What´s bothering Holdan?

We can see that Holdan has a lot of problems. His behavior is weird and his humor a constantly changing, it is worst than women when they are angry.
All these problems could have some origin, like a psychological or a psychiatric origin.
Let´s see if he has the symptoms of some mental illnesses.

Post Traumatic Stress Disorder 

PTSD (Post Traumatic Stress Disorder) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

People who have PTSD may feel stressed or frightened even when they are not in danger.

Symptoms: 

 Intrusive memories

•             Recurrent, unwanted distressing memories of the traumatic event
•              Reliving the traumatic event as if it were happening again (flashbacks)
•             Upsetting dreams about the traumatic event
•             Severe emotional distress or physical reactions to something that reminds you of the event

Avoidance

• Trying to avoid thinking or talking about the traumatic event
• Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

• Negative feelings about yourself or other people
• Inability to experience positive emotions
• Feeling emotionally numb
• Lack of interest in activities you once enjoyed
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships

Changes in emotional reactions

• Irritability, angry outbursts or aggressive behavior
• Always being on guard for danger
• Overwhelming guilt or shame
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble concentrating
• Trouble sleeping
• Being easily startled or frightened

 People may have more PTSD symptoms when they're stressed in general, or when they run into reminders of what they went through.

Depression 

Depression is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. 

 There are a lot of types of depression: 

•  Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years.  
• Perinatal depression. Many women experience it after giving birth.  The feelings of extreme sadness, anxiety, and exhaustion.
• Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs, or having  hallucinations.  
• Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain.

Symptoms: 

 Psychological symptoms

• Continuous low mood or sadness
• Feeling hopeless and helpless
• Having low self-esteem 
• Feeling tearful
• Feeling guilt-ridden
• Feeling irritable and intolerant of others 
• Having no motivation or interest in things
• Finding it difficult to make decisions
• Not getting any enjoyment out of life
• Feeling anxious or worried 
• Having suicidal thoughts or thoughts of harming yourself
• Physical symptoms

 Physical symptoms  

• Moving or speaking more slowly than usual 
• Changes in appetite or weight (usually decreased, but sometimes increased) 
• Constipation 
• Unexplained aches and pains
• Lack of energy
• Low sex drive (loss of libido)
• Changes to your menstrual cycle 
• Disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

Social symptoms

• Not doing well at work
• Avoiding contact with friends and taking part in fewer social activities
• Neglecting your hobbies and interests
• Having difficulties in your home and family life

Severities of depression

Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realising they're unwell. It can sometimes take a friend or family member to suggest something is wrong.

Doctors describe depression by how serious it is:

- Mild depression – has some impact on your daily life

- Moderate depression – has a significant impact on your daily life

- Severe depression –  makes it almost impossible to get through daily life; a few people with severe - 

Depression may have psychotic symptoms 

Five stages of grieving and loss 

Dealing with grief is not easy. As someone well-acquainted with death and loss. Loss visits us all in one form or another, and where is loss, there is also grief.  

Like Rando. T said “Grief is the process that allows us to let go of that which was and be ready for that which is to come.”  That’s the purpose of grief, it helps us move on. There are several models of grief that can provide a framework for what to expect and can help us “move on”. One of the most well-known models of is “The 5 Stages of Grief”.

 The 5 stages of grief and loss are: Denial and isolation, Anger, Bargaining, Depression and  Acceptance. People who are grieving do not necessarily go through the stages in the same order or experience all of them.

 1. Denial & Isolation

The first reaction to learning about the terminal illness, loss, or death is to deny the reality of the situation. “This isn’t happening, this can’t be happening,” people often think. It is a normal reaction to rationalize  devastating emotions. It is a defense mechanism that buffers the immediate shock of the loss. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain. It is the first part.

 2. Anger

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be pointed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Remember, grieving is a personal process that has no time limit, there is no one “right” way to do it.

 3. Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control

-If only we had sought medical attention sooner…

-If only we got a second opinion from another doctor…

-If only we had tried to be a better person toward them…

Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

4. Depression

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words.

The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.

5. Acceptance

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by retirement and calm. This is not a period of happiness and must be distinguished from depression.

Coping with loss is ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.

Loneliness

Some people may say that the happiness for them is to have fortune.   But we all know that  friends and family are the real prize. Even though our need to connect is innate, some of us always go home alone. You could have people around you throughout the day or even be in a lifelong marriage, and still experience a deep, pervasive loneliness. Unsurprisingly, isolation can have a serious detrimental effect on one's mental and physical health.

In fact, evidence has been growing that when our need for social relationships is not met, we fall apart mentally and even physically. There are effects on the brain and on the body. Some effects work subtly, through the exposure of multiple body systems to excess amounts of stress hormones. Yet the effects are distinct enough to be measured over time, so that unmet social needs take a serious toll on health, eroding our arteries, creating high blood pressure, and even undermining learning and  memory.

Your friends and  your family generally bring the emotional discomfort or distress known as loneliness. It begins with an awareness of a deficiency of relationships. This cognitive awareness plays through our brain with an emotional soundtrack. It makes us sad. We might feel an emptiness. We may be filled with a longing for contact. We feel isolated, distanced from others, deprived. These feelings tear away at our emotional well-being.

Impact of death on a family 

Holdan lost his little brother, Allie. This lost could be the origin of the problems for Holdan. 

Holdan is a teenager, teen´s behavior after losing a member of them family is like this: They think abstractly, they have a minimal magical thinking, they want to find the balance between dependence and independence. They have some concepts in their minds, for example, they believe that the death is the final, they think that they caused the death, they try to understand what loss is for them in the present and what it will mean in the future. 

Some grief issues that they have are irritability, changes in sleep, eating, school and social settings and they are concern about the future. 
Some of the possible long therms effects are problems in school, problems in relationships, antisocial behavior and suicide. 

   Diagnosis 

I think that Holdan have a combination of three of the "illnesses" and problems that were mentioned. 
With depression (Persistent depressive disorder and Seasonal affective disorder), with loneliness and the impact of death on a family. 
After reading al the characteristics of the topics I realized that Holdan has a lot in common to these three. 
He is sad, he can´t tolerate the others (He call them "phonies"), he has no motivation to do things, he is anxious, once he had a suicidal thought, he started thinking what would it happened if he dies, that is not a normal thought, it seems like he just doesn´t want to live anymore. 
He feel lonely, he doesn´t want to talk with nobody, just with Phoebe, but, for example, one of his plans was going away from his home and work in a gas station pretending that he can´t hear, just because he doesn't want. 
I think that he misses Allie a lot and his problems are caused because of that. He had problems in school, in his relationships, he has an antisocial behavior and he taught in the suicide as a solution of all the things that he is living. 


Treatment 

First the doctors would try with some "Talk therapy". I think that at the beginning Holdan will resist a little bit but then he just will say to the doctor all his thoughts and all the problems that he is having on his life. 
After these I think that Holdan should be medicated because his depression is very severe. They would give him antidepressants, like serotonin reuptake inhibitors  norepinephrine reuptake inhibitors, serotonergic and other medications. These medicaments keep the serotonin more time in the body. The serotonin is a neurotransmitter that inhibits the anger and the agression. Those things are related to the depression. The serotonin "makes us happier". 

With all these help Holdan would be better and hopefully he could decide what to do with his life, he could notice the potential that he has. 

Sources: http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/symptoms/con-20022540
http://www.helpguide.org/articles/ptsd-trauma/post-traumatic-stress-disorder.htm
https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

http://www.nhs.uk/Conditions/Depression/Pages/Symptoms.aspx

https://www.nimh.nih.gov/health/topics/depression/index.shtml
http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/
https://prezi.com/6ijgankhxgdj/the-impact-of-grief-loss-and-death-on-individual-and-family-development/
https://prezi.com/6ijgankhxgdj/the-impact-of-grief-loss-and-death-on-individual-and-family-development/
https://www.nimh.nih.gov/health/publications/espanol/depresion/index.shtml
https://www.psychologytoday.com/basics/loneliness
https://www.psychologytoday.com/articles/200307/the-dangers-loneliness
http://www.webmd.com/depression/symptoms-depressed-anxiety-12/treating-depression