Primal Fear: The Intersection of Law & Psychology with Randolph Brickey

Note: This episode was co-created and produced by Randolph Brickey.

Randolph Brickey is a trial attorney, writer, and former public defender who joined us to talk about the movie, Primal Fear. First, we gave an overview of the plot and characters in the movie. Then, Randolph explained legal terms, such as not guilty by reason of insanity and competency to stand trial. We also talked about how accurate the film was from legal and psychological perspectives. This included discussion of dissociative identity disorder, psychopathy, and malingering, as well as typical outcomes for people found not guilty by reason of insanity. A theme throughout the episode was that certain types of mental health problems tend to evoke more sympathy from judges and juries than others. We enjoyed making this episode a lot, and we hope you enjoy listening to it!

If you like what you hear, please tell a friend, rate and review us on iTunes, and follow us on Twitter. Thanks so much for listening!

Show Notes

Follow Randolph on Twitter and read his writing in places like Ordinary Times, where he once wrote about The Definition of Insanity. You can also hear him on the podcast, This Week in Atrocity. For example, you can find the episode Our Precious Judicial Resources here. Randolph also previously appeared on Jedi Counsel to talk about the Morality of Batman, which was inspired by this Batman article he wrote for Ordinary Times.

Here are links that provide further information about topics from the episode:

-More information about dissociative identity disorder is available here, and in 3 previous episodes of Jedi Counsel here, here, and here.

-A paper called Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder by Foote & Van Orden (2016) is available here.

A New York Times video about dissociative identity disorder

Kenneth Bianchi, one of the Hillside Stranglers, malingered by pretending to have dissociative identity disorder

-A study mentioned in the episode by Spanos et al. (1985)

Cleckley’s book The Mask of Sanity

-A documentary called The Iceman and the Psychiatrist

The Psychopath Test, an episode of This American Life

Episode 117 – Narcissism in The Office Characters with Dr. Leonardo Bobadilla

Professor and clinical psychologist, Dr. Leonardo Bobadilla, joined us to discuss examples of narcissism in characters from The Office. We first discussed where the term narcissism came from and what it means to the public, therapists, and researchers. Then, we talked about different aspects of narcissism: pathological vs. adaptive and grandiose vs. vulnerable. Next, we talked about the narcissistic features that Michael Scott, Andy Bernard, and Ryan Howard express in the show, while recalling our favorite scenes and quotes. We concluded with a discussion of the need for more treatment research. We really enjoyed making this episode for you all, and we hope you enjoy listening to it!

If you like our podcast, please rate and review us on iTunes, check out our website, and follow us on Twitter. Thank you!

For More Information:

Jedi Counsel Episode 111 – Addiction, Personality, & Religion with Dr. Joshua Grubbs

We spoke to Dr. Joshua Grubbs, an Assistant Professor of Psychology, about his research on behavioral addictions (e.g., compulsive sexual behavior, gambling), narcissism, and religious beliefs. First, he told us about the interesting pathway that led him to clinical psychology. Next, he shared how his observations led him to fascinating scientific questions and nuanced answers about the nature of self-perceived pornography addiction. Then, we discussed how Dr. Grubbs has used Motivational Interviewing and Acceptance and Commitment Therapy to help clients live authentic, healthy lives. We concluded with the importance of the Open Science movement for clinical psychology and commentary on the accuracy of fictional depictions of narcissism and behavioral addictions. We learned a lot making this episode, and we hope you enjoy listening to it!

For more information:

Check out Dr. Grubbs’ website and follow him on Twitter.

Learn about Acceptance and Commitment Therapy and Motivational Interviewing.

Learn about Open Science.

Read Addiction by Design: Machine Gambling in Las Vegas.

You can follow Jedi Counsel on Twitter and like us on Facebook. Thanks so much for listening!

Killing Time with Kelly Kapoor

PSYCHOLOGICAL REPORT

Name: Kelly R. Kapoor
Date of Birth: February 5, 1980
Education: High school diploma
Employment: Customer Service Representative, Dunder Mifflin, Scranton (current)
Date of Initial Interview: March 24, 2010
Date of Report: May 16, 2013
Therapists: Katie Gordon, Ph.D., Brandon Saxton, M.S.

Presenting Problem
Kelly Kapoor presented as a 30-year-old woman who was referred for treatment by her on-again/off-again romantic partner, Ryan Howard. Ryan was not very friendly or clear about why he was dropping Kelly off at our office. He kind of just ushered her in, while she was speaking to him rapidly about the latest pop culture drama, and then quickly left the building.

History
Listen; to whoever reads this report, we’ll be honest. It was very hard for us to get any relevant history from Kelly during this interview…we learned that she has three living sisters and one who passed away. She also mentioned that she spent a year in a juvenile detention center for stealing her ex-boyfriend’s father’s boat.

The rest of the interview covered an incredible range of information on various celebrities’ lives. At one point, after asking more about her life, she explained that she had so much to tell us about and then proceeded to report that Brad Pitt and Angelina Jolie had a baby that they named Shiloh. We reiterated our question asking for more information about her life, and she replied that she had just told us more. This example is representative of what the entire interview was like.

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Diagnostic Impressions
All assessment information was gleaned from behavioral observations (i.e., watching The Office more times than one would think is humanly possible – like, probably thousands of times between the two of us). It appeared that Kelly’s presenting problem was best captured by a diagnosis of histrionic personality disorder, which is “a pervasive pattern of excessive emotionality and attention-seeking.” Specifically, she met criteria for 5 of 8 symptoms of histrionic personality disorder: 1) is uncomfortable in situations in which he or she is not the center of attention (e.g., Kelly’s new year’s resolution was “to get more attention by any means necessary”); 2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior (e.g., she asked a co-worker if she should seduce her new boss, Charles Miner, shortly after meeting him; she started a musical duo with co-worker, Erin, that is ironically called Subtle Sexuality); 3) shows self-dramatization, theatricality, and exaggerated expression of emotion (e.g., in an effort to get her ex-boyfriend and boss, Ryan, to pay attention to her, she asks him, “How dare you?” in the middle of a work meeting that he is conducting and also faked a pregnancy, when deciding between getting back together with Ryan and staying with her boyfriend Ravi, she said, “Ravi makes me incredibly happy. And Ryan puts me through so much drama. So, I guess I just have to decide which of those is more important to me”); 4) is suggestible (i.e., is easily influenced by others or circumstances; e.g., Dwight convinces Kelly to apply for an executive training program to suit his own needs, describing her as a “malleable simpleton who can be bought for a few fashion magazines”); and 5) considers relationships to be more intimate than they actually are (she overestimates the strength of her romantic relationships with Ryan and Darryl, as well as the strength of her friendship with Pam – e.g., she asks Pam if she can be her bridesmaid).

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Treatment Recommendations
Currently, there are not any well-established treatments for histrionic personality disorder that have been tested in large randomized clinical trials. Approaches that have been used effectively include cognitive therapy focused on thoughts and behaviors that emphasize assertiveness and sharing attention with others over theatricality and self-centeredness in interpersonal interactions.

Status at Termination
The last we saw of Kelly was at Dwight and Angela’s wedding. Ryan intentionally induced an allergic reaction in his child, so that Kelly’s husband, Ravi (a pediatrician), would focus on the child’s medical needs, while Kelly and Ryan ran off together. Needless to say, this does not reflect a ton of therapeutic progress or serve as a great prognostic sign for things to come.

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THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

Though it is unlikely that Kelly was purposely designed as a character with histrionic personality disorder, the depiction nonetheless portrays some of the symptoms accurately. However, the symptoms are exaggerated, at times, for comedic effect.

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

Kelly was not particularly characterized in a way that elicits compassion. She typically appears to be viewed as annoying and shallow by her co-workers.

Overall ratingIf this depiction of histrionic personality disorder in Kelly Kapoor were to receive a Dundie, it would be the Jenna Maroney-of-30-Rockish Dundie.

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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!

Diagnosing Dunder Mifflin’s Finest

PSYCHOLOGICAL REPORT

Name: Michael Gary Scott
Date of Birth: March 15, 1964
Education: High school diploma
Employment: Regional Manager, Dunder Mifflin Scranton (past), CEO, Michael Scott Paper Company (past), Director of Paper Distribution, Department of Natural Resources (current)
Date of Initial Interview: 9/23/2010
Date of Report: 5/16/2013
Therapists: Katie Gordon, Ph.D., Brandon Saxton, B.S.

Presenting Problem
Michael Scott presented as a 46-year-old man who was referred, interestingly, by all of his employees and supervisors at the Dunder Mifflin Paper Company. Michael was referred primarily due to problems related to a consistent pattern of interpersonal conflicts. The behavioral symptoms Michael was exhibiting have resulted in financial, vocational, and social impairment.

History of Presenting Problem
Behavioral observations were gathered to determine the extent and severity of Michael’s presenting problem. We selected a few of the more diagnostic moments to outline in further detail. An exhaustive outline can be gleaned through watching The Office.

Some of the specific examples that we observed included:

  • Experiencing emotions that are unstable, intense, and/or out of proportion with the given circumstances
    1. When Michael asks Carol (his realtor and, at the time, short-term significant other) to marry him spontaneously at a Diwali celebration
    2. When Michael photoshops himself into a picture of Carol and her children by putting his face over the face of her ex-husband and uses it as a Christmas card
    3. When Michael locks all of his co-workers in the office after they joke that jail seemed better than the office
    4. When a pizza delivery boy does not accept Michael’s coupons and he won’t let him leave the building
    5. Demanding one of his gift baskets back when potential customers won’t give Dunder Mifflin their business
  • Attention-seeking in ways that antagonize others
    1. Getting an iPod for the office Secret Santa exchange instead of sticking to the $20 limit
    2. Buying himself a World’s Best Boss mug
    3. Taking over the corporate-mandated diversity training and making his own “diversity training”
    4. Calling meetings others have to attend, often times for personal reasons
    5. Insisting on being in Phyllis’ wedding party and giving an uninvited toast
  • Behaving irresponsibly, impulsively, and engaging in dangerous risk taking
    1. Quitting his job to start his own paper company on a whim
    2. Reconciling with his ex-girlfriend Jan because she got breast implants
    3. Promising economically disadvantaged children that he will pay for their college tuition if they graduate from high school when he does not have the resources
    4. Playing with the baler in the warehouse despite how unsafe it is and being explicitly told not to
    5. Planning to jump off a building onto a bounce house

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Family History
Michael was born in Scranton, PA. He came from a single-parent home (though his mother did remarry) and described his childhood as lonely. Michael stated that he has an older brother as well as a half-sister with whom he had a tumultuous relationship. However, the two did reconcile, leading to Michael hiring his nephew Luke as an intern. Michael did not talk much about his childhood, but did offer a few memories that seem to stand out to him. For example, Michael was once featured on an episode of the television show Fundle Bundle. On the episode, when asked what he would like to do when he grows up, Michael replied,“I wanna be married and have 100 kids so I can have 100 friends. And no one can say no to being my friend.” Another childhood memory Michael has was attending a baseball game with Jeff, who he identifies as his “mother’s boyfriend, who she married.” Michael went on to say that during the game he “… felt really bad, because the pitcher wasn’t able to play with his friends anymore. But Jeff said that the manager was making a really good move, by taking the pitcher out. He really respected the manager.”

Educational/Employment History
Michael graduated high school on time in Scranton, PA. He was not able to attend college though, as he lost his tuition money in a pyramid scheme. Michael seemed to hold a variety of jobs during/after high school, including a position as a greeter at Men’s Warehouse. He reported receiving his position at Dunder Mifflin after following an attractive women to the office park, where the Scranton office is located. Michael started with the company as a salesman, a position in which he excelled. After becoming the best salesman in the company, evidenced by his winning consecutive awards for best salesman, Michael was promoted to a regional manager position. Unfortunately, it seemed that the qualities that made Michael great at sales did not translate to the managerial position.

Psychiatric/Medical History
After Michael physically reprimanded his nephew, Luke, for being insubordinate, the corporate office mandated that he attend six hours of counseling with Toby Flenderson from the Human Resources department of the Scranton branch. Due to Michael’s strong dislike of Toby, he refused to engage in the counseling process. Michael began the session by refusing to speak and then reporting fictional stories as his own life. Over time, Michael began to inadvertently share details from his life with Toby. Once he realized this, Michael got angry and refused to participate. Toby eventually gave up on the entire process and allowed Michael to fill out the counseling report himself. The records indicated that Michael was severely depressed and homicidal. We have chosen not to include these results further in this assessment, as we question their validity.

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Diagnostic Impressions
As mentioned above, information about the presenting problem was obtained through behavioral observations (i.e., viewing The Office repeatedly) and by filling out a self-report personality questionnaire as we imagined Michael Scott would (this is not a valid method and should not be used in real life).

Because Michael exhibited a persistent pattern of interpersonal issues, it was hypothesized that he might meet criteria for a personality disorder. While Michael had substantial distress and impairment from issues associated with his personality characteristics, he did not meet diagnostic criteria for any of the ten personality disorders that are specified in the current version of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). Rather, his symptoms were best captured by a category that is used when there are significant personality issues that do not fit within the other categories: other specified personality disorder.

A diagnosis of other specified personality disorder does not provide nuanced details about Michael’s specific presentation, so we utilized the alternative model for personality disorders in the appendix of DSM-5 to further explore his presentation. This model moves away from the traditional categorical models of personality disorder (i.e., you either have a personality disorder or do not, with no in-between) through its focus on dimensional measures of 1) personality functioning impairment in four domains and 2) five research-derived pathological personality traits.

We rated personality functioning impairment on the DSM-5 scale from 0 (little or no impairment) to 4 (extreme impairment) based on the match between our behavioral observations and one or more of the descriptions at each level. The results are presented and described below:

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  • Identity (moderate impairment): “Has vulnerable self-esteem controlled by exaggerated concern about external evaluation, with a wish for approval” and “Emotional regulation depends on positive external appraisal. Threats to self-esteem may engender strong emotions such as rage or shame”
  • Self-Direction (some impairment): “May have an unrealistic or socially inappropriate set of personal standards, limiting some aspects of fulfillment”
  • Empathy (severe impairment): “Ability to consider and understand the thoughts, feelings, and behavior of other people is significantly limited” and “is confused about or unaware of impact of own actions on others”
  • Intimacy (severe impairment): “Relationships are based on a strong belief in the absolute need for intimate others”

Pathological personality trait scores were derived from the self-report questionnaire that we filled out as we thought Michael would (again, you should not do this in real life ever). Scores ranged from a minimum of 0 (reflecting low levels of a trait) and a maximum of 3 (reflecting high levels of a trait) and were believed to underlie the functional impairment described above. The results are presented and facets that fit Michael are listed:

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  • Negative Affect: “instability of emotional experiences and mood; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances”
  • Detachment: This refers to a tendency to generally avoid interpersonal experiences and does not apply to Michael.
  • Antagonism: “engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration”
  • Disinhibition: irresponsibility, impulsivity, distractibility, dangerous risk-taking
  • Psychoticism: This reflects odd or bizarre thought processes and behavior and does not apply to Michael.

Treatment Recommendations
In summary, the most appropriate categorical diagnosis for Michael Scott was other specified personality disorder. His significant distress and impairment appeared to be most related to his persistent pattern of speaking and behaving impulsively (reflecting his high levels of disinhibition), paired with an intense need to be liked. When he believed that someone disapproved of him or his behavior (often because he had offended them with his impulsive behavior due to impaired perspective-taking), he tended to spiral into a dysregulated, negative emotional state (consistent with his elevated level of negative affect). He then coped with this painful emotional state by engaging in attention-seeking (reflected in his elevated level of antagonism), and sometimes vengeful, behavior which usually exacerbated the problem.

While there is not a specific scientifically-tested and supported treatment for other specified personality disorder, there are therapeutic strategies designed to specifically strengthen impulse control, increase interpersonal skills, and build adaptive emotional coping. Michael would likely experience improvement in his symptoms if he worked with a therapist in these areas, while capitalizing on his strengths: being a fun-loving person who cares a lot about his relationships with others.

Status at Termination (last episode)
At follow-up, Michael exhibited substantial improvement in his personality functioning. While he retained his unique (and sometimes inappropriate) sense of humor and life perspective, he appeared to become more skilled at navigating interpersonal relationships and formed meaningful relationships with his co-workers. Their affection for Michael was evident as they said good-bye to him when he moved to Colorado to be with his wife, Holly, and their excitement at seeing him a few years later at Dwight & Angela’s wedding. He reported that he and Holly had a fun and mutually supportive marriage and that he enjoyed being a father very much.

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THE GORDON/SAXTON TEST
Was the portrayal of mental illness accurate?
Michael Scott was created as a comedic character who repeatedly offends people by speaking and acting in incredibly inappropriate ways. While the creators of the show were likely aiming to make a character who would make people laugh because of his unusual personality, it is highly doubtful that they had a personality disorder in mind. Thus, by design, Michael Scott is not a realistic representation of someone suffering from a mental disorder. That being said, some of the aspects of his personality that lead to problems (excessive and intense need for others’ approval, disinhibited behavior, marked emotional fluctuation) do represent realistic components of some mental disorders. However, these pathological personality traits do not typically present in the extreme and silly manner that is portrayed in The Office. In conclusion, no, it is not an accurate portrayal of mental illness, but Michael Scott is an incredibly entertaining character.

Was the character struggling with mental health issues depicted with compassion?
In the earlier episodes of The Office, Michael is not presented as a sympathetic character. He ridicules numerous people based on personal qualities (e.g., appearance, age, ethnicity, sexual orientation, ability, gender) and acts in an irrational manner. However, as the seasons progress, the audience sees more of Michael’s sweet, caring, fun side, and this results in more compassion for his struggles and more sympathy about his lack of insight into his role in his own struggles.

Overall rating:
When considered overall, we award The Office with a Dundie for the “Best Television Show Ever!” Although the portrayal of mental illness is not entirely accurate, the writers did not set out with this goal in mind. We can’t fault them for missing a goal that they never had. Beyond that, the show does not seem to add to the stigmatization of mental disorders. In fact, in the episode Here Comes Treble (Season 9, Episode 5) Nellie helps to dispel some of the misconceptions that Dwight holds about individuals suffering from anxiety. And in the episode Stairmageddon (Season 9, Episode 19), Jim approaches Toby to ask what he and Pam can expect from couples counseling. Both episodes normalize experiences related to receiving mental health services.

Diagnosing the Dark Knight

PSYCHOLOGICAL REPORT

Name:  Bruce Wayne, aka Batman
Date of Birth: February 19th
Age: 30 – 32 years of age (in the current Batman comics)
Ethnicity/Race: Caucasian
Education: Degrees in Criminal Science, Forensics, Computer Science, Chemistry, Engineering, Biology, Physics, Advanced Chemistry, and Technology
Date of Initial Interview: 3/01/2016
Date of Report: 3/24/2016
Therapists: Brandon Saxton, Kathryn Gordon

Presenting Problem
Bruce Wayne (Batman) presented as an approximately 30- to 32-year-old man, who was referred for treatment by his former guardian and current butler, Alfred Pennyworth. Alfred primarily had concerns related to the traumatic loss of Bruce’s parents at a young age and the obsessive and unrelenting way that he wages war on the criminals of Gotham City which has resulted in significant distress, physical harm, and in some cases death to his family, co-workers and the individuals he apprehends.

History
Bruce Wayne was born on February 19th in Gotham City. Bruce was the only child of Thomas and Martha Wayne. In addition to his medical career, Thomas and his wife, Martha, owned Wayne Enterprises and were both dedicated philanthropists. They were both heavily involved in efforts to restore Gotham City which was battling a depression, rising crime rates and corruptions, and overall despair. Overall, Bruce reported mostly positive memories regarding his childhood, during which he lived with his parents and butler at Wayne Manor. Bruce identified two traumatic childhood events that helped to shape him into who he is today. The first occurred when he was very young and playing on the grounds surrounding Wayne Manor. While playing, he fell through a hole in the ground that dropped him into a cave system that ran under Wayne Manor. Unfortunately for young Bruce, the cave system was home to hundreds of bats. He reported that this instilled in him a strong fear of bats. Subsequently, he reported seeing one uniquely large bat from the cave system multiple times following the event.

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The second traumatic event that Bruce reported occurred a while after when he fell into the cave system. Bruce, along with his parents, attended the film The Mask of Zorro. As they were leaving the theater, the Wayne family was confronted by a mugger demanding their valuables. Thomas resisted the mugger which resulted in both he and Martha being shot and killed. Bruce was left alone with the dead bodies of his parents. Bruce identified this as being the most traumatic and defining moment of his life. With the passing of Bruce’s parents, Alfred, the family butler, became his guardian and caretaker. While processing his parents’ murder, Bruce reported experiencing a great deal of distress. At the peak of this transformative process, Bruce recalled finding himself standing in front of the graves of his parents. It was then and there that he vowed to get vengeance for what happened to his parents and to keep that from happening to anyone else ever again. Bruce reported that this was the moment where, in his mind, Bruce Wayne died, and Batman was born.

Holding true to the promise he made at the graves of his parents, Bruce threw himself into his schoolwork. He was very successful and reported performing at the top of his class. After graduating high school, Bruce left the country to travel the world training under a variety of martial arts masters. He sought out the best of each discipline to train under. When he felt prepared, he returned to Gotham City to begin his crusade against the criminal underworld. Bruce started off small by simply patrolling the more dangerous areas of Gotham City on foot. His goal was singular; to learn more about the criminals that ran Gotham City. Unfortunately, one night Bruce was attacked and involved in a street brawl. As a result of the fight, he was seriously injured. Bruce was fortunate enough to make it back to Wayne Manor safely and without being identified. Bloody, broken, and seemingly defeated, Bruce recalled sitting in his father’s study. Contemplating what went wrong, he realized that criminals, although cowardly and superstitious, would never fear a common, unarmed man on the street. At that moment, the large bat he had reported seeing previously made its return. The bat smashed through the window into the study. Though nearing unconsciousness, due to blood loss — the answer was obvious to Bruce. He would become the thing he feared most, a bat.

With the help of Alfred, Bruce worked tirelessly to design a functional, yet frightening suit, weaponry, and base of operations for the Batman. Ultimately, Bruce settled on the cave system under Wayne Manor which he coined “the Batcave.” Bruce reported that he grew quickly as the Batman. As he combined experience to his years of training, he become much more effective and competent. The police force, ripe with corruption, demonized and hunted him. However, there was one officer, James Gordon, who held out against the corruption. After some time, Batman and James Gordon began what would be a long-term professional partnership. As Batman gained more notoriety, the villains he faced evolved from common criminals to supervillains. Bruce reported that some of the more fearsome foes he faced included Edward Nygma, known as The Riddler, Oswald Cobblepot, known as The Penguin, Harvey Dent, known as Two-Face, Pamela Isley, known as Poison Ivy, Dr. Jonathan Crane, known as Scarecrow, and perhaps most fearsome of all, the Joker, whose identity is yet unknown. As the criminals of Gotham City evolved, Batman knew he had to as well.

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To ramp up his war on crime, Batman decided to take a sidekick. Dick Grayson, known at the time as Robin, joined Batman. For quite some time, the two worked well together in what was a major change in the way Batman, who was used to operating alone, battled crime. However, as the criminals became more dangerous, Bruce decided he did not want to place Robin in more danger than was necessary. As such, Batman started to keep Robin on the sidelines. Eventually, the two split, with Dick Grayson taking up the mantle of Nightwing and leaving to operate independently of Batman. Sometime later, Batman took his second Robin, Jason Todd. Todd was a young man whose parents were killed by Two-Face. Bruce reported empathizing with Todd’s experience and wanting to help guide the young man down a path where he could channel his emotional responses for good. Despite this, Todd was much more rebellious and angry in his approach to crime fighting than Dick Grayson was before him. One night, while working solo, Jason Todd was taken, tortured, and killed by the Joker.

Bruce reported that the loss of Jason Todd hit him hard. He returned to fighting crime alone as a much darker force than he ever had been before. This new, darker, less refined Batman was noticed by a young boy named Tim Drake. Tim, an extremely bright young man, was able to work out the identity of Batman and the original Robin, Dick Grayson. He urged Dick Grayson to return to his role as Robin, as he felt that Batman needed someone to stabilize and support him again. Dick Grayson refused to return as Batman’s sidekick. However, through this pursuit, Tim Drake himself ended up becoming the third Robin. Bruce reported refusing to make the same mistake again and insisted that Tim train with the individuals from whom Bruce learned. As a result, Tim was a Robin who was much closer in ability to Batman himself.

Bruce then reported what he identified as the most challenging moment of his career, a time where he was not able to wear the cape and cowl. This period of time was the result of Batman battling and ultimately being defeated by the criminal known as Bane. Bane was able to defeat Batman, physically overpowering him and breaking his spine. While Bruce recovered, one-time villain, Azrael, took the mantel of the Bat. Azrael proved a poor Batman though, becoming so unstable that he was eventually close to executing criminals. Bruce was able to recover and defeat Azrael to reclaim the cowl.

Tim Drake moved onto a new, more independent role as Red Robin. Meanwhile, Bruce’s son, which he didn’t know he had, Damian Wayne, stepped into the role as the next Robin. Damian’s mother was Talia al Ghul, the daughter of Ra’s al Ghul, leader of the League of Assassins. As such, Damian received training from the league and was exceptionally skilled. Bruce, however, clashed with his son’s assassin training and reported trying his best to instill in him the values he had gotten from his parents. However, in an event outside of his control, Damian was killed battling an adult clone of himself known as The Heretic. Bruce reported that this event would have ended him without the support of the Bat-family and Alfred.

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Assessment & Diagnostic Impressions
All diagnostic assessment information was obtained through this interview and behavioral observation (i.e., Batman comics, television shows, and movies). Based on the client’s history and presenting problems, diagnoses related to posttraumatic stress disorder, cluster B personality disorders, and cluster C personality disorders were considered. Bruce does exhibit some symptoms related to posttraumatic stress disorder. Specifically, he met the following criteria: 1) exposure to actual of threatened death, serious injury, or sexual violence (the murder of his parents), 2) presence of intrusion symptoms associated with the traumatic event, beginning after the traumatic event(s) occurred (Bruce experiences repeated distressing memories, dreams, flashbacks, and distress at symbols of the death of his parents), and 3) marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred (the war Bruce wages on Gotham could be defined as reckless or self-destructive behavior with elements of hypervigilance). Ultimately, a diagnosis of posttraumatic stress disorder was ruled out because Bruce does not meet all of the required criteria, specifically avoidance of stimuli associated with the traumatic event, as evidenced by his being the Batman.

A diagnosis related to cluster B personality disorders, specifically borderline personality disorder, was also considered. Bruce only meets the requirements for two of the five or more symptoms required to make the diagnosis. Bruce does experience some identity disturbance (e.g., he sometimes seems unsure of whether he is Bruce Wayne or Batman, many times moving between the two). Bruce also experiences inappropriate, intense anger or difficulty controlling anger at times when dealing with criminals. Taken together though, these two symptoms do not constitute borderline personality disorder.

When fully considered, the symptoms that Bruce Wayne is presenting with are best represented by obsessive-compulsive personality disorder. He experiences 1) an excessive devotion to work and productivity to the exclusion of leisure activities and friendships (he often disregards relaxation and social activities to pursue his mission of justice), 2) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (Bruce refuses to deviate from his moral compass under any circumstances), 3) is reluctant to delegate tasks or to work with others unless they submit to exactly his way of doing things (this is demonstrated both in the way he mentors his sidekicks but also in the way he serves as a tactician for the Justice League), 4) shows rigidity and stubbornness (once again, Bruce does not deviate from his moral compass and refuses to abandon his war on crime even if it means he dies in the line of duty).

Treatment Recommendations
In summary, the most fitting diagnosis for Bruce Wayne (Batman) is obsessive-compulsive personality disorder. Currently, there are not any well-established treatments for obsessive-compulsive personality disorder that have been tested in large randomized clinical trials. It is worth noting that obsessive-compulsive personality disorder is different from obsessive-compulsive disorder, which is a disorder that does have clear evidence-based treatment for it. Approaches that have been used effectively with obsessive-compulsive personality disorder include cognitive therapy, which focuses on challenging maladaptive thoughts related to the disorder. Following his experience of trauma due to an act of evil (i.e., witnessing the murder of his parents as a young boy), Bruce developed a strong moral code focused on helping others through his pursuit of justice and committed firmly to upholding it. While this has been of great benefit to the people of Gotham City and beyond, at times, it has come at the cost of his personal health and happiness. A therapeutic approach that prioritizes flexibility and healthy balance as goals may help Bruce to improve his mental health and experience less symptoms of obsessive-compulsive personality disorder.

Status at Termination
Six months later, Bruce returned to our office. He reported that a lot had happened since our first appointment. During this time, Batman faced off against Joker in what Bruce reported was the hardest battle of his life. The Joker was set to release the Endgame Virus in Gotham City. During the conflict, it appeared that both Batman and the Joker had died. Ultimately, Bruce ended up surviving, but lost all of his memories. The loss of his parents, his training, and his time as Batman, everything that made Bruce the Batman, was gone. Bruce reported that he started living a normal life, getting more involved in Wayne Enterprises, and even meeting someone to whom he got engaged. Bruce was seemingly happy and healthy. However, after some time, it all fell apart. Even without conscious access to his memory, Bruce knew he was supposed to be doing and giving more. His engagement ended and he withdrew from his more active role in Wayne Enterprises. He demanded to a heartbroken Alfred to be taken to his cave, of which he had no memory of. Even though he did not necessarily want to, he decided to be the Batman again.

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THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

The symptoms that Bruce Wayne experiences related to obsessive-compulsive personality disorder appear to be accurately depicted. Beyond that, Batman serves as an example of someone who takes what is an extremely traumatic event and uses it to find meaning and purpose in life. He uses the death of his parents as a drive to make positive changes in the world around him as both Bruce Wayne (e.g., pursuing philanthropic efforts such as an orphanage funded by the Wayne Foundation) and Batman (e.g., by keeping criminals off the street to prevent other children from experiencing what he did.

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

We find the portrayal of mental illness most broadly seen across mediums portraying Batman to be compassionate. Although authors do not typically set out to depict Batman as experiencing mental illness, it is clear that he has experienced severe trauma that influences him throughout his life. Beyond that, many of Batman’s greatest villains experience mental illness more explicitly. Particularly, in the seminal Batman: The Animated Series, these individuals are portrayed very compassionately, with Batman often empathizing with their experiences and seeking to rehabilitate them.

Overall rating: From a rating from Superman (e.g., the worst ever) to Batman (e.g., the best ever) we rate the overall depiction of Batman as… Batman (sorry Superman fans!). For the reasons above, we believe that Batman’s universe serves as an accurate and compassionate depiction of mental illness. Even as a fictional character, Batman has served as a real-life inspiration for others who are also pressed to overcome insurmountable challenges and odds (e.g., such as depicted in the documentary Legends of the Knight) or want to make a difference for those in need (e.g., organizations such as the real life Wayne Foundation).

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**Disclaimer**

Bruce Wayne, the Batman, made his debut in Detective Comics #27 on May 19, 1939. Over the last 75-plus years, Batman has been portrayed in comics, novelizations, video games, television shows, and movies by a variety of different actors, authors and directors across multiple timelines in the DC Comics Multiverse. As such, this evaluation focused on the most well-known canonical story as presented by Bruce Wayne during the timeline in the current Batman series by Scott Snyder and illustrated by Greg Capullo (which we recommend!)

 

 

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.