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Lars and the Real Girl Steve Franklin, MSW, LCSW 6829 Gravois Ave St. Louis, MO 63116 [email protected] www. Steve FranklinMSW.com 314-517-8383 Difference between “eccentricity” and “disordered” What kind of problem? Mental illness, other or none? Does Lars need treatment? Doctor’s approach? Family and community response? Community Mental Health movement How do you think you might have responded? What is the problem? People will laugh Attachment to objects Doctor interview: “ADL’s”? Violence? Psychosis? DSM-IV “The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.” Differential Diagnosis Avoidant personality disorder? Social inhibition Feelings of inadequacy Extreme sensitivity to negative evaluation Feel socially inept, unappealing Excessively monitor reactions of people Schizoid personality disorder? Lack of interest in social relationships Solitary, secretive, and emotionally cold Little interest in having sexual experiences takes pleasure in few, if any, activities lacks close friends or confidants other than first-degree relatives appears indifferent to praise/criticism “Dependency and love are dangerous” Psychodynamic Diagnostic Manual: Panic disorder with agoraphobia Remains at home, or in just a few comfortable places fear of having panic attack Social Anxiety Disorder Social Phobia? Persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by one's own actions. Physical symptoms often accompany social anxiety disorder including Panic attacks. Asperger’s Disorder? Involves an impairment in social interaction Such as impaired in the use of multiple nonverbal social behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction failure to develop peer relationships lack of social or emotional reciprocity Asperger’s Disorder? B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities preoccupation with an area of interest that is abnormal either in intensity or focus Adherence to routines, rituals Stereotyped/repetitive mannerisms Preoccupation with parts of objects Asperger’s Disorder? They may be unusually sensitive or insensitive to sound, light, touch, texture, taste, smell, pain, temperature, and other stimuli Delusional Disorder Delusion that doesn’t fit another disorder Tactile or olfactory hallucinations if related to theme Functioning and behavior otherwise normal. Ignore information that contradicts belief Delusional Disorder Types :erotomanic, grandiose, jealous, persecutory, somatic, … and unspecified. Psychodynamic: protective response to stress Behaviors’ Extremeness/inappropriateness rather than the simple truth or falsity of the belief, indicate its delusional nature Developmental analysis Lars afraid of manhood: Saw dad sad in the responsibility Note family difficulty in discussing emotion Recent change? Afraid of Karin’s childbirth Developmental Analysis Doctor: “He’s been decompensating for some time.” “Mental Illness can be a communication, a way to work something out.” Compensate for lack of a mother/ father’s distance/blaming. Embraces his loneliness/withdrawal Others’ need for connection is weakness. Karin’s pregnancy arouses unconscious loss/abandonment feelings Jungian Bianca as anima, the projection of disowned female self projection of disowned idealized self Missionary, Doesn’t care about superficial things, Can’t have babies (or die in childbirth),Has nurse’s training Like him: left-handed; her mom died; God made her to help people; Doesn’t feel sorry for self-just wants to be normal..” Treatment Is his “difference” something to be treated or pathologized? Lars doesn’t seem to experience being treated so much as being in relationship. Ethics of doctor’s approach? Treatment Typical approaches: Antipsychotic and antidepressant medication Cognitive-behavioral therapy top help challenge the delusion. Insight-oriented therapy: develop a sense of creative doubt in the internal perception of the world Treatment Community can provide support and encourage the patient to regain his or her abilities. If goals not seen as attainable, person feels pressured/criticized, probably increasing stress… worsening of symptoms. Avoiding direct confrontation of the delusional symptoms (When confronted by brother, Lars simply doesn’t hear.) Disability: Embracing strength Minister: “From her wheelchair, Bianca reached out and touched us all.. “ (Lars sees her “difference” as an expression of her disability. It’s not that Bianca was artificial. She was just. “Realness challenged”) Community Finds ways for Bianca to contribute in ways she can be helpful/productive… model, help at nursing home. They project themselves: they believe that Bianca, like them, would want to help Community Minister in church scene: “There really is only one law.. the lord has told us what to do: Love one another. That, my friends, is the one true law.”