When we first meet the main character, only identified as “Jack”, he has a gun to his head battling his split personality, Tyler Durdan. He then takes you back many months so you can know how it is he came to that state. Jack is a 30 year old single white male complaining of insomnia for over 6 months. His job as a liability consultant for an automotive company requires him to take frequent trips to different time zones, usually on a short notice, therefore leaving him jet lagged.
This issue has endured for at least six months. He states he is in “pain” and wants something to just make him sleep. Jack states that on several occasions he has woken up in strange places and does not know how or when he got there. He realized that having blackouts (not due to substance abuse or general medical condition) was disturbing and unusual behavior. The doctor he visited dismisses his claims and suggests he attend a support group for cancer to witness “real” pain. An image of his alter-ego briefly appears at that moment. Due to his job, Jack does not have any immediate friends or family. He refers to the passengers on the planes as his “single serving friend.” Jack begins attending a variety of support groups for ailments that he does not have in order to do something during his bouts of insomnia. After the first few meetings, Jack’s insomnia seemed to elapse and he uses the meetings as his sleeping pill. His recovery is short lived due to another fake “survivor”, Marla Singer. Her presence in his groups threatened his sleep because she knows that he is faking.
The patient is coherent and can fully comprehend what is going on around him. His dress is appropriate however his clothes are unkempt. His hair is disheveled and dirty. He appears to look anxious with dark circles under his eyes and not shaven in a couple of days. His posture is slumped.
PRESENTING PROBLEM:
While on a plane returning from a business trip Jack meets Tyler Durdan, his split personality. Tyler is the complete opposite of Jack. He is everything that Jack wishes he could be. With his red tinted sunglasses and leather jacket he resembles more of a rock star as compared to Jack’s drab wardrobe of white button up shirts and brown ties. Jack seems intrigued about Tyler and claims he is the most interesting “single serving” friend that he has ever met. When Jack returns to his condo he finds out that his apartment has exploded. All of his prize possessions, his IKEA furniture, have been destroyed. He feels pathetic of the fact that when they recover his belongings they will only find condiments in his refrigerator, thus exposing that he had no life. Jack called onto his inner self, Tyler to help rescue him from his dismal life. Jack retreats to a vacant house in the middle of no where and that is where the relationship between Jack and Tyler formulate. Initially, Jack is unaware that Tyler is not real. This is shown by the fact that he refers to himself as “us”, engages in conversions, fist fights with Tyler and at one point even sharing a beer with Tyler.
SITUATIONS STRESSORS:
Jack feels unsatisfied with his life. He feels abandoned by friends and most importantly his family. His father deserted the family when he was a little boy. His career leaves him discontented and unfulfilling. After the explosion of his condo his old personality, Jack, began to digress and Tyler Durdan was brought to surface. The initial meeting with Tyler ends in an altercation attack. Tyler encourages Jack to hit him, which in reality is really him. He has a physical fist fight with himself in the parking lot, leaving him badly bruised externally however emotional healed. The fighting allowed him to release all of his pent up frustrations with his life. From this emerged Fight Club. Fight Club was a place where men could go and fight each other to let it all go. They’re fighting was a way to relieve stress for their cruel lives. These men felt refreshed and saw it as therapy.
MENTAL STATUS EXAM:
During the duration of the movie Jack’s appearance continued to deteriorate. His clothes became more tousled. He went to work looking as if he didn’t take a bath, wash his hair or shave, the circles under his eyes got darker and heavier. His shirts were often stained with blood and his face was always bruised from the fights. His boss noted his appearance and suggested he take time off to get himself together. Although Jack physically looked horrible, his work performance did not suffer. He would turn in his assignments on time and complete.
When Tyler was in charge of the body he engaged in a sexual relationship with one time nemesis, Marla Singer. When Jack’s personality would reappear after an encounter with her he would be verbally hostile towards her and kick her out of his house. Marla, who was a self destructive person to begin with, continued this relationship despite the verbal abuse she received from Jack.
Jack continued to participate in Fight Club for over a year. He no longer needed the support groups to feel good about himself. The clubs grew from a few members, to hundreds, even thousands. As the Fight Clubs expanded, so did the destruction. It went from men fighting in the basement of a bar to vandalizing buildings, cars and other symbols of repression by society. In a sense, Fight Club turned into a mini-army of men who felt repressed by the government. Most of the men were blue collar workers who seemed as if they could never get ahead in life. They idealized Tyler Durdan and looked up to him as if he were God. They terrorized cities in his honor. The exposure from the media only fueled their zeal for destruction. As Fight Club grew so did the persona of Tyler Durdan. When Jack noticed these men were giving credit for their new found happiness only to Tyler, he felt jealous and rejected.
SYMPTOMS OF IMPAIRED FUNCTIONING:
Jack’s bouts with insomnia, violent behavior, and black outs, interrupted his normal day to day living. When Jack had his insomnia, Tyler’s personality took over and got jobs where he could interject subtle doses of shock to people. For instance, he worked as a waiter where he urinated in the food. He also worked at a movie theater changing the film. Instead of just changing the rolls of film, he cut and pasted snippets of pornographic images into the film. The people viewing the movies only saw a snapshot of a naked person for less than a second. Jack’s aggression carried over into his work place. When his boss became annoyed with his unkempt appearance, absenteeism and apathetic attitude he fired him. Instead of responding rational, Jack beat himself up in his boss’s office and blackmailed by threatening to expose company corruption or to keep him on as an outside consultant in exchange for his silence. This afforded him and Tyler with more time to devote to Fight Club to participate in the expansion in different cities and states. Most times when Jack involved himself with Tyler Durdan he was aware of what actions that Tyler was doing. He usually was a silent bystander while Tyler masterminded mayhem. Other times he would have outright conversations with Tyler in front of others, questioning his actions. The only times Jack was not conscious of what was going on around him was when he was with Marla Singer or traveling to recruit new members.
PATIENT’S STRENGTHS AND ASSETS:
Even though Tyler Durdan had no respect for others, experienced no fear or regrets, Jack’s caring disposition makes him rational in chaotic situations. He understands the difference between what’s right and wrong. When Fight Club escalated to the mayhem that erupted on the city, Jack did not feel comfortable with it. He questioned Tyler’s intent; however, Tyler did not want Jack to be involved. He stated that Jack determined his own level of involvement with him. His regard for other people is evident when one the Fight Club members, Bob, was killed during a botched vandalism attempt. The other members of the club wanted to bury him in the back yard as if he were just evidence of their devious acts. Jack had to remind the men that he was a human being with feelings not just a disregarded object.
Another example of Jack’s softer side was obvious when he felt that Marla was in danger. He attempted to rescue her by putting her on a bus away from harms way. Tyler did not want Jack to discuss him or his actions to anyone, especially her. When the lines between Tyler and Jack started to get blurry, he went to Marla to ask her questions about Tyler. Once this door was opened, Tyler Durdan wanted to get rid of Marla to prevent Jack from seeking out more answers about reality. Tyler felt as though, once Jack knew that Tyler was really within him and causing all this havoc that he would retreat back to his old boring self.
It is clearly apparent that Jack possess’ excellent organizational skills and leadership ability. The way he evolved fight club from a bunch of guys just fighting into an a group of soldiers conducting calculated terrorist attacks to the city was more on the lines of a General in the army instead of a Liability Consultant. Even though Tyler Durdan’s persona was the mastermind behind the coordination, the ability to do so came from deep within Jack.
DIAGNOSIS:
AXIS I: NONE AXIS IV: NONE
AXIS II: DISSOCIATIVE IDENTITY DISORDER AXIS V: GAF SCORE-30
AXIS III: NONE
DIAGNOSTIC COMMENTS:
Jack’s life was unfulfilling and unsatisfying. He had no friends or family. He lived alone and the only contact to the outside world was his job. Jack wanted a change in his life. The personality of Tyler Durdan was created to make Jack become the person he wished he could be. He created the other self to free himself from his bleak world. However, Jack was oblivious to the fact that he indeed was creating an alternate personality. After a car accident that Tyler caused, which Tyler Durdan referred to as a near life experience, he had a revelation and that is when it became apparent to him that he and Tyler were undoubtedly one in the same. Tyler Durdan’s philosophy on life was “live life like you were dying” while Jack was cautious and calculated. Since he worked as a Liability Consultant for an automotive company he saw the danger in everything. The split between the conscious happened once Jack was completely frustrated at how his life at 30 years old turned out. He intentionally blew up his condo to start fresh. However, when his alter-ego turned out to be more than he was willing to handle that is when he decided to wipe him out. He did this by attempting to kill himself in order to get rid of Tyler Durdan. Fortunately, he only killed Tyler Durdan not himself.
TREATMENT GOALS
Learn to disentangle Jack from his alternate personality
Boost Self Esteem
Teach Jack how to deal with situation stressors rationally
Teach Jack how to control impulses
Learn about healthy defense mechanisms
TREATMENT PLAN
Refer to a psychiatrist for long term individual therapy
Recommend medication for depression or antic-psychotic behavior
Hypnotherapy