Placeholder Image

Subtitles section Play video

  • - Okay, do you wanna play rough?

  • Okay!

  • Say hello to my little friend!

  • - They said hello to his little friend.

  • That's actually a line that's kinda funny

  • because cocaine can also cause erectile dysfunction.

  • That's something to just keep in mind

  • while this is going on too.

  • Hey, GQ!

  • I'm Dr. Eric Bender.

  • I'm a psychiatrist who specializes in child,

  • adolescent, adult,

  • and forensic psychiatry.

  • And this is "The Breakdown."

  • [upbeat music]

  • - First up, "Fight Club."

  • - [The Narrator] For six months, I couldn't sleep.

  • I couldn't sleep.

  • I couldn't sleep.

  • I couldn't sleep.

  • With insomnia, nothing's real.

  • - Right away, the narrator talks about being sleep-deprived.

  • Insomnia for six months.

  • When you are sleep-deprived, you do not think clearly.

  • In fact, it's considered unethical to sleep-deprive someone

  • more than 48 hours.

  • In some places,

  • sleep deprivation is considered a form of torture.

  • - [The Narrator] Everything's far away.

  • Everything's a copy of a copy of a copy.

  • - You can see that quick flash of Tyler Durden coming up.

  • And he's saying everything's a copy of a copy of a copy.

  • And you see him kinda sleeping.

  • "Fight Club" is, I'm guessing, purposefully, unclear

  • as to what is going on with The Narrator.

  • Here, you see him have this hallucination.

  • This is very common with sleep deprivation.

  • When you have sleep deprivation,

  • you can first start to get very confused,

  • and then, after time, you can have some delusions

  • and some hallucinations.

  • And the hallucinations in sleep deprivation can be complex.

  • You can actually have auditory and visual hallucinations.

  • You can actually have distortions even of your own body.

  • Sensing that your body is changing.

  • And, as we know,

  • The Narrator looks quite different from Tyler Durden.

  • So there's quite a change in how he appears.

  • You can also believe you are someone else.

  • In fact, in studies of sleep-deprived individuals,

  • some of them said, "I felt like I was another person."

  • A lot of themes in "Fight Club" have to do with

  • consumerism and belonging.

  • The idea that a club, a place to belong,

  • here you have this group of men fighting each other

  • and beating each other to a pulp,

  • you have to wonder if they're getting in

  • some nice shots to the head,

  • and does that actually make people have more delusions

  • or more hallucinations.

  • In the beginning of the movie, after he goes to the group,

  • there is a moment when he cries and then he sleeps.

  • There can be a very cathartic experience.

  • Meaning this release of something

  • that helps you move on with it in your life.

  • There can be a release of emotions when you cry,

  • and it doesn't surprise me that he would sleep.

  • The data show you actually need to sleep

  • about 50% of the time you've been deprived

  • in order to get back to a baseline functioning cognitively

  • and behaviorally, the way you were before.

  • He clearly didn't do that,

  • and maybe that's why we actually see Tyler Durden

  • more and more present,

  • because he's more and more sleep-deprived.

  • There was a study that was done

  • showing how people that were sleep-deprived

  • responded to certain texts, just reading texts.

  • Those that were sleep-deprived for about 35 hours,

  • looked at the texts,

  • and they actually did a scan in the brain.

  • They showed that the connections between the amygdala,

  • where your emotions are kinda centered in your brain,

  • and the frontal cortex, where you can actually organize them

  • and keep stable,

  • it doesn't connect the way it should

  • when you're sleep state is actually good.

  • When you're sleep-deprived, there's not a connection.

  • And, instead, you go into this fight or flight reaction

  • and "Fight Club" or flight, I guess,

  • is more appropriate in this case.

  • Next up, "Scarface."

  • [multiple things clattering]

  • [feet pattering]

  • [men shouting in foreign language]

  • - This is Tony Montana,

  • who's become this cocaine emperor, essentially.

  • He is so high, that he has missed on the screens earlier

  • that all these people are invading his home.

  • He's also becoming more and more paranoid

  • throughout the movie

  • - You wait here, okay?

  • I'll be with you.

  • I'll be back.

  • - When Tony's talking to his sister here,

  • it's possible that

  • that's some of the psychosis he's experiencing,

  • that everything's gonna be fine,

  • as he's talking to his dead sister.

  • He's now got this incredible drive

  • to kill everybody around him.

  • This is cocaine-induced psychosis, quite possibly,

  • or at least the effects of using cocaine.

  • Cocaine's a drug that can make someone feel

  • like they have more energy.

  • It increases the dopamine in the system

  • by blocking dopamine from being taken up by the brain.

  • Dopamine is the pleasure chemical that your brain makes.

  • It also can make you feel more confident.

  • It can make you feel paranoid and delusional.

  • So, throughout the film, we've seen Tony get more paranoid.

  • Here, he's pretty delusional.

  • He's gonna take down all of these agents

  • while they're coming into his house.

  • Before this, you've seen a mountain of coke on his desk

  • and he's just snorting it,

  • or even, like, dropping his head into it.

  • So, there's definitely some cocaine on board.

  • - You wanna play rough?

  • Okay!

  • Say hello to my little friend!

  • - Pause here.

  • There is the delusion

  • that he's gonna just take everybody out himself.

  • They said hello to his little friend.

  • That's actually a line that's kinda funny

  • because cocaine can also cause erectile dysfunction.

  • That's something to just keep in mind

  • while this is going on too.

  • Again, violence is not inherent

  • for people who have mental illness.

  • There are certain situations where violence can occur.

  • We've talked about when somebody might have a delusion

  • and they wanna protect themselves.

  • And it's an acute psychosis issue.

  • Then another place where you might have more violence

  • is actually with substances,

  • and cocaine is one of those.

  • You can get more aggressive.

  • So, grabbing a grenade launcher

  • certainly is a sign of aggression.

  • Tony's reaction here, the cocaine is working in his system.

  • He's not feeling like he's doing anything wrong

  • or out of the ordinary.

  • He's also defending his house.

  • Cocaine was used as an anesthetic, originally.

  • When he gets shot, many times,

  • it's interesting that he doesn't necessarily

  • fall down right away, but stays upright.

  • Was it that much of an anesthetic?

  • I doubt it, but, that was likely more Hollywood.

  • It does actually have some anesthetic purposes.

  • We don't use it for that anymore, obviously.

  • "Black Swan."

  • [feet pattering]

  • Here, we see Nina, who's working really hard,

  • and she's not feeling quite herself.

  • Suddenly, in the mirror,

  • it seems like her movements are not happening in real time.

  • That can illustrate an illusion.

  • She might see something go,

  • but it looks like it's larger than it is,

  • or it looks like somebody that she doesn't know.

  • Hallucination would be if it weren't there to begin with.

  • It's not clear exactly what's happening.

  • There's so many factors contributing

  • to why she might be experiencing this.

  • She has this overbearing, overprotective mother,

  • this competitive frenemy,

  • there's some stress levels that are going up.

  • There's also some hints that she has an eating disorder.

  • And when your brain is not fed or nourished,

  • you don't think clearly.

  • So, it's possible that all this is contributing

  • to how she's seeing the world around her.

  • That Nina's seeing her reflection differently,

  • that could be more of an illusion

  • that she's seeing her reflection which is there,

  • but it appears distorted.

  • I don't know that there's any particular significance

  • to the fact that she's seeing herself,

  • other than she's now been really, really focused,

  • and obsessive about things.

  • And there does seem to be a level of obsession

  • that can be almost psychotic.

  • It's delusional that you need to do this

  • or else this is gonna happen.

  • You're gonna lose your part.

  • You're gonna not have friends, whatever it is.

  • So there can be a level of anxiety

  • that almost seems delusional.

  • And maybe she's experiencing that

  • along with seeing these other things.

  • When someone has body dysmorphic disorder,

  • they see their body differently than it actually is.

  • Someone might focus on their ear

  • and think their ear is not formed correctly,

  • and see plastic surgeons and wanna change it,

  • and they just don't see how their body's shaped

  • the way it actually is.

  • If she has some form of this,

  • it would make sense that she's not seeing

  • how her body looks in the mirror properly.

  • But this looks more to be, like,

  • a hallucination or an illusion,

  • because it's doing things differently.

  • It's actually moving differently.

  • If Nina is sleep-deprived too, from all the work

  • and times she's putting into her dancing,

  • that can also generate some of these possible hallucinations

  • and worries, and the way she sees herself.

  • "Shutter Island."

  • - Let's put them at the table, Andrew.

  • We'll dry them off.

  • We'll change their clothes.

  • They'll be our living dolls.

  • - Here, we see Dolores,

  • having just committed this horrible crime.

  • She's talking about her kids who are deceased,

  • as if they can be living dolls.

  • She has had a history in the movie of bipolar disorder.

  • That's what they're at least suggesting.

  • In bipolar disorder, you can have psychotic symptoms too.

  • You can have hallucinations.

  • And it sounds like she either had hallucinations

  • or some delusional beliefs about killing her children.

  • It's not clear exactly what was going on.

  • Was there a command auditory hallucination

  • that told her to do this?

  • Was it delusional thinking?

  • She is really delusional.

  • And you can see how Andrew's responding here, really upset.

  • A colleague of mine had a 14-year-old boy who was psychotic

  • and the boy actually asked him,

  • "So, am I gonna become a serial killer now?"

  • That's not what we need to teach people.

  • That because there's mental illness, there's violence.

  • There are some states during which

  • someone with mental illness could be prone to violence,

  • but it's not because they're prone to being violent,

  • they might be trying to defend themselves

  • because of a delusional belief.

  • That kind of violence

  • is actually often most occurring at home.

  • The likelihood of being hurt by someone

  • who's got a mental illness

  • is way less than getting struck by lightning.

  • [Dolores whimpering]

  • - Set me free.

  • - I love you so much.

  • - So much, I love you.

  • [gun firing]

  • - When Dolores says, "Set me free,"

  • it is possible that she's letting us know

  • just how much she's struggling in her life.

  • What Andrew ends up doing in killing her,

  • he then ends up in this forensic setting

  • on "Shutter Island."

  • That's a little unlikely in reality.

  • He knows what he's doing.

  • He knows what he's doing is wrong.

  • And he's even crying about killing her after,

  • crying about the kids.

  • He knows what's going on.

  • That means you would not qualify for

  • a not guilty by reason of insanity defense.

  • That's actually even applied,

  • unless the 1% of the cases

  • and a small fraction of that even go through.

  • That doesn't mean that someone is getting off scot-free.

  • What that actually means

  • is someone goes to a forensic hospital

  • where they're treated for the mental health issue

  • that was present at the time of the crime to help them.

  • In some cases, that amount of time takes longer

  • than someone would have served time in a prisoner jail

  • for the crime they committed.

  • What I think happens with Andrew

  • is that he has a traumatic reaction.

  • He realizes what he's done.

  • It's so heinous to him, that he dissociates.

  • Meaning, he is not in touch

  • with what is going on in the world.

  • He's not in touch with many things.

  • And this exercise on "Shutter Island"

  • would be almost a depersonalization that he's stepped away.

  • And he's this Teddy person in this scenario.

  • This would not happen.

  • Why is he in a forensic hospital,

  • when, in fact, he knew what he was doing,

  • he knew what he was doing was wrong?

  • He'd probably be in prison.

  • The jumping of the camera angle could possibly represent

  • that now, Dolores is recognizing what she's done.

  • So suddenly it shifts from this place

  • where she's not clear about things

  • or maybe had some delusional belief

  • to realizing what happened,

  • because that's when she actually says to Andrew,

  • "Set me free."

  • "Split."

  • - Then kill me.

  • Wait, wait, wait, wait, wait.

  • No, no, no, no. Don't do that, don't do that.

  • He can't handle reality.

  • - The character in "Split"

  • is showing signs of what is now called

  • dissociative identity disorder.

  • A former term was multiple personality disorder.

  • Typically, someone has had chronic trauma

  • in their lives early on,

  • and has dissociated,

  • meaning they've separated from that experience

  • because it's too much to handle emotionally.

  • And another personality develops.

  • It's not another person, it's another personality,

  • and alters what the name is

  • for that other personality develops.

  • And these alters help the individual deal with the trauma

  • that they've experienced.

  • - My name is Jade.

  • Has Dr. Fletcher been getting our emails?

  • This is what we have to do. We can... [grunting]

  • As in 1008,

  • when Anandapala suffered the Shahi's most crushing defeat.

  • - So in this scene,

  • we see that James McAvoy go through Jade

  • and then there's another one,

  • and there's Barry.

  • - Everybody, just take a minute!

  • - And then we come to The Beast, the last one,

  • that all the other personalities

  • supposedly have been helping

  • to keep these girls captive.

  • Personalities that are alters are there to help the host

  • or the person who has all these alters deal with trauma.

  • They are not going to gather captives

  • for another one of the personalities.

  • This is not a weaponization of an individual,

  • this is a way to cope.

  • As you watch the changes from one alter to the next,

  • you could see there's a difference

  • in how they were speaking.

  • That can actually happen.

  • The research that used neuroimaging to look at the alters

  • showed that the alters function differently

  • in the brain regions.

  • You can have some that have different accents.

  • You can have some that are left-handed.

  • Some might be right-handed.

  • You can have some that show physical changes.

  • In fact, when you look at the last change here,

  • into what seems to be The Beast, finally,

  • it looks as if James McAvoy is almost stronger in some way.

  • In order to have a diagnosis

  • of dissociative identity disorder,

  • you need to have at least one additional alter,

  • or feeling of being possessed.

  • You can have memory lapses

  • and that can often be believed to happen

  • as you transition from one alter to the other.

  • How fast somebody transitions from an alter?

  • I think this is somewhat of a plot-driven device

  • to have this all come down to this moment in the movie.

  • During therapy, you work with a therapist

  • to ultimately integrate the personalities,

  • but it's not so much about integrating the personalities

  • as it is about processing the trauma

  • that someone has gone through,

  • and understanding how this has affected their life,

  • how it's affected their confidence,

  • how it's affected their sense of what's safe and secure.

  • So, if you really wanna work with somebody in a gentle way,

  • to go through some of this trauma,

  • and as you deal with that,

  • the idea is that some of these alters

  • and these personalities get integrated more

  • into the one host personality.

  • This depiction is highly dramatized.

  • You can have up to 100 personalities.

  • This character has 23.

  • The average is 10 from the literature,

  • and some of the literature suggests

  • the personalities can start to develop as early as age 5.9.

  • That's realistic in the sense of having

  • multiple personalities in one host.

  • The violent piece is not accurate.

  • You're not gonna have a personality

  • that is just out to be violent.

  • Again, it's gonna be more protective.

  • There might be a personality that has beef

  • with the other personalities

  • or other people that are in the person's life,

  • but you're not gonna have somebody who's gonna go out

  • and just wreak havoc.

  • Legally, if someone actually did commit a crime,

  • just because they have dissociative identity disorder,

  • doesn't mean they would go to a forensic hospital

  • or meet criteria for not guilty

  • by reason of insanity defense.

  • You look at whether that alter knew right and wrong,

  • and knew the nature and quality of what they were doing.

  • "Primal Fear."

  • - Is Aaron Stampler capable of murder?

  • - No, he is not.

  • He is far too traumatized to express normal anger

  • and frustration.

  • He keeps his emotions repressed,

  • which is why he created Roy, who is capable of such a crime.

  • - Objection, Your Honor.

  • - The idea that when he's in trouble, he calls you,

  • that does fit an idea of

  • if someone were to have dissociative identity disorder,

  • that a personality would be protective.

  • It's a way of dealing with trauma.

  • So it loosely fits that idea

  • that there's some protection from the alter.

  • What's not accurate in "Primal Fear"

  • is the way this plays out.

  • - No further questions, Your Honor.

  • - Where the hell do you think you're going?

  • - Excuse me? - Hey!

  • - Aaron's on trial.

  • And, suddenly, this Roy alter comes up

  • and threatens someone in the court.

  • The judge ends up ending the trial mid-jury,

  • and saying, "Let's adjudicate this not guilty

  • by reason of insanity."

  • Aaron goes to a forensic hospital.

  • In reality, even if it were legally okay

  • to stop a trial mid-trial

  • and change the way it's functioning,

  • California, the legal statute is,

  • do you know what you're doing

  • or do you know what you're doing is wrong?

  • Roy knew what he was doing,

  • knew what he was doing was wrong.

  • Even if the end of the movie he reveals that he's faking,

  • the way he's doing in the movie,

  • he wouldn't go to a forensic hospital.

  • They make it so that it can't be changed in the movie.

  • But again, the direction it goes is just a little off.

  • There are actually measures you can do

  • when you interview someone to make sure they're not faking.

  • This character's doing what's called malingering.

  • That's presenting as if you have mental illness,

  • faking it, essentially, in order to get something,

  • usually what's called a secondary gain,

  • meaning something outside yourself,

  • like food, clothing, shelter, or a different treatment.

  • In this case, to not go to prison and go somewhere else.

  • If the ruling becomes not guilty by reason of insanity,

  • the individual would go to a forensic hospital

  • and have their mental health issue treated.

  • Malingering does happen,

  • and there are ways to detect

  • whether or not someone is malingering,

  • and that's very important.

  • That's an important role for a forensic psychiatrist

  • to interview someone

  • and make sure there's not evidence suggesting

  • that the person is feigning symptoms just to get something.

  • "The Dark Knight Rises."

  • - I told you I was immortal.

  • - Here, Batman, Bruce Wayne, is,

  • just had his back broken by Bane.

  • He's alone, so it's a question of

  • is the solitary confinement, so to speak,

  • has that caused him to have some hallucinations?

  • What this actually could be is delirium.

  • Delirium's a state where you're thinking

  • is waxing and waning.

  • Meaning, sometimes it's accurate, sometimes it's not,

  • and it can happen with pain,

  • it can happen with infection.

  • It often happens in the hospital,

  • in the ICU for patients, particularly at night.

  • It can be called sundowning,

  • or at night, suddenly somebody's completely restless,

  • tries to rip out all the IVs that they have,

  • maybe rip out foley catheter.

  • And that's part of delirium.

  • It's this changing in their cognition.

  • That might be part of what's going on.

  • Bruce Wayne's getting ideas about Ra's al Ghul.

  • He might be seeing him, hallucinations can occur.

  • That's my thought on why he might be experiencing this

  • the way he is.

  • On the way to sleep,

  • sometimes your thoughts get all strange.

  • They call that hypnagogic hallucinations,

  • where things kinda seem strange.

  • And when you wake up it's called hypnopompic.

  • It's possible if he's delirious,

  • where he's kind of in and out of thinking clearly,

  • maybe his thoughts are all getting mixed together.

  • In the same way, when you're on your way to sleep,

  • and you sometimes get an idea for something,

  • you could have an idea like this come up

  • when you're delirious,

  • it's just unclear whether you'd actually remember it

  • or who knows exactly what's going on in someone's mind

  • when this occurs.

  • It's also possible that Bruce Wayne's experiencing

  • sensory deprivation hallucinations,

  • meaning that he hasn't been in touch

  • with anything in this solitary confinement that he's in.

  • The pain that he's experiencing

  • can also be contributing to him

  • possibly having hallucinations.

  • Pain can be a reason why people have hallucinations.

  • In multiple settings when they experience

  • that much of discomfort from pain,

  • that can really cause some psychotic symptoms at times.

  • "Oldboy."

  • [speaking in foreign language]

  • Here, we see Dae-su, who's been kept in this room

  • and not been allowed to get out.

  • He starts to see that there are ants coming out of his skin

  • and all over his body.

  • That is a visual hallucination.

  • Meaning he's seeing something that's not there.

  • It's actually a particular type.

  • There's a name for this.

  • There's something called Ekbom Syndrome,

  • which is when you believe

  • that you're infested with parasites.

  • Now ants aren't parasites.

  • And I think ants represents

  • something particularly in this film,

  • but the idea that there's something infesting you,

  • some kinda parasite, is a delusion.

  • So that's a delusion,

  • meaning that you believe something that's not true.

  • Visual hallucinations are more common

  • with drugs and substance use, particularly stimulants,

  • but there might be something

  • that is happening here we don't see.

  • We don't see what he's being given.

  • We know that the captors in his mind

  • want to take him out of the room at times

  • and bring him back.

  • They probably do this through drugging him.

  • So this could be a visual hallucination

  • due to whatever he's being given.

  • Another delusion that Dae-su might be experiencing

  • is Cotard's syndrome.

  • There's a range of things that someone

  • with Cotard's syndrome can believe,

  • but you can believe you're rotting to death,

  • or you can actually believe you're dead.

  • And in the end here, we see him dying.

  • These are hallucinations that he's seeing too.

  • So this is a psychotic issue he's having.

  • So, at first, when you see Dae-su itching,

  • that's actually a term called formication.

  • And again, that can be from drug use.

  • You might remember the "Chappelle's Show,"

  • where he's itching all over the place after using crack.

  • Yeah, that's the idea of formication,

  • you itch all over the place,

  • and often it's because you think

  • it's due to things crawling on your skin.

  • When someone is left in solitary confinement,

  • they can develop hallucinations.

  • There are all kinds of research that has been done

  • in the correctional population,

  • showing even that after a few days,

  • you can have some kind of hallucinations

  • in solitary confinement.

  • After 15 days, there's a consideration

  • of it not being ethical.

  • And there's some research suggests

  • even after a short amount of time,

  • you could have permanent mental health issues

  • as a result of solitary confinement.

  • Hallucinations are things that aren't really there.

  • So you won't die from a hallucination.

  • You could die if you acted on something

  • because of delusional thinking,

  • or because of paranoia and you act on something,

  • then you could die.

  • It's actually extremely important

  • to ask patients, who are psychotic, about suicide,

  • just because they have psychosis,

  • doesn't mean they also have other symptoms

  • of mental health issues.

  • In about 15% of suicides, psychotic thinking

  • or psychotic belief was involved.

  • Thanks so much for watching these clips with me.

  • Hope you learned something.

  • Until next time.

- Okay, do you wanna play rough?

Subtitles and vocabulary

Click the word to look it up Click the word to find further inforamtion about it