Psychological Evaluation of the Characters: Movie, What about Bob - Research Paper Example

? Psychological Evaluation of the Characters: Movie, “What about Bob” Affiliation with more information about affiliation, research grants, conflict of interest and how to contact Psychological Evaluation of the Characters: Movie, “What about Bob” This paper talks about the case evaluation of two individuals, portrayed in the movie “What about Bob?” The story develops through the relationship between a psychiatrist, Dr. Leo Marvin and his patient, Mr. Bob Wiley, who suffers from multiple phobias and visits the doctor for a consultation. The movie emphasizes the extreme difference between these two characters. Case Evaluation 1: Mr. Bob Wiley is the first case being considered for this paper. Bob, a good natured, educated, middle class man with no friends, goes to Dr. Marvin for the consultation of his problems. During the interview, Bob says “I am divorced,” and this suggests his loneliness (Oz, 1991). When Dr. Marvin assures Bob that he will save him, he responds “for the first time in my life I feel hope,” and this hope strengthens as the story progresses (Oz, 1991). Bob’s dialog, “I feel like I can be somebody,” reveals his need for family support (Oz, 1991). The movie also shows a fish that Bob cares for, to illustrate his compassion for others. He even takes it with him when he goes to visit Dr. Marvin’s vacation place Further, Bob bonds well with the doctor’s family also. The movie does not depict any of his previous incidents or trauma. Bob Wiley’s behavior is quite interesting. He dresses up well and has his own way of doing things as well as treating people. There are many instances that suggest this. For example, his interaction with ‘Good morning America’ people, how he mingles with the doctor’s family, how he appreciates the people in the coffee shop etc. He is aware of his problems and he explains everything to the doctor. Bob says “doctor I am having problem with touching things and moving,” (Oz, 1991). He overreacts whenever he touches things due to his fear of acquiring diseases. He shouts or starts panicking on phobic intervals, and the reason is his unusual thoughts. He is unreasonably concerned about things such as “What happens if my heart stops beating suddenly” (Oz, 1991). He manifests symptoms such as sweating, nausea, numb lips, difficulty in breathing and swallowing on such occasions. “As long as I am in my apartment I am okay, when I go out, I feel scared” (Oz, 1991). Obviously, Bob suffers from behavioral problems as a result of his phobic personality. His symptoms match the manifestations of DSM-1V disorders. The DSM Axis classifications according to American Psychiatric Association (APA) are: “Axis I: Clinical Syndrome (Typically considered as the diagnosis depression, schizophrenia, social phobia) Axis II: Developmental Disorders and Personality Disorders Axis III: Physical conditions crucial to the development, continuance, or exacerbation of Axis I and II Disorders Axis IV: Severity of Psychosocial Stressors Axis V: Highest Level of Functioning” (All Psych & Hefner Media Group, Inc., 2011) Multi-Axial Evaluation Report Form: Case Bob Wiley (From DSM-IV-TR, p.36) AXIS I: Clinical Disorders Other Conditions of Clinical Attention Focus Diagnostic Code DSM-IV Name 309.21 Separation Anxiety Disorder AXIS II: Personality Disorders Mental Retardation Diagnostic Code DSM-IV Name 300.21 Panic Disorder with Agro-phobia AXIS III: General Medical Conditions ICD-9-CM code ICD-9-CM name “Axis III Deferred” “Axis III Deferred” AXIS IV: Psychosocial and Environmental Problems Axis IV features Patient Characteristics Problems with Primary Support group Divorce/Family Separation Problems related to the social environment Living alone/no friends Educational problems Inadequate information Occupational problems: Inadequate information Housing problems None Economic problems None, apparently Problems with access to healthcare None, but over sensitive about own heath Problems relating interaction with legal system nil Other psychosocial and environmental problems Inadequate social support or relation AXIS V: Global Assessment of Functioning Scale The psychological, social and occupational functioning of Mr. Bob altered due to his mental illness, which was measured with the help of GAF scale. During the starting stage Bob had a score of 60-51and, which had improved to 70-61 by the later events and finally it reached 90-81. According to DSM-1V-TR diagnosis made by American Psychiatric Association (2000), Mr. Bob Wiley belongs to Axis-I category of anxiety disorders characterised by multiple phobia and panic attacks. Diagnostic Criteria for a Panic Attack related to phobia on the basis of DSM -1V diagnosing criteria are: “A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: •palpitations, pounding heart, or accelerated HR , Sweating, trembling or shaking• sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, light headed, or faint derealization or depersonalization, fear of losing control or going crazy, fear of dying , paresthesias numbing or tingling sensations” (American Psychiatric Association, 2000, p.7). Bob experiences these symptoms in his daily life. The patient symptoms in accordance with book profile follows: # Patient Profile Book Profile Remark 1 Fear of moving phobia 2 Fear of touching the things phobia 3 Fear of getting ill/sick phobia 4 Palpitation, numbness Anxiety and panic attack 5 Unusual thoughts and anxiety anxiety 6 Nausea and discomfort anxiety 7 Difficulty in swallowing and breathing Anxiety and panic attack 8 Making loud noise Panic attack 9 shouting Panic attack. Bob’s symptoms fulfill these criteria as depicted in the movie and the causes may be his phobias and emotional stress caused by separation. The finding which leads to the specified diagnosis are Mr. Bob has multiple phobias and some peculiar beliefs such as he is okay in his own apartment, he is alone there but when he comes into an elevator or road he feels like he is losing control. While helping the doctor’s son to dive, Bob’s posture and his walk show his fear. These are evidences for his phobia that point to how anxious he is. The treatment is based on supportive interventions. “Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy. In general, continue a selected medication regimen for at least 6-12 months, the physician can gradually taper the patient off the medication. Psychotherapy usually helps make the transition off medication more successful. Inpatient treatment is indicated only for severe cases presenting with acute suicidal ideation and/or attempt” (Preda, 2013,). In this case, Bob harbors suicidal thought in his deeper mind. He acts as another person by saying that Bob has committed suicide and that he needs to get information from doctor. The doctor prescribes him psychotherapy, setting up of a tiny goal to achieve in daily living with the help of a book “baby steps” (Oz, 1991). “Selective serotonin-reuptake inhibitors (SSRIs), or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor, generic),” are the primary first-line treatment for anxiety disorders (A.D.A.M., Inc, 2013). Drug therapies for anxiety disorders work best in combination with cognitive behavioral therapy or some other form of “psychotherapy, commonly called emotion-based psychotherapy (EBT), psychodynamic therapy, or "talk" therapy, and these deal more with the roots of anxiety and usually, although not always, require longer treatments” (University of Maryland Medical Center, 2011). The patients with anxiety disorders should undergo pharmaco therapies along with psychotherapy for a better recovery. Bob recovers from his problems with the help of psycho and behavioral therapies due to Dr. Marvin’s support. The treatment also needs to be aligned with family or other relationship support, as it helps in the better prognosis than other interventions. Dr Marvin’s family has influenced Bob and he teaches himself to behave normally with them. Bob’s awareness of his problem makes him follow the doctor’s instructions. Moreover, the final attempt of Dr Marvin facilitates a thought alteration in him. Thus, the episode validates psychotherapy method as an essential treatment for this category. While treating the patients with such problems several legal and ethical issues may surface. These include suicidal attempts, social attacks, threatening behavior, rejection of treatment or hospitalization etc. Hospitalization is the best way to avoid such situations. These patients may have problems with the decision making too. While treating a patient who has these problems, one should be aware of his attitudes or activities. Case Evaluation 2 Dr. Leo Marvin is the second case. The movie “What About Bob?” progresses with him and his family along with Bob. Dr. Marvin belongs to highly educated family. He has a close attachment with his family but is highly egoistic. He is a famous psychiatrist and is the author of many scientific books and is quite proud of his achievements. Dr. Marvin’s behavior appears normal in the beginning. However, he discriminates. For example, when he talks to Bob as a patient and he tries to make him feel that. Even in his family, he gives first priority to himself and tries to keep up his image everywhere and craves for attention. For example, during Good Morning America interview preparations, he feels jealous of Bob when others recognize him from the TV show (Oz, 1991). He gets nervous while his family talks to or is getting along Bob. He is a reputed psychiatrist but does not have any insight to his problems. He is always conscious about himself and his family. Dr Marvin’s behavior is extremely different from Bob’s. When the latter comes for consultation, the former tries to send him away by simply giving him the guide book, “The Baby Steps” (Oz, 1991). He tells Bob to follow it for one month and refer to another doctor. He avoids Bob saying, “I am on vacation,” and asks him to take one too (Oz, 1991). It is an unprofessional way of dealing and with an intension to avoid patient’s interference with his vacation. His patient’s unusual behavior unsettles the doctor. The family members’ bonding with Bob and his continuous interactions worries him and slowly behavioral changes occur in Dr Marvin. According to APA, the DSM multi axis deals with the following:  “Axis I: Clinical Syndromes This is what is typically considered as the diagnosis (e.g., depression, schizophrenia, social phobia) Axis II: Developmental Disorders and Personality Disorders Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders Axis IV: Severity of Psychosocial Stressors Axis V: Highest Level of Functioning” (All Psych & Hefner Media Group, Inc., 2011) Multi Axial Evaluation Report Form for Dr. Leo Marvin (From DSM-IV-TR, p.36) AXIS I: Clinical Disorders Other Conditions That May Be a Focus of Clinical Attention Diagnostic code DSM-IV name 295.30 Schizophrenia- paranoid type AXIS II: Personality Disorders Mental Retardation Diagnostic code DSM-IV name 301.0 Paranoid personality disorder. AXIS III: General Medical Conditions ICD-9-CM code ICD-9-CM name “Axis III deferred” “Axis III deferred” AXIS IV: Psychosocial and Environmental Problems Axis IV features Patient characteristics Problems with primary support group Inadequate information Problems related to the social environment Superior feeling Educational problems Not applicable Occupational problems: Not applicable Housing problems Not applicable Economic problems Not applicable Problems with access to health care Not applicable Problems related to interaction with legal system Not applicable Other psychosocial and environmental problems Suspicious/paranoid characteristics. AXIS V: Global Assessment of Functioning Scale. “Global assessment of functioning scale (GAF) considers psychological, social and occupational functioning on a hypothetical continuum of mental health/illness” (DSM IV TR Multiaxial Classification System). In the case of Dr. Marvin the GAF score in the movie’s beginning was 90-81, and most symptoms were absent. During the later stages, however, the psychological, social and occupational functioning worsened and the GAF was 30-21, where the patient had delusions, judgment impairment etc. However, the GAF scale score improved with treatment. On the basis of DSM-1V-TR Dr Marvin belongs to Axis-II category of paranoid personality disorder or paranoid schizophrenia. But schizophrenia is termed in Axis-I. The situations and conditions have aggravated his problem. Schizophrenics harbor mistaken beliefs that people are plotting against them or their loved ones and they tend to spend a lot of time thinking about how to protect themselves. Other symptoms include “becoming socially isolated, feeling tense, suspicious, guarded, and reserved, having an exaggerated sense of self importance (grandiose delusions), having unrealistic feelings of jealousy (delusional jealousy) (Loyola University Health System, 2013). Patient features in relation to evidence will be as follows: # Patient profile Book profile remark 1 Suspicious thoughts Paranoid schizophrenia 2 High self importance Paranoid schizophrenia 3 Unwanted tension Paranoid 4 Getting nervous with thoughts and distress Anxiety 5 Unusual thoughts and anxiety Anxiety/ Paranoid Personality 6 Jealous on others happiness or victory Personality Disorder 7 Delusions delusion 8 Feeling of isolation schizophrenia 9 Shouting Personality disorder The behavioral patterns of Dr Leo Marvin show his false beliefs regarding Bob. Moreover, he is worried of his family and tries to protect them, based on his own reasons and views. When his daughter Anna takes Bob for sailing and Simon, his son, dives with Bob’s assistance, Dr. Marvin becomes tense and reacts violently. Even he loses control during the dinner with family and Bob and also feels jealous that his family cares more for the patient. His paranoid behavior reaches its peak at the birthday party and he even tries to kill Bob. The treatment recommendations for Dr. Marvin include treatments to eliminate the symptoms. Medications, psychotherapy, hospitalization, electroconvulsive therapy (ECT), vocational skills training along with family therapy can fetch productive outcomes. Similarly, antipsychotic medications and various psychosocial treatments will also help to contain the symptoms. Some of the atypical antipsychotic medications in use are “Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone (Invega)” (AHRQ Effective Health Care Program, 2012). Along with the drugs therapy coping skill improvement, psycho and rehabilitation therapies etc should also be followed. The treatment prognosis will be based on the severity of the illness and the way of responding to it. Though he is a psychiatrist, Marvin does not have any insight about his problems. The paranoid behavior renders him completely out of consciousness and when crisis situations arise he becomes violent. While comparing with Bob’s case, Dr. Marvin’s prognosis is fair. So schizophrenia patients should be treated through this method by recreating the incidents to remove their unwanted suspicions. Dr Marvin’s hospitalization, medication and family therapy can work together for the recovery. The same method is applicable for the majority of the population affected with similar problems. The prognosis will be good if the treatment regimen is planned well by understanding the patients and their condition. Ethically, the degree to which a psychiatrist withholds information may disrespect a patient’s autonomy and may even be regarded as lying by omission” and “some patients with schizophrenia are exceptionally ambitious. This may cause some conflict for them and for their psychiatrist” (Howe, 2008). Dr. Leo Marvin tries to kill Bob. So care should be taken and the health personnel or care takers should be conscious about such behaviors. The movie presents two characters having different mental illness, as per the DSM-IV-TR. This paper has discussed the DSM-1V-TR Multi Axis Classification of the mental disorders along with examples. The main category was on Axis-I and Axis-II. Through multi axial evaluation one can understand and classify the disorders appropriately. On this basis, the rest of the plan for treatment can be developed. Signs and symptoms of each illness is categorized with the specific codes and each code indicates specific axis too. This film’s main characters are two patients that are different in all areas of symptoms, prognosis, recovery etc. The movie offers an overall idea about categorizing of symptoms and multi axial evaluation or identification of specific diseases, possible treatment plan development and it also deals with the ethical and legal issues in the treatment field too. Moreover, it also presets the irony of a situation where a psychiatric patient is aware of his condition whereas the psychiatrist, who has a psychological condition, fails to attain any insight into his own problems. References: ADAM, Inc (2013). Generalized Anxiety Disorder Medications - Generalized Anxiety Disorder Health Information - NY Times Health. Retrieved October 19, 2013, from AHRQ Effective Health Care Program (2012). Consumer Summary- Medicines for Treating Mental Health Conditions: A Review of the Research for Adults and Caregivers. Retrieved from All Psych, & Hefner Media Group, Inc. (2011). Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Retrieved October 19, 2013, from American Psychiatric Association (2000). Summary of DSM-IV Diagnostic Criteria. Intermountain Healthcare, 1-8. Retrieved from Howe, E. (2008). Ethical Considerations When Treating Patients with Schizophrenia. Retrieved October 19, 2013, from Loyola University Health System (2013). Schizophrenia - Paranoid Type -. Retrieved October 19, 2013, from Oz, F. (Director). (1991). What About Bob [Motion picture]. Preda, A. (2013). Phobic Disorders Treatment & Management. Retrieved October 19, 2013, from University of Maryland Medical Center (2011). Anxiety disorders. Retrieved October 19, 2013, from Read More