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Diagnosis Presentation

JHU Grad School
by

Laura Neugebauer

on 25 October 2013

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Transcript of Diagnosis Presentation

Science in Popular Culture
By Laura Neugebauer
Spring 2012
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:
04/30/1978
DOB:
Lisbeth Salander
Examinee:
Lisbeth is a
fictional character
. She is the main character in the Swedish crime novel and movie series by Stieg Larrson.
Case Study #1
DIAGNOSIS
Case Study #2
Examinee:
Hannibal is a
fictional character
. He is the main character of the acclaimed novel and movie series by Thomas Harris.
Dr. Hannibal Lecter
DIAGNOSIS
Examinee:
John Nash
Case Study #3
John Nash is
not fictional
. He really lived. A critically acclaimed book and movie were modeled after his experiences.
Patient History
DIAGNOSIS
The real John Nash
Russell Crowe in the movie
Axis I: 309.81 Chronic Posttraumatic Stress
Disorder with dissociative features
Axis II: None
Axis III: None
Axis IV: Victim of and witness to sexual/physical
abuse, removal from home, discord with
mental health professionals
Axis V: GAF = 60 (current)
PTSD is characterized by developing specific symptoms following exposure to a traumatic experience.
re-experiencing the traumatic event
avoiding stimuli that might remind one of the traumatic event
increased anxiety or emotional arousal upon remembering the traumatic event
(APA, 2000)
Dr. Peter Teleborian makes her endure “sensory deprivation” at the psychiatric institution she is sentenced to
For an entire year
restrained to a bed in a dark room
forced to ingest psychotropic drugs and sedatives
frequently deprived of food as punishment for not corresponding to treatments
Nils Erik Bjurman sexually assaults her and brutally rapes her
Examples of traumatic events...
witness to her mother’s brutal physical abuse and sexual assault at the hands of their father
Other Criteria Met...
Salander experiences recurrent thoughts, images, and vivid nightmares about the events with her mother, her father, and her own rape
Salander persistently avoids contact with people, things, and places that remind her of these traumatic events
She has a restricted range of affect and a feeling of detachment or estrangement from others
Salander has difficulty falling or staying asleep; she is hypervigilant about her safety
The condition has been ongoing for years, making this the chronic type.
Science in Popular Culture
she is labeled “mentally incompetent”
Lisbeth might suffer from
Asperger’s Syndrome
Paranoid Schizophrenia
or Antisocial Personality Disorder
From the books and movies ...
Dr. Hans Steiner, professor of psychiatry and behavioral sciences, child psychiatry, and human development at Stanford University School of Medicine, also diagnoses her with PTSD and dissociative features.
Examples of PTSD are becoming more prominent in popular culture, especially regarding women who are physically or sexually assaulted.
So what does this trend say about American culture?
It could be mirroring the movements in society that promote stopping violence against women and the skyrocketing crime stats that show violence has increased.
But it might also send the message: women are always the victims and they are helpless innocent creatures. This isn’t always true!
Axis I: None
Axis II: 301.7 Antisocial Personality Disorder
Axis III: None
Axis IV: Death of family members, arrest,
incarceration, exposure to war, discord
with mental health professionals
Axis V: GAF = 12 (current)
The defining feature of Antisocial Personality Disorder (APD) is a “pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood” (APA, 2000).
This condition is also known as psychopathy, sociopathy, or dyssocial personality disorder
(APA, 2000).
Examples of disregard and
violations of others' rights...
He tricks people, uses aliases, and defeats polygraph tests
He cons others into believing he is an “innocent medical student” or a “respected psychiatrist” for personal pleasure or gain
Hannibal stalks his victims and brutally kills them without remorse
Lecter experiments with homicidal cannibalism as a symbolic means of paying homage to his murdered and cannibalized little sister, Mischa

*Taken from Hannibal Rising*
Other Criteria Met...
One must be a legal adult, 18 years old or older to be diagnosed (APA, 2000).
Hannibal is at least 18 when he acts on his psychopathic desires.
There must also be evidence of Conduct Disorder before the age of 15 (APA, 2000).
Hannibal shows aggression towards people, deceitfulness, and serious violation of rules when at the orphanage
Hannibal does not experience Schizophrenia or a Manic Episode confirming that he suffers from APD (APA, 2000).
At 8 his parents, aristocrats from Lithuania, were murdered – caught in the crossfire of Soviet and German soldiers during World War II.

Hannibal witnesses and is left alone to care for his little sister, Mischa.

Mischa became victim to a brutal murder and cannibalism at the hands of the starving Soviet soldiers who found them (Webber, 2007).
Etiology of Hannibal’s APD

Cannibalism is not listed in the DSM-IV TR as a distinct disorder, but this behavior is a manifestation of his psychopathy.
Science in Popular Culture
Hannibal Lecter has become the “poster child” of Antisocial Personality Disorder in popular culture.
Hannibal is a paradoxical character. He is a “brilliant scientist and bestial madman, a psychiatric case-study who, as a psychiatrist himself, ridicules the models which his captors apply to him, the serial killer who is a consultant to the police (Oleson, 2005).
Lecter is the American Film Institute’s number one villain of all time (AFI, 2005).
Serial killers and sociopaths saturate American television, movies, and literature.
What does this trend
say about American
culture?

We have an insatiable appetite for crime. Something to think about, especially since recent studies say that watching crime passively on TV might desensitize society and have other negative effects.
The essential characteristic of
Paranoid Schizophrenia is a presence
of pervasive delusions and auditory
hallucinations “in the context of a
relative preservation of cognitive
functioning and affect” (APA, 2000).
The delusions can manifest in a
variety of themes:
persecutory
grandiose
jealousy
religiosity
somatization
or others (APA, 2000).
Axis I 295.30 Schizophrenia Paranoid Type
Axis II None
Axis III None
Axis IV Problems with primary support
group, Occupational Problems,
Problems related to interaction with
the legal system/crime
Axis V GAF = 32 (current)
Nash thought a story in the New York Times had “an encrypted message from inhabitants of another galaxy" --> Delusion
Nash believed that all men with red ties were out to get him --> Delusion
In the film: Nash had "Charles" "Marcee" and "Mr. Parcher" --> Auditory Hallucinations
Examples of delusions and hallucinations...
In the movie
Nash is portrayed as having awkward social functioning.
He wears a knit hat and runs around the Princeton campus seemingly unaware of other people, essentially withdrawing from society to concentrate on mathematical equations.
Nash’s inability maintain work at the university
He resigned his position at MIT
Other Criteria...
Nash did not suffer from Schizoaffective or Mood Disorders
Did not abuse substances
Did not have a general medical condition
Childhood did not reflect evidence of a pervasive development disorder (Nasar, 2001).

Science in Popular Culture
A Beautiful Mind accurately portrays Paranoid Schizophrenia.
One of the most difficult features of this disorder for popular society to comprehend is “how can they not know that stuff isn’t real?”

Not only does the film about Nash redirect our presumptions about the disorder, but also the cinematography allows for the viewer to experience the confusion of the delusions and hallucinations.
Kudos to the movie industry for deviating from the stereotype and humanizing the condition.
References
Alfredson, D. (Director.) (2009). The girl who played with fire [Film]. Denmark: Yellow Bird.American Film Institute. (2005). Top ten heroes and villains. Retrieved April 16, 2012 from
http://www.afi.com/100years/handv.aspx.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Howard, R. (2001). A beautiful mind [Film]. Bayoone: Universal.Larrson, S. (2011). The girl with the
dragon tattoo trilogy bundle: the girl with the dragon tattoo, the girl who played with fire,
and the girl who kicked the hornet’s nest. New York: Random House Digital.
Nordström, G. (2008). A beautiful mind: a review for healthcare staff. Retrieved April 16, 2012 from
http://www.cnsforum.com/educationalresources/filmforum/a_beautiful_mind/.
Nasar, S. (2001). A beautiful mind. New York: Simon & Schuster.
Oleson, J. (2005). King of killers: the criminological theories of Hannibal Lecter, part one. In C. Dunton
(Ed.), Journal of criminal justice and popular culture (pp. 186-210). 12 (3). Albany: U at
Albany.
Oplev, N. (Director.) (2009). The girl with the dragon tattoo [Film]. Denmark: Yellow Bird.
Steiner, H. (2011). If Lisbeth Salander were real. In R. Rosenburg, S. O’Neill, & L. McDonald-Smith
(Eds.), The psychology of the girl with the dragon tattoo: understanding Lisbeth Salander and
Stieg Larrson’s millennium trilogy (pp.153-168). New York: BenBella Books.Webber, P.
(Director.) (2007). Hannibal rising [Film]. Prague: Barrandov Studios.

This video is from the Swedish film, please carefully read English subtitles.
Full transcript