Lars and the Real Girl

1
Lars and the Real Girl
Steve Franklin, MSW, LCSW6829 Gravois Ave
St. Louis, MO 63116SteveFranklin_at_JUNO.com
www. Steve FranklinMSW.com 314-517-8383
2

• Difference between
• eccentricity and disordered
• What kind of problem?
• Mental illness, other or none?
•  
• Does Lars need treatment?
• Doctors approach?

3

• Family and community response?
•  
• Community Mental Health movement
• How do you think
• you might have responded?

4
(No Transcript)
5
What is the problem?

• People will laugh
• Attachment to objects
• Doctor interview
• ADLs? Violence? Psychosis?

6
DSM-IV

• The disturbance causes
• clinically significant impairment
• in social, occupational, or
• other important areas of functioning.

7

• Differential
• Diagnosis

8
Avoidant personality disorder?

•  
• Social inhibition
•  
• Feelings of inadequacy
• Extreme sensitivity to negative evaluation
• Feel socially inept, unappealing
•  
• Excessively monitor reactions of people

9
Schizoid personality disorder?

• Lack of interest in social relationships
• Solitary, secretive, and emotionally cold
• Little interest in having sexual experiences
• takes pleasure in few, if any, activities
• lacks close friends or confidants other than
  first-degree relatives
• appears indifferent to praise/criticism
• Dependency and love are dangerous
• Psychodynamic Diagnostic Manual

10
Panic disorder with agoraphobia

• Remains at home,
• or in just a few comfortable places
• fear of having panic attack

11
Social Anxiety Disorder Social Phobia?

•  
• Persistent, intense, and chronic fear
•   of being judged by others and
• of potentially being embarrassed or humiliated
  by one's own actions.
• Physical symptoms often accompany social anxiety
  disorder
•  
• including Panic attacks.

12
Aspergers Disorder?

• Involves an impairment in social interaction
• Such as
• impaired in the use of multiple nonverbal social
  behaviors
• such as eye-to-eye gaze, facial expression, body
  postures, and gestures to regulate social
  interaction
• failure to develop peer relationships
• lack of social or emotional reciprocity

13
Aspergers Disorder?

• B.Restricted repetitive and stereotyped patterns
  of behavior, interests, and activities
• preoccupation with an area of interest that is
  abnormal either in intensity or focus
• Adherence to routines, rituals
• Stereotyped/repetitive mannerisms
• Preoccupation with parts of objects

14
Aspergers Disorder?

• They may be unusually sensitive or insensitive to
  sound, light, touch, texture, taste, smell, pain,
  temperature, and other stimuli

15
Delusional Disorder

• Delusion that doesnt fit another disorder
•  
• Tactile or olfactory hallucinations if related to
  theme
•  
• Functioning and behavior otherwise normal.
•  
• Ignore information that contradicts belief

16
Delusional Disorder

• Types erotomanic, grandiose, jealous,
  persecutory, somatic, and unspecified.
•  
• Psychodynamic protective response to stress  
• Behaviors Extremeness/inappropriateness
• rather than the simple truth or falsity of the
  belief, indicate its delusional nature

17
Developmental analysis

• Lars afraid of manhood
•  
• Saw dad sad in the responsibility
• Note family difficulty in discussing emotion
•  
• Recent change? Afraid of Karins childbirth

18
Developmental Analysis

• Doctor
• Hes been decompensating for some time.  
• Mental Illness can be a communication, a way to
  work something out.
• Compensate for
• lack of a mother/ fathers distance/blaming. 
• Embraces his loneliness/withdrawal
• Others need for connection is weakness. 
• Karins pregnancy arouses unconscious
  loss/abandonment feelings

19
Jungian

• Bianca as anima,
• the projection of disowned female self
• projection of disowned idealized self
• Missionary, Doesnt care about superficial
  things, Cant have babies (or die in
  childbirth),Has nurses training
• Like him left-handed her mom died God made her
  to help people Doesnt feel sorry for self-just
  wants to be normal..

20
Treatment

• Is his difference something to be treated or
  pathologized?
•  
• Lars doesnt seem to experience being treated so
  much as being in relationship.
• Ethics of doctors approach?

21
Treatment

• Typical approaches 
• Antipsychotic and antidepressant medication
•  
• Cognitive-behavioral therapy top help challenge
  the delusion.
•  
• Insight-oriented therapy develop a sense of
  creative doubt in the internal perception of the
  world

22
Treatment

• Community can provide support and encourage the
  patient to regain his or her abilities.
• If goals not seen as attainable, person feels
  pressured/criticized, probably increasing stress
  worsening of symptoms.
•  
• Avoiding direct confrontation of the delusional
  symptoms (When confronted by brother, Lars simply
  doesnt hear.)

23
Disability Embracing strength

• Minister From her wheelchair, Bianca reached
  out and touched us all..
•  
• (Lars sees her difference as an expression of
  her disability.
•  
• Its not that Bianca was artificial.
• She was just. Realness challenged)

24
Community

• Finds ways for Bianca to contribute
• in ways she can be helpful/productive model,
  help at nursing home.
•  They project themselves they believe that
  Bianca, like them, would want to help

25
Community

• Minister in church scene
• There really is only one law..
• the lord has told us what to do
• Love one another.
• That, my friends, is the one true law.