Case Study of Rosa Lee Cunningham

Rosa Lee Cunningham is a Black American woman who has lived a pathetic life being a victim of extreme poverty, child abuse and deprivation of love and nurturance from her mother. The traumatic experiences in her life has led to her addiction to a lifestyle that further degrades her as a person instead of rising from her unfortunate situation.
From childhood, she has learned the harsh reality that black girls needed to be “trained” to care for the family and household while black boys are pampered. Rosa Lee underwent hard labor for the family under the watchful eye of her severely harsh mother, Rosetta.
Education was not given a priority in Rosa Lee’s growing years. Her mother would prefer that work and chores were done well and schooling was not as important, as she inculcated to Rosa Lee that she would never amount to something more than engaging in domestic work. Rosa Lee felt deprived of play in her childhood, as she needed to chop wood, carry heavy things, scrub a room spotless and cater to her family’s every need. As an adult, being overly clean with the house became her way of coping with stress.

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Rosa Lee craved for her mother’s approval. Her attempts to be close to her mother were often met with hostility. When she learned to shoplift nice things to offer her mother, she would be reprimanded, but later, as her mother would inspect the merchandize, would throw her arms around her with appreciation. Such acts of intimacy were short-lived, as Rosetta did not hesitate to inflict physical harm at Rosa Lee whenever she displeased her. On the other hand, her father, Earl Wright, an alcoholic had better regard for her and indulged her with whatever coins he can spare for her whenever he was drunk.
In school, Rosa Lee felt that her poverty was holding her back from becoming what she was destined to be. In her puberty, she noticed that other children had nice clothes while she wore rags. At this age, the need to belong and be noticed by other children becomes very strong. Her first shoplifting episode was borne out of this desire to be upgraded in terms of fashion. From then on, stealing became a way of life, and she became better and better at it until such time when she managed to subtly slip merchandize in her waiting bag or under her skirt.
Rosa Lee fared poorly in school, not realizing that she was a slow learner until she had the unfortunate episode of being thrown out of a class with a teacher she admired. With Mrs. Whitehead, she felt that she was learning, and enjoyed her teaching strategies. However, when she was caught in her class, she was instructed to join another class which Rosa Lee wanted to escape from in the first place. This prompted her to become truant in school. Since she never took school seriously after Mrs. Whitehead, she did not develop her literacy skills to the fullest. This lack of reading skills proved to be disadvantageous to her.
Her misdemeanors have brought her to troublesome situations, leading to an early pregnancy at age thirteen. She had to stop schooling to have her first born which her mother cared for. Soon after, she found herself pregnant again, and again and again, making her a mother of multiple children before she reached her twentieth birthday. Her promiscuous behavior is a desperate call for help to be released from her mother’s clutches. Once, she succeeded in having a man marry her only because he was threatened by Rosetta, but a few months later, Rosa Lee found herself back in her mother’s house as she had no other way to go because her husband beat her.
To feed her children, she had to resort to prostitution and selling illegal drugs. She always justified such ways of generating income as means of “survival” for her eight children. Her steady income came in the way of welfare checks which her mother had full control of.
Rosetta’s idea of child-rearing was to Rosa Lee, inappropriate. The noble cause of setting the children on the straight path (ex. that stealing is bad) is often implemented by violent acts. Such beatings or harsh cursing became a staple situation in Rosa Lee’s household. The traumatic events and painful feelings that come of it made Rosa Lee vow that she would never do harm to her own children.
Because Rosa Lee had no credible role model for morality, she set her own standards, which unfortunately were easily bent. She herself taught her children to steal clothes so they had something nice to wear or other things so they had something to sell to buy food. Later on, she would involve her children and grandchildren in the drug trade because policemen don’t usually go after young children. She never expected that they would get hurt in the process, but failed to consider that she was putting them at high risk.
When Rosa Lee eventually became a drug addict herself, it became so natural to her and her children to share the illegal drug use. Their joint drug sessions impressed upon the children her tolerance of such a habit, making it convenient for them to justify it and even depend on their mother to supply it or money to get it from their drug dealers. This series of substance abuse shared by Rosa Lee and her six children merited them jail sentences and even acquiring the HIV virus for Rosa Lee and her two children she shared needles with.
It is pathetic that Rosa Lee and her children do not learn from the consequences of engaging in their drug habit, since upon release from jail, they are soon at it again. Even the threat of the AIDS disease did not deter them from continued pursuit of the next high.
Waking up to a painful reality of poverty and hopelessness after the high has worn off, her children merely exist. They do not have the drive to go out and make something of themselves to live normal lives. Instead of being employed in a decent job, they would rather depend on Rosa Lee who pushes herself to do what she does best – selling drugs and shoplifting just so her children are fed, housed and even given money to get their drugs. For Rosa Lee, this is her way of showing love for them.
Prolonged use of dangerous drugs, and her high level of stress have resulted in some physical illnesses in Rosa Lee as manifested by seizures, memory lapses and stomach pain. To manage it, she has been receiving her daily dose of Methadone at the community clinic. However, at times, such symptoms become too much to bear and she ends up confined in the hospital.
This paper attempts to analyze Rosa Lee’s psychological profile and diagnose her psychological situation using a multiaxial evaluation from the data gathered from her life story by Leon Dash and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Axis I: Substance Abuse/ Dependence
Rosa Lee’s manifested symptoms may be diagnosed as Substance Abuse/Dependence. Under DSM-IV-TR (text revision of 2002). Following are the usual behaviors exhibited by substance abusers/ dependents:
SUBSTANCE ABUSE
Manifests one or more of the following behavior:

Failure to fulfill major obligations: Rosa Lee has been habitually tardy in settling her bills, resulting in cut-off of services. She is unable to manage her finances, as she misappropriates her budget to her and her children’s drug supply instead of food for everybody or payment of utilities.
Use when physically hazardous: In spite of the threat of her HIV virus turning into a full-blast AIDS disease, or simply when she knows that her physical condition makes drug use lethal for her, Rosa Lee continues to indulge in drugs.
Recurrent legal problems: Rosa Lee has been arrested several times for shoplifting or busted for selling or using drugs.
Recurrent social or interpersonal problems: Rosa Lee is unable to control her children’s addictive behavior. She continually supports their drug habit by handing them the money to buy drugs and then tries to save them whenever they get in trouble associated with their drug use. Personally, she is frustrated with how they treat her but she seems helpless as she keeps her feelings usually bottled up inside and occasionally pushed to the limit. Since she has vowed never to be like her abusive mother to her children, she instead indulges their whims even if it brings disastrous results for them.

“With SUBSTANCE ABUSE the user has a choice: he/she uses in spite of illegal, unsafe consequences, or inappropriateness of the drinking/drugging experience.” (DSM-IV-TR, 2002).

With Rosa Lee’s history of drug use, she continues to use drugs despite her awareness of its consequences to herself or her family.
SUBSTANCE DEPENDENCE (ADDICTION/ALCOHOLISM)
Manifests three or more of the following behavior:

Tolerance: Rosa Lee tolerates the consequences that follow her drug use – pain, inability to function normally, even her children’s seemingly abusive behavior towards her.
Withdrawal: Rosa Lee’s body responses to drug use withdrawal are usually associated to how she takes medication to control the accumulated and related symptoms that the use of dangerous drugs have caused. Since her reading skills are inadequate, she is not accurate in following the dosage of the prescribed medication, causing her body to react with seizures, memory lapses, etc.
Large amounts over a long period: Rosa Lee’s intake of drugs/ illegal substances depends on its availability. The more drugs available for the taking, the more she can consume. This has gone on for most of her adult life.
Unsuccessful efforts to cut down: Despite her numerous attempts/ announcements to stop and reform her life by avoiding drugs, she would usually fall back into the drug habit.
Time spent in obtaining the substance replaces social, occupational or recreational activities: Rosa Lee’s numerous commitments have usually been missed due to her drug problem.

Continued use despite adverse consequences: Rosa Lee has gotten herself in dire circumstances because of her substance abuse/ dependency. Her repetitive confinements in the hospital, the threat of AIDS, the risk of being hurt by drug dealers may force her to stop using drugs, but when a stressful event comes to her life, or when her defenses are down, she would weakly give in to the temptation of taking drugs when it presents itself.
Axis II: Developmental Disorders/ Personality Disorders
From the data gathered, Rosa Lee seems to present a number of developmental disorders. From childhood, it was shown that she was a slow learner and her inadequate literacy skills has led her to troublesome consequences (e.g. misreading prescribed dosages of medication has caused her aggravated physical illnesses; her lack of understanding of simple systems such as billing or legal consequences has pushed her further in deeper problems).
Her poverty and feelings of deprivation has pushed Rosa Lee to impulsively steal from stores. Gaining approval from her family members due to the merchandise she has stolen has become the reward for this inappropriate behavior. Her usual excuse for it is “just trying to survive”, a rationalization she has passed on to her children and grandchildren.
Rosa Lee shows some obsessive-compulsive behaviors when she is stressed. She cleans her house in earnest to the point that it is spotless.
Axis III: Physical Conditions
Rosa Lee’s prolonged substance abuse/ dependency has caused her a lot of physical illnesses such as memory loss, body pains, seizures, general malaise and most of all, HIV from sharing needles when injecting dangerous substances to the body. Such illnesses has made Rosa Lee progressively weaker physically confining her to her bed whenever these attack.
Axis IV: Severity of Psychosocial Stressors
The prominence of her mother’s role in her life has greatly affected the formation of her character and personality. Rosa Lee was terribly afraid of her exploitative and cruel mother who forced her to do things against her will. She was physically and verbally abused. In spite of this, Rosa craved for her love and affection. When she already felt suffocated of her mother’s hold on her and her life, she found ways to get away from her such as getting pregnant and marrying early, which backfired and led her back to her mother.
Being a breadwinner of the family (both her own children and her mother and siblings) pushed Rosa Lee to work harder at acquiring income to support them all. In spite of this, she felt unappreciated and taken advantage of, but she passively accepted her fate.
Continuously supporting her children even in their adulthood was also a strong psychosocial stressor for Rosa Lee, as they were very much dependent on her that they even expect her to save them from the detrimental consequences such as bailing them out of jail, covering for their transgressions and taking their place to suffer the consequences of their own misdemeanors. Rosa Lee’s idea of maternal love is just to give and to give, as her selfish and inconsiderate children continually take and take, giving their mother nothing in return.
The environment where she lives in is another source of stress for Rosa Lee, as it eggs on her continuous engagement in the drug trade. If she or any of her children is guilty of crossing anyone, the threat of harm becomes prevalent.
Axis V: Highest Level of Functioning
Upon the thorough and keen reporting of Leon Dash, Rosa Lee has been portrayed as a street-smart woman who is truly a survivor in the context of her personal situation. She knows how to manipulate the sentiments of judges or other people who easily fall for her deceptive demeanor. She manages to acquire the necessary income for her family to survive in dire circumstances. When things are carefully explained to her and made sure that she understood the consequences of her behavior, Rosa Lee does the necessary action to normalize her life and become drug-free for a certain period of time. Her weak will may be made stronger with careful scaffolding of reminders and even threats to her safety. She also needs to be prodded to assert herself when it comes to her children who control her emotionally by pushing the right buttons.
Proposed Treatment Plan
In coming up with an appropriate treatment plan for Rosa Lee, many factors are to be considered. Like in most cases, treatment needs to combine psychological therapy with the treatment of the physical addiction.
Before any treatment plan is attempted, Rosa Lee’s intrinsic desire to be reformed must be expressed. The decision to be healed of her addiction should help her commit to being cooperative with the concrete vision that she will indeed be free from the bondage of the addiction.
To cleanse her body of the chemicals she has ingested, Rosa Lee needs to go through medical detoxification. “While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.” (National Institute on Drug Abuse, n.d.). As it is, Rosa Lee has been taking her doses of Methadone, a drug that helps her in stabilizing her life and reducing her illicit drug use. Her treatment plan must likewise include treatment and management of her HIV positive state to prevent it from becoming a full-blast AIDS disease. Priority should be helping Rosa Lee regain her physical vigor and feisty spirit.
Since her immediate environment is one factor that encourages her addiction, she must be moved to a less threatening environment that promotes well-being. Being in a stress-free environment greatly helps in achieving peace. A conducive environment also facilitates deep introspection and coming up with an action plan to pursue a drug-free and positive lifestyle after the treatment process.
The most important element in the treatment plan is Rosa Lee’s psychological therapy. Managing the effects of her trauma from childhood entails getting to the root of it. Therapy must include her revisiting of the past and steps to achieve closure from the psychological pain inflicted by her overpowering mother and the prejudicial socio-cultural environment that exploited her dignity as a person.
Family therapy is essential in the healing of Rosa Lee’s affliction. Since the dysfunctional members are likewise culprits in encouraging Rosa Lee’s addiction, they themselves must undergo psychological therapy not only for her but also for their own good. In doing so, an empowered sense of self and responsibility is hoped to be developed.
Psychotherapy will help in treating Rosa Lee’s emotional wounds. The need to understand why things turned out the way they are should be met so the individual is equipped to resolve the situation and move on. One example is for Rosa Lee to understand the dynamics she shared with her mother and how she should manage the strong feelings her painful relationship still brings about. Being able to manage it will help her in dealing with stressful situations associated with her mother.
Rosa Lee’s strengths should be used in the treatment plan. Among these are her deep love for her family and her creative and critical thinking abilities. In helping her understand how her dysfunctional behavior puts her children and grandchildren at risk may help her shift her paradigm on love. Encouraging her to be strong in denying her children the whims which may bring them harm by using “tough love” may be effective in likewise strengthening her character. She may find it very difficult at first considering giving in to all her children’s whims has been her parenting style for a long time and her way of showing love for them, but eventually, as she reaps the fruits of her sacrifice, she will eventually be accustomed to it.
Her creative and critical thinking skills may be called upon whenever she feels tempted to relapse into her addiction after treatment. She may find ways and means to avoid anything that would trigger her urges to take illicit drugs like old co-drug dependent friends, drug dealers, or even places she associates with her former life in the drug trade.
In the book, there were frequent references to the power of religion over her. This may mean that Rosa Lee finds it important. Being exposed to the teachings of her chosen religion may help her acquire proper understanding of moral values. It would be ideal if religion and spirituality would be her substitute for the ultimate “high” she is perennially in search of.
Even at a late age, she may still be given tutorial sessions on developing literacy skills. Not only will she learn to read and write, but her confidence and self-esteem will be improved, giving her hope for a better future. Vocational rehabilitation such as engaging in arts and crafts, gardening, cooking, etc. will not only keep her mind off her addiction but also equip her with more skills. Such skills will help her find appropriate, decent and gainful employment to start her off in her reformed life.
Rosa Lee is also recommended to get into assertiveness training to enable her to non-defensively express her emotions. This will help her not to be easily taken advantage of people, especially her family members who are always out to get a cut of her welfare checks. She will likewise be empowered to think of herself positively, and even contest the societal norms and beliefs she grew up on, which were partly responsible in lowering her self-esteem.
An effective treatment plan attempts to administer to her medical, psychological, vocational, social, and even legal needs. Rosa Lee had left a lot of pending legal cases, and these need to be resolved or if need be, she should be amenable to face the verdict responsibly.
As Rosa Lee gets better in her treatment plan, consistent monitoring of her progress must be assessed continually and modified as necessary to ensure that the plan meets her changing needs.

“Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.” (National Institute on Drug Abuse).

The complications in Rosa Lee’s life have contributed to the state she is currently in. Like a pack of a wrongly- knitted ball of yarn, her treatment plan should carefully release the knots to unravel the strands so a more accurate weave may be started and completed before she finally expires.
No matter how unfortunate one lives his life, there is always hope for change. In Rosa Lee’s case, if she is determined to turn her life around, no one can stop her from achieving the happiness and fulfillment a “clean” life and amend her ways and teachings she has previously imparted to her children and grandchildren. She will continue to carry the burden of being responsible for her family being the matriarch, but change needs to begin with her. Hopefully, positive change will rub off on her children and grandchildren. Only then could a trans-generational woundedness begin to heal, as she may be the first real credible role-model they can ever have.