I. Abstract

Oskar Schell of the novel Extremely Loud and Incredibly Close lives a life full of panic and repetitive habits and mannerisms. He only wears white clothes; he spends most of his time inventing things in his head and playing his tambourine to ease his pain when he can’t pinch his stomach to self-harm. Oskar suffers from Post Traumatic Stress Disorder and Asperger’s Disorder. The PTSD directly sprouted from his experience of his father’s death on 9/11, and his Aspergers influences his behaviors used to cope.
II. Case History
1. Background Information

Oskar Schell is nine-year-old boy who lives in New York who shared strong bond with his father before he died in the terrorist attacks of 9/11. He used to spend most of his time on “Reconnaissance Expeditions” that his father sent him on to quench his constant need for exploration. He would look at maps and patterns, and would search Central Park with his metal detector to find clues he’d later inspect in his lab. After his death, Oskar found a key in his dad’s closet and is currently searching the five boroughs of New York to find the lock it opens. His mother has a boyfriend and it upsets him that’s she doesn’t appear to be as sad as himself.
2. Description of the Presenting Problem
Oskar also explores in his own mind by making inventions. Most of his inventions clearly demonstrate his anxiety over skyscrapers, brought on by the attacks. He wishes for elevators that stay in place with floors that move to you, so you’re never far off of the ground, and “birdseed shirts” for flying. The sight of elevators, suspension bridges, airplanes, fireworks, Arab people, and smoke make him “panicky” he reported. Other than making inventions, he conjugates French verbs to take his mind off of depressing and stressful thoughts. He walks for hours every weekend to avoid public transportation on his search for the lock. Oskar’s bad insomnia keeps him up for hours and he says he counts the 7 minutes it takes the average person to fall asleep. He shows irritability when he fights with his mother on the topic of her boyfriend, and even remarked “If I could have chosen, I would have chosen you,” referring to the death on 9/11.
Oskar’s relationships with people don’t start off well because he is upfront and asks inappropriate questions. When he first met Abby Black, a middle-aged woman, he asked her if he could kiss her. He carries around a tambourine everywhere he goes, because he says it calms him down. He certainly isn’t delayed because his extreme intelligence and curiosity.
3. Diagnosis

Oskar Schell’s emotions and behaviors suggest he suffers from Post Traumatic Stress Disorder (309.81). To be formally diagnosed, he must display symptoms in each set of criteria. According to the DSM-IV, his symptoms of the disorder are (A1) experience of an event where others died, (A2) intense fear and helplessness, (B4) intense psychological distress at exposure to external cues that symbolize the traumatic event, (C1) efforts so avoid thoughts, (C2) effort to avoid activities, (C7) sense of foreshortened future, (D1) suffers from insomnia, (D2) irritable with outbursts of anger, and it’s chronic according the DSM-IV because (E1) symptoms lasted over 3 months.

Oskar’s habits and social skills demonstrate that he has Asperger’s Disorder (299.80). In reference to the DSM-IV, his symptoms of the disorder are (A2) failure to develop appropriate relationships, (A3) lack of social or emotional reciprocity, (B3) repetitive motor mannerisms, (C1) social impairment, (D1) no language delay, (E1) curiosity in nature and no cognitive delays, and (F1) criteria not met for other PDDs or Schizophrenia.

Axis 1: Post Traumatic Stress Disorder and Asperger’s Disorder

Axis II: No Diagnosis

Axis III: Bruises on stomach from self-harm

Axis IV:
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Father’s death
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Mother’s boyfriends
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Sight of buildings, smoke, Arab people, elevators, and public transportations
Axis V: 50
III. Intervention
1. Psychoanalytic Approach

In this approach, the psychoanalyst would find the unconscious thoughts of the patient through activities like word association, to reveal childhood experiences that have changed their way of thinking. In the novel, Oskar’s psychologist Dr. Fein does a word association game to understand him. When Fein says the word “hurt,” Oskar replies with the word “realistic” and “Dad” is the response to “emergency.” The psychoanalyst can then go more in depth with the effects the 9/11 attacks had on him. He often had inappropriate responses in the word association activity which supports the idea that he has Asperger’s.
2. Cognitive Behavioral Approach

A cognitive-behavioral psychologist would approach the patient by focusing on current negative thoughts and behaviors. “Talk therapy” is effective on PTSD patients where the psychologist and the patient talk until certain thoughts are identified as negative and they learn to replace them with happy thoughts. Dr. Fein asked Oskar if “anything good could come from your father’s death” so he could focus on the positive, but Oskar’s inappropriate social behaviors set them back when he cursed Fein out.
IV. References
Works Cited
"Diagnostic Classifications." Autism Society. N.p., n.d. Web. 12 Dec. 2012.
"DSM Criteria for PTSD." DSM-IV-TR Criteria for PTSD. N.p., 5 July 2007. Web. 12 Dec.

2012.
Foer, Jonathan Safran. Extremely Loud and Incredibly Close. New York: Mariner, 2006. Print.
Guess, Katie. "CBT for PTSD." Health Psychology Home Page. N.p., 5 Oct. 2009. Web. 13 Dec.

2012.
Heydasch, Kathy, and O. Wallace. WiseGeek. Conjecture, n.d. Web. 13 Dec. 2012.