Tuesday, November 1, 2016

Grade A paper for CANVAS

PSY 399 Movies and Mental Illness
Canvas Review
        The movie Canvas (2006) is centered on an attempt to portray the main character, Mary, as suffering from the mental illness schizophrenia. This review uses the symptoms listed in DSM-5 to aid assessment of the accuracy of its portrayal by the actress Marcia Gay Harden.  The symptoms of schizophrenia include both positive and negative symptoms (i.e. those symptoms that are composed of distortion/overload of normal function and also those that reflect an absence of normal function regarding speech and behavior). Symptoms include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms defined as flat affect, deficiency in amount or content of speech, and inability to persist in important activities. A diagnosis of schizophrenia can be considered for an individual who possesses two or more of these symptoms during a one month period. The criteria also requires evidence of marked social or occupational dysfunction, continuous signs  of disturbance for at least 6 months, and the qualifier that the symptoms cannot be caused by mood disorder, substance abuse, general medical condition or autism.
     Evidence of the first DSM listed symptom, delusion, is sprinkled throughout a number of scenes in the film. Delusions are false beliefs about reality held firmly despite proof that such beliefs are false and only held by the one individual. The first time we see this is near the beginning of the story when Mary’s husband, John, is shown in front of their home where a police officer is telling him that they cannot continue to be called out to their address. We learn that Mary has placed a call to the police feeling she needed them to come out to the home to check for footprints around the windows, and this is obviously a repeated occurrence. As her husband works to clear up the situation that her false belief regarding intruders lurking about outside has caused, Mary lies huddled in her bed in a frightened panic. This symptom arises again as she jumps onto her son’s school bus one afternoon in an alarmed state convinced that something awful has happened to him and that he has gone missing. These two events depict delusional behavior and also serve to show evidence of the qualifier that the individual shows marked social dysfunction. Even the school children recognize this behavior as highly unusual and call her “crazy”. The delusions increase in intensity as we see John engaged in a telephone conversation with the health insurance company attempting to obtain payment for Mary’s medical bills as she waits apprehensively in the background. At the end of the call, Mary anxiously tells her husband that she doesn’t want him calling those “people in government” and doesn’t want the FBI knowing her business. When the phone rings she jumps up screaming “don’t answer!!” in a panic. She also won’t allow her son to go to his friend’s for a sleepover because it’s “not safe” although she can’t give any evidence to support the claim, believes “they” have wired the house, and believes her husband is “one of them”. Other signs were evident in such paranoid behaviors as not wanting her skin to show and constantly checking the windows interrupting an amorous time with her husband and also in her delusional belief that she is not living in “the real Florida.”
      Hallucinations, perceptual sensory disturbances that are not real or present, are another indication of possible schizophrenia.  Visual hallucinations are evident when Mary looks out the window at one point and runs out into the pouring rain, although it is not clear whether she is seeking to escape a visual hallucination from inside the house or checking out a skewed interpretation of what she thought she saw going on outside the house. Either way, the activity ends in neighbors summoning the police and Mary being carried to a cruiser in handcuffs to “protect” her by bringing her to the hospital. Several times it is unclear whether she is experiencing auditory or visual hallucinations when she responds to prompts that only she can perceive with inappropriate, hysterical laughter or with extreme anger, such as when she yells “you’re all liars!” Her family can only look on in confusion. The character more explicitly expresses that she is experiencing auditory hallucinations at times; she asks who is laughing when she is all alone in a room and tells another inpatient “when you paint, they go away” and responds “the voices” when asked who goes away. This hallucinatory symptom, along with the delusional symptoms from the previous paragraph supply the necessary 2 out of 5 needed for diagnosis, but more symptoms become evident as well.
               The DSM’s third criterion listed in the diagnosis of schizophrenia was subtly presented, if at all. This viewer was only able to observe disorganized speech in the manner of weak, unrelated responses once or twice. There was an occasion during a visit to a restaurant on Thanksgiving day when the host was attempting to explain why the family’s reserved seating was delayed and Mary was seen in the background softly mumbling “I want pumpkin pie” over and over in apparent oblivion to the host’s excuses. For the most part though, the character was mostly engaged and aware of the conversations around her, only slipping off the topic track during hallucinations. Mary’s speech pattern tended to stay quite stable throughout except for when medication slurred her speech. It might be of importance to note here however, that her laughter was oddly timed and screechy in a way that this viewer found to be unusual.
     The symptom of grossly disorganized or catatonic behavior was regularly displayed throughout the story. Disorganized behavior included her overly effusive response each time she saw her son after a short period of separation, her agitated jumping onto the school bus previously discussed, yelling at and hitting her husband when he suggested medication, lashing out wildly with a knife which results in cutting her son on the arm, and agitated behavior in the restaurant lobby when she realizes they have run out of pumpkin pie. There was a slightly catatonic event which showed Mary sitting at her sewing machine, the needle continuing up and down relentlessly as she stared at a blank wall. Another example of disorganized behavior is that of her holding a perfectly rigid posture as the police attempted to guide her into the cruiser and her refusal to follow their directions.
      The final of the possible 5 criteria specified by the DSM are the negative symptoms, those that show an absence of normal affect or activity. Alogia, deficiency in amount or content of speech, perhaps was shown in mild expression when the character spoke in a low mumble on occasion or when she at times remained quiet when the subject under discussion was in regards to her own fate. An absence of motivation and/or ability to obtain gainful employment seemed obvious. Finances were always an issue for the family, but employment for Mary would have been impossible due to her symptoms often spiraling out of control and her repeated medication noncompliance. Her only attempt at continuous productivity was shown in repeated scenes where Mary is painting. Their home is filled with her artwork with varied scenes and styles displayed. However when she is experiencing strong symptoms, Mary dysfunctionally paints the same scene of her son at the lighthouse beach over and over. True flat affect was predominately evident only when Mary was medicated, and as such would not be a factor influencing diagnosis.
     Many other points were made that contributed to the impression that the illness schizophrenia was accurately represented by the movie Canvas. For example, the screenplay dialogue included the disclosure that Mary had been ill for 18 months which is consistent with the necessary qualifier that the patient must experience symptoms for at least 6 months. In addition, there were no events in the film that would lead a viewer to believe the symptomology could have had an alternate explanation such as substance abuse or other medical condition. The character’s reluctance to be medicated, despite the clearly debilitating symptoms that she was experiencing, also rings true as many patients have difficulty tolerating the side effects. Another, more subtle point depicted was that prescribed medication often suddenly ceases to be effective. This was explicitly stated at one point by her husband, John, and acted out by Mary when her auditory hallucinations resumed after being medicated as an inpatient. In the story, Mary’s son was portrayed to be 10 years old which likely would set Mary’s age to be in her thirties. This would be consistent with the average age of onset of schizophrenia in women occurring just after 30 years (mayoclinic.org).
     This reviewer found the film’s portrait of a schizophrenic patient to be remarkably accurate according to DSM-5 criteria. Although the character did not display all symptoms equally, not every individual with the disorder will present with the same exact symptom set. In researching schizophrenia in women for this review, evidence was found to support that women most often display a milder form of the disorder (mayoclinic.org). Many women show less extreme overt symptoms, instead often presenting with mood symptoms and less impaired functionality. Mary did not possess this milder form common to women, but even this cannot be stated as a criticism of the character considering not all women are spared strong symptoms.
    And finally, the nuanced manner of presentation of the film, i.e. no evident overacting or preachy attitude, left the viewer to experience mental illness in a rather pure and touching format. The subtlety of the depiction of schizophrenia in this movie did not detract from the inclusion of important aspects of its effects: fear, stigma, social isolation and punishment, insurance difficulties, medication non-compliance, and the devastating effects on the patient and those close to the afflicted.   In conclusion, Canvas presented an excellent portrayal of schizophrenia, not only the symptoms but also the many intricacies that accompany mental illness.


Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 2013

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