Mental health misfits: When the process of diagnosis fails to deliver a verdict
It isn't fun being a misfit. It isn't always pretty either, especially if you're a mental health misfit. But it gets worse. One could be the victim of a mental health misfit. I came up with the term mental health misfit as I was considering an all-too-common phenomenon in the field of mental health. A mental health misfit, according to my own definition, is a person who suffers (and in some cases, causes another to suffer) from a mental illness that isn't easily organized according to a single, specific clinical diagnosis.
We see it in the character of Annie Wilkes, who repeatedly performs unlawful, cruel, sadistic acts in fits of hysterical rage, switching abruptly from smitten, obsessed fan of Paul Sheldon and his novels, to raging maniac. She certainly meets the criteria for a diagnosis of Antisocial Personality Disorder, but does that diagnosis alone give us a clear, accurate picture of who she is, from a clinical perscpective? No, there's something missing, something that other disorders don't quite capture.
What about the mother and daughter in the movie Dolores Claiborne. Their rough exteriors serve as defenses against unspeakable trauma. Yet Post Traumatic Stress Disorder doesn't quite capture what is going on with each of them individually, and it certainly doesn't take us any further towards gaining an understanding of the dynamics between them.
Mrs. Jones, in the song, Mrs Jones, Mrs Jones, Mrs. Jones, is a striking enough character in the song link to now be prompting up to 1,000 hits a day, yet what does the song tell us about her that a definitive diagnosis would explain?
In the game of blog n roll, I provide the topics and the tunes, and you, the blog visitor/participant provide the talk. Today, in the comments section, I would ask you to shed some insight into the characters of Annie Wilkes in Misery; Selena St. George and Delores Claiborne in the movie, Delores Claiborne; and Mrs. Jones in the song, Mrs. Jones, Mrs. Jones, Mrs. Jones.
Dr BLT
words and music by Dr BLT copyright 2009
I'm not going to ask you to offer any diagnostic hypotheses about any of these characters. Instead, I want you to describe that element of their respective presentations that are not easily addressed via the methods of clinical diagnosis. After discussing each individually, in non-diagnostic, but none-the-less clinically relevant terms, discuss the dynamics between the mother and daughter in Delores Claiborne, and then discuss what it is that Delores Claiborne, Selena St. George and Mrs. Jones (in the song) share in common.
Categories: diagnosis
Tags: psychiatric diagnosis clinical assessment psychology diagnosis and treatment diagnosis music and mental health clinical psychology
Anne Wilkes,can be diagnosis as a Antisocial Personality Disorder,but that does not in reality tells us who she really was. What made her be that way. Was it her upbringing,or the isolation of living up in the hills being isolated for months till the roads were possible.Does snow madness really exist? Could it be a combination of the environment,the lack of social interactions,and the lack of maternal bonding that help make her the individual she turned out to be. Anne was possibly a victim of her own environment.
Looking at the realtionship between mother and daughter one can definitely see that their environment was the determining factor of the strained relation as well as the mental break down of Selene and the reason that Delores left the house and lived with her boss. Delores did what she could as a mother would to protect her child. But unfortunately the well meaning actions come back to haunt her and Selene only seems to protect the father and resents her mom. Could it be the Stockholm's syndrome she is experiencing? For Delores it is complete removal of herself from the house that had to many negative memories, and then hiding those memories way under the surface. Sometimes the relationship need to remain strain in order survive what ever ugly experiences they have faced.
In Mrs.Jones she is going though the phases many women may feel. The phase of wanting to be wanted and loved by someone. The starting and ending of any relationship can harm one more than one thinks. Not everyone is strong enough to survive. Yet Mrs.Jones seems to find a man yet he is not the one, as he does not seem to treat her well, but to the outside world, she is in her mind now acceptable because she has a man in her life. Even though she feels she is naked to the world. It seems she is vulnerable, and still all alone.
What the three women have in common is that they are surviors. Each experienced dramtic life changing issues. They each dealth with their perspective life tramuas differently, but each seemed to be able to navigate on the surface of their daily life and go about their daily routines. But in reality they were jusy holding on to a very thin string of their memories.
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I don't know that I can agree that diagnostic categories explain anything. We hope they inform us about prognosis and help us select the treatment most likely to effect healing, management or cure. I suspect you are familiar with Lakof's Women, Fire, and Dangerous Things. If not I strongly suggest you have a look.
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In the case of Annie Wilkes from Misery, she definitely does display symptoms of Antisocial Personality Disorder. However, there are additional things about her that are not clearly explained by the diagnosis. What happened to her (if anything) as a child or young adult that may have contributed? WHY ON EARTH would she choose nursing as a profession if she is anti-social and deviant?? She displays caring, thoughtful behaviors at times and at others she is completely devoid of normal human emotion. It is as if she has varying "personalities."
Delores Claiborne and her daughter Selena both clearly do display symptoms of post-traumatic stress disorder, but that diagnosis in itself does not explain either of the characters fully. Delores is complex, hiding her pain in a mask of "bitchiness" towards others. Yet she displays a great deal of caring towards Vera Donovan and also towards her daughter and the protection of Selena. Even though she had a hand in the death of her husband, her motives were clearly out of a fierce protection of her daughter Selena, and self protection from his physically and mentally abusive ways.
Selena deals with the trauma by self-medicating with alcohol and lots of pills. She has completely masked the memory of the sexual abuse she endured at the hands of her father and has a completely distorted view of reality as it relates to her childhood and her parents. She clearly has distanced herself from reality by emersing herself in work and meaningless relationships with people other than her family. However, even though she blames her mother for her father's death, there is clearly some part of her that wants to believe in Delores, otherwise she would not have come to her side during the crisis when Vera was found dead. These inconsistencies don't fit into the neat category of PTSD.
Mrs. Jones, in the song, also appears to endure physical abuse at the hands of her husband. She "found a man" but is still alone. Why does she stay? Low self-esteem? Co-dependency? Does she too suffer from PTSD? Could be a million reasons that we cannot tell from the information we are given.
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In the movie Delores Claiborne, both her and her daughter Selena had experienced direct traumatic events in which they have suffered. Both characters can be diagnosed with PTSD, but they clearly exhibit different symptoms and coping mechanisms to deal with the events and experiences. Both individuals do demonstrate signs of anger, shame and guilt of the experiences that have been portrayed. Delores, because she feels like if she didn’t protect her daughter and Selena because she was abused by her father, someone whom she felt was suppose to provide for and protect her. Such experiences drove both Delores and Selena to disengage with one another and try to live separate lives to hide and/or maybe forget the events that have happened. In order to work with individuals with PTSD, especially like Selena who had turned to alcohol and medications to numb the pain (dual diagnosis), as therapists we need to be nurturing and empathetic to the pain felt by the client, but also build the rapport that could allow you to have the client re-tell her story and work through the pain. Also as a therapist, one would want to empower the client and redirect the faulty beliefs of being a victim to being a survivor.
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Mrs. Jones, the song lyrics were quite confusing to me. I was having a hard time trying to examine whether the DV caused the SA or was the SA the antecedent to the DV?? To me, either one could trigger the other, therefore as a therapist we would need to further explore the history of DV and SA.
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All of the characters described present with issues and behaviors that are not only not easily or simply diagnosed. In the movie Misery, Ms. Wilkes, presents emotional issues in dealing with anger as well as disappointment and acceptance. Her behaviors also demonstrate some issues that might be difficult to address. On one hand she appears to be obsessed with her “hostage” but yet she subjects him to horrific acts of aggression and cruelty. She appears to be obsessive in one sense, but also presents a clear need to have power and control over others. The movie depicts some of the murders she has committed in the past, which presents another aspect of her behaviors which is her constant need for attention.
Selena also presents several diagnostic difficulties. Her concerning behaviors include substance abuse as well as the apparent repression of memories related to painful events from her past. Selena appears to carry a lot of guilt towards her mother, when, as the movie concludes, the person she may really be angry with is her father. Selena shows that she may have some counter transference issues emerging. She also appears to have some trouble managing painful events, and lacks appropriate coping skills.
Dolores Claiborne is another complex character. Dolores deals with issues of grief as well as some possible depression related to the fact that her daughter has almost literally disowned her. Dolores finds her only comfort in living with a woman, who on some levels she is able to relate to, but subjects her to frequent and regular emotional and verbal abuse.
The dynamic between Selena and her mother is perplexing from an outside perspective. Selena appears to have renounced any type of relationship with her mother, yet when her mom is in trouble she comes to her aid. Dolores in her own ways accepts whatever relationship is available with Selena. Dolores seeks to reveal the truth to Selena regarding the past circumstances. Selena is resistant and this puts a further strain on the relationship. However, as the reality of their lives and the situations they have endured unveils, the 2 appear to become closer and begin to relate to each other on the basis of a shared sadness.
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I think that it is very important to consider that because there is a diagnosis; not necessarily do we have a full disclosure of each and every descriptor of how a person suffering from this should or shouldn't act. I think that these diagnosis help us to understand a little but this is why we get the (so very mentioned) Not other specified) due to the person having some of the many symptoms. Also, the other aspect that you have to begin with one diagnosis and then maybe discover that indeed was another.
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Annie Wilkes definately displays Antisocial characteristics. Angie points out that if she is a nurse she must have some compassion, but if you are familiar at all with female serial killers, they usually murder by poison and other less "messy" methods that male killers use. It is not uncommon for these folks to find their way into a profession like nursing becuase it gives them plenty of helpless victims to kill easily. They satiate their need to inflict harm and gloat in their power and the ability to fly under the radar and go unsuspected, so perhaps that was truely Annie's motive for choosing nursing as a career. She also desplayes some Obessessive tendencies and does everything she can to keep her fantasy world in tact by controlling the person that creates that world for her. She either has multiple diagnoses, or she just doesn't fit neatly into any particular diagnosis.
As for Delores and Salena, they both appear to have PTSD, which led to different coping mechanisms for them. Dolores had to put on a hard exterior, and Selena self medicates. Dolores probably never would have killed anyone had she not been in the predicament she was in. She saw it as her only way out. It is about survival. Again, however neither fit neatly into a diagnoses.
With Ms. Jones, she probably has some characteristics of Dependent personality disorder because she doesn't feel right unless she has a man. She is willing to give up herself and who she is to have that sense of being wanted and belonging. She also probably suffers from PTSD/Battered Women's Syndrome and is stuck in the cycle of domestic violence and cannot get out. Other theories can help explain things that a diagnoses alone cannot help to explain.
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Annie Wilkes is a woman who seems to be quite bitter with the outcome of her life. During one of her rages, it seemed that she was saying the exact words that were possibly spoken to her as a young girl,
something to the effect of " I do everything for you and you are ungrateful" It sounds like she may have grown up in a very controlling household, where she may not have had much say... thus went into the caring profession where she could be in control and possibly unconsciously got revenge on all who had controlled her life. Her pattern seemed to be that she would establish a relationship as she did at first with Paul Sheldon. At first she took good care of him and seemed truly -genuine, and then in her crisis moments would lash out, and be totally controlling in every aspect of his life.
Dolores Claiborne and Mrs. Jones, both lived the silent life of Domestic Violence. It is this silence which has claimed the lives of many victims in our society. Just in Kern county this year this silence of domestic violence has claimed the lives of 16 women. Let's not be fooled there are men who are victims of domestic violence as well. We don't know how Annie Wilke's husband died, could it be that he too was a victim of domestic violence?
The silence for Dolores Claiborne ended when she discovered that her daughter was a victim of molestation. It is then that the "mother Lioness" in Dolores came to the rescue of her "cub" Selena.
The relationship between Selena and her mother was a rocky one. Both women lived their lives trying to hide the pain they carried inside of them, while all along it alienated the person they most loved in their life!
Being a "mental misfit" is a very difficult task. I know a 20 year old young woman who is in the lower spectrum of autism. In her early years, she was unaware that she was different, but as she has grown up, she has become more aware of this difference. It has been very difficult for both her and her family. When she was in grade school, children would make fun of her, which ended in her parents taking her out of school and homeschooling her. In her teens she wondered why everyone else had a boyfriend and she didn't, and now most of her cousins are attending college. Her parent's concern is what will happen to her when they are gone? It can be rough feeling like a misfit and being shunned.
The DSM talks about Autism diagnosis, but what does it doesn't talk about is what to do with the feeling of being a misfit.
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Annie Wilkes was an interesting character. She displayed antisocial behavior, major mood swings, and delusional thoughts. How can one simply diagnosis such extremes with such a complex character. At the beginning, she was a wonderful and caring nurse. At one point, she had to of had compassion and a sense of caring for others. What happened in her life to of changed to such an extreme. What brought her to that point of complete antisocial and delusional behaviors. Environmental, genetic, and behavioral factors can all contribute to some diagnosis, but not so easily determined from such a complex character.
Dolores and Selena were all survivors in an abusive and destructive home environment. Dolores was abused, but to ashamed to leave because of her daughter and the so called "times in which she lived." In those days, it was very had to leave a husband. She only had the courage and determination to leave when she found out the her husband was abusing her daughter. Her daughter was filled with such anger, hurt, and denial about her past that she self-medicated so she could just cope with life.
Mrs. Jones was another example of a person being physically abused. She endured the physical pain by another. The words in the song describes her suffering and humiliation. Was she to afraid to leave or did she have a fear of being alone? But, realizing that you can be in a relationship and still be alone. She survived by taking drugs to numb the pain.
All the characters in some form or another were all trying to survive. They were survivors, doing what they had to do in that time to make it through each day.
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