Power_of_the_Unknown

The film, K-Pax, depicts a man who is not your typical delusional. He claims that he is an extra-terrestrial named Prot from a planet called K-Pax. He exerts such power of conviction through his extraordinary knowledge in astrophysics that it almost has his own psychiatrist second-guessing. On top of that, he is imbued with wisdom and shows great compassion towards others. While Prot’s case may be unlike any other, a variety of diagnoses can be made. He could possibly suffer from schizophrenia, severe posttraumatic stress disorder, or dissociative identity disorder. The method of treatment used in the film is through anti-psychotic drugs, therapy sessions, and hypnosis. In the end, this is not enough to save Prot from falling into a state of catatonic immobility in the end and other possible interventions could have been employed to prevent that. There are many legal and ethical issues that arise but I feel that it is more so purposely put into the story to give it a more dramatic effect. It is a film, after all. From start to finish, the film is open to interpretation. It alludes to the idea that Prot might actually be an alien from another planet who is taking form in a human’s body. However, from a pure psychological point of view, there are a few probable diagnoses for Prot. Schizophrenia is a disorder that might seem fitting in this situation. Paranoid schizophrenia would be the subtype of the disorder that I would categorize Prot in. The key feature to this specific subtype is the presence of prominent delusions. In Prot’s case, they are quite grandiose. He strongly believed he was an alien life form from another planet. The DSM-IV-TR requires that these symptoms to last for at least six months and it is later explained that these delusions have been occurring for a long time. His speech is not disorganized and the flat affect is not really portrayed which are other criterions of paranoid schizophrenia (Kring, et al.). At the conclusion of the film, it seems that Prot is hit with catatonia. Catatonic immobility is a symptom of schizophrenia that can be described as people maintaining unusual postures for long periods of time. When it is time for Prot to “leave,” he is found motionless underneath his bed and then is wheeled out. It is highly likely that Prot suffers from posttraumatic stress disorder because he witnesses a very traumatic event 5 years prior. Dr. Powell manages to identify Prot as Robert Porter and finds out that he came home one day to find both his wife and daughter killed. Porter kills the perpetrator and eventually attempts suicide. This traumatic event is considered the one criterion that really separates PTSD from other disorders. Along with this criterion, the event causes extreme fear or helplessness, it can be reexperienced, stimuli associated with the trauma is avoided, there is increased arousal, and the symptoms last more than a month (Kring, et al.). Prot displays a lot of these symptoms in the film. By taking on another identity, he is repressing his fears and helplessness about the incident. This is later brought up through hypnosis. His alternative identity is also a way to avoid anything associated with the trauma. There is a scene where Prot is exposed to the sprinklers at one point and he reacts adversely. His actions illustrate intense reactivity to a reminder in that particular scene. The duration of the symptoms also fit the DSM-IV-TR criteria for PTSD. Another disorder that could plague Prot is dissociative identity disorder. The DSM-IV-TR criteria for this disorder is the presence of two or more personalities, at least two of the alters recurrently taking control of behavior, and the inability of at least one of the alters to recall information (Kring, et al.). The alter can be an extremely complex character and is usually the polar opposite of the other. It commonly begins in childhood and because it is more severe than other dissociative disorders, recovery can be difficult. DID can be paired with amnesia, depersonalization, suicide attempts…etc. Other diagnoses can be present with this disorder such as posttraumatic stress disorder (Kring, et al.). The hypnosis sessions reveals all of the traumatic and stressful events from his past. He explains that his father used to work at a slaughter-house and one day died from an accident. Eventually he ends up working at the slaughter-house too and impregnates his girlfriend at seventeen. After some time passes, he witnesses the murder of his wife and daughter. During these recollections, Prot still refers to himself as an alien from K-Pax that is called upon by his human friend whenever he is in trouble. His friend is of course, himself and Prot is the alter that was created when his father died at a young age. Since then, whenever he experiences a stressful or traumatic event, he assumes his alter, Prot. Forming a new identity is a way to cope with the trauma. Prot is also a highly intellectual and almost a messianic character, which is far from the kind of qualities a man who worked in a slaughter-house would possess. Prot’s charm has a considerable amount of influence over the other patients, each of whom believes unquestioningly that he is indeed from K-Pax. He is able to convince the mysophobic Ernie to enter the Institute's courtyard and to remove the surgical mask he habitually wears. Ernie definitely has a specific phobia. In his case, it is fear of objects or situations that is out of proportion to any real danger (Kring, et al.). Other than the surgical mask, he makes it clear that he is afraid of any kind of contact with contamination or germs. He makes ridiculous requests to the doctor because of this fear. Prot also induces the delusional Mrs. Archer who seems to have narcissistic personality disorder, to uncharacteristically leave her room. People with this disorder have extravagant views of themselves. They believe that they are special and have a strong sense of entitlement. Because of this, they can be arrogant, exploit others, and show a lack of empathy (Kring, et al.). Mrs. Archer shows this by throwing a plate of food at the staff member and by the way she presents herself to Prot when he invites himself in. She mentions to him that she’s waiting for someone, which indicates that she experiences delusions along with her disorder. Prot stays in good standing with another patient named Sal, who suffers from severe phantosmia. This condition involves a person being able to smell odors that do not derive from physical stimulus. This is also known as of as olfactory hallucinations. This is exemplified when Sal approaches him and asks if he can accompany him to K-Pax since Prot is the only person who does not stink. There is a wide range of disorders depicted in the film and an array of interventions that get executed in attempt to treat these patients. As for the main character, Dr. Powell gives Prot Thorazine, which is a strong anti-psychotic drug and pairs it with therapy sessions and hypnosis. In the film, Dr. Powell demonstrates the psychoanalytic paradigm. As it has been discussed in class, the core assumption of this paradigm is that the behavior reflects unconscious conflicts. This is derived from Freud’s theory of personality and the concept of hypnotism comes from Franz Anton Mesmer. Dr. Powell figures out the root of the problem through age regression and discovers a repressed traumatic upbringing. With a little detective work, he manages to uncover the identity of Prot and the basis of his issues. The film illustrates though that this tactic does not work. Research shows that there is little evidence that age regression relieves symptoms and that sometimes it can actually make it worse (Kring, et al.). The efficacy of psychoanalytic treatment does not prove to be successful in Prot’s case. His decline into a worsened psychological state might have been avoided through possibly cognitive behavioral therapy. And, this type of therapy would fall under the cognitive behavioral paradigm respectively. This is a common form of treatment for those who suffer from schizophrenia. The goal of cognitive behavioral therapy as we have gone over in class is to change maladaptive thought patterns. In my opinion, Dr. Powell spends too much time trying to learn about Prot’s way of thinking. He becomes very wrapped up in the ideals and beliefs of Prot because he is a very, “convincing delusional.” Instead of actually focusing on changing the way Prot thinks and addressing his beliefs as erroneous, he probes further into Prot’s vivid delusions. This in turn is almost seen as a selfish and self-fulfilling act. A combination of both pharmacological and psychosocial interventions has been proven to be useful by studies. This rings true especially in the case for Kay Redfield Jamison. In class, it was discussed how Jamison stresses the importance of taking both lithium and therapy sessions. In the beginning, she experiences bad side effects to the drug and is inconsistent with it. In due time, she settles on taking a lower dosage regularly and finds that it did work for her. Interestingly, the drug Thorazine has no effect on Prot whatsoever. Trying out different dosages or testing other drugs might be helpful. The usage of drugs would fall under the biological paradigm because it alters the synaptic level of neurotransmitters. Another form of treatment under this particular paradigm would be electroconvulsive therapy. It induces seizures and has been administered to people with schizophrenia and severe depression. Refinements in the ECT procedures have made it less problematic than in the past and it is an effective treatment (Kring, et al.). Many might view this option as a drastic approach but Prot implies that his case is almost untreatable at times. The effects of ECT could be just what Prot needs to get better. Ultimately, there are alternative methods of treatments that could be used to treat Prot with the results being more successful. The failure of Prot’s intervention is in large part due to Dr. Powell’s many errors and faults as a psychiatrist. He violates a lot of legal and ethical boundaries associated with his job. Some major issues that come up in the film is the breach of the Dr./Patient confidentiality. He invites Prot into his home to spend time with his own family and he showcases Prot’s remarkable intellect and talent to an entire group of astrophysicists. When Prot undergoes the last hypnosis session in the film, Dr. Powell keeps pushing his patient to continue on with his story even though he is visibly in a state of danger to himself. Dr. Powell also did not focus his attention on the fact that Prot alludes to committing suicide at a set time. Like my proposed paradigm to treat Prot, cognitive behavioral approaches might be a promising therapy to reduce suicidality. Dr. Powell should be constantly challenging Prot’s thoughts and provide ways/reasons to stay on earth. These actions go way beyond the code of ethics that any patient should be treated under. This reminds me of Clifford W. Beers’ case when he was submitted in a facility after his mental breakdown. The doctor and staff did not provide him with the proper care and treatment and he gradually finds the path to self-recovery. This brings up the question of whether institutionalizing Prot is actually the best choice for him as an individual to get help and get better. The idea of involuntary commitment to a facility is challenged throughout the film because Dr. Powell keeps reiterating how he is not violent and makes positive contributions. The film makes the point that Prot might have been better off than normal people. There are qualities about him that seem to impact others in good and profound way. He might be happier as being, “abnormal,” but society’s view of him will never allow him to live the way he wants to. Stigmas and labels are inevitably attached to people who do not think and act within the norm. Because of this, the majority of society would probably keep Prot in an institution. Bringing Prot back to reality might a long journey and a rude awakening but I feel that reality is something that we has human beings must face as long as we are living. As it has been debated many times in class, involuntary commitment is a sensitive subject. Prot is not an immediate threat to society and his far-fetched delusions could potentially produce dangerous outcomes at some point. This is shown when the sprinklers come on and Prot is not able to control his actions. The final climax of the film is somewhat tragic for Prot. I would have liked to see Dr. Powell make more of an effort to help Prot because it seems as if he is trying to help himself through Prot. While it is hard for me to pin-point which disorder Prot exhibits, it could be a combination of DID, PTSD, and dissociative identity disorder. But, cognitive behavioral therapy is the approach I would personally take and it might have had more substantial effects. I do like the fact that the film exudes a theatrical aspect to a psychological story, which turns it more into a science-fiction/fantasy genre. There is a parallel that is made between other extra-terrestrial life forms and the human form. It sheds light on the power of the unknown and the effects it can have on us.