Psychology

Reign Over Me (2007)
The movie revolves around a man named Charlie Fineman who lost his whole family, including their dog, to the tragic 911 terrorism.  His college roommate Alan Johnson and psychiatrist Angela Oakhurst helps him move on, slowly but surely.

Characteristics A look into Charlie Fineman
When we first saw Charlie, he was disheveled he looked as if he hadnt showered for days, and his hair is unkempt.  His clothes are a little weird, too.  If not for his motor scooter, his rather spacious apartment and his fascination for vinyl records and computer games, youd assume that hes homeless.
Hes a married man who must be in his late thirties, early forties. His family composed of his wife Doreen and their three daughters, Julie, Jenny, and Geena, whose ages are 9, 7 and 5, respectively.  Hes a graduate of dental school and has lived a great life, until his family all passed away in a plane crash during the 911 Terrorist attacks in New York.

Amnesia
At first look, Charlie seemed to be suffering from a medical illnessamnesia, specificallysince he was unable to recognize Alan who was his roommate in college from years ago.  He was also unable to remember specific facets of his previous life, particularly the life he had before the tragedy.

I ruled this out, however, when I saw how he was able to recall things that he and Alan did before, albeit slowly.  It was as though he had to be reminded of it first, claim overnight, then remembers it the next morning.  For example, Alan told him that they used to jam together when they were in college.

He said he didnt remember the next night, he invited Alan out to jam in his apartment to the music they both loved.  I thought he may just be suffering from dementia, and not amnesia.  Dementia is a form of memory loss where the patient is still able to remember events if given a precursor to it.  Since he seemed to remember things, Id say that he might have dementiawhich, I ruled out all the same as I approached the inevitability of the symptoms of the diagnoses Ive given him.

Avoidant Personality Disorder
I also saw symptoms of Avoidant Personality Disorder 1) Avoidance of activities that requires interpersonal contact.  Charlie is uncomfortable with dealing with other peopleAngela Oakhurst for one.   He didnt want to see her during their psychiatric sessions and 2) extreme sensitivity to criticism, as characterized in the part where he and Alan met Nigel, a therapist, and the latter kept on asking about his work and his present disposition.  Moreover, Charlie is selective with the people he avoids, generally the people who knew him between graduation and the death of his family.  He stopped taking calls from his in-laws, and never talked to anyone apart from Sugarman, his accountant, and his landlady.  He trusts his landlady, who does her best to keep him away from his in-laws Ginger and Jonathan, who comes by to see him.  Sugarman, on the other hand, he doesnt trust that much except in the context of keeping tabs of his finances.

This too, Avoidant Personality Disorder, I ruled out.  The cue words in this disorder are inferiority and fear of rejection and embarrassment.  Apparently, Charlie is not at all embarrassed of what he does, and does not need the approval of someone else to do what he wants to do.  He may be inferior, but it may be attributed to his keeping a low-profile.  I guess Avoidance here is objective he avoids the people connected to his past.

Paranoid Personality Disorder
Another disorder that I have found him to have symptoms of is Paranoid Personality Disorder.  He has an obvious distrust in a lot of people, Alan included.  Id justifiably say that the only person he trusts is his landlady, and this is in a purely platonic level.  Several times he accused Alan of working for his in-laws, trying to pry out some emotion in him.  He held a grudge against his in-laws for forcing him to grieve, when he already is grieving, albeit personal.  In some instances in the movie, he doesnt believe that Alan knows nothing about his family and that he is there for him as a friend.  Alan had to keep up with Charlies outbursts and various moods.

However, I attributed Charlies lack of trust and paranoia due to the fact that his family died as a result of terrorism.  Also, it is apparent that he is keeping the pain to himself, and he doesnt want to do with anything that doesnt tickle the fancy of his recreation of himself.  He wants to be kept as far away as possible from the people who knows him before that any kind of attempt they have of rekindling connections with him, he shuts off.  Maybe this paranoia is just another manifestation, and not a disorder in itself for Charlie.

Borderline Personality Disorder
The rapid mood swings that Charlie exhibits in several scenes in the film could also be a sign of Borderline Personality Disorder.  Some of the symptoms that he has are the following 1) Unstable interpersonal relationship 2) Feelings of emptiness 3) Lack of anger management 4) Dissociative personality and paranoia and 5) Impulsive actions that may have led to harming himself, or worse, to his death.

The instability of his relationships doesnt manifest only with his in-laws, whom he kept avoiding, but also with the breaking of any familial connections with his then best friend Sugarman.  His relationship with Alan is not really fine, since he has trust issues with him even as they began to know each other again.  The feelings of emptinessalthough it is implied that he is experiencing this immediately after the deaths of his wife and daughtersdidnt mark itself until after he opened  up to Alan at the suggestion of Angela.  As he began spiraling into a helpless heap, he remembered the days where her daughters would be playing, running across the hallway of their apartment, and how his wife Doreen looks at him every time.  Its as if his whole life began unraveling right before his very eyes.

His mood swings usually stems from his distrust on people, so the dissociation and paranoia contributes to this.  It usually comes in bursts of disruptive anger, in which he later realized that he is at fault and tried to make amends.  He offered Alan, through Sugarman, a million dollars for the former to forgive him.

I realized soon, however, that all these are just facets of a greater problem, just one of the many manifestations of the real diagnosiswhich Angela has easily laid on my plate.  Charlie has Post-traumatic Stress Disorder.

Post-traumatic Stress Disorder
The symptoms that Charlie manifests either dont fully fit the criteria given in the abovementioned disorders, or they rule out each other in complication.  There is something lacking with the prior diagnoses like a shoe that fits, but does not match the dress presently worn.

Thats when I realized that I am forgetting one little thing, the most important of all.  Charlie lost his family in a tragic fate, and although it is natural to feel grief, his is on the extreme all to the point that he almost wanted to kill himself just to be able to get away from seeing them, remembering them.  So all is put into perspective, Charlie is suffering from Post-traumatic Stress Disorder.

Basing on the situations laid out in the movie, Charlie is in denial of his past life.  He doesnt acknowledge the fact that he had a family, and has long since stopped from practicing dentistry.  We dont know if he were practicing even before his family died, but it can be assumed since they still call him Dr. Fineman.

He avoided so much his in-laws, and he is highly antisocial, a loner.  Antisocial here does not refer to the disorder, but to his characteristic of being always alone.  He lives by himself in his apartment, most times playing a computer game, Shadows of the Colossus.  Even with his choice of computer game, which shows a giant being taken down by a small character, is an allusion to his wife and daughters deaths.  The giant is one of the Twin Towers, and the small character is the plane hijacked to crash into it.

He is particularly insensitive to death, as established when he still wanted Alan to hang out with him even after the latter told him that his father had just died.  Charlie didnt even come by Alans house for the memorial.  His accountant Sugarman was actually his best friend before his family passed away, saying that they always went out together as a family.  When Charlie found out about their deaths, he just withdrew and never spoke to him and to the rest of his family again.

Like all other individuals who were told to go to a shrink to have their selves straightened out, Charlie was hesitant.  Its like, he wanted to change and he acknowledges that, but he is afraid of something that he withholds his words.  He frequently bursts into fits of anger when he seems to be misunderstood and resorts to his headphones with his iPod on full volume for consolation and instant escape.  When he doesnt want to listen to Angela or to his father-in-laws testimony in court, hed put on his earphones and rock himself until he feels more calm and oriented.

Post-traumatic Stress Disorder (PTSD) can happen to anyone even those who havent experience any first-hand traumatic event may develop this disorder.  Its enough for one to witness a rather horrifying happening and take the toll of having to carry that particular happening in his mind for longer than whats necessary.  It is characterized by stress or fright even though the traumatic event is no longer happening and that danger is no more imminent.

The symptoms of PTSD may be characterized into three (NIMH, 2009) 1) Re-experiences, like flashbacks, nightmares, and hallucinations 2) Avoidance, which may lead to a wrong diagnosis of Avoidance Personality Disorder if not assessed properly and 3) Hyperarousal, feelings of being tense and having angry fits.  The cue word here, however, is that these symptoms should be present for more than a month.

The above symptoms are common to anyone whos had a traumatic experience so time is of vitality in this context.  A month of manifestation may be diagnosed as Acute Stress Disorder if present for a longer period of time, its already PTSD.

Charlie fits in all of the three categories mentioned, and it has been going on for several years already.  He experiences hallucinations one scene in the movie showed his family running around in his apartment, while he was contemplating on his suicide.  In a scene outside the courtroom, he told his in-laws I dont need to talk about her or look at pictures... cause the truth is, a lot of times, I see her... on the street. I walk down the street, I see her in someone elses face... clearer than any of the pictures you carry with you. I get that youre in pain, but you got each other. You got each other And Im the one whos gotta see her and the girls all the time. Everywhere I go I even see the dog. Thats how fucked up I still am I look at a German shepherd, I see our goddamn poodle.

His avoidance and hyperarousal symptoms were addressed above.
For this endeavor, we are going to assess Charlies situation following the Diagnostic and Statistical Manual of Mental Disorders Fourth Editions Five Axes.  Axis I is the identification of the Clinical Disorder.  There are 14 categories under Clinical Disorder, with has several component characteristic under it as well.  Axis II, on the other hand, identifies Personality Disorders and Mental Retardation this is done so well know what kind of intervention we could use on the patient.  Knowing about his personality, we can better handle him.

Axis III aims to pinpoint any General Medical Condition that will affect the development or degradation of the patients mental health.  Sometimes, there can be no General Medical Condition indicated.  Axis IV reports the Psychosocial and Environmental Problems that has an immediate effect to any course of action laid out or to be laid out.  Take note that these stressors should impair the patients ability to function.  Last but not the least, Axis V the Global Assessment of Functioning Scale measures the over-all level of psychological, social and occupational functioning of the patient (Psy Web, 2009) in a 100-point scale.  Bear in mind that this does not include any physical limitation that promotes impairment of the senses.

Charlie is having an Anxiety Disorder, particularly Post-traumatic Stress Disorder (Axis I) for a long term now.  He may also have the following 1) Borderline Personality Disorder 2) Avoidant Personality Disorder andor 3) Paranoid Personality Disorder.  However, these personality disorders could be just facets or components of the principal diagnosis (Axis II).  He has no General Medical Condition, since he has no order prior diseases, sickness or mental impairment that will have contributed to his present disposition (Axis III).

It was apparent that he has problems with young professionals like Angela Oakhurst and Lawyer Fallon, doubting their ability to handle complex situations, especially ones that involved him and his present situation.  He also seem to be disoriented around beautiful women like the orally fixated Donna Remar, asking Alan to schedule his meetings with Angela as far away from the schedule of Donna because she is just too beautiful. What might also be included in here is the lack of supportor rather, his obvious disregard for any kind of supportduring the times of his moving on.  It has made him become transfixed in a child-like environment where he could only think of himself and no one else (Axis IV).

Global Assessment of Functioning measures at  31, rather low for a seemingly normal person.  Charlie shows inability to communicate well and has major depression, leading to his avoiding of past friends and inability to be responsible for any work, what with hallucinations of his family, therefore destroying family relations due to lack of proper judgment and fluctuating mood swings (Axis V).

Etiology or Origins
Charlie has gone through a life-altering experience when he learned of the death of his family during the 911 attacks.  Well, it is understandable for him to grieve as such, but seeing that it has been like that for a long time, he has not only put himself into danger but also his relations with the people he once learned to love and cherish.

There are several cases in point that has contributed to his present disposition 1) He is the Man of the House and, although it was not said in the movie, he may be trying hard to fit into a family of girlsnot that its a feat for him or anything 2) they were supposed to meet that day after his wife took the kids to Boston, meaning he hadnt seen them for a while 3) he had snapped at her during their last conversation about remodeling the kitchen and 4) he lost them to a national disaster, and his family had no means of surviving anyhow.

Everything about his familys death was so sudden that Charlie was unable to prepare himself for it.  His excitement dissolved into grief went he learned that two planes from Boston were hijacked, hoping against hope that it wasnt his family in there.  But the inevitable came at him like a slap in the dark his family is dead, and there was nothing he could ever do about it.  He was helpless and hopeless.

It could have been nice if someone was there for him to help him move on someone who would understand him and would tell him to take his time, to make him realize that all is going to be okay, and that although his family is dead, he is not alone.  So okay, we know that his in-laws tried to help him, but what I see in here is that they were pushing him to reminisce, not knowing that what theyre doing is actually doing some more damage on his already bruised emotions.  It must be hard to live through the death of your wife and daughters alone.  Ostensibly, these have contributed to his shut down, to his inevitable closing down of emotions.  He forced himself to forget about that life, to forget about his life, to be able to get on with everyday.  It is quite shocking that he didnt take his life early on hes dug a very deep hole and buried everything in it.  Angela and Alan were able to dig that hole, and when everything came out, thats the time where Charlie broke down and started thinking about suicide.

Treatment
During the courtroom hearing, Angela argued that what Charlie needs is time to heal, and that time is not anyones time, or the states time, but Charlies.  Angela was able to get Charlie talking about Doreen, Julia, Jenny and Geena, and it was a good start.  They are on the path of giving Charlie what hes always wanted peace of mind.  The judge has implied that too, saying that Charlie may need to be hospitalized, but would it be beneficial for him  Wouldnt it be better if he was left to his own decisions, since his pain is emotional.

I totally agree with Angela, about Charlie taking his time.  I would suggest that Charlie go under an individual therapy, one-on-one sessions that will be coordinated according to what he wants and how he wants the day to be.  It would be great if hes able to express himself, and for that to happen, there must be an established trust.  I do not really recommend group therapy since he might have extreme difficulty expressing himself with unfamiliar people present, he might not disclose vital information and impede his way to progress.  If hes not fine with being alone in the room with a psychiatrist then we could ask Alan to be present with him, too.

Given some time, Charlie should be able to talk more about his family, widen his social contacts, and open up himself to others.  He should also be able to reestablish his connections with the people he knew before the tragedy, like his in-laws Jonathan and Ginger, for example.  Or his best friend Sugarman, who has never left him hanging even though he was utterly disregarded.  It is a good step that he has moved into another apartment and had his familys things towed away.

For his case, we should be like Angela whos understanding and hospitable towards him.  If we try to have him in a firm and authoritative relationship, he might clam up and well lose his trust.  Someone as emotionally fragile as Charlie should be given proper attention.  The primary goal that we want to achieve her is to have a major change in his personality and his behavior, to mold him into the Charlie that he once used to be, for him to move on.

It might be a difficult task, seeing as how complicated Charlie could be, but time is of the essence here, Charlies time.