How Does Andrew Act As An Angry And Irritable Man?
Andrew also experiences negative alterations through a persistent negative emotional state (e.g. anger, guilt) and a persistent inability to experience positive emotions (e.g. happiness, satisfaction). Additionally, PTSD calls for two or more marked alterations in arousal and reactivity associated with the traumatic event(s), this falls under criteria E., and contains six subcategories (APA, 2013). Andrew experiences all six alterations, which includes, irritable behavior and angry outburst, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbances. Overall, throughout the movie we see Andrew act as a very angry and irritable man. An example is when Andrew requests
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files on the missing patient, when the doctor kindly explains the limits of confidentiality, Andrew slams the table breaking a glass while aggressively screaming at the doctor and other staff members. Continuing to move forward with diagnostic criteria, Andrew meets criteria F., G., and H. Criteria F., calls for the duration of the disturbances to occur more than 1 month (APA, 2013). It is revealed in the final scene that Andrew has been on the island for 24 months receiving treatment while experiencing reoccurring episodes. Criteria G., states that the disturbance causes clinically significant distress or impairment in important areas of functioning (APA, 2013), this is clearly the case for Andrew. Lastly, criteria H. states, the disturbance is not attributable to the psychological effects of a substance or other medical condition (APA, 2013). Andrew meets criteria as he has been on the island for two years, drugs and alcohol were not a factor. In conclusion, Andrew meets all DSM diagnostic criteria for severe PTSD with derealization. The next section of the paper will focus on Andrew’s strengths, resources, and coping strategies, along with relevant socio-cultural considerations.
These are important factors to consider when painting a clinical picture. Andrew appears to be an intelligent and strong individual. However, he consistently shows irritability and hostility through externalizing behaviors both before being on the island and during, overall showing poor coping strategies. Andrew joined the Army and provided for his family, overall falling in a higher socioeconomic status as we see the beautiful lake house, fancy clothes, and nice possessions in Andrews flashbacks. Having a higher SES allows an individual better access to resources, facilities, and treatment plans. Andrew may also receive more resources and support as he identifies as white, male, and heterosexual, this is especially true during the 1950’s (when the movie took place) but still an issue of privilege and oppression within our American society today. However, it’s important to note, although he may be able to gain better access to resources, he may choose to not seek help in order to protect his masculinity. We see Andrew come home from WWII and fail to seek treatment for his trauma. His only true support seems to be his family, yet his wife is severely suffering from bipolar disorder. Evidence suggests a supportive family is immensely helpful when healing from trauma (Ray & Vanstone, 2009), this unfortunately wasn’t the case for Andrew. Literature on the impact of PTSD on veterans’ family relationships suggest major themes that emerge in relationships when healing from trauma include, 1. Emotional numbing and anger, 2. Emotional withdrawal from family support (Ray & Vanstone, 2009). We see this in Andrew’s flashback when his wife tries to support him (in a loving and caring way) by saying he’s not acting like himself anymore and needs to put the bottle down. However, the more she tries to engage the worse things would
get. Andrew reacts in a stereotypical way for veterans suffering from PTSD, with emotional numbing, anger, and withdrawal. In sum, by considering other relevant factors we paint a more accurate clinical picture for the individual. To wrap up this topic exploration and diagnostic fit and to paint an even clearer clinical picture, I will discuss possible co-occurring and rule-out diagnoses. I will start with rule-out diagnoses. I have ruled out all Schizophrenia Spectrum and Other Psychotic Disorders, these disorders are defined by abnormalities in one or more of the following domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms (APA, 2013). Although Andrews symptoms seem to be marked by delusions and hallucinations, the true root of his troubles stem from the trauma history he experienced. One disorder that may seem diagnosable but should be ruled out is Delusional Disorder. DSM criteria for Delusional Disorder states, “functioning is not markedly impaired, and behavior is not bizarre or obvious”, Andrew is clearly significantly impaired as he has been inpatient on the island for two years. A second disorder that may seem diagnosable is Dissociative Identity Disorder, distinguished by a distribution of identity characterized by two or more distinct personality states (APA, 2013). Andrew meets criteria with his two identities 1.) Teddy Daniels 2.) Andrew Laeddis, he further meets the rest of the DID diagnostic criteria, making for a possible co-occurring disorder. However, it is important to note the DSM states, “individuals with dissociative identity disorder manifest dissociative symptoms that are not a manifestation of PTSD” (e.g. amnesia of everyday events - nontrumatic) (APA, 2013, p. 296). There would need to be a closer examination of the DID criteria and what is an overlap from PTSD. Lastly, I have chosen to rule-out bipolar and depressive disorders as there is no presence of a major depressive episode or hypomanic episode (APA, 2013). In the end Andrew would be diagnosed with severe PTSD specifically with derealization. The diagnosis of Dissociative Identity Disorder (DID) should not be ruled-out nor fully diagnosed till further analysis occurs. Lastly, the substance use Disorder, Alcohol Use Disorder would have been a diagnosis prior to becoming impatient on Shutter Island. In sum, like in Andrews case and many others suffering from mental health problems, trauma is hugely influential.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Scorsese, M. (Director). (2010). Shutter Island [Motion picture]. United States: Paramount Pictures.
Ray, S. L., & Vanstone, M. (2009). The impact of PTSD on veterans’ family relationships: An interpretative phenomenological inquiry. International Journal of Nursing Studies, 46(6), 838-847.
files on the missing patient, when the doctor kindly explains the limits of confidentiality, Andrew slams the table breaking a glass while aggressively screaming at the doctor and other staff members. Continuing to move forward with diagnostic criteria, Andrew meets criteria F., G., and H. Criteria F., calls for the duration of the disturbances to occur more than 1 month (APA, 2013). It is revealed in the final scene that Andrew has been on the island for 24 months receiving treatment while experiencing reoccurring episodes. Criteria G., states that the disturbance causes clinically significant distress or impairment in important areas of functioning (APA, 2013), this is clearly the case for Andrew. Lastly, criteria H. states, the disturbance is not attributable to the psychological effects of a substance or other medical condition (APA, 2013). Andrew meets criteria as he has been on the island for two years, drugs and alcohol were not a factor. In conclusion, Andrew meets all DSM diagnostic criteria for severe PTSD with derealization. The next section of the paper will focus on Andrew’s strengths, resources, and coping strategies, along with relevant socio-cultural considerations.
These are important factors to consider when painting a clinical picture. Andrew appears to be an intelligent and strong individual. However, he consistently shows irritability and hostility through externalizing behaviors both before being on the island and during, overall showing poor coping strategies. Andrew joined the Army and provided for his family, overall falling in a higher socioeconomic status as we see the beautiful lake house, fancy clothes, and nice possessions in Andrews flashbacks. Having a higher SES allows an individual better access to resources, facilities, and treatment plans. Andrew may also receive more resources and support as he identifies as white, male, and heterosexual, this is especially true during the 1950’s (when the movie took place) but still an issue of privilege and oppression within our American society today. However, it’s important to note, although he may be able to gain better access to resources, he may choose to not seek help in order to protect his masculinity. We see Andrew come home from WWII and fail to seek treatment for his trauma. His only true support seems to be his family, yet his wife is severely suffering from bipolar disorder. Evidence suggests a supportive family is immensely helpful when healing from trauma (Ray & Vanstone, 2009), this unfortunately wasn’t the case for Andrew. Literature on the impact of PTSD on veterans’ family relationships suggest major themes that emerge in relationships when healing from trauma include, 1. Emotional numbing and anger, 2. Emotional withdrawal from family support (Ray & Vanstone, 2009). We see this in Andrew’s flashback when his wife tries to support him (in a loving and caring way) by saying he’s not acting like himself anymore and needs to put the bottle down. However, the more she tries to engage the worse things would
get. Andrew reacts in a stereotypical way for veterans suffering from PTSD, with emotional numbing, anger, and withdrawal. In sum, by considering other relevant factors we paint a more accurate clinical picture for the individual. To wrap up this topic exploration and diagnostic fit and to paint an even clearer clinical picture, I will discuss possible co-occurring and rule-out diagnoses. I will start with rule-out diagnoses. I have ruled out all Schizophrenia Spectrum and Other Psychotic Disorders, these disorders are defined by abnormalities in one or more of the following domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms (APA, 2013). Although Andrews symptoms seem to be marked by delusions and hallucinations, the true root of his troubles stem from the trauma history he experienced. One disorder that may seem diagnosable but should be ruled out is Delusional Disorder. DSM criteria for Delusional Disorder states, “functioning is not markedly impaired, and behavior is not bizarre or obvious”, Andrew is clearly significantly impaired as he has been inpatient on the island for two years. A second disorder that may seem diagnosable is Dissociative Identity Disorder, distinguished by a distribution of identity characterized by two or more distinct personality states (APA, 2013). Andrew meets criteria with his two identities 1.) Teddy Daniels 2.) Andrew Laeddis, he further meets the rest of the DID diagnostic criteria, making for a possible co-occurring disorder. However, it is important to note the DSM states, “individuals with dissociative identity disorder manifest dissociative symptoms that are not a manifestation of PTSD” (e.g. amnesia of everyday events - nontrumatic) (APA, 2013, p. 296). There would need to be a closer examination of the DID criteria and what is an overlap from PTSD. Lastly, I have chosen to rule-out bipolar and depressive disorders as there is no presence of a major depressive episode or hypomanic episode (APA, 2013). In the end Andrew would be diagnosed with severe PTSD specifically with derealization. The diagnosis of Dissociative Identity Disorder (DID) should not be ruled-out nor fully diagnosed till further analysis occurs. Lastly, the substance use Disorder, Alcohol Use Disorder would have been a diagnosis prior to becoming impatient on Shutter Island. In sum, like in Andrews case and many others suffering from mental health problems, trauma is hugely influential.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Scorsese, M. (Director). (2010). Shutter Island [Motion picture]. United States: Paramount Pictures.
Ray, S. L., & Vanstone, M. (2009). The impact of PTSD on veterans’ family relationships: An interpretative phenomenological inquiry. International Journal of Nursing Studies, 46(6), 838-847.