Mental Illnesses in Films: Depiction of Bipolar Disorder in Silver Linings Playbook

Everyone in their lives will experience some sort of mental ill-health, some more severe than others. We can define mental illness as a health condition that drastically affects a person’s emotions, behaviour and social interactions all in very different ways. Everyone that suffers from a mental illness is on their own journey to recovery that is very different and is completely subjective. One’s illness experience can greatly differ to another person as there are many risks and protective factors that the person is exposed to. The movie Silver Linings Playbook directed by David O. Russel highlights the illness experience of bipolar disorder through the main protagonist Pat Solitano Jr. In the movie, Pat is just released from psychiatric hold for 8 months and is determined to get his ex-wife back after finding out that she cheated on him (Russel, 2012). Bipolar disorder is described as a mood disorder that individual's experience, ranging from extreme manic episodes, hypomania to major depression.

Health care providers must understand the importance of an individual’s distinctive illness experience. This can be done by investigating the biopsychosocial risk and protective factors that one is exposed to. Everyone is exposed to different factors making their journey to remission and or recovery unique. The World Health Organisation defines risk factors as when there is an increased probability of developing a disease or injury through factors such an environment, certain characteristics or exposure to an individual ('WHO', 2019). Some of the risk factors that Pat is exposed to are medication non-adherence, stress from a traumatic experience and family history of mental illness. Protective factors are the opposite, they are factors that decrease the undesirable outcomes of a risk factor (Baltes et al., 2001). Supportive relationships, physical activity and access to health care such as psychotherapy are examples protective factors. Patients are more likely to have an increased recurrence risk and increased hospitalisations due to lack of supportive relationships and stress. Complying to medications and attending psychotherapy sessions are associated with a more positive prognosis of bipolar.

To improve and maintain a person’s life that is diagnosed with Bipolar disorder, there must be pharmacological intervention. Medication non-adherence can be referred to as a patient not complying and not taking their prescribed medication that is agreed to and is given to them by the prescriber. This is an important and serious impediment to patient’s road to recovery and effects the way health care teams can efficiently treat bipolar (Li et al., 2014). This concept of nonadherence is highlighted in the movie through the main protagonist Pat, through his journey of dealing with this mental illness.

Medication nonadherence can cause debilitating effects to the patient as it significantly increases the risk of relapse, suicide attempts, hospitalisation which leads to a less chance of remission and recovery (Jawad, Watson, Haddad, Talbot & McAllister-Williams, 2018). This negatively impacts their experience of mental illness. It can cause depression and mania if mood stabilisers such as lithium are stopped suddenly (Jawad et al., 2018). Nonadherence is completely subjective and varies from person to another, at one end a patient can be completely adherent or completely not (Jawad et sl., 2018). A patient can be non-compliant due to several factors such as negative side effects, elaborate medication regime, poor awareness of the illness and unhealthy relationship between phycologist and patient.

Bipolar medication side effects are a common reason for non-compliance and have an impact on the patient’s mental ill health experience. Pat deals with bad side effects due to the medication and therefore does not take his medication (Russel, 2012). The medications make him “foggy-headed and bloated” and “not as sharp” (Russel, 2012). It depicts the struggle of side effects as it has a great impact on normal functioning which deters people from taking it.

Non-adherence also increases the risk of violence and suicide rates. Research states that “plasma drug levels for prescribed antipsychotic and antidepressant medications suggested that 3 out of 24 were non-adherent to antipsychotics and 10 out of 10 were non-adherent to antidepressants at the time of their suicide”. In the movie, Pat goes through episodes of extreme violence with his family and friends. This is explicitly shown in the movie when Pat hurts his parents during manic episodes. Throughout the movie, the audience is shown the irritability in Pat’s mood, agitation and has a difficult time controlling his emotions which impacts his recovery.

Poor insight and awareness of this disorder is a common factor for non-compliance (Jawad et al.,2018). It would be hard to understand the illness without proper knowledge about the disorder. In relation to this, patients that are non-compliant with their medications have a lesser understanding of their illness and what it entails (Jawad, et al., 2018). The stigma placed on mental illness contributes to this denial and lack of insight which contributes to this risk. The protagonist is in denial of his illness and thinks he is okay therefore, does not take his medication. He is trying to overcome his illness by being optimistic however, that is not possible. This shows his lack of insight about his illness which affects his day to day life and recovery.

Engaging in physical activity of any kind is one of the many ways to improve a person’s mental ill-health experience. A variety of mental illness’ can be prevented and treated by physical activity. This is a protective factor that is a recurring theme in the movie, highlighted through Pat. Research demonstrates that people experience fewer depressive symptoms when involved in physical activity which results in a greater quality of life (Ho et al., 2009). Patients with bipolar are usually more sedentary, and low levels of exercise are related to lower quality of life, higher depressive symptoms and poorer functioning in various aspects of their life. Due to the inactive lifestyle, it has direct implication to not only their mental health but, physical health as well (Hearing et al., 2016). Bipolar individuals that are more physically active have better functionality in all areas of life such as work, cognitive functioning, managing finances and social interactions which have a positive impact on their illness experience (Melo et al., 2019). There is a higher risk of getting obesity, stroke, heart disease and type 2 diabetes. These are linked with a sedentary lifestyle.

Physical activity has a profound positive impact on one’s cardiovascular endurance and quality of life (Melo et al., 2019). It also reduces the risk of suicide attempts. The illness progresses less as physical activity enhances “levels of neurotransmitters, neurotrophic factors, beta-endorphins and cortisol (Melo et al., p. 101)”. Exercise significantly enhances mood and reduces depressions, anxiety and stress levels (Hearing et al., 2016).

Physical activity is linked to severe insomnia which is a symptom of bipolar disorder (Melo et al., 2019). Serotonin is an important neurotransmitter in this relationship. When there is a decrease in serotonin a person can experience sleep issues which effects a person’s mood. Exercise stimulates the serotoninergic systems and will, therefore, increase sleep quality which then improves overall mood (Melo et al., 2019). Melo 2019 stated that patients that are inactive present with high levels of anxiety. Cardio training and resistance training decrease anxiety not only amongst people that suffer from mental illness but also healthy people.

Pat is heavily engaged in exercising daily and losing weight to feel and look his best in attempts to get his ex-wife Niki back. As the movie progresses he starts to dance with Tiffany, who is friends with Niki and is his way to get back with her. The audience is shown that through this creativity of dance tiffany is helping Pat move on from the past and deal with his bipolar disorder. As the movie progresses, we see a shift in his mood, outlook on life from being more pessimistic to optimistic (Russel, 2012). Exercise and dance is a big contributor to his illness experience journey and recovery. We see less manic episodes and a sense of accomplishment when Tiffany and Pat perform their dance routine. Through working on the dance routine, we see Tiffany and Pat become more disciplined, co-operative, determined whilst simultaneously stabilising their mental illness.

To conclude, people diagnosed with mental illness undergo their own journey of mental ill-health that is unique in the hopes of reaching full remission. However, it’s not a straight road to recovery, but one that is multifaceted. This is well presented in the movie through the themes of medication non-compliance, trauma, physical activity and supportive social relationships. The movie and literature highlight the importance of adhering to medication regimes and physical activity.

References

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• Department of Health | What is mental illness?. (2007). Retrieved from http://www.health.gov.au/internet/publications/publishing.nsf/content/mental-pubs-w-whatmen-toc~mental-pubs-w-whatmen-what
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• Ho, P., Bryson, C., & Rumsfeld, J. (2009). Medication Adherence. Circulation, 119(23), 3028-3035. doi: 10.1161/circulationaha.108.768986
• Jawad, I., Watson, S., Haddad, P., Talbot, P., & McAllister-Williams, R. (2018). Medication nonadherence in bipolar disorder: a narrative review. Therapeutic Advances In Psychopharmacology, 8(12), 349-363. doi: 10.1177/2045125318804364
• Li, C., Chen, C., Qiu, B., & Yang, G. (2014). A 2-year follow-up study of discharged psychiatric patients with bipolar disorder. Psychiatry Research, 218(1-2), 75-78. doi: 10.1016/j.psychres.2014.04.029
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• Risk factors. (2019). Retrieved from https://www.who.int/topics/risk_factors/en/
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