Sunday, 24 March 2013

Mad, Bad and/or Dangerous: Side Effects (2013)

I am drawn to films claiming to portray issues pertaining to the work of fellow psych professionals, or mental health issues.  That was how I came to see Side Effects (2013).  That, and the fact that I'd seen (the brilliant) Arbitrage (2012) the previous evening. 
Side Effects has perhaps one too many twists. It's brilliantly clever, and I was utterly engrossed throughout. But there were some obstacles to overcome. The first of which was the believability factor. It simply wouldn't happen that way.
There is something known as Professional Indemnity that would have had a radical bearing on the story line - altering it substantially - albeit with consequently compromised drama. It was, I think, a great portrayal of someone with undiagnosed Personality Disorder. There was some minor and fleeting reference to an alternative diagnosis towards the end of the movie, when psychiatrist Jonathan Banks (played by Jude Law who, my fellow cinema-goers and I agreed, might as well shave his head and be done with it, as it's been receding for an eternity) throws the words Schizoaffective Disorder at his patient but this doesn't, I think, fit with what we'd witnessed for the preceding 100 minutes.

Schizoaffective Disorder is one of the more common and disabling mental illnesses affecting approximately 1% of the US population. This illness manifests itself through a combination of symptoms of schizophrenia and an affective (mood) disorder. Today, many believe that this disorder is a form of schizophrenia, though this may be somewhat of an ad hoc assessment.

The diagnosis entails that a person needs to have primary symptoms of schizophrenia (such as delusions, hallucinations, disorganised speech, and disorganised behaviour) along with a period of time with symptoms of major depression or a manic episode.
From the film's portrayal of Emily Taylor, the main character played by Rooney Mara, it would be almost impossible to diagnose Schizoaffective disorder with any confidence.  Law was adamant that his patient was not depressed, requiring her to fit the criteria for the bipolar subtype, for which the requisite episodic mania was only hinted at by her impulsivity.   
So, once again, we are faced by the difficulty of diagnostic criteria.  I hold the contents of my copies of both the DSM and ICD lightly.  It is infrequently that I ever feel compelled to consult either.  But that's not unusual, given where I sit, amidst my co-professionals.  Therapeutic outcome is not always determined by diagnosis.  Though a label can, for some, on occasion, be helpful. 
Jumping to conclusions is a perennial hazard of the job.  And one that is all too real a risk when working under pressure and without adequate guidance or supervision.  Inexperience often leads to assumptions.  Whatever one has most recently been reading about starts to show up in one's practice.  Suddenly everyone has borderline traits (including, from my perspective, Emily).  Caution should be a rule of thumb.  And consultation. 

Whether or not this will truly be Soderbergh's final flick we shall have to wait and see. In the meantime, Ablixa is not, and will never be, prescribed. 

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