Download Identity Final Project May 2/04 1.) Malcolm Rivers 2.) Symptoms a

Identity
Final Project
May 2/04
1.) Malcolm Rivers
2.) Symptoms
a.) Biological- Headaches, eventually started blacking out.
b.) Environmental- Mother was a prostitute, she kept him "there as long as she
was busy." She abandoned him at a motel leaving him tortured and evil. Had
a hearing for Malcolm River s the night before his execution. He kept a diary
for each personality trait. In different writing. He was supposed to be executed
but he was moved to a psychological ward to be watched because of his
problems.
c.) Psychological: Repetitive, "don't beat around the bush, don't beat around the
bush, etc" "I remember, I remember" He has multiple personalities and uses
them all.
3.) Diagnosis: Malcolm Rivers has Dissociative Multiple Personality Disorder. Multiple
personality disorder (MPD) is a psychiatric disorder characterized by having at least
one "alter" personality that controls behavior. The "alters" are said to occur
spontaneously and involuntarily, and function more or less independently of each
other. The unity of consciousness, by which we identify our selves, is said to be
absent in MPD. Another symptom of MPD is significant amnesia which can't be
explained by ordinary forgetfulness. All his personalities stem from a different part of
his past and how he can deal with it. Timothy is probably a personality created by
Malcolm to deal with the murderous hatred he felt toward his mother. All of the
personalities were created to handle different situations and/or emotions that Malcolm
could not. Paris, for example, was probably created to handle his conflicted feelings
about sex, due to his mother's profession. Timothy's mother may have been created to
protect Timothy from the consequences of his murderous actions. In most multiple
personality scenarios, there is a dominant personality who is aware of the other
personalities (some or all, not sure). Timothy probably left the other personalities in
place because they served his best interests, until the good Doctor set in motion his
plan to eliminate the murdering personality that put him into confinement. Then it
became Timothy's best interest to rid Malcolm of all of the personalities except one
(and Paris had a future planned already, so what better candidate), until that one too
could be eliminated, giving Timothy total control. The diagnosis requires medical and
psychiatric evaluation, including specific questions about dissociative phenomena.
4.) His Multiple Personalities
A) Timothy (the boy)
1.) Watched his mother get killed by the car
2.) Doesn't talk much after his father left. His father left
them with a bad temper problem.
3.) In room #4
4.) Was the "6"th person killed with Genie in the car
explosion
5.) Actually was the last one alive, he was the
murderous personality.
6.) He took over Malcolm's body
7.) Malcolm yells out whores don't get second chances
when he kills Paris and in real life kills his doctor.
B) Father
1.) He is the step father of the boy
2.) Very defensive
3.) In Room number 6
4.) He was the 4th killed- killed by the truck that Larry
was driving
5.) Found with key number 7- was fixing the tire.
C) Mother (Alice)
1.) Was hit by the limo when she stood back from the car.
Edward fixed her open neck wound.
2.) Was in room number 4
3.) 6th to die
4.) Key number 6 under bed.
D) Actress (Karolin Suzanne)
1.) Uptight
2.) Was trying to get her cell phone to work in range and
goes outside where she is killed, stabbed in the rain.
Her head is stuffed into the dryer where Edward finds
it. Found with a key to room one.
3.) First to be killed
4.) Was assigned to room 9
5.) Carries around a lot of cash E)
Motel Clerk (Larry)
1.) Jumpy
2.) Tries to make everyone more comfortable
3.) Strange habits, like stammering
4.) Is accused of killing the prisoner.
5.) A dead body was found in his freezer with a hidden
picture, and actress's wallet.
6.) He is not the real hotel clerk, the real one died of a
heard attack, and Larry put the man in the freezer to
preserve and then took over.
7.) Ran over the step father
8.) Threatens to kill the slut (Paris)
9.) Shoot by the (cop) Ross.
F) Limo Driver (Edward)
1.) He was the one to hit the mother
2.) Stitches up Alice's neck
3.) Taking medication because he was a cop before and
that burned him out. He took a medical leave, and
blacking out
4.) He was the first to find the actress, the husband and
the prisoner.
5.) Follows a trail of rings from the shower curtain the
actress had above her head. When hi finds her, her
head is in the dryer.
6.) Finds open knife cases in the trailer
7.) Started repeating
8.) Gets shot by the cop, Ross G)
Husband (Lue)
1.) Anger issues
2.) Gets made at wife for lying to him and when she locks
herself in the door he is outside and gets stabbed.
3.) Murdered by an axe
4.) In room six but number swung so it was a nine H)
Wife(Ginny)
1.) Feels something cold but no one else feels it
2.) 6th to die with car explosion. I)
Slut (Paris)
1.) In room number 7
2.) Has a ton of cash in her suitcase
3.) Her show popped the family's tire of their car.
4.) Moves back home to grow her orange orchard after
everything it over.
J) Police Man (Ross)
1.) Hits the prisoner
2.) Hit on Paris
3.) Has a blood stain on his back
4.) Room 10
5.) He is really one of the convicts he killed the real cop.
6.) Shoots Larry
7.) Edwards shoots Ross K)
Prisoner
1.) Gets away from the toilet.
2.) Charged for multiple homicides
3.) Third to be killed
4.) Killed with a base ball bat down his throat
5.) Room #10
Treatment Plan: Symptoms wax and wane spontaneously, but dissociative identity disorder
does not resolve spontaneously. Drugs help manage specific symptoms but do not affect the
disorder itself. All successful treatments that aim to achieve integration
involve psychotherapy that specifically addresses the dissociative identity disorder. Some
patients are unable or unwilling to pursue integration. For them, treatment aims to facilitate
cooperation and collaboration among the personalities and to reduce symptoms. This treatment
is often arduous and painful, and many crises tend to arise as a result of the personalities' actions
and the patient's despair when dealing with traumatic memories. One or more periods of
psychiatric hospitalization may be necessary to help some patients through difficult times and
during the processing of particularly painful memories. Hypnosis is often used to help access
the personalities, facilitate communication between them, and stabilize and interpret them.
Hypnosis is also used to discuss traumatic memories and diffuse their impact. Eye movement
desensitization and reprocessing (EMDR), applied cautiously, is a useful adjunct. EMDR tries
to process traumatic memories and to replace negative thoughts about self that are associated
with these memories with positive ones.
Generally, two or more psychotherapy sessions per week for 3 to 6 years are necessary to
integrate the personalities or to achieve harmonious interaction among them that allows normal
functioning without symptoms. Integration of the personalities is the most desirable outcome.
Psychotherapy has three main phases. In the first phase, the priority is safety, stabilization, and
strengthening of the patient in anticipation of the difficult work of processing traumatic material
and dealing with problematic personalities. The personality system is explored and mapped to
plan the remainder of the treatment. In the second phase, the patient is helped to process the
painful episodes of his past and to mourn the losses and other negative consequences of the
trauma. As the reasons for the patient's remaining dissociations are addressed, therapy can move
to the final phase, in which the patient's selves and relationships and social functioning can be
reconnected, integrated, and rehabilitated. Some integration occurs spontaneously, but much
must be encouraged by conversing with and arranging the unification of the personalities or
must be facilitated with imagery and hypnotic suggestion. After integration, patients continue
treatment to deal with some issues that have not been resolved. After post integration treatment
appears complete, visits to the therapist are tapered but are rarely completely terminated.
Patients come to think of the psychiatrist as someone who can help them deal with psycho logic
issues, just as they periodically need assistance from a primary care physician.
A Beautiful Mind
June 8, 2004
1.) John Nash
2.) Symptoms
a. Biological- There are billions of nerve cells in the brain. Each nerve cell has
branches that transmit and receive messages from other nerve cells. The
branches release chemicals, called neurotransmitters, which carry the
messages from the end of one nerve branch to the cell body of another. In the
brain afflicted with schizophrenia, something goes wrong in this
communication system and that happens inside the brain to make it biological.
Biochemistry - People with schizophrenia appear to have a neurochemical
imbalance. Thus, some researchers study the neurotransmitters that allow
communication between brain cells. Modern antipsychotic medications now
target three different neurotransmitter systems (dopamine, serotonin, and nor
epinephrine.) Stress can make the symptoms worsen.
b. Environmental- He was surrounded by scholars at University, but
environmental information does not have much to do with schizophrenia.
John Nash was not very sociable and into himself a lot. Impulsive satisfaction
of immediate needs without regard for others.
c. Psychological- Psychotic manifestations, such as hearing internal voices or
experiencing other sensations not connected to an obvious source
(hallucinations) and assigning unusual significance or meaning to normal
events or holding fixed false personal beliefs (delusions).
i. Delusions - false beliefs strongly held in spite of invalidating
evidence, especially as a symptom of mental illness: for example,
1. Paranoid delusions, or delusions of persecution, for
example believing that people are "out to get" you, or the
thought that people are doing things when there is no external
evidence that such things are taking place.
2. Delusions of reference - when things in the environment seem
to be directly related to you even though they are not. For
example it may seem as if people are talking about you or
special personal messages are being communicated to you
through the TV, radio, or other media.
3. Somatic Delusions are false beliefs about your body - for
example that a terrible physical illness exists or that
something foreign is inside or passing through your body.
4. Delusions of grandeur - for example when you believe that
you are very special or have special powers or abilities. An
example of a grandiose delusion is thinking you are a famous
rock star.
ii. Hallucinations - Hallucinations can take a number of different forms they can be:
1. Visual (seeing things that are not there or that other people
cannot see),
2. Auditory (hearing voices that other people can't hear,
3. Tactile (feeling things that other people don't feel or
something touching your skin that isn't there.)
4. Olfactory (smelling things that other people cannot smell, or
not smelling the same thing that other people do smell)
5. Gustatory experiences (tasting things that isn't there) iii.
Disorganized speech (e.g., frequent derailment or incoherence) these are also called "word salads", iv. Grossly disorganized or
catatonic behavior (An abnormal
condition variously characterized by stupor/inactivity, mania, and
either rigidity or extreme flexibility of the limbs), v. Negative
symptoms, these are the lack of important abilities.
Some of these include:
1. lack of emotion - the inability to enjoy activities as much as
before
2. Low energy - the person sits around and sleeps much more
than normal
3. lack of interest in life, low motivation
4. Affective flattening - a blank, blunted facial expression or less
lively facial movements or physical movements.
5. A logia (difficulty or inability to speak)
6. Inappropriate social skills or lack of interest or ability to
socialize with other people
7. Inability to make friends or keep friends, or not caring to have
friends
8. Social isolation - person spends most of the day alone or only
with close family Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to the difficulties with
concentration and memory. These can include:
vi. disorganized thinking
vii. slow thinking viii.
difficulty understanding
ix. poor concentration
x. poor memory
xi. difficulty expressing thoughts
xii. difficulty integrating thoughts, feelings and behavior
Social/occupational dysfunction: For a significant portion of the time since
the onset of the disturbance, one or more major areas of functioning such as
work, interpersonal relations, or self-care are markedly below the level
achieved prior to the onset (or when the onset is in childhood or adolescence,
failure to achieve expected level of interpersonal, academic, or occupational
achievement). Duration: Continuous signs of the
disturbance persist for at least 6 months. This 6-month period must include at
least 1 month of symptoms (or less if successfully treated) that meet Criterion
A (i.e., active-phase symptoms) and may include periods of prodromal or
residual symptoms. During these prodromal or residual periods, the signs of
the disturbance may be manifested by only negative symptoms or two or
more symptoms listed in Criterion A present in an attenuated form (e.g., odd
beliefs, unusual perceptual experiences). Schizoaffective and mood disorder
exclusion: Schizoaffective disorder and mood disorder with psychotic features
have been ruled out because either (1) no major depressive, manic, or mixed
episodes have occurred concurrently with the active-phase symptoms; or (2) if
mood episodes have occurred during active-phase symptoms, their total
duration has been brief relative to the duration of the active and residual
periods.Substance/Reneral medical condition exclusion: The disturbance is
not due to the direct physiological effects of a substance (e.g., a drug of abuse,
a medication) or a general medical condition. Relationship to a pervasive
developmental disorder: If there is a history of autistic disorder or another
pervasive developmental disorder, the additional diagnosis of schizophrenia is
made only if prominent delusions or hallucinations are also present for at least
a month (or less if successfully treated).
Diagnosis: John Nash is suffering from Schizophrenia. Because other diseases can also cause
symptoms of psychosis, psychiatrists make the final diagnosis. The following factors may
suggest a schizophrenia diagnosis: Developmental background, Genetic and family history,
Changes from level of functioning prior to illness, Course of illness and duration of
symptoms, Response to pharmacological therapy. CT scans of the head and other imaging
techniques may identify some changes associated with schizophrenia in the research literature
(such as enlarged ventricles in the brain) and may rule out other neurophysiological disorders.
It is valuable to understand the difference between psychosis and schizophreia. Psychosis is a
general term used to describe psychotic symptoms. Schizophrenia is a kind of psychosis.
Several different brain disorders can lead to psychotic symptoms, including lesions in the
brain resulting from head traumas, strokes, tumors, infections or the use of illegal drugs. If a
serious depression goes untreated for a long time psychotic symptoms may develop. These
examples demonstrate that not all psychosis is schizophrenia. If is for this reason that doctors
may take quite some time (6 months or more) to diagnose someone, because while the
symptoms of schizophrenia are quite obvious - the fact that the symptoms are not being
caused by some other brain disorder is frequently not obvious
3.) Treatment Plans:
• ECT (Electro-Convulsive Therapy)
Research suggests that Electroconvulsive therapy (ECT) has a modest but
definite role to play in the treatment of schizophrenia despite the adverse
publicity it has received. In A Beautiful Mind this treatment was used on John
Nash to cure him, but it didn't do well as the symptoms still occurred. There is a
lot of controversy on this treatment and it is not used often.
Personal Therapy - Personal Therapy is a psychosocial intervention designed to
help patients with schizophrenia recognize and respond appropriately to
arousing stimuli improves function and reduces relapse. Personal therapy, as it
is called, aims to create a therapeutic umbrella to protect the patients from undue
personal stress. Individual psychotherapy tailored to strengthen interpersonal
skills and control social stress markedly helps many people suffering from the
disorder. It is a relatively new form of a schizophrenia treatment that has
resulted in lower relapse rates and progressively better social functioning over 3
years. Family therapy and assertive community treatment have clear effects on
the prevention of psychotic relapse and rehospitalization. However, these
treatments have no consistent effects on other outcome measures (e.g., pervasive
positive and negative symptoms, overall social functioning, and ability to obtain
competitive employment). Social skills training improves social skills but has no
clear effects on relapse prevention, psychopathology, or employment status.
Supportive employment programs that use the place-and-train vocational model
have important effects on obtaining competitive employment. Some studies
have shown improvements in delusions and hallucinations following cognitive
behavior therapy. Preliminary research indicates that personal therapy may
improve social functioning.
Family Therapy: Research has also suggested that relatively simple, long-term
psychoeducational family therapy should be available to the majority of persons
suffering from schizophrenia. Assertive community training programs ought to
be offered to patients with frequent relapses and hospitalizations, especially if
they have limited family support. Patients with schizophrenia can clearly
improve their social competence with social skills training, which may translate
into a more adaptive functioning in the community. For patients interested in
working, rapid placement with ongoing support offers the best opportunity for
maintaining a regular job in the community. Cognitive behavior therapy may
benefit the large number of patients who continue to experience disabling
psychotic symptoms despite optimal pharmacological treatment.
Antioxidant Vitamins - Research has shown that there is a positive correlation
between superoxide generation and the negative symptoms of schizophrenia,
indicating a possible role for oxidative stress in the development of the disease
(and the potential for antioxidants to help in decreasing the risk or severity of
the disease). Foods high in antioxidants include blue berries (frozen or fresh),
dried plums, spinach and strawberries.
Sarcosine (N-methylglycine): This is a treatment that are showing some early
positive results. In a study Harvard Medical School study with consumers who
suffer from schizophrenia it was revealed that patients who received sarcosine
treatment revealed significant improvements in their positive, negative,
cognitive, and general psychiatric symptoms. This research looks like it could
work out but it still needs to be retested.
Animal-Assisted Therapy
Research has shown that pets (dogs and cats) may offer a low cost, yet helpful
type of therapy for people with schizophrenia. What the researchers call
"Animal-assisted Therapy" has been shown to encourage mobility,
interpersonal contact, and communication and reinforced activities of daily
living, including personal hygiene and independent self-care.
Music Therapy - Music therapy is one of those things that sounds great, but
doesn't seem to deliver much. Perhaps it is dependent upon the type of music,
since if you listen to low-key, relaxing music it would seem to be likely that it
would lower your stress levels and therefore be beneficial. If however, you're
listening to acid rock/heavy metal with loud electric guitar solos - you're
probably not doing anyone a favor, including yourself. Right now the prognosis
for music therapy for schizophrenia unfortunately doesn't look good. Music
may, however, be useful as a means of relaxation or group discussion stimulus.
Future research may reveal more positive results.
Ignoring- In the Movie, John Nash used his brain power to will the hallucinations
away. He was able to distinguish which was real and which was false and when
he could not do that he asked another person to help him, a person he knew was
real. This treatment is not recommended for everyone though because not
everyone has such brain power as John Nash did. This treatment proved
effective although the schizophrenia never really went away and he had to
suffer with it his entire life.
Psychotherapy- Psychotherapy is not the treatment of choice for someone with
schizophrenia. Used as an adjunct to a good medication plan, however,
psychotherapy can help maintain the individual on their medication, learn
needed social skills, and support the person's weekly goals and activities in their
community. This may include advice, reassurance, education, modeling, limit
setting, and reality testing with the therapist. Encouragement in setting small
goals and reaching them can often be helpful. People with schizophrenia often
have a difficult time performing ordinary life skills such as cooking and
personal grooming as well as communicating with others in the family and at
work. Therapy or rehabilitation therapy can help a person regain the confidence
to take care of themselves and live a fuller life.
Cognitive Therapy: The misinterpretation of events in the world is common in
schizophrenia. Using cognitive therapy with schizophrenia requires the
psychologist to accept that the cognitive distortions and disorganized thinking
of schizophrenia are produced, at least in part, by a biological problem that will
not cease simply because the "correct" interpretation of reality is explained to
the client. Cognitive therapy can only be successful if the psychologist accepts
the client's perception of reality, and determines how to use this "misperception"
to assist the client in correctly managing life problems. The goal is to help the
client use information from the world (other people, perceptions of events, etc.)
to make adaptive coping
decisions. The treatment goal, for the cognitive therapist, is not to "cure"
schizophrenia, but to improve the client's ability to manage life problems, to
function independently, and to be free of extreme distress and other psychological
symptoms.
Behavior Therapy: Behavior therapy assumes that certain skills increase our ability to
function in the world, and to solve problems as they arise. Many psychosocial skills
develop as a consequence of our experiences in the world. We "learn from our
mistakes" and from our successes in managing different types of problems. Since
people have different life experiences, some people learn skills well, and others do
not learn as many skills. Another individual difference, is our ability to learn from
our experiences. In order to learn from experience, we must correctly analyze what
was effective and what was not effective in solving a problem. We can also "learn"
ineffective or maladaptive responses to problems, especially if those responses lead
to immediate reduction of pain or embarassment, despite having no affect on the
long term solution to the problem. The learning of maladaptive responses top
problems is often the result of cognitive distortions or making mistakes in assessing
cause and effect. That is why cognitive therapy and behavioral therapy are often
combined. Individuals with schizophrenia often make incorrect assessments of
cause and effect. Also, they often do not learn as well from experience because of
their disordered and disorganized thinking. Behavior therapy teaches them the
social skills they never learned, and helps them understand when to apply those
skills to problems in the world.
Matchstick Men
Final Project
June 13/04
1.) Roy
2.) Symptoms
a. Environmental
• Lots of handwashing
• constant counting (counting 3 times before doing anything
• touching
• checking things over and over (such as doors, locks, or stoves)
• doing things a certain number of times (like when he checked the
door 3 times before opening it)
• arranging things in a certain way
• asking the same question over and over
• tying and retying shoes over and over until they feel right
• cleaning and cleaning
1. over compulsive cleaning
Obsessions
• Repetative ideas, thoughts and impulses
• Examples, a need to do things perfectly/correctly
• The obsessions cause much anxiety
• May focus on violence, sex, or illness b.
Biological
• Passed on through generations, we never met Roy's parent's so we
cannot be sure whether or not it could have been passed down.
• He wasn't actually OCD, he was just so sure he was, that he
convinced himself of it.
• Panic attacks c.
Psychological
• Obsessive behaviour
• Cane be accompanied by depression, eating disorders, substance
abuse (Roy was a chain smoker) ADD, or any other kind of anxiety
disorder
• His wife left him because he punched her, years ago
1. was left with the strain of whether he had a child in the
world or not.
3.) Diagnosis: Obsessive compulsive agoraphobia. This is the condition where conscious
or sub-conscious thought processes control your thoughts or actions
compulsively. These actions are said to be obsessive because they usually involve a
normal action that is repeated over and over again forming what is described as a
ritual. At the root of OCD are overwhelming feelings of anxiety, fear and being out of
control of things around you. A person suffering from OCD usually knows that their
actions are irrational but the obsessive behavior helps to alleviate the anxiety and
makes them feel more in control. Roy seems to feel as though he has to have this
anxiety. He feels better when he takes little pink pills that he was popping in the
beginning of the movie that were actually menopausal pills. This tells us that his OCD
problem may be all in his head. When he doesn't take them anymore he goes into fits
of cleaning and being afraid of dirt. He also has agoraphobia, which is the fear of the
outdoors. He is referred to psychologist who helps him to reconnect to his "daughter"
who moves in with him and when she is with him he forgets about his OCD. Roy
may have had problems as he was younger that caused this to arise, but as viewers of
the movie we do not know this.
4.) Treatment Plan: Behavioral therapy can work for these patients. There are two
different types, which are called exposure and response prevention; they have been
proven to be useful in treating OCD. It involves exposing the person to whatever
triggers the problem and then helping them forego the usual ritual for instance, having
the person touch something dirty and then not wash her hands. This therapy is often
successful in patients who have completed a behavioral therapy program.
There are some medications that have been proven successful which are
clomipramine, fluoxetine, fluvoxamine, sertralin, and paraozetine. Once one drug
doesn't work the therapist goes onto another. A type of behavioral therapy known as
"exposure and response prevention" is very useful for treating OCD. In this approach,
a person is deliberately and voluntarily exposed to whatever triggers the obsessive
thoughts, and then is taught techniques to avoid performing the compulsive rituals
and to deal with the anxiety. Medications affecting serotonin (a neurotransmitter) can
decrease the symptoms of OCD significantly. Three selective serotonin reuptake
inhibitors (SSRIs) have been approved by the United States Food and Drug
Administration (PDA) for the treatment of OCD: Prozac (fluoxetine), Luvox
(fluvoxamine), and Paxil (paroxetine). Studies have also shown that the SSRI Zoloft
(sertraline) may also be helpful. If one medication is not helpful, another one may
work. People who find relief from their symptoms by taking these medications often
will need to take them indefinitely.
Psychotherapy and Behavior therapy also has been found to be extremely effective as
an adjunctive therapy, and may have more long lasting benefits. It is used now to help
patients recover from OCD. Primary care physicians have an opportunity to make an
early diagnosis, which may improve the outcomes of treatment, and can save patients
from many years of life-constricting misery. The key to early diagnosis is asking the
right questions in a comfortable milieu, with a strong patient and physician
relationship. Behavior therapy: This is widely recognized as an effective
psychological treatment for obsessive-compulsive
disorder. Patients are encouraged to participate in feared activities and are helped
and supported in resisting compulsive. Cognitive therapy: This type of therapy
can be used alone or combined with behavior therapy. The combination is known
as rational emotive behavior therapy. In cognitive therapy, patients learn to
confront their irrational or faulty belief system, particularly their overwhelming
needs for perfection and certainty. Obsessive-compulsive patients are also
challenged to deal with their over inflated sense of responsibility and the fusion of
thoughts and actions. The goal of such therapy is to examine underlying beliefs,
rather than obsessional thoughts. Religious psychotherapy: The religious and
spiritual beliefs of patients with obsessive-compulsive disorder should always be
attended to in both psychiatric and medical practices. Patients are often troubled
by guilt, which, if not addressed during individual psychotherapy, can be
reinforced by religious rituals and practices. Data on the effectiveness of religious
beliefs on reducing obsessive-compulsive symptoms are scarce, however.
Religious psychotherapy supports patients through prayer, meditation, church or
synagogue attendance, scriptural studies, and spiritual awakenings. This type of
psychotherapy has been shown to help patients with anxiety disorder. The
therapist who does not share the same beliefs as the patient needs to integrate this
dimension in the treatment plan, rather than attempting to challenge or change
these beliefs. Roy really didn't have any type of religious beliefs that were
mentioned in the movie so this type of therapy probably wouldn't be sufficient.
Family therapy: Families of obsessive-compulsive patients may ask for help in
coping with frustrations of daily life. A family therapy referral is often useful to
reduce marital discord and family conflicts and to build an alliance that involves
family members in the treatment plan. I don't believe this type of therapy would
work very well for Roy because he doesn't have any family that would help him
at all. He is pretty much alone in the world because his only friend was the guy
that robbed him. Group therapy: The overwhelming feelings of loss of control
over obsessive-compulsive symptoms causes many patients to withdraw socially
and may further complicate the course of this illness. Group therapy can provide a
mutually supportive treatment setting. Group Therapy would work for Roy
because he doesn't have any one to support him in his troubles.
MATCHSTICK MEN
CHARACTERS/SYMPTOMS
Roy:
- opens everything 3 times (P)
- ticks/ voice stutters (B) (P)
- neat freak (P) (E)-due to his stress
- doesn't like outdoors (P) (E)
- stressed/nervous (P) (E)
- smokes (due to stress) (E)
- pills: when he doesn't take them he gets stressed (P)
- distracted easily (E)
- no personal relationships (P) (E)
DIAGNOSIS
- OBSESSIVE COMPULSIVE DISORDER: He cleans all the time, hates dirt, and doesn't
allow people in his home often, and when he does, they have to take their shoes off He
worries about his carpet a lot, and whenever something goes wrong, he cleans his whole
house, even when it's not dirty. He also only eats tuna and then washes out the tin cans in
gloves, and seals them.
- AGORAPHOBIA: He doesn't like being outdoors and around lots of people. He has no
personal relationships because he's not good with dealing with people, and fears open and
public places. He keeps to himself a lot.
- Both these disorders fall under Anxiety Disorders. Roy responds to all situations with great
anxiety, as if everything that goes wrong is "the end of the world."
TREATMENT PLAN
- BEHAVIOUR THERAPIES: Because Roy has anxiety disorders, it would be beneficial
for him to receive behaviour therapy. To deal with his phobia, (agoraphobia) behaviour
therapies use classical and operant conditioning. In classical conditioning, one way to
relieve the fear of being in public places is to have Roy be in public places (UCS) while
nothing fearful is presented. Eventually the feared response (CS) will become extinct.
Another way to deal with his anxiety is through systematic desensitization. By using a
procedure called counterconditioning, a new response that is incompatible with anxiety is
conditioned to the anxiety-arousing CS. (Relaxing the muscles, while talking about
anxiety-arousing events). By ridding the anxiety, the agoraphobia and obsessive
compulsions will decease. Another aspect of behaviour therapy is social skills training.
Because Roy has no personal relationships, this will be beneficial, in order for him to
learn how to deal with people in the real world.
- COGNITIVE THERAPIES : Another way to rid Roy of his anxiety, is through cognitive
therapy. By pointing out the error in Roy's irrational thought patterns, his way of thinking
can be changed. Using Ellis's rational-emotive therapy, first we identify the activating
event, which triggers the emotion (fear). Then we look at Roy's belief system (the way he
appraises events - how he overreacts to situations). Then we discuss the consequences of
his beliefs, and challenge his belief system.
A BEAUTIFUL MIND
CHARACTERS/SYMPTOMS
John Nash:
- not good with people (P)
- stutters/gets nervous around others (E)(BXP)
- is exceptionally smart/genius (B)
- HALLUCINATIONS (P):
- roommate Charles, Charles's niece Marcee, and some undercover guy
- those were his first real friends
- DELUSIONS (P):
- he believes he works undercover for the government cracking codes.
- he believes he has a chip in his arm and rips open his arm to find the chip.
- he would drop off packages at some abandoned house, but to him it was part of his
undercover job and it seemed real.
- PARANOID (P): he thought the Russians were coming for him
- because he thought his job was undercover, he kept his life secretive, and he felt he was in
danger of people who were against the government.
DIAGNOSIS
- SCHIZOPHRENIA: John Nash falls under the subtype of Paranoid type
schizophrenia. He has delusions that people are out to harm him, and has delusions of
grandeur (he believes he is enormously important, having the job of a undercover agent).
Suspicion, anxiety, and anger accompanies his delusions and he has hallucinations, (the 3
people invented in his mind).
TREATMENT PLAN
- COGNITIVE THERAPIES: In order to deal with his delusions, cognitive therapies would
be helpful because it provides change in the way of one's irrational thinking. Using Beck's
cognitive therapy, a first step is to help John Nash realize that his thoughts, not the
situation, cause his maladaptive emotional reactions. However, this method would not be
enough to help John Nash's disorder on its own.
- BIOLOGICAL APPROACHES TO TREATMENT: One biological approach would be
to apply electroconvulsive therapy (ECT). These electric shocks were displayed in the
movie, and are designed to create a seizure in the central nervous system. Another
treatment is drug therapy, specifically anti-psychotic drugs, which were also present in
the movie. These drugs have dramatic effects in reducing hallucinations and delusions,
but the user can become tolerant to them overtime. Again, the electric shocks and drugs
alone are not enough. Drugs may be used to bring psychotic symptoms under control so
that other approaches such as social skills training (BEHAVIOUR THERAPY), family
therapy and group therapy can be applied to maintain the initial improvement.
- GROUP, FAMILY, AND MARITAL THERAPIES: Once John is done his treatment in
the hospital, he will be able to move back into his home and into the real world. However,
in order to adjust properly, and maintain adjustment, he needs to receive therapy with his
wife (and other family members?). It is important for them to understand his disorder in
order for them to provide social support.
IDENTITY
CHARACTERS/SYMPTOMS
George York (stepdad):
- nervous (E)
- tense (B)
- can't deal under pressure (P) (E)
- insecure (P)
- anxious (anxiety disorder?) (P)
Timothy York (boy):
- quiet (E)
- "killer personality" (B)-real dad had bad temper
Paris Texas (hooker)
- smokes (E)-smokes due to stress
- trying to start a new life - she represents how Malcolm Rivers wanted his mom to be
Carolyn Suzanne (actress):
- high maintenance (P) (E)-she lives rich lifestyle
- demanding, selfish (E)-rich lifestyle
- she represents Malcolm Rivers's mom, and the way she really was Ed
(driver):
- takes medication (B)
- used to be a cop, but got headaches/blackouts due to a traumatic experience (E) (P)
- (possible PTSD)
- leadership role (tries to help) (E) (P)
- he represents the inner child who's trying to maintain order Jenny:
- lied about being pregnant -thought husband would leave her (E)
- doesn't like to be yelled at, but gets mad when it stops (P)
Lou:
- temper/violent (P) (B>could run in his family
- yells at his wife Jenny (B)-could run in his family Larry
Washington:
- frantic outbursts (E)
Robert Maine (convict):
- convicted of homicide (B) (E) (P)
- tried to run away/didn't work (P)
Mr. Roads ("cop"):
- defensive (E)-because he wasn't a real cop
- lied about being a cop (E)- to fit in with environment
- convicted criminal (B) (E) (P)
Malcolm Rivers
- headaches (B) (P)
- murdered 6 residents (P)
- had diary written in different view points (P)- DID
- abandoned as a child, his mom left him at hotel (E)
- couldn't deal with the stress, as a result he formed new personalities (E) (P)
DIAGNOSIS
- DISSOCIATIVE DISORDER: Malcolm Rivers, because he was abandoned as a child, he
couldn't cope with the stress, and as a result multiple personalities developed, diagnosing
him with dissociative identity disorder. It's possible he suffered from PTSD too because
of his abandonment as a child, which led to high levels of anxiety which he wasn't able to
cope with.
TREATMENT PLAN
- PSYCHODYNAMIC THERAPY: I would use Freud's psychodynamic therapies to treat
Malcolm Rivers because it focuses on the internal conflict and unconscious factors that
had major influence on his behaviours. It takes a look at the past, which in this case
would be meaningful, considering that his disorder stems from how he was treated as a
child. In psychoanalysis, the goal is to achieve insight, dealing with buried emotions,
motives, and conflicts. The psychic energy that kept Malcolm's unconscious conflict
under control can be released using this technique. It's important to deal with his
childhood, and interpret the meaning of the events in order to gain insight into how his
behaviour has evolved due to childhood events. Free association would be used, whereby
Malcolm would just speak while the therapist, out of sight, would take notes, in hopes to
attain information about him and his disorder. Dreams could be interpreted to analyze
underlying meanings, that Malcolm could be unaware of. Dreams can express impulses,
feelings, fantasies, and wishes that are hidden away in the unconcsious.