go, and Pablo was shaking...
[Pablo] went to the window because even though they hit him, he still wouldn't stop. He
went outside, going after them, and all this stuff. They stopped [the car]. Don went after
him because he was making a whole lot of noise and everybody was up. My dad said,
"So, hey, why don't you take care of these chavalos?" Don just left. [Pablo] went to my
mom and he was crying [all night] and he was shaking. He was trying to call his mom
and his dad.

After all that had happened that night, I got angry because all the kids were crying. All of
them were crying. My mom was all upset because all of the kids were getting on her
nerves. My dad was getting all mad and got angry because of the kids and my sister.
Don didn't want to go for the kids. He didn't want to do nothing. They [the kids] were just
right there. I got angry and I tried to [commit] suicide with pills. I took three pills [for
depression] and some others. I don't remember and I was all shaky. I was sleepy... I
took like a whole bottle of Tylenols... My sister saw me and told [my mother]. She saw
me. They were all calling, telling me, going into my room, "Get up, you have to go to the
hospital." I just go, "I don't want to go nowhere." Don was right there, but he was sitting
down on the couch, just doing nothing, letting the kids cry and everything.

My mom told Don, "Come. Help me get her to the car." They were going to get me and
just put me in the car. And I go, "No, I'll do it by myself." I was all
mad. We were going to [the hospital]. I was sleepy [at the hospital]. The [social worker}
called me and said that the drugs, the pills, I had taken may be dangerous to my heart
and my liver. They might stop my heart or poison my liver. They took me to the hospital
and checked everything. They pumped my stomach. All day, like 30 minutes or more, I
would just be throwing up all over the tube. I would bite on [the tube] because I wanted
to take it out. They tied my hands down. I was on a thing that was like a bed. I was all
trying to get my hands out to pull [the tube] out. After everything was done, I was wiping
my mouth. I was all grossed out and everything. The hospital told me that I had to go to
Domingo Behavioral Health Hospital.

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