Ridin’ along with “Mad” Max Rockatansky

PSYCHOLOGICAL REPORT

Name: “Mad” Max Rockatansky
Date of Birth: Pre-nuclear apocalypse
Occupation: MFP Pursuit Officer (former)
Road Warrior (current)
Date of Initial Interview: 05/5/2015
Date of Report: 02/01/2017
Therapists: Brandon Saxton, M.S., Katie Gordon, Ph.D.

NOTE: Some information in this report contains chronological gaps and inconsistencies. This information was collected via diagnostic interview (i.e., watching the films, playing the game, and reading the graphic novel) while roaring through the wasteland in Max’s V8 Interceptor: Pursuit Special being pursued by raiders from Gastown. This made for a difficult intake session…

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Presenting Problem:
Max was self-referred to therapy with the goal of reducing his distress levels. After the loss of his family and some other traumatic experiences, Max reported having intrusive thoughts and flashbacks that interfered with his everyday functioning.

Family History:
Max did not disclose much about about his childhood. He mostly responded with grunts when asked about it. In his previous position as a police officer, Max was a highly-skilled driver who often engaged criminals in high-speed chases on the open road. Realizing that he was losing himself in his work, Max retired and moved to the country with his family. Unfortunately, his past followed him. A gang leader took revenge on Max by killing his wife and son in front of him, and he was reduced to a shell of his former self. As a result, he left his life completely behind and became a road warrior in the wasteland.

Occupational History:
Max commandeered the V8 Interceptor: Pursuit Special and his old police gear. He was able to locate and take revenge on each of the gang members who took his family from him. For three years after, Max traveled the wasteland with a dog aptly named Dog. Max moved into his car, which was heavily modified for long distance travel. While scavenging, Max was nearly ambushed by a gyrocopter pilot. Turning the ambush around, Max forced the pilot to bring him to a nearby compound where he could obtain fuel.

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Once there, Max saved people who were under attack with the hope of being rewarded with fuel. Instead, they detained Max and his car. Eventually, Max made a deal with their leader, offering to retrieve a vehicle that they could use to transport gasoline away from the compound in exchange for his car and fuel. After delivering on his end of the deal, Max left the compound. However, he did not make it very far before being run down by Lord Humongous’s gang. Fortunately, he was saved by the gyrocopter pilot. After being nursed back to health, Max agreed to help the people in the compound escape with gasoline. He lead the escape in the tanker. It was then that Max learned that the tanker was filled with sand, and that it was all a ruse to get the hidden fuel away in smaller vehicles.

Many years later, Max was still wandering the wasteland and found his way to Bartertown. Max was forced into entering the Thunderdome, Bartertown’s gladiatorial arena, where he was pitted against Master Blaster. Max was could not bring himself to kill his opponent, who was an innocent man with a disability.

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Because he did not kill Master, Max had to “face the Wheel.” With the Wheel of Fortune deciding his fate, Max was sent into the wasteland to die. Max was saved by a tribe of young children who believed he was their hero of prophecy. Max returned to Bartertown to find Master,  who he believed could help the children. He fled Bartertown with Master in tow, which lead to a terrible road war. Eventually, Master and the tribe of children escaped.

Some time following these events, Max was again run off the road and taken captive. This time, Immortan Joe and his war boys took Max to use him as a “blood bag.” Finding his blood being drained while strapped to the front of a car racing across the dessert, Max was able to escape while the war boys pursued Furiosa, one of Immortan Joe’s Imperators.

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Max joined with Furiosa who was fleeing the warlord dictator, Immortan Joe, with his Wives. Max and Furiosa were ultimately able to escape with the Wives and find Furiosa’s old clan. Furiosa learned that The Green Place that she had been seeking was no longer there. Furiosa decided to take everyone and flee across the wasteland instead. Max, with his own supplies, went in the opposite direction.

Then, Max experienced a flashback of a young girl. This prompted him to go back to Furiosa and her group. He believed that their best bet for a safe home was to take the Citadel from Immortan Joe while his forces were out pursuing them. After yet another destructive road war, Max, Furiosa, and the rest were able to defeat Immortan Joe and his army. They returned to the Citadel as heroes and liberators. However, Max left them behind to continue his life alone.

Psychiatric/Medical History:
Max denied any history of psychiatric treatment. With regard to medical history, Max suffered an injury after being shot in the leg and subsequently wore a leg brace.

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Assessment & Diagnostic Impressions
Max’s symptoms appear to be best captured by a diagnosis of post-traumatic stress disorder (PTSD), as defined by the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition.

As detailed previously, Max has experienced a variety of traumatic events (defined by the DSM-5 as exposure to actual or threatened death, serious injury, or sexual violence). Max’s symptoms primarily seem to be related to the people he has been unable to save throughout his life. For example, Max appears to experience multiple intrusive symptoms in Mad Max: Fury Road. These flashbacks consist of a young girl asking Max for help. They appear to be very distressing. Beyond that, Max also appears to engage in avoidance of situations that remind him of the traumatic events. Specifically, after losing his family, Max is seen refusing to get close to others again and again. This is particularly worth mentioning as solitude in the wasteland almost always means death. Additionally, following the loss of his family, Max appears to have negative changes to his thoughts and moods. He goes from being a light-hearted, family man to a dark killer. His life goal becomes revenge. Additionally, Max appears to have suffered from changes in his arousal and reactivity (e.g., irritable mood, angry outbursts, etc.). Max is always on alert for danger. He rarely falls into a trap (such as the one set by the gyrocopter pilot) and is usually on edge.

Treatment Recommendations
In summary, Max appears to meet full diagnostic criteria for PTSD. Fortunately, evidence-based treatments are available. Such treatments include therapist-guided processing of traumas (e.g., Cognitive Processing Therapy, Prolonged Exposure) and decreasing unhealthy behavioral patterns without focusing directly on the trauma (e.g., Present-Centered Therapy).

THE GORDON/SAXTON TEST

  1. Was the portrayal of mental illness accurate?
    The changes that Max undergoes after losing his family do appear to be within the realm of possibility for someone experiencing such trauma. Max loses his sense of his former self, exhibits extreme negative affect, avoids getting close to others, and experiences many reminders of those he has lost.
  2. Was the character struggling with mental health issues depicted with compassion?
    Overall, Max was not written specifically to depict mental health issues. That being said, he does appear to be a character who, despite intense trauma, is able to rise above and help those in need. Additionally, Max refuses to harm Blaster, of Master Blaster, while battling in the Thunderdome, as Blaster appears to have a developmental disability. So, not only is Max depicted with some compassion, he also displays some. Nice work, George Miller.

Overall rating:
Overall, we rate Mad Max as SHINY AND CHROME! That is, totally awesome. Max is a complex character. He is continually seen trying to shun connections with others, often acting as if he only cares about his own safety and survival. Despite this, he always ends up being guided by his moral compass. Time and time again, we see Max come to the aid of those in need, never able to completely turn away.

AKA Jessica Jones & PTSD

PSYCHOLOGICAL REPORT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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THE GORDON/SAXTON TEST

1. Was the portrayal of mental illness accurate?

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

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

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

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

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

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