Psychological Consultation
Patient:
Cash, Johnny
Date of Birth:
February 26, 1932- September 12,2003
Dates of Consultation:
December 29, 1983
December 30, 1983
January 10, 1984
Age:
51
Employer:
Columbia Records
Grade Level:
Highest Achieved Grade Level: Grade 12
Broadcasting school in Memphis, TN
Parents:
Carrie Rivers Cash and Ray Cash
PRIMARY CARE PHYSICIAN:
Dr. Smith, M.D
Evaluator:
Sarah Niespodziany
Referral Question
Johnny Cash’s psychiatrist, Dr. Smith, at the Betty Ford Center, refers Johnny for a
psychological consultation regarding his reoccurring depressive symptoms,
substance abuse, and inconsistent mood swings.
Major Depressive Disorder
Johnny has many emotional issues and fluctuating mood swings. Cash had one failed
attempt at suicide where he entered into a cave, hoping to never return. His moods
wings and substance dependencies have taken a toll not only on his body, but on his
success as well. He has one failed marriage and has been banned from many
establishments due to his violent behaviors and careless actions. Johnny and his
family checked him into the Betty Ford rehabilitation Center in order to prevent him
from hurting himself anymore. Johnny may suffer from Major Depressive Disorder.
Amphetamine Intoxication Disorder
Johnny has been on a 20-years binge of amphetamines that started at the beginning
of his career. He has had many run-ins with the law due to his compulsive drug
seeking and drug using. Johnny has displayed highly aggressive and at some points
violent outbursts. Johnny’s Parkinson’s could quite possibly be a result of the
dramatic affects amphetamines have on the central nervous system.
Alcohol Dependence Disorder
Along with his drug addiction, Johnny has always displayed traits of alcoholism even
at a young age. For many of his shows Johnny would show up almost too intoxicated
to perform. His condition caused one of his early tours to be cancelled. It is clear that
Johnny does have an addiction problem, which is increased when drugs are
involved. Johnny’s father also developed a drinking problem after his brother’s
death.
Medical History
Johnny’s childhood consisted of minor illness and major psychological distress. As
an adult, Johnny suffered with an addiction to both drugs and alcohol, which
involved painkillers, amphetamines and barbiturates. He also suffered from
depressions that led to a failed suicide attempt in 1967. In Johnny’s later years, he
was diagnosed with a form of Parkinson’s called Sky-Drager Syndrome, which he
had been battling with for many years, along with diabetes.
Family Medical History
There is no known history of Parkinson’s, diabetes, or drug addiction within
Johnny’s family. However, after the traumatic and unexpected death of Johnny’s
older brother in 1944, the Cash family never really recovered. His father did develop
increased drinking habits, which triggered violent outbursts and abusive behaviors.
There is no reported history of other forms of psychological illness.
Social History
Johnny’s life was full of unexpected turns. He was born into an extremely poor
farming family with six other children, during the Great Depression. At the age of 14,
Johnny’s brother Jack died as a result of a table saw accident, which Johnny never
fully recovered from. The resentment Johnny faced from his father after the death
created a divide between the two. Because of the bitterness, Johnny never felt
wanted. He joined the Air Force in 1950 and was discharged in 1954. He became
famous for his music in 1956 after many years of struggling. Johnny’s grueling tour
pace of 100, 000 miles in two years prompted his addiction. He had one failed
marriage with his first wife, and four children. The divorce was a result of his drug
addiction deepening, destructive behaviors, and numerous affairs. In 1965 his
drinking and violent behavior resulted in his banishment from Nashville’s Grand Old
Opry. John also spent a total of seven nights in jail for different incidences, one of
which was drug related, after he attempted to smuggle amphetamines across Mexico
borders. He continued this abuse for many years, but was still able to win numerous
awards, have gold albums, host his own TV program, and act in numerous secondary
TV parts. His second marriage to June Carter in 1968 seemed to be the best thing
that had every happened to Johnny
Educational History
Johnny attended Dyess High School in Arkansas. After graduation in 1950, Johnny
left Arkansas and joined the US Air Force. He was stationed in a Germany and
worked as a radio intercept officer, eavesdropping on Soviet Radio traffic. This
prompted his interest in music. Under the GI Bill, Johnny went to broadcasting
school, in Memphis Tennessee. He enjoyed studying music, along with playing
guitar, singing, and writing his own songs. After graduation, he decided to further
his musical career.
Behavioral Observations
Johnny Cash is a male of average size and shape. He has dark black hair, and a
noticeable scare on his right cheek from a botched surgical procedure in the Air
Force. Johnny was known as “The Man in Black” because he always performed in all
black clothing. For someone who did not know him, Johnny gave off the impression
if being a quiet, impersonal, and at times a depressed man. Because if his Sky-Drager
Syndrome, which is a form of Parkinson’s, his mannerisms often gave off interesting
motions. Johnny reached the point where people couldn’t distinguish between the
effects of the drugs and alcohol and the disease. Johnny made many songs about his
childhood hardships, along with his stints in jail. He never had a problem reveling
his tragic life experiences. Although he never did time in jail, Johnny and his music
has always related well with prisoners. He would often performed for them at
various jails.
Test Results
Depression Screening
Johnny scored very highly in the depression screening. He answered most of the
questions true, inferring that he has entertained and/or attempted the idea of
suicide. He also feels extremely anxious and sad.
Biopsychosocial Assessment
During this study we asked Johnny basic questions about many areas of his life
including his early childhood, education, and medical history. We observed
moments of distress especially when speaking about his brother.
CAGE Questionnaire
Cut down on drinking: NO
Annoyed if people comment about your drinking: YES
Feeling guilty about drinking: YES
Eye-opener drink to start the day: YES
Johnny does feel guilty about his habits bad is looking for a way to stop them.
Drug Screening Test: Johnny Cash’s completed drug screening test proved him to
have substance abuse problems.
Tested positive for dextroamphetamine (Dexedrine) and methamphetamine
(Desoxyn)
Summary
During my consultation with Johnny, it was very clear that his traumatic early
childhood plays a large role in his ability to function today. He uses drugs such as
amphetamines to numb the pain and anxiety that he feels regularly. He has
attempted to stop the drugs any times, but the withdrawals have gotten too savior
to handle on his own. His dedication the alcohol also plays a large role in his mood
swings. Johnny clearly has a Major Depression Disorder, and even though the drugs
and alcohol may take the physical pain away, it is only temporary. Johnny seems to
showcase his emotions and feelings within his music, but is unable to speak openly
about his feelings one-on-one. Johnny has lived a very successful life however, it
seems his success if always followed by heart ship and he feels that he is to blame.
Johnny presented many of the symptoms of the DSM-IV-TR diagnosis of Major
Depression Disorder, Amphetamine Intoxication Disorder, and Alcohol Dependence
disorder.
Diagnosis: DSM-IV-TR
Axis I- Major Depressive Disorder
Axis II- Amphetamine Intoxication Disorder
Axis II- Alcohol Dependence Disorder
Recommendations
Treatment:
Medical Consultations: Johnny is referred to a medical consultation to his primary
care physician, Dr. Smith, M.D. Medical consultation will serve to rule out alternative
explanations for these findings as well as assess Johnny’s psychological evaluations.
Drug Therapy: Jonny needs to be taken out of any environment where drugs are
available to him. I believe he should stay at the Betty Ford Center for at least 60 days
to receive intensive drug therapy.
Alcohol Education: Johnny is clearly struggling with substance abuse but his
drinking habits are very acute. HE just needs to be informed on the effects of mixing
alcohol with any for of drug.
Psychological Testing: I believe due to Johnny’s Major Depression Disorder,
psychotherapy would be extremely beneficial for Johnny. It will help him improve
relationships with the people close to him, along with his career.
Suicide Prevention: Johnny should get involved in some sort of therapy of program
to receive counseling regarding any suicidal thoughts or behaviors he may be
harvesting internally. Especially since he already made one attempt.
 Close supervision
Work Cited
"Johnny Cash Biography." Johnny Cash. N.p., n.d. Web. 5 Dec. 2013.
<http://www.thebiographychannel.co.uk/biographies/johnny-cash.html>.
"Johnny Cash." - Education. N.p., n.d. Web. 5 Dec. 2013.
<http://www.music.us/education/J/Johnny-Cash.htm>.
"Depression Tests -- Blood Tests, Screening, and Other Tests." WebMD. WebMD, n.d.
Web. 5 Dec. 2013. <http://www.webmd.com/depression/guide/depression-tests>.
"Johnny Cash." Rolling Stone. N.p., n.d. Web. 5 Dec. 2013.
<http://www.rollingstone.com/music/artists/johnny-cash/biography>.
"Johnny Cash (1932â2003) - Encyclopedia of Arkansas." Johnny Cash
(1932â2003) - Encyclopedia of Arkansas. N.p., n.d. Web. 5 Dec. 2013.
<http://www.encyclopediaofarkansas.net/encyclopedia/entry-detail.aspx?entryID=9>.