Wicked Smart Will Hunting

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

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

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

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

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

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

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

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

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

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

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

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

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THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?

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

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

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

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

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AKA Jessica Jones & PTSD

PSYCHOLOGICAL REPORT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

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

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

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

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

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

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