Biopsychosocial Assessment: Morris S.

Schwartz

SSWU 3007
Professor Dannenfelser
May 5, 2014
 IDENTIFYING INFORMATION:

Morris S. Schwartz, mid-70s, is a happily married, heterosexual, Caucasian male. He

was diagnosed recently with amyotrophic lateral sclerosis (ALS) and presented in the clinic

expressing concern with morning bouts of atypical anxiety, fear, self-pity and crying (Albom,

Tuesdays with Morrie, 1997). Mr. Schwartz’s daily medical needs are provided by a palliative

care nurse in his home. He has no desire to be transitioned into a nursing home or hospice center

as he reaches the end of his life. What follows is a biopsychosocial assessment of Mr. Schwartz,

or Morrie, as he prefers to be called.

BIOLOGICAL - MEDICAL CONCERNS:

Morrie was in his mid-70-s when diagnosed with ALS (Morris S. Schwartz, 1995) and

was probably already experiencing symptoms and health conditions related to aging, “…such as

high blood pressure, heart conditions and orthopedic impairments” (Zastrow, 2013). ALS is a

progressive neurodegenerative disease of the central nervous system, “…resulting in the gradual

paralysis of the limbs, respiratory, and bulbar muscles” (Foley, 2014). Although 15 and 35

percent of ALS patients develop frontotemporal dementia or cognitive impairment, respectively,

Morrie does not suffer from these symptoms. The life expectancy following a diagnosis of ALS

is two to four years, but in reality, this period is much shorter. The peak age of onset for most

ALS patients is in their 60s, so Morrie developed the disease at a more advanced age and will

probably progress at a faster rate. In 1995, the average life expectancy for a male in the USA

was 72.54-years old (Saniski, 2014).

At the micro level, Morrie can no longer meet all of his physiological needs and overtime

his inability to engage in daily living activities will rapidly decline (Albom, Tuesdays with

Morrie, 1997) ; therefore, he will grow increasingly dependent on the mezzo systems with his
wife, nurse, friends and other family members to meet his feeding, bathing and other needs. The

interventions ALS patient would typically receive, depending on need, would be, “…the drug

riluzole, feeding tubes and respiratory assistance devices” (Sreedharan, 2013). On a macro level,

all of Morrie’s health and medical needs are being met by the U.S. health system. Even though

mechanical ventilation support would be provided eventually if he was unable to breathe on his

own, Morrie’s advanced directive contains a DNR (do not resuscitate). If the biological items on

the biopsychosocial INTERMED instrument were used to evaluate Morrie, he would score high

on disease chronicity, diagnostic dilemma, symptom severity, impairment, diagnostic/therapeutic

challenge, complications and life threat (Mazzocato, 2000).

PSYCHOLOGICAL - MENTAL STATUS

Morrie’s concern about his morning bouts of melancholy appear to be just that, nothing

more than the normal grieving process formulated by Kubler-Ross (Zastrow, 2013). The

relevant stages would be 2 and 4, anger and depression, but Morrie put strict time limits on his

morning bouts of self-pity (Albom, Tuesdays with Morrie, 1997). Accordingly, his concerns are

not sufficiently worrisome to warrant clinical intervention. The primary psychological concerns

for ALS patients are mild cognitive impairment, loss of insight, mental rigidity and dementia

(Mitsumoto, 2007). Morrie remains cognitively intact and active.

According to Erikson’s theory, the final psychological conflict is ego integrity versus

despair, which involves, “…coming to terms with one’s life. Adults who arrive at a sense of

integrity feel whole, complete and satisfied with their achievements” (Zastrow, 2013). Erikson

believed that successful aging requires acceptance of reality and the approach of death. Morrie

has been quite successful in this regard, even to the point of documenting his demise with his

former student, Mitch Albom. Another theorist, Robert Peck, refined Erikson’s vision of late
adulthood, “…specifying the tasks and thought processes that contribute to a sense of ego

integrity” (Zanden, 2002). In Peck’s theory, ego integrity requires older adults to move beyond

their life’s work, their bodies and their separate identities.

According to Peck, successful aging requires three adjustments. The first adjustment is

from the role of wage earner to retiree, which Morrie successfully managed by grieving the loss

of his old role as teacher and establishing a mentoring role with Albom. Morrie has also

accepted the fact that he is gradually losing his ability to walk, write or even hold lengthy

conversations and has transcended these limitations by remaining intellectually involved on both

the micro and mezzo levels. The third adjustment necessary for successful aging is self-

transcendence, which Morrie accomplished by shifting his attention away from self-pity by

sharing his death with loved ones (Zanden, 2002). Morrie came to realize and taught others,

“Once you learn how to die, you learn how to live” (Albom, Tuesdays with Morrie, 1997).

Morrie often mentions his acceptance of death and lack of fear. “Aging is not just decay,

you know. It’s growth. It’s more than the negative that you’re going to die, it’s also the positive

that you understand you’re going to die, and that you live a better life because of it” (Albom,

Tuesdays with Morrie, 1997). If the psychological items on the INTERMED instrument were

used to evaluate Morrie, he would score very low on all items (Mazzocato, 2000).

Psychologically, Morrie is doing very well.

SOCIOLOGICAL – PERSONAL HISTORY AND CURRENT TREATMENT

Morrie lives in an affluent Northeastern city in the United States (Albom, Tuesdays with

Morrie, 1997). Morrie has spent the majority of his life as a sociology professor at Brandeis

University. He was well liked by his students and known by many as an excellent teacher.

Morrie was forced into retirement due to the reoccurring symptoms that accompany ALS, such
as the loss of his motor skills. This aspect of the disease also caused Morrie to stop one of his

favorite activities, dancing. “Morrie danced by himself. He shimmied and fox-trotted, he did

old dances to modern rock music. He closed his eyes and fell into the rhythm, twirling and

spinning and clapping his hands” (Albom, A professor uses death to show us how to live, 1995).

Fortunately, as the disease effects his physical abilities and his body, Morrie remains realistic,

insisting that he keeps his mind working by teaching Mitch , “…the meaning of life” (Albom,

Tuesdays with Morrie, 1997).

On a macro or community level, Morrie does not suffer from any discrimination due to

race, ethnicity or gender. However, typically, an elderly person would experience ageism at

some point in their life. In addition, suffering from ALS and/or any other disability would confer

a lower societal status (Zastrow, 2013). The lower societal status could threaten Morrie’s mental

health, but he appears to be adequately buffered by a strong mezzo system, consisting of family,

friends, students and former colleagues (Ogden, 1999).

On a micro level, Morrie appears to be an outgoing, gregarious and good-humored

individual, who has remained intellectually sharp and active (Albom, Tuesdays with Morrie,

1997); therefore, Morrie does not have any impairment that would prevent social interactions.

On a mezzo level, Morrie is receiving love and care from his family, friends, former students and

colleagues (Ogden, 1999). Compared to other patients in palliative care, patients with ALS tend

to be less of a burden on caregivers; however, with increased symptom severity and behavioral

problems the burden can become significant enough to threaten the psychological health of

caregivers (Hecht, 2005). Morrie’s caregivers do not appear to be at risk due to the large number

of people, informal and professional, involved in his care. Should this change as Morrie nears

the end of his life, additional support could be obtained on a macro level from the U.S.
healthcare system. Based on this assessment, Morrie would score very low on the INTERMED

social items (Mazzocato, 2000).

CONCLUSION AND SUMMARY IMPRESSION

From a biopsychosocial perspective, the greatest threat to Morrie’s health is

physiological. This is due to the rapid progression expected of an ALS patient his age and the

imminent threat of death. One of Morrie's last aphorisms is, "When you're in bed, you're dead"

(Albom, Tuesdays with Morrie, 1997). Morrie has now moved from his study to his bed,

indicating his battle with ALS will soon end. Morrie uses a breathing tube that has been inserted

up his nose, as he experiences more severe coughing spells. Morrie remains both optimistic and

realistic throughout his battle with ALS. Morrie accepts the fact he will never return to being the

man he was, as he becomes fully dependent on others. He reveals in his final days that he

“enjoys being a baby again” (Albom, Tuesdays with Morrie, 1997). As a child, Morrie did not

receive the love and affection he needed, which is why he is comfortable admitting to and

seeking this type of treatment in late adulthood. Even though psychologically and socially

Morrie aged successfully, he died on November 4, 1995.

 Works Cited

Albom, M. (1995, November 12). A professor uses death to show us how to live. Retrieved from

Inspiration: Morrie Schwartz: http://mitchalbom.com/d/bio/3720/inspiration-morrie-

schwartz

Albom, M. (1997). Tuesdays with Morrie. New York City: Broadway Books.

Foley, G. (2014). Acceptance and Decision Making in Amyotrophic Lateral Sclerosis From a

Life-Course Perspective. Qualitative Health Research, 24(1), 67-77.

Hecht, M. J. (2005, May 24). Caregiver burden and patients’ perception of being a burden in

ALS. Pallative Medicine, 64(10), 1780-1782.

Mazzocato, C. (2000). Comprehensive assessment of patients in palliative care: A descriptive

study utilizing the INTERMED. Journal of Pain and Symptoms Management, 19(2), 83-

90.

Mitsumoto, H. (2007). Palliative care for patients with amyotrophic lateral sclerosis: Prepare for

the worst and hope for the best. Journal of the American Medical Association, 298(2),

207-216.

Morris S. Schwartz. (1995, November 9). Retrieved from The New York Times:

http://www.nytimes.com/1995/11/09/us/morris-s-schwartz-professor-78.html

Ogden, J. (Producer), & Jackson, M. (Director). (1999). Tuesdays with Morrie [Motion Picture].

USA.

Saniski, D. (2014, May 1). Life Expectancy- United States. Retrieved from Data 360:

http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195

Sreedharan, J. (2013). Amyotrophic lateral sclerosis: Problems and prospects. Annals of

Neurology, 74(3), 309-316.

Zanden, J. W. (2002). Human Development (7th ed.). New York City: McGraw-Hill.

Zastrow, C. H. (2013). Understanding Human Behavior and the Social Environment. Belmont:

Cenage Learning.