Jedi Counsel Episode 110 – Discussing Addiction with Dr. Ted Bender, CEO of Turning Point at Addiction Campuses

Note: This episode includes discussion of drug use, self-harm, and overdose deaths.

 

We invited Dr. Ted Bender, the CEO of Turning Point at Addiction Campuses, to talk to us about his expertise in the treatment of substance use disorders. The episode included an overview of the risk factors and consequences associated with addiction. We discussed the opioid epidemic and the types of actions necessary to fight it effectively. We also talked about topics that are regularly in the news, such as fentanyl (a pain medication with high risk for addiction), Narcan (a nasal spray that reverses opioid overdoses) and Suboxone (used for medication-assisted therapy in harm reduction treatment models). We discussed the challenges faced by people struggling with addiction and how treatment is individually-tailored for patients at Turning Point at Addiction Campuses. Dr. Bender concluded with a message of hope and encouragement to view addiction through a non-stigmatizing lens. If you like what you hear, please consider leaving a review on iTunes or telling a friend about us. Thank you so much for listening!

 

For more information about topics discussed in this episode:

 

You can follow Dr. Ted Bender on Twitter and learn more about Turning Point at Addiction Campuses here.

 

You can read the full obituary for Madelyn Linsenmeir here.

 

You can learn more about Dialectical Behavior Therapy here.

Jedi Counsel Podcast 109 – Asian Representation in Crazy Rich Asians & Hamilton with Dr. Gina Hiraoka

Dr. Gina Hiraoka is a clinical psychologist with expertise in mental health treatment for veterans.* In this episode, we discussed misconceptions about treatments for posttraumatic stress disorder (e.g., short-term vs. long-term decisions related to avoidance and exposure). Next, we talked about Crazy Rich Asians and Dr. Hiraoka’s experiences with (lack of) representation growing up. She told us about the term hapa (meaning part-Asian and/or Pacific Islander) and shared her thoughts on some of the controversy surrounding Henry Golding being cast in the film. We concluded with some discussion of Hamilton and Phillipa Soo being cast as Eliza Schuyler Hamilton. We learned a lot from Dr. Hiraoka and hope you enjoy this episode! Thanks so much for listening!

 

*All of Dr. Hiraoka’s opinions are her own and do not reflect those of her employer/the federal government.

 

You can follow Dr. Gina Hiraoka on Twitter: @QueenGina511

You can learn more about The Hapa Project by Kip Fulbeck here: https://kipfulbeck.com/the-hapa-project/

For more information about posttraumatic stress disorder and its treatment, check out this website: National Center for PTSD.

You can check out more Hamilton psychology stuff from us here:

Dueling Personalities: The Psychology of the Hamilton-Burr Conflict

10 Hamilton Quotes for Therapists

 

We are part of the Geek Therapy network. If you like our show, please consider rating and reviewing us on iTunes. Thank you!

Jedi Counsel Podcast 108 – Restorative Justice & the #MeToo Movement with Dr. Leonardo Bobadilla

Note: This episode includes discussion of sexual assault.

We invited Associate Professor and Clinical Psychologist, Leonardo Bobadilla, back to talk about his expertise in restorative justice for cases of sexual violence. The episode included an overview of a blog post he wrote titled Restorative Justice and the #MeToo movement: The Kavanaugh hearings as a case study. We first discussed research related to the decision to report sexual assault. Next, we talked about a range of risk factors associated with committing sexual assault and how this knowledge can be used to prevent it. Dr. Bobadilla then described historical and current applications of restorative justice. We discussed the challenges faced by scientists and others who work in this field. Dr. Bobadilla concluded with thoughts about the dangers of viewing people as all good or all evil and the benefits of nuanced, individualized systemic responses to sexual violence. If you like what you hear, please consider leaving a review on iTunes or telling a friend about us. Thank you so much for listening!

Show Links:

More from Dr. Leonardo Bobadilla

Aggression Blog: Using Science to Reduce Violence

Jedi Counsel Podcast Episode on the Assessment & Treatment of Paraphilic Disorders

Resources for Sexual Assault Survivors

RAINN (Rape, Abuse, & Incest National Network)

Association for Behavioral and Cognitive Therapy

National Center for PTSD

Information on the Treatment and Prevention of Sexual Abuse

Association for the Treatment of Sexual Abusers

American Association of Sexuality Educators, Counselors, and Therapists

Information on Restorative Justice

Centre for Justice & Reconciliation

Information about the U.S. Criminal Justice System

Serial: Season 3

The Marshall Project

More Information about the Psychopathy Checklist-Revised

Can a Test Really Tell Us Who’s a Psychopath?

Creator of Psychopathy Test Worries About Its Use

 

Jedi Counsel Podcast 107 – The Science of Memory and the Kavanaugh Allegations with Dr. Jonathan Corbin

We invited Dr. Jonathan Corbin to talk to us about his expertise in memory research. We first asked Dr. Corbin’s thoughts on media claims about Dr. Ford’s allegations. He described current scientific knowledge about how memory works, including explanations of flashbulb memories, eyewitness testimony, false memories, repressed memories, and best practices for asking people about events that occurred long ago. Dr. Corbin also explained how the context for memory influences the way it is assessed (e.g., clinical vs. legal vs. everyday settings). We discussed depictions of memory in fiction (e.g., Memento) and then concluded with Dr. Corbin’s thoughts about the questioning of Dr. Ford by the Senate panel. You can learn more about Dr. Corbin’s work on his website: http://www.jonathancorbin.net/ and by following him on Twitter: @JonathanCorbin2.

 

For more information, here are links to topics mentioned in the episode:

How to Get the Kavanaugh Hearings Right by Dr. Anita Hill

Kavanaugh Bears the Burden of Proof by Benjamin Wittes

Memory researchers who were mentioned: Drs. Loftus, Simons, Brainerd

Resources for Sexual Assault Survivors

Jedi Counsel Podcast 106 – Giving Away Psychology with The Arkham Asylum Doc, Dr. Andrea Letamendi

We spoke to Dr. Andrea Letamendi, who is a clinical psychologist and the Associate Director of Mental Health for Residential Life at UCLA. In addition to her work helping college students with their mental health needs, she also admirably shares scientifically accurate mental health information with the public. She does this through co-hosting an amazing Batman podcast (The Arkham Sessions) and an awesome Star Wars podcast (Lattes with Leia), through her writing on Under the Mask and an inspiring TEDx talk, and through other public speaking appearances. We spoke to Dr. Letamendi about how she got interested in clinical psychology, what it’s been like sharing her personal experiences with imposter syndrome with the public, and how she embraces her identity as a geek in her work. Dr. Letamendi also told us about her experience consulting with Gail Simone on the New 52 Batgirl series and having a therapist comic book character named after her. We concluded with discussion of Dr. Letamendi’s future projects. We hope you enjoy listening to this episode – we had a lot of fun recording it!

 Check out more of Dr. Andrea Letamendi’s work at her website: http://www.underthemaskonline.com/ and on Twitter: @ArkhamAsylumDoc .

** due to some Skype connectivity issues, some of the sound quality varies a bit in the second half of the episode. Although the quality wavers, the content does not!

Jedi Counsel Podcast 105 – Suicide Prevention Awareness Month 2018

Hi folks! For suicide prevention month, we decided to take the week and chat just a bit about suicide. We started off by talking a bit about how we got involved in suicide prevention research and then talked about some of the causes of suicide and Dr. Thomas Joiner’s interpersonal theory of suicide. We finished up by responding to a question about how you can help a friend who you think might be suicidal that was submitted by friend of the pod Murray.

In this episode we discussed several important people working to help understand and prevent suicide including (in no particular order) Dr. Thomas Joiner, Dr. Michael Anestis. Dr. Joy Cox-Anestis, Dr. David Klonsky, Dr. Mathew Nock, Dr. Mitch Prinstein, Dese’Rae L. Stage, and Rudy Caseres. Please check out the work that these many wonderful people are doing for very worthwhile content.

For more information on suicide, please visit the American Psychological Association’s reference sheet here: http://www.apa.org/topics/suicide/index.aspx or the National Institute of Mental Health’s reference sheet here: https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml. If you or someone you know is at risk for suicide, please call 1–800–273–TALK (8255), 24 hours a day, 7 days a week.

Links to topics mentioned in the show:

Klonsky & May (2015)’s The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the “Ideation-to-Action” Framework

Joiner’s Why People Die By Suicide

Joiner, Van Orden, Witte, & Rudd’s The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients

Rudy Caseres’ No Restraints

Dese’Rae Stage’s Live Through This Project

Suicide Prevention Social Media

Van Orden et al. (2010)’s The Interpersonal Theory of Suicide

Jonathan Singer’s Social Work Podcast

Nock & Prinstein’s A Functional Approach to the Assessment of Self-Mutilative Behavior

Suicide Prevention Information & Resources

Mike Anestis’ work on Guns & Suicide

Jedi Counsel Podcast 104 – Mental Health Themes in Queer Eye

Hello, Jedi Counsel listeners! In this episode, we talked about some of our favorite moments from the Netflix series Queer Eye and how they map on to concepts in the field of psychology. We talked about advice given in the show that is consistent with principles of behavioral activation for depression, exposure for social anxiety, oppose-to-emotion action from dialectical behavior therapy, and acting “as if” and reframing unhelpful thoughts in cognitive-behavioral therapy. Overall, the show is sweet, heartwarming, and funny. We hope you enjoy our discussion of it – let us know what the show has meant to you!

PS – If you hear trickling water in the background, it is Brandon’s in-home hydroponic garden!

Jedi Counsel Podcast 103 – Geek Culture in Therapy with Dr. Patrick O’Connor

We spoke to Dr. Patrick O’Connor, who was a pioneer in the use of geek culture (e.g., comic books, science fiction movies, video games) in therapy! He is a professor who uses innovative teaching methods like gamification of learning to engage students in his psychology classes. Dr. O’Connor has published and presented on his use of superheroes in therapy and created a database of comic book stories categorized by therapeutic themes. It was fascinating to hear all about Dr. O’Connor’s work and his connections to Geek Therapy!

 

Check out more of Dr. O’Connor’s work at his website: http://www.comicspedia.net/ and on Twitter: @Comicspedia.

 

Thank you for listening! You can find us on TwitterFacebook, & Patreon!

Rickistential Podcast 7 – A Rickle in Time, Mortynight Run, & Auto Erotic Assimilation (S2, Eps 1-3)

In this episode, we continued to explore the pain that Rick is masking and discussed suicide themes in the show. We referenced a Jedi Counsel podcast episode with special guest Rudy Caseres about using restraints in mental health settings – you can listen to that here. We previously talked about Rick’s suicidal behavior with our friends at Suicide Prevention Social Media (#SPSM), and you can watch that here. Please check out our suicide prevention information and resources here.

Jedi Counsel Podcast Episode 102 – Sharing Psychology with the Public with Dr. Ali Mattu

We spoke to Dr. Ali Mattu, who is a licensed clinical psychologist in New York City. In addition to treating individuals with anxiety and related disorders, he also does an admirable job of sharing accurate mental health information with the public. He does this through his YouTube channel on The Psych Show, through his blog on the psychology of science fiction (Brain Knows Better), and through co-hosting a weekly podcast (GT Radio). We spoke to Ali about how he got interested in clinical psychology, what it’s been like sharing his personal mental health stories with the public, and how he embraces his identity as a geek in his work. Ali also talked to us about what The Simpsons character, Apu, meant to him growing up and about media representation. We concluded with discussion of Ali’s future projects. We hope you enjoy listening to this episode – we had a lot of fun recording it!

 

Check out more of Dr. Ali Mattu’s work at his website: http://alimattu.com/ and on Twitter@AliMattu.

 

Thank you for listening! You can find us on TwitterFacebook, & Patreon!

The Rickistential Podcast 6 – Close Rick-counters of the Rick Kind & Ricksy Business (S1, E10 & E11)

In this episode, we talked about whether we think Rick is truly in emotional pain, what we think is Morty’s motivation for covering for Rick’s house party, and whether people with antisocial and narcissistic personality disorder traits truly experience emotional pain.

 

You can find us on TwitterFacebookour website, or Patreon. Thanks so much for listening!

The Rickistential Podcast 5 – Rixty Minutes & Something Ricked This Way Comes (S1, E8 & E9)

In this episode, we talked about the themes of regret, reality TV and social media (including the #PlaneBae story), meaning-making, and the nature of changes made in science from Pluto to the diagnostic system of mental disorders (Bring Back Pluto).

 

You can find us on TwitterFacebookour website, or Patreon. Thanks so much for listening!

Jedi Counsel Podcast 101 – Science and Fiction with Dr. Aaron Hanlon

Dr. Aaron Hanlon is an Assistant Professor of English at Colby College and a visiting scholar in the Department of History and Philosophy of Science at the University of Cambridge. He is a literary historian with expertise in the Enlightenment, 18th century literature, epistemology and the organization of knowledge, and fictionality. He also writes articles on a variety of topics for national media outlets. We talked to Aaron about philosophy of science (including Popper’s The Logic of Scientific Discovery), misconceptions about English professors and humanities disciplines, and his research on the ways that fiction and science influence each other.

You can learn more about Aaron and his work by going to his website: http://www.aaronrhanlon.com/ or by following him on Twitter: @AaronRHanlon.

Thank you for listening! You can find us on Twitter, Facebook, & Patreon!

Jedi Counsel Podcast 100 – Frasier Crane Day

It’s our 100th episode of the Jedi Counsel Podcast! We are grateful for all of our listeners, readers, and other people who we have connected with through Jedi Counsel! Frasier Crane celebrated 1000 radio episodes with Frasier Crane Day, so we decided to celebrate 100 podcast episodes with Frasier Crane Day as well. We talked about the difference between psychology and psychiatry, the ethical issues faced in Frasier, our favorite episodes/moments, and the mental health of the main characters. Thank you so much for listening!

In this episode, we talked about Daphne & Marris showing symptoms of eating disorders. For more information about eating disorders and their treatment, please see the Academy for Eating Disorders website. We also discussed potential obsessive-compulsive disorder (OCD) symptoms in Niles. Please see the International OCD Foundation for more information about OCD. Finally, Frasier showed signs of depression, which you can learn more about here.

You can find us on Twitter, Facebook, & Patreon!

Jedi Counsel Podcast 99 – Podcasting, Mental Health, & Humor with Aryeh Cohen-Wade

We spoke to Aryeh Cohen-Wade, who is the executive editor of bloggingheads.tv and meaningoflife.tv, the host of the podcast Culturally Determined, an excellent writer, and a funny tweeter. First, he provided us with some background on bloggingheads.tv and walked us through his podcasting process. Culturally Determined includes discussions of a broad range of controversial and interesting topics (e.g., cultural appropriation, the Rick & Morty fandombody positivity) with diverse guests (e.g., David LittOsita NwanevuNatalie Wynn of ContraPoints). Next, we discussed a particularly powerful Culturally Determined episode on long-term antidepressant use with Danielle Tcholokian. Aryeh told us what it was like to share some of his own experiences with depression on that episode. We concluded with a discussion about mental health and humor, and Aryeh recommended listening to The Hilarious World of Depression.

Check out more of Aryeh’s work and writing at his website: https://aryehcw.wordpress.com/ and on Twitter: @AryehCW.

Thank you for listening! You can find us on TwitterFacebook, & Patreon!

Reunite Families Separated at the Border

We are completely opposed to children being separated from their parents after crossing the border into the United States. The purpose of this post is to 1) link to research and information on the long-lasting, damaging effects of parent-child separation and 2) suggest actions that you can take to fight this abhorrent policy and insist that families are reunited.

Statements from Experts About the Harm of Separating Children from their Parents:

Circle of Willis Podcast: Children at the Border We strongly recommend listening to this episode. The host spoke to 5 developmental scientists about the likely impact of this policy.

Washington Post Article by Clinical Psychologist and Neuroscientist, Jim Coan

Letter to President Trump from the American Psychological Association

Statement from the American Academy of Pediatrics

Statement from the Association for Research in Personality

Statement from the American Association for Marriage and Family Therapy

Statement of APA President Regarding the Executive Order Rescinding Immigrant Family Separation Policy

American Association of Suicidology’s Statement on the Detrimental Effects of the Administration’s Family Separation Policy

Statement from the Association for Behavioral and Cognitive Therapies on Taking Children Away from their Parents

Ways to Take Action:

Call your representatives in Congress and tell them that you want them to pass legislation that stops this policy immediately.

Donate to RAICES (the Refugee and Immigrant Center for Education and Legal Services) to reunite families.

Vote in the midterm elections for candidates that oppose these types of policies.

Attend a Families Belong Together protest.

Get informed and spread the word to others.

Donate to candidates who are against family separation & in close November races:

– Small
– Eastman
– Slotkin
– Fletcher
– Heitkamp
– O’Rourke

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Suicide Prevention Information & Resources

This week involved a lot of heartbreaking suicide-related news. We tragically lost Kate Spade and Anthony Bourdain to suicide. We also learned that U.S. suicide rates increased substantially over the past several years. If you want to learn and do more to prevent suicide, we want to help you out by linking to some good sources. We hope you find them useful.

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If you need help:

National Suicide Prevention Lifeline

Trans Lifeline

The Trevor Project (for LGTBQ+ youth)

Veterans Crisis Line

Find a Therapist

Find a Support Group for People Who Have Lost Someone to Suicide

Listen to a Hopeful Music Playlist Made by College Students

Research-Supported Treatments for Adults

Research-Supported Treatments for Children

Feeling Good: The New Mood Therapy by David Burns

How to help others:

Warning Signs

How to Help Someone Who is Suicidal

Take a Mental Health First Aid Training Course

Get involved:

Call Your Representatives and Tell Them to Prioritize Policies linked to Suicide Prevention (e.g., access to quality healthcare, funding for research)

Participate in an Out of Darkness Community Walk

For information:

Suicide Statistics

Suicide Prevention Social Media Chat

Live Through This Photo Project

Wil Wheaton Essay about Mental Health

Rudy Caseres, Mental Health Advocate

Robert Vore, Mental Health Advocate

It Gets Better Project

Why People Die by Suicide by Thomas Joiner

Myths about Suicide by Thomas Joiner

Guns and Suicide by Michael Anestis

Cracked Not Broken by Kevin Hines

Speaking of Suicide by Stacey Freedenthal

Things We Liked in 2017

Here’s an (incomplete) list of things we liked in 2017! Some of the things listed came out before this year but are included because of how much we enjoyed them in 2017.

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Interacting with You!

We are so grateful for our listeners and the people that we connected with via social media. We loved talking about mental health and our shared nerdy interests with you!  Thank you for a wonderful year! We’ll work hard to create lots of high quality content for you in 2018! Special thanks go out to our Patreon patrons, to anyone who rated and reviewed us on iTunes, and to anyone who shared our stuff with a friend!

Podcasts

We are part of the Geek Therapy Podcast Network, which celebrates mental health and geek culture! You can check out the other podcasts on our network here.

My Brother My Brother and Me (which we got to see recorded live!) and SModcast made us laugh a lot.

Naming It made us think about the intersection of social justice and psychology.

Trends Like These helped us examine current events and news in greater depth.

Stay Tuned with Preet gave us insightful, diverse interviews with people interested in justice.

The Black Goat Pod helped us to think critically about the science of psychology.

The Adventure Zone brought us into an amazing Dungeons and Dragons campaign.

S-Town told a compelling story of a man who struggled with mental health issues.

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Movies

This was a great year for movies! Some of our favorites include: Wonder Woman, Star Wars: The Last Jedi, Logan, Justice League, Thor: RagnarokGet Out, Spiderman: Homecoming, & The Big Sick.

Comics

2017 also brought us many fantastic comics! Some of the ones we particularly enjoyed were: DC Rebirth Wonder Woman, Batman/The Flash: The Button, Justice League vs. Suicide Squad, a Yoga Hosers One Shot, DC Rebirth Batman, DC Rebirth Green Arrow, & DC Rebirth Batgirl and the Birds of Prey.

Games

Some of our favorite games this year were Stardew Valley and Dungeons & Dragons.

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Music

Katie loved new music from Dessa, and Brandon got really into Hamilton! We both enjoyed this song from My Crazy Ex-Girlfriend:

TV Shows

We loved some newer shows like Stranger Things, Wynonna Earp, and Rick & Morty, while rewatching older classics like Frasier and The Office.

Comedy

Katie really liked this stand-up comedy special: Hasan Minhaj: Homecoming King.

Mental Health Folks on Social Media

The Suicide Prevention Social Media (SPSM) Chat crew is awesome, and you should check out the great stuff they do!

We wish you all a very happy & healthy 2018!

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Analyzing Anya’s Bunny Phobia

PSYCHOLOGICAL REPORT

Name: Aud AKA Anyanka AKA Patron Saint of The Women Scorned AKA Anya Emerson AKA Anya Christina Emanuella Jenkins
Year of Birth: 806
Year of Interview: 2002
Therapists: Katie Gordon, Brandon Saxton

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Presenting Problem
Anya’s employer, Rupert Giles, referred her for a psychological evaluation because her fear of bunnies was affecting her ability to work effectively as a cashier at The Magic Box. While the store primarily provided witchcraft-related supplies such as crystals and ingredients needed for spells (e.g., raven’s feathers, rat’s eyes), some customers would enter looking for magic trick supplies. Occasionally, aspiring magicians would request rabbits for pulling-out-of-hat purposes, and Anya would scream at the customer, “Get the HELL out of the store and never come back!” Those customers would then spread the word about what had happened, and there would be a notable decrease in sales. Giles had tolerated Anya’s, shall we say, “brusque” interpersonal style, but this particular problem led him to fire Anya. She said she loved money and business (as evidenced by her attempt to sell her children for money while playing the board game, Life, and her performance of The Dance of Capitalist Superiority as she closed the cash register) and begged Giles to let her stay at the store. He allowed her to continue with the contingency that she must seek treatment to reduce her rabbit fears.

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History
Anya was born as Aud in Sweden in the 9th century and actually bred and raised rabbits during that time period. After a boyfriend cheated on her, she used magic to punish him (e.g., turning him into a troll). Anya’s spiteful acts drew attention from a demon who specialized in vengeance. He granted her immortality and gave her a powerful amulet that allowed her to fulfill wishes of scorned women. For centuries, as Anyanka, she executed these wishes all over the world.

In 1998, a Sunnydale High School student named Cordelia was brokenhearted that her boyfriend, Xander, had cheated on her with his best friend, Willow. Disguised as a student named Anya Emerson, Anyanka befriended Cordelia and persuaded her to wish for revenge on Xander. Cordelia linked her romance problems to Buffy’s arrival and wished that Buffy had never moved to Sunnydale. Once Giles discovered this, he destroyed Anyanka’s amulet, which took away her powers and immortality.

After some significant time had passed, she started dating Xander and ultimately proved herself helpful to his friends (who called themselves The Scooby Gang) as they fought the vampires, demons, and other Big Bads in Sunnydale. Anya had proven that she was reformed into a trustworthy person….so much so, that Giles hired her at The Magic Box.

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Diagnostic & Assessment Information
All assessment information was obtained through watching Buffy the Vampire Slayer and by consulting this amazingly detailed Buffyverse wiki. Due to the nature of Giles’ expressed concerns, Anya was evaluated for Specific Phobia, Animal Type. According to the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, an individual has a specific phobia when they exhibit a “marked fear or anxiety about a specific object or situation” that lasts a minimum of six months and “the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

We asked Anya to give us some examples that would help us better understand her relationship with bunnies, and she named the following events:

  1. On Halloween, Xander asked her to dress as something scary and she showed up in an adorable & funny bunny costume. While this shows a certain ability to not avoid all bunny-related stimuli, it also indicates the presence of a marked fear.

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2. She was doing a spell that accidentally made a bunny appear, and she had an exaggerated response, jumping back in fear.

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3. She sees a cute, little stuffed rabbit and, startled, she says, “Who would put this here? Is this some kind of sick joke?”

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4. When Sunnydale was overtaken by a musical spell, the Scoobies went around guessing who was responsible for it, and Anya proclaimed that bunnies were responsible through the following lyrics, “Bunnies aren’t just cute like everyone supposes. They got them hoppy legs and twitchy little noses, and what’s with all the carrots!? What do they need such good eyesight for anyway!? Bunnies, bunnies, it must be bunnies!!”

5. Xander suggested that it might be nice if they were up against a cult who was bunny-worshipping some time instead of the usual evil-worshippers. Anya replied, “Thank you very much for those nightmares.”

Treatment Recommendations
In summary, Anya appeared to meet diagnostic criteria for Specific Phobia, Animal Type, and it caused significant impairment in her place of employment. Currently, there is strong scientific research supporting exposure therapy as the frontline treatment for phobias. There are a variety of approaches to exposure therapy, with the commonality that each involves the individual habituating to the feared stimuli through facing, rather than avoiding, it. Please click here for more details on exposure and/or watch this excellent, informative video by Dr. Ali Mattu:

THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

Mostly, Anya’s phobia is used as a type of comic relief in the series. While phobias and their associated distress and impairment are not funny, the humor often comes through highlighting the irrational part of phobia-related fears. At times, Anya displays typically phobic behaviors (e.g., nightmares, exaggerated fear responses, avoidance). However, her anger toward the phobic object is not quite as typical. Overall, Anya is an awesome character, and her portrayal shows that someone who has bravely faced many awful things is not immune to a specific phobia of a benign stimuli.

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2. Was the character struggling with mental health issues depicted with compassion?

Compassion for Anya is generally demonstrated throughout the show (e.g., people tend to forgive her abrasive interpersonal ways and accept her feelings about bunnies), but as mentioned above, her fear of bunnies is mostly treated as another quirky, funny aspect of Anya. She was literally a demon for over 1000 years, and yet, bunnies frighten her. In real life, phobias can cause substantial distress and problems for people who are afflicted by them. Fortunately, as mentioned above, they tend to be highly responsive to exposure therapy.

Overall rating
On a scale of Energizer to Bugs, we rate this depiction as Thumper!

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The Psychology of Wonder Woman & Hippolyta

SPOILER WARNING: This post is mostly based on the movie, Wonder Woman, and it contains lots of spoilers.

Part I

Name: Diana
Age: 6ish
Occupation: Princess of Themiscyra (Paradise Island)
Therapists: Katie Gordon, Ph.D., Brandon Saxton, M.S.

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Presenting Concern:
Hippolyta, Queen of the Amazons, sought therapy for her daughter, Princess Diana. She was concerned that Diana was disobeying her wishes. As an immortal goddess, she was unaccustomed to having her authority defied. Yet, she often caught Diana watching the Amazons’ warrior training and asking her aunt, Antiope, to begin secretly training her in the arts of war. Hippolyta’s goal in seeking therapy was to learn effective parenting strategies to protect her daughter from the harm she feared would befall her if she began training as a fighter. She also wanted Diana evaluated for oppositional defiant disorder.

History:
Diana reported that her mother wanted a child more than anything, so she made her out of clay.  Zeus then brought her to life. Hippolyta motioned to us that she wanted to speak to us without Diana. We brought Diana out to the waiting room and returned to speaking with Hippolyta, who explained that Diana was actually Zeus’ child and given to the Amazons to protect them from Ares, the god of war. Hippolyta explained that she did not tell Diana the real story because she feared it would put her in more danger.

Hippolyta’s love for Diana was so strong that she couldn’t fathom the possibility of Ares taking her away. She said she would never recover from that kind of pain. She believed that sheltering Diana would keep her safe.

Assessment & Diagnostic Impressions
After interviewing Hippolyta alone, it became clear that Diana did not have oppositional defiant disorder. Her behavior was not causing her any distress, impairment, and was typical for her age. To the contrary, she was already highly educated (though her behavior did appear to lead to some of her teachers resigning) and fluent in numerous languages, and full of energy, bravery, and kindness. It was our impression that Hippolyta was a loving, concerned mother acting out of protection for her child and her fear of losing her.

Treatment Recommendations:
Hippolyta’s worries were founded in the reality of her situation and Diana’s destiny. We did not find that she or Diana met diagnostic criteria for any clinically significant mental health problems. However, we offered Hippolyta support with her concerns. In addition, we recommended strategies for increasing openness and reducing secrecy between she and Diana (e.g., by displaying acceptance and listening, even if her impulse was to shut down any conversations about warrior training). We provided feedback that it was evident that their mother-daughter bond had a strong foundation. They enjoyed many activities together (Diana listed bedtime stories and exploring the island as personal favorites). We encouraged Hippolyta to continue building on that relationship and that therapy was available if she wanted extra support as she navigated the healthy balance of protecting her daughter while accepting her autonomy.

Part II

Name: Princess Diana of Themiscyra (via Hippolyta)
Age: 20s-ish
Occupation: It is her sacred duty to defend the world.
Therapists: The Jedi Counsel again

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Presenting Concern:
Hippolyta returned to us to ask for guidance with Diana. A pilot’s plane crash-landed into the ocean near Themiscyra, and Diana saved his life. The pilot, Steve Trevor, explained that he was a soldier in the fight to end “the war to end all wars.” Diana told her mom that she wished to leave the island with Steve and stop the war by killing Ares and his poisonous influence on man.

History:
Hippolyta explained that, since our last appointment, she had decided to allow Diana to begin openly training with Antiope in the arts of war (rather than continuing to push her to secrecy). Hippolyta continued to protect her child, but recognized the limits of her control. She decided to prioritize trust and a close relationship by supporting Diana’s independence at a developmentally-appropriate level. Hippolyta found that talking through concerns with her sister, Antiope, helped her to clarify the line between being overprotective and protective. As a result, her relationship with her daughter had grown stronger than ever….which is why Hippolyta felt so distressed at the thought of Diana leaving Paradise Island to fight with Steve (though Hippolyta did note that he seemed like an egalitarian, intelligent man pursuing a noble mission well-suited for Diana’s abilities).

Session Notes:
Hippolyta came to us with her own wisdom about how to best handle the difficult situation. She knew that she could not control Diana, who had already decided to join Steve and help all those suffering due to the war. She recognized that her choice was to try to stop Diana, which would ultimately be unsuccessful, or to support her and have an opportunity to say good-bye. We listened to Hippolyta as she processed her feelings and thoughts about the situation and came to her own conclusion about the right decision for her family and herself.

Follow-Up:
Hippolyta reported that she was able to say good-bye to Diana, “You have been my greatest love. Today, you are my greatest sorrow.” She knew she had taken the right course of action and was grateful for the time she had with her child. We told Hippolyta that she was welcome to come back and meet with us if she wanted any support from us as she dealt with her separation from Diana. We encouraged her to seek support from others, to take good care of herself, and to feel pride in the wonderful daughter she raised with love, empathy, a commitment to peace, education, understanding, and undeniably badass warrior skills.

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Part III

Name: Princess Diana AKA Diana Prince AKA Wonder Woman
Age: 20s-ish
Occupation: Superhero
Therapists: Same ones, in our Man’s World office location

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Presenting Concern:
Diana’s friend, Etta Candy, referred her to meet with us to discuss her transition from Princess of Paradise Island to Superhero in Man’s World and the recent loss of the person she was in love with, Steve Trevor. Etta felt that her friend might benefit from speaking to professionals while coping with these drastic changes and significant stressors.

Session Notes:
Diana presented as open and willing to meet with us. She became tearful as she described losing Steve, but said that their love remained powerful. She recognized that his death meant preventing others’ suffering and that it was his way of doing his part to defend the world. She would remember him fondly and draw inspiration from the honor he exhibited. It was that type of goodness that helped her to cope with the realization that humans could sometimes do terrible, evil acts, even when they were not directly under the influence of Ares.

She described missing her mother, loved ones, and the beauty of Themiscyra. However, Diana said that she had made the right decision to leave and fulfill her sacred duty. She would not have felt okay with herself if she didn’t try to stop the war. Having recently learned that she was a goddess, Diana also contemplated what it would mean to be immortal while those around her age and die. Fortunately, in the context of her strong relationship with her mother, they had many discussions about how Hippolyta had coped with the blessings and curses of immortality. Diana felt she could draw on her mother’s wisdom as she navigated the associated privileges and pains.

Diana expressed frustration and bewilderment at the societal status of women and people of color in Man’s World. From clothes that constrain optimal battle movement to expectations to be in subordinate positions to rules about women not speaking up or being in leadership positions, Diana said she intended to fight alongside all those with a mission of equality until it was achieved. She also expressed zero intent to conform to unjust societal norms that would have her reduce her strength, powers, or peace efforts. That alone would empower countless people to follow her lead and embrace their true selves. Amazons wore their bracelets as a reminder of their past subjugation, and as a symbol to resist any return to that state. Diana also wore them to connect her to her home and Themiscyran values (they handily deflect bullets and wield energy too).

In conclusion, Diana did not feel she needed ongoing therapy to cope with her various concerns at the time. However, after having a positive experience with therapy at an earlier age, she said that she would not hesitate to return for help as-needed and left us with the wisdom that “only love could truly save the world.”

Follow-Up:
100 years later, Wonder Woman was working at the Louvre, saving people from suffering, and teaming up with Batman and Superman to defeat evil. She remains a symbol of courage, knowledge, acceptance, justice, compassion, and overall awesomeness. We look forward to seeing more of her when she teams up with the Justice League in November!

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The Gordon/Saxton Test

Was the portrayal of mental health accurate?
Wonder Woman and Hippolyta were not portrayed as exhibiting mental health issues. Despite the fictional world the characters were set in, the authenticity of their relationship and related issues was moving and made it relatable to nonfictional people too.

Was the character struggling with mental health issues depicted with compassion?
Wonder Woman is the epitome of compassion. You see it throughout the movie as a primary motivation for her actions, and that is one of many things that makes Wonder Woman so incredibly special and inspirational. Hippolyta is also portrayed in a way that elicits compassion.

Overall Rating: On a scale of Ares, god of war to Athena, goddess of wisdom, we Aphrodite, goddess of LOVED this movie!

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So many thanks to the creator of Wonder Woman, psychologist William Moulton Marston!

Also thanks to the many amazing artists, comic writers, letterers, colorists, actresses, actors, and others who have contributed to Wonder Woman’s story. Some of our favorites include Gail Simone, Renae De Liz, Ray Dillon, Susan Eisenberg, Gal Gadot, Patty Jenkins, Chris Pine, Nikola Scott, Greg Rucka, Liam Sharp, and Laura Martin!

Check out our podcast episode on our initial reactions to the movie here!

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13 Thoughts on 13 Reasons Why

**WARNING: SPOILERS APPEAR IN THIS POST.**

I watched the new Netflix series 13 Reasons Why (based on a book with the same title). This post sums up my reactions, and I am also in the process of recording detailed Jedi Counsel podcast episodes on the series with my co-host. Some people say this is art and entertainment, and therefore, exempt from social responsibility. Nonetheless, many people will watch this series, and that makes it important to view it critically and to consider its implications. My thoughts aren’t fully formed yet, but I wanted to post something as the series came out without waiting until I had it all sorted out. My feelings and opinions may develop more as I process the material for a longer period of time. I’m open and curious about other perspectives.

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  1. The series is set up as a mystery that quickly pulled me into the story. I finished the whole series within a few days. The framework for the series is that an adolescent, Hannah Baker, has died by suicide and left behind audio tapes detailing every component that she believes led up to her death. In addition, she has a methodical plan for the specific people who should listen to the tapes, how they should be listened to, and the order in which people hear them. While this is a compelling way to reveal a mystery, I believe that it contributes to stigma by painting the picture of a woman who ended her life for the purposes of getting attention from the individuals she believed ruined her life. The tone of her delivery is blaming and feels vengeful. I worry this perpetuates the myth that suicide is typically driven by desire for attention, selfishness, or revenge…which it most certainly is not.
  2. There is a scene that is explicitly blaming of one of the few kind (though not perfect) people in the series (Hannah’s friend and love interest, Clay). Hannah’s friend, Tony, tells Clay that Hannah would have been alive if he had acted differently. He later softens his tone, saying it is not Clay’s fault and Hannah is responsible for the choice that she made. Still, the blame message is there in a scene where Hannah tells Clay repeatedly to leave her alone. He reluctantly leaves the room. The show then depicts a parallel universe where the “right” things happened: Clay insists on staying despite Hannah clearly asking him to leave her alone, he turns the conversation around through persistence, Hannah feels loved, and suicide is prevented. In light of the violations of consent elsewhere in the series (including two rape scenes), I was bothered by Clay being painted as having done the wrong thing when he honored Hannah’s wishes to leave her alone.
  3.  Hannah decides, as her last attempt at help-seeking, to reach out to her school counselor about her suicidal thoughts and being the victim of rape. The counselor, insensitively and against best practice guidelines, implies she may be partially to blame (e.g., asking if she verbally said no to the perpetrator, asking if she had been drinking) and jumps right into telling her that her only choices are to: 1) report the assault or 2) to move on. She leaves the office, and he doesn’t follow-up with her in any way. He doesn’t ask for more details or conduct a suicide risk assessment, and he does not try to reach out to her parents to prevent her from harming herself. Of course, there are some counselors out there who might act in this irresponsible way. However, the vast majority would not. In a show that is viewed by a lot of young people, the depiction of the counselor matters a lot. People are already reluctant to reach out to mental health professionals. I worry people would feel even more discouraged from seeking help after seeing this terrible, judgmental, unethical interaction.
  4. The series accurately portrays some of the risk factors for suicide: social isolation, loneliness, and disconnection from others (including in the painful forms of bullying), perceiving herself as a burden (e.g., she describes herself as a “problem” for her parents and especially feels burdensome after accidentally losing some of their money), family conflict (her parents argue about issues including finances), witnessing and then being a victim of sexual assault, and hopelessness about her future (e.g., with regard to college and other plans).
  5. I appreciated the series emphasizing how crucial social connections are for health and talking about different types of loneliness – including individuals truly isolated and those who feel “lonely in a crowd.” It seemed to make the point that even apparently popular people (like Zack) can feel lonely. I believe this sends the message that anyone is vulnerable to loneliness, and we shouldn’t assume people are doing well just because they appear that way on the outside.
  6. One of the themes of the series is that – at any point – one person listening, reaching out, or doing something differently could have prevented Hannah’s suicide. Ultimately, this is a positive message. Unfortunately, I think it’s lost and distorted because it is used to blame people for their failures to save Hannah rather than demonstrating that one person could have made a difference and changed the story to a hopeful one. If the counselor or one of her parents had connected with Hannah and supported her in seeking help for her struggles, this point would have been much more persuasive. Instead, the story feels more demoralizing than inspiring to me.
  7. Hannah’s death scene is a graphic depiction of her cutting her wrists with razorblades in a bathtub. In a documentary-type episode made about the series, they said that it was to show the painful and hard-to-look-at nature of suicide. To me, it feels like a choice to make a dramatic, visually startling conclusion to the story rather than to deliver a lesson. It makes sense – this is a series meant to be watched and to get people glued to their screens- not a PSA. It’s possible that an individual who feels suicidal might see that and be afraid; however, it’s also quite plausible that an individual feeling suicidal might mistakenly view it as an end to all of Hannah’s emotional pain and problems. Anecdotally, there are cases of suicidal individuals watching scenes of suicide building up to taking their own life.
  8. There are warnings in the beginnings of episodes where there are graphic scenes (e.g., sexual assault, suicidal behavior). It would have been helpful if the episodes had information about resources, such as the National Suicide Prevention Lifeline and the American Foundation for Suicide Prevention, embedded in them too. It would be a simple way to reach a lot of people. Again, the series created a separate short documentary-like episode with mental health professionals and resources in it. However, it appears completely separately from the series (rather than as the 14th episode, for example). It would reach more people if it was connected to the full series.
  9. The pain Hannah’s parents experience after her death is excruciating. I feel this is one of the most realistic aspects of the series. It shows their horror, their confusion, their regret, and their desire to prevent other suicides from occurring. In the documentary afterwards, they suggest that this might show individuals who feel suicidal about the pain that others would experience if they died. I think this may be the case for some, but for certain individuals, tragically, they might imagine that people wouldn’t feel the same way about their death. That’s the cruelty of perceiving oneself as a burden – people struggling with mental health problems may not see how the world is better with them in it.
  10. Related to the second point, several characters clearly violate Hannah. Marcus and Bruce grab her, Tyler and Justin take and share revealing pictures without permission, and Bryce rapes her. When Hannah and Clay are starting to kiss, Clay asks, “Is this okay?” I really liked this scene because it shows how asking about consent is natural and enhances, rather than ruins, the moment. It also shows a welcome contrast in that Clay genuinely respects and cares about her feelings and perspective. Sadly, this positive point gets diminished when the scene turns into Hannah yelling for him to “get the hell out” and the suggestion that if he had only ignored her wishes, he would have saved her life (as described above).
  11. From one perspective, it seems like a point of the series is to teach bullies that their actions can lead to someone dying by suicide. However, most people who are bullied do not die by suicide – people are often remarkably resilent in the face of great adversity. It’s important that people who are on the receiving end of bullying know that. Secondly, most of the people on Hannah’s tapes are more concerned about protecting their own secrets (e.g., that Courtney is attracted to women, that Justin allowed Bryce to rape Jessica, that Ryan published Hannah’s poem without her permission) than how they hurt Hannah. If the message is supposed to be an anti-bullying one, I don’t think it really connects with bullying people in the audience. I guess that it would resonate more with people on the receiving end of bullying who feel a sense of hopelessness about the bullies having any potential for empathy and a sense that there is no help available to them.
  12. On two occasions, two adults (the counselor and the communications teacher) state that the warning signs for suicide include withdrawing from friends and family, changes in appearance, and trouble in group projects. This was a great opportunity to share the real warning signs for suicide, but unfortunately, only the first one really maps onto the list.
  13. A lighthearted, sweet aspect of the series is that Clay is different from his peers in that he cares relatively less about what other people think of him. He still cares what people, including Hannah, think of him to some extent, but he doesn’t try as hard as his peers to be something he’s not. He feels nervous around Hannah, but doesn’t ever really pretend to be someone else. He doesn’t let other people’s opinions make him feel bad about himself. Again, Clay’s not perfect (he says some mean things to Hannah and looks at a revealing picture that Tyler took without consent). But, overall, he’s smart, sensitive, caring, a good student, interested in the world beyond the walls of his school, helps others, takes reasonable caution in his decision-making, and likes geek stuff like Lord of the Rings and Star Wars. During one exchange, Hannah says to Clay, “Wow. You’re an actual nerd. There’s courage in that.” Most of the other characters in the series view themselves and their worth in terms of what their peers think of them. This generally rings true with regard to this developmental period in adolescence. It’s refreshing to see someone who has some self-acceptance and a sense of what’s right in the midst of all of the tragedy.

You can check out our first podcast episode on this series here and our second episode here.

If you or someone you know needs help, please reach out. There is hope and help is available here.

Dueling Personalities: The Psychology of the Hamilton-Burr Conflict

Note: Most of the words in this post are direct or slightly modified excerpts from the brilliant lyrics written by Lin-Manuel Miranda for the musical, Hamilton. This analysis is based on the portrayals of Burr and Hamilton in the musical.

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PSYCHOLOGICAL REPORT

Names: Aaron Burr, Alexander Hamilton
Ages: 48 (Burr), 47 (Hamilton)
Education: Bachelor’s degree from College of New Jersey/Princeton; theological, military, and legal training (Burr), Bachelor’s degree from King’s College/Columbia; military & legal training (Hamilton)
Date of Session: July 10, 1804
Therapists: Katie Gordon, Ph.D., Brandon Saxton, M.S.

Presenting Problem
Alexander Hamilton’s wife, Eliza, grew concerned when he said that he “had an early meeting out of town.” Hamilton’s disagreement with his long-time frenemy, Aaron Burr, had recently escalated, and she was suspicious that this meeting might actually be a duel. She insisted that Hamilton and Burr attend a therapy session to resolve their conflict peacefully. Eliza told him that she felt helpless after losing their son in a duel and that he owed it to her after burning her with the whole Reynolds Pamphlet ordeal. Hamilton couldn’t say no to this.

We started the session by walking up to the two men in the waiting room and asking one of them, “Pardon me, are you Aaron Burr, sir?” To which he responded, “Alexander Hamilton. My name is Alexander Hamilton.” After getting clarity on who was who, we introduced ourselves and invited them back to our office to further assess the problem. During the interview, we did not find Burr to be forthcoming on any particular stance. He’d glance off, obfuscate, and dance. Meanwhile, Hamilton did not equivocate on his opinion; he wore it on his sleeve.

Apparently, the heart of the conflict was that Burr wanted desperately to be in “the room where it happens” and blamed Hamilton for his losses in the Presidential election of 1800 and the New York Governor election in 1804. Specifically, Burr believed that Hamilton’s public attacks on his character swayed these elections. Hamilton’s criticisms of Burr included saying that he had no principles and acted in an opportunistic, self-interested fashion. He called him “amoral” and a “dangerous disgrace.”

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History
Burr’s grandfather was a fire and brimstone preacher; his mother was a genius; his father commanded respect. Tragically, both of his parents died when he was a young boy. When asked how he managed without them, he replied, “I’m a trust fund baby, you can trust me.” He was raised by relatives and reaped the benefits of their wealth, including access to an excellent education and connections with powerful people. After graduating in two years from college, he fought in the Revolutionary War. He was romantically involved with a married woman named Theodosia, whose husband was fighting on the British side in Georgia. Ultimately, he and Theodosia married (after her husband died) and had a daughter, who he referred to as “Dear Theodosia.” Burr practiced law and was active in politics as a Senator and Attorney General. The highest office he held was the Vice President of the United States from 1801-1805. The fact that Burr was born into financial and societal privilege may have influenced his life philosophy to wait patiently for opportunities to arise before acting on them. By working hard and avoiding huge public errors, he believed he could maintain the status and wealth he was born into and use them as a foundation to achieve even greater political power.

Hamilton presented as a bastard, orphan, son of a whore and Scotsman, dropped in the middle of a forgotten spot in the Caribbean by providence impoverished and squalor who grew up to be a hero and a scholar. When he was 10, his father split, full of it, debt-ridden; two years later, he and his mother were bed-ridden, half-dead sittin’ in their own sick, the scent thick. Hamilton got better but his mother went quick. He moved in with a cousin, who died by suicide. Left to fend for himself, he got a job for his late mother’s landlord trading sugar cane and rum and all the things he couldn’t afford. By 14, he was in charge of a Trading Charter. Then, a hurricane came, and devastation reigned. He wrote a letter describing the hurricane’s impact, and it was so beautifully stated, that the people in his town took up a collection to send him to the mainland to get an education and nurture his talents. Like Burr, Hamilton graduated from college, fought in the Revolutionary War (Hamilton served as Washington’s right-hand man), practiced law, and was active in politics as the first Secretary of Treasury for the United States. He married Eliza Schuyler, after meeting her at a winter’s ball, and they had eight children together. Their oldest son, Philip, died at a young age in a duel. The fact that Hamilton was born into a stigmatized position at the time (i.e., being born out of wedlock) and into poverty may have influenced his life philosophy to persistently pursue his dreams without inhibition. By fervently seeking out chances to ascend in society and working non-stop, he believed he could attain status, wealth, and political power only by working a lot harder than others, by being a lot smarter than others, and by being more of a self-starter than others.

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Diagnostic Impressions
After an evaluation, we concluded that while Burr and Hamilton share many qualities, the areas where they differ led them to the point where they were considering a duel. An analysis of these overlapping and divergent qualities are depicted in the Venn diagram below:

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Treatment Recommendations
To our knowledge, there are not any evidence-based strategies for duel prevention. However, we intervened by explaining to Burr and Hamilton that participating in a duel would negatively impact them and interfere with their personal goals. We told Burr that killing Hamilton would hinder his ability to be in the room where it happens. We hoped that this would motivate him to find an alternative approach to handling the conflict. Similarly, we told Hamilton that duel participation would increase the likelihood that he would actually “run out of time” before establishing the legacy he desired, and we reminded him, “history has its eyes on you.”

We experienced resistance from Burr, who argued that he looked back on where he failed, and in every place he checked, the only common thread was Hamilton’s disrespect. His overwhelming blame of Hamilton for all of his thwarted plans formed a significant obstacle to duel dissuasion.

Similarly, Hamilton wasn’t willing to decline the duel invitation. Hamilton’s personality rarely involved backing down from positions or challenges. Indeed, when Burr asked him for an apology, Hamilton responded with, “Burr, your grievance is legitimate. I stand by what I said, every bit of it. You stand only for yourself. It’s what you do. I can’t apologize because it’s true.”

To this, Burr replied, “Then stand, Alexander. Weehawken. Dawn. Guns drawn.”

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Status at Follow-up
Burr shot Hamilton in a duel the day following our session, and Hamilton died the day after that. Hamilton’s legacy was planting seeds in a garden he’d never get to see. and he is remembered as a ten-dollar founding father, hero, and a scholar. Meanwhile, Burr became the villain in your history books. When Burr was asked if he had any regrets, he said that he now understood that “the world was wide enough for both Hamilton and me.” We would have strongly preferred that Burr had that revelation before killing Hamilton.

THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

Lin-Manuel Miranda was not portraying characters with mental disorders. However, his depictions of Burr and Hamilton appear both psychologically and mostly historically accurate. Miranda went to great lengths to examine historical records and consult with historical experts when he created Hamilton. He took some artistic liberty for the sake of storytelling and this approach resulted in fascinating, relatable characters.

  1. Was the character struggling with mental health issues depicted with compassion?

Miranda depicted his characters with great compassion. Burr is generally remembered as a villain and Hamilton as a hero, but Miranda went beyond that simple dichotomy of good versus evil and presented two realistic characters with both redeeming and irritating qualities.

Overall rating: On a scale of Darwin Award to EGOT, we rate the Hamilton depictions of Burr and Hamilton as EGOT!

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The Room Where It’s Happening is an awesome Hamilton fan podcast! You can check it out here.

If you’d like to read 10 Hamilton Quotes for Therapists, you can click here.

We joined The Geek Therapy Podcast Network!

We have exciting news! We joined The Geek Therapy Podcast Network, which hosts 4 other shows: Geek Therapy (about the potential benefits of comics, games, TV shows, and movies), PsychTech (exploring the human side of technology), Headshots (about psychology and gaming), and Rolling for Change (about the educational and therapeutic side of gaming). We highly recommend all of these shows. They’re high quality, thoughtful, and super-fun to listen to! gtc

 

Wicked Smart Will Hunting

Name: Will Hunting
Age: 20
Education: Some high school
Occupation: Between jobs
Date of Report: December 5, 1997
Therapists: Katie Gordon, Ph.D., Brandon T. Saxton, M.S.

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Presenting Problem
Will was punching a man who had bullied him in kindergarten when three police officers showed up and tried to stop him. As they pulled Will away, he responded by kicking one of them. After Will appeared in court for this incident, the judge ordered a psychological evaluation. When Will arrived at our office, he made it clear that he was disinterested in meeting with us. He told us that he had read our website and listened to our podcast before coming in, and he was not impressed. He then lit a cigarette and told us to “go #$%&” ourselves. After being reminded that his timely release from jail was dependent on his cooperation with our evaluation, he said, “I’m pumped. Let the healing begin!”

Family/Social History
Will did not want to share his history with us, but we were able to obtain information from medical and court records. We learned that Will was an only child whose parents died when he was a young boy. He was then placed in the foster care system and was removed from three homes due to severe physical abuse (e.g., being stabbed with a knife and burned with cigarettes). Tragically, these early childhood experiences disrupted Will’s ability to form healthy attachments and trust people. He also developed a persistent fear that people would abandon him once they knew the truth about his past.

According to one of Will’s previous therapist’s notes, Will tended to act in an arrogant, cocky manner to push people away and protect himself from getting hurt. There were some exceptions to this pattern, however. Will had a close group of friends (including his best friend, Chucky) that he grew up with in South Boston (“Southie”). They spent time together driving around, watching local little league games, and hanging out at bars. He described them as “good guys” and “loyal.”

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Educational/Employment History
Will dropped out of high school due to disinterest, but actively pursued self-education through reading materials on a wide range of topics including history, chemistry, art, physics, and literature. He also chose to work as a janitor at MIT in order to gain more exposure to advanced mathematics. Based on Will’s verbalization and impressive knowledge, he appeared to have superior intellectual functioning. After explaining his educational history to us, Will stood up and looked at the diplomas and degrees on our walls and said, “You wasted $150,000 on an education you could’ve got for $1.50 in late fees at the public library.” He then made his way to our bookshelf, eyed a history book, and said, “If you want to read a real history book, read Howard Zinn’s A People’s History of the United States. That book will #$%&ing knock you on your #$%.” We thanked him for the advice and turned to his employment history, which consisted of working a string of different jobs including custodial work and construction.

Legal History
Will’s criminal records revealed the following charges: Assault (June, 1993; September, 1993), Grand Theft Auto*(February, 1994), Impersonating a Police Officer (January, 1995), Mayhem, Theft, and Resisting Arrest (dates unknown).

*He had this charge dropped by arguing that it fit within Free Property Rights of Horse and Carriage from 1798.

Diagnostic Impressions & Treatment Recommendations
Based on his presentation and behavior in Good Will Hunting (available on Netflix!), we decided to evaluate Will for antisocial personality disorder and posttraumatic stress disorder (PTSD). While he exhibited some PTSD symptoms in response to severe childhood abuse (e.g., persistent and exaggerated negative beliefs about oneself, others, or the world), he did not appear to meet full diagnostic criteria for the disorder (e.g., he did not appear to exhibit signs of recurrent, intrusive memories of the trauma).

According to the DSM-5, antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15. Will clearly met at least 4 of the 7 criteria (3 are required for this diagnosis): 1) failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest (see legal history section), 2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure (e.g., lied about having 12 older brothers: Marky, Ricky, Danny, Terry, Mikey, Davey, Timmy, Joey, Robby, Johnny, and Brian; had Chucky pretend to be him during a job interview), 3) irritability or aggressiveness, as indicated by repeated physical fights or assaults (see presenting problem and legal history sections), and 4) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (he quit at least two jobs without providing notice to his employers). While we can’t be completely certain that some of these behaviors were present by age 15, it seems reasonable to suspect that in light of his criminal record dating back to age 16.

A subset of individuals with antisocial personality disorder also exhibit psychopathic traits, including extreme callousness with regard to other people’s feelings. While Will displayed antisocial patterns, including criminal behavior, he did not appear to lack in conscience or concern for others. He experienced genuine and deep feelings for Skylar (a woman he dated) and his friends from Southie. Therefore, Will did not appear to be psychopathic. That is important for treatment planning, because there is evidence that individuals with psychopathy do not tend to improve or actually become worse with therapeutic intervention. Treatment research on antisocial personality disorder has not clearly identified effective treatments for this disorder. Most effective treatments for these types of behaviors target adolescents in family-focused, multicomponent treatments, which draws attention to the importance of early intervention for antisocial behavior.

Though he did not appear to meet criteria for PTSD, many of Will’s problems likely stem from, or were exacerbated by, tragic and traumatic childhood events. Therefore, he may benefit from a therapeutic approach that addresses the negative impact of these experiences while teaching him healthy emotional coping and behavioral strategies. Because this particular approach has not been scientifically-tested, his therapist should regularly monitor Will to ensure that he is receiving benefit from it. If he is not improving or becoming worse, this approach should be discontinued. Will has a number of strengths including his insight, knowledge, and desire for interpersonal connections – all which suggest that he may benefit from therapy, if he is willing to participate in it.

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Status at Follow-up
We contacted Will’s therapist, Sean Maguire, to follow-up on his status. Sean informed us that their therapy had a rough start, but they ultimately formed a strong, meaningful rapport and made substantial progress. Sean said that he last heard from Will through a letter that said he “had to see about a girl,” meaning that he had finally left his comfort zone in Southie and went to California so that he could continue his relationship with Skylar. We viewed this as a hopeful sign of progress for Will.

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THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

Some aspects of antisocial personality disorder were accurate, as specified above. Will’s intellect is atypically high, and that fact is recognized with the fictional world of the movie.

  1. Was the character struggling with mental health issues depicted with compassion?

Yes, Will was written and portrayed as a nuanced and sympathetic character who effectively evoked compassion.

Overall rating:
On a scale of not liking them apples to very much liking them apples, we love them apples.

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AKA Jessica Jones & PTSD

PSYCHOLOGICAL REPORT

Name: Jessica Jones
Date of Birth into Comics: November, 2001
Education: High school diploma
Date of Initial Interview: 11/20/2015
Date of Report: 10/01/2016
Therapists: Katie Gordon, Ph.D., Brandon T. Saxton, M.S.

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Presenting Problems:
Jessica Jones was referred for a psychological evaluation by her sister, Patricia “Trish” Walker. Trish was concerned that Jessica was experiencing negative effects from the multiple traumatic events that had occurred throughout her life, including developing a drinking problem to cope with trauma-related stress. Trish expressed a belief that Jessica’s life would be much better if she received treatment, despite Jessica denying experiencing any problems at all. Jessica presented as very resistant for this interview, calling us “a#$holes” and maintaining that she would not waste her time whining to therapists.

Family/Social History:
Jessica Jones was the only daughter of Brian and Alisa Jones. She grew up with her parents and younger brother, Philip. Jessica was not a very social young woman, preferring to spend time alone and often expressing annoyance at others. Tragically, Jessica’s family was killed in a car accident. Jessica recalled that the accident was caused by her father’s distraction as she and her brother were fighting. It was clear that Jessica still blamed herself for this event.

After the death of her family, Jessica was adopted by Dorothy Walker, a talent agent. According to Jessica, Dorothy only adopted her as a publicity stunt to promote her daughter’s television show. Jessica’s new family and home life came with turmoil. Jessica would often overhear the Walkers fighting over Trish’s television show. Jessica stated that Dorothy put the show’s success above all else. She recalled seeing bruises on her sister’s neck, which she suspected were inflicted by Dorothy.

At one point, Jessica found Dorothy forcing Trish to vomit into a toilet in an attempt to make her lose weight. Jessica used her incredible strength to throw Dorothy across the room. Dorothy fled in terror, and this sparked the beginning of a closer friendship between the sisters.

Later in Jessica’s life, while toying with the idea of becoming a superhero, she met a man named Kevin Thompson, better known as Kilgrave. Kilgrave was experimented on as a child by his parents. They were hoping to treat his neurodegenerative disease but ended up giving him the ability to control people’s minds. He met and became fascinated with Jessica when he witnessed her overpowering some criminals to prevent a mugging.

Jessica spent the next few months under Kilgrave’s mind control. They stayed together in a motel room, and he commanded her to tell Trish that everything was fine whenever she would check on Jessica. Kilgrave felt that they were in an actual relationship, but Jessica identified the traumatic time as his forcing her to be with him with his power of controlling people. At one point, when Jessica had a few moments of free will, she contemplated jumping off of a building. Kilgrave found her and ordered her to step down from the ledge.

Later on, Kilgrave was trying to obtain a flash drive that contained evidence of his parents trying to treat his neurogenerative disease through experimental and painful methods. Kilgrave discovered that a woman had buried the flash drive under concrete. He commanded Jessica to dig it up, which took hours. Then, Kilgrave commanded Jessica to kill the woman. She punched her so hard in the chest that her heart stopped. Jessica stated that, after killing the woman, she was so distraught, she actually walked away from Kilgrave. While walking away, Kilgrave was screaming for her to come back, and he was hit by a bus. This ended his control over her. Jessica believed he was dead.

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Educational/Employment History:
Following high school, Jessica worked a few different jobs. The first was in an office. Jessica hated the position, stating that “This job was sucking my brains out through the air vent.” After a few weeks there, Jessica used her investigation skills to blackmail her boss. He was committing fraud, and Jessica leveraged this information into a six-month severance package in addition to a letter of recommendation.

Jessica’s next job was working at a sandwich shop. She wore a sandwich costume, handed out fliers, and hated the job. While passing out fliers on the street, Jessica saw a young girl run into the road. Springing into action, Jessica was able to use her powers to save the girl from being hit by a taxi. Hearing the gratitude in the girl’s voice, in addition to the urging of her sister, Jessica actually considered using her powers to become a superhero.

Ultimately, after the events involving Kilgrave, Jessica gave up on the notion of becoming a hero. Instead, she opened a private investigation firm called Alias Investigations. Jessica’s work at Alias often involved being hired by people who thought their romantic partners were having affairs, and she also helped locate missing people.

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Psychiatric/Medical History:
Jessica reported experiencing some prior psychiatric treatment from a therapist who taught her to recite her childhood neighborhood street names when experiencing posttraumatic stress disorder (PTSD) symptoms. She had a negative view of mental health services, reporting that her previous therapist was a “quack,” saying that she did not want to join a “group of whiners,” and “screw therapy.” Jessica also once had a physician prescribe her antipsychotic medications, claiming that she was paranoid. Another person stated that Jessica was “coming across as distinctly paranoid,” to which she responded, “Everyone keeps saying that. It’s like a conspiracy.” However, the physician and other person were incorrect in their assumptions about her being paranoid, because Jessica was, in fact, being stalked by Kilgrave. Beyond obtaining super-strength, near invulnerability, and remarkable jumping ability while hospitalized following her family’s car accident, Jessica denied any other significant medical history.

Assessment & Diagnostic Impressions:
All assessment information was gathered through behavioral observations (i.e., watching Jessica Jones on Netflix). Jessica’s symptoms were best captured by two diagnoses featured in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5): PTSD and alcohol use disorder.

As mentioned above, Jessica directly experienced multiple traumatic events (defined by the DSM-5 as exposure to actual or threatened death, serious injury, or sexual violence). Jessica’s PTSD symptoms mostly related to her traumatic experiences with Kilgrave, which included rape, emotional abuse, and being subject to extremely controlling and manipulative behavior. For example, Jessica appeared to experience multiple intrusive symptoms, such as nightmares (e.g., she woke up crying after dreaming that Kilgrave licked her face) and flashbacks (e.g., she felt as if Kilgrave was talking to her, which led her to burst into tears). Jessica also exhibited avoidance of situations that reminded her of the traumatic events (e.g., veered away from talking or thinking about what happened, consumed large quantities of alcohol to cope with trauma-related thoughts). When a friend suggested that she talk about her traumatic experiences, Jessica responded, “I prefer repression.” The friend added, “And self-medication,” referring to her frequent alcohol use. Additionally, she appeared to have negative changes to her thoughts and moods including distorted beliefs about herself and others (e.g., isolated herself from people due to self-blame for what she did under Kilgrave’s control). For example, a neighbor commented that she used sarcasm to distance herself from people and another neighbor stated that Jessica picked apart other people’s happiness because she was all alone (to which Jessica responded, “You are a very perceptive asshole!”). Jessica also told her sister, “I’m life-threatening, Trish. Stay clear of me.” Consistent with this pattern, Jessica tried to push Luke Cage away early in their budding romantic relationship. Finally, Jessica suffered changes in her arousal and reactivity (e.g., irritable mood, angry outbursts, reckless behavior including drinking alcohol to the point of being kicked out of a bar). A lawyer who she worked with described Jessica as “erratic” and “volatile.” When the same lawyer suggested that Kilgrave’s powers might be used for good, Jessica reacted by shattering glass with her fist. Jessica’s response to someone suggesting that she get a massage for stress reduction was, “Massages make me tense,” which is an atypical reaction to massages and may potentially be related to altered reactivity following her traumatic experiences (though this is speculative).

The DSM-5 defines alcohol use disorder as “a problematic pattern of alcohol use leading to significant impairment or distress, as manifested by at least two” of eleven symptoms. Jessica appeared to experience the following symptoms of alcohol use disorder: spending a significant amount of time using and recovering from alcohol (Jessica is shown drinking frequently throughout the day) and cravings to use alcohol (this was especially apparent when Jessica experienced elevated stress levels). It is difficult to assess the presence of some of the other alcohol use disorder symptoms based on the series, but it seemed possible that Jessica also developed some tolerance due to her frequent drinking and may have used alcohol in situations where it was dangerous to do so. Moreover, multiple people commented on her excessive drinking. Trish stated that she had alcoholism, and Kilgrave asked if she thought she drank too much (to which she replied, “It’s the only way I get through my day after how you treated me.”

Treatment Recommendations:
In summary, Jessica appeared to meet full diagnostic criteria for PTSD and alcohol use disorder. Well-established treatments exist for both disorders. Evidence-based treatments for PTSD include therapist-guided processing of traumas (e.g., Cognitive Processing Therapy, Prolonged Exposure) and decreasing unhealthy behavioral patterns without focusing directly on the traumas (e.g., Present-Centered Therapy). With regard to alcohol use disorder, research suggests that multiple types of treatment (e.g., Motivational Enhancement Therapy, which aims to strengthen desire and ability to decrease substance use) are most effective. Finally, Seeking Safety may be an appropriate choice for Jessica, because it is a research-supported treatment specifically designed for individuals struggling with comorbid PTSD and substance use problems. Seeking Safety includes teaching healthy coping strategies and skills to clients, so that they find safety in their relationships, feelings, and thoughts.

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THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

The portrayal of mental health problems in Jessica Jones was among the most accurate depictions we’ve seen. It’s rare for works of fiction to clearly identify mental disorders, and PTSD was specifically named as Jessica’s primary mental health problem in the series. Moreover, Jessica exhibited multiple DSM-5 PTSD symptoms, as well as associated distress and impairment, realistically across episodes. Finally, individuals with PTSD are at elevated risk for substance use disorders, and the series realistically displayed Jessica excessively using alcohol in an attempt to reduce the emotional pain she was experiencing.

2. Was the character struggling with mental health issues depicted with compassion?

The series reveals the events leading up to Jessica’s mental health problems in a manner that compels viewers to sympathize with her struggles. The writing and storytelling are superb, and Krysten Ritter is a phenomenal actress. Her portrayal of Jessica reflected a nuanced and complex understanding of PTSD. We believe that the series has the potential to help raise awareness about PTSD to broad audiences, which will hopefully lead to greater empathy for those suffering from it.

Overall rating:
On a scale of be-cool-and-just-watch-one-episode-per-day to RESISTANCE-IS-FUTILE-JUST-SURRENDER-TO-THE-BINGE-WATCH, we rate the depiction of mental health issues in Jessica Jones as RESISTANCE-IS-FUTILE-JUST-SURRENDER-TO-THE-BINGE-WATCH!

For more information on PTSD, please visit the National Center for PTSD website by clicking here.

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Diagnosing The Dude

PSYCHOLOGICAL REPORT

Client Name: Jeffrey Lebowski, AKA The Dude, His Dudeness, Duder, or El Duderino (if                                         you’re not into the whole brevity thing)
Education: College
Occupation: Currently unemployed
Date of Birth: December 4, 1942
Date of Interview: March 6, 1998
Therapists: Katie Gordon, Brandon Saxton

Presenting Problem
Jeffrey “The Dude” Lebowski was referred for a psychological evaluation by his special lady friend, Maude Lebowski, who told him that we were good people “and thorough.” Once described as “quite possibly the laziest in Los Angeles County, which would place him high in the running for laziest worldwide,” The Dude presented as a 47-year-old man who was dressed casually in a lavender t-shirt, patterned pants, and jelly sandals. Right away, the mental status exam raised clinical concerns, as The Dude did not seem fully oriented to time, person, and place. When asked the date, The Dude responded with, “Is this a…what day is this?” and then asked, “Mind if I do a J?” When asked what his chief complaint was, The Dude explained that his rug had recently been destroyed by people who broke into his house. He appeared very distressed by this, and when asked why it was so bothersome to him, he replied that, “it really tied the room together.”

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History
Gathering a comprehensive history was challenging with The Dude. He reportedly attended college and spent most of his time there “occupying various administration buildings…smoking a lot of Thai stick…breaking into the ROTC…and bowling.” When asked about the type of degree he was pursuing, The Dude stated, “To tell you the truth, I don’t remember most of it.” In response to a question about the kind of work he did, The Dude said, “a little of this, a little of that.” He recalled being a roadie briefly for Metallica on the Speed of Sound tour. He remarked that they were “a bunch of assholes,” and also reported hating “the <expletive> Eagles, man.” Earlier in his life, The Dude engaged in some social activism, reporting that he was one of the Seattle Seven and contributed to the first draft of the Port Huron Statement. Lately, his career had reportedly “slowed down a bit,” such that he spent the majority of his time bowling, driving around, and having an “occasional acid flashback.” The Dude stated that he had friends who he spent time with, and in particular, someone named Walter who played in his bowling league (except on Shabbos). When asked about his marital status, The Dude replied, “Do you see a wedding ring on my finger? Does it look like I’m <expletive> married?”

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Diagnostic Impressions
All assessment information was obtained through observing The Dude in The Big Lebowski. In general, The Dude presented as a laidback, go-with-the-flow kind of guy who seemed generally happy with his life. Thus, we approached our diagnostic examination with an effort to not over-pathologize his eccentricities and stuck to exploring potential areas of distress and impairment. The Dude’s areas of distress included the loss of his rug and tense interactions with his friend, Walter (e.g., when Walter pulled a gun out during a bowling league game). Meanwhile, The Dude exhibited impairment in managing some of his responsibilities (e.g., failing to pay his rent on time, driving unsafely). For example, The Dude attempted to throw a joint out of a closed car window while driving, and it fell in his lap and burned him. He then poured the liquor he was drinking on it and crashed his car.

The possibility of adjustment disorder following the loss of The Dude’s rug was investigated. While The Dude’s emotional and behavioral reactions to the stressor (e.g., going to the real Jeffrey Lebowski’s house to demand a new rug) were a bit out of the norm, they did not cross the threshold into a pattern of clinically significant emotional problems that caused substantial impairment in important areas of functioning. Therefore, adjustment disorder was ultimately ruled out.

The full extent and range of The Dude’s alcohol and other substance use at the time of assessment was not totally clear, but he did mention at least some previous LSD use and tell Maude that he was “adhering to a pretty strict drug regimen to keep my (his) mind limber.” He appeared to, at a minimum, regularly smoke marijuana and drink White Russians. Due to the limited available information, we could not conclusively determine whether he met full criteria for alcohol use disorder. However, he likely met criteria for cannabis use disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)cannabis use disorder is defined as “a problematic pattern of cannabis use leading to significant impairment or distress, as manifested by at least two” of eleven specified symptoms (e.g., tolerance, repeated failed attempts to quit using). He appeared to exhibit the following: 1) a great deal of time is spent in activities necessary to use cannabis 2) recurrent cannabis use in situations in which it is physically hazardous (e.g., driving), and 3) craving, or a strong desire or urge to use cannabis.

Treatment Recommendations
Overall, this is a very complicated case with a lot of ins, a lot of outs, and a lot of what-have-yous. However, the probable diagnosis for The Dude is cannabis use disorder. If The Dude decided to pursue treatment, there are several well-established treatments for substance use disorders that have been tested in rigorous scientific studies. These evidence-based approaches include strategies focused on enhancing motivation for change (motivational interviewingmotivational enhancement therapy), identifying and changing thoughts and behaviors that contribute to the substance use problem (motivational enhancement therapy plus cognitive-behavioral therapy), and participation in a behavioral program that reinforces drug abstinence (prize-based contingency management).

Status at Follow-Up 
The Dude abides.

THE GORDON/SAXTON TEST

Was the portrayal of mental illness accurate?
The Dude’s primary purpose as a fictional character is comedic in nature. Nonetheless, he does exhibit some symptoms that are realistically consistent with cannabis use disorder (as outlined above). Remarkably, his character was based on a real person who has striking similarities to the fictional Dude. Check out this video about the real Dude (Jeff Dowd), who views his fictional counterpart affectionately as a holy fool, which he defines as “one who subverts conformity in order to point to the truth in a funny way.”

Was the character struggling with mental health issues depicted with compassion?
Even though The Dude is fairly irresponsible during the time period depicted in the film, people seem to really like him, want to emulate aspects of his approach to life (e.g., some view it as consistent with Zen philosophy), and feel sympathy for the loss of his rug. Therefore, it seems reasonable to conclude that he is portrayed with some compassion…but, that’s just like our opinion, man.

Overall rating: On a scale of very Dude to very un-Dude, we rate this portrayal as calmer than you are!

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Addams Family Therapy

PSYCHOLOGICAL REPORT

Name: Wednesday Friday Addams
Ethnicity: Ghoulish human
Age: 13
Date of Initial Interview: November 19, 1993
Therapists: Katie Gordon, Brandon Saxton

Christina Ricci in Addams Family Values

Presenting Problem
Wednesday’s teacher, Susan Furkins, referred her for treatment after she turned in an assignment about a person who she loved and admired. While Wednesday’s classmates selected people such as Barbara Bush, the New Kids on the Block, and Jane Pauly, she brought in a picture of her Great-Aunt Calpurnia, who was burned as a witch in 1706 after dancing naked in the town square and enslaving a minister. When Ms. Furkins told Wednesday’s mother about it, Morticia responded, “Don’t worry. We’ve told Wednesday that she has to go to college first.” Because Morticia and Gomez (Wednesday’s father), did not see any problems with their daughter’s behavior at the time, they initially ignored the referral. In addition, they felt reassured by Ms. Furkins’ comment that Wednesday was generally an excellent student. However, when their youngest son was born two years later, they grew concerned about Wednesday’s aggressive behavior and decided to schedule a psychological evaluation.

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Family Background & History
Wednesday was born into a ghoulish, yet close family. In her younger days, Wednesday was described as intelligent and by her father as “a child of woe is wan and delicate….sensitive and on the quiet side, she loves the picnics and outings to the underground caverns…a solemn child, prim in dress and, on the whole, pretty lost…secretive and imaginative, poetic, seems underprivileged and given to occasional tantrums…has six toes on one foot.” At the time of intake, she resided with her mother and father, who had a loving and passionate marriage, her younger brothers (Pugsley and Pubert), her Uncle Fester, her grandmother, their butler (Lurch), and Thing. Wednesday reported that their family credo was, “Sic gorgiamus allos subjectatos nunc,” which is fake Latin for, “We gladly feast on those who would subdue us.” In general, the Addams family bonded over their macabre interests, which included pain and the grimmer aspects of life. Therefore, when Wednesday exhibited behavior that would be considered unusual by typical families (e.g., burning her dolls with a blowtorch, rarely smiling), it did not particularly distress them. However, they grew concerned after Wednesday attempted to kill Pubert three times shortly following his birth.

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Diagnostic Impressions
All assessment information was obtained through watching The Addams Family and Addams Family Values. Due to the nature of her parents’ concerns, Wednesday was evaluated for disruptive behavior problems and was found to meet diagnostic criteria for conduct disorder. According to the fifth edition of the Diagnostic and Statistical Manual for Mental Disordersconduct disorder is defined as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of a minimum of 3 criteria in the past 12 months, with at least 1 criterion present in the past 6 months.” Examples of behavior for each criterion that Wednesday met are listed below.

1) Often bullies, threatens, or intimidates others

She regularly harmed her brother, Pugsley (e.g., tried to electrocute him), intimidated a nanny by saying she would clean her room in exchange for the nanny’s soul, and told another nanny to, “Be afraid. Be very afraid.” After a girl scout asked Wednesday if the lemonade at her lemonade stand was made from real lemons, Wednesday responded in an intimidating manner, “Are your cookies made of real girl scouts?” Finally, Wednesday also attempted to scare a boy who had a crush on her to death.

2) Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) 

Wednesday frequently used a crossbow and has used other dangerous weapons (e.g., a guillotine) that can cause harm to others.

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3) Has been physically cruel to people

She helped to bury two people alive after they had wronged her family and also tied up a peer at summer camp. Wednesday also attempted to kill her infant brother by dropping him off the roof, throwing him down a stairwell, and putting him in a guillotine.

4) Has been physically cruel to animals               

Wednesday buried a live cat with her grandmother and brother.

5) Has deliberately engaged in fire setting with the intention of causing serious damage

A nanny was telling Wednesday and Pugsley that she would teach them to prevent forest fires, and Wednesday responded by lighting a match and asking quizzically, “Prevent them?” In addition, she led a group of children to destroy (including through the use of fire) their summer camp while performing a play.

Treatment Recommendations
In summary, Wednesday appeared to meet full diagnostic criteria for conduct disorder, and it caused significant impairment in her social interactions with peers and family members, as well as physical and emotional harm to property, people, and at least one animal. Currently, there are evidence-based treatments for conduct disorder in adolescents that have been tested in rigorous scientific studies. These evidence-based approaches include strategies focused on intervening in multiple areas for behavioral change (e.g., parent and family, peers, school, community via multisystemic therapy). Treatments that have been shown to potentially exacerbate conduct disorder problems for some individuals, and therefore should not be used for Wednesday, include boot camp and Scared Straight programs.

THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

Some of the symptoms that Wednesday Addams exhibited were consistent with some true manifestations of conduct disorder (e.g., animal cruelty, fire setting). However, her main purpose as a character is to deliver dark humor in a comedic film. Therefore, aspects of her behavior are extremely exaggerated and entertaining, but not typical of real cases of conduct disorder.

2. Was the character struggling with mental health issues depicted with compassion?

Wednesday hurts others and destroys property yet remains a fan-favorite, so there must be something about her depiction that evokes a level of compassion. Perhaps viewers place Wednesday’s behavior in the context of her family and home life and see her conduct problems as a product of her environment, which often applies in nonfiction cases of conduct disorder as well.

Overall rating
On a scale of frolicking with unicorns to writhing in agony, we rate this portrayal as staring into the abyss!

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Nerd Nite Talk Video

We discussed how the scientific process is used in diagnosing and treating mental health problems at a local Nerd Nite event. Batman and Buffy the Vampire Slayer are presented as case examples. It was a lot of fun, and we’re grateful to all of the people who came out to the talk!

Gaming Disorder in The Guild

PSYCHOLOGICAL REPORT

Name: Cyd Sherman AKA Codex
Employment: Violinist through ~2006, Unemployed ~2007-2012, Vice-President of Community Creative Consultancy, The Game ~2012-present
Date of Initial Interview: July 27, 2007
Date of Report: January 8, 2013
Therapists: Katie Gordon, Brandon Saxton

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Presenting Problem
Cyd Sherman presented as a single, casually-dressed woman in her twenties. She walked in, lied down on the couch, and explained that she had been dealing with symptoms of depression and anxiety. She also reluctantly admitted that the significant amount of time that she devoted to playing a massively multiplayer online role-playing game (MMORPG) could be contributing to some of her problems (e.g., not seeking out new employment, having few social contacts IRL). Recently, her life had taken a turn for the worse when her therapist, Dr. Hammond, “broke up” with her. When asked to elaborate, Cyd explained that Dr. Hammond “fired” her saying, “You can’t grow if you are still immersed in an imaginary social environment.” Cyd then asked if it was “even medically legal” for her therapist to discontinue treatment.

History
Cyd disclosed that her father “made her” see a therapist due to his concerns about her being depressed. When she started seeing Dr. Hammond for treatment, she was employed in an orchestra, “I’m a violinist. You know, former child prodigy…now I’m old,” and she was dating a man named Trevor. Life started to go downhill when Trevor manipulated Cyd into writing his band’s songs without giving her any credit and generally treating her poorly. The last straw was when she caught him cheating on her with the first chair oboist, Günther. In response, she burned pages of Trevor’s band’s songs and inadvertently created a fire that destroyed his $100,000 cello. Consequently, she was fired from the orchestra because of concerns about her burning a musical instrument. Cyd actually felt better initially because her unemployment allowed her more time to spend with her gaming guild playing the MMORG (The Game). However, she ultimately chose to seek help for her gaming because of financial concerns related to unemployment (e.g., maxing out credit cards, subsisting on Ramen), as well as distress related to feeling rejected by her last therapist.

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Diagnostic Impressions
All assessment information was obtained through reading The Guild comics, watching the web series (available on youtube and Netflix!), and music videos. First, due to the nature of referral, Cyd was evaluated for disorders related to her internet gaming. According to the Conditions for Further Study section in the appendix of the DSM-5 (reserved for disorders requiring additional research and not yet considered officially included), internet gaming disorder is defined as “persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by 5 (or more) symptoms in a 12-month period.” Cyd clearly exhibited at least 6 of the 9 symptoms:

1) Preoccupation with internet games

Cyd characterized her time spent playing The Game as taking “5…8…9 hours a day.” When she decided to meet up with her fellow guild members in person, they struggled to talk about anything other than The Game. At one point, there was a threat of The Game being sold to a new owner and Cyd responded with, “This game is my life,” and “My life is empty. What will I do without the game?” Her preoccupation was also apparent when she introduced herself to her neighbor as Codex (her avatar’s name).

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2) Withdrawal symptoms when internet gaming is taken away

When The Game was shut down for four hours for a server update, Cyd and her fellow guildies treated it as a crisis situation. Cyd also panicked another time when her computer stopped working. She hit a fellow guild member (Bladezz), started crying, and said, “I’m so stressed right now. I need to have a computer for The Game…for living.” In desperation, she took a job without pay at Cheesybeard’s (a restaurant) simply so that she would have access to a computer and the internet.

3) Unsuccessful attempts to control the participation in internet games

This is a post-it note on Cyd’s computer:

post-it4) Has deceived family members, therapists, or others regarding the amount of internet gaming

Cyd told her therapist, “I’m setting parameters. Kind of,” when she was failing to keep to agreed-upon limits. Cyd could not even stop playing The Game while talking to Dr. Hammond on the phone about her excessive gaming problem. She told her therapist, “You’re killing me…literally,” in reference to action in the game.

5) Use of internet games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety)

While upset about her ex-boyfriend cheating on her, Cyd decided to go on a “video-game bender.” She stocked up on energy drinks and played The Game from 7:42pm one night until she fell asleep at 11:14am the next morning. She also said, “I guess I can’t cope well with anything. In the game, at the end of the day, you can just log off. You can’t log off of your own life.”

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6) Has jeopardized or lost a significant relationship, job, or educational career opportunity because of participation in internet games

After being fired from the orchestra, Cyd reported that she was “still jobless, yay” and hadn’t left the house in a week. In fact, the first job she pursued was the aforementioned unpaid job at Cheesybeard’s. Her ex-boyfriend, Trevor, also claimed that he cheated on her with Günther because they “drifted apart” due to her use of video games. At a later point, when a romantic interest didn’t work out, she reacted with, “At least I don’t have to make room for dating around my gaming schedule.”

In addition to internet gaming disorder symptoms, Cyd reported a variety of different anxiety symptoms. For example, Cyd said that she felt squeamish, faint, and tended to vomit at the sight of “raw chicken liver, really bad acne, and people’s toe hair,” which may be indicative of an overactive anxiety response. Other examples of this tendency include having an “anxiety attack” while trying to convince a former guild member to come back to their guild (The Knights of Good) and a “panic attack” when trying to convince a man (Fawkes) to go out with her again. She also referred to herself as generally “neurotic” and provided examples: 1) “I always get everywhere a half hour early and spend a lot of time sitting in the car,” 2) she planned to keep her guild from finding out that she had a one night stand with a rival guild member from the Axis of Anarchy by “all night…obsessively” thinking about it, and 3) purposely having her character die while reading ‘choose your own adventure’ books because she couldn’t handle the stress of uncertainty.

Cyd also displayed significant social anxiety (or potentially avoidant personality disorder) symptoms. With regard to her youth, she said, “I was never the teacher’s pet. I specifically underperformed so that the teacher wouldn’t pay any attention to me whatsoever.” She also described feeling awkward and uncomfortable at parties and meeting strangers, and having significant anxiety when trying to contact a friend through a internet chat channel filled with people she didn’t know. Cyd showed insight about the incident saying, “Meta-social anxiety….that’s sad.” Perhaps in relation to her social anxiety, Cyd also struggled with assertiveness. For example, she had a hard time asking her Guild-mate, Zaboo, to leave her house when he showed up uninvited and moved in and also recalled, “One time I got caught holding the door open after an orchestra concert for 25 minutes, so I’m not really the best measure of assertiveness.”

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Finally, Cyd also appeared to be experiencing symptoms of depression. She pondered being rejected by the neighbor that she was romantically interested in, “What’s the worst that could happen? I would just cry a lot – which I’d do anyway,” and reported feeling depressed “always.”

Treatment Recommendations
In summary, Cyd appeared to meet full diagnostic criteria for internet gaming disorder. While not enough information was available to specifically determine if she met criteria for a current major depressive episode or which specific anxiety disorder(s) she would meet criteria for, it was clear that these symptoms negatively impacted her. Moreover, her anxiety and depression symptoms likely played a role in her internet gaming disorder. Therefore, it was recommended that she receive treatment for anxiety and depression along with specifically targeting her internet gaming disorder symptoms.

Currently, there are several well-established treatments for anxiety and depression that have been tested in rigorous scientific studies. These evidence-based approaches include strategies focused on changing thoughts and behaviors and increasing positive interpersonal interactions (e.g., via cognitive-behavioral therapy), as well as other treatment modalities.

With regard to Cyd’s internet gaming disorder, there is substantially less research on the condition and its treatment in light of its current status in the DSM as a disorder in need of further study. A recent review on available research on the topic found very few clinical trials available to guide treatment planning. Thus, a behavioral approach identifying and addressing the functions and situational triggers that maintain excessive internet gaming was recommended. In light of Cyd’s ambivalence about change (i.e., she both loves playing The Game and simultaneously is concerned about her excessive use), an approach focused on enhancing her motivation might also be appropriate. However, because these are not scientifically-tested and established approaches for internet gaming disorder (due to the recency of the proposed disorder), it would be particularly important for the therapist to closely monitor and assess the impact of the interventions and adjust them as needed (e.g., ceasing this approach if it causes harm).

Follow-Up Assessment
At follow up, Cyd exhibited significant improvement with regard to her depression and anxiety symptoms, as well as a reduction in distress and impairment related to internet gaming disorder. The most powerful component of this change was Cyd’s development of meaningful in-person friendships with her fellow guild members. Through her interactions with them, she faced and overcame her anxiety in pursuit of shared goals, which helped to strengthen her confidence and assertiveness, while decreasing her avoidant coping tendencies. In addition, she was able to gain employment and channel her passion for The Game through taking a paid position in their company.

THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

Felicia Day is the creator, writer, and actress who portrayed Cyd in The Guild. She based Cyd’s anxiety, depression, and internet gaming disorder symptoms on her own experiences struggling with these issues and playing World of Warcraft. Overall, The Guild provided an accurate presentation of ways that these mental health issues can manifest.

    2. Was the character struggling with mental health issues depicted with compassion?

Yes, Cyd was portrayed as a sympathetic, humorous character. In addition, Felicia Day has helped to raise awareness and reduce stigma associated with these mental health issues by writing, in detail, about her experiences in her memoir You’re Never Weird on the Internet (Almost).

Overall rating
On a scale of n00b to MLG, we rate this depiction MLG!

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Silent Bob’s Psyche

PSYCHOLOGICAL REPORT

Client Name: Silent Bob
Date and Location of Birth: 1970s-ish in New Jersey
Date of Initial Interview: January 19, 2006
Date of Report: July 21, 2006
Therapists: Katie Gordon, Brandon Saxton

Presenting Problem
Silent Bob presented as a man in his early 30s who was dressed in a backwards hat, long coat, and jeans. After we greeted him in the waiting room, he used charade-like behavior to ask if we would hold the session outside so that he could smoke cigarettes. After going to an outside area, he leaned against a wall, and continued to communicate mostly through emphatic facial expressions and gestures rather than speaking.

A review of Silent Bob’s paperwork indicated that he was court-ordered to treatment following charges of possession of marijuana with intent to sell. The police report stated that he and his friend, Jay, were driving around with a deployed airbag when a police officer pulled them over for “suspicion of mischief.” The police officer then searched their car and found two pounds of “Jamaican Landswolf” marijuana. The prosecutor wanted Jay and Silent Bob to be sentenced to prison for ten years, but the judge ordered them to complete drug rehabilitation instead.

Educational/Employment History
Silent Bob completed a minimum of eighth grade (when he won the science fair) and likely continued beyond that. However, details could not be confidently discerned from Silent Bob’s gestures. After completing school, he became a self-employed drug dealer with his best friend, Jay. He and Jay particularly enjoyed selling marijuana in front of a Quick Stop convenience store in New Jersey. Another source of income for Silent Bob was from a movie (Bluntman and Chronic) that was developed from a comic book starring a character based on him.

Psychosocial History
Little is known about Silent Bob’s family history and not much could be gleaned from his nonverbal behavior on this topic either. There was one mention of his mother, in that he won that eighth grade science fair by turning one of her personal belongings into a CD player through the use of chicken wire. For this accomplishment, his friend Jay referred to him as an “electrical genius” and “better than MacGyver.” He also reportedly had a cousin named Olaf from Moscow, Russia who was a metal singer.

In terms of significant romantic relationships, Silent Bob was in a relationship with a woman named Amy approximately ten years prior to the initial interview. In a rare moment of speech, he described them as “inseparable” and “big time in love.” Due to feelings of insecurity about her romantic past, he ended their relationship and deeply regretted it, saying that he “spent every day since then Chasing Amy…so to speak.”

With regard to friendships, Silent Bob spent most of his time with his best friend, Jay, ever since they met as young babies in strollers outside of the Quick Stop. Together, they spent the vast majority of their time loitering, smoking and selling marijuana, and beating up people who were critical of Bluntman and Chronic on the internet. True to his name, Bob was often silent while Jay regaled him and others with crass, colorful stories and commentary. They also enjoyed listening to music together and dancing while loitering. In fact, during one of the rare times when Silent Bob spoke, he revealed that he “always wanted to be a dancer in Vegas.” It should be noted that, as occasions arose to help others, Jay and Silent Bob often stepped up to the challenge. For example, they once helped their friends T.S. and Brodie reunite with their ex-girlfriends and, another time, they liberated animals from a testing facility. Remarkably, they also played important roles in preventing two fallen angels (Bartleby and Loki) from ending all of existence.

Diagnostic Impressions
All assessment information was obtained through behavioral observations and record review (i.e., watching, reading, and listening to ALL the Kevin Smith movies, books, and podcasts). First, due to the nature of the court-ordered referral, Silent Bob was evaluated for disorders related to his marijuana use. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), cannabis use disorder is defined as “a problematic pattern of cannabis use leading to significant impairment or distress, as manifested by at least two” of eleven specified symptoms (e.g., tolerance, withdrawal, repeated use in dangerous situations such as driving, repeated failed attempts to cease marijuana use). Due to the limited communication from Silent Bob during the assessment, we could not conclusively determine whether he met full criteria for this disorder. However, we speculated that he was likely to have met criteria for cannabis use disorder as evidenced by the following symptoms: 1) substantial time devoted to obtaining and using cannabis and 2) the presence of intense cravings to use cannabis. Moreover, he appeared to be experiencing associated impairment in light of his legal troubles.

Secondly, Silent Bob also appeared to meet criteria for a second disorder: selective mutism. He exhibited all of the DSM-5 criteria for selective mutism: 1) repeated failure to speak in social situations where one is expected to speak, despite speaking in other situations, 2) the disturbance interferes with social communication, 3) the duration is at least one month, 4) the failure to speak is not attributable to lack of knowledge of spoken language.

Treatment Recommendations
In summary, probable diagnoses for Silent Bob include cannabis use disorder and selective mutism. Currently, there are several well-established treatments for substance use disorders that have been tested in rigorous scientific studies. These evidence-based approaches include strategies focused on enhancing motivation for change (motivational interviewing, motivational enhancement therapy), identifying and changing thoughts and behaviors that contribute to the substance use problem (motivational enhancement therapy plus cognitive-behavioral therapy), and participation in a behavioral program that reinforces drug abstinence (prize-based contingency management).

With regard to Silent Bob’s selective mutism, existing scientific evidence points to cognitive-behavioral approaches as effective. These approaches teach individuals with the disorder skills for adaptively coping with and reducing the obstacles to their verbal communication, while behaviorally reinforcing them for communicating through spoken language.

Status at Follow-Up (Clerks II)
At a follow-up session six months and two days later, Silent Bob denied the presence of any cannabis use disorder symptoms. Through a series of questions that Silent Bob responded to with head nods, head shakes, gestures, and occasionally drawing pictures, we determined that he had maintained sobriety since our initial meeting. He attributed his marijuana abstinence to his enrollment in a six-month rehabilitation program that utilized the 12 Steps of Narcotics Anonymous. While Silent Bob should be commended for his dramatic behavioral change, there were several risk factors for relapse that were identified. First, his beloved Quick Stop convenience store had burned down. He was reportedly coping with this stressor by loitering in front of a fast-food restaurant (Mooby’s) instead. Secondly, though Jay was also sober, they both continued to sell marijuana. When asked how he would resist smoking marijuana while selling it, he pulled a bible out of his coat. Silent Bob had been raised Catholic and reconnected with Christianity during rehabilitation, which led him to feel that his spiritual connection would prevent a relapse. Nonetheless, it was strongly recommended that Silent Bob explore other occupations in order to reduce his chances of relapsing.

THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

Silent Bob is a comedic character that Kevin Smith created mainly so that the character, Jay, had someone on the receiving end of all of his funny behavior. Still, he does exhibit symptoms that are realistically consistent with cannabis use disorder, as outlined above. With regard to selective mutism, Silent Bob exhibits many of the actual symptoms of the disorder. However, it is worth noting that the disorder is extremely rare in adults and tends to occur in children. Moreover, it is likely that Silent Bob would speak more frequently to Jay in the context of their close friendship. In children with selective mutism, they often speak with their family members and sometimes close friends, but are silent in other settings (e.g., in school, with strangers).

2. Was the character struggling with mental health issues depicted with compassion?

As mentioned above, Kevin Smith was not specifically aiming to have Silent Bob represent a person suffering from mental health issues. However, Silent Bob is certainly a likable character. Furthermore, it is very clear from reading Kevin Smith’s books and listening to his podcasts that he has great compassion for his friends who have struggled with substance use and other mental health issues. He is openly supportive and helpful to his friends in real life, and in this way, he helps to reduce stigma surrounding these mental health issues.

Overall rating: On a scale of snoogans to snootchie bootchies, we rate this portrayal as snootch to the nootch!

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The Remarkable Resilience of Princess Leia

Psychological Report

Name: Leia Organa
Date and Location of Birth: A long time ago in a galaxy far, far away….
Ethnicity/Race: Force-sensitive human
Date of Initial Interview: December 18, 2015
Date of Report: May the 4th, 2016
Therapists: Brandon Saxton, M.S., Katie Gordon, Ph.D.

Presenting Problem
General Leia Organa presented for treatment as a strong, witty, and compassionate woman in her 50s who was referred for treatment by a concerned friend, Chewbacca, for “uuhgguughhhghghghhhgh wuuh raaaaahhgh uugggh aguhwgggghhh raaaaaahhgh huuguughhg.” Translated from Shyriiwook, that meant that she recently suffered the traumatic loss of her ex-husband (Han Solo) at the hands of her son (Ben Solo, aka Kylo Ren, aka Matt the Radar Technician). 

History
Leia reported viewing the timeline of her life as clustering into a series of events that felt like distinct episodes. When asked to elaborate, she provided details about five of these so-called episodes.

Episode III
Leia and her twin brother, Luke Skywalker, were born 19 years before the Battle of Yavin on Polis Massa to their biological mother, Padme Amidala. Tragically, Padme died immediately following childbirth. Meanwhile, their biological father, Anakin Skywalker (Darth Vader) had turned to the dark side and would not have been a suitable parent. A family friend and mentor, Obi-Wan Kenobi, took great care to place Luke and Leia in loving homes. The twins were reared apart: Luke was raised on Tattooine by his step-aunt and step-uncle, while Leia was adopted by Senator Bail and Queen Breha Organa and raised on Alderaan.

Episode IV
The Organas were a royal family, and Leia was a princess on Alderaan. By age 19, she was a member of the Imperial Senate like her father before her. She also worked with the Rebel Alliance, a group fighting the evil Empire. After the Rebels stole the plans for the Empire’s massive weapon (the Death Star), they were given to Leia, a testament to the high regard in which she was held. Darth Vader captured Leia, tortured her, and utilized a mind probe in order to learn the location of the Rebel base. However, none of these strategies were effective on Leia, who exhibited exceptional fortitude and refused to reveal the base location. In response, the Empire tragically destroyed her home planet, killing her entire family. She was ultimately freed from capture by a smuggler named Han Solo, Chewbacca (Han’s co-captain), Obi-Wan Kenobi, and Luke (who she did not know was her brother at the time), and re-emerged as a major player in the ultimately successful mission to destroy the Death Star.

Episode V
Leia continued in a leadership role against the Empire, which attacked the Rebel Alliance’s base on the planet Hoth. She organized the evacuation of the base and then escaped with Han and Chewbacca on their ship, the Millenium Falcon. During their challenging voyage from Hoth to Cloud City to seek ship repairs, Han and Leia fell in love. When they arrived at Cloud City, Darth Vader captured them. He froze Han in carbonite and gave him to a bounty hunter (Boba Fett), who was hired by a gangster named Jabba the Hutt. Eventually, Leia and Chewy escaped Darth Vader with the assistance of Han’s friend, Lando Calrissian, and reunited with Luke. 

Episode VI
Leia courageously developed a plan to disguise herself and rescued Han from Jabba. Unfortunately, she was later captured and enslaved by Jabba. Leia’s bravery, resourcefulness, and strong interpersonal connections helped her to break free (with the help of Lando). She and her friends then went to Endor to continue fighting with the Rebels against the Empire’s second Death Star. With some help from the Ewoks, they successfully defeated the Imperial forces. This episode was particularly significant because Leia learned that Luke was her twin brother and that Darth Vader (now deceased) was her father, and she reaffirmed her love for Han. Leia recalled this period as the beginning of one of the happiest times in her life.

Episode VII
For a while, Han and Leia had a wonderful life together, got married, and had children. The happiness did not last, however. One of their sons, Ben, was training as a young Jedi with Luke and turned to the dark side. Ben took the name Kylo Ren and began working as a commander for the evil First Order. This absolutely devastated Han, Leia, and Luke. Feeling helpless and heartbroken, Han and Leia separated and turned to their old lines of work for solace and distraction while Luke disappeared. Han returned to smuggling with Chewbacca and Leia became the General of the Resistance, leading the fight against the First Order. Circumstances brought Leia and Han together again to fight the First Order, and it was clear that they still shared a deep love and respect for one another. As Han left to disable the First Order’s weapon (Starkiller Base), Leia pled with him to bring their son home, saying, “There is still light in him. I know it.” He tried his best to bring Ben back home, but tragically, Kylo Ren killed Han.

Diagnostic Impressions
All diagnostic assessment information was gathered through behavioral observations (i.e., watching Star Wars movies). Based on the losses and traumatic events Leia went through, it was hypothesized that the most likely disorder that Leia might be experiencing, or be at risk for, was post-traumatic stress disorder (PTSD). When considering the diagnostic criteria for PTSD offered in the current version of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), Leia certainly faced traumatic events (e.g., loss of her home planet, loss of her father, loss of her husband, and the loss of her son to the dark side of the Force). However, Leia did not exhibit any of the other diagnostic features (e.g., re-experiencing of the traumatic event, avoidance of related objects or environments, or hyperarousal) associated with PTSD. Beyond that, Leia did not seem to exhibit any other symptoms related to mental disorders. Her emotional response appeared to be an expected amount of grief and emotional pain in light of the circumstances.

Treatment Recommendations
In summary, Leia does not currently meet the diagnostic criteria for any specific mental disorder. Overall, she appeared to be displaying an appropriate amount of grief given the tremendous amount of loss she had experienced. It is recommended that Leia return for a follow-up session to assess her mental health once some more time has passed to determine whether Leia experiences a normal grieving process. In situations like this, even in the absence of a specific disorder, it is possible for complicated grief to develop. Complicated grief is when an individual engages in avoidant coping strategies while never actually processing through their emotions. Oftentimes, this leads to increased risk for psychological disorders.

In the meantime, Leia should continue to engage in good self-care, embrace social support, and return to therapy if needed. Supportive counseling or bereavement support groups are also options for Leia, should she decide to seek additional help.

Follow-up Appointment: Scheduled for December 15, 2017

GORDON/SAXTON TEST

Was the portrayal of mental health concerns accurate?

It seems unlikely that Princess Leia was written with the goal of portraying any specific mental disorders, particularly given that she isn’t shown to be experiencing any significant symptoms. That being said, the manner in which she handles challenges and losses is certainly within the realm of realism for someone with her resources and personality characteristics. Moreover, while many people develop PTSD in the face of trauma, the majority of people do not. Therefore, the depiction is accurate in that sense as well.

Was the person with mental health concerns depicted with compassion?

As depicted so far, Leia is not experiencing any mental health symptoms; however, we do feel that she is depicted compassionately. The reality is that all individuals face loss, challenges, and adversity in different ways. Leia is seemingly able to navigate these tremendous hurdles with strength and grace. Not only is she able to maintain her personal values and continue pursuing her own goals, she also often provides emotional support and guidance to others.

Overall rating:

On a rating scale from Star Wars: The Holiday Special (it really is terrible) to Star Wars: The Empire Strikes Back (probably our favorite in the series), we give Princess Leia the rating of…. Empire Strikes Back! Princess Leia is a role model for all of us. She is brave, caring, intelligent, and does her best to help others even at great personal risk. Everyone around her looks to her for strength and leadership.

Finally, it is also worth noting that Carrie Fisher, the actress who plays Leia Organa, has been open about her own struggles with mental health issues including bipolar disorder and addiction. She fights stigma and has been a real-life hero to many people.

Buffy’s Battle with Depression

PSYCHOLOGICAL REPORT

Name: Buffy Anne Summers (the Slayer)
Date of Birth: January 19, 1981buffy tells spike
Ethnicity/Race: descendant of the Slayer line
Education: some college, Slayer training
Date of Initial Interview: 11/7/01 (~middle of Season 6)
Date of Report: 09/24/02 (~beginning of Season 7)
Therapists: Katie Gordon, Brandon Saxton

Presenting Problem

Buffy Summers presented as a 20-year-old single woman, who was referred for treatment by her Watcher, Giles. Specifically, Giles expressed concern that Buffy did not seem like herself and that she had recently made statements that she was “going through the motions” and that she wanted “something to sing about.” Giles reportedly had faith in Buffy’s ability to cope effectively with the challenges in her life, but worried that lately he had been “standing in the way” by jumping to her rescue too frequently.

Buffy described feeling down ever since she was brought back from death through witchcraft. Consistent with this, a friend noted that Buffy “came from the grave much graver.” When she was resurrected by her friends, she was in her coffin and had to claw her way out of her own grave. This experience was incredibly traumatic for her. She also struggled with the contrast between happiness in heaven and the return to her stressful life as the Slayer, “There was no pain, no fear, no doubt, ’til they pulled me out of heaven. So that’s my refrain, I live in hell, ’cause I’ve been expelled from heaven.”

Buffy described her emotional state as, “I touch the fire, but it freezes me. I look into it, and it’s black. Why can’t I feel? My skin should crack and peel. I want the fire back.” In addition, she disclosed that she had recently become romantically involved with Spike, a vampire who was in love with her, but who she mostly disliked. She stated that her relationship with Spike was unhealthy, and that she felt disgusted with herself for being part of it.

Family History

Before being called as the Slayer at age 15, Buffy lived in Los Angeles, California with her biological mother (Joyce) and biological father (Hank). Buffy recalled that, prior to becoming the Slayer, she was “popular, superficial, and vapid…kinda like Cordelia (a former classmate of hers).” After her parents divorced when she was 16, Buffy moved to Sunnydale, California with her mother. Buffy had hoped that she would be able to leave her vampire-slaying life behind when she moved. However, she soon learned that Sunnydale was built on a Hellmouth, and that it had even higher levels of supernatural activity than Los Angeles.

Buffy reported that her father had little to no involvement in her life currently, and that she used to blame herself for that when she was younger. Buffy recalled a close relationship with her mother, who tragically and unexpectedly died from a brain aneurysm in the past year. Currently, the only family member she maintained regular, close contact with was her younger sister, Dawn. However, she reported having close friends who she viewed as family members. In addition, she viewed her Watcher, Giles, as a father figure.

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Educational/Employment History

Throughout high school, Buffy faced numerous hardships. She often struggled to balance academics with her other responsibilities (e.g., Slayer training with Giles, nighttime patrolling to protect Sunnydale, fighting off various Big Bads). Moreover, she experienced turmoil about embracing her role as the Slayer, while still feeling a strong desire to be a “normal girl” who had time for fun with her friends and dating, a typical lifespan expectation, and was not responsible for saving the world. When asked to identify two of the most difficult events (of many) that she experienced in high school, she named 1) being killed by the Master (though her friend Xander reviving her meant a lot to her) and 2) her first love, Angel, losing his soul after she lost her virginity to him. When asked how she coped with these stressors, she stated that she was the Slayer – someone chosen to persevere and keep fighting. She also noted that her mother, her Watcher (Giles), her friends (especially Xander and Willow), and Angel (at times when he had his soul) provided support and assisted her, as much as possible, with fighting evil.

After high school graduation, Buffy began college at University of California, Sunnydale. She continued to face similar challenges related to her role as the Slayer, as well as more typical struggles of her peers (feeling used by a man who she thought was genuinely interested in her, making difficult choices about whether to continue a relationship with her boyfriend, Riley). Buffy left college due to her mother’s health problems. Without parental financial support, Buffy was in need of an income quickly and took a job in fast food at Doublemeat Palace. She ultimately tried to reapply for college, but was denied admission.

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Psychiatric/Medical History

When Buffy first saw vampires in Los Angeles, she told her parents, and they scheduled a psychiatric evaluation. The mental health staff viewed her experiences as hallucinations and delusions caused by psychosis. Buffy reportedly stopped talking about vampires after a few weeks, so that she could stop the mental health services. Later, a demon causes Buffy to believe that all of her supernatural experiences and life in Sunnydale were the result of undifferentiated schizophrenia. After taking an antidote to the demon’s poison, Buffy learned that the second experience at the psychiatric hospital was actually a hallucination.

Buffy faced several severe physical injuries (including dying twice) in the past. As the Slayer, her remarkable physical resilience meant that she was not suffering from any medical problems as a result.

Diagnostic Impressions

All assessment information was obtained through record review (reading Buffy comics) and behavioral observations (i.e., binge-watching Buffy the Vampire Slayer on Netflix). The group of symptoms that Buffy presented with are best captured by a diagnosis of major depressive disorder (also referred to as depression). She exhibited five of nine depression symptoms most of the day, nearly every day for well over the minimum of a two-week period required by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The symptoms Buffy displayed were: 1) sad mood (though she tried to hide it from most of her loved ones, she broke down crying to Tara and revealed her deep, persistent sadness), 2) markedly diminished pleasure or interest in activities (as mentioned above, she reported feeling like she was “going through the motions”), 3) feelings of worthlessness or excessive guilt (when Buffy confided in Tara about her relationship with Spike, including using him to feel better about herself, she insisted that what she had done was unforgivable), 4) increased difficulty making decisions (significant indecisiveness about whether she should go back to school or get a job and whether or not she should be involved with Spike – though some of these are typical in light of her circumstances and developmental stage) or increased difficulty concentrating (she blamed herself for not noticing Willow’s magic use getting out of control or Dawn’s frequent shoplifting, and attributed this to difficulty concentrating on things outside of her own pain), and 5) thoughts of death or suicide (Buffy became invisible at one point, learned that she might die again, and then realized that she wanted to live, which implies that she did not before).

buffy crying

Treatment Recommendations

In summary, the most fitting diagnosis for Buffy Summers is major depressive disorder. Currently, there are several well-established treatments for depression that have been tested in rigorous scientific studies. These evidence-based approaches include: behavioral activation, cognitive therapy, cognitive behavioral analysis system of psychotherapy, and interpersonal therapy. In light of Buffy’s busy slaying schedule, it is also possible that she might be interested in some bibliotherapy options rather than standard treatment sessions. Two scientifically-informed options include Feeling Good: The New Mood Therapy and The Mindful Way Through Depression.

In response to numerous stressful life events (e.g., the death of her mother, her own death, having to escape her own grave, the responsibility of caring for her sister without parental support, the responsibility of saving the world), Buffy developed major depressive disorder. She attempted to hide her feelings from her loved ones and coped with her emotional pain with an unhealthy relationship with Spike. A common obstacle that arises for individuals with mental health problems is their fear that they will be judged negatively if they seek help or that they will burden friends if they speak out about it. A therapist should address these obstacles with Buffy by providing her with education about the nature of depression – including taking time to dispel myths that asking for help is a sign of weakness.

Status at Termination (beginning of Season 7)

At follow-up, Buffy returned to her baseline functioning and no longer exhibited symptoms of major depressive disorder. This change could be attributable to multiple factors. Some that likely had an impact were: 1) ending her relationship with Spike, which temporarily lifted her symptoms at times, but ultimately increased her symptoms overall, 2) having her view of herself as defective and pathetic challenged by two individuals who she trusted and who knew her very well (Tara assured her that nothing was wrong with her; Riley affirmed that she was the strongest woman he had ever known), 3) realizing that the responsibility of saving the world did not fall solely on her (her friends, Anya, Giles, and especially Xander, played a huge role in the most recent world-saving), 4) when the world did not end, she had a powerful experience of feeling glad (she previously had not felt a strong internal drive to live), and 5) her feelings of despair were replaced with an excitement and optimism about seeing her sister grow up. Each of these factors appeared to have culminated in a strong sense of purpose, a return of joy, and the reestablishing of meaningful interpersonal connections for Buffy.

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THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

Even in the context of a supernatural universe, Buffy’s major depressive disorder was depicted accurately. She displayed several symptoms that are described in the DSM-5 after experiencing negative life events, which commonly (but not always) precede a major depressive episode. Between the compelling (and entertaining!) acting and writing, the audience could truly get a sense of the deeply painful, often isolating, experience of depression. Moreover, the fact that Buffy – an incredibly physically and mentally strong superhero – is vulnerable to depression, may help to reduce stigma. It sends the accurate message that depression has nothing to do with weakness.

  1. Was the character struggling with mental health issues depicted with compassion?

It is our opinion that Buffy, and her struggle with depression, were depicted with compassion. Viewers see Buffy’s attempts to feel better on her own, as well as her desire to hide her emotional pain from her loved ones in order to protect them. She was reluctant to seek help, which is understandable, but that likely prolonged her emotional pain. One of us may or may not have been brought to tears a few times by the compassion evoked through this portrayal of depression.

Overall rating: On a rating scale from Angelus (least truthful and compassionate) to Angel (most truthful and compassionate), we rate this portrayal of Buffy Summers’ depression as Angel. For the reasons described above, we believe the portrayal reflects an accurate representation of depression in a way that elicits sympathy.

Diagnosing Darth Vader

PSYCHOLOGICAL REPORT

Name: Anakin Skywalker (Darth Vader)DD
Date of Birth: 41 B.B.Y.
Age: 46 (at death)
Ethnicity/Race: Force-Sensitive Human
Education: Jedi Knight, Sith Lord
Date of Report: 03/01/16
Therapists: Katie Gordon, Ph.D., Brandon Saxton, B.S.

Presenting Problem

Anakin Skywalker (Darth Vader) presented as a widowed, 46-year-old man, who was referred for treatment by his son, Luke Skywalker. Specifically, his son expressed concern about his father’s persistent and pervasive pattern of violent, self-centered behavior, which caused significant distress and impairment to his family, co-workers, and the galaxy as a whole.

History

Anakin Skywalker was a Force-sensitive, human born on the desert planet, Tatooine. Anakin was presumed to be born of the will of the Force with no biological father. His mother, Shmi Skywalker, was enslaved when he was born. As such, Anakin was born into slavery as well. As a child, Anakin was noted for his kindness, generosity, intelligence, and willingness to risk his life for others. Even at a young age, Anakin was a very skilled pilot and mechanic.

At age nine, Anakin met Jedi Master Qui-Gon Jinn. Qui-Gon recognized Anakin as being Force-sensitive. Upon testing Anakin’s midichlorian count, it was revealed that he had a higher count than any other Jedi. Qui-Gon, who needed parts for his ship to leave the planet, bet on Anakin in an upcoming pod race. Through his skill as a pilot, Anakin won the pod race, winning not only the needed spaceship parts, but his freedom as well. Qui-Gon asked Anakin to leave the planet with him, hoping that the Jedi Council would allow him to take Anakin as a padawan learner. It was then that Qui-Gon began to suspect that Anakin might be the Chosen One, prophesized to bring balance back to the Force. With excitement, anxiety, and some regret, Anakin left his mother to train with Qui-Gon. Unfortunately, the Jedi Council ruled that Anakin was too old to begin training as a Jedi.

Qui-Gon and his padawan at the time, Obi-Wan Kenobi, were sent on a mission to protect Queen Padme Amidala. The two Jedi faced the Sith Lord, Darth Maul, and Qui-Gon was killed in the battle. With his dying breath, Qui-Gon asked Obi-Wan to take Anakin as a padawan learner despite the ruling of the Jedi Council. It was then that Anakin began his Jedi training.

Anakin’s training under Obi-Wan was not always smooth. Because he began his training at an older age, the other padawan learners were not always accepting of him. Anakin already appeared to have an emotionally labile temperament, and the stressors that he faced (e.g., being a slave, leaving his mother behind, being initially denied by the Jedi Council, losing Qui-Gon Jinn) further fueled those flames. During this period, Anakin started to become aware of how powerful his connection to the Force was. As such, he started to develop a flair of arrogance and sense of superiority over other padawan learners. Observing the power that Anakin possessed led Senator (and eventually Supreme Chancellor) Sheev Palpatine to express interest in young Anakin.

Years later, Anakin met Padme Amidala (then a senator) again, and developed intense, romantic feelings for her. His mentor, Obi-Wan, reminded and warned Anakin that those kind of feelings are expressly forbidden by the Jedi Order, as they often lead to the dark side of the Force. While Anakin was on a solo mission to protect Padme, he experienced dreams of his mother experiencing pain. Anakin believed that his dreams were a vision and quickly left with Padme to return to Tatooine. When he arrived, he found that his mother had been abducted by Tusken Raiders. Anakin found the village she was taken to, but it was too late – she died in his arms. Filled with intense rage, he slaughtered the entire village, including women and children who were not responsible for his mother’s death. He experienced immense pain and guilt at the loss of his mother and his actions. He then vowed to become powerful enough to save those he loved from death. Shortly after, he secretly married Padme.

Later on, Obi-Wan and Anakin embarked on a mission to save Palpatine from General Grevious. Despite Anakin’s reservations, Palpatine convinced him to kill Count Dooku. After the mission, Anakin learned that he was to become a father, as Padme was pregnant. They were both overjoyed by this news, but shortly after, Anakin began to have dreams about Padme dying during childbirth. Recalling how his mother died after his visions, Anakin became desperate to save Padme. He went to Master Yoda for guidance, who simply told him to let go of connections, as they lead to the dark side. Anakin was dissatisfied with Yoda’s response, which provided no comfort or solution. It was also during this period that strong distrust began to form between Palpatine, who requested Anakin to be his representative on the Jedi Council, and the Jedi Council itself, who requested Anakin to spy on Palpatine for them. Despite Anakin joining the Jedi Council to represent Palpatine, the Council still denied him the rank of Jedi Master.

Palpatine sensed the turmoil in Anakin and asked him what was troubling him. It was then that Palpatine told Anakin that he possessed the power to save an individual from death. He revealed himself to Anakin to be the Sith Lord who the Jedi Council were hunting for. He warned Anakin that if he turned him over to the Jedi Council, he would never be able to teach him to save Padme. Jedi Master Mace Windu, Anakin, and other Jedi went to arrest Palpatine. Palpatine defeated some of the Jedi, but right as Windu was about to overpower him, Anakin saved Palpatine, killing Windu. It was then that Anakin realized he had truly fallen to the dark side. Palpatine renamed him Darth Vader. Vader then lead the assault on the Jedi temple, killing all of the Jedi there, including the younglings. He then traveled to Mustafar and killed the entire Separatist Council, effectively ending the Clone Wars. Padme fled to Mustafar to try to get Vader to see the light again. When Vader saw that Obi-Wan was with her, he attacked Padme, Force-choking her. Obi-Wan attacked and dismembered Vader and left him for dead. Palpatine found Vader and rebuilt his body, resulting in him being more machine than human. Palpatine also told Vader that in his rage, he killed Padme. Vader did not know that his children survived.

Having lost his family and friends, Vader felt he had nothing left. Consequently, he became strongly loyal to the now Emperor Palpatine and embraced his new role as an enforcer for the Empire. During this period, he was described as ruthless, merciless, heartbroken, self-loathing, devoted, in emotional and physical pain, impatient, and haunted by his past. He was ruthlessly effective in his new role. About 19 years into Vader’s new role, he learned that his son, Luke, had survived. For the first time in a long time, Vader felt connection and concern for another person. This would ultimately motivate him to turn back to the light before his death.

Diagnostic Impressions

All diagnostic assessment information was gleaned through behavioral observations (i.e., watching Star Wars movies). Based on his history and presenting problems, it was hypothesized that Vader met criteria for a Cluster B personality disorder. Vader exhibited symptoms of antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. Specifically, he met five criteria for antisocial personality disorder: 1) failure to conform to social norms with respect to lawful behaviors (e.g., murders Obi-Wan Kenobi, assaults others regularly), 2) displays of irritability and aggressiveness, as indicated by repeated physical fights (e.g., using the Force to choke people), 3) reckless disregard for the safety of self or others (particularly others), and 4) lack of remorse, as indicated by being indifferent to or rationalizing having hurt or mistreated others (e.g., his justification that others, even the Jedi younglings, deserved to die). Despite these symptoms, antisocial personality disorder was ultimately ruled out due a lack of evidence of conduct disorder before age 15.

While Vader has received prior diagnoses of borderline personality disorder, the behavioral observations do not support this diagnosis. He falls short of the requirement to exhibit five or more of the nine symptoms, and only clearly meets the criteria for two symptoms: frantic efforts to avoid real or imagined abandonment (e.g., turning to the dark side in an effort to prevent Padme’s death) and intense anger and difficulty controlling anger (e.g., killing a large group of Tusken Raiders after his mother’s death, choking pregnant Padme when he thinks that she intentionally led Obi Wan Kenobi to find him in Mustafar).

The constellation of symptoms that Vader presents with appear to best be captured by a diagnosis of narcissistic personality disorder. He exhibits 1) a grandiose sense of self-importance and devalues others (e.g., regarding the Death Star, he tells Admiral Motti, “Don’t be too proud of this technological terror you’ve constructed. The power to destroy a planet is insignificant next to the power the Force,”) and 2) shows arrogant, haughty behaviors or attitudes (e.g., he tells Padme that he will be the most powerful Jedi ever), 3) a preoccupation with fantasies of unlimited success and power (e.g., he tells Padme that he will overthrow the Chancellor and, together, they will rule the galaxy and tells his son, Luke, that he can defeat the Emperor and they can rule the galaxy as father and son), 4) has a sense of entitlement  and unreasonable expectations of automatic compliance with his expectations (e.g., when Admiral Motti challenges him, Vader chokes him and says, “I find your lack of faith disturbing,” Anakin feels entitled to being named a master on the Jedi Council at a younger age than anyone else), 5) a lack of empathy/unwillingness to recognize or identify with the needs of others (e.g., refusal to see Padme and Obi-Wan’s perspectives about his choice to turn to the dark side and responding with aggression toward them), and 6) a belief that others are envious of him (e.g., tells Padme that Obi-Wan Kenobi is holding up his advancement in the Jedi Council back because of jealousy).

Treatment Recommendations

In summary, the most fitting diagnosis for Anakin Skywalker (Darth Vader) is narcissistic personality disorder. Currently, there are not any well-established treatments for narcissistic personality disorder that have been tested in large randomized clinical trials. Approaches that have been used effectively include cognitive therapy and other types of treatment focused on improving relationships with others. Due to numerous extraordinarily stressful life events (separation from his mother, the loss of his wife, being enslaved as a child, extreme physical damage to his body), Anakin developed maladaptive coping skills for dealing with his fear and anger. A therapeutic approach that prioritized building a repertoire of healthy coping skills for effectively managing emotions may have helped him to improve his mental health and reduce the harm he caused others. A common hurdle that arises for individuals with this disorder is low motivation to change in therapy. There is some hope that Anakin might have been motivated to change through his desire to connect with his children.

Status at Termination

When Vader revealed himself to Luke as his father, Luke rejected Vader and the dark side. Vader expressed sadness, not anger, over this. At a later meeting, Luke attempted to convince his father to abandon the dark side and join him, expressing that he sensed the light in his father. Vader told him that it is too late for him and turned Luke over to the Emperor. Through their interrogation of Luke, Vader learned he also had a daughter. The Emperor became angered and attacked Luke using his Force lightning capability. Unable to face this, Anakin attacked and killed the Emperor to save his son. At long last, Anakin fulfilled the destiny and returned balance to the Force. Anakin, knowing that he was dying, asked Luke to remove his helmet so he can see him with his own eyes. He told Luke that he was always right about the light in him and asked him to tell his sister as well. He then passed away peacefully, becoming one with the Force.

THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

Though it is unlikely that George Lucas purposely set out to portray Anakin as having narcissistic personality disorder, the depiction is nonetheless a fairly accurate representation of the disorder.

2. Was the character with mental health issues depicted with compassion?

It is our opinion that Anakin was portrayed as a sympathetic character despite his numerous problematic behaviors. The films tell the story of a boy with enormous talent who faces trauma after trauma and desperately tries to cope and protect his loved ones. He is preyed upon by Palpatine during an extremely vulnerable time and is ultimately unable to resist the dark side.

Overall ratingOn a rating scale from Youngling (least accurate and least compassionate) to Jedi Master (most accurate and most compassionate), we rate this portrayal of Anakin Skywalker as Jedi Master. For the reasons described above, we believe the depiction reflects an accurate representation of narcissistic personality disorder in a way that elicits sympathy despite Anakin’s wrongdoings.