"In a time of universal deceit telling the truth is a revolutionary act." -George Orwell

Fictional Stars, Real Problems

In Uncategorized on June 10, 2010 at 8:50 am

From Melinda Beck @ The Wall Street Journal:

The case of two troubled teens captivated psychiatrists at the University of South Carolina School of Medicine for months. Eleven residents and four attending psychiatrists read up on their symptoms and met once a week to discuss them.

They stipulated early on that Edward was, indeed, a vampire. But since he was supposedly 100 years old, not 17 as he appeared, his adolescent moodiness suggested arrested development.

As for Bella, her self-loathing and willingness to sacrifice herself made her especially vulnerable to a dangerous relationship. Treatment plan: cognitive behavioral therapy to counter her automatic negative thoughts.

So what if the patients weren’t real? Analyzing the neuroses in the popular “Twilight” saga was such an effective teaching tool that the 12-week elective, dubbed “Therapy Bites,” was presented at the American Psychiatric Association’s conference last month.

“It was much more fun than sitting in a didactic lecture,” says chief resident Ashley Jones.

Sigmund Freud named the Oedipus complex for Sophocles’ tragic character and was fascinated with Shakespeare and Dostoevsky. Increasingly, professors from Psych 101 to medical schools and psychoanalytic institutes are using fiction and film in classroom assignments or outside electives.

“Students in the mental-health disciplines can sometimes learn as much about what it means to be human from studying popular films and novels as they can from sitting with a patient,” says Glen Gabbard, a professor of psychiatry and psychoanalysis at Baylor College of Medicine in Houston. Dr. Gabbard wrote “The Psychology of ‘The Sopranos,’ ” which offers a clinician’s look at the TV series’ dysfunctional characters. He holds his own optional monthly gatherings for residents to watch and discuss films such as “The Hurt Locker” and “Precious.”

The use of books and movies in teaching is growing in part because fictional characters obviously aren’t protective of their privacy the way real patients can be. Even when their names and identifying details are disguised, patients must give consent to have their case histories written about or discussed with others, and many are reluctant to.

What’s more, with fiction, students can experience a much wider range of disorders than they may ever encounter in real life. “Unless they work in prisons, very few psychologists will ever see many real sociopaths or severe antisocial characters,” such as Hannibal Lecter in “The Silence of the Lambs” or Anton Chigurh in “No Country for Old Men,” says John Rosegrant, a psychoanalyst and director of the Arizona Center for Psychoanalytic Studies in Tucson.

Critics argue that studying the human condition through fiction is unrealistic, since the characters have only as much dimension as the author wants to give them, and their actions serve the plot more than anything else. Defenders counter that real patients sometimes lie too and only reveal as much as a therapist can extract.

Assessing fictional characters’ motivations can also help budding psychologists and psychiatrists gain experience and confidence. In the “Twilight” assignment, residents evaluated the biological, psychological and cultural factors affecting each character, and practiced differential diagnoses, examining every possible explanation for the symptoms presented. (Could Edward’s changing eye color be a symptom of Wilson’s disease, a rare condition that causes the body to retain copper? Could drinking blood be a form of pica, a medical disorder in which people feel compelled to eat non-food items like dirt or paper?)

Stipulating that vampires and werewolves were real was necessary, says Nioaka Campbell, director of the psychiatry resident program at the University of South Carolina School of Medicine. “Otherwise, we would have had to conclude that Bella was just psychotic.”

Besides recognizing symptoms, several residents said that reading “Twilight” helped them better understand their real patients. “Young girls, in particular, really identify with Bella, not feeling like you fit in and not being good enough,” says Dr. Jones. “I think that’s why the books have become so popular.”

Indeed, books and movies that become global sensations often do so precisely because they involve universal psychological themes that even mentally healthy adolescents and adults experience. “They have to tap into subconscious anxieties and conflict in the audience or we wouldn’t see them,” says Dr. Gabbard.

The Harry Potter books are rife with teen angst, themes of disenchantment, the struggle for identity, even aggression and castration fantasies, as Dr. Rosegrant wrote in the Journal of the American Psychoanalytic Association last year.

Harry’s battle with Voldemort can be seen as an internal conflict between aspects of his own psyche, Dr. Rosegrant notes. Phallic symbols (snakes, wands) are prominent throughout the books, a common subconscious dynamic in young male adolescents. Hermione at one point complains about male wizards competing to see whose wand is most powerful.

As the books evolve, Harry’s biggest challenge becomes confronting adult weakness. He goes through the painful process of de-idealizing his parents, discovering that his father could be arrogant and cruel and that even his protector, Dumbledore, had a shameful past.

The struggle to control newly experienced sexual impulses is also a major theme—both in fiction and real adolescence—Dr. Gabbard notes. From “Romeo and Juliet” to “Titanic” to “Twilight” to a host of slasher films, there is a recurrent message: “if you have sex, you will die.”

“These kind of things are worked through at a safe distance on the screen, so that adolescents and adults can have the illusion of mastering them,” says Dr. Gabbard.

Mental-health students even explore children’s literature for buried psychological themes. Analysts have had a field day in the “Hundred Acre Wood” with A.A. Milne’s characters. While the world of Winnie the Pooh seems innocent on the surface, “it is clear to our group of modern neuro-developmentalists that these are in fact stories of seriously troubled individuals, many of whom meet DSM-IV criteria for significant disorders,” wrote Sarah E. Shea and colleagues in the Canadian Medical Association Journal in 2000, referring to the handbook of diagnoses.

Piglet clearly suffers from generalized anxiety disorder, the authors noted. Eeyore has chronic dysthymia (mild depression) and could benefit greatly from an antidepressant. Tigger is hyperactive, impulsive and a risk-taker.

Pooh is a bundle of comorbidities that may include cognitive impairment, as he is often described as a “bear of very little brain.” “Early on, we see Pooh being dragged downstairs bump, bump, bump, on the back of his head,” the authors write. “Could his later cognitive struggle be the result of a type of Shaken Bear Syndrome?”

Movies that depict psychiatrists and psychologists at work are also highly instructive for students—if mainly to show what not to do.

Dr. Gabbard says that out of some 400 portrayals of therapists in films, he’s found only a handful that were reasonably accurate. Among them: Judd Hirsh’s character in “Ordinary People,” Vanessa Redgrave’s in “Girl, Interrupted” and Lorraine Bracco’s in “The Sopranos.” But even Bracco’s Dr. Melfi violates her patient’s trust when she lies to Tony about why she has bruises. “He can tell she’s lying, and the session rapidly deteriorates,’ says Dr. Gabbard.

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