Lars and the Real Girl

advertisement
Lars and the Real Girl
Steve Franklin, MSW, LCSW
6829 Gravois Ave
St. Louis, MO 63116
SteveFranklin@JUNO.com
www. Steve FranklinMSW.com
314-517-8383

Difference between
“eccentricity” and “disordered”

What kind of problem?
Mental illness, other or none?

Does Lars need treatment?

Doctor’s approach?

Family and community response?

Community Mental Health movement

How do you think
you might have responded?
What is the problem?

People will laugh

Attachment to objects

Doctor interview:
“ADL’s”? Violence? Psychosis?
DSM-IV
“The disturbance causes
clinically significant impairment
in social, occupational, or
other important areas of functioning.”
Differential
Diagnosis
Avoidant personality disorder?

Social inhibition

Feelings of inadequacy

Extreme sensitivity to negative evaluation

Feel socially inept, unappealing

Excessively monitor reactions of people
Schizoid personality disorder?
Lack of interest in social relationships
 Solitary, secretive, and emotionally cold
 Little interest in having sexual experiences
 takes pleasure in few, if any, activities
 lacks close friends or confidants other
than first-degree relatives
 appears indifferent to praise/criticism
 “Dependency and love are dangerous”
Psychodynamic Diagnostic Manual:
Panic disorder with agoraphobia

Remains at home,
or in just a few comfortable places

fear of having panic attack
Social Anxiety Disorder
Social Phobia?

Persistent, intense, and chronic fear
of being judged by others and
of potentially being embarrassed or
humiliated by one's own actions.

Physical symptoms often accompany social
anxiety disorder

including Panic attacks.
Asperger’s Disorder?

Involves an impairment in social interaction
Such as
impaired in the use of multiple nonverbal
social behaviors
such as eye-to-eye gaze, facial expression,
body postures, and gestures to regulate
social interaction
 failure to develop peer relationships
 lack of social or emotional reciprocity

Asperger’s Disorder?

B.Restricted repetitive and stereotyped
patterns of behavior, interests, and
activities
preoccupation with an area of interest that
is abnormal either in intensity or focus
 Adherence to routines, rituals
 Stereotyped/repetitive mannerisms
 Preoccupation with parts of objects

Asperger’s Disorder?

They may be unusually sensitive or
insensitive to sound, light, touch,
texture, taste, smell, pain,
temperature, and other stimuli
Delusional Disorder

Delusion that doesn’t fit another disorder

Tactile or olfactory hallucinations if
related to theme

Functioning and behavior otherwise normal.

Ignore information that contradicts belief
Delusional Disorder



Types :erotomanic, grandiose, jealous,
persecutory, somatic, … and unspecified.
Psychodynamic: protective response to stress
Behaviors’ Extremeness/inappropriateness
rather than the simple truth or falsity of
the belief, indicate its delusional nature
Developmental analysis

Lars afraid of manhood:

Saw dad sad in the responsibility

Note family difficulty in discussing emotion

Recent change? Afraid of Karin’s childbirth
Developmental Analysis
Doctor:

“He’s been decompensating for some time.”
“Mental Illness can be a communication, a
way to work something out.”
 Compensate for
lack of a mother/ father’s distance/blaming.
 Embraces his loneliness/withdrawal
 Others’ need for connection is weakness.
 Karin’s pregnancy arouses unconscious
loss/abandonment feelings

Jungian

Bianca as anima,
the projection of disowned female self
projection of disowned idealized self

Missionary, Doesn’t care about superficial things, Can’t
have babies (or die in childbirth),Has nurse’s training

Like him: left-handed; her mom died; God made her to help
people; Doesn’t feel sorry for self-just wants to be normal..”
Treatment



Is his “difference” something to be
treated or pathologized?
Lars doesn’t seem to experience being
treated so much as being in relationship.
Ethics of doctor’s approach?
Treatment
Typical approaches:

Antipsychotic and antidepressant
medication

Cognitive-behavioral therapy top help
challenge the delusion.

Insight-oriented therapy: develop a sense
of creative doubt in the internal perception
of the world
Treatment

Community can provide support and
encourage the patient to regain his or her
abilities.

If goals not seen as attainable, person
feels pressured/criticized, probably
increasing stress… worsening of symptoms.

Avoiding direct confrontation of the
delusional symptoms (When confronted by
brother, Lars simply doesn’t hear.)
Disability: Embracing strength

Minister: “From her wheelchair, Bianca
reached out and touched us all.. “

(Lars sees her “difference” as an
expression of her disability.

It’s not that Bianca was artificial.
She was just. “Realness challenged”)
Community

Finds ways for Bianca to contribute
in ways she can be
helpful/productive… model, help at
nursing home.

They project themselves: they
believe that Bianca, like them, would
want to help
Community
Minister in church scene:
“There really is only one law..
the lord has told us what to do:
Love one another.
That, my friends, is the one true law.”
Download