Abnormal Psych in Media Disorganized

Abnormal Psych in Media

Disorganized Schizophrenia in Cronenberg's Spider

Wedding, Boyd, and Niemiec (2005) write about David Cronenberg's film Spider (2002) that "This dark and dreary film maps out the psychological terrain of a man with schizophrenia" (p. 109). They continue, saying, "This is also a good depiction of childhood schizophrenia as we see the young boy distort reality, express paranoia that his father and his father's mistress killed his mother, and the boy's complete isolation from social contact" (Wedding, Boyd, and Niemiec, 2005, p. 109). This assessment of the character of Dennis Cleg or "Spider" (played by Ray Fiennes) seems accurate. The portrait of Spider clearly replicates many of the symptoms common in schizophrenia. This essay will show what symptoms lead to this conclusion and will discuss the film's main character using a cognitive approach to schizophrenia. It will show how a cognitive approach would analyze and explain Spider's mental illness, and what kinds of therapeutic interventions it would use to help him.

The DMS-IV-TR defines schizophrenia as "a disorder that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)" (American Psychiatric Association, 2000, p. 298). It understands delusions as "erroneous beliefs that usually involve a misinterpretation of perceptions or experiences" (APA, 2000, p. 299). When hallucinations occur, they are usually auditory (hearing voices), but can be visual. Disorganized thinking means any range of incoherence that impairs communication. Disorganized behavior encompasses things like silliness, unpredictable agitation, inability to perform daily tasks, dishevelment or unusual dressing, and inappropriate sexual behavior. Further, there are negative symptoms such as affective flattening, alogia with brief empty replies or silence, and avolition or the inability to initiate and persist in activities due to lack of interest (anhedonia). In addition, other associated symptoms may occur like abnormal psychomotor actions (rocking, pacing, or immobility), anxiety and phobias, depersonalization, and suicidal tendencies. All these symptoms create social dysfunction and detachment.

Spider's character shows evidence of schizophrenia given these diagnostic criteria. Spider shuffles slowly and awkwardly, distracted by objects on the ground. Often he looks expressionless or afraid. His dialogue is sparse, disorganized, and mumbling. Throughout the film, it is difficult to understand anything he says. He is characteristically unclean and unkempt. He wears four shirts at once. Even his smoking is indicative, since according to the DSM-IV-TR, 80-90% of schizophrenics are nicotine dependent (APA, 2000, p. 304). Spider is virtually dependent on others for the basic needs of life. He is emotionally flat except when he breaks out unpredictably in anger when he rips up a puzzle. Much of his time he spends writing things comprehensible only to himself in a small notebook, which when shot up close is illegible, almost a foreign language. There are symbolic images that suggest his schizophrenia -- webs and shattered windows. While there are no auditory hallucinations, he demonstrates paranoia by not letting the caretaker touch him or his suitcase, and by imagining her (in hallucinations) as the prostitute. He eventually tries to kill her with a hammer because he believes she is a different person. There are some signs of catatonia, such as lying still in the fetal position in the bathtub or sitting for hours on a bench. Among the various forms of schizophrenia, he fits best in the Disorganized Type of schizophrenia, with elements of the paranoid and catatonic.

As important as these clear symptoms is that Spider's mind is fraught with delusion and hallucination. It is not till the end of the film that the audience realizes that most of his recreation of his own childhood is fiction. He imagines that his father has an affair with a prostitute and kills his mother with a spade when she finds out. Then the prostitute lives with them, becoming a surrogate mother. As the older Spider watches the recreated scene, the young Spider yells, "Murderer" and is chased away with a belt. There are several reasons for believing this view is delusional. For one thing, the father Bill (played by Gabriel Byrne) is shown explaining a different point-of-view to the child in which the mother is not dead. The father tells him, "I don't know where you get your ideas from; you're by yourself too much, you need some mates." The audience suspects that the boy is deluded. The father cannot understand why the boy is so angry. The most compelling reason comes toward the end. After the boy has rigged up a twine device for pulling the gas stove on, the prostitute dies from gas inhalation. Yet when the father pulls her out into the street, it is his real mother, and the father cries, "You did you mum in." It is significant that the older Spider is not there to witness this scene. It is not a hallucinatory flashback, but the real past. Spider's belief that his father killed his mother is false. It is significant as well that his "memories" are not memories -- they are hallucinations. This is clear because they involve imagining situations that he could not have experienced as a child, such as the scene at the prostitute's house. The young Spider could not have been there or known what happened. When he is in a bar, for example, he is not remembering seeing his parents. He is hallucinating them. This puts him clearly into the category of schizophrenia.

There are a number of explanations for the development of schizophrenia. Virtually every psychotherapeutic approach recognizes there to be a genetic component. Beck et al. (2009) write, "Eighty years of behavior genetics research in the form of twin, family, and adoption studies indicate that schizophrenia is highly heritable" (p. 11). It seems to run in families, but the precise mechanism for this is still unclear. Other approaches stress neurochemical imbalances or brain dysfunctions alongside this. In these approaches, schizophrenia is primarily something to be understood and treated by anti-psychotic pharmaceuticals that antagonize serotonin.

The cognitive or cognitive-behavioral approach stresses biological vulnerability combined with environmental factors. Kingdon and Turkington give this perspective: "The vulnerability-stress hypothesis of schizophrenia simply states that vulnerabilities and stresses combine to produce the symptoms characteristic of the disorder" (Kingdon & Turkington, 2005, p. 8). As the same time, it prioritizes thought formation. The cognitive paradigm for understanding schizophrenia stands on the major assumption that intellect comes first and influences what emotional and behavioral patterns follow. While recognizing biological vulnerabilities, it explains emotion and behavior as the result of intellectual processes such as beliefs and interpretations. In other words, there is some underlying distorted cognitive process that gives rise to the disorder of schizophrenia, even though this thought process emerged in a social environment. Dudley et al. (2009) say, "The defining characteristic of CBT is the cognitive model, which emphasizes the deceptively simple notion that the way a person makes sense of an event determines how he or she feels and behaves" (p. 267). When explaining schizophrenia, cognitive psychology does not decontextualize these beliefs and thoughts, but keeps them linked to the social context even while focusing on them. When looking at Spider's case, it would attempt to understand the social factors that contributed to schizophrenia.

One environmental factor that has been well explored is the family. The cognitive approach does not ignore family communication patterns as an important context which may contribute to schizophrenia. Stierlin (2009) has outlined some of the important family-oriented explanations. He points to communication problems in the family of origin. The family may be so distorted and skewed in its features that it makes it impossible for the child to communicate successfully. Irrationality is transmitted when family relationships are undefined or ambivalent. Communication deviances have confirmed that "an unclear, odd, confusing or strange way to communicate was the most noteworthy feature of the schizophrenic's family" (Stierlin, 2009, p. 235). What this means is that family dynamics must be accounted for in treatment.

From this point-of-view, Spider's schizophrenia can be understood as developing out of inadequate communication in the family. In the film, the father says very little to the son and is often absent, drunk, or angry. It is the mother that Spider knows and loves. But this attachment is strange. It verges on Oedipal and would be good for a psychodynamic interpretation. Spider looks on his mother several times with almost lust as she tries on a dress or applies make-up. He runs away angry when she mentions his father. He looks on with jealousy as they go out, leaving him alone, and he sinks down in disgust when he sees them acting affectionately. While the cognitive approach would not go in this direction, it would point out that something confusing was in the young boy's environment. There were mixed messages perhaps, and a blurring of identity between the boy and his mother. Spider was never given to understand the relationship, and the mother maybe acted too affectionately toward the child. There was not enough separation into individuality, and perhaps the incapacity to please the parents. This confusion would have been intolerable for him, creating disorganized patterns of thought. Out of this disorganization developed delusion. The boy came to imagine that the father killed the mother.

Another way cognitive (and psychodynamic) approaches explain the genesis of schizophrenia is by reference to childhood trauma. Things such as abuse, divorce, a domineering mother, or witnessing murder are seen as major factors in schizophrenic development (Koehler & Silver, 2009, p. 225). Traumatic events lead to dissociation from parents and from reality. Other related factors are stress, fear, anxiety, and social isolation that lead to schizophrenia. In other words, it is how the person is embedded in extreme and dysfunctional social relations that may shape their development. Here Spider's malady would be discussed in terms of intense family strife. There is evidence for severe marital tension in the film, exemplified by the man's having an affair. Combined with poor family communication and confusion, this could easily have lead to perceived trauma. The boy may have interpreted this as catastrophic and thus developed delusions and schizophrenic symptoms, including murderous impulses.

Cognitive psychology, then, interprets the development of childhood schizophrenia by linking traumatic or catastrophic family circumstances with resulting thought patterns and delusional belief systems. These delusions are understood as cognitive distortions and dysfunctional beliefs. Cognitive errors -- such as taking things too personally or out of context, jumping to conclusions, all-or-nothing thinking and overgeneralizing -- are central in this view to the creation of delusions (Kingdon & Turkington, 2005, p. 102). In terms of therapy, the goal is to understand the initial events that led to the delusional belief. Hallucinations arise, in the cognitive viewpoints, when the person attributes internal experiences (thoughts) to an external source. They are often accompanied by obsessions and compulsions (Kingdon & Turkington, 2005, p. 8). Spider is clearly obsessive-compulsive when he writes in his notebook and collects objects from the road. His hallucinations are distortions of real perception. His delusions can easily be seen to have arisen out of his past in which he interpreted his parental environment as traumatic and confusing. He also has irrational reactions to the smell of gas, which is an olfactory hallucination that relates to his past murder of his mother.

This cognitive paradigm has the advantage of considering the social environment in which schizophrenia arises. It is valuable as well in showing how important thought processes are in influencing maladaptive behavior and emotion. It explains the persistence of Spider's symptoms through an inability to adjust his thoughts and beliefs to more real conditions. This is perhaps out of shame and guilt at his past act, which has irrevocably damaged him and his esteem. More simply, it could be out of the pain of trauma. Spider's symptoms persist also in this view because he was unable as a child to challenge his interpretations of events. The confusion of his family situation is so entrenched that it makes it impossible for him to organize his thoughts, or to see the past in a different way. The whole film is about him trying to reconstruct his identity, through delusory hallucinations. He is trapped in a repetitive cycle. He is unable to realize that his father did not kill his mother, as he believes. In all the years, he still has not put the shattered pieces back together to form a coherent narrative based on the truth. It is why his speech is so disorganized. The cognitive approach would point to this and say that he needs teaching so that he can form a rational system. The therapist would work with him to reexamine the origin of the delusion about his parents and point subtly toward alternative interpretations of the same events. Combined with this would be social skills training, coping methods, and the attempt to do reality testing which reinforces behaviorally the cognitive changes.