Introduction
In the 2012 movie Silver Linings Playbook, Bradley Cooper plays Pat Solitano Jr, a young man suffering from Bipolar Affective Disorder (BD). He is trying to piece his life together following a life-changing event that sees him admitted to a mental health institution. According to Carvalho et al. (2020), BD causes acute mood swings in patients and can either be BD Type I, or BD Type II. BD Type I occurs as prolonged high or manic moods that may devolve into episodes of hallucination. On the other hand, BD Type II manifests itself as prolonged depressive episodes punctuated by random instances of hypomania (McIntyre et al., 2020). One of the criticisms leveled at the movie Silver Linings Playbook is that the nuances of BD are not adequately interrogated as Pat Jr is only said to have unspecified BD (Lookadoo et al., 2020). Learnings can be taken from the movie’s portrayal of the etiology and psychosocial impact of BD as well as the critical role of a nurse figure in the recuperation of the BD patient as will be discussed in this paper.
BD from a Pathological Perspective
The Etiology of BD
Psychiatric research has pointed to hereditary factors as the most likely cause of BD. In particular, people with BD exhibit some “DNA markers on the short arm of chromosome 11” (Jain & Mitra, 2023, p. 3). Miskowiak et al., (2019) describe BD as one of the most genetic disorders with a heritability of 85%. Jain and Mitra (2023) point out that more than thirty genes predict the occurrence of BD in an individual in many cases. In identical twins where one twin has BD, the other half of the pair is 57% likely to have BD as well (Jain & Mitra, 2023). This is perhaps the strongest indicator of the heritability of BD. However, there is more to the manifestation of BD than genetic inclination.
BD is often propelled into outward manifestation by the interaction of genetic, neurochemical, and environmental elements. From an environmental perspective, at least three out of five BD sufferers point out one stressful event that preceded the first episode of BD that necessitated clinical intervention (Jain & Mitra, 2023). Such events include childhood trauma, disability, divorce, and unemployment. On the other hand, people with BD display unstable levels of mood-regulating neurochemicals dopamine and serotonin. Jain and Mitra (2023) add that neuroimages of people living with BD reveal certain deviations from the norm. As such, BD is caused by both physiological and environmental aspects of the individual.
The Pathophysiology of BD
The pathophysiology of BD involves the interactions of neurochemical, genetic, and environmental factors. Following the onset of BD symptoms, the sufferer exhibits physiological changes in nerve growth, neurotrophic levels, and neuroplasticity (Jain & Mitra, 2023). Additionally, there may be a body-wide mitochondrial malfunction and immune imbalance over time. Neuroimages reveal changes in neuronal processes and functional connectivity as BD progresses in a patient. One of the most significant pathophysiological markers of BD is the neurotransmitters; dopamine, serotonin, and norepinephrine (McIntyre et al., 2020). During manic episodes, patients experience high levels of dopamine and norepinephrine whereas, during depressive episodes, patients experience low levels of the two neurochemicals. In both cases, serotonin is low as it is responsible for the regulation of the other two neurotransmitters (Miskowiak et al., 2019). Thus, neuro-chemical imbalances are a distinct pathopsychological marker of BD.
Outwardly, the patient exhibits an increased inability to deal with stressful events as well as mood disorders. In some cases, the victim may be prone to violent outbursts, anxiety, and even suicidal ideation (Rodrigues & Duarte, 2022). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gives the criteria for the diagnosis of BD using the external symptoms and not the pathophysiological symptoms of BD which commonly overlap with other mental illnesses (Jain and Mitra, 2023). However, a thorough assessment of the patient using neurochemical and genetic markers as well as neuroimaging can be used to diagnose BD. Media depictions of BD try to maintain a fidelity to the above stated markers of BD.
In the movie Silver Linings Playbook (2012), the etiology of Pat Solitano Jr’s BD diagnosis is implied to be the father. In particular, the father manifests symptoms of mental illness himself in the form of an obsessive-compulsive disorder (OCD) (Rusell, 2012). Notably, Pat Sr’s OCD is debilitating to the point where he has been banned from attending live games by the Philadelphia Eagles following “explosions” or incidents of violent outbursts (Russell, 2012). Moreover, Pat Sr admits to not being able to support his mentally ill son when he was a child. In this regard, the movie is in line with medical research regarding mental health.
Psychosocial Impact of the Mental Illness on the Individual, Family, and the Community
Pat Solitano Jr’s BD affects him on a personal level by predisposing him to poor decisions. Firstly, Pat Solitano Jr is in a Baltimore mental hospital for physically assaulting a man with whom he found his wife committing adultery. His violent and unmeasured response to this setback, albeit significant, is painted as a manic episode of his BD. When Pat Jr is let out of the institution on strict watch, he is erratic as evidenced by his reluctance to take his medication and see his psychiatrist (Russell, 2012). Another poor decision he makes is constantly seeking his ex-wife to the point of an unhealthy obsession. Naturally, his wife, Nikki, is unwilling to associate with him due to his unpredictable moods and has sought a restraining order against him. However, Pat Jr. has to be constantly reminded and restrained from seeking out Nikki by his parents and friends. As such, Pat Jr. is a victim of the disease in as far as it places him in a mental institution and predisposes him to a chain of irresponsible acts that are likely to place him back in the institution.
Similarly, Pat Jr’s family suffers immensely following his placement in a mental facility. His mother, Dolores, assumes all legal liability following his premature release from the holding facility because she cannot bear to have him locked up in the long term. This highlights the responsibility heaped on parents of children with mental illness who remain the primary caregivers for their children even when a role reversal is merited (Chen et al., 2021). On the other hand, his father remains concerned about Pat Jr’s behavior and constantly gets into fights with him, including physically (Russell, 2012). After Pat Jr. returns to his parent’s home he is a disruptive presence for everyone. In several incidents, he rouses his parents from their sleep in the dead of night as he rants over his insecurities. Similarly, he is a disruptive factor in the neighborhood as he occasionally causes a ruckus and approaches old acquaintances who do not want anything to do with him. He acts erratically including in the psychiatrist’s waiting room by losing his temper and trashing items. Overall, he is a liability to both his family and the community.
BD significantly affects psychosocial functioning in its sufferers and can result in a total inability to coexist with other human beings. At the start of the movie, Pat Jr. is in a mental facility because he has been adjudged as a threat to others. Depp et al. (2022) note that people with BD cannot sustain employment and are likely to be dependent on others. This is the exact scenario Pat Jr is in as he was jobless, homeless, and dependent on his parents for his basic and secondary needs. Moreover, people with BD can be a source of stigma for their close family and peers (Depp et al., 2022). This is evident in the case of Pat Jr’s brother Jake whose career and personal life are on an upward trajectory. Jake is ashamed of his brother’s condition as evidenced by his decision not to visit him in the mental facility (Russell, 2012). BD thus places Pat Solitano Jr in an untenable social situation.
The Role of the Mental Health Nurse
Pat Jr finds a capable friend and soulmate in the fractured and unpredictable Tiffany. In many ways, Tiffany acts as his main support system and, a nurse figure, as he comes to terms with living with bipolar disorder (Wilde, 2019). Hartley et al., (2020) note the need for nurses to develop a good rapport with their mental health patients for positive therapeutic outcomes. This is exactly what Tiffany does in Silver Linings Playbook (2012) as she sets upon building a meaningful relationship with Pat Jr. As his friendship with Tiffany grows, Pat Jr’s self-perception improves considerably as evidenced by his decision to stop wearing a garbage bag over his clothes (Russell, 2012). Hartley et al., (2020 p. 3) define the collaboration between a mental health patient and their caregiver as an “effective alliance”. Mental health nurses who show compassion to their patients often create a positive environment where the patient can heal both mentally and emotionally. In this case, Pat Jr’s relationship with Tiffany keeps him active and engaged as he learns how to manage his unpredictable moods.
Another role of the mental health nurse is to facilitate the mental health patient as they undertake their non-pharmacological therapeutic exercises. In this case, Tiffany introduces Pat Jr to dancing practice with the possible reward of appearing in a dance competition. This particular engagement gives Pat Jr a fresh impetus as he dedicates his time and energy to practicing dance moves with Tiffany (Mahmutami, 2020). He makes it a habit to join Tiffany in her house where they practice moves for the dance competition which is additional motivation for them. Nyboe et al (2019) note that physical interventions can mitigate side effects of BD such as gaining weight and insomnia by giving the patient an avenue to expend their emotional and physical energy. Moreover, such exercises occupy the BD patient’s time so they do not ruminate on obsessions, or suicidal thoughts or go into manic or depressive episodes (Miller & Black, 2020). The nurse is important in such interventions as they verbally motivate and remind the patient to participate consistently. Additionally, they can design the exercise regime by scheduling and providing the necessary equipment for the patient.
For the mental health patient who is out of touch with reality, the nurse provides an avenue to reconnect with the world. From a socialization perspective, mental health can severely affect a person’s ability to interact with others (Carvalho et al., 2020). A case in point is Pat Jr who cannot empathize with others as evidenced by his uncensored remarks that often hurt Tiffany (Russell, 2012). However, for Pat Jr, Tiffany remains the only person with whom he can socialize extensively and hopefully learn about his off-putting behavior. Similarly, many mental health sufferers need their nurses to support them rebuild or develop proper social skills. Kirca et al., (2019) point out the significance of nurses communicating effectively with mentally unwell patients. Notably, nurses can empathize with the predicament of the patient while being able to interact with them habitually. Moreover, nurses can provide an important link between the mental health patient and their families. They keep them focused on the milestones that will enable them put their careers back together. In many cases, they offer the only avenue for patients to receive routine social and communicative interactions.
Conclusion
In conclusion, BD defines a range of symptoms detailed in the DSM-5 diagnosis manual. In the USA, more and more attention continues to be dedicated to mental health awareness including by the film and media industry as is the case in the 2012 movie Silver Linings Playbook. From the movie, it is clear that for the current American adult demographic, mental health was not a cultural priority in their formative years. However, there is an increased cultural understanding of mental health as mentally ill patients who commit crimes are provided with adequate psychosocial support as opposed to being imprisoned. While living with mentally unwell persons can be a daunting task, mental health nurses can assist mentally ill persons in a variety of ways. Unlike psychiatrists, nurses spend a lot of time with mental health patients and can facilitate them by providing them with non-pharmacological support. They assist the patients develop the necessary social skills over the course of their treatment.
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