Sunday, February 28, 2016

Diagnosing the Oscars

The 2016 Academy Awards are tonight and it got me thinking – let's look at the Best Picture nominees through a clinical/DSM lens to make studying more entertaining!

Image credit Kate McHugh Akbar

There will be no spoilers in this post because I have not actually seen any of the movies. I'll pull the “I have little kids and I don’t get out much” card here. 

To be truly transparent, this post should probably be titled Diagnosing the Oscar Best Picture Nominee Trailers, because that reflects what I have seen.  Regardless, let’s dig in.

These movies feature a few different mental health issues.  To start, Spotlight covers the story of journalists investigating the priest pedophilia (now called pedophilic disorder in DSM-5) scandal in Boston.  Brooklyn’s main character seems to encounter normal bereavement—not a DSM diagnosis on its own but should be assessed carefully, keeping consideration of possible major depressive disorder.  The Big Short makes me wonder if there’s some narcissistic personality disorder going on, what with the themes of success, power, and arrogance, but it’s hard to say based solely from the trailer.

However, the award goes to… (see what I did there?)

Six of the eight Best Picture Nominees showcase some seriously traumatic stress.

Posttraumatic stress disorder is diagnosed when someone has “exposure to actual or threatened death, serious injury, or sexual violence” (DSM-5). 

The experience results in 1) intrusive symptoms (e.g., flashbacks and dreams), 2) an avoidance of reminders of the trauma, 3) negative alterations in one’s cognition and mood, and 4) changes in arousal (e.g., outbursts, reckless behavior, and hypervigilance).  PTSD used to be included as an anxiety disorder in DSM-IV, but in 2013’s DSM-5 it has been moved to a new chapter entitled “Trauma- and Stressor-Related Disorders.”

Here are the Best Picture nominees whose characters could reasonably be suffering from posttraumatic stress disorder:

  •  Multitude of survivors of childhood sexual abuse, victimized by priests
Bridge of Spies
  •  Main character forced to go to East Berlin during the Cold War and lead a hostage trade negotiation; also witnesses killings
  • Additionally, his family suffers attacks on their home from angry neighbors
Mad Max: Fury Road
  • Judging by the trailer, this whole movie looks like an unending barrage of chase scenes, killings, and near death experiences
  • Also hints at captivity and sexual abuse for female characters
The Revenant
  • Main character mauled by a grizzly bear, left for dead, engages in intense physical battles
The Martian
  • Near death experiences for astronaut main character who survives a storm but is accidentally abandoned on Mars with limited resources
  •  Possible trauma for astronaut crew that embarks on rescue mission
  • Main character Ma, abducted by a predator and held captive for several years in a room, victim of recurrent sexual abuse
  • Her son Jack (the product of Ma’s rape) who has spent his whole life in the room, leads their escape, and adjusts to life outside


Two clinical notes to consider: 1) PTSD can be diagnosed when the disturbances last for a month or longer.  Acute stress disorder can be diagnosed when similar symptoms occur less than one month after the traumatic event.  2) Five-year-old Jack’s character in Room would specifically be diagnosed with the child’s subtype of PTSD for children 6 years and younger.

There's an awful lot of stress in these movies.  Is outrageous stress the key ingredient to deem a movie Oscar-worthy?

Honestly, I saw one or two movies this past year, and given the choice I did not select a stressful movie experience.  Some trauma workers, including social workers, encounter enough vicarious trauma through the job and don’t desire to witness more as entertainment.  Another topic for another time.

Who has seen these movies and can offer further commentary? What did I miss?  Bonus points for whoever correctly predicts Best Picture winner!

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