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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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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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 “assholes” 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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Diagnostics with Dwight

PSYCHOLOGICAL REPORT

Name: Dwight Kurt Schrute III
Date of Birth: January 20, 1968
Ethnicity/Race: Caucasian
Education: High school diploma
Employment:  Assistant to the Regional Manager, Dunder Mifflin, Scranton (past)
Paper Salesman, Staples (past)
Beet Farmer, Schrute Farms (current)
Regional Manager, Dunder Mifflin, Scranton (current)
Date of Initial Interview: 09/23/2010
Date of Report: 05/16/2013
Therapists: Brandon Saxton, M.S., Katie Gordon, Ph.D.

Presenting Problem
Dwight Schrute presented as a 42-year-old male who was referred by his boss, Michael Scott, via the Dunder Mifflin Paper Company. Michael had some concerns that Dwight was “kind of weird” and seemed to “not get along with others.” We’re not sure of the scientific validity of that assessment, so we decided to continue with an assessment of our own. Behavioral symptoms seem to include a variety of interpersonal conflicts that have influenced Dwight socially and vocationally.

Social/Family History
Dwight comes from a large and eccentric family. He recalls his own birth, stating specifically that his father, Cody Schrute, removed him from the womb and his mother bit off the umbilical cord. Dwight has one brother and one sister. Beyond that, he stated that he also had a twin in the womb, but he “reabsorbed” his twin giving him “the strength of a grown man and a little baby.” Dwight was born weighing 13 pounds and five ounces and performed his own circumcision. Growing up, Dwight reports that, as per family tradition, the youngest child raised the other children.

Dwight did not seem to want to spend much time describing his childhood. He did mention that he was shunned by his family from approximately age four through age six after he failed to save the extra oil from a can of tuna. He also reported losing an elementary school spelling bee by misspelling the word “failure.” This writer wonders whether these negative events created an avoidance in Dwight when it came to discussing his childhood. At any rate, Dwight was quick to begin describing his life as an adult and time working at Dunder Mifflin.

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Currently Dwight lives in a nine-bedroom, one-bathroom home located on a 60 acre beet farm that he inherited from his family. Dwight currently lives with his cousin Mose. Beyond growing beets on their farm, they also operate a small bed and breakfast and host events including weddings and garden parties. Currently, Dwight is employed as Assistant Regional Manager (it should be noted that his boss, Michael Scott, clarified that Dwight’s actual title is Assistant to the Regional Manager) at the Dunder Mifflin Paper Company. Dwight has been employed with Dunder Mifflin for several years and is considered one of the top sales staff in the company.

Interpersonally, Dwight seems to have a higher than average amount of conflict with his coworkers. This information was primarily obtained through collateral sources (i.e., Dwight’s coworkers and his personnel file). When asked about some, or most, of these incidents, Dwight seemed to not understand why his coworkers reacted the way that they did. A select list of these conflicts follows (for a more thorough review of these conflicts, please consult the large, surprisingly full, manila folder next to Dwight’s medical file). In one instance, Dwight attempted to test his coworkers’ emergency preparedness by locking them all in the office, simulating a fire, and yelling commands to them through a microphone. His coworker, Stanley, had a heart attack. During a subsequent CPR training, Dwight cut the face off the CPR dummy and wore it a la Silence of the Lambs.

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In another instance, Dwight tricked his coworker Phyllis into coming with him on a sales call. He actually drove her to a bad part of town, took her phone and wallet, and left her to walk home. He did this to help his branch win a corporate weight loss competition by forcing her to exercise. A final example included Dwight asking his coworker, Stanley, to join him on a sales call. Stanley declined. As such, Dwight shot Stanley with a bull tranquilizer, wrapped him in bubble wrap, slid him down the stairs, and loaded him into the car. Dwight then took Stanley, unconscious, with him on the sales call. These three examples are a fairly representative example of the types of behaviors in which Dwight engages at his workplace.

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Psychiatric/Medical History
Dwight has not received any formal psychological assessment or treatment. Despite this, there is some indication that he may have suffered from mental health symptoms in the past. For example, in episode 6.12, “Secret Santa,” Dwight says “… I’m just tired. The days are short. I don’t know. Maybe I’m depressed.” In addition, in episode 9.5, “Here Comes Treble,” Dwight says “You don’t think I have anxiety? I have anxiety all the time. Every waking moment of my life is sheer torture.” Taken together, these quotes suggest that Dwight may have previously struggled with an undiagnosed mood or anxiety disorder.

Diagnostic Impressions
All diagnostic assessment information was obtained through an interview with Dwight, his manager, and his workers. Beyond that, we reviewed his HR personnel file (i.e., we watched every episode of The Office. Multiple times). Based on the client’s history and presenting problems, diagnoses related to Cluster B and Cluster C personality disorders were considered. Diagnoses related to depressive and anxiety disorders were not further considered, as the symptoms related to each appeared very brief and not distressing.

A diagnosis related to Cluster B personality disorders, specifically a Narcissistic Personality Disorder, was considered. Dwight only meets the requirement for two of the five or more symptoms required to make the diagnosis. Dwight does exhibit a “grand sense of self-importance.” One example of this behavior in the way in which Dwight persists in calling himself Assistant Regional Manager as opposed to Assistant to the Regional Manager (much to the chagrin of his boss). Dwight also exhibits “arrogant, haughty behaviors or attitudes.” This seems to occur quite often, with Dwight often commenting on how he is a better salesman than his coworkers.

When fully considered, the symptoms that Dwight Schrute is experiencing are best captured by an obsessive-compulsive personality disorder. He exhibits 1) an excessive devotion to work and productivity to the exclusion of leisure activities and friendships (Dwight once comments on a sale that he never takes vacations, sick days, nor celebrates any major holidays – a pattern of behavior that is reinforced when he is named Northeastern Pennsylvania Salesman of the Year), 2) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (Dwight allows himself to be fired to respect his girlfriend, Angela’s, prioritization of privacy in the office; he instigates a formal investigation, including drug testing of every employee of the office, after finding a small amount of marijuana in the parking lot; he goes to excessive lengths to act consistently with his highest personal value, which is respect for authority and hierarchical systems), 3) is reluctant to delegate tasks or to work with others unless they submit to exactly his way of doing thinks (do we need to explain this one?? If you’ve watched the show, you’ve seen this!), 4) shows rigidity and stubbornness (Dwight trying to impress a manager for a promotion despite experiencing acute appendicitis and consistently refuses any flexibility in his actions despite extremely reasonable requests from his coworkers).

 Treatment Recommendations
Currently, there are not any well-established treatments for obsessive-compulsive personality disorder that have been tested in large randomized clinical trials (the gold-standard for testing what treatments work best!) 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 include cognitive therapy, which focuses on challenging maladaptive thoughts related to the disorder. It’s possible that Dwight developed his personality characteristics as a consequence of being raised according the Schrute Family Rules (as Dwight reports, “Schrute boys must learn 40 rules before the age of five. They are told that if they don’t learn their rules, they will be eaten in their sleep.”) Dwight would likely benefit from therapy focused on flexibility and balance to decrease his rigidity with this rule-set.

Status at Termination (last episode)
Sometime later, Dwight returned to our office for a booster session, although this writer wonders whether the session was necessary. It seemed, perhaps, that Dwight more so wanted to share with us his new station in life. He reported having finally achieved the position of Regional Manager at the Dunder Mifflin Scranton office. Dwight reported that he is currently happily married to Angela. The two of them, and their son, Philip, live at Schrute Farms. In addition, Dwight reported that his relationships with this subordinates (yes, he did use that term) had improved dramatically. He said he now considered them all friends (despite firing Kevin Malone). All in all, it seemed that Dwight had experienced significant symptom reduction and was operating and feeling much happier in life.

The Office - Season 9

THE GORDON/SAXTON TEST

Was the portrayal of mental illness accurate?
Full disclosure: some of Dwight’s behaviors are exaggerated. And we’re thankful for it. He is easily one of our favorite fictional characters for this very reason. Despite this exaggeration, some of the behaviors that Dwight exhibits are not entirely out of the question. Oftentimes individuals who grow up in strict, rigid homes develop these characteristics themselves. This does not always lead to the formation of a mental health disorder, but in Dwight’s more extreme case, it certainly seemed to.

Was the character struggling with mental health issues depicted with compassion?
Overall, we do find the portrayal of Dwight to be a compassionate one. Yes, sometimes he is a nuisance to his coworkers. One could even argue that, at times, he is a danger to them! But overall, as the series progresses we see Dwight develop and evolve into a really caring individual and a capable leader. This is the kind of progression that we hope to see with clients in therapy, so seeing it in one of our favorite fictional characters just seems right.

Overall rating:
Overall, from a rating scale from Toby (yuck) to Dwight (oh, yeah!), we would rate the portrayal of Dwight as Dwight K. Schrute, Manager! The Office is one of our favorite shows and Dwight is a main reason for that. He starts off as a rough-around-the-edges kind of person. Throughout the nine seasons, we see him experience a lot and grow into a really lovable character. By the end, Dwight gets along well with his coworkers, has a family, and finally leads the branch!

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.

crossbow

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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