Case study - PSY 302: Abnormal Psychology Summer I 2018 PDF

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Running head: CASE STUDY OF PAT SOLITANO

Case Study of Pat Solitano in Silver Linings Playbook Jade C. Boyd New Mexico State University

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Case Study of Pat Solitano in Silver Linings Playbook Introduction Pat Solitano is the main character from the movie Silver Linings Playbook. He is a middle aged white man who spent 8 court ordered months in a psychiatric institution after a violent attack which lead to him being diagnosed with bipolar disorder. First, this paper will contain information on bipolar I disorder. Next, the paper will break down the experiences and actions of the character that lead to the diagnosis and contributed to the hypothesized disorder using the biopsychosocial model. Lastly, the conclusion will be summarized. Hypothesized Diagnosis Bipolar I disorder is characterized by manic episodes that alternate with major depressive episodes (Durand & Barlow, 2016). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes a manic episode using several criteria (American Psychiatric Association, 2014). Specifically, individuals experience an abnormal increase in energy or activity. They also experience unusually elevated, uninhibited, or irritable mood. To be considered a manic episode, both of these must occur for most of the day, almost every day, for 1 week. The only exception to this is if the period of mood disturbance requires hospitalization for any amount of time. Additionally, Individuals will have at least three of the following symptoms during a manic episode: amplified sense of self-esteem, decreased need for sleep, increased talkativeness, racing thoughts, become easily distracted, increase in either goal-oriented or nongoal-oriented activity, and increase in dangerous activities. The DSM-5 outlines many different criteria for a major depressive episode such depressed mood and decline in interest or pleasure, but mentions that while major depressive

CASE STUDY OF PAT SOLITANO episodes occur frequently in bipolar I disorder, they are not required to make a diagnosis (American Psychiatric Association, 2014). Biopsychosocial Factors and Interactions of Factors Biological Factors First, we explore biological factors that might have contributed to Pat Solitano’s development of bipolar I disorder. While twin studies have found evidence that mood disorders such as bipolar disorders are hereditable, this may not be the case with Pat Solitano (Durand & Barlow, 2016). One could argue that Pat has a genetic predisposition to his condition because his father shows signs of undiagnosed obsessive-compulsive disorder, but there is not enough research examining the genetic relationship between bipolar disorder and OCD. Therefore, I believe Pat’s relationship with his father to be a social factor contributing to his condition, which will be examined later in this paper. However, it should be noted that both OCD and bipolar disorder share some of the same biological factors with anxiety in general, such as an overactive neurobiological response to stress (Durand & Barlow, 2016). Consequently, if Pat’s father carries a gene putting him at greater risk for anxiety, he could have passed that gene to Pat. Following this theory, Pat and his father’s overactive neurobiological responses to stress predispose them to having disorders but they have different disorders because of the different psychological and social factors they experienced in their lives. Psychological Factors Next, we examine in which ways Pat Solitano met the psychological criteria for bipolar I disorder. Throughout the movie Pat wakes his parents up in the middle of the night for reasons that most wouldn’t think worthy, such as his contempt for Ernest Hemingway. It is during these

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scenes that he was experiencing manic episodes. The first indication of this is that it occurred at 3 A.M. meaning he wasn’t sleeping. Along with his lack of a need for sleep, his thought were racing, he was hyperactive and he was extremely talkative, all of which are listed as symptoms for a manic episode in the DSM-5 (American Psychiatric Association, 2014). During another point in the movie, Pat mentions to his therapist that he called the police on his wife because he believed she was conspiring against him. This constitutes as a delusion because it is something he believes to be real even though it isn’t (Durand & Barlow, 2016). A frequent delusion Pat suffers from during times of extreme stress and panic is he can hear his wedding song even though it’s not playing. This song is even more significant to Pat because it is the song that was playing when he walked in on his wife cheating on him. Pat’s delusion of hearing this song is frequently followed by an angry outburst, often times physical. The DSM-5 states that when individuals with bipolar I disorder are delusional, they may become physically and verbally hostile towards others (American Psychiatric Association, 2014). Pat also exhibits a cognitive style frequently seen in individuals with bipolar disorder. In these styles, individuals ambitiously strive for goals and perfectionism and are overly critical of themselves (Durand & Barlow, 2016). Pat can be seen striving for perfection when he talks about changing for his wife Nikki. He believes that reading the books from her syllabus and running every day will make him a fit and perfect husband. He thinks that these actions will convince her return to him despite her having no interest in doing so. Pat is also overly critical of himself and this is discovered when he argues with Tiffany. In response to his judgement of her actions, Tiffany tells Pat that she loves the bad parts of herself and asks if he can say the same about himself. Later when he is recanting the argument to his therapist, he admits that he doesn’t love the bad parts of himself.

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Social Factors Environmental factors. In this section, we discuss the environmental factors that contributed to Pat’s hypothetical disorder. In the 7th edition of Essentials of Abnormal Psychology, the case of Jane is given to serve as an example of bipolar disorder (Durand & Barlow, 2016). Jane’s son, Mike, has obsessive compulsive disorder which the authors believe is related to his relationship with his mother. As previously stated, Pat’s father also has OCD. It is possible to surmise that Pat’s bipolar disorder is related to his relationship with his father. Initially, his father’s obsessions seem to be centered around football. He holds the TV remotes a certain way and rubs a special handkerchief when he watches the games because he believes that will make his team will win. However, as the film continues it becomes clear that Pat’s father’s obsessions are actually focused on Pat. His father believes that Pat is a lucky charm and blames Pat when their team doesn’t win the game. His father’s disorder is clearly stressful to Pat and impacts his life. From this it can be inferred that the environment Pat was raised in affected him negatively and, similarly to Mike’s environment, contributed in the development of his disorder. Traumatic events. In this section, we discuss the stress related factors that contributed to Pat’s hypothetical disorder. One traumatic event in particular haunts Pat throughout the movie, his wife cheating on him. The 7th edition of the Essentials of Abnormal Psychology explains how traumatic and stressful events such as that have been found to be related to the onset of bipolar disorder (Durand & Barlow, 2016). For instance, negative stressful events trigger depression and positive stressful events trigger mania. At first glance, this information doesn’t align with the hypothesized diagnosis because Pat’s wife cheating on him was a negative event even though it seems to have triggered a manic episode. However, Pat’s reaction to seeing his wife cheat on him

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was not Pat’s first sign of bipolar disorder. He told his therapist that one week before his wife cheated on him he had the delusion that his wife was conspiring against him. Thus, another positive stressful event, such as getting a promotion, could have caused the onset of a manic episode. Following the criteria in the DSM-5 that a manic episode lasts longer than one week, Pat would have been in a manic episode during the time he walked in on his wife with another man which lead to his violent outburst, arrest, and hospitalization. Interaction of Factors Although it would be much simpler if only one factor caused psychological disorders, that is not the case. Pat Solitano is a perfect example of how biological, psychological, and social factors work together to contribute to bipolar disorder. The social factor of unjust guilt instilled on him by his father when their team lost contributed to the psychological factors of feelings of inadequacy and a negative cognitive style. This negative cognitive style, in combination with the biological factor of an overactive behavioral approach system mentioned in the 7th edition of Essentials of Abnormal Psychology, lead Pat to be especially vulnerable to bipolar disorder (Durand & Barlow, 2016). So much so, that when he experienced stressful life events, he was unable to cope and became manic. All three factors contributed to the onset and continuation of Pat’s disorder. Hence, all three factors must be examined to diagnose Pat properly. Conclusion In conclusion, Pat Solitano more than likely has bipolar I disorder. This conclusion was reached by using the biopsychosocial model. This model explains how the integration of Pat’s genetic predisposition, psychological symptoms, and stressful life lead to his disorder.

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Diagnostic and statistical manual of mental disorders: DSM-5. (2014). Washington: American Psychiatric Publishing. Durand, V. M., & Barlow, D. H. (2016). Essentials of abnormal psychology. Boston, MA: Cengage Learning....