First Name
Age Group
Clinton Twp
Zip Code
Marital Status
How many people share the living space with you?
What is your highest level of formal education?
High School
What race/ethnicity do you belong to?
What is the frequency of your visits to the health care provider?
Are you presently employed? If yes, what is your occupation?
yes, but struggling, House painter
Were you employed previously? If yes, when and where?
yes, To many to list
What conditions have you been diagnosed with? When? Where?
Bipolar mixed with rapid cycling
Have you ever been hospitalized? If yes, how many times? When was the last time that you were hospitalized?
Please describe everything you know about your condition(s) and how you obtained such information?
I know alot but am very confused, i've read everything i could find at the library
Please illustrate your life before, during, and after learning of your condition(s) and engaging in therapies, if any?
all through my 20's my life felt out of control, iwas being treated for depression for most of my life, i've been in and out of therapy over the years. My life feels like it has not changed one bit, i just wanna be happy again and live life to its fullest
Please describe how you cope with your condition(s), if at all, and the effectiveness of each strategy?
i struggle everyday to understand why i do the things i do!
Does the state of your health impede in any way your everyday activities such as work, housework, studies and so on?
yes everyday
Does the state of your health impede in any way your social activities, such as inviting others to your residence, accepting invitations, going out with friends and so on?
How would you classify your daily interactions with people in general? (Comfortable, neutral, awkward, unpleasant) Please describe in detail.
sometimes confortable but mostly awkward
How do you envision your future?
at this point i don't
On the whole, I am satisfied with myself.
Strongly Agree
At times I think I am no good at all.
Strongly Agree
I feel that I have a number of good qualities.
I am able to do things as well as most other people.
I feel I do not have much to be proud of.
I certainly feel useless at times.
I feel that I'm a person of worth, at least on an equal plane with others.
I wish I could have more respect for myself.
All in all, I am inclined to feel that I am a failure.
I take a positive attitude toward myself.
I can always manage to solve difficult problems if I try hard enough.
If someone opposes me, I can find the ways and means to get what I want.
I am certain that I can accomplish my goals.
I am confident that I could deal efficiently with unexpected events.
Thanks to my resourcefulness, I can handle unforeseen situations.
Strongly Agree
I can solve most problems if I invest the necessary effort.
I can remain calm when facing difficulties because I can rely on my coping abilities.
When I am confronted with a problem, I can find several solutions.
If I am in trouble, I can think of a good solution.
I can handle whatever comes my way.
With my illness experience, I feel I am:
Often tense
Equally comfortable and uncomfortable
Often in agony
Often distraught
Often discouraged
Often unsure
Often helpless
Often uncertain
My relationships help me feel I am:
Often worthless
Often distressed
Often distant
Often isolated
Often excluded
Often blamed
Often criticized
Towards those who are emotionally close to me, I feel I am:
Equally forgiving and resentful
Often unreceptive
Often rejecting
Often discouraging
Often distrusting
Often misunderstanding
Often disrespectful
Universal beliefs and principles or a divine presence help me feel I am:
Often uninspired
Often troubled
Often judged
Often aimless
Often rejected
Often out-of-step
Often adrift
Towards universal beliefs and principles or a divine presence I feel I am:
Often ignoring
Often closed
Often demanding
Often critical
Often receding
Often resisting
Often separating