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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Silent Bob’s Psyche

PSYCHOLOGICAL REPORT

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

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

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

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

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

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

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

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

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

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

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

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

THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

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

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

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

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

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