Abstract
The movie, “What about Bob?” is a comic feature that illustrates the relationship between a doctor (Marvin Leo) and his client (Bob Willey). Mostly, the movie shows the problem of mental disorders, which exist in both Bob and Marvin. However, while Bob is well conversant with his problems of anxiety, fear, and dependency, Leo is oblivious that he suffers from Obsessive-compulsive Disorder. In effect, the writer is going to analyze both cases of mental disorders regarding the movie, analyzing each party as an independent patient. Among the areas of analysis is their family background, their behavioral conduct, Application of DSM-5 criteria for their diagnosis, possible treatment, and the ethical issue of Doctor-patient boundary consideration, as illustrated in the movie.
Introduction
Dr. Leo Marvin is a Caucasian male aged 60 years. He is married to Faye Marvin, and they both have two children, named, Anna and Sigmund. He is a psychiatrist by profession and has attained an MD-PhD in education (Oz, 2000). On the other hand, his patient, Robert is also known as Bob Willey is a Caucasian male aged 39 years. He is presently divorced though later remarries to Dr. Marvin’s sister. He does not have any children and is not employed. Also, His education level is unknown.
Behavior wise, Dr. Marvin Leo cares for himself very well. He dresses sharply, and neatly, an evident sign of good grooming. He changes his clothes regularly from time to time and ensures to look sharp all through with evidently thorough ironed clothes. His interaction with other people is pleasant though he appears to be a little high-handed and tough (Oz, 2000). Essentially, he has a big ego and believes that he can control everything without getting angry or upset.
He further assumes that he has the ability to handle all situations perfectly with clarity and ease. In fact, his family accuses him of being rigid and not fun. This reflects in his mood because he is always irritable, in a snappy mood with Bob, and shouts a lot. However, he is very intelligent considering that he has written a book, has a high educational level, and attracts a show with Good Morning America (Oz, 2000). His problem is that he has an anger management problem and is a perfectionist. He desires things to go a certain way and constantly nags his family with recommendations about everything.
Main Body
On the other hand, Bob Wiley tries to care for himself though he at times neglects himself. His dressing is consistent, as he puts on one jacket all the time. When he undertakes a vacation with the Marvin’s, he hardly changes his clothes. He consistently puts on a green T-shirt and shorts that look ripped from the knee. Their size is not balanced. His hair is also messy all the time. Nevertheless, he interacts very well with people, and as Marvin’s daughter suggests, he is fun (Oz, 2000).
He is easy to talk to and compliments people all the time to gain their affection. He is also hilarious, and this makes his lovely company. This further reflects on his mood as he appears to be happy all the time. There is never one time when he is serious with issues, even when he is asked to leave. I assume that the character is also intelligent owing to his ability to manipulate people to like him. He understands what people want to hear and tells them just that.
Through his words, Bob states that he suffers from obsessive-compulsive disorder, suffers panic with agoraphobia and hypochondria, and has a myriad of phobias (Oz, 2000). He also states that he has an extremely dependent personality. Also, Bob seems to be manipulative. He manipulates his death to get information about Marvin’s whereabouts. He appears to manipulate the people around him to like him even when he is annoying and intrusive to Leo’s family.
The DSM-V criteria for Bob show that he suffers from multiple specific phobias as well as general anxiety disorder and Personality dependency disorder. The various specific disorders are very common being that most people that suffer from a phobia exhibit three or more (American Psychiatric Association, 2013). As Adler (2012) mentions, the development of these phobias is inclined towards one’s fears and emotions. He also exhibits a severe case of obsessive-compulsive disorder characterized by compulsions and obsessions, primarily aligned towards thorough contamination and safety.
According to DSM-V, Dr. Marvin Leo suffers from an obsessive-compulsive personality disorder. He also tends to suffer from acute stress owing to the constant dealings with Bob. This is further evidenced when he suffers a coma after he watches his house turn into flames (Oz, 2000).
There is minimal background information to support the diagnosis for both Bob and Marvin. In the case of Bob, there is little background information that guides his diagnosis. However, the insight we get at the start of the movie stating that he suffered a divorce implies that he suffered from that trauma (Oz, 2000). Thus, he exhibits these fearful and emotional memories of the traumatic past life he has lived. He also has problems leaving his house and constantly is in the fear of the unknown.
However, an evaluation of his bio-psychosocial factors better helps us make a diagnosis of his condition. It is not certain whether he has inherited his multiple phobias’ problem as there is little information concerning his family history. However, his reaction could be interpreted through the anxiety sensitivity theory (American Psychiatric Association, 2013). According to this theory, people tend to interpret their anxiety response in a hypersensitive manner. This is illustrated when Bob pulls out a bag wanting to vomit then pulls it back citing false alarm. It looks like he hyperventilates and interprets his stress in a catastrophic manner
Secondly, his dependent personality problem can be evaluated using a psychological perspective, owing to little family background information. According to this point of view, the reasons for his dependency could have arisen out of traumatic events in his life, learned reactions, and distorted way of thought. One such traumatic experience is the divorce that he suffered. He states that his wife was a lover of Neil Diamond, and he was not, a factor that led to their divorce (Oz, 2000). It is essential to state that they were two different people and possibly could not relate. However, it is possible that there could be more to the divorce that Bob is willing to admit, characterized by the fits and made up stomach pains and cardiac arrest attack when the doctor mentions this fact to him.
GSM-5 criteria that justify Bob’s diagnosis are:
He is constantly anxious and worries about some issues. In his conversation with Anna, he states that he fears his bladder would burst, etc. Furthermore, he has had this problem for a very long time, and this is essentially why his previous clinician recommended him to Doctor Leo.
Bob also has trouble controlling the fear that he feels making him have panic attacks. He often worries about germs, his safety when outside the house among other things (Oz, 2000). This in turn reflects on the difficulty in sleeping unless he faces the Southeast direction. Further, he experiences nausea and profuse sweating.
GSM-5 criteria that inform the Personality dependency disorder diagnosis for Bob
The main feature that Bob suffers from is the excessive need to be cared for, evidenced by his submission and clinging to Dr. Leo. Even when the doctor goes on vacation, he is scared of being left alone for fear of abandonment and thus, follows him there.
He shows signs of:
- Inability to decide on his own
- Constant needs to be reassured
- He fears to disagree with people, and that is why he always tells them what they want to hear
- He is scared of being alone
- Excessively clingy and needs to be nurtured and supported by his doctor and his family
- Feels scared and helpless when alone
- Creates another relationship when one ends so he can get a cling person (American Psychiatric Association, 2013).
Leo
- There is also little background information to guide in the diagnosis of Dr. Leo. However, through behavioral observation of the patient, it is clear and evident that he meets most of the diagnosis criteria for the illness. Mostly, he exhibits the behavior of being preoccupied with order, is a perfectionist, desires to mentally and personally control those around him, and is often accused of being rigid by his children (Oz, 2000). In effect, he meets six of the total eight diagnosis criteria for this condition.
- GSM-5 criteria for diagnosis are:
- • He is occupied with order and organization as evidence by his preparation for the Good Morning America Interview.
- • He struggles to achieve perfection in everything. Thus, hardly accomplishes most tasks. For instance, when looking for the perfect spot to carry out the interview, he is unable to decide what would do
- • Third, he is so much devoted to his job and career. Despite being on vacation, he is constantly talking to his family about his career and how important the Good Morning America interview is to him. In fact, he hardly has any friends.
- • He is very rigid and stubborn on many issues (American Psychiatric Association, 2013). His family states that he is not flexible and fun.
- • He also forces people to do things his way. For instance, he dictates everything and every decision at home. He is not able to interact openly with his son about diving, with his daughter about having some alone time and fun among other things.
Treatment
Some treatment is likely to work for Bob. Cognitive-behavioral therapy is likely to work with his general anxiety disorders and multiple phobias. Through this method, it is possible that Bob will be able to learn some ways through which he can manage his levels of stress and be able to cope with his issues. This would be through training and relation techniques that would incorporate breathing techniques (Halgin & Whitbourne, 2009). Later, after he has established effective coping mechanisms, the patient could work towards uncovering his cause of fear. Working with his therapist to understand why cause and reasons for fear would be an effective therapy to ensure that he ultimately deals with them and eliminates them (Adler, 2012).
For his germ problem, systematic desensitization would work. This technique would involve helping him drop his fears and assumptions about germs (Kessler et al., 2005). However, the level of anxiety that the patient exhibits warrants the need to carry out desensitization.
Another form of treatment that the patient could get is panic therapy control. Bob displays a sense of false alarms which is accompanied by anxiety. Thus, the control sensation therapy will help the patient to understand his body more and know when they experience symptoms of a panic attack (Adler, 2012). Consequently, the patient will deal with anxiety more effectively. However, anxiety disorders tend to create physiological manifestations in the patient (Kessler et al., 2005). In effect, it is necessary to offer a drug prescription that would be able to deal with these events when they occur, in the case where he is not able to relax or breathe calmly. In this case, Librium, Valium, or Xanax would be efficient drugs (Kessler et al., 2005).
For his personality disorders, I would also offer cognitive behavioral therapy. It is imperative that the patient learns how to foster his independence. Thus, activities geared towards fostering such independence would be suitable for him. Some of the techniques include promoting his self-esteem so that he feels good about himself even when alone. This way, he will start enjoying his company.
Further, this will give him the courage to make an independent decision as well as acknowledge the importance of being able to do so. One way this could be done is by taking baby steps as encouraged in the movie, meaning that he would be able to start making little meaningful decisions in life to allow for his gradual progression. However, I would be keen as the therapist to ensure that he does not depend on me to make personal changes in his life.
Another form of treatment to complement behavioral therapy would be psychotherapy. It is imperative to find out where the sense of dependence grew from. This will help to identify the underlying problem (Halgin & Whitbourne, 2009). It may be that Bob developed this problem from a traumatic event that took place when he was still a child and has since become dependent on people for protection. It is also possible that his divorce would have been a trigger especially if it happened abruptly without any separation. Mainly, this therapy will prevent other future relapses as the cause of the problem would be handled. It is likely that Bob will not respond to treatment very well owing to his consistent dependency behavior on previous clinicians.
Leo
To treat this problem, Leo should be subjected to therapy with a psychotherapist with long term experience in the treatment of this disorder. Also, Librium can be prescribed to loosen his manic reactions (Kessler et al., 2005). Leo may respond to treatment somewhat, owing to his know-it-all attitude and being that he is a doctor himself.
Ethical/Legal Considerations
Bob is partly a danger to other people and not to himself. His fear and panic attacks prevent him from doing most things alone though his dependence means he creates unwarranted attachment of people around him especially his clinicians. This is a case for concern as the level to which he goes through to get access to them is quite detrimental. However, an evaluation of the movie shows that Bob’s problems are not potentially violent or physical but manipulative.
On the other hand, Leo is a danger to other people more, as well as to himself. Owing to his obsessive-compulsive disorder, he is likely to overexert himself to attain perfection, and this may be detrimental to his health. Also, he applies the same level of need for other people and may endanger their lives in the process. This is seen in how he lets go of his son when he was not ready to dive. Also, to get rid of Bob, his stress levels force him to tie him up with bombs to kill him. He seems to be able to do anything at whatever cost.
An evaluation of his previous behavior with clinicians shows that Bob is not able to make competent decisions for himself. He has idolized Dr. Marvin that he believes he is the solution to his problem (Oz, 2000). He considers every advice given to him very seriously and acts on it as he thinks this doctor is capable of healing him. To some extent, Bob’s behavior warrants reporting to the government agencies.
First, he fabricates stories at the calls exchange center to get details about Dr. Marvin’s whereabouts (Oz, 2000). He even lies that he is a detective investigating a suicide. This is a falsification of a police officer and the crime warrants an arrest. Further, he keeps following and coming to Dr. Leo’s house despite knowing that he was not welcome (Oz, 2000). Such behavior is stalking and is dangerous as could result in possible harm to those he is stalking. However, he does not display manic psychotic tendencies that would warrant his forceful hospitalization.
An analysis of Leo shows that he is also not very able to make intelligent decisions concerning his condition. Nonetheless, it is possible for him to respond to the treatment being that he is not dependent. In the event of manic stress behaviors, it may be necessary to confine him to a hospital institution, lest he causes harm to the general public. Besides, his attempt to kill Bob requires reporting to the police.
If I were the doctor in charge of treating Bob, I would do the following to ensure the protection of ethical rights and code of conduct:
- First, Bob is intrusive when he comes to maintaining the Doctor-patient relationship. Such is in violation of the moral code of conduct in clinical practice, which requires that the doctor should respond appropriately (Corey, Corey, Corey & Callanan, 2014). In the case of the movie, Bob, the client is the one that violates the boundary-crossing rule. Thus, as his therapist, among the things I would do, would be to take control of the situation and only require him to answer questions I expected him to respond to. Any attempts to extract information from me would end up futile and directly reprimanded.
- Second, I would not hang a picture of my family for all my clients to see. That provides them a leeway to know my personal life.
- Third, should I talk to the client and ask him to deists following me like Bob did to no avail; I would report them to the police for intrusion and stalking.
- Finally, I would also discontinue my work relationship with them, plainly stating and voicing the reasons why. However, I might consider recommending them to another therapist.
References
Adler, J. (2012). Erasing painful memories. Scientific American, 306(5), 56-61.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA.
Corey, G., Corey, M., Corey, C., & Callanan, P. (2014). Issues and Ethics in the Helping Professions with 2014 ACA Codes. Boston, MA: Cengage Learning.
Halgin, R., & Whitbourne, S. K. (2009). Abnormal psychology: Clinical perspectives on psychological disorders (6th ed.). New York, NY: McGraw-Hill.
Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E.,… & Zaslavsky, A. M. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352(24), 2515-2523.
Oz, F. (2000). What about Bob? Burbank, CA: Buena Vista Home Entertainment.