Pat the main character of the movie has bipolar disorder. Bipolar Disorder is also known as Manic Depressive Disorder. Bipolar Disorder consists of mood swings from the lows of depression to the highs of mania. These mood swings may happen as often as a few times a day to a few times a year. The exact cause of Bipolar Disorder is still unknown. Since the exact cause of Bipolar Disorder is unknown it is unknown what parts of the brain is exactly affected by Bipolar Disorder.
Current research indicates that structural abnormalities of the amygdala, basal ganglia, and the prefrontal cortex are the parts of the brain that are affected by Bipolar Disorder. “Silver Linings Playbook” follows the story of Pat Solitano Jr. He is a former teacher who was recently released from a mental health facility after he was treated for Bipolar Disorder. His mother released him from the hospital after his minimum eight months. He was released against medical advice and on the terms that he lived with his mother and father and attends mandatory therapy sessions with a psychiatrist.
He was admitted to and treated at the mental health facility after he was arrested for almost beating a man to death after catching the other man sleeping with his wife. It was at that time that doctor’s diagnosed him with Bipolar Disorder. He was able to plea bargain to go to a mental health institution to be treated rather than go to jail. During his treatment he was able to identify one of his triggers that cause him to lose control. One of his wedding songs was “My Cherie Amour” by Stevie Wonder.
When Pat discovered his wife in the shower with another man that same song was playing in CD player that was in the hallway, so that was the reason why that song became a trigger for his anger. Working with his therapist, family and friends Pat tries to overcome his disorder, conquer his trigger, live life positively, and to look for the “silver linings” in his life. Another goal that he has after being released from the hospital is to try and fix his relationship with his wife, Nikki. His wife currently has a restraining order against him. He seems to have a good supporting relationship with his family.
His father, Pat Solitano Sr. seems to have an unhealthy obsession with football and specifically the Philadelphia Eagles. Pat Sr. has had a temper that has had him banned from the Eagles stadium. He also does bookmaking and bets for the Eagles games. He has traditions and compulsions that he has to follow during each Eagle’s game or else he thinks that it will mess with the Eagle’s “ju ju”. Towards the end of the movie Pat Sr. makes a significant bet that he loses. He makes another bet to try and win back the money that he lost.
His second bet is based on the outcome of an Eagle’s game where the Eagles need to win and that Pat Jr. nd Tiffany must score a 5. 0 or higher in their dance routine that they are doing for the dance competition. Pat Jr. winds up meeting Tiffany who is another person whose husband passed away and a person with an unspecified mental disorder. They make a connection with each other and try to help each other. They make a deal to help each other. Pat Jr. will practice and dance with Tiffany in the dance competition that she is in and in return she will relay letters for him to his wife, Nikki. They both hold up their own ends of the bargain.
Towards the end of the movie Pat Sr. akes a significant bet that he loses. He makes another bet to try and win back the money that he lost. His second bet is based on the outcome of an Eagle’s game where the Eagles need to win and that Pat Jr. and Tiffany must score a 5. 0 or higher in their dance routine that they are doing for the dance competition. Towards the end of the movie Tiffany has fallen for Pat Jr. Thorough the movie Pat Jr. keeps trying to reestablish contact with his wife. Pat’s family and Tiffany trick Pat Jr. to attend the dance competition by saying that Nikki will be there.
Nikki does wind up showing up to the dance competition since some of Pat Jr. ’s friends have tried to help Pat by bringing Nikki to the competition hoping that Pat Jr. and Nikki can fix things between the two of them. Tiffany is heartbroken since she was hoping to be with Pat Jr. After the competition Pat Jr. goes to talk with Nikki. Tiffany storms off thinking that Pat will try and fix things with Nikki and be with her. After Pat speaks with Nikki he chases after Tiffany and tells her that he wants to be with her and not Nikki. The movie first ends with Pat Jr. eflecting back on the recent events and saying that he is happy again.
Then he and Nikki spending time together with Pat’s family and friends getting ready to watch another Eagle’s game. Pat Jr’s. age is not specified in the movie however, he appears to be in his mid-30s. According to Erikson’s stages Pat should be in the Intimacy vs. Isolation stage. In the movie Pat is trying to reestablish his relationship with his wife. However, at the end of the movie he ends his relationship with his wife and starts a relationship with Tiffany. He also works on his relationship with all his family and friends.
So at the end of the movie he achieves his age milestone according to Erikson of establishing intimate loving relationships. Pat is a male. It is not said during the movie whether there are any history of mental health issues in Pat’s family but, his father may have anger management issues. Pat’s father has had issues where he has gotten into a few fights and has been banned from the Eagle’s stadium. Pat seems to have a good relationship with his family. He lives with his mother and father after he was discharged from the mental institution. He also has a good relationship with his brother.
He also has good relationships with his friends. He also has maintained a friendship with another patient from the institution. It is not shown in the movie whether Pat has a history of drug or alcohol problems. Pat’s major life difficulty is his relationship with his wife. He caught her cheating on him and he tries to fix their relationship throughout the movie. However, at the end of the movie he decides to end his relationship with his wife and start a new relationship with Tiffany. Another life difficulty for Pat is triggers. Pat learns that a song is one of his triggers.
He seems to become angry whenever he hears that song. He tries to control his feelings whenever he hears the trigger song. Pat does not seem to have any language barriers. Pat utilizes sublimation as a defense mechanism. Ever since Pat was discharged from the mental health institution he exercises a lot. He says that he wants to get back in shape. Pat does a lot of thinking especially in trying very hard to find the silver linings in negative situations. So he uses a lot of intellectualization.
Pat tries very hard to find the silver linings in his life. Even when he is in negative ituations he looks for the positive aspects or silver linings in everything. Pat has a trigger. Every time he hears the song that was played at his wedding and when he discovered his wife cheating on him he becomes very angry. So he experiences the emotional symptom of the trigger triggering an emotional memory of his wedding and the day his wife cheated on him, which causes him to become angry. As the movie moves along Pat starts to learn how he can control his emotions when he hears the trigger song. He displays his anger physically. But he usually realizes that he is displaying his anger outwardly and stops to apologize.
Pat does not display any sensory symptoms. Pat gets angry and sometimes he displays his anger either outwardly or physically. When he does he usually realizes quickly that he is. He will stop what he is doing and apologize for what he has done as well as try and correct things. So when he gets angry he does perceive that he is displaying his anger and that he is affecting the others around him. He probably feels bad and apologetic since after he realizes what he is doing when he is angry he stops himself and apologizes to every one while trying to correct what he has done.
For example, when he first goes to see Dr. Patel. Dr. Patel plays Pat’s trigger song over the overhead speakers to see whether Pat has been able to control his feelings due to the trigger. He initially asks the receptionist to turn off the song realizing that the song is his trigger. The receptionist tells him that she is unable to stop the song as she has no control over what song is played through the speaker. Pat begins to look for the speaker. When he thought the speaker was behind a display for magazines. He flipped the magazine display over and spilled everything onto the ground looking for the speaker.
After flipping it over he sees that the people in the office are all looking at him and several people have come out of other private offices to see what is going on. He stops and apologizes to everyone and says that he will fix the display. He picks up the display and magazines and tries to get everything back in order. The three nursing diagnosis that I believe are most for Pat are: Ineffective relationship, Ineffective coping, and Readiness for enhanced coping. I am not sure if Pat has Bipolar I or Bipolar II disorder.
So, I believe that Bipolar Not Otherwise Specified is the appropriate diagnosis for Pat. The DSM-IV code for Bipolar NOS is 296. 80. I decided that the nursing diagnosis of ineffective relationship was appropriate because he had an ineffective relationship with his wife, Nikki. His wife cheated on him and had a restraining order served on him. His relationship with his wife was ineffective. He also seemed to have a few other ineffective relationships. When Pat was first released from the mental health institution he tried to help, Danny, a fellow patient to escape.
I believe that Pat’s relationship with Danny was also ineffective for both people. Pat was aiding in a crime and was exhibiting signs of codependency in his relationship with Danny. Danny was not getting the help that he needed from the institution by escaping. He should have stayed, made a full recovery, and been medically discharged. Pat also had an ineffective relationship with his father Pat Sr. Pat Sr. became a book keeper, had an unhealthy obsession with football games and especially Eagles football games.
Pat Sr. pulled Pat Jr. into his obsession by having Pat Jr. atch the football games with him and participating in the rituals that he has when it comes to the football games. Ineffective coping as a nursing diagnosis is appropriate for Pat because during several points of the movie Pat becomes very angry and can’t control himself when he experiences his trigger. I chose the nursing diagnosis readiness for enhanced coping for Pat. because he is able to towards the beginning of the movie Pat does know what his trigger is and he knows that he needs to control expressing his feelings when he hear his triggering song.
But, sometimes he still explodes in anger when he hears his trigger song. When Pat experiences his first trigger during the movie he asks the receptionist to stop the trigger song. He gets angry only after the receptionist states that she can’t stop the song. As Pat progresses you can see that he is able to control his anger a little better each time. During the movie Pat seems to be in the manic phase of Bipolar Disorder. He is awake and reading at sometimes three or four in the morning. He even wakes his parents to point out issues that he has with books that he is reading.
At one point during the movie he wanted to look for his wedding video. Both of his parents were asleep and it looked to be either very late at night or very early in the morning. Both of his parents are asleep and his neighborhood was asleep as well. He was still dressed in street clothes as opposed to sleepwear. He rummaged through the house and the entire attic looking for his wedding video. He even resisted his mother when she tried to stop him and encourage him to go to bed. He wound up getting into a fight with his father.
Many people in their neighborhood were woken up and the police officer assigned to his case was called to the house. Whenever Pat has free time and he is not reading he runs a lot. Pat is awake a lot of times when he should be asleep. These are all signs and symptoms that Pat is in the manic phase of his Bipolar Disorder. During the movie Pat states that he was on Lithium, Seroquel, and Abilify. Both Abilify and Seroquel are anti-psychotics. All three medications are listed as commonly prescribed to treat the symptoms of Bipolar Disorder.
Other medications commonly prescribed for Bipolar Disorder are anticonvulsants such as Depakote, anti-depressants such as tricyclics or MAOIs. Symbyax, which, is a medication that combines the antidepressant fluoxetine and the antipsychotic olanzapine is also prescribed at times. Benzodiazepines, such as: Ativan, Valium, Xanax are also prescribed to help with sleep. Pat and his illness are accepted by most of the other people in the movie. His family accepted him for the most part. They seem a little frustrated when he has times when he sets his mind on something especially if it disturbs their sleep.
Some people are wary of him such as when he goes to the school where he and his wife worked. He met a teacher there and it appeared that she did not feel comfortable around him. There was a teenager in his neighborhood who wanted to interview him for a school project. When Pat goes to the Eagles some of his brother friends make comments like “I heard you just got out of the loony bin. ” And “Better watch your coo coo brother. ” Bipolar Disorder is getting more and more coverage in news. In the past Bipolar Disorder was sort of grouped in with other mental illnesses and labeled as a crazy person disease.
Now with more exposure and medical professionals talking about Bipolar Disorder many more people are beginning to understand the facts rather than the fiction of Bipolar Disorder. Pat’s conclusion at the end of the movie was he ended his relationship with Nikki and started a new one with Tiffany. He looks like he has a great relationship with his family and friends as well as with Tiffany. In a voice over Pat says that even though the world will break your heart ten ways to Sunday. Sunday has once again become his favorite day as he remembers everything that everyone has done for him and he feels like a very lucky guy.
[Warning: The following article contains spoilers. If you have not seen the film and do not wish to have key plot points and character dynamics revealed, do not proceed further.]
As discussed in all of my previous posts, dramatizing mental illness and mental health treatment is a risky pursuit. Sometimes the resulting product richly moves and informs, while other times it exploits and misleads. Perhaps an even riskier venture than dramatizing this topic is milking it for laughs. However, director David O. Russell decided he was up to the challenge, bringing his adaptation of Matthew Quick’s novel Silver Linings Playbook to the big screen this past November. The film mixes elements of several genres, but is ultimately a romantic comedy about a man with bipolar disorder and a woman with borderline personality disorder. The result has been a huge hit with every key sector. The Hollywood elite just rewarded it with 8 Oscar nominations and gave it the distinction of being the first film in 31 years (since Reds, Warren Beatty’s epic about Russian communism) to receive an Oscar nomination in every major category (Best Picture, Best Director, Best Screenplay, and all four acting categories). Critics have been kind as well, heralding the film as one of the best of the year. Audiences, too, have been enthused. The film has already earned nearly $80 million at the global box office (which is an enormous profit for a film that only cost $21 million to produce). There seems to be consensus that Silver Linings Playbook is a great film. But how does it fare as a portrayal of mental illness?
The film centers on Pat Jr., a Philadelphia native who at the beginning of the film is sprung from a residential treatment facility by his mother. We learn that he has been in an inpatient mental health facility for 8 months following a violent episode in which he attacked the man he caught his wife sleeping with. We are informed that he has a diagnosis of bipolar disorder and are given hints that while this was his first (or at least the worst) manic episode, Pat Jr. had brewing emotional and behavioral problems prior to it. Bipolar disorder is a mood disorder characterized by the presence of at least one manic episode. A manic episode is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week that includes symptoms such as inflated self-esteem, impulsive behavior, increased rate of speech, and decreased need for sleep. As the term bipolar disorder suggests, afflicted individuals also experience the opposite of mania – depression. The result is an oscillation between extreme mood states that is often accompanied by severe distress and impairment and requires consistent and intensive medication management (the traditional remedy is a mood stabilizer such as Lithium, although many other classes of drugs have been shown to be effective for its treatment).
In the role of Pat Jr., Bradley Cooper (best known for his role in the raunchy Hangover films) shows heretofore-unseen range and talent. As is often the case with individuals with bipolar disorder, he plays Pat Jr. as remarkably charismatic and intense. Despite this, the portrayal of bipolar disorder is a mixed bag. Only in one terrific scene when Pat Jr. obsessively finishes a classic novel and storms into his parents’ bedroom in the middle of the night to deliver a rapid-fire rant about the book’s ending do we see a true manifestation of the disorder. Throughout most of the rest of the film, his tendency toward verbal and physical aggression and his obsessive thought patterns are the primary symptoms on display. Although these symptoms are not atypical of bipolar disorder, they are hardly the hallmarks and overlap with a wide range of other pathologies. There is nothing particularly dishonest or blatantly inaccurate about the depiction, but it pales in comparison to others that have been captured on film and television. For example, the award winning work of Claire Danes as a CIA agent with bipolar disorder on the cable drama Homeland could be studied alongside real life case vignettes by medical residents and psychologists (and should be studied by acting classes as well).
Much more successful is the depiction of borderline personality disorder in the character of Tiffany, the sister of Pat Jr.’s best friend’s wife. Interestingly enough, although hers is the most accurate and interesting portrayal of mental illness in the film, the label of “borderline personality disorder” is never applied to her. Rather she is referred to as “crazy,” “unstable,” “a sex addict,” and a variety of other terms that do not come close to representing the whole picture. Throughout the film we learn that Tiffany has a history of extreme emotional reactions, unstable interpersonal relationships, compulsive and impulsive sexual activity, difficulty controlling anger, and self-harm. These are the hallmarks of borderline personality disorder, a severe and impairing disorder, which has only begun to gain major attention in the past two decades (mostly due to the work of psychologist Marsha Linehan, who developed the most effective treatment known for the disorder – dialectical behavior therapy). As is the case with Pat Jr., we learn that she had traits and symptoms consistent with the disorder prior to a traumatic event that triggered full-blown pathology. In Tiffany’s case, it was the unexpected death of her husband.
Tiffany is bravely and beautifully played by Jennifer Lawrence, who is best known to audiences as Katniss Everdeen in the film adaptation of the wildly popular Hunger Games book series, but first came to attention in her Oscar-nominated role in the haunting drama Winter’s Bone in 2010. She has exquisite line delivery and is the rare actress who is as comfortable in wild comic moments as she is in explosive dramatic ones and as effective at displaying subtle heartbreak as she is at virulent rage. Her character’s pathology is best seen in a scene when she and Pat Jr. have a date at a diner. She is clearly smitten with him and tries awkwardly and ineffectively to steer his attention off of his cheating wife and on to her. One cutting comment of his deeply upsets her and her explosion is a stunning one, leading to her verbally eviscerating him on a public street. Rarely has the phenomena of “splitting” been so well depicted in cinema. “Splitting” involves an inability to integrate multiple aspects of another individual, resulting in a designation of someone as either “very good” or “very bad.” This is very common in borderline personality disorder and often results in individuals with the disorder rapidly and frequently oscillating between idealizing/loving and devaluing/hating important figures in their lives. This is what makes individuals with this diagnosis so hard to treat clinically and often so hard to be in relationships with.
The relationship between Pat Jr. and Tiffany is an extremely odd one. It involves enormous deceit, a fair amount of stalking, and offensive, blunt, and callous barbs repeatedly flung back and forth. Despite this, the incredible chemistry of Cooper and Lawrence (and some sharp writing) makes the audience root for them to fall in love. But is that really a good idea? A great deal of work in evolutionary and social psychology has focused on the factors that go into our selection of potential mates. We know that individuals across cultures and throughout history are attracted to others who share our attitudes, values, and various other characteristics. (If we want to speak in clichés, the research concludes that in general “birds of a feather flock together,” not that “opposites attract.”) We also know that individuals with mental illness are more likely to have unstable and unsuccessful romantic relationships and that this is enhanced when both individuals have mental illness. This seems especially the case for Pat Jr. and Tiffany, who each have limited social skills, primitive emotional processing, very underdeveloped emotion regulation skills, and a history of traumatic relationships. The film sweeps us up in their wildly unconventional romance, but I could not help but project a rocky, painful future for these two characters.
As if the story did not already have enough characters with mental illness, a third is thrown in. Pat Jr.’s father (obviously named Pat Sr.), is out of work and is deeply involved in sports betting. Pat Sr. clearly suffers from obsessive-compulsive disorder, an extremely impairing and prevalent anxiety disorder in which intrusive thoughts that produce uneasiness, apprehension, or fear are accompanied by repetitive behaviors aimed at reducing these unpleasant feelings. As is characteristic of the disorder, Pat Sr. engages in rigid and irrational thinking marked by superstition and unrealistic evaluations of event occurrence (which is clearly not an ideal set of traits for a gambler). He has difficulty relating to his son and feels an enormous amount of guilt for how Pat Jr. turned out. The subtlety with which Pat Sr.’s pathology is revealed is nicely realistic and quite effective. Although the relationship between the two Pats is not the primary focus of the film, it is arguably its most moving. This is mostly due to the stellar portrayal of Pat Sr. by film legend Robert DeNiro (who finally returns to high quality work after languishing in second-rate thrillers for the past decade).
Although Pat Jr., Tiffany, and Pat Sr. are nuanced and interesting characters, the film really fumbles with three others. As Danny, a friend of Pat Jr.’s from them mental institution, Chris Tucker is mostly a one note caricature of a mental patient, the type of cheap characterization that is completely out of sync with the others in the film. As Pat Jr.’s psychiatrist Dr. Patel, Anupam Kehr dispenses unhelpful advice (e.g., repeatedly telling the client to “figure out a way” to “get over it” rather than demonstrating skills, helping him generate potential solutions, and empathically validating his pain). Furthermore, in the most atrocious depiction of ethical violations in film since Anna Kendrick and Joseph Gordon-Levitt went on a date at the end of 50/50, Dr. Patel ends up shirtless and intoxicated in the family’s living room after a rowdy football game. The less said about this ridiculous, unfunny, and unnecessary plot development the better. And finally, despite her enormous talent (which was on display in her recent Oscar-nominated turn in the recent Australian crime drama Animal Kingdom), Jacki Weaver is unable to overcome the poorly written and woefully underdeveloped character of Delores, the family matriarch. It is true that in a family with such strong personalities and volatility, a wife and mother is likely to fall into a more passive role. However, while the characters’ indifference to her is painfully honest, the filmmakers’ lack of interest in her is an enormous missed opportunity. She clearly plays a huge role in how this dysfunctional family’s dynamics and the film would have been all the richer for exploring that facet.
The mix of stellar and poor characterizations result in a film that is never as good as it could be. I enjoyed it immensely, but it is certainly not without flaws. The acting is uniformly excellent and the story is an engaging one, but it fizzles out in the final act, sacrificing its edginess and honesty for an all-too-easy and contrived Hollywood ending. On the other hand, it is refreshing to see a risk-taking entry in the normally trite and cliché-ridden romantic comedy genre. Additionally, its lightness and laughs adds variety to the sea of Oscar contenders, which are excellent but tackle relentlessly depressing subject matter such as slavery (Lincoln and Django Unchained), violent global conflicts (Zero Dark Thirty and Argo), terminal illness (Amour), natural disaster (Beasts of the Southern Wild and The Impossible), and an excruciating mix of oppression, poverty, starvation, prostitution, exploitation, and war (Les Miserables). Indeed, I laughed heartily at the film and smiled wide when the credits rolled. Later reflection, however, highlighted the deep sadness that runs through these characters (and the film itself) and made me think about just how rocky the road ahead for these characters is likely to be.