Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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.