Tuesday, February 23, 2016

PTSD & Jessica Jones

This is the first installment in my PTSD series.
Look for more in the upcoming months.
(I'm already working on Kimmy Schmidt.)




Does the portrayal of PTSD in Marvel & Netflix's 
"Jessica Jones" ring true?

Let's start with our criteria. In this article, I will be using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (aka: The DSM-5) as well as comparing my own experiences with Post Traumatic Stress Disorder (PTSD) to those of Jessica Jones. Using the DSM-5 is incredibly important because PTSD takes many forms and it is many different things to many different people. The DSM-5 is the tool used by psychologists to diagnose their patients. 

Heads up: Spoilers abound in the entirety of this article.


Jessica Jones and Me

I originally approached Jessica Jones with caution. A friend had asked me if that's what PTSD is really like. The series had just debuted and he felt that he had misjudged my reluctance to face my triggers head on. With this in mind, I sat down to watch a few hours of what turned out to be a jarring, but accurate to my experience, depiction of Post Traumatic Stress Disorder. 

While my case has not led to binge drinking, I can completely understand how a person would want to numb themselves from it. Many years ago, I found out that the man who had hurt me when I was a child was returning to live in my neighborhood. The flashbacks and hallucinations hit me hard and I turned to my psychiatrist for help. The meds were nearly worse than the symptoms they were treating. Luckily, it was all temporary. I adjusted and the medication was no longer needed. During the time when I was waiting for medication to kick in, I can tell you that I often felt my attacker creeping up behind me. My back could be against a brick wall and I could still feel him; still hear him whispering in my left ear. The first episode of Jessica Jones includes a scene where Jessica approaches a hotel room where she may or may not come face to face with Kilgrave, the man who hurt her. Krysten Ritter's performance here felt real. It took me back to that time and I had to use every coping mechanism available to me in order to keep myself from slipping back to the worst of my own PTSD experience. 

You may think that I would hate that. I should, perhaps, hate it. I actually love it, though. It is rare to find media that so accurately depicts what I've been through. It makes a nice reference point when I tell people I can't go to certain events. "If you're scared, shouldn't you face that fear?" Yup. In a healthy, controlled way. Not in a way that can leave me cowering in my room for the next two weeks. 


Jessica Jones and the DSM-5 

By the time you make it through the last episode of the series, you're on board with this idea that Jessica must have PTSD. She says she does. She has flashbacks. Isn't that was PTSD is? 

It can be, but it isn't strictly flashbacks. People self-diagnose all the time. I wanted to go back to the first episode and use the limited information within it to see if this glimpse at Jessica's life was enough for a formal diagnosis. If this were her first visit with a psychologist, would they be able to say that she met all criteria for the diagnosis? 

Let's review. 

The criteria for Post Traumatic Stress Disorder per the DSM-5 comes down to 8 factors. 
(I'll be paraphrasing here for ease of understanding.) 

1. Was she traumatized? 
Yes. Clearly, she was directly traumatized by Kilgrave. Furthermore, by the end of the first episode, we could also conclude that she had subsequently been witness to the traumatic deaths of Hope's parents. 

2. Is her past intrusive? Does it mess things up for her now? 
Yes. She's using coping skills (repeating childhood street names, drinking) to manage it, but it's a problem. Additionally, we see that she is experiencing sleep disturbances to the point that she avoids sleep when possible. 

3. Does Jessica avoid reminders of the trauma? 
Yes. She's been avoiding seeing Trish for months and she tells Trish that she has no interest in returning to therapy to talk about her past. When she approaches the restaurant where she had dined with Kilgrave, she had to steady herself before she could enter. Her alcohol use could be seen as avoidance, too. 

4. (This one needs to come straight from the DSM-5) "Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two (or more) of the following:" 

The relevant items from the list: "2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world." - as expressed in the very first monologue in the very first scene of the series. This is also expressed in the first line of the official trailer. Now, I'm not about to count the trailer, as I've already stated we're diagnosing purely based upon episode 1, but this is as good a place as any to share it. 


Also relevant: "4. Persistent negative emotional state" - which we clearly see throughout the episode. 
                       "6. Feelings of detachment or estrangement from others." - Trish. 

Jessica easily meets this criteria. 

5. (Again, I quote the DSM-5) "Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occured, as evidenced by two (or more) of the following:" 

Relevant line items: "1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects." - There were multiple ways she could have completed her job from Hogarth. She chose to be forceful. 
"2. Reckless or self-destructive behavior." - The very nature of her employment speaks to this. 
"4. Exaggerated startle response." - Reaction to nightmare
"6. Sleep disturbance" - Again we look to her nightmare. 

6. Has this been going on for more than 1 month? 
Yes. Per the conversation between Trish and Jessica, it's been going on for about a year and Jessica has been reclusive for approximately 6 months. 

7. Is it significant enough to mess up her social life or her job or anything else of great importance?
Yes. Hogarth comments that she had offered Jessica a full time job as a private investigator. Jessica refused, noting that she prefers "freelance, no ties". She's been avoiding Trish. In general, things are not going so great for Jessica Jones. 

8. Are her symptoms actually from substance abuse or a medical condition? 
No. Now, before you fight me on this one, please note that there's nothing telling us that her alcoholism began BEFORE the trauma. Her behaviors are a result of her trauma. The trauma causes the drinking; the drinking didn't cause the trauma. Follow? Great. Let's keep moving. 

Jessica clearly meets all 8 criteria. She can be diagnosed with PTSD with just the information available in Episode 1. 

If I were doing a full diagnosis of Jessica, I would also note that this is Posttraumatic Stress Disorder with Dissociative Symptoms, though we are not given enough information to determine if these symptoms are depersonalization or derealization. The scene in the hotel hallway clearly exhibits dissociative symptoms, but the viewer cannot know if Jessica feels that she is a part of this slowed time and odd, dreamlike state. The same can be said of her reaction earlier at the restaurant. 

Furthermore, I would definitely include F10.20 - Alcohol Use Disorder, Moderate in my diagnosis. In episode 1, she meets only 5 criteria. 6 criteria would be needed for the disorder to be considered Severe. There are a few other codes that could be assigned including Discord with a Neighbor and the past sexual abuse by Kilgrave. I wouldn't readily rule out a comorbidity of Conduct Disorder, either. 


For the next installment of this series, I'm currently working through "The Unbreakable Kimmy Schmidt". If you'd like me to come back to Jessica Jones to determine whether or not 
Kilgrave can be diagnosed with either PTSD or a Personality Disorder, comment below. 




Citations

American Psychiatric Association, & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.

ABC Studios, Marvel Studios, & Netflix (Producers). (2015). Jessica Jones[Television series]. Netflix.


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