Discuss about the Consistency and Coherence in Treatment.
Every human being, when he or she is born enjoys a state of physical and mental health. The physical and mental health of the child grows with the passage of time (Enos, 2017). But there are also cases where either the physical or the mental development of any child is not in accordance with the age of the child. It is easy to analyze whether the child is growing physically as it is visible to the naked eyes. The problem comes in case of mental health which is not visible to the naked eyes. Another problem related to the mental health development is that at times there are cases where the problem does not come to surface till the adolescence or the late teenage. One such mental disorder is the Borderline Personality Disorder (Bech, Elklit and Simonsen, 2015). This disorder has always been the topic of debate amongst the mental health professionals. It is the borderline between the psychosis and neurosis. In this essay, we will discuss the aetiology and pathophysiology of this mental illness as with respect to the character Susana in the movie Girl Interrupted. We all also assess the treatment or the mental health assessments as shown in the movie regarding the borderline personality disorder (“Borderline personality disorder: management“, 2014). The essay will also try to assess the impact of the disorder on the lives of the individual, family and the community as a whole along with the stigma and discrimination attached to it by the people and society. The movie Girl Interrupted will try to provide us with a practical approach towards the disease and a peek into the life of a person who suffers from such an ailment, her sufferings and the trauma she has gone through during her stay in the mental health facility.
The Borderline personality disorder affects close to 7% of Americans in their lifetime. It affects approximately 50% more patients as compared to Alzheimer’s and more than 2.25% schizophrenia and bipolar diseases together. The current scenario regarding the circumstance focuses on the in-progress patterns of intricacies involved in self-control i.e. ability to pacify oneself in times of pressure and trouble with behavioural relationships emotions, thoughts, and self-image (Crowell, 2016). If we try to analyze the causes of borderline personality disorder it can be said that the research is in its early stages. Mainly there are two major causes of borderline personality disorder i.e. genetic causes and environmental causes. Scientists agree that the above mentioned two factors are majorly responsible for this mental disorder. In the movie also when Susana’s parents come to Claymore facility, and they are having a discussion about when they can take her home Susana asks the doctor if it is genetic. Then the doctor says that there are 5% more common among those with the borderline parent. Whereas some personality traits are symptomatic of borderline personalities akin to the recklessness and hostility can be inherited or genetic but the brain expansion and growth are not entirely genetic (Stroud & Parsons, 2012). They get affected by the environment also.
In addition to this, it has been found in the current as well as the available research that it is more likely to be found in the females as compared to the males. The environmental factors can be like events during the childhood like emotional abuse, social-cultural surroundings, post-traumatic stress disorder, intense and chronic stress, loss of a family member, neglected child, bullying, sexual abuse, physical abuse, mental agony, unstable relationships and disturbed family life, etc which too play a task in the growth of the disorder at the later stage of life (“Borderline features are associated with inaccurate trait self-estimations“, 2014). All such risk factors increase the chances of the brain abnormalities. In the movie also it is also shown that during the party, how Bonnie’s mom Bobby Gilchrist flaunts in front of Susana and her mother about her daughter being accepted into Redcliff College. Apart from the research, the existing theories are more expected to build up borderline personality disorder owing to harmful childhood experiences biology, genetics (Amad, 2014). When examinations are done during the research on the borderline personality disorder patients it has been found that the prefrontal cortex in the patients which helps in regulating self-control, behavior and emotions may be comparatively minor as compared to normal or not as grown as it may be required to fully function. Contrarily the amygdala is on the other hand so much proactive which in turn leads to more intense emotional reactions and heightened emotions as in case of Susana when she behaves angrily when she is in session with Dr. Mrs. Potts. Neurotransmitters inside the human brain whose responsibility is to regulate learning, mood and sleep are also at lesser levels as required in case of borderline personality disorder cases (“Characterizing adult attention-deficit/hyperactivity disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors”, 2016). If we see the pathophysiology or the symptoms of the disorder we can list them down as under. The first symptom is the intense fear of rejection and abandonment which has been shown in the movie when Susana visits a doctor who is a friend of Susana’s father who has left counseling but gives her time due to his friendship. At the end of the session, Susana’s mother leaves her baggage at the door with the doctor and doesn’t come out of the car when she goes. Another symptom is unstable moods and intense emotions. Susana shows intense emotions in the argument with the Lisa and she yells at her saying that you are dead already and her heart is cold. The patients with borderline personality also depict the chronic feeling of emptiness and extreme sadness (Brickman, Ammerman, Look, Berman & McCloskey, 2014). At various accounts, the protagonist Susana shows sadness like when her friend commits suicide and a feeling of emptiness surrounds her when she leaves her boyfriend. Such patients are also sensitive to criticism. They get easily frustrated with themselves and the surroundings. When the people they care the most disappoint them they get annoyed at them or when the things don’t go as they have planned it in their minds. Susana gets frustrated or annoyed when she watches a fellow inmate getting out of the facility whom she thinks is not eligible to get out. They also get angry and show aggression. They also indulge in self-harming behavior at times which may also include the attempt of suicides like Susana gulped a bottle of aspirins with a bottle of vodka. They also have unstable and changing relationships like Susana first have relation with Jared and then suddenly leave him because she has established a bond with the institution (Lewis, Caputi & Grenyer, 2012).
It is also possible for the mental health professionals to make mental assessments of the borderline personality disorder patients after having a few sessions with them . Dr. Melvin Potts in her mental health assessment if Susana writes that she suffers from psychoneurotic depression reaction, although she is judged to be highly intelligent but she has been found in denial of her existing mental condition resistance and also her there is a personality pattern disturbance which is resistant and mixed type r/o undifferentiated schizophrenia. There are many treatments which have been researched and developed over the period of time (Biskin & Paris, 2012). Some of the prominent ones are like talk therapy, dialectical behaviour therapy, metallization based therapy, transference-focused therapy, good psychiatric management, cognitive behavioural therapy, medication and self care activities. The first and major treatment is the talk therapy which is the foremost choice of the professionals as compared to the medicines in other ailments or diseases. In the movie also Susana’s father sends her to his friend who is a mental health professional. Generally, there are one or two sessions a week depending on the response of the patient to the treatment. This treatment to be successful the patient must feel relaxing and a relation of fidelity must be established. This treatment reduces anger and self-harm and overall improves the social and mental functioning of the patient. Another therapy practiced by the professionals is dialectical behavioral therapy (Abdelhamid Gado, 2016). It lays emphasis on the notion of mindfulness or paying consideration to the current sentiment. It teaches methods to be in charge of strong emotions minimize self-destructive behavior and handle anguish and get better at relations like Susana at the end of the movie make amends with Lisa and how she let go the emotions attached with the cat by handing her over to the inmate. This proactive problem-solving technique was specially designed for borderline personality disorder and includes therapy sessions and group tasks. Another therapy is a metallization based treatment which is also a talk based therapy which assists people identify and comprehend what other people are possible understanding and feeling about them (Bohus, Schmahl & Oldham, 2014). Next is the transference-based therapy which assists the patients to comprehend their interpersonal and emotional problems by the means of association between the patient and professional therapist. The insights the patients learn in the sessions are applied by them in different scenarios. Good psychiatric management provides the mental health professionals a particular set of the toolbox which they can use with patients with severe disorders. Then comes the cognitive behavioral therapy which studies the relationship between the thoughts and beliefs vis-a-vis feelings and behavior. It basically combines cognitive therapy and behavioral therapy. Medication is also a treatment for the borderline personality disorders but professionals are of the opinion that it cannot be cured with medication but it helps in treating other conditions that worsen the situation for this disorder like anxiety, depression, etc (“Psychotherapy for Borderline Personality Disorder Reduces the Need for Prescription Medication”, 2015). Patients with this disorder are always encouraged to talk with their doctors about the effects of medicines and side effects. The most effective remedy is the self-care techniques like scheduled exercise, good quality sleep habits, nourishing diets, eating medicines as approved and health stress administration all this can assist in reducing routine symptoms of borderline personality disorder like mood swings, impulsive behavior. Finding a mental health professional is equally important as it is to get the treatment. He must have certain qualities or traits before anyone is selected. He/she must be an experienced consultant with which the patient feels comfortable and it is easy to trust him/her. He must use a blend of various techniques for the patient so as to avoid monotony. He/she must have a valid license for practice and cares and understands about the patient. He should accept the patient without any judgment. As it is all a talking therapy he should be a good listener. Similarly, a faculty also must have a license to operate and must have specially trained professionals and must be in existence for a minimum number of years (“Consistency and coherence in treatment outcome measures for borderline personality disorder”, 2015). Patient staff ratio is also an important criterion. Facilities provided are also an important number of times therapy is offered in a week, kind of staff trained or untrained, aftercare options, rules handbook etc.
Every ailment or mental disorder affects the life of the individual, family and the society in a way or other. The borderline personality disorder also affects the individual in an adverse manner. The major effects are discussed as under. The first effect is that the person suffering from borderline personality disorder has to go through the emotional irregularity. Researchers suggest that the brain areas responsible for emotional response become overactive and less active are the areas controlling emotions and aggressive impulses. It becomes confusing to live with when you are not sure whom to trust and not. Every emotion is exaggerated and over-amplified. Difficulty in controlling anger and getting bored easily creates a feeling emptiness and restlessness. Another impact on the individual is the unstable relationships, being sensitive to what we call as rejection. They start hating the persons on the basis of fear that they are going to leave them at the end. They start manipulating people without being aware of the fact they are doing so. They become possessive, suspicious and paranoid regarding their relationships. They are not able to judge anyone like Susana left Jared when he asks her to go with him. Another impact on the patients is that they become impulsive in behavior (“The impact of posttraumatic stress disorder on the symptomatology of borderline personality disorder”, 2016). They start keeping to themselves in case of certain events like Susana keeps lying on her bed after the death of the inmate. The doctor and has carry her to put her in a bathtub to break the continuity. Another example of the impulsive nature is when Susana runs away with Lisa from Claymore, establishes a relationship and comes back. Borderline personality disorder patients also suffer from identity disturbances. They always have a conflict going on with themselves. They have a fluctuating self-esteem. Along with the individual suffering, the family of the patient also suffers (Flynn et al., 2017). Their pains and sufferings are also heightened. The first impact on the family is the social stress and taboos fixed, as depicted in the movie, Susana’s parents are worried that when will she be back as there is Christmas and what are they supposed to tell the family members and relatives coming to their place. They always feel a sense of guilt around them as if they have committed some crime in the society if their children have a mental disorder. The immediate and the extended family also suffer in their respective workplaces, colleges, schools as they are also taunted regarding their relationship with the person. At times there is also a risk of the family members getting into depression because of the personal sufferings and the individual sufferings. Another impact is that they are not trained to handle the mental disorder people even though they are their relations. There is always a chaotic environment at the home. People go to their workplaces with problems in their minds which have an adverse impact on their professional lives. Such people also face lack of social support which can be a great morale booster of received. As the treatments are expensive also they come under the financial stress also after a period of time. Individual and the families when combined together give us society or community in which we live in. The mental disorders whether borderline personality disorder or any other do have an impact on the society. Although it is not in control not to have such diseases or problems and they cannot be avoided but till the time they exist or occur they will continue to have financial impact on the society, the funds which are used for providing facilities can be used for some more constructive purposes. As we have studied already that the behaviour can get impulsive or aggressive, the patients have to be kept under observation and control so that it may not happen that they harm anyone close to them (“The Effectiveness of Dialectical Behavior Therapy on Reducing Symptoms of Borderline Personality Disorder: Case Study”, 2016).
Also, there is a discrimination and stigma attached to the personalities and people attached to such kind of disorders (Myers, 2017). It is necessary to fight stigma so that the patients can be cured and joined with the mainstream people. But the irony of the fate is that the people who are expected to cure them, bring them to the mainstream ate the ones who are pulling their legs. They are ones majorly responsible for bringing them down. The mental health professionals have more stigma and discriminating attitude toward the patients then their families or the society as a whole has. The professionals are the persons who misunderstand the patients; they misdiagnose the patients as compared to any other illness. It has been even found that the mental health professionals go to the extent of denying the patients their right to treatment on the grounds that they do not have any problem. In some cases i.e. where the professional take the cases they do not perform the case studies professionally. They do it just for the sake of doing it. They do not have any professionalism in their approach or any feeling of attachment towards the patient. Those who do it, they do it without proper training which is comparatively more harmful than beneficial thus making the therapy sessions more frustrating, mentally painful and physically uncomfortable. A little knowledge of anything is a dangerous proposition which these professionals always apply. The frustrated patients are misjudged and denied treatments by the professionals who act as an act of hopelessness (Ramleth, Groholt, Diep, Walby & Mehlum, 2017). The abandonment by the professionals of the patients closes all the doors for them and makes the situation for them, even more, worse as it was in the beginning. Then they are condemned for their destructive actions, their families distance themselves, but in the end, all they need is a help. The therapists push the limits during the sessions between the client and professionals. People having borderline personality disorder require a very special type of treatment. The stigmatization of the patients within the mental health profession as well as in the society at large needs to be discontinued (Kling, 2014). The same stigma then moves on to the society thus expanding like a tumor in the minds of the society. The discrimination is often linked to the prejudicial attitudes which develop amongst the society due to various reasons like upbringing of the family, peer and society’s company, etc. The stigma being faced by the people is nerve wrecking be it from the friends as shown in the movie when all the inmates go out to the ice-cream parlor how Susana tries to avoid her family friend Bonnie and her mother. The stigma can be ended by creating awareness and correcting the common misconceptions. The people who are subject to the stigma and discrimination at the hands of the professionals providing services or the society in which they live in and are an integral part of the same, they have rights as granted to them by their countries. Many countries provide fundamental rights like right to equality and right to life which when violated the person can move to the courts. They have the right to be treated with dignity and the respect they deserve like fellow human beings (“The impact of childhood temperament on the development of borderline personality disorder symptoms over the course of adolescence”, 2014). They have the right to privacy like all others and it cannot be made public at any cost whatsoever. It may lead to social isolation, poor housing, and mental health problems. It also affects the process of getting treatment. It is also because of such treatment by the mental health professionals, the society that the patients with borderline personality disorder or any other disorder do not recover completely. The situation gets worsened by the exaggerated media reports which highlight the matter so much that it becomes a taboo of the society. The best way to challenge these stigmas of the society is through the first-hand meetings and contact of the people with the patients. The society should feel itself that they are a part of their society and as much as part of the society as they are. There is a need for deeper understanding by the family especially mothers social interactions and professionals (Ball Cooper, Venta & Sharp, 2018). We need to develop new skills that promote positive nature and amicable atmosphere for all. We must not forget that the patients are human beings too; all that is required is attention and care. Once all the required efforts are put it is bound to be a success and they will also be the part of the mainstream.
Conclusion
Movies are considered as the mirror of the society they reflect what happens in the society if Susana can be cured and go home, so could all others who suffer from such mental health disorders. We must remember that all those patients who are suffering from such diseases did not choose themselves to be the patients. It was their bad luck that they got chosen by their destiny. They do not come from someplace else. They are the part of the same society of which we are. Being the part of the same society they and us, it becomes our moral and societal duty to comfort them, provide the treatment and professional help they require. All they need is love, care, and support of their families and a little bit of medical attention from the doctors (Madan & Fowler, 2015). When the stigma is removed and no discrimination is made on the basis of their illness and they are given their due place in the society they will be able to cope up faster than expected and will be the part of the mainstream society. All the mental health disorders are curable with proper counseling and medication as all other ailments are.
References
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