Mental Health Issues
Mental Health Issues
In the 1997 film As Good as It Gets, several of the characters have mental health issues that would benefit from treatment. The three main characters, Melvin Udall (Jack Nicholson), Carol Connelly (Helen Hunt), and Simon Bishop (Greg Kinnear) each have different mental health issues that affect their work, well-being, and relationships with others. Melvin appears to have Obsessive Compulsive Disorder (OCD) and social anxiety, Carol has stress and anxiety, and Simon has depression and anxiety. All three of these characters would benefit from appropriate treatment for these mental health problems affecting their lives.
Melvin’s OCD is the most obvious mental health issue presented in the movie. The genesis of his problem is not touched on, but the effects are numerously displayed. For instance, he locks his door five times every time he returns home, he disposes each bar of soap he uses to wash his hands after only one use, he panics if other people touch him, and he avoids walking on cracks in the sidewalk. He believes he always has to sit at the same table when he goes out for lunch, he wears gloves when touching a dog or driving, and he brings his own plastic utensils to the restaurant instead of using the restaurant’s flatware. He is afraid of germs but he is also afraid of taking medication. These are just a few of the rituals and obsessions that Melvin has each day.
Although Melvin appears to be a high-functioning individual, for example, he is an extremely successful writer of romance novels, he lives a life of isolation and is often at odds with the people he interacts with. The viewer can imagine that if the action-spurring incidents of the movie had not occurred, Melvin would have sat in his apartment writing books forever and never done anything else. There is evidence that Melvin has a psychiatrist that he sees, but also that he has resisted treatment because of his fear of taking medication.
Melvin is a textbook case of OCD. His repeated thoughts leading to his obsessions are a fear of germs, intruders, and adversity to change. According to the National Institute of Mental Health (NIMH n.d.b), another symptom of OCD is doing “the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again,” which is behavior Melvin constantly displays. Additionally, he is unable to control those behaviors and thoughts.
If any of Melvin’s rituals are interrupted, he feels extreme anxiety and his negative reactions are displayed with socially unacceptable behavior. For example, when Simon’s dog Verdell urinates in the hallway he is rude to Simon and his friend by using homophobic slurs against them, he throws Verdell down the apartment building’s garbage chute, and he accosts a Jewish couple sitting at the restaurant table he wants to sit at by loudly making anti-Semitic comments until they leave. Although his behavior in these situations is socially unacceptable, it does not meet the criteria for anti-social or borderline personality disorder. Instead, this behavior is fueled by the anxiety Melvin feels when he confronts situation where he may not be able to perform the rituals that his OCD compels him to do.
Although it is evident that Melvin has received some treatment for his OCD, it is apparent he has not been compliant. According to NIMH, treatment for OCD can involve psychotherapy, medication, or both. The typical psychotherapy treatment involves cognitive behavioral therapy (CBT) and exposure and response prevention. CBT is designed to teach “a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively” (NIMH, n.d.b). Exposure and response prevention is a specific form of CBT that involves the patient being gradually exposed to feared obsessions or objects in order to learn techniques to deal with anxiety (Mayo Clinic 2010). CBT can take place in group, family, or individual sessions. Melvin could benefit from any of these types of CBT sessions and techniques; it would help him deal with his fear of germs and adversity to change so that he would feel less anxiety and react more appropriately in social situations.
Additionally, becoming compliant in taking his prescribed medication can augment his CBT. According to the Mayo Clinic, several antidepressants are specifically recommended by the Food and Drug administration to treat OCD, including Paxil, Zoloft, Prozac, Pexeva, Luvox, and Anafranil (2010). A problem with psychiatric medications is that sometimes they are not effective in helping a problem or have undesirable side effects. Therefore, it is important to work closely with a doctor in order to monitor the effects of the drug, and if it is not working or the side effects are intolerable, the patient should switch to a different medication (Mayo Clinic 2010). When CBT and medications are not working, there are a few other options for patients, including Electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation (Mayo Clinic 2010).
However, a combination of CBT and medication will probably best help Melvin with his OCD. As he encounters situations in the movie, such as caring for Verdell, helping Carol’s son, taking Simon on a trip to Maryland to see his parents, and letting Simon move in with him when Simon loses his apartment, he shows signs of improvement. In his interacting with Carol, whom he has fallen in love with, he finds motivation to make improvements in his life instead of continuing a life of isolation. For Melvin, compliance with treatment will make a big difference for his outcome, allowing him to experience a better quality of life and to enjoy the social elements in his life including his relationship with Carol and his friendship with Simon.
Although Melvin’s mental health issues are the most obvious, Simon and Carol also experience some of their own. Simon, who appears to be a very happy and well-adjusted character at the beginning of the movie, becomes extremely depressed when his art does not sell and after his brutal assault when he stumbles on to men robbing his apartment. Additionally, he has unresolved issues surrounding his father’s abuse of him when he was younger. Simon displays many symptoms of depression including a persistent feeling of sadness, hopelessness, pessimism, and worthlessness (NIMH n.d.a). He has lost interest in his great passion in life, art. He has insomnia and even expresses a desire to die. Unable to work, losing friends, an unsupportive family, and feeling helpless, Simon’s depression is fueled by recent events as well as past problems. Although Simon’s depression symptoms appear to dissipate because of his interaction and friendship with Carol, he could still benefit from therapy. For depression, CBT and interpersonal therapy (IPT) are recommended (NIMH n.d.a). Although medication is appropriate for severe cases of depression, CBT and IPT may be enough to help Simon. This therapy can help Simon to deal with his current stressful situation as well as to resolve the issues of his past. Although he has found ways to cope with his problems on his own, the stress of having no home of his own as well as a lack of income are issues he must continue to deal with; he will be healthier and more likely to pursue his work and passion if he has a support system including a therapist. If his depression continues or becomes worse, then medication should be considered.
Carol appears to have much milder mental health issues than either Melvin or Simon, but her difficult life and constant stress cause her great anxiety. At the beginning of the film, her son is constantly ill and she frequently has to take him to the emergency room. Later, this stress is alleviated when Melvin gets his publisher’s husband, a medical doctor, to help her son. However, her evolving relationship with Melvin brings new stress. Carol probably does not need to see a professional about her stress and anxiety issues, although it may benefit her to see a therapist in order to help her deal with the changes happening in her life. A therapist might suggest making some lifestyle changes including things like meditation, taking more time for fun activities, participating in hobbies, or journaling to understand stressful situations (“Stress” n.d.). Since the problems with her son’s health have been alleviated, Carol can improve her own mental health by letting go of the guilt she feels when she takes steps to do things for herself and make improvements in her own life.
As Good as It Gets, although a comedy, is a movie that deals directly with serious mental health issues and how these issues affect the lives of the characters. Despite the severity of some of the mental health issues, the movie depicts a positive trajectory for the characters because it shows that all of them are willing to work to make improvements. In effect, the movie answers Melvin’s psychiatrist waiting-room question, “What if this is as good as it gets?” by demonstrating that no, this is not as good as it gets, and that in spite of all the problems the characters have, things are definitely going to get better.
Mayo Clinic (15 Dec. 2010). Obsessive-compulsive disorder (OCD): Treatments and drugs. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189/DSECTION=treatments-and-drugs
NIMH (n.d.a). Depression. U.S. Department of Health and Human Services. Retrieved 16 Feb. 2013 from http://www.nimh.nih.gov/health/topics/depression/index.shtml
NIMH (n.d.b). Obsessive-Compulsive Disorder, OCD. U.S. Department of Health and Human Services. Retrieved 16 Feb. 2013 from http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
Stress and anxiety (n.d.). Medline Plus. Retrieved 16 Feb. 2013 from http://www.nlm.nih.gov/
Ziskin, Laura (Producer), & Brooks, James L. (Director). (1997). As Good as It Gets [Motion picture]. United States: TriStar Pictures.