Irregular heartbeat and rapid uncontrollable palpitations.

V​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ignette: Zaid [age 28, works as a manager for a construction company] and Mike [age 31, works as a middle school teacher], come to see you for therapy. The couple has been married for five years and inform you that this is their first time seeking the help of a therapist. As they present in your office, both men come across nervous, anxious, and untrusting. They sit apart from one another with Mike directly facing you (therapist) and Zaid sitting closer to the corner of the couch forcing you to turn in order to communicate with him. Both men look healthy, well groomed, present with no challenges in the areas covered by the mental status exam and seem to be financially stable. Before delving into the presenting problem, Zaid and Mike clearly state that they are comfortable with their sexuality and are not here to process their homosexual existence in a heterosexual world. As you attempt to gather more information regarding why the couple have come to see you Zaid says that he simply cannot take living with Mike anymore. Zaid shares that Mike always has some type of illness that prevents them from having any sort of fun. He elaborates by saying in the last year, Mike has become a hobbit. As you asked for more clarification, Zaid shares that Mike refuses to go out and only wants to stay at home. As you look to Mike to get a sense of why he believes they have come to see you he shares that Zaid is a brute who constantly wants to go out, have some beers, dance, and party. He elaborates by saying that Zaid is constantly leaving the house to hang out with his friends, to play basketball, to watch the game, to play pool, and to be around everyone else except for himself. Mike states that he feels Zaid does not want to settle down and is wondering why they are married. Zaid shares that Mike fakes being ill in order to get him to simply stay at home and do nothing. In a frustrated voice he remarks, the doctors can never find any​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​thing wrong with him. Mike is always claiming to feel lethargic and fatigued. Then he claims to have an irregular heartbeat and rapid uncontrollable palpitations. Zaid continues by sharing that Mike has phantom pains in his side, and for some reason there seems to be no medical explanation for the pain. Zaid exasperates as he states that they have been to every specialist possible in the last year and no one ever has an answer for Mike’s “pains.” With tears in his eyes, Mike crosses his hands over his chest and says in a firm unmistakably authoritative voice that his ailments are not fake. The pain he feels are not in his head, as one of the doctors stated. Mike continued to say that Zaid does not understand him and does not care to understand what he is going through. Zaid simply wants to go out and have fun, all the time. Mike further shares that Zaid conveniently forgets to share the fact that he had an affair and just wants him to forget about it and move on. Zaid in an agitated manner shares that the “affair” was 3 years ago. Zaid shared that the “man” Mike is referring to was a co-worker and nothing happened between them except for text messages where he shared some the problems he was having with Mike at the time. Zaid thinks that Mike exhibits the physical symptoms and the crying spells to manipulate him into doing what he wants. In a sarcastic tone Zaid says that the symptoms tend to magically appear when Mike is asked to go somewhere, he does not want to (hanging out with Zaid’s friends), and they magically disappear when Zaid does what Mike wants for him to do. Mike looked at Zaid and says, I still cannot believe that you would share our personal problems with that man, a stranger who knows our personal issues. Why would he need to know about any of our problems and the fact that you refuse to adopt a child with me. I am so tired of all of this. I just want a family with the man. Is that too​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ much to ask for?

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