Monday, October 17, 2016

Example of Grade A paper for Mr Jones

The Depiction of Bipolar Disorder I in Mr. Jones

The film Mr. Jones presents the audience with a portrait of bipolar disorder I in its titular character as he experiences the highs and lows of the disorder, as well as the effects of treatment. Richard Gere inhabits the character with, what seemed to this writer, a strong understanding of how such an individual would interact with the world. The movie also deals with the interaction between Mr. Jones and psychiatrist Dr. Elizabeth Bowen, portrayed by Lena Olin, who encounters him in treatment. This essay will consider the presentation of bipolar disorder I in Mr. Jones from the perspective of a Psychology student, and attempt to evaluate the accuracy of the symptoms presented, any inaccuracies, and what the film could have done to improve its depiction of the illness. The two main symptoms of bipolar disorder I, mania and depression, both clearly on display in the film, will each be evaluated, and a subsequent paragraph will offer evaluation of additional elements germane to the character’s diagnosis. Finally, the essay will conclude with a summary of this writer’s evaluation, as well as further thoughts on the presentation offered by the film, and how it may affect the audience’s perception of individuals with bipolar disorders.
Before turning to the evaluation of how Mr. Jones portrays mania and depression, it may be helpful to outline the symptoms of each. Mania can include exaggerated euphoria (feelings of exceeding happiness and/or contentment), irritability (up to and including aggression and agitation), distractibility (lacking capacity to focus attention on an activity for any sustained length of time), insomnia (including high energy state), grandiosity (expressing immense self-esteem, sometimes to the point of delusions of celebrity or godhood), flight of ideas (racing thoughts), increased activity (increased intensity in goal pursuit related to work, school, social, and/or sexual activities), rapid speech, and poor judgement (engaging in high-risk activities, usually pleasure oriented, that can lead to social and professional ramifications, and, in some cases, life threatening behavior). Due to the positive feeling engendered by many of these symptoms, individuals with bipolar disorder I often view their manic periods favorably, which can be a challenge in treatment. Symptoms of depression, meanwhile, include sadness, fatigue (or diminished energy), sleep problems (such as insomnia, excessive sleep, and/or poor sleep), appetite changes, loss of concentration and decision making ability, agitation (or high sedation), low feelings (such as guilt, pessimism, lack of self-confidence, and/or lack of self-agency), anhedonia, and suicidality. Nearly all the symptoms for mania, and many for depression, can be found in Gere’s character over the course of the movie.
Mr. Jones opens the movie as a seemingly exuberant individual riding his bike to a construction job. Very quickly, however, it becomes clear that he is in the midst of a manic episode. Over the course of the film, Gere’s character spends much of his time manic, and ticks off nearly every symptom by the end. The opening sequence can be viewed as one demonstration of exaggerated euphoria, once one is aware of the character’s diagnosis. Others include his mood while working on the roof, and even when he’s up on the beam, when he is released from the hospital for the first time and is talking to Dr. Bowen, afterward when he does a little dance and sings, in the piano store, at the concert he eventually interrupts, when Dr. Bowen agrees to buy him food and on the dock while they’re talking, and finally again at the end of the movie when he goes to get his tools at Howard’s house. In contrast with the many displays of euphoria, Mr. Jones’ irritable moments are few and far between. The first comes when he is strapped to the bed after interrupting the concert. In the scene he gets agitated and angry with the doctors, yelling at them at one point. Another seems to come during a ping-pong game while he is in treatment, but potentially skipping meds. This incident is quickly followed by a verbal explosion at a nurse trying to give him meds, knocking over her tray, and later by a verbal altercation with Dr. Bowen before checking himself out. It is never made clear if he is, in fact, off his meds and in a manic episode during this period.  The lack of clarity of the inpatient portion of the movie will be discussed at greater length in a later paragraph. The final incidents of irritability come during a clear manic episode at the end of the movie. The first occurs when he is walking down a street, looking upset, kicks a garbage can and yells at a shop keeper. The second when he yells at Howard after showing up at his house.  Distractibility is another symptom that is infrequently, but clearly, depicted. His distraction on the job site at the beginning of the movie is probably the most obvious manifestation of this symptom in the movie. He gets distracted by an airplane mid conversation, and again while working, and bounces from conversation to work to singing. Other instances where Mr. Jones displays distractibility, albeit less clearly, include in the piano store and, later in the movie, when he is walking down the street in an agitated mood. One symptom of mania that is not truly depicted in the movie is insomnia, although it could be argued that his general high level of energy during his manic periods fall under this category, and there is a moment when he’s strapped to the bed that he tells them he won’t sleep. Grandiosity, on the other hand, is on full display throughout the manic episodes in the movie. At the beginning of the movie he shows up for a job he doesn’t have and, when the foreman tells him they don’t need more workers, Mr. Jones claims he can do twice the work of any other worker, that he is a ‘precision machine’, that it would be a huge mistake not to hire him, and that in three days he’ll have the foreman’s job. Other points of grandiose behavior in the movie include his initial attempt to ask Dr. Bowen out, his seduction of the bank teller, his attempt to conduct the orchestra at the symphony, in a portion of his interaction with the doctors when he’s strapped to the bed, in court his self-representation could be considered grandiose, not to mention that he literally states that he is grandiose in the courtroom and argues he could have done a better job as conductor, and finally in his discussion with Harold at the end of the film. Flight of ideas is a bit trickier to discern, but it could be argued that he is experiencing the symptom when he is walking out on the beam at the construction site talking about angles and trying to calculate how to fly. Another scene that seems to show a fast changing flow of thoughts is when he is strapped to the bed after interrupting the symphony. One final example might be his final conversation with Howard and his son. In contrast, increased activity is easily found in Mr. Jones. From his initial pursuit of the carpentry job, to his seductions of both Dr. Bowen and the bank teller, to his fixation on his tools, Mr. Jones exhibits goal driven behavior on multiple fronts. Even his fixation on trying to fly could be seen as tangentially related to this symptom, given his determination, though it fits much more readily into poor judgement, as discussed later. Rapid speech can also be easily found during Mr. Jones’ periods of mania. He displays it when talking with Dr. Bowen outside the hospital after his initial release, again when he is strapped to the bed after the concert interruption, and finally when talking to Howard from the motorcycle near the end. The last symptom of mania on display in the film is poor judgement related to high-risk activities which usually involve the pursuit of pleasure. This symptom features heavily in both of the clearly manic episodes in the movie. His attempts at flight serve as bookends to the narrative, and obvious examples of this behavior. He also exhibits poor judgement when he hands out excessive amounts of money, withdraws what appear to be his savings from the bank, asks out the teller, and goes on a spending spree, including the purchase of a piano, when he asks out his doctor, when he gets on stage at a concert, and finally when he steals the motorcycle at the end. It could also be argued that he is exhibiting poor judgement when he represents himself in court, although, as indicated above, that may fall more in line with grandiosity. All in all, Mr. Jones presents a well-rounded, and fairly accurate picture of what manic episodes can entail. The main difficulties this writer had with the film were not with the clear cut episodes of mania in the film, and will thus be discussed in later paragraphs.
Like mania, depression has a clear presentation in the character of Mr. Jones. Unlike mania, the depiction does not hit nearly every symptom, nor are the symptoms shown repeated as frequently. However, they do present a convincing picture of an individual in deep depression. It begins quietly, with a Mr. Jones displaying a muted mood and a lack of focus at Howard’s dinner table. His lack of concentration is such that he is unable to help Howard’s son with long division after the dinner, and he gets slightly agitated. The next scene finds him walking lethargically thorough a music conservatory, indicating fatigue, and at one point getting somewhat agitated. After that the viewer sees him unkempt, unshaven, and distracted to the point he walks into traffic. In his unwashed, unfocused, and uncaring state he is also exhibiting signs of anhedonia. When he returns to his apartment to find Dr. Bowen, he admits he can’t stop being sad. Once he is back in the hospital, he initially continues to display the flat affect commensurate with anhedonia. He also admits to an episode of suicidality in his past, although that symptom is not on display during this depressive episode. In total, he seems to display sadness, fatigue, loss of concentration and decision making ability, agitation, anhedonia, and he references a period of suicidality in his past. It could also be argued that he is experiencing low feelings, based on his demeanor, but it is not explicit. Given the relative brevity of this paragraph, compared with that on mania, the reader may reach the conclusion that depression was not as well represented in the film. In terms of length and depth of depiction, that would be an accurate conclusion. However, what is shown is a fair, and somewhat poignant representation when cast against the extremes that precede, and eventually follow it during Mr. Jones’ mania. While the depiction could have been done in more depth, and covered more of the symptoms of depression, on the whole it seemed a well done portrayal. It is possible that the reasons for the fairly brief representation could be related to the overall issues this writer had with the move, and will be discussed in the following paragraphs.
Depictions of both mania and depression throughout the movie lend themselves nearly perfectly to the initial diagnosis of bipolar disorder I, which requires that the individual experience at least one clear episode of mania lasting at least seven days, and almost always also includes periods of depression. The qualifier of ‘nearly’ relates to one of the main, negative critiques this writer had of the film, having to do with Mr. Jones’ time as an inpatient, the lack of clarity both of timeframe and some symptomatology, and the love story. Beginning with the lack of clarity, the indeterminate length of time between many of the scenes made it difficult to determine the length of Mr. Jones’ mania and depression, as well as the speed at which they reoccurred. This is the only source of uncertainty with the initial diagnosis. It also seemed to this writer that he may have had a subtype of bipolar disorder I referred to as rapid cycling, but it is tough to tell. Given that rapid cycling is more prevalent in bipolar disorder II, and found more often in women, this writer would be hesitant to make a firm determination based on what is presented in this movie. The depiction of his stay in the mental hospital also adds to the difficulty determining for or against. It seems as though he may reenter a period of mania during his stay due to non-compliance with the drug routine, but it is never clearly established. It occurs to this writer that perhaps the clarity of the depiction of bipolar disorder I fell apart somewhat in the latter half of the film in service to the drama and build-up of the romance, and its consequences. Another aspect of symptomatology that remained somewhat unclear throughout the film was that of auditory hallucinations. If present, they would indicate the addition of ‘with psychotic features’ to the diagnosis. They are referenced in his initial intake, and potentially depicted when he is in the conservatory, near the beginning of his depressive episode, but they are never addressed directly. The love story, and the end of the film, are not just objectionable based on their depiction of a dramatically unprofessional relationship, but also in the disservice they do to the rest of the portrayal. It is not outside the realm of possibility for a doctor to have an inappropriate relationship with their patient, though it is perhaps not as romantic as the writers thought it would be when viewed from the perspective of someone intending to become a clinician. The way they end the movie is somewhat facile and unrealistic. It would have, perhaps, been more realistic, if darker, to have Gere’s character truly attempt to fly. That aside, his moment of transformation as the plane passes seems to transition him from full-blown mania to an even temperament instantaneously, letting the movie end on a happy note. This seems somewhat disingenuous after an otherwise fairly accurate portrayal. To the movie’s credit, it does present the effects of the medications used to treat bipolar disorders correctly, as well as the difficulty many patients experience maintaining a regular schedule of said medications.
Overall, Mr. Jones provides the viewer with a fairly accurate picture of how some individuals experience bipolar disorder I. While it has its failings, chiefly the fuzziness of the timeline and the ending, it should leave the viewer with a better understanding of what a diagnosis of bipolar disorder I means. One change that might have improved the movie would be to switch the focus from the romance between Dr. Bowen and Mr. Jones to fuller pictures of some of the other patients in the hospital. In particular, the patient who commits suicide near the end of the film could have served as an interesting contrast to Mr. Jones, had she been more fully realized. Criticisms out of the way, the one truly mesmerizing element of the film is Richard Gere’s inhabitation of the disorder. When he is allowed to portray it clearly, he does so with commitment and pathos. His performance makes the movie.

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