Psychopathology from a Clinical Perspective

Psychopathology from a Clinical Perspective Final Project

Walden University

Professor:

PSYC-8781L-2 Psychopathology from a Clinical Perspective

Psychopathology from a Clinical Perspective Final Project

Abstract

This paper has the main goal of describe and diagnose the character of Pat Solitano from the novel and film “The Silver Linings Playbook”. Mr. Solitano is a man around his thirties, a former teacher that was eight months in a mental institution for an aggressive outburst eight months ago when he caught his wife Nikki cheating on him (Fleming, 2011). The main goal for Pat is to be diagnosed and treated in order to return to normal life. The diagnosis is most likely to be Bipolar I Disorder, which is a long-term manic-depressive illness caused by the brain that results in severe mood swings, activity shifts, energy changes and variations in carrying on daily activities (Mayo Clinic Staff, 2016). The causes of bipolar disorder could be: genetic factors, environmental factors or neurochemical factors. Despite knowing his condition, his family tend to put a lot of pressure on him and therefore exacerbating his condition (Russell, 2012). Possible treatments are medication or therapies such as group therapies, cognitive-behavioral therapy, interpersonal and social rhythm therapies, psychoeducation and family-focused therapies (National Institute of Mental Health, 2016).

The following manuscript intends to describe the character of Pat Solitano from the novel and film “The Silver Linings Playbook”. In addition, it will present an assessment, diagnosis and potential treatments according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) V.

1. Introduction

The Silver Linings Playbook was written by Matthew Quick and adapted to film under the direction of David O. Russell (Donahue, 2013). The film has been considered both critically and box office success by gaining over $200 millions and being nominated for eight Academy Awards, including best director, best actor, best picture, best actress and best adapted screenplay (Donahue, 2013). Quick praised the film adaptation and that it promotes more openness and acceptance of mental illness (Donahue, 2013).

The main character of the film is a man around thirty years old named Patrick ‘Pat’ Solitano, a former obese teacher that was eight months in a mental institution for an aggressive outburst when he caught his wife Nikki cheating on him (Fleming, 2011). After getting out of there he tries to win back his ex-wife while adapting to his life again (Fleming, 2011). In the process, he meets an outgoing neighbor that have also similar mental issues and start a friendship with her (Fleming, 2011).

Demographics. Patrick ‘Pat’ Solitano is a white man in his thirties who lives in Philadelphia and that is married to a woman named Nikki, but right now they are living separately and do not have children (Russell, 2012). Currently, he has a girlfriend called Tiffany Maxwell, a young widow with mental issues (Russell, 2012). He is a high school teacher but he hasn’t worked for the past eight months and is not currently employed either (Russell, 2012). Mr. Solitano has always demonstrated an erratic behavior, but this was exacerbated by an incident eight months ago (Russell, 2012).

1. Background Information

Presenting problem and relevant history. That day he was on his way to work when he forgot something and go back to his house (Russell, 2012). When he arrived, his wedding song was being played while he saw some of his wife clothes on the floor and go to the bathroom where it was his wife with an old coworker having sex in the shower (Russell, 2012). After he saw this, he stated beating and kicking him but such furious that he almost killed him. Later on, he was sent to a mental institution due to his previous history of mental issues (Russell, 2012). He spent eight months there, and was sign off the institution by his mother under strict supervision, with the conditions of not getting in any trouble with the law and to move back with her and his father (Russell, 2012). After getting out of there, he had problems reintegrating back to his family, community and society. Mr. Solitano was determined to win back his wife and did everything he could to know about her and to get her attention (Russell, 2012). He has had severe mood swings and aggressive episodes as soon as his wedding song starts to play in his head again (Russell, 2012).

Client goals. The main goal for Pat is to be diagnosed and treated to return to normal life. He wants to reduce significantly those aggressive outbursts and mood swings while taking the least amount of medications possible.

Diagnosis and definition of the disorder. According to the information presented so far, the diagnosis is most likely to be Bipolar I Disorder (Mayo Clinic Staff, 2016; National Institute of Mental Health, 2016). Bipolar Disorder is a long-term manic-depressive illness caused by the brain that results in severe mood swings, activity shifts, energy changes and variations in carrying on daily activities (Mayo Clinic Staff, 2016). This type of bipolar disorder could cause severe periods of increased emotions which are called mania (Mayo Clinic Staff, 2016). He can also present moderate periods of increased emotions named as hypomania (Mayo Clinic Staff, 2016). In other moments he can feel the opposite, feelings of sadness and low energy mimicking depressive episodes (National Institute of Mental Health, 2016). In general, it can be an impairing condition that might be controlled with medications and psychotherapy (Mayo Clinic Staff, 2016).

1. Diagnosis

Manic episodes of the disorder. The Bipolar I Disorder diagnosis was made by evaluating the disorder’s characteristic maniac, hypomanic and depressive episodes. The A criterion for manic episodes indicates the existence of a period with significantly and constantly increased emotions, irritable mood, unusual energy and uncommon goal-directed activities that least for a week almost all day (American Psychiatric Association, 2013). In the case of Patrick, the goal he had was to get back Nikki so all he did was directed towards her, from running in the mornings to passing by the college he used to teach in (Russell, 2012). The B criterion for the manic episodes requires that at least three of the following symptoms are present: feelings of grandiosity, decreased sleep, more talkative than usual, flight of ideas, easily distracted by irrelevant things, increase in goal-directed activity and/or excessive amount of activities that may have painful consequences (American Psychiatric Association, 2013). In the case of Mr. Solitano, the most marked are the decrease need for sleep, more talkative than usual and increase goal-directed activities (Russell, 2012. He tends to use most of the nights to read books written by her, look for their wedding videotape or other stuffs directed towards getting her back (Russell, 2012). The C criterion for the manic episodes is that those mood swings can impair severely his social, familiar and occupational life to the point that may even have to be hospitalized to prevent him from doing harm to other people (American Psychiatric Association, 2013). In this case both are true, he has not worked for months due to the bipolar disorder, was hospitalized after nearly killing a man and his mood swings often prevent him from socializing or maintaining friendships (Russell, 2012). The D criterion for the episodes requires that the episode must not be attributed to effects of a substance or a medical condition (American Psychiatric Association, 2013). In addition, to diagnose this type of bipolarity the maniac episode must have occurred at least one time during the lifetime (American Psychiatric Association, 2013).

Hypomanic episodes of the disorder. The A and B criteria for hypomanic episodes are similar to the manic episodes A and B criteria, except for the duration and severity (American Psychiatric Association, 2013). In hypomanic episodes, the A criterion must last just four days instead of a whole week (American Psychiatric Association, 2013). The C criterion for the episodes requires that those signs are a change in normal behavior and must not be present when the person is in normal condition (American Psychiatric Association, 2013). The D criterion requires that those mood swings and changes in behavior are appreciated by other people such as family or friends (American Psychiatric Association, 2013). The last two criteria, E and F, are exactly like the C and D criterion of the manic episodes (American Psychiatric Association, 2013).

Depressive episodes of the disorder. The A criterion for major depressive episodes requires that at least five of the following symptoms are presented for the same 2-week period almost always and are a change from normal behavior: depressed mood most of the time indicated by the person or as an observation from others, disinterest in almost all activities, increase or decrease in appetite along with unintentionally weight gain or loss, hypersomnia or insomnia, psychomotor retardation or agitation, fatigue or tiredness, worthlessness feelings or inappropriate guilt, not being able to concentrate or indecisiveness, and recurrent suicidal thoughts without planning (American Psychiatric Association, 2013). From those symptoms at least either depressed mood or disinterest must be present along with the other four (American Psychiatric Association, 2013). In the case of Pat, he presents: insomnia, psychomotor agitation, disinterest, inappropriate guilt and fatigue. He is often seen in bed just looking up even if he has things to do and expressing his tiredness. The disinterest in football is present almost all of the time, which is something he used to enjoy watching with his father (Russell, 2012). There are moments in which he blames himself only over and over again for not being with Nikki as a sign of inappropriate guilt (Russell, 2012). The B and C criteria for the depressive episodes are also exactly like the C and D criteria for the manic episodes (American Psychiatric Association, 2013).

In addition to the criteria mentioned, the occurrence of those manic and depressive episodes must be better explained by an other disorder (American Psychiatric Association, 2013). In the case of Pat, the schizophrenia, schizoaffective, delusional disorder and other psychotic disorders are ruled out due to the absence of delusions and hallucinations.

The causes of bipolar disorder could include: genetic factors, environmental factors or neurochemical factors. As established by the DSM-V, environmental factors such as high income and losing the partner through divorce or death can increase the risk for bipolar disorder (American Psychiatric Association, 2013). In the case of Pat, he is having both, his family seems to have financial solvency with his father constantly gambling and is currently separated from his wife. In addition, genetic causes can also be a risk factor for the bipolar disorder (American Psychiatric Association, 2013). While Mr. Solitanos’ parents do not present aggressive episodes, his father have a similar behavior and his mother tend to be more depressed, but this is unclear.

1. Risk and Resilience Factors

His family tend to be difficult, especially his father puts a lot of pressure on him and therefore it enrages him way more and force him to become violent (Russell, 2012). Pat’s father tends to compare him with his brother which is successful in his business and is engaged (Russell, 2012). His mother is very susceptible to Pat’s mood swings; each time he has an episode she starts to cry and this tend to calm him (Russell, 2012). Despite that, is implied that both parents have less severe mental disorders such as Obsessive-Compulsive Disorder (Russell, 2012). In addition, as he was in probation, the police tend to go over their house each time there is an episode to remind him he can go back to the mental institution at any time (Russell, 2012). Furthermore, there is a neighbor that goes often to their house asking for Pat so he can get an interview about mental disorders (Russell, 2012). And finally, his best friend called Ronnie, is married to Nikki’s best friend so they tend to put pressure on him as well to do things right for Nikki (Russell, 2012).

1. Psychosocial and Family Issues

Later on, he starts to develop a relationship with a women named Tiffany that has similar mental issues. This woman helped him to cope with his disorder through dancing but also added more pressure to him by obligating him to dance even if he did not want to do it and by giving him hope that he could see Nikki again (Russell, 2012).

In the case of his career, he is a certified teacher and had a job at that, but after the incident he has not work on that again (Russell, 2012). The only time he got interested in something relating to teaching was actually to find Nikki at their old school. Therefore, he seems to have no intention of returning to teach anytime soon.

1. Career and Vocation

In this type of disorder, the manage of information must be extremely cautious because any uncertified disclosure of information to family or friends might result in more stress for the patient (Parker, 2002). A situation like this might cause discrimination towards the clients and even exclusion or fear.

1. Legal and Ethical Issues

In Bipolar disorder, the suicide risk is fifteen times higher, therefore the psychologist must be able to differentiate suicidal thoughts from possible suicidal attempts because possible suicidal attempts must be informed and prevented at any cost (American Psychiatric Association, 2013). If the person is seriously considering suicide, the psychologist must not leave him alone, must call 911 or the nearest hospital and remove potential arms for suicide (National Institute of Mental Health, 2016).

In addition to the information obtained, there must be a clear assessment for the parents and brother for genetic risk factors pertaining to the condition. They also must be assessed for any mental disorder and for further information of Pat’s behavior when he was younger. Furthermore, an interview to Nikki must be intrinsic as well to analyze the type of relationship they had before the incident, if she observed any erratic behavior previously and any other data we might have been missing. Also, there must be further investigation on his medical history, if he has any physiological condition, and if he is taking any medication. Moreover, asking about drug o alcohol abuse is intrinsic to certify the diagnosis.

1. Continued Assessment

Possible treatments are medications like antidepressants, lithium, antipsychotics, anticonvulsants, sleep medications symbyax and benzodiaphenes (National Institute of Mental Health, 2016). Also, there are approaches such as the Electroconvulsive Therapy that could be used as the last resource, when other treatments have not been successfully (National Institute of Mental Health, 2016). Despite that, the medications must be prescribed by a Medicine Doctor, therefore the therapist must focus on other approaches (National Institute of Mental Health, 2016).

1. Follow-up Recommendations for Treatment

Other treatments could include: group therapies, cognitive-behavioral therapy, interpersonal and social rhythm therapies, psychoeducation and family-focused therapies (National Institute of Mental Health, 2016). These therapies combines can help to support, educate and guide the patient and his family (National Institute of Mental Health, 2016). In addition, new activities and new friends also make him happy. In addition, less stress in his family and community life might help him even more (Mayo Clinic Staff, 2016). Significant reduction in pressure from his mother, father, friend, former sister in law and brother will be significantly good for him. In addition, less prosecution from a young teenage boy that tend to go around to interview him about his mental condition would be helpful as well. Furthermore, lesser uncertainty regarding his wife and fewer people giving him hope would have helped him to canalize the disorder.

Finally, having a healthier lifestyle by: eliminating any drugs and alcohol, doing regular exercise, trying to sleep more and having a balanced diet might help to regulate the disorder (Mayo Clinic Staff, 2016). Drugs and alcohol could increase the depressive episodes and therefore worsen the condition (Mayo Clinic Staff, 2016). The exercise will help with the release of endorphins that could help him to sleep better and to have more energy during the day (Mayo Clinic Staff, 2016). Also, sleep deprivation affect severely your mood, so taking a good sleep will help to stabilize that (Mayo Clinic Staff, 2016).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Donahue, D. (2013). ‘Silver Linings Playbook’ success isn’t exactly how author drew it up. USA

TODAY. Retrieved from http://www.usatoday.com/story/life/books/2013/02/19/silver-linings-playbook-matthew-quick-novel-author-hit-movie/1930635/

Fleming, Mike (August 1, 2011). “Bradley Cooper Back In Silver Linings Playbook Talks,

Robert DeNiro Too”. Deadline.com. Retrieved October 23, 2011.

Mayo Clinic Staff. (2016). Diseases and Conditions: Bipolar Disorder. Retrieved from

http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/lifestyle-home-remedies/con-20027544

National Institute of Mental Health. (2016). Bipolar Disorder. Retrieved from

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145406

Parker, L. S. (2002). Ethical issues in bipolar disorders pedigree research: privacy concerns,

informed consent, and grounds for waiver. Bipolar Disord; 4(1):1-16.

Russell, D. O. (Director) & Gigliotti, D. (Producer). (2012). Silver Linings Playbook [Motion

Picture]. United States: The Weinstein Company.