As good as it gets

I am going to be assessing and diagnosing Melvin Udall form the film As Good As It Gets. He displays multiple patterns of behavior, and symptoms, which indicate the presence of a psychopathology. His recurrent behaviors and actions along with being pessimistic and sarcastic to everyone around him make his life in general, ability to form relationships, and ability to function in society nearly impossible or difficult. He complains of being tired and not feeling like himself, as well as disclosing that his father also had spells of isolation. The onset is unknown and he refuses to take the medication prescribed by Dr. Green.
Melvin has an Axis I disorder. Axis I disorders consist of clinical disorders and learning and development disorders. Melvin suffers from OCD which falls under the category of anxiety disorders (300.3). He receives this diagnosis due to his avoidance of sidewalk cracks, germ phobia, rituals, and obsessions along with compulsions; which include checking, ordering, and cleanliness.
Axis two OCPD

There appears to be no characteristic that would fall under Axis III criterion, which include medical and or physical conditions or disorders.
Axis IV involves factors that affect the current disorder and the treatment outcomes. In Melvin’s case he has strained relationships along with homophobia. He is also anti-Semitic, and has no social support. Melvin deals with multiple stressors mostly caused by his compulsions. He is lonely and dislikes the neighbors he does have. His therapist also turns his away, which defers him from seeking help.

At first I thought that Melvin may have OCPD because he was orderly, and wanted things to be perfect, while also focusing on lists, and interpersonal control. He was also very miserable and in denial about his problem, which are factors in OCPD. But I ruled this out because it didn’t interfere with actually doing the tasks at hand, nor does OCPD necessarily focus on the obsessions and compulsions relating to fear, but as a way to improve effectiveness. In Melvin’s case, he wasn’t fixated on effectiveness more on avoidance hence why I ruled out OCPD. He was also only miserable because people didn’t understand him nor was he receiving therapy or on the medication to help with the disorder. And as for the denial, I believe he changed his denial when Verdell started to act the same way he did by not stepping on cracks, thus opening his eyes to the problem. Then I thought that he may have Narcissistic Personality Disorder because he has a lack of empathy, is arrogant and also has a strong sense of entitlement but I ruled this out because he does not meet five of the diagnostic criteria nor would it explain his other actions. Overall his actions most closely fit that for the diagnostic criteria of obsessive compulsive disorder.
Cognitive behavioral therapists focus on how we think and how those thoughts affect what we do. The cognitive side looks at how thoughts are misinterpreted, while the behavioral looks at the relationship between fear and the stimulus. Cognitive therapist believe that people with OCD exaggerate the importance of their thoughts and respond to them as threats, which cause the person distress and anxiety. Because they fear their thoughts they attempt to neutralize the anxiousness by avoiding the possible threats or by engaging in rituals that they believe reduce the anxiety; behavioral side. Cognitive behavioral therapists state that as long as the person views these thoughts as harmful, they will continue to practice avoidance or the rituals until they are taught that the thoughts are not as harmful as they perceive them to be. Some other thought processes, besides fear or danger, that occur with OCD clients are exaggerated responsibility, thought of perfection, and the belief that some ritual or though can cause good luck.
Cognitive behavioral therapy is proven to be an effective way to treat obsessive compulsive disorder. Cognitive behavioral therapists focus on problems occurring in the present versus problems earlier in development and or unconscious processes. The therapists act as couches that help change the way the client thinks and acts by educating them on the realities of the issue at hand. Cognitive behavioral therapists focus on an intervention versus a treatment when it comes to treating OCD. The intervention is called “exposure and response prevention,” or ERP. With this type of therapy the client is exposed to the stimulus that makes them anxious, and then attempts to stop themselves from engaging in those behaviors that they believe relieve the anxiety. This reinforces the idea that the behavior that the person believes is lessoning the anxiousness is just temporary causing a feeling of relief that will shortly subside. This therapy works by inducing the body’s natural process of habituation, or tolerance to the stimulus. ERP has to be a choice and commitment because the client must go through lengthy trials of exposure until the desensitization occurs.
I completely agree with the cognitive behavioral approach. Thought goes hand in hand with behavior, so if our thoughts are distorted our behaviors will also be abnormal. I also agree with the objective behind ERP. The only way to change the thought process is to become educated on the topic at hand. Which in the case of OCD it has to be experienced for the client to believe that the fear and anxiousness they feel is actually unnecessary.
In the film, As Good As It Gets, I do believe that obsessive compulsive disorder, as well as mental illnesses in general, was respectfully presented. Nothing they had the actors do was disrespectful to those with the disorder or with an illness in general. Most of the material presented was accurate in relation to OCD. The film showed the compulsions of the disorder correctly by having Melvin lock/unlock the locks on the door five times each, while also having him turn the lights on and off multiple times when entering and leaving a room. At this point in the movie it shows the frustration of having to do the rituals and the frustration of losing count. It also showed him using a different bar of soap for every time he washed his hands under scolding water and avoiding physical contact with others, while also bringing his own silver wear to eat, and not using his hands to open or close doors; thus imposing that he believes germs are harmful in some way. He also avoided all cracks in the ground and was very orderly when it came to the stuff in his apartment such as cd’s and room décor, even all his books were color coded by paper. Another ritual the movie focused around was the fact that he had to eat a certain restaurant at a certain table during a certain time with the same waitress. This showed the need for certainty and ritual. The movie also does an accurate display of the impact of the OCD by showing his inability to form relationships, and the fact that he has a negative outlook about life. Also, the fact that Melvin denies that he has a problem even though he was diagnosed also shows the denial many people with not only OCD, but with mental illnesses in general face.
Although the movie shows many correct displays of OCD it also shows some that aren’t as accurate. An example of this would be the therapist he attempts to go and see, turns him away. This could be discouraging to those who want to get help. Another would be the fact that it only spoke twice of the “pill” he was on to help with the OCD; the movie wants the audience to believe that having the relationship with Carol and Verdell is what helps him with his compulsions. Overall the movie did a great job at showing the disadvantages/struggles of those with OCD.