Discrepancies And Similarities In The Portrayal Of Schizophrenia In Film

Oftentimes, the portrayal of mental illness in movies is skewed solely for cinematic purposes. However, careful examination of current evidence can better guide perceptions and accepted management of such illnesses. A focused comparison of schizophrenia as seen in evidence-based publications, current psychiatric care, and a motion picture film better reveals discrepancies and similarities in the representation of this illness.

To begin, schizophrenia is the selected topic of focus for several reasons. Predominantly, schizophrenia is simply one of the more fascinating and interesting mental illnesses. An element of mystery encompasses this diagnosis as healthcare providers simply cannot see or hear the exact hallucinations that the patient

may experience. Aside from its intriguing nature, schizophrenia is the chosen topic of focus also because current evidence is continually suggesting more appropriate and efficient ways to manage this illness.
Next, multiple journal articles pertaining to the best current management of schizophrenia have been published. Gerlock, Buccheri, Buffum, Trygstad, and Dowling (2010) write about the dangers of command hallucinations and the need for more thorough, standardized assessment tools. Gerlock et al. (2010) discuss a study conducted on a group of schizophrenic patients over the course of ten weeks. This study trialed the use of the Unpleasant Voices Scale and the Harm Command Safety Protocol (Gerlock et al., 2010). While the Unpleasant Voices Scale measures the severity and danger of command hallucinations, the Harm Command Safety Protocol is a tool used to speedily assess any risk of harm to the patient or others and provides guided feedback to briskly intervene (Gerlock et al., 2010). At the end of the study, it was found that these tools established enhanced safety for patients with schizophrenia and staff caring for them as well as addressed commonly neglected crucial assessment data (Gerlock et al., 2010). Meerwijk et al, (2010) feel strongly about developing a guideline for nurses to use when assessing suicidal tendencies in schizophrenic patients specifically. The developed guideline consists of openly examining suicidal thoughts with the schizophrenic patient, analyzing the intensity of suicide risk, and choosing applicable nursing interventions based on results (Meerwijk et al., 2010). The guideline was tested with twenty-one nurses in inpatient, outpatient, heavily populated, and rural settings (Meerwijk et al., 2010). Results show that the amount of data gathered using this guideline far exceeded that gathered from typical suicide risk assessments (Meerwijk et al., 2010). Evidence from this study also shows that the trialed guideline allowed greater freedom for the patient to disclose thoughts and feelings (Meerwijk et al., 2010). Both of the discussed studies have proven usefulness in newly developed tools for the management of schizophrenic patients.
Gerlock et al. (2010) and Meerwijk et al. (2010) raise awareness of how current psychiatric care for schizophrenic patients could be bettered. Gerlock et al. (2010) offer standardized scales to assess risk involved with command hallucinations. Current psychiatric care has developed similar tools, such as the Breset Violence Checklist, which ranks the patient at a low or high risk for violence based upon current and past behaviors. However, such checklists are not specific to schizophrenic patients and do not provide detailed information as to why the patient is at a risk for being violent. The tools proposed by Gerlock et al. (2010) are much more specific and detailed, allowing for significantly more assessment data. Similarly, Meerwijk et al. (2010) present new means for determining suicide risk tailored for schizophrenic patients by using a written assessment form. Currently, a typical, verbal suicide risk assessment is performed oftentimes by the nurse on all patients, regardless of their admitting diagnosis. This method is simply not as effective and gathers far less information from the schizophrenic patient.
Multiple discrepancies and similarities exist between the movie K-Pax (Pollock & Softley, 2001) and actual care provided to schizophrenic patients in clinical settings and theory.

The main character of K-Pax (Pollock & Softley, 2001) is depicted to be a calm, delusional schizophrenic patient who holds strong belief in being an alien from another planet. The patient often wanders and creates neologisms, though he is cleanly and appropriate. Clinically, the observed patient is agitated, has pressured speech, does not tend to personal hygiene, holds persecutory delusions, experiences dangerous command hallucinations, and responds to internal, auditory stimuli. The care provided to the patient in K-Pax (Pollock & Softley, 2001) resembles care encouraged clinically and in theory by the use of individual therapy with a psychiatrist, courtyard therapy, and milieu therapy. Also, the staff in K-Pax (Pollock & Softley, 2001) often encourages sleep and highly stresses the importance of family or other support systems in the management of psychosis. The patient observed clinically is noncompliant with the prescribed regimen of Haldol and Risperdol, whereas the patient in K-Pax (Pollock & Softley, 2001) willingly abided by treatment with Thorazine and Haldol. Another similarity noticed is the practice of least-restrictive treatment. Clinically, when the patient becomes agitated, staff begins with a verbal approach and proceeds to institute a behavioral approach. In K-Pax (Pollock & Softley, 2001), the patient progresses past requiring a behavioral approach to needing a chemical treatment. Some aspects of care in K-Pax (Pollock & Softley, 2001) did not align with care encouraged in theory or observed clinically. For example, the patient in K-Pax (Pollock & Softley, 2001) is often allowed to take a taxi to leave to unit. In one instance, the patient even spends an afternoon at the psychiatrist’s home for holiday celebrations. Actual patient care discourages discharge from the

unit until the patient is deemed stable. In K-Pax (Pollock & Softley, 2001), men and women are allowed to spend time in each other’s rooms. In actual practice and in theory, this is not permitted for safety reasons. For further safety reasons, objects that could be used as weapons for self-harm are collected upon admission in both theory and clinically. In K-Pax (Pollock & Softley, 2001), patients often wore necklaces or stethoscopes around their necks. Lastly, hypnosis is used several times in K-Pax (Pollock & Softley, 2001) to manage the patient’s schizophrenia and identify the trigger of the current psychotic episode. Although this practice is not commonly observed clinically, it is still taught in theory as it can be a useful tool in identifying repressed causes of anxiety.
A mental status exam can be performed on the patient in K-Pax (Pollock & Softley, 2001) to reveal further information regarding mental health. The patient’s thought process consists of flight of ideas reflecting almost anything and everything viewed in the environment. The patient experiences grandiose delusions with beliefs of being an alien from another planet. The patient has an impaired pattern of speech evidenced by frequent neologisms and appears clean and appropriate. The patient’s cognitive status is oriented to the current situation, but long-term memory is not intact. The patient’s mood is calm, content, and appropriate. The patient’s affect, however, is blunt and flat. The patient sometimes exhibits psychomotor retardation by walking and moving slowly. The patient’s behavior is social and calm. The patient makes good eye contact and holds an upright posture. Finally, the patient’s judgment is good with an ability to logically and rationally solve problems.
Lastly, several nursing diagnoses with appropriate interventions exist for the patient in K-Pax (Pollock & Softley, 2001). The priority diagnosis would be disturbed thought processes related to repressed fears as evidenced by delusional thinking. An appropriate intervention for this diagnosis may be accepting the need for the untrue beliefs, but voicing to the patient that you do not hold those same beliefs. It is also important to focus on reality without arguing false beliefs with the patient. Most importantly, it would be beneficial to utilize the guidelines developed by Gerlock et al. (2010) and Meerwijk et al. (2010) as any patient with disturbed thought processes should be thoroughly assessed for risks of suicide and violence. Another fitting nursing diagnosis is impaired verbal communication related to unrealistic thinking as evidenced by use of neologisms. Useful interventions to manage this diagnosis include continuing unchanging staff assignments with the patient, approving any forms of communication that aid in preserving reality, and striving to utilize only concrete phrases and expressions with the patient.
In conclusion, it is confirmed that a focused comparison of schizophrenia as seen in evidence-based publications, current psychiatric care, and a motion picture film better reveals discrepancies and similarities in the representation of this illness. Media and motion pictures often omit the full, realistic portrayal of mental illness for public entertainment. It is beneficial for healthcare workers to stay current with latest evidence regarding management of mental illness in order to separate fiction in movies from reality in the clinical setting.