What Can We Learn from Batman about Being a Therapist?

Hi everyone, Brandon here. Come on in, have a seat. I know what you’re thinking… “Hey Jedi Counsel, this is not one of the classic psychological evaluations about one of my favorite, beloved fictional characters that I’ve come to expect every month or so! What gives?” Well, let me tell you what gives, friend. This is my fifth year of graduate school and last semester at North Dakota State University. This summer I will begin the final year of my Ph.D., which will consist of a full time, yearlong clinical position at a non-profit community mental health clinic. I’m entering a time of pretty significant personal change. I started at NDSU during my undergraduate. The university and my status as a student have been a central part of my identity for a very long time. I’ve been reflecting a lot about the transition out of this role and into my new role as a full-time clinician. Because this, I started thinking a lot about my favorite fictional character and the lessons I can take from him to help guide me in my clinical work. To that end, I asked my ever-accommodating co-host/blogger if we could mix it up this month. Please get comfortable as I take you through a journey of the lessons I’ve learned from Batman that I believe could apply to being a good therapist.

Lesson 1: Do what is right, even if it is not always easy.

“It has nothing to do with easy. It’s about doing what’s right because it’s right. That’s the only reason you need.” – Batman

When Bruce Wayne was very young, he witnessed the murder of his parents. This was a life-altering event for Bruce that would dramatically change the trajectory of his life. In response to this, he made it his mission to do whatever he could to prevent other people from having the same experience that he had. Now, depending on the nature of the event, available social support, and the overall psychological make-up of an individual, people can respond to trauma in many ways. This is just the way Bruce Wayne responded (though it isn’t clear that he ever emotionally recovered from the loss of his parents, see here for more info). It’s clear this wasn’t easy for him, though. He could have had a perfectly relaxing life, relying on his fortunes to live comfortably and happily for all his days. He has a mansion and cars and even a butler. He had it made in the shade. Instead he chose to do what he felt was right and become Batman. Years of study and training (sound familiar?), self-sacrifice, and a rough road were the rewards Batman got. Nevertheless, he continued to move forward to help make the world a little bit better for the people in his city.

To me, this applies directly to clinical work. We simply have to do what is right. Specifically, we are expected to act in accordance to the ethical standards prescribed to us (click here to see the wiki that I helped to write that outlines the APA Ethics Code!). At times, these situations aren’t always easy. Mandated reporting is an example. You might have a strong therapeutic relationship with a client. You could feel like you’re really making progress. But if you learn about an incident or behavior that you’re required to report, it has to happen (note: the client would be informed of this during the informed consent for treatment). Other examples include avoiding, or if necessary, navigating dual-relationships, maintaining confidentiality, respecting client autonomy, identifying and practicing within your competency areas, maintaining thorough documentation, and sticking to evidenced-based treatments and assessments. These are just a few of the many examples where clinicians might face challenging situations. It’s important that we rely on our ethical codes to do what is right in the same way that Batman relies on his own personal moral code to do what is right in his war on crime.

Lesson 2: Stand up for those who might not be able to stand up for themselves.

“I’ll be standing where I belong. Between you and the people of Gotham.” – Bruce Wayne, Batman Begins (2005)

The center of Batman’s mission is doing all he can to prevent anyone from experiencing what he experienced as a child. This theme is consistent throughout the many stories of Batman across the various mediums. For example, in the recent Batman comic series authored by Tom King, Batman takes control of an airplane that is going to crash into Gotham City. He intends to divert the plan and crash with it. Another example is in Nolan’s The Dark Knight (2009), in the end Batman takes the blame for everything Harvey Dent did so that the people still have someone to look up to. In the 2015 video game, Arkham Knight, Batman sacrifices himself to save the city from Scarecrow’s chemical attack. It seems like almost every Batman story has an element of him taking to hit, pain, or blame so that someone else can be spared.

To me this translates to engaging in advocacy work. As a field, Clinical Psychology has not always done a good job advocating for those who may need it. Looking back at the history of how the LGBTQ+ communities were treated within our field is a good example of this (see our Jedi Counsel episode for a primer on this and a list of further resources). I believe that people should advocate for whatever social justice rights that lead to the betterment of others that they are comfortable with. Due to our clinical training, our expertise is in mental health. So one potential area of professional advocacy falls clearly in that realm. One example is challenging the claims that failures in our mental health systems are the cause of violence (see here for a brief fact-sheet outlining the research between mental health and violence). Another example might be disseminating mental health resources so individuals know where to get help (we just gave a talk related to this recently on campus!) Or it might be just doing what you can in your day to day life to reduce mental health stigma which can sometimes take the voice from others and keep them from getting help they might need. Batman makes it a point to stick up for people who might be going through tough times and may not have a voice or way of defending themselves. Through our expertise and clinical work, we have the opportunity to do the same.

Lesson 3: You don’t have to be a superhero to make a difference.

“A hero can be anyone. Even a man doing something as simple and reassuring as putting a coat around a young boy’s shoulders to let him know that the world hadn’t ended.” – Bruce Wayne, The Dark Knight Rises (2012)

In The Dark Knight Rises, Batman tells Jim Gordon how he was a hero to him when he was younger and coping with the loss of his parents. We see this role reversed many times throughout several Batman stories. When many people think of Batman, they think of the rough and tough dude in a suit who punches the baddies and saves the day. However, for folks who have had the good fortune to dig deeper into the character through the various comic book series or animated depictions, we see a much softer side of Batman from time to time. A perfect example of this can see seen in the Justice League cartoon. Amanda Waller wants to destroy a young girl who has developed terrible powers. Instead of doing so, Batman goes and sits with the young girl on a swing set and holds her hand while she dies as a result of her powers. In Batman, we have a character who has no super-powers at all but still manages to go toe-to-toe with aliens, Amazons, and gods. Despite that, he never forgets what it means to be a hero for him.

For clinical work, it’s important for each of us to remember the impact that we can have. It is a fairly safe assumption to assume that most people go into mental health because they want to help others. However, between a lot of schooling, navigating licensure, tough hours, large caseloads, challenging clients, difficulties in insurance reimbursement, and the many, many other things involved in clinical work, it can sometimes be easy to lose sight of what your initial goal was. It can be helpful from time to time to reframe things and remind oneself what an honor it is that you have the opportunity to step into these peoples’ lives and help them get to a better place. Just by meeting with you, clients can learn new skills, get regular social interaction, learn more about what they are experiencing through psychoeducation, and receive validation through normalization that others are likely struggling with the same disorder or challenges that they are. Any one of those benefits alone can really mean something to someone who is struggling. For young Bruce Wayne, having Jim Gordon hang a coat on his shoulders was everything in the world for him. For your clients, you can serve the same role by simply being collaborative in providing an explanation for what they are experiencing, which alone can help them feel better and more hopeful (see here for a study on how careful diagnostic feedback leads to increases in positive emotions and hope).

Lesson 4: Be humble and know when to ask for help.

“The first truth of Batman… It had to be one I didn’t like to admit. The gunshots left me alone. For years I was alone in the echoing dark of that well. But something else defined the exact moment Batman was born. The First Truth of Batman… The saving grace. I was never alone. I had help.” – Bruce Wayne, The Return of Bruce Wayne

Another major theme of Batman is that despite his independent nature and desire to work alone, he always knows when he needs to ask for help. Whether it is having a side-kick, relying on Alfred, or calling in the Justice League, Batman knows when he needs back-up. Part of this is that he acknowledges his skills. For example; he can’t fly. In the Justice League animated series, there is a scene where he calls in for some air support (see here). Or in the newest Justice League (2017) film, Batman recognizes that something beyond him is coming to Earth. As such, he recruits Wonder Woman and others to join him in preventing an invasion.

For Batman, it all boils down to knowing his skills and knowing when he needs help. In clinical work, it is largely the same. We know that therapist competence is largely predictive of therapy outcomes (see here for a study related specifically to Cognitive Behavior Therapy for depression). As such, it is important to recognize when a client has a problem or requires a treatment that falls outside of your competence area. Additionally, it is important to seek support when you need it. This can be in the form of supervision when you are still developing or perhaps learning a new treatment. Another way of seeking support is through consultation. Consulting with a peer or other professional can help to illuminate problems or ideas you might have missed. Consultation can also help with treatment adherence. In fact, for Dialectical Behavior Therapy, consultation is required to ensure that all therapists are adhering to the treatment manual (see here for more details). The last way of seeking support is related to work-life balance. Take the time to recognize if you are feeling therapist burnout. It can happen. Managing work/life balance and seeking consultation and peer support or advice can help. In the end. Batman recognizes his expertise and when he needs help. In clinical work, we need to be doing the same thing.

Lesson 5: Trust the data.

“Maybe it is time we stopped trying to outsmart the truth, and let it have its day.” – Alfred Pennyworth, The Dark Knight Rises (2012)

The final lesson that we can learn from Batman is to trust the data. At his core, Batman is a detective. Many in the DC universe call him The World’s Greatest Detective. He has degrees in criminal science, forensics, computer science, chemistry, engineering, biology, physics, and advanced chemistry and technology. When he is solving a mystery, he knows to trust in the latest available science and data. Additionally, he follows the clues and data he collects along the way to figure out who is behind whatever heinous crime he is working on at that time. He tries to keep his own personal judgment or emotion out of the equation and trusts in what he can observe, quantify, and measure.

The same ideals should hold true in clinical work. When comparing clinical judgment to statistical judgment, we know that the stats are at least as good, and often times better, than our own clinical judgment (see here for a great reading on this). Looking further, there are many researchers working hard to determine what the most empirically-supported interventions and assessments are. There is a range in the level of evidence available for different treatments. We owe it to our clients to select the treatment with the greatest statistical likelihood of working for each given disorder. If no single treatment stands out statistically, or if an empirically-supported intervention is not working, then we can adopt a hypothesis testing approach to treatment. By selecting a treatment that we have reason to believe will work and testing whether it is through an appropriate outcome measure, we can continue to move forward in a data-driven manner. Just like Batman trusts the data and science before his own judgment or conclusions, we as clinicians ought to as well.

In Closing

            Are you still here? Amazing. Because that post got much longer than I ever expected. At the end of the day, Batman is a character with over 75 years of content in comics, movies, video games, television shows, and novels. He’s a character who can fit the needs we have as readers or viewers. Today, we just wanted to think about some of the ways in which Batman might help guide us in clinical work. There are a lot of amazing fictional and non-fictional individuals who can guide us in any profession or life in general. Who are some that you look up to?

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Talking Batman on DoxCast

We were fortunate enough to make our third guest appearance on DoxCast, a podcast hosted by folks at our favorite comic book store, Paradox Comic-N-Cards!

We talk all about Batman characters in two of them (Batgirl, Robin, The Joker, Harley Quinn, The Riddler, Two-Face, and Scarecrow)! You can check out both on Twitch here and here.

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The Psychology of Wonder Woman & Hippolyta

SPOILER WARNING: This post is mostly based on the movie, Wonder Woman, and it contains lots of spoilers.

Part I

Name: Diana
Age: 6ish
Occupation: Princess of Themiscyra (Paradise Island)
Therapists: Katie Gordon, Ph.D., Brandon Saxton, M.S.

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Presenting Concern:
Hippolyta, Queen of the Amazons, sought therapy for her daughter, Princess Diana. She was concerned that Diana was disobeying her wishes. As an immortal goddess, she was unaccustomed to having her authority defied. Yet, she often caught Diana watching the Amazons’ warrior training and asking her aunt, Antiope, to begin secretly training her in the arts of war. Hippolyta’s goal in seeking therapy was to learn effective parenting strategies to protect her daughter from the harm she feared would befall her if she began training as a fighter. She also wanted Diana evaluated for oppositional defiant disorder.

History:
Diana reported that her mother wanted a child more than anything, so she made her out of clay.  Zeus then brought her to life. Hippolyta motioned to us that she wanted to speak to us without Diana. We brought Diana out to the waiting room and returned to speaking with Hippolyta, who explained that Diana was actually Zeus’ child and given to the Amazons to protect them from Ares, the god of war. Hippolyta explained that she did not tell Diana the real story because she feared it would put her in more danger.

Hippolyta’s love for Diana was so strong that she couldn’t fathom the possibility of Ares taking her away. She said she would never recover from that kind of pain. She believed that sheltering Diana would keep her safe.

Assessment & Diagnostic Impressions
After interviewing Hippolyta alone, it became clear that Diana did not have oppositional defiant disorder. Her behavior was not causing her any distress, impairment, and was typical for her age. To the contrary, she was already highly educated (though her behavior did appear to lead to some of her teachers resigning) and fluent in numerous languages, and full of energy, bravery, and kindness. It was our impression that Hippolyta was a loving, concerned mother acting out of protection for her child and her fear of losing her.

Treatment Recommendations:
Hippolyta’s worries were founded in the reality of her situation and Diana’s destiny. We did not find that she or Diana met diagnostic criteria for any clinically significant mental health problems. However, we offered Hippolyta support with her concerns. In addition, we recommended strategies for increasing openness and reducing secrecy between she and Diana (e.g., by displaying acceptance and listening, even if her impulse was to shut down any conversations about warrior training). We provided feedback that it was evident that their mother-daughter bond had a strong foundation. They enjoyed many activities together (Diana listed bedtime stories and exploring the island as personal favorites). We encouraged Hippolyta to continue building on that relationship and that therapy was available if she wanted extra support as she navigated the healthy balance of protecting her daughter while accepting her autonomy.

Part II

Name: Princess Diana of Themiscyra (via Hippolyta)
Age: 20s-ish
Occupation: It is her sacred duty to defend the world.
Therapists: The Jedi Counsel again

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Presenting Concern:
Hippolyta returned to us to ask for guidance with Diana. A pilot’s plane crash-landed into the ocean near Themiscyra, and Diana saved his life. The pilot, Steve Trevor, explained that he was a soldier in the fight to end “the war to end all wars.” Diana told her mom that she wished to leave the island with Steve and stop the war by killing Ares and his poisonous influence on man.

History:
Hippolyta explained that, since our last appointment, she had decided to allow Diana to begin openly training with Antiope in the arts of war (rather than continuing to push her to secrecy). Hippolyta continued to protect her child, but recognized the limits of her control. She decided to prioritize trust and a close relationship by supporting Diana’s independence at a developmentally-appropriate level. Hippolyta found that talking through concerns with her sister, Antiope, helped her to clarify the line between being overprotective and protective. As a result, her relationship with her daughter had grown stronger than ever….which is why Hippolyta felt so distressed at the thought of Diana leaving Paradise Island to fight with Steve (though Hippolyta did note that he seemed like an egalitarian, intelligent man pursuing a noble mission well-suited for Diana’s abilities).

Session Notes:
Hippolyta came to us with her own wisdom about how to best handle the difficult situation. She knew that she could not control Diana, who had already decided to join Steve and help all those suffering due to the war. She recognized that her choice was to try to stop Diana, which would ultimately be unsuccessful, or to support her and have an opportunity to say good-bye. We listened to Hippolyta as she processed her feelings and thoughts about the situation and came to her own conclusion about the right decision for her family and herself.

Follow-Up:
Hippolyta reported that she was able to say good-bye to Diana, “You have been my greatest love. Today, you are my greatest sorrow.” She knew she had taken the right course of action and was grateful for the time she had with her child. We told Hippolyta that she was welcome to come back and meet with us if she wanted any support from us as she dealt with her separation from Diana. We encouraged her to seek support from others, to take good care of herself, and to feel pride in the wonderful daughter she raised with love, empathy, a commitment to peace, education, understanding, and undeniably badass warrior skills.

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Part III

Name: Princess Diana AKA Diana Prince AKA Wonder Woman
Age: 20s-ish
Occupation: Superhero
Therapists: Same ones, in our Man’s World office location

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Presenting Concern:
Diana’s friend, Etta Candy, referred her to meet with us to discuss her transition from Princess of Paradise Island to Superhero in Man’s World and the recent loss of the person she was in love with, Steve Trevor. Etta felt that her friend might benefit from speaking to professionals while coping with these drastic changes and significant stressors.

Session Notes:
Diana presented as open and willing to meet with us. She became tearful as she described losing Steve, but said that their love remained powerful. She recognized that his death meant preventing others’ suffering and that it was his way of doing his part to defend the world. She would remember him fondly and draw inspiration from the honor he exhibited. It was that type of goodness that helped her to cope with the realization that humans could sometimes do terrible, evil acts, even when they were not directly under the influence of Ares.

She described missing her mother, loved ones, and the beauty of Themiscyra. However, Diana said that she had made the right decision to leave and fulfill her sacred duty. She would not have felt okay with herself if she didn’t try to stop the war. Having recently learned that she was a goddess, Diana also contemplated what it would mean to be immortal while those around her age and die. Fortunately, in the context of her strong relationship with her mother, they had many discussions about how Hippolyta had coped with the blessings and curses of immortality. Diana felt she could draw on her mother’s wisdom as she navigated the associated privileges and pains.

Diana expressed frustration and bewilderment at the societal status of women and people of color in Man’s World. From clothes that constrain optimal battle movement to expectations to be in subordinate positions to rules about women not speaking up or being in leadership positions, Diana said she intended to fight alongside all those with a mission of equality until it was achieved. She also expressed zero intent to conform to unjust societal norms that would have her reduce her strength, powers, or peace efforts. That alone would empower countless people to follow her lead and embrace their true selves. Amazons wore their bracelets as a reminder of their past subjugation, and as a symbol to resist any return to that state. Diana also wore them to connect her to her home and Themiscyran values (they handily deflect bullets and wield energy too).

In conclusion, Diana did not feel she needed ongoing therapy to cope with her various concerns at the time. However, after having a positive experience with therapy at an earlier age, she said that she would not hesitate to return for help as-needed and left us with the wisdom that “only love could truly save the world.”

Follow-Up:
100 years later, Wonder Woman was working at the Louvre, saving people from suffering, and teaming up with Batman and Superman to defeat evil. She remains a symbol of courage, knowledge, acceptance, justice, compassion, and overall awesomeness. We look forward to seeing more of her when she teams up with the Justice League in November!

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The Gordon/Saxton Test

Was the portrayal of mental health accurate?
Wonder Woman and Hippolyta were not portrayed as exhibiting mental health issues. Despite the fictional world the characters were set in, the authenticity of their relationship and related issues was moving and made it relatable to nonfictional people too.

Was the character struggling with mental health issues depicted with compassion?
Wonder Woman is the epitome of compassion. You see it throughout the movie as a primary motivation for her actions, and that is one of many things that makes Wonder Woman so incredibly special and inspirational. Hippolyta is also portrayed in a way that elicits compassion.

Overall Rating: On a scale of Ares, god of war to Athena, goddess of wisdom, we Aphrodite, goddess of LOVED this movie!

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So many thanks to the creator of Wonder Woman, psychologist William Moulton Marston!

Also thanks to the many amazing artists, comic writers, letterers, colorists, actresses, actors, and others who have contributed to Wonder Woman’s story. Some of our favorites include Gail Simone, Renae De Liz, Ray Dillon, Susan Eisenberg, Gal Gadot, Patty Jenkins, Chris Pine, Nikola Scott, Greg Rucka, Liam Sharp, and Laura Martin!

Check out our podcast episode on our initial reactions to the movie here!

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13 Thoughts on 13 Reasons Why

**WARNING: SPOILERS APPEAR IN THIS POST.**

I watched the new Netflix series 13 Reasons Why (based on a book with the same title). This post sums up my reactions, and I am also in the process of recording detailed Jedi Counsel podcast episodes on the series with my co-host. Some people say this is art and entertainment, and therefore, exempt from social responsibility. Nonetheless, many people will watch this series, and that makes it important to view it critically and to consider its implications. My thoughts aren’t fully formed yet, but I wanted to post something as the series came out without waiting until I had it all sorted out. My feelings and opinions may develop more as I process the material for a longer period of time. I’m open and curious about other perspectives.

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  1. The series is set up as a mystery that quickly pulled me into the story. I finished the whole series within a few days. The framework for the series is that an adolescent, Hannah Baker, has died by suicide and left behind audio tapes detailing every component that she believes led up to her death. In addition, she has a methodical plan for the specific people who should listen to the tapes, how they should be listened to, and the order in which people hear them. While this is a compelling way to reveal a mystery, I believe that it contributes to stigma by painting the picture of a woman who ended her life for the purposes of getting attention from the individuals she believed ruined her life. The tone of her delivery is blaming and feels vengeful. I worry this perpetuates the myth that suicide is typically driven by desire for attention, selfishness, or revenge…which it most certainly is not.
  2. There is a scene that is explicitly blaming of one of the few kind (though not perfect) people in the series (Hannah’s friend and love interest, Clay). Hannah’s friend, Tony, tells Clay that Hannah would have been alive if he had acted differently. He later softens his tone, saying it is not Clay’s fault and Hannah is responsible for the choice that she made. Still, the blame message is there in a scene where Hannah tells Clay repeatedly to leave her alone. He reluctantly leaves the room. The show then depicts a parallel universe where the “right” things happened: Clay insists on staying despite Hannah clearly asking him to leave her alone, he turns the conversation around through persistence, Hannah feels loved, and suicide is prevented. In light of the violations of consent elsewhere in the series (including two rape scenes), I was bothered by Clay being painted as having done the wrong thing when he honored Hannah’s wishes to leave her alone.
  3.  Hannah decides, as her last attempt at help-seeking, to reach out to her school counselor about her suicidal thoughts and being the victim of rape. The counselor, insensitively and against best practice guidelines, implies she may be partially to blame (e.g., asking if she verbally said no to the perpetrator, asking if she had been drinking) and jumps right into telling her that her only choices are to: 1) report the assault or 2) to move on. She leaves the office, and he doesn’t follow-up with her in any way. He doesn’t ask for more details or conduct a suicide risk assessment, and he does not try to reach out to her parents to prevent her from harming herself. Of course, there are some counselors out there who might act in this irresponsible way. However, the vast majority would not. In a show that is viewed by a lot of young people, the depiction of the counselor matters a lot. People are already reluctant to reach out to mental health professionals. I worry people would feel even more discouraged from seeking help after seeing this terrible, judgmental, unethical interaction.
  4. The series accurately portrays some of the risk factors for suicide: social isolation, loneliness, and disconnection from others (including in the painful forms of bullying), perceiving herself as a burden (e.g., she describes herself as a “problem” for her parents and especially feels burdensome after accidentally losing some of their money), family conflict (her parents argue about issues including finances), witnessing and then being a victim of sexual assault, and hopelessness about her future (e.g., with regard to college and other plans).
  5. I appreciated the series emphasizing how crucial social connections are for health and talking about different types of loneliness – including individuals truly isolated and those who feel “lonely in a crowd.” It seemed to make the point that even apparently popular people (like Zack) can feel lonely. I believe this sends the message that anyone is vulnerable to loneliness, and we shouldn’t assume people are doing well just because they appear that way on the outside.
  6. One of the themes of the series is that – at any point – one person listening, reaching out, or doing something differently could have prevented Hannah’s suicide. Ultimately, this is a positive message. Unfortunately, I think it’s lost and distorted because it is used to blame people for their failures to save Hannah rather than demonstrating that one person could have made a difference and changed the story to a hopeful one. If the counselor or one of her parents had connected with Hannah and supported her in seeking help for her struggles, this point would have been much more persuasive. Instead, the story feels more demoralizing than inspiring to me.
  7. Hannah’s death scene is a graphic depiction of her cutting her wrists with razorblades in a bathtub. In a documentary-type episode made about the series, they said that it was to show the painful and hard-to-look-at nature of suicide. To me, it feels like a choice to make a dramatic, visually startling conclusion to the story rather than to deliver a lesson. It makes sense – this is a series meant to be watched and to get people glued to their screens- not a PSA. It’s possible that an individual who feels suicidal might see that and be afraid; however, it’s also quite plausible that an individual feeling suicidal might mistakenly view it as an end to all of Hannah’s emotional pain and problems. Anecdotally, there are cases of suicidal individuals watching scenes of suicide building up to taking their own life.
  8. There are warnings in the beginnings of episodes where there are graphic scenes (e.g., sexual assault, suicidal behavior). It would have been helpful if the episodes had information about resources, such as the National Suicide Prevention Lifeline and the American Foundation for Suicide Prevention, embedded in them too. It would be a simple way to reach a lot of people. Again, the series created a separate short documentary-like episode with mental health professionals and resources in it. However, it appears completely separately from the series (rather than as the 14th episode, for example). It would reach more people if it was connected to the full series.
  9. The pain Hannah’s parents experience after her death is excruciating. I feel this is one of the most realistic aspects of the series. It shows their horror, their confusion, their regret, and their desire to prevent other suicides from occurring. In the documentary afterwards, they suggest that this might show individuals who feel suicidal about the pain that others would experience if they died. I think this may be the case for some, but for certain individuals, tragically, they might imagine that people wouldn’t feel the same way about their death. That’s the cruelty of perceiving oneself as a burden – people struggling with mental health problems may not see how the world is better with them in it.
  10. Related to the second point, several characters clearly violate Hannah. Marcus and Bruce grab her, Tyler and Justin take and share revealing pictures without permission, and Bryce rapes her. When Hannah and Clay are starting to kiss, Clay asks, “Is this okay?” I really liked this scene because it shows how asking about consent is natural and enhances, rather than ruins, the moment. It also shows a welcome contrast in that Clay genuinely respects and cares about her feelings and perspective. Sadly, this positive point gets diminished when the scene turns into Hannah yelling for him to “get the hell out” and the suggestion that if he had only ignored her wishes, he would have saved her life (as described above).
  11. From one perspective, it seems like a point of the series is to teach bullies that their actions can lead to someone dying by suicide. However, most people who are bullied do not die by suicide – people are often remarkably resilent in the face of great adversity. It’s important that people who are on the receiving end of bullying know that. Secondly, most of the people on Hannah’s tapes are more concerned about protecting their own secrets (e.g., that Courtney is attracted to women, that Justin allowed Bryce to rape Jessica, that Ryan published Hannah’s poem without her permission) than how they hurt Hannah. If the message is supposed to be an anti-bullying one, I don’t think it really connects with bullying people in the audience. I guess that it would resonate more with people on the receiving end of bullying who feel a sense of hopelessness about the bullies having any potential for empathy and a sense that there is no help available to them.
  12. On two occasions, two adults (the counselor and the communications teacher) state that the warning signs for suicide include withdrawing from friends and family, changes in appearance, and trouble in group projects. This was a great opportunity to share the real warning signs for suicide, but unfortunately, only the first one really maps onto the list.
  13. A lighthearted, sweet aspect of the series is that Clay is different from his peers in that he cares relatively less about what other people think of him. He still cares what people, including Hannah, think of him to some extent, but he doesn’t try as hard as his peers to be something he’s not. He feels nervous around Hannah, but doesn’t ever really pretend to be someone else. He doesn’t let other people’s opinions make him feel bad about himself. Again, Clay’s not perfect (he says some mean things to Hannah and looks at a revealing picture that Tyler took without consent). But, overall, he’s smart, sensitive, caring, a good student, interested in the world beyond the walls of his school, helps others, takes reasonable caution in his decision-making, and likes geek stuff like Lord of the Rings and Star Wars. During one exchange, Hannah says to Clay, “Wow. You’re an actual nerd. There’s courage in that.” Most of the other characters in the series view themselves and their worth in terms of what their peers think of them. This generally rings true with regard to this developmental period in adolescence. It’s refreshing to see someone who has some self-acceptance and a sense of what’s right in the midst of all of the tragedy.

You can check out our first podcast episode on this series here and our second episode here.

If you or someone you know needs help, please reach out. There is hope and help is available here.

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!