Silver Linings Playbook

Silver Linings Playbook Abnormal Psychology In the movie ”Silver Linings Playbook” viewers are being thrown into the world of Patrizio ”Pat” Solitano Jr. A man diagnosed with bipolar disorder who moves in with his parents after eight months in a mental health facility. Determined to win his estranged wife Nikky back (although he has a restraining order against him), Pat is convinced he has changed for the better and believes he is ready for ”the real world”. What separates this movie from many others is the fact that we, for the most part, get to follow Pat post-treatment and not so much pre-treatment. David O. Russell does a great job in depicting how environmental factors can be a trigger for a (possible) genetic sensibility and how outside factors can make that gene(s) express itself. Pat comes home from work one day and finds his wife in the shower with his colleague – making love to the very song Pat and Nikki got married to. Pat almost beat him to death. The song haunts him and turns out to be the one trigger that makes him relapse over and over again. He can hear it play over and over in his head, even when it is not actually being played anywhere. While beating someone up is not reason enough to put someone in a mental facility or even diagnose them with a mental abnormality – it was, however, the environmental trigger that put Pat in that place. Pat was diagnosed with a bipolar disorder a week before this episode due to another rather impulsive and irrational act. Sometimes depressive and bipolar symptoms can seem to appear out of nowhere, with no obvious cause. This appeared to be the case when he called the cops and told them that his wife and the history guy were plotting against him by embezzling money from the local high school, which was a delusion. As Pat is talking to his therapist, he continues: ”They told me I was undiagnosed bipolar, with mood swings and weird thinking brought on by severe stress which, rarely happens thank God. And then the shower incident happened and that’s when everything snapped so… I then realized ’Wow, I’ve been dealing with this my whole life, without any supervision. I’ve been doing it on my own, that’s a lot to deal with especially when you dont know what the hell is happening, which I do now… sort of.” Having a mental disorder is hard enough as it is, but to be a middle-aged man who has been undiagnosed his entire life, comes with its additional battles and stress. While talking to his therapist – whom he continues to see following the releasement from the facility, Pat does his best to convince his therapist Dr. Patel, that he no longer needs to be on medication because he is feeling better. Pat tells him that he has a different mind-set and focuses on the silver lining of things now. This is a typical move for patients with a bipolar disorder because a person experiencing, for example, hypomania – may associate those episodes with periods of high productivity or creativity and are ”less likely to repost their symptoms as distressing or problematic.” He is working out regularly and enjoys this newfound increase of energy. In other words, he is being productive. His refusal to take his medication becomes a battle in his own home as well. In one scene viewers get to see Pat and his mom get into an argument in the kitchen about him having to take his medication, whereas he replies: ”I can’t mom, I can’t. I don’t feel good when I’m on them I’m so much clearer without them.” Lithium can have major side effects which could be the reason Pat is feeling like he does not want to deal with that when he is finally feeling better. However, it is important for patients with a bipolar disorder to keep taking their medication even if they feel like they have recovered from the diagnose because the disease requires a lifelong maintenance treatment and clinical management. And even when patients do take their medicine, they are not immune to residual symptoms between episodes. Pat’s unwillingness to do so could explain the following episodes of violent outburts that he has in the film, or relapses after being released from the mental health facility. At one point he wakes his parents up at 4 AM to ask where his wedding movies are and become very irritable and aggressive when they do not give them to him. Shortly after that incident he wakes his parents up in the middle of the night again to discuss a book that Nikki is reading to her students and becomes very upset about things he finds in the book. He throws the book out the window (and breaks it) and asks his parents repeatedly, ”what is Nikki thinking?”. A third time he actually ends up beating his own mother, although not purposely and it escalates to a point where he is physically fighting his dad. His disorder is clearly causing a lot of distress for him and his family. A prominent feature of Pat throughout the movie is his rapid speech and flight of ideas, especially at night when he continously wakes up his parents. While Pat was still in the hospital, he was seen being given medication but spit it out when noone was watching. It is unclear how long he has been doing that for and clearly it has interfered with his recovery as he has relapse episodes following his move back home. There is a strong genetical component in the etiology for bipolar disorders. Estimates of heritability of bipolar disorder range from 59 to 87% and one of the common comorbid psychological conditions are anxiety disorders. OCD is one of the disorders that fall under the umbrella term ”anxiety”. Pat’s dad shows signs of OCD. Although they might not be causing significant distress to his dad, the symptoms are there. For example, he has to put the TV remotes in a certain way while watching the Eages – his favorite football team – ”to make sure they win.” By the end of the movie he bets his entire fortune on whether or not the Eagles will win their next game, and he is so sure that they will win because ”he knows the signs” and what brings good luck etc. Quite an impulsive and irrational act. He is also supersticious so he makes sure that Pat hangs out with his friend at the time of the next game, to ensure a win. By doing so Pat’s dad feels a sense of relief and comfort. It removes anxiety and give him a sense of control, also called negative reinforcement. Again, although his dad is not necessarily diagnosed with OCD – Pat could have a predisposition for anxiety disorders in his genes. Children of parents with anxiety disorders are a high risk-group when it comes to developing a psychological abnormality themselves. ”Stress from major life event could lead to the onset of a major depressive episode” in just about anyone. So environmental factors definitely plays a key role here as well. It is likely that environmental factors could have triggered an already existing genetic desposition for bipolar disorder in Pat. Stress and emotional distress could be a trigger for anyone, let alone someone with a genetical predisposition. The biggest sign of his distress is the wedding song playing over and over again in his head, even when it is not actually playing, as mentioned before. It usually causes him to have an outburst of anger and he can not control himself for that period of time. The cheating incident has clearly taken a toll on him. Another environmental factor that could have triggered the onset of bipolar in Pat, is his dad. He seems to have an estranged relationship with his dad whom is sceptical about his son returning home because he is not convinced that he is ”healthy” enough just yet. The environment surrounding Pat at home and its possible effect on his health becomes clear when he tells his therapist: ”I’m not gonna take any medication doctor, it makes me foggy, I don’t want to, doctor. I’m not the explosion guy, my father is the explosion guy! I’m not that guy. He got kicked out of the stadium because he’s beat up so many people at Eagles games. I had ONE incident.” Pat spitting out his medicine and refusing to take it, is another strong component as far as why his problems persist and symptoms (such as rapid speech, insomnia, irritability, impulsiveness, anger) persist. One important aspect of treatment for people with bipolar disorder, besides medication, is teaching the patients about the disorder they have. In other words, cognitivebehavioral therapy, also called CBT, ”develops skills to change inappropriate or negative thought patterns and behaviors. Psychoeducation would not only teach the patient about the disorder, it also educates them on accurate treatment, helps them recognize warning signs or precursors of mood shifts within themselves and more importantly, help the patients understand the importance of early recognition and how that can help patients improve social and occupational functioning, as well as minimizing the risks of relapse.” Psychotherapy benefit individuals with bipolar disorder when used together with medicine. Pat’s therapist Dr. Patel tries to educate Pat on this matter by telling him that he has to learn how to recognize the ”warning signs” and go to a quiet place whenever those feelings and signs occur to prevent these outburts (and relapses) from happening. Since Pat is diagnosed bipolar and shows several signs of both low and high mood that are severe enough to impair his ability to engage in ”normal” activities, such as making friends, obtaining and keeping a job – he needs to continue taking his medicine and see his therapist on a regular basis. The medicine he would need to take is Lithium to moderate the glutamate levels in his brain. Too much glutamate puts you in a ”manic” episode whereas too little causes depression. The movie does a great job at showing how small, daily activities such as working out, can have a tremendous effect on your health. Even for someone with a lifelong disorder, whether it be bipolar or any other mental illness. One thing that was kept constant following the release of Pat from the mental health facility, was his workout regime. It always made him feel better. The positive effects were not only clear for Pat, but for everyone around him as well. Exercise could be a part of interpersonal and social rhythm therapy (IPRST) for Pat. The movie also did a great job at showing the importance of regular therapy sessions, like the one time Pat’s mom made him go see his therapist even though he felt like he was completely ”fine” and did not need to – saying that ”that was the deal if he was gonna move back home. He was gonna continue to see his therapist.” So he went, which also turned out to be a good thing because he did have a relapse; his therapist made the receptionist at the clinic play the ”wedding song” only to see if it was still a trigger for him, which it was. However, the movie failed at making the audience understand that bipolar is a lifelong disorder that does not just ”go away”, although one can heal and feel much better. It seemed like Pat stopped taking his medication completely, even before he was released, and still ended up being ”cured” by the end of the movie. In reality you would most likely have to be on medication for the rest of your life, especially if you want to feel any better. You can not just suddenly stop taking your medication, only see your therapist and still feel better. If you had a major depressive disorder; seeing a therapist without accompanying that with any medicines, could help in some cases. But as far as bipolar diseases goes, you have to have the medical component as well. Pats’ wife cheating on him seemed to be the ”reason” for his mental illness in this movie. Although, it could not be. It could have been a trigger but the movie did nothing to show that there could have been a genetic component to it, and that it could have expressed itself in him sooner or later whether or not the cheating incident had happened. However, someone without a psychology education might not be aware of this inaccuracy and having the cheating incident being portrayed as the main reason for his impairment and disfunction might seem plausible in their eyes, although it is not. This could shape society into thinking that a break-up can cause a bipolar disorder in itself, not true! They should have done more in making the viewers understand that it is not merely ”his fault” nor was it his estranged wife’s fault as far as the disorder goes, it could have happened either way. Or it might not have ever expressed itself had the cheating-incident never happened. The movie made it clear that Pat has a bipolar disorder, but never mentioned what kind of bipolar disorder. The ”manic” episode in bipolar I and bipolar II is different. Someone with bipolar II experiences a milder form of mania called hypomania. Pat most likely has bipolar II which is something I doubt the movie makers even thought about. Besides reasons stated in the beginning, I question Pat having manic episodes because he was never that full of energy, he did not plan a trip around the world and bought a new house on the same day, for example. Although hypomania is a mood elevation as well, it is not as extremely elevated as mania. Still abnormal, but not as elevated. Pat is an overly talkative character, very excitable one second only to have that shift to being very irritable the next. Typical signs of a person in a hypomanic state.