Psyc 420 Paper 2

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Dec 6, 2023

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1 BP, BPD, & PTSD Seeing Bipolar Disorder, Borderline Personality, and Posttraumatic Stress Disorder on the Big Screen Evan Sandefur Department of Psychological and Brain Sciences, University of Louisville PSYC 308: Psychopathology Dr. Brooke Shriner November 5 th , 2023

2 BP, BPD, & PTSD Seeing Bipolar Disorder, Borderline Personality, and Posttraumatic Stress Disorder on the Big Screen Reflecting back on the disorders that were covered three stood out, and I was interested to learn more about them and how they have been portrayed in the media. The textbook (Hooley et al., 2020) talks about each of these disorders in detail, including “hallmark symptoms” which are traits of the disorder that are the most common and recognizable. Borderline personality disorder is characterized by “ Impulsiveness; inappropriate anger; drastic mood shifts; chronic feelings of boredom; attempts at self- mutilation or suicide” (Hooley et al., 2020, p. 329). Bipolar personality disorder is symptoms of mania and depression, often in bouts or swings of severity. Bipolar disorder has a type of one or two, and these differ by the presence of manic episodes. A mental health professional usually consults with an individual and will diagnose between the two when necessary. Posttraumatic stress disorder (PTSD) is a disorder that people usually develop after a trauma-inducing life event. Symptoms for this include rumination on the event, avoidance of triggers, high-stress levels, and oftentimes depression and anxiety. Three movies have been selected to highlight the symptoms of these disorders, the movies being Silver Linings Playbook , Girl, Interrupted , and Perks of Being a Wallflower . Visual/Narrative Depictions of the Disorders Mania and Mood Swings in Bipolar Disorder 1 Link/Location: Silver Linings Playbook - Bipolar Disorder 2:21-5:13 Mania is the defining feature of bipolar 1 disorder, defined as high levels of elevated, or irritable mood. During a manic episode, individuals may experience heightened energy levels, increased self-esteem, or grandiosity, decreased need for sleep, and an exaggerated sense of their

3 BP, BPD, & PTSD abilities. Bipolar 1 disorder also involves dramatic mood swings between manic and depressive episodes. Depressive episodes are characterized by persistent feelings of sadness, hopelessness, low energy, and loss of interest in previously enjoyable activities. In this clip from Silver Linings Playbook, the main character Pat Solitano (played by Bradley Cooper) is experiencing these symptoms of Bipolar 1 disorder. Pat experiences manic episodes in the movie, which are characterized by his high energy levels, impulsivity, and erratic behavior. He is fixated on getting back together with his estranged wife Nikki and believes that everything in his life will be perfect once they reconcile, displaying the grandiosity often seen in manic episodes. In this clip, we can see Pat reading a book and then throwing it out of the window in anger. His mood swings from calm to angry in a matter of seconds, as we see him waking his parents up in the middle of the night to rant about the situation with him and Nikki. In Mutz (2022), the existing literature was reviewed of the various types of brain stimulation that are used to treat bipolar 1 and 2 disorders in tandem with psychotherapy and medication. The brain stimulation treatments that were reviewed include Electroconvulsive therapy (ECT), Transcranial magnetic stimulation (TMS), Transcranial direct current stimulation (tDCS), Magnetic seizure therapy (MST), Deep brain stimulation (DBS), and Vagus nerve stimulation (VNS). Specifically, these treatments were vetted for their tolerability, efficacy, and maintenance. The study found that this method of treatment as an add on, or replacement for other forms of treatment has much room for improvement, being in the follow up of long-term treatment in order to understand the efficacy of treatment. Impulsivity and Unstable Relationships in Borderline Personality Disorder Link/Location: Girl, Interrupted - BPD 3:28-3:54, 5:11-5:53

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4 BP, BPD, & PTSD "Girl, Interrupted" is a 1999 film directed by James Mangold and based on the memoir of the same name by Susanna Kaysen. The movie is a psychological drama that follows the experiences of Susanna Kaysen, played by Winona Ryder, who is admitted to a psychiatric hospital in the late 1960s having borderline personality disorder. She befriends fellow patients, including Lisa Rowe, portrayed by Angelina Jolie, and the film explores their complex relationships and the challenges they face dealing with mental illness and the mental health system. It delves into themes of identity, conformity, and the blurred line between sanity and insanity. In the first clip, we see Susanna interact with her nurse Valarie played by Whoopi Goldberg. Susanna is in the bathtub with her clothes on while expressing her anger to Valarie, exemplifying their unstable relationship. In the second clip, we see Susanna taking pills, an example of her impulsivity and her addiction to prescription pills. She takes pills without fully understanding their effects, which is a sign of impulsive behavior. Jørgensen et al. (2020) examined the implementation of Mentalization-based treatment (MBT) in adolescents with borderline personality disorder. They observed a gap in the literature for this age group, so they formed group sessions in hopes of affecting early stages of borderline personality disorder. They define mentalization based treatment as, “making sense of each other and ourselves, implicitly and explicitly in terms of subjective states and mental processes” (Jørgensen et al., 2020, p. 700). They found that results were similar to that of other treatment methods, specifically those that the individuals were already undergoing. They concluded that more work was necessary to better understand effective methods of treatment for early symptoms of borderline personality disorder in adolescents. Flashbacks and Rumination in PTSD Link/Location: Perks of Being a Wallflower - PTSD 0:00-3:07

5 BP, BPD, & PTSD Flashbacks are involuntary and vivid re-experiences of the traumatic event. They can be triggered by various cues, such as sights, sounds, smells, or even emotions that are reminiscent of the traumatic experience. Flashbacks are typically associated with intense emotions, such as fear, panic, or extreme distress. Individuals may also experience physiological responses like rapid heart rate, sweating, and hyperventilation during a flashback. Rumination refers to persistent and repetitive thinking or dwelling on a traumatic event. It involves mentally revisiting the details of the trauma, the emotions associated with it, and trying to make sense of what happened. Rumination is often accompanied by strong negative emotions like guilt, shame, anger, or sadness. In the clip, we can see the main character Charlie reflecting on his past trauma, having multiple flashbacks, and ruminating on the past. He cries and is trapped in his past trauma that has culminated over the duration of the movie. When looking for a treatment study relating to posttraumatic stress disorder, my thoughts were with the innocent lives lost in the countries of Palestine and Israel and how those living in conflict or having to flee as refugees oftentimes suffer from posttraumatic stress disorder. In Tissue et al. 2023, they measured the effects of Skills Training in Affective and Interpersonal Regulation for refugees (STAIR-R) in a case study, as well as Narrative Exposure Therapy (NET). The case study involved Sara, who is a sixty-year-old woman from Iraq who was suffering from posttraumatic stress symptoms due to war. The article is worth a read in its entirety, but it catalogs Sara’s trauma across decades, as well as the treatment plan that was developed within a culturally aware manner. At the start of this case study, Sara underwent a Clinician Administered Post-Traumatic Stress Disorder Interview (CAPS-5) in order to determine the prevalence and severity of PTSD symptoms that Sara had. Sara reported severe sleep issues, social isolation, and negative impacts on life. The case study concluded that after using the STAIR-R methodology and teaching self-regulation,

6 BP, BPD, & PTSD positive impacts were made. According to the study, “overall improvement in her PTSD symptoms...gains were seen in the development of emotional insight .... improved sleep and a renewed sense of connectedness with her spirituality .... cope more effectively with ongoing stressors” (Tissue et al., 2023, p. 301). Conclusion In closing, I learned a lot from these movies and also the studies that I found along the way. I had previously seen Perks of Being a Wallflower , but the other movies were new to me, so it was interesting finding the disorders and the hallmark symptoms when I was not familiar with the plot of the film. The studies that I found laid out methods of treatment for bipolar disorder, borderline personality disorder, and posttraumatic stress disorder, which helped me gain a more in-depth knowledge of the disorders. The posttraumatic stress disorder study really stuck with me, in light of current world events. The ongoing conflicts of Ukraine, Russia, Israel, and Palestine really highlight the importance of the Tissue et al. 2023 study, and how much work will have to be done in terms of psychological care for all those affected by the lost life and destruction. Most of the literature I found relating to the treatment of posttraumatic stress dealt with veterans, and I appreciated that this study looked at the other side of war, those who are affected by violence just trying to live normal lives. As mentioned, I had not previously seen Silver Linings Playbook , so it was eye opening to see Pat’s mood swings and how it accurately portrayed symptoms of bipolar 1 disorder. It highlights the importance of understanding and support for people living with this condition and the potential for recovery and finding silver linings even in the midst of mental health challenges.

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7 BP, BPD, & PTSD References Cohen, B., & Gordon, J., & Gigliotti, D. (Producers), Russell, D. (Director). (2012). Silver Linings Playbook [Video file]. https://youtu.be/i-QnliinDig?si=XVu9ToHxacFj3mBI Hooley, J., Nock, M., Butcher, J. (2020). Abnormal Psychology, 18th Edition. Pearson Jørgensen, M. S., Storebø, O. J., Bo, S., Poulsen, S., Gondan, M., Beck, E., Chanen, A. M., Bateman, A., Pedersen, J., & Simonsen, E. (2021). Mentalization-based treatment in groups for adolescents with Borderline Personality Disorder: 3- and 12-month follow-up of a randomized controlled trial. European Child & Adolescent Psychiatry, 30(5), 699 – 710. https://doi-org.echo.louisville.edu/10.1007/s00787-020-01551-2 Konrad, C., & Wick, D. (Producers), Mangold, J. (Director). (1999). Girl, Interrupted [Video file]. https://youtu.be/lzgtP1sK4KY?si=oGUq1bEmA3MqdEJb Malkovich, J., & Halfon, L., & Smith, R. (Producers), Chbosky, S. (Director). (2012). Perks of Being a Wallflower [Video file]. https://youtu.be/9rTcIUk9Aio?si=tl-VKZAPLlfLCPbH Mutz, J. (2022). Brain stimulation treatment for bipolar disorder. Bipolar Disorders , 25 (1), 9 – 24. https://doi.org/10.1111/bdi.13283 Tissue, A., Specker, P., Hoffman, J., Uppal, S., Cloitre, M., Neuner, F., O’Donnell, M., & Nickerson, A. (2023). Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers. Clinical Case Studies, 22(3), 285-306. https://doiorg.echo.louisville.edu/10.1177/15346501221133315

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Psyc 420 Paper 2

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