Psychological Diagnosis of Anne Wilkes in Misery - Term Paper Example

Misery case study paper Synopsis “Misery”, a novel written by Stephen King in 1987 and adapted into a motion picture directed by Rob Reiner in 1990 centres on the characters of Paul Sheldon portrayed by actor James Caan and Annie Wilkes portrayed by actress Kathy Bates. Wilkes and Sheldon first met after she rescued him from a car wreck. She decided to take him into her house where she nursed him back to health. It was during this time that Wilkes revealed that she was a big fan of Sheldon’s work. In fact, she insisted that Sheldon let her read the manuscript for his latest novel. Sheldon is inclined to agree, as Wilkes tended to his physiological needs devotedly and appeared to be a sensible, caring fan. This marked the beginning of Sheldon’s dilemma whereby, he had to deal with Wilkes’ fluctuating moods that bordered on psychopathic tendencies. Conversely, Wilkes felt no remorse for physically venting her displeasure over Sheldon’s immense use of profanities in his novel and his decision to kill the main character Misery Chastaine, whom she idolized. Sheldon’s attempts to escape did not succeed; however, he wound up uncovering Wilkes’ scrapbook, which detailed the vast number of mysterious brutal, unsolved murders she had witnessed. It was not until a police officer interested in Sheldon’s disappearance case came to check Wilkes’ house that Sheldon managed to escape despite Wilkes shooting the officer. Psychological diagnosis of Anne Wilkes Background Information Anne Wilkes is single, Caucasian woman in her late 40s. She lives alone in a well-organized, clean cabin located in Silver Creek, Colorado. She tends to the animals and her piece of farming land alone, as she has no friends, family, or close acquaintances. She is a certified nurse by profession, graduating with honors from nursing school. However, she goes into town for supplies whenever she needs them. Wilkes’ only pet is a sow named Misery. She is very religious, which influences her dressing and use of language whereby, she dresses conservatively and does not use profanities when speaking and constantly mentions God in her conversations. She enjoys watching late night dating shows and reading Sheldon’s novels. She associates closely with Misery Chastaine, Sheldon’s main character in his novel. Information about her childhood life and past experiences remains elusive. The only information regarding her developmental history is depicted in the form of newspaper articles organized in her scrapbook. From these newspaper clippings, it becomes apparent that Wilkes’ was a witness to several mysterious murders including her father’s. The police found Carl Wilkes’ corpse at the bottom of the staircase. They were alerted to his death by 11-year-old Wilkes. Wilkes was also a witness to a fellow nursing student mysterious death while she was attending the University of California in Los Angeles (UCLA). She also kept newspaper clipping of obituaries detailing mysterious deaths of patients at the intensive care unit where she was the head nurse. The sudden demise of patients seemed to follow her whereby, five infants died while she was heading the maternity wing of the County Memorial Hospital in Denver. The police questioned her after this incident; however, they had no evidence to convict her. According to the minimal information relayed to Sheldon about her past, it is evident that she was unpopular in school because of her temper. In addition, she also revealed that her previous marriage ended, which compelled her to take on more responsibilities at the hospital. Multi-axial diagnosis Axis I: 295.70 Schizoaffective Disorder, Bipolar Type Wilkes meets all the symptoms outlined in the diagnostic criteria given in the Diagnostic Statistical Manual (DSM). Due to the fact that she displays delusions combined with mixed episodes of hypo manic states and depressed moods, her Schizoaffective Disorder falls into the subtype Bipolar. Wilkes’s symptoms manifest early in the film. She resorts to insane tactics aimed at coercing Sheldon to re-write the book. During one of her manic episode, she poured gasoline on Sheldon’s bed and threatened to burn the house down if he refused to comply with her wishes. Wilkes’ delusions made her believe that she was God’s messenger sent to help Sheldon with his writing, which included refraining from using profanities in his writing and finding another ending for his main character Misery Chastaine. In addition, Wilkes suffers from shifting moods; for example, she fluctuates from suicidal thoughts to a hyper, energetic phase where she plays with her pet and makes pig noises. Axis II: 301.22 Schizotypal Personality Disorder Wilkes’ symptoms reveals that she has most of the symptoms outlined in the criteria for diagnosing Schizotypal Personality Disorder. She is incapable of forming intimate social relationships with other people. Therefore, she chooses to isolate herself from society by living in a cabin far away from town and has no friends or acquaintances. This reflects a pervasive pattern of interpersonal and social deficits respectively. Her mannerism is eccentric and bizarre; for example, she uses words such as “dirty-bird” when referring to Sheldon’s use of profanity in his manuscript, and also displays behaviors of a young child such as jumping up and down whenever she is elated. Axis III: None Throughout the movie, no scene alludes to Wilkes suffering from any medical condition. Her character depicts her as a healthy, strong middle-aged woman. Axis IV: Problems with primary support system: Wilkes witnessed the death of her father at a very tender age and her mother’s whereabouts remain unknown. In addition, her failed marriage was not amicab Problems with primary support group: Annie’s father died when she was 11 and her mother’s ware about is unknown. She has no siblings or family members. Husband abandoned her several years ago and she has no children. Problems related to the social environment: No support system is available. Living alone. Annie was fired from the hospital and can no longer work as a nurse. She has been nicknamed “The Dragon Lady” by the media following the baby deaths. Problems related to interaction with the legal system/crime: Annie had been a suspect in the deaths of newborn babies several years ago. She was found not guilty. Axis V: Global Assessment of functioning (GAF) Although Annie seems functional she is a “persistent danger of severely hurting self and others…” and thus her GAF falls in the rage of below 10. Major Defense Mechanism Denial: Annie continues to believe that Paul will eventually like being with her even though it is obvious that he despises her. Fantasy: Annie is consumed in the Misery novels and lives vicariously through Misery. Projection: Annie has killed many people in her life; however, when Misery dies in the novel she accuses Paul of being a murder. Rationalization: Annie rationalizes her actions and behaviors by saying that God told her to do what she is doing and that it is her duty. Reaction formation: Annie has become very religious, she says people should help other people and wants to “rid the world of filth” even though she has killed and hurt people all of her life. She has chosen the nursing profession where she has to nurse people despite the fact that she hurts and kills them. Emotional Insulation: Annie’s disconnect with people and living alone could be an example of trying to reduce ego involvement. Regression: Annie behaves very immaturely and childlike when she is excited or not in charge. Identification: Annie associates herself with the Misery novels and feels important by being Paul Sheldon’s “biggest fan”. Acting out: Annie said she was unhappy and lonely working long hours at the hospital, at the same time she began killing babies which could be an example of acting out. Splitting: Annie sees Paul as all good one minute and all bad in another minute. She feels overwhelmingly happy and feels that life is full of joy and romance when her needs are met but suicidal and depressed when she feels vulnerable. Fixation: Annie is obsessed with Paul and the Misery novels. Annie Wilkes has many features of borderline personality disorder as well; however, does not meet the DSM criteria or the key feature of this personality disorder, which is a pattern of unstable and intense interpersonal relationship and intolerance for being alone. Some of these borderline” features are: She has no impulse control. She becomes angry and irritable very easily and goes from sitting quietly to jumping from her seat and screaming at the top of her lungs. After reading a few pages of Paul’s unpublished book she is sitting by his side, feeding him soup and expressing her concern with the profanity and in mere few seconds she becomes so angry that she spills the soup on the bed. Her feelings for Paul Sheldon shifts from adulation to loathing. When she realizes that at the end of the eighth book Misery dies she barges into Paul’s room in the middle of the night hysterically and yells “YOU! YOU DIRTY BIRD, HOW COULD YOU! She cant be dead, MISERY CHASTAIN CANNOT BE DEAD! I DONT WANT HER SPIRIT! I WANT HER, AND YOU MURDERED HER! I thought you were good Paul but you’re not good! You’re just another lying dirty birdy!” Only a day before this event she had said that the Sistine Chapel and Misery’s child (Paul’s book) were the only two divine things on earth. Another major feature that is worth mentioning is that Annie feels no empathy and does not seem to regret her destructive behaviors. In this sense she displays features of Anti-social personality disorder. Possible Etiology Schizoaffective disorder is most probably caused by biological and genetic factors. The personality disorder can be rooted from traumatic childhood experiences, family instability, and maladaptive role models. In Annie’s case, very little is known about her upbringing and family dynamic therefore it cannot be determined what could have set the stage for her behaviors. Treatment Modalities Annie needs to be incarcerated immediately and under 24 hour supervision in order to prevent her from killing herself or someone else. Under a psychiatrist’s care she need to be put on antipsychotic medication and perhaps mood stabilizers. Her medications need to be closely monitored in order to stabilize her and prevent her from not taking them. The best therapeutic approach for Annie would be a cognitive-behavioral approach to help her manage her anger, and control her impulses. Since Annie is intellectually capable, a psychodynamic therapy can also be useful in understanding why she engages in hurting others and helping her face reality by giving up her maladaptive habitual defense mechanisms. Prognosis: Very Poor  Due to the severity of her symptoms the only hope would be to maintain her from being a danger to herself and others. Treatment should mostly be focused on stabilization her. Treatment of Schizoaffective Disorder, Bipolar type entails the use of psychotherapeutic interventions; however, extreme cases might require complementary psychopharmacological intervention. Cognitive Behavioral Therapy (CBT) proves to be the most efficient form of psychotherapeutic intervention for individuals diagnosed with the disorder. CBT encompasses restructuring of negative thought patterns, beliefs by replacing them with more positive and realistic thoughts and beliefs respectively. References APA. The Diagnostic Statistical Manual TR-IV. New York: American Psychological Association, 2000. Print. Read More