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!
Name: Buffy Anne Summers (the Slayer)
Date of Birth: January 19, 1981
Ethnicity/Race: descendant of the Slayer line
Education: some college, Slayer training
Date of Initial Interview: 11/7/01 (~middle of Season 6)
Date of Report: 09/24/02 (~beginning of Season 7)
Therapists: Katie Gordon, Brandon Saxton
Buffy Summers presented as a 20-year-old single woman, who was referred for treatment by her Watcher, Giles. Specifically, Giles expressed concern that Buffy did not seem like herself and that she had recently made statements that she was “going through the motions” and that she wanted “something to sing about.” Giles reportedly had faith in Buffy’s ability to cope effectively with the challenges in her life, but worried that lately he had been “standing in the way” by jumping to her rescue too frequently.
Buffy described feeling down ever since she was brought back from death through witchcraft. Consistent with this, a friend noted that Buffy “came from the grave much graver.” When she was resurrected by her friends, she was in her coffin and had to claw her way out of her own grave. This experience was incredibly traumatic for her. She also struggled with the contrast between happiness in heaven and the return to her stressful life as the Slayer, “There was no pain, no fear, no doubt, ’til they pulled me out of heaven. So that’s my refrain, I live in hell, ’cause I’ve been expelled from heaven.”
Buffy described her emotional state as, “I touch the fire, but it freezes me. I look into it, and it’s black. Why can’t I feel? My skin should crack and peel. I want the fire back.” In addition, she disclosed that she had recently become romantically involved with Spike, a vampire who was in love with her, but who she mostly disliked. She stated that her relationship with Spike was unhealthy, and that she felt disgusted with herself for being part of it.
Before being called as the Slayer at age 15, Buffy lived in Los Angeles, California with her biological mother (Joyce) and biological father (Hank). Buffy recalled that, prior to becoming the Slayer, she was “popular, superficial, and vapid…kinda like Cordelia (a former classmate of hers).” After her parents divorced when she was 16, Buffy moved to Sunnydale, California with her mother. Buffy had hoped that she would be able to leave her vampire-slaying life behind when she moved. However, she soon learned that Sunnydale was built on a Hellmouth, and that it had even higher levels of supernatural activity than Los Angeles.
Buffy reported that her father had little to no involvement in her life currently, and that she used to blame herself for that when she was younger. Buffy recalled a close relationship with her mother, who tragically and unexpectedly died from a brain aneurysm in the past year. Currently, the only family member she maintained regular, close contact with was her younger sister, Dawn. However, she reported having close friends who she viewed as family members. In addition, she viewed her Watcher, Giles, as a father figure.
Throughout high school, Buffy faced numerous hardships. She often struggled to balance academics with her other responsibilities (e.g., Slayer training with Giles, nighttime patrolling to protect Sunnydale, fighting off various Big Bads). Moreover, she experienced turmoil about embracing her role as the Slayer, while still feeling a strong desire to be a “normal girl” who had time for fun with her friends and dating, a typical lifespan expectation, and was not responsible for saving the world. When asked to identify two of the most difficult events (of many) that she experienced in high school, she named 1) being killed by the Master (though her friend Xander reviving her meant a lot to her) and 2) her first love, Angel, losing his soul after she lost her virginity to him. When asked how she coped with these stressors, she stated that she was the Slayer – someone chosen to persevere and keep fighting. She also noted that her mother, her Watcher (Giles), her friends (especially Xander and Willow), and Angel (at times when he had his soul) provided support and assisted her, as much as possible, with fighting evil.
After high school graduation, Buffy began college at University of California, Sunnydale. She continued to face similar challenges related to her role as the Slayer, as well as more typical struggles of her peers (feeling used by a man who she thought was genuinely interested in her, making difficult choices about whether to continue a relationship with her boyfriend, Riley). Buffy left college due to her mother’s health problems. Without parental financial support, Buffy was in need of an income quickly and took a job in fast food at Doublemeat Palace. She ultimately tried to reapply for college, but was denied admission.
When Buffy first saw vampires in Los Angeles, she told her parents, and they scheduled a psychiatric evaluation. The mental health staff viewed her experiences as hallucinations and delusions caused by psychosis. Buffy reportedly stopped talking about vampires after a few weeks, so that she could stop the mental health services. Later, a demon causes Buffy to believe that all of her supernatural experiences and life in Sunnydale were the result of undifferentiated schizophrenia. After taking an antidote to the demon’s poison, Buffy learned that the second experience at the psychiatric hospital was actually a hallucination.
Buffy faced several severe physical injuries (including dying twice) in the past. As the Slayer, her remarkable physical resilience meant that she was not suffering from any medical problems as a result.
All assessment information was obtained through record review (reading Buffy comics) and behavioral observations (i.e., binge-watching Buffy the Vampire Slayer on Netflix). The group of symptoms that Buffy presented with are best captured by a diagnosis of major depressive disorder (also referred to as depression). She exhibited five of nine depression symptoms most of the day, nearly every day for well over the minimum of a two-week period required by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The symptoms Buffy displayed were: 1) sad mood (though she tried to hide it from most of her loved ones, she broke down crying to Tara and revealed her deep, persistent sadness), 2) markedly diminished pleasure or interest in activities (as mentioned above, she reported feeling like she was “going through the motions”), 3) feelings of worthlessness or excessive guilt (when Buffy confided in Tara about her relationship with Spike, including using him to feel better about herself, she insisted that what she had done was unforgivable), 4) increased difficulty making decisions (significant indecisiveness about whether she should go back to school or get a job and whether or not she should be involved with Spike – though some of these are typical in light of her circumstances and developmental stage) or increased difficulty concentrating (she blamed herself for not noticing Willow’s magic use getting out of control or Dawn’s frequent shoplifting, and attributed this to difficulty concentrating on things outside of her own pain), and 5) thoughts of death or suicide (Buffy became invisible at one point, learned that she might die again, and then realized that she wanted to live, which implies that she did not before).
In summary, the most fitting diagnosis for Buffy Summers is major depressive disorder. Currently, there are several well-established treatments for depression that have been tested in rigorous scientific studies. These evidence-based approaches include: behavioral activation, cognitive therapy, cognitive behavioral analysis system of psychotherapy, and interpersonal therapy. In light of Buffy’s busy slaying schedule, it is also possible that she might be interested in some bibliotherapy options rather than standard treatment sessions. Two scientifically-informed options include Feeling Good: The New Mood Therapy and The Mindful Way Through Depression.
In response to numerous stressful life events (e.g., the death of her mother, her own death, having to escape her own grave, the responsibility of caring for her sister without parental support, the responsibility of saving the world), Buffy developed major depressive disorder. She attempted to hide her feelings from her loved ones and coped with her emotional pain with an unhealthy relationship with Spike. A common obstacle that arises for individuals with mental health problems is their fear that they will be judged negatively if they seek help or that they will burden friends if they speak out about it. A therapist should address these obstacles with Buffy by providing her with education about the nature of depression – including taking time to dispel myths that asking for help is a sign of weakness.
Status at Termination (beginning of Season 7)
At follow-up, Buffy returned to her baseline functioning and no longer exhibited symptoms of major depressive disorder. This change could be attributable to multiple factors. Some that likely had an impact were: 1) ending her relationship with Spike, which temporarily lifted her symptoms at times, but ultimately increased her symptoms overall, 2) having her view of herself as defective and pathetic challenged by two individuals who she trusted and who knew her very well (Tara assured her that nothing was wrong with her; Riley affirmed that she was the strongest woman he had ever known), 3) realizing that the responsibility of saving the world did not fall solely on her (her friends, Anya, Giles, and especially Xander, played a huge role in the most recent world-saving), 4) when the world did not end, she had a powerful experience of feeling glad (she previously had not felt a strong internal drive to live), and 5) her feelings of despair were replaced with an excitement and optimism about seeing her sister grow up. Each of these factors appeared to have culminated in a strong sense of purpose, a return of joy, and the reestablishing of meaningful interpersonal connections for Buffy.
THE GORDON/SAXTON TEST
- Was the portrayal of mental illness accurate?
Even in the context of a supernatural universe, Buffy’s major depressive disorder was depicted accurately. She displayed several symptoms that are described in the DSM-5 after experiencing negative life events, which commonly (but not always) precede a major depressive episode. Between the compelling (and entertaining!) acting and writing, the audience could truly get a sense of the deeply painful, often isolating, experience of depression. Moreover, the fact that Buffy – an incredibly physically and mentally strong superhero – is vulnerable to depression, may help to reduce stigma. It sends the accurate message that depression has nothing to do with weakness.
- Was the character struggling with mental health issues depicted with compassion?
It is our opinion that Buffy, and her struggle with depression, were depicted with compassion. Viewers see Buffy’s attempts to feel better on her own, as well as her desire to hide her emotional pain from her loved ones in order to protect them. She was reluctant to seek help, which is understandable, but that likely prolonged her emotional pain. One of us may or may not have been brought to tears a few times by the compassion evoked through this portrayal of depression.
Overall rating: On a rating scale from Angelus (least truthful and compassionate) to Angel (most truthful and compassionate), we rate this portrayal of Buffy Summers’ depression as Angel. For the reasons described above, we believe the portrayal reflects an accurate representation of depression in a way that elicits sympathy.