Understanding Bipolar Disorder In Silver Linings Playbook Essay.

You are to select one of the following movies or come up with another movie by the the date of the midterm exam and email in your choice of movie to the instructor. 

Give a short synopsis of the movie

Give an initial diagnosis for this character in the movie
Then you must list what diagnoses one would need to rule out as one continues to work with this character as a client.
Then you must provide a tentative treatment plan utilizing Empirically Validated Treatment (EVT) or Evidence Based Best Practices (EBBP) if possible. You must be very precise and detailed in what the treatment would entail.

You must talk about:
Type of treatment
Length of treatment
Specific methodology used in the treatment
Benefits of the EVT or EBBP for the client
Possible negative effects of the EVT or EBBP for the client

You then must talk about whether or not one would refer this client to a psychiatrist for psychopharmacological treatment. If referring to a psychiatrist for possible medication you would have to detail out what possible type of medication the psychiatrist might choose, the rationale for its utilization, and what would be the benefits and possible negative side effects of it for the client.

Lastly, if the movie character had been successful in getting the treatment outlined by you, how would the change in this character have affected the outcome of the story line in this movie?

Synopsis of the movie

The aim of the essay is to understand the mental health issue that the main character suffers from in the movie Silver Linings Playbook. The essay will follow a systematic order starting with a brief synopsis or summary of the movie. This will be followed by providing an initial diagnosis of the main character. The next step will be to rule out those diagnoses that do not associate with the main character wile gradually understanding the character. A tentative treatment plan utilizing the Evidence Based Best Practices (EBBP) shall be prepared as well. Initial diagnoses of the character shall be done followed by cancelling out the diagnoses as the character evolved. The essay will also include the preferred EBBP treatment plan for the character including its benefits and negative effects.

Silver Linings Playbook, released in 2012 narrates the story of Pat Solitano (played by Bradley Cooper) who suffers from bipolar disorder (Imdb.com, 2018). Directed by David O. Russell, the film also has another character with bipolar, Tiffany (played by Jennifer Lawrence) who is shown being a major influence in Pat’s life. The film begins with Pat being released from the mental health institution by his mother, Dolores (played by Jackie Weaver) (Imdb.com, 2018). After coming home, Pat finds it difficult to adjust to the normal life and often looses temper on petty things. He assures his parents that he is completely cured now and that he would only think about positive things and brings his wife Nikki (played by Brea Bee) back in his life. His father, Pat Solitano Sr. (played by Robert De Niro) had no clue about his son’s release since Dolores did not inform him. Pat visits Dr. Cliff Patel (played by Anupam Kher) on couple of occasions to discuss his issues but refuses to take any medication as he believes the medicines escalate his condition. He initially runs away from Tiffany assuming that her bipolar is far worse than his is but gradually, they collaborate and things begin to improve.

In the movie, Pat is diagnosed with bipolar disorder but with mild symptoms. He was out into the mental health institution for eight months after he beat his wife’s lover almost to death. His mother has him released getting a court order and brings him home. On the first day of his return, Pat starts showing symptoms of bipolar disorder, as he is over excited and pumped up to be back and plans to get his wife back. During the night, Pat shows extreme signs of anger when he throws away a book of Ernest Hemingway through the window because he did not like the story. He storms into his parent’s room and expresses his anger even though they tell him that is four in the morning.  The movie excels in the part where it shows the father having a mental health issue of his own, which Obsessive Compulsive Disorder or OCD. The OCD, similar to bipolar disorder is where an individual has reoccurring and uncontrollable behaviors and thoughts the she or he has the “urge to repeat over and over” (Nimh.nih.gov, 2018). In case of Pat Sr., the obsession is with the game and the superstition to keep things in a specific order to make his team win.

Initial diagnoses of the main character

As per the DSM-5 criterion, a person is diagnosed with bipolar disorder when he or she demonstrates symptoms of anxiety, unusual restlessness, and feeling tensed among others (Severus & Bauer, 2013). These symptoms align with those demonstrated by Pat when he returns home and tries to improve his life. Other initial diagnosis reveal that Pat has rapid and pressured speech toggling from loud to illogical, mood switch, flashbacks concerning manic episodes. In addition, the diagnosis also included severe and sudden mood changes, delusions before traumatic incident, low grab of desire control and fair insight and extreme obsession with wife (Vancampfort et al., 2013).

As one moves ahead with the character gradually, one would have to cancel out certain diagnoses as the character shows improvement over the course of time. The first diagnosis that would be ruled out is rapid and pressured switching of speech. Then, other diagnoses such as severe changes in mood, and hallucinations before the traumatic event, impulse control and obsession with the wife will be listed out as well.  However, the labile effect or mood switching in different topics and irrational thought processes would not be cancelled out. Pat first states confidently that he would take all the negativities and turn those into positives but switches constantly. He becomes excessively angry and uncontrollable especially when he fails to find his wedding video tape one night. The irrational thought process was demonstrated by Pat when he decides to write a letter to his wife Nikki and deliver it through Tiffany, as she is in touch with her through her sister. The thought is irrational because he knows that his wife has secured a restraining order from the court against him.

The Evidence Based Best Practices or EBBP include treatments that are based on evidence and best practices (Buscemi & Spring, 2014). These treatments have been academically and scientifically researched, proven efficient, and duplicated in numerous studies and investigations. The EBBP model integrates individual values of the patients with evidences that are researched medically and with clinical knowledge of the provider. Cognitive Behavioral Therapy (CBT), exposure therapy, functional family therapy, dialectical behavior therapy and motivational interviewing amongst others are some of the best-known EBBP treatments.

The therapy chosen for Pat is the Cognitive Behavioral Therapy (CBT), which focuses on exploring relationships between an individual’s behaviors, thoughts and feelings. During the CBT session, the therapist would actively engage with Pat in conversations that would help unravel the detrimental patterns of thought that are resulting in self-destructive behaviors.

Ruling out diagnoses and understanding character

The length of the treatment would last around 20 to 30 weekly or fortnightly sessions with every session having duration of 30 to 60 minutes. In Pat’s case, the session treatment would take around 20 sessions with 30-minute duration, as Pat does not have severe symptoms of bipolar (Allen et al., 2015)

The methodology that would be used in the treatment includes journaling, by which the counselor would be able to gather data about Pat’s thoughts and moods. The next technique would be to unravel cognitive distortions where the counselor has no role to play but the client himself has to do the work. Pat must first become aware of his distortions that he is most vulnerable to and then work on those. The last but very effective methodology is the exposure to response prevention. With the help of this technique, Pat would be able to refrain from any compulsive behavior when he is exposed to any situation or object that instigate such behavior.

The CBT under the EBBP is an extremely effective treatment for bipolar patients like Pat and has several benefits. First, the therapy helps identify and remove negative thoughts in the patient. The major theory of CBT is that people’s own thoughts, behaviors and feelings cause them to act in a certain way and not the people or environment. Second, it makes people able to control their feelings through strategies and techniques. Third, it changes the beliefs people have about themselves and help them learn new things about themselves. Fourth, the CBT helps manage excessive anger through various mental exercises like meditation and so on. Fifth, the therapy helps the individual develop positive thoughts about the future as well.

Along with the benefits, the CBT however has certain negative effects as well. Primarily, for the treatment to be successful the counselor has to have the cooperation of the client without whom, it would not work. Secondly, the therapy requires too much time from the client and hence, it takes a toll on both the counselor and the client. Thirdly, as CBT involves talking about the negative thoughts or feelings and/or traumatic events, it might make the patient more anxious and uncomfortable. Fourth, as Sullivan et al. (2015) argue, since CBT involves addressing only the current state of mind and feelings of the client, it fails to acknowledge other underlying issues such as events in the childhood.

Assessing the benefits and adverse effects of the CBT treatment, it could be advised that Pat need to be referred to a psychiatrist to have a psychopharmacological treatment. The reason is evident from the analysis of the client, which demonstrated that his behavior is controllable and only needs proper addressing that could be given by an EBBP therapist (Mueser & Glynn, 2014). However, the movie showed that Pat declined taking any medication but that must not be done in real life. A client like Pat must be encouraged to take medication in cases of sleeplessness especially. According to Scott et al. (2013), the best medicine for bipolar disorder is the medicine that works best for the specific client because the symptoms vary. Pat could be advised to take medications that would control his mania and help him have a good sleep. The psychiatrist could prescribe Divalporex SODIUM for Pat in order to control his manic phases. The medication however, has some side effects as well. It might cause other illnesses such as diarrhea, drowsiness, double or blurred vision, shakiness and so on (Brittain, 2013). Therefore, it is advisable that the psychiatrist provides caution beforehand while prescribing this medication.

EBBP treatment plan

In the movie, the main character Pat receives counseling in very few instances and does not take medications. In real life, this would have aggravated the patient’s condition but the film depicted otherwise. It instead depicted that another character with similar conditions of bipolar treats the character majorly. The treatment plan suggested in the paper, if given to the character would have completely changed the outcome of the story especially for the other main character, Tiffany.

The main character, if received the suggested treatment, would not have had frequent encounters with Tiffany and the parallel love story between the two, would not have developed. Further, looking at the negative effects of the treatment, if the character’s symptoms had aggravated due to emotional outbursts, he would have to be admitted to the mental health institution again and the story’s climax would have been entirely different. Further, the scene where Pat loses his cool on not finding the wedding videotape would also have escalated due to the negative effects of the treatment. In addition, since the treatment involves regular visits to the CBT counselor, Pat would not have had the chance to meet Tiffany. The dance sessions, which he had to attend with her, would also not have been possible considering the time he required to attend the sessions. However, the benefits of the treatment could have had a positive effect on his behavior especially with tiffany. One scene in particular, would have been different – the scene where the two main characters engage in an interaction while having their respective milk and tea. In the scene, Tiffany shares her secrets about being sexually engaged with all the employees where she previously worked. Pat forms a judgment of her character that enrages Tiffany and she bursts out of the café. With the treatment, Pat would have not made such judgments because it would have given him a positive outlook about everything. Apart from that, he would have also been able to help Tiffany with an alleviated outlook, feelings and behavior. It is therefore evident that the successful application of the treatment suggested would have changed the story line in various ways depending on the success or failure of the treatment.

Conclusion:

The analysis thus concluded, brings to light the various aspects of the bipolar disorder and the effectiveness of an EBBP treatment such as the Cognitive Behavioral Therapy or CBT. The analysis began with a short synopsis of the film Silver Linings Playbook (2012) starring Bradley Cooper and Jennifer Lawrence. Then, it provided the initial diagnoses of the main character Pat Solitano (Bradley Cooper). After that, the analysis included the diagnose that needed to be ruled out gradually as the character developed.  It is however suggested that further research into the bipolar disease be carried out since the film did not explicitly show what a person with bipolar disorder could experience.

References:

Allen, J. D., Hall, L. W., Collier, R. J., & Smith, J. F. (2015). Effect of core body temperature, time of day, and climate conditions on behavioral patterns of lactating dairy cows experiencing mild to moderate heat stress. Journal of dairy science, 98(1), 118-127.

Brittain, H. G. (2013). Pharmaceutical cocrystals: the coming wave of new drug substances. Journal of pharmaceutical sciences, 102(2), 311-317.

Buscemi, J., & Spring, B. (2014). Evidence?Based Practice in Psychology. The encyclopedia of clinical psychology, 1-6.

Imdb.com. (2018). Silver Linings Playbook (2012). Retrieved from https://www.imdb.com/title/tt1045658/

Mueser, K. T., & Glynn, S. M. (2014). Have the potential benefits of CBT for severe mental disorders been undersold?. World Psychiatry, 13(3), 253-256.

Nimh.nih.gov. (2018). NIMH » Obsessive-Compulsive Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Scott, J., Leboyer, M., Hickie, I., Berk, M., Kapczinski, F., Frank, E., ... & McGorry, P. (2013). Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. The British Journal of Psychiatry, 202(4), 243-245.

Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5.

Sullivan, P. J., Keller, M., Paternostro, J., & Friedberg, R. D. (2015). Treating emotionally dysregulated and perfectionistic youth with transdiagnostic cognitive behavioral procedures. Journal of Contemporary Psychotherapy, 45(3), 151-158.

Vancampfort, D., Vansteelandt, K., Correll, C. U., Mitchell, A. J., De Herdt, A., Sienaert, P., ... & De Hert, M. (2013). Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. American Journal of Psychiatry, 170(3), 265-274.