The character in Silver Linings Playbook that is depicted to be mentally ill is Pat Solitano, played by Bradley Cooper. Pat was married to a woman name Nikki. However, he discovered Nikki in the act of an affair one day, with a teacher from his own job. In a fit of rage, Pat beats Nikki’s lover. It was determined that Pat was Bipolar and was at a mental facility to get his disorder treated. In the beginning of the film, Pat is in the facility with his friend and coaxes his mother to release him after his eight months of treatment. His mother agrees and Pat moves back in with his mother and father.
The illness is communicated to the audience through his placement in a facility, his one on one therapy with a psychiatrist, and his arguments with his family regarding his medication compliance. A particular scene that represents Bipolar Disorder accurately is Pat’s altercation with his father after he moves back home. As mentioned earlier, Pat was not compliant with his medication once he was released. His mother tries very hard to coax Pat and prevent any situations wherein Pat may become agitated. Unfortunately, Pat’s mother accidentally bumps into her son and Pat loses it. He and his father get into a scuffle and the cops are called.
He is hyper-agitated, hyper-impulsive, and extremely irritable. Due to his Bipolar disorder, he gets into a fight with his father and begins screaming loudly, scaring his mother and father and waking up his neighbors. This is something that could occur to patient with Bipolar Disorder. However, Pat never shows any depressive symptoms of Bipolar Disorder, only aggression. Pat is unfortunately depicted as an angry, dangerous person when we learn his wife’s reaction to his mental illness. She decides to leave him after she saw what he was capable of in a rage of anger and ultimately has a restraining order placed on him.
He is vulnerable and emotional when he thinks about Nikki. He has unrealistic ideas of reuniting with Nikki and having her accept him. He dreams of her taking him back after reconciling with him. This represents the grandiose thoughts Pat expresses. In addition, he is lacking sleep. He also has pressure of speech. The typical conditions of Bipolar Disorder include feeling very “up,” “high,” or elated, having a lot of energy, increased activity levels, feeling jumpy, having trouble sleeping, and feeling more active than usual.
People exhibiting a manic episode may also include talking really fast about a lot of different things, being agitated, irritable, or “touchy,” feeling like their thoughts are going very fast, and doing risky things. A patient in a depressive episode include feeling “sad, down, empty, or hopeless,” having decreased activity levels, trouble sleeping, lack of enjoyment, trouble concentrating, forgetting things, eating too much/too little, and suicidal ideation (NIH, n. d. ). These symptoms are displayed through Pat’s actions, such as his irritability, agitation, and talking really fast and about different things.
He doesn’t necessarily depict any signs of the depressive aspect of Bipolar Disorder. What is your nursing assessment, nursing diagnosis, goals, interventions, & evaluations for the character with the mental illness? Nursing assessment for Pat would be mid thirties male, agitated, irritable, pressure of speech, hostile, loud voice, grandiose, confrontational, and at times, violent. He is unable to control his emotions or instill any coping skills, instead he lets his feelings and memories get the best of him. In addition, he is restless and hyperactive.
He is, at times, very labile and exhibits flight of ideas. He also has an obsession with the idea of getting back with Nikki and winning her back. A nursing diagnosis that would address Pat’s main problem would be the following: Risk for Injury due to his acute mania. Individuals that are experiencing acute mania will often exhibit signs such as “excessive and constant motor activity, poor judgment, lack of rest and sleep, poor nutritional intake” which can all put the Pat at risk for injury, specifically cardiac collapse (Varcarolis 288).
In addition, patients may also exhibit symptoms such as “loud and crass speech” which may annoy others, increasing risk for violence (Varcarolis 288). Due to these symptoms, the patient is at an increased risk for injury. Education on the patient’s medication management, as well as psychotherapy management would be of utmost importance. Ensuring that the Pat is aware of the importance of psychotherapy and medication management should be the first nursing intervention. This is due to the fact that should he not be compliant with medication and therapy, mania will most definitely recur and lead to more complications for the patient.
These medications may include benzodiazepines, antipsychotics and mood stabilizers. These would greatly assist Pat in getting a sleep schedule back on track. In addition, it would be beneficial for him to build trust with another health care provider so he can work on feeling less agitated, irritable, and labile. Some goals would be related to Pat’s lack of sleep and eating. A short term outcome that would be appropriate for Pat’s situation would be for Pat to “get sufficient sleep and rest while home, as evidenced by 4 to 6 hours sleep at night and 10-minute rest periods every hour” (Varcarolis 288).
This is a great short-term outcome for Pat because one of the main contributing factors that puts Pat at risk for injury. If left untreated, he can experience severe exhaustion and even death. As Varcarolis discusses, “this nonstop physical activity and the lack of sleep and food can lead to physical exhaustion and even death if not treated and therefore constitutes an emergency (Varcarolis 286). Thus, another short-term outcome for Pat could include the consumption of at least three meals and have adequate fluid intake during each day.
Some questions that could be asked to determine the success of these nursing interventions include the following: How many hours of sleep do you get every night? Have you been eating three nutritious meals each day? How do you take your medication? What is your medication used for? When do you take your medication? Have you been attending psychotherapy sessions? Which therapies have been more beneficial than others? Have you had any recent episodes of elation, euphoria, or increased impulsivity since you were last hospitalized? Are you knowledgeable about the adverse effects you should report immediately to your physician?
What are the inaccurate statements or depictions of mental illness in the film? Are there accurate depictions within the film? What was accurate or inaccurate and why do you think the moviemakers chose to depict the mentally ill in this manner? I believe that this film accurately depicted mental illness, for the most part, in terms to Bipolar Disorder. I feel that what the film decided to depict, they did so accurately. They did not show the depressive side of Bipolar Disorder, so I believe that the elimination of it could be considered inaccurate.
However, Pat was not compliant with his medication so his manic phase could have easily been drawn out as long as the film drew out. I think that they chose to depict this mental illness in this manner because the general public usually associates Bipolar Disoder with angry episodes, irritability, and agitation. We rarely think of depression when we think about Bipolar Disorder. In addition, many individuals would do what Pat did to his wife’s lover if they found out their spouse in the act of infidelity.
What is to say that this was solely Pat’s undiagnosed Bipolar Disoder? He could have easily been diagnosed prior to his episode of uncontrolled rage. His character accurately represented Bipolar patient’s mannerisms and interactions. He was not sleeping, eating much, irritable, agitated, hostile, grandiose, and exhibited pressure of speech and flight of ideas. The only thing that I would say was an inaccurate representation was the fact that his therapist joined him for a football game, relinquishing his professional role.
Once again, they did not depict Pat’s potential depressive episode and only focused on the aggressive aspect of Bipolar Disorder. Overall, one can say that this film did a great job at depicted this disorder and everything that comes with it – medication compliance, changes in family dynamics, changes in relationships, loss of loved ones due to fear, and even loss of occupation. It’s a culmination of effects that can only make the conditions harder for the individual to recover. We can see that with Pat and his struggle to health.