10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

10 signs of mental illness you should never ignore

   

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There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional. 

1. Hallucinations

Hallucinations are experiencing the presence of something that is actually not there. Visual and auditory hallucinations are the most well-known, but they can also be smells, tastes, tactile stimulation and more. Hallucinations are a symptom of several serious mental illnesses, so they should always be taken seriously. It is possible that there is a more benign explanation – it could be a lack of sleep or the side effect of a medication. But it can be difficult to judge what the  cause of a hallucination is,
                                                                                                                   meaning that a professional evaluation is called for.

2. Antisocial behavior

Antisocial behavior is not a reference to being introverted and liking alone time; rather, it’s deviating from the norms and laws of society. This often is expressed through aggressiveness, dishonesty, disregard for safety and criminal behavior. Antisocial actions can have long-lasting consequences for both the person performing them and for others, so it’s important to get it under control. When there’s a pattern of these types of behaviors, it’s important to seek help in order to prevent more permanent damage.

3. Identity confusion

There are times when people start questioning who they really are and what they want their lives to look like. Adolescence and mid-life crises are a couple examples. But if taken too far, this uncertainty is potentially dangerous. If someone suddenly abandons what was previously loved and don’t know what to replace them with, it could be a sign that something more serious is going on. At the extreme, there might be complete blank on who one is, which can be indicative of amnesia. It’s important to talk to a mental health professional to identify the cause of losing one’s sense of self.

4. Mania

Everyone gets worked up and excited sometimes, leading to increased activity in one’s life. But sometimes, it becomes out of control. If someone has persistent and abnormal elevated or irritable moods for over a week, it might be a manic episode. These episodes, a hallmark of bipolar disorder, might present with an inflated sense of self-esteem, a decreased need for sleep, racing thoughts, distractibility, being unusually productive or engaging in behaviors that will have serious negative consequences. Because of the lasting impact these episodes can have on one’s life, professional help is warranted.

5. Learning difficulties

It’s normal to struggle with learning sometimes. We are all better at some things than others. But when someone is, in at least one area, several grade levels below where one should be, it could be a learning disability. This doesn’t mean that someone’s stupid, but rather indicates a lack of the ability to learn in certain areas. Learning difficulties could also be indicative of a high level of distress, which needs to come down before one can resume regular patterns of learning. A sharp change in one’s ability, like suddenly being unable to perform tasks one could do before, should also be looked into.

6. Self-injury

Self-injury is indicative of severe distress. It often means that someone is in a lot of pain and is unable to cope with it in a healthy way. Self-injurious behaviors include cutting, burning, bruising, interfering with wound healing and intentionally sustaining injuries. While most of the time there is no intent to cause lasting damage, it might happen anyway. This is one reason why, when someone engages in self-injury, it’s important to intervene. Talking with a therapist can help in terms of finding healthier alternatives and in understanding what caused the behavior in the first place.

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7. Delusions

Delusions are beliefs that are unique to oneself and that contradict the generally accepted reality. Some examples include believing that one is under surveillance by the government without sufficient reason; thinking a song was written about oneself despite never even having met the artist; and insistence that a partner is cheating despite a complete lack of evidence. Something like believing in alien visitations or prevalent conspiracy theories are not delusions, as they are beliefs shared by lots of people. Delusions can seriously impact quality of life and might even lead to people making dangerous decisions, so talking to a professional is important.

8. Substance abuse

As discussed in an earlier post, substance abuse is highly correlated with mental illness. The two can feed off of each other, with substances being used to mask symptoms which in turn become worse due to the substances. While not all substance abuse is indicative of mental illness, it is a serious problem that should be addressed either way. It can also cause physical health problems or lead to acting impulsively in a risky way. There are lots of professionals that specialize in treating substance abuse, so find someone with experience.

9. Major shifts in personality/goals

People are generally pretty consistent in how they act and what they want. While some variations are normal, like deciding to end a relationship or to take up a new hobby, there are times when changes can be a cause for alarm. These changes are more notable when they occur rapidly. A consistently cheery person might abruptly become frequently cynical or someone may suddenly drop out of school despite indications that things were going well. It is important to take a good look at what caused these types of change, as they can be a sign of distress or mental illness. 

10. Suicidal thoughts

Thoughts of suicide should always be addressed. The risks that come with brushing it off or not seeking help are not worth it. Suicides have permanent impacts on both those who commit them and their loved ones. It’s not a decision that happens and stays in a vacuum. Surviving a suicide attempt can also lead to lasting health problems. If you feel like ending your life or suspect someone else might, talk to a professional. The earlier one gets help, the easier treatment will likely be. To learn about what suicidal people talk about, read this. I have also put together a list of hotlines, which can be found here. 

What symptoms made you seek help? Have you seen these signs in a loved one and encouraged him or her to get help? Let us know in the comments.

7 signs you need a new therapist

Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.

1. You are not being respected.

One of the great tasks in life is learning to get along and grow with those who are different than us. The variety of people in the world should be celebrated, as it allows humanity to reach its highest potential. But these differences can also be a source of prejudice and unkind behavior. If your therapist is devaluing your experiences, not honoring your belief system, asking you to change culturally appropriate behavior or making you feel inferior in any way, it’s time to switch therapists.

2. You can’t establish trust.

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Sometimes, we just don’t trust people. Maybe they remind us of someone that hurt us in the past or appear similar to a stereotype we have problems with. If this is the case, the first thing you should do is talk to your therapist about it. Working through that mistrust can be huge in terms of personal growth. But if you’ve tried your best and just can’t make yourself trust her, find someone that makes you feel more secure.

3. Your therapist is crossing boundaries.

Your therapist should be your therapist and nothing else. He is not a potential business partner. She is not someone you’ll hang out with at social events. He is not the friend you call at 3:00 a.m. Most importantly, she is not a romantic or sexual partner. If your relationship with your therapist is expanding into these areas, that needs to stop immediately. It’s highly unethical and could even have legal implications for your therapist. If he can’t stick to his job, find someone who can. 

4. Your therapist doesn’t respect your time.

When you go into a session, that is your hour. Your therapist should not be focusing her attention on anything but you. He should not, for example, answer calls when with you. She should also be more or less on time and not frequently canceling sessions. Be understanding that occasionally, something major might be going on. But if you see a pattern of these behaviors, you might want to look into finding someone else.

5. Your therapist breaks confidentiality.

Your therapist has to keep all information about you private. He can’t give your information to anyone, even another therapist or healthcare provider, without your permission in written form. If someone asks, she can’t even acknowledge whether or not she’s seeing you for therapy. The only exceptions are related to major safety concerns and rare legal orders, which can be read about here. But if your therapist is, for instance, chatting with your significant other about your progress without your express permission, that’s an ethical violation and a legitimate reason to dump the therapist. 

6. Your personalities clash. 

We all have certain types of people we just don’t get along with. If your therapist has a personality that is particularly irritating or difficult for you, don’t give up right away. You can become a more open and accepting person by working through those issues with your therapist. If it doesn’t work, though, it doesn’t work. On the other hand, sometimes self-improvement is secondary to an immediate concern, in which case, find someone you get along with.

7. Nothing is happening.

Progress in therapy is not as simple as a line gradually moving upwards. You’ll be all over the place. Sometimes, you’ll have a huge change for the better, while other times you’ll take a few steps back. There is some truth to the “getting worse before it gets better” concept, so don’t jump ship just because you become a bit more symptomatic. It’s part of the healing process. But if everything just stays the same, then something’s wrong and you could be better off working with someone else. 

Have you ever switched therapists? Why did you do so and how did it go? Report your experiences in the comments.

Diagnosis spotlight: depersonalization/derealization disorder

We all experience dissociation in some way or another. It can be as simple as highway hypnosis, where you suddenly realize you’ve driven for miles without noticing, and as complicated as dissociative identity disorder, formerly known as multiple personality disorder. Somewhere in-between, there is depersonalization/derealization disorder.

First of all, what are depersonalization and derealization?

Depersonalization refers to a distortion in self-awareness. You are, in a sense, unfamiliar with yourself. One typically experiences detachment from the body or the sense that it is unreal. It can even mean watching yourself from outside your body. The self just doesn’t feel real and things might seem like a part of a dream. It can also be watching yourself go about your day and making decisions, but not really feeling in control. Time might also be distorted and there can be physical and/or emotional numbing. 

Derealization is when everything else doesn’t feel real. Your surroundings might feel foggy, distorted, unreal or, again, like a dream. People, places and things that may be familiar seem strange or surreal. It’s hard to fully perceive the world around yourself and it might seem like you are watching everything through a filter of sorts. It can be like living in a bubble. What is around you is very separate from you and it can be hard to fully engage in life. 

Depersonalization/derealization disorder means having episodes of one or both of these. It can be accompanied with a feeling that you’re “going crazy.” There might also be vague physical symptoms, like tingling or lightheadedness. It is often associated with anxiety and/or depression. 

Approximately one-half of adults have had an episode of depersonalization or derealization. It happens. But when it is recurring or even constant, it can become pathological. Onset is almost always before age 25, so it’s something that can be experienced from a very young age. Childhood trauma is considered one of the causes of depersonalization and derealization, but it can happen without it. Symptoms can also be caused by physical conditions or substance use, so those need to be ruled out. Episodes are often preceded by high levels of stress, anxiety, depression, traumatic events (or reminders of them) and/or drug use.

Both therapy and medication are used to treat depersonalization/derealization disorder. In particular, cognitive behavioral therapy allows people to reinterpret the symptoms and psychodynamic therapy can look at unresolved and suppressed internal conflicts. Medication-wise, nothing has been approved specifically for the treatment of this disorder, but anxiety medication and anti-depressants have shown some success. There is also research supporting the use of lamotrigine, an anti-convulsant typically used to treat epilepsy. Using grounding techniques can also be very helpful.

Having the experiences of depersonalization and derealization can be very frightening. But it is a recognized mental health condition and a notable amount of people experience it. If you feel like the symptoms described apply to you, please talk to a doctor or therapist. It is possible to gain control over it enough to where it is not interfering with your life, if it doesn’t go away altogether. 

Have you experienced depersonalization or derealization? What was it like for you? Share your experience in the comments.

5 things suicidal people talk about

    

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Being suicidal can come with a wide range of symptoms and behaviors. It will manifest in as many different ways as there are people. But there are commonalities that tend to appear. One of those is what they talk about. If the following topics come up, you may want to pry further to check on the wellbeing of the person in question.

1. Wanting to die

The idea that suicidal people don’t talk about suicide is definitely a myth. They frequently give indications of their desire to die, sometimes even flat out saying that they want to commit suicide. Saying it does not mean that they won’t do it. Sometimes it’s more indirect, with statements like, “I wish I’d just get hit by a bus.” If someone says anything at all that indicates a desire to be dead, it should be pried
                                                                                                                    into.

2. Feeling stuck, hopeless and having no reason to live

Suicide sometimes happens because there seem to be no other options. Talking about hopelessness or entrapment can therefore be a warning that the person is headed in that direction. There are always options. We may not like them, but they are there. When suicidal, though, those options can seem to disappear. This topic is an indicator that should be taken seriously.

3. Being a burden

Being suicidal can make one feel like a waste of space. Suicidal individuals might feel like they are simply a problem in the lives of others. They might think that others would be better off without them. This can be especially true when illness is present that requires assistance. If the person can’t contribute in the same way others are contributing, it can set off thoughts about the lives of loved ones being better without him or her.

4. Suddenly making big improvements

Sometimes, suicide is preceded by a significant increase in mood. The person might be a lot happier and more positive. This can come from feeling at peace with the decision to actually end ones life. Talking about how something “won’t be a problem any longer” or “doesn’t matter anymore” can stem from the decision to not be around at all. The more rapid and extreme the change is, the more you should ask questions to see what’s really going on.

5. Saying goodbye

It is normal to want a sense of closure. That’s why suicidal people sometimes go around and say goodbye to or make amends with others. It might be in an indirect way, such as, “I value our friendship and would miss it if we were away from each other,” or, “If anything happens to me, I want you to know…” The hypotheticals might not be so hypothetical after all, so it’s important to look out for these statements.

In combination with other warning signs, especially, it is important to take action. Always make sure that the person you care about has resources. There are suicide hotlines, doctors, therapists and community mental health organizations. If you aren’t sure of what to do, you can reach out to these resources as well and ask for appropriate advice. If you believe suicide is imminent or there is an actual attempt, call 911 or take the person to the emergency room. It may cause some upset in the short term, but having an angry loved one is better than having a dead one.

Have you talked to someone and worried about suicidality? How did you know that you needed to reach out?

7 rights you have in therapy

  

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Because therapy can become so intimate, you might occasionally lose sight of the fact that it is also a business transaction. As the client, you have a set of rights. These also apply with psychiatrists and other doctors.

1. Right to know your therapist’s qualifications

You have the right to know that your therapist has been properly trained and is professionally competent. You can ask about his education, membership in professional organizations and standing with regards to his license. Any therapist who is hesitant to give you this information is worth investigating or dropping altogether. 

2. Right to know the limits of confidentiality

For the most part, you can tell your therapist anything. But by law and ethics, there are a few things she might have to disclose. At the beginning of therapy, you should be informed of these. It might be in your initial paperwork. If you are unsure about something, ask. You can also read the post about the limits of confidentiality.

3. Right to know diagnostic information

If you want to know any diagnostic impressions your therapist has, you can ask for that information. You are also entitled to an explanation of what your condition is and how it is treated. Don’t expect him to have this information at the end of the first session. An accurate diagnosis takes time. But as you move forward, you can check in on it.

4. Right to know your treatment plan

When treating a client, a therapist should think ahead and see where treatment is going. This is information you can ask for as well. There won’t always be a written plan, but your therapist should be able to tell you where she is going and what strategies she will be using to get there. Don’t expect a play-by-play, but you have a right to know the basics.

5. Right to have questions answered

While your therapist will probably be the one asking the most questions, you can ask for information, too. This can range from explanations of terms used to his reaction to something you said or did. When it comes to personal information, therapists have varying levels of comfort in disclosing. Respect that. But if your question is relevant to your treatment, ask away.

6. Right to be treated with respect

As intimate as therapy can get, you are also in a professional situation. You are paying for a service and that entitles you to a certain level of respect. Your therapist should not be rude, mock you, blow you off, be offensive or otherwise make you have an uncomfortable experience. While minor offenses should be worked out in sessions (read how here), a pattern of disrespect is grounds for termination. 

7. Right to have boundaries observed

Another part of therapy being a professional situation is that there are certain boundaries. Your therapist is not your friend. She should not be a business partner. And he should certainly never, ever be your lover. Your relationship should be confined to the therapy room and never be physical. Your therapist might be okay with occasional contact between sessions (email or phone calls), but that should only be about treatment.

What has been your experience in regards to client rights? Tell us your stories in the comments.

20 questions to ask a potential therapist

First sessions with therapists can be kind of like first dates or job interviews. You want to find someone who is a good fit for you, so you ask a lot of questions. Figuring out what to ask, however, might not be the easiest thing to do while you’re in the moment. Pick whichever of the following questions are the most important to you and bring a list to your fist session. It’s better to know sooner rather than later if your therapist is the right person for you to be working with.

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1. Are you currently licensed? (In the U.S., this can be verified by searching “license lookup [state]”.)

2. How long have you been practicing? 

3, What is your educational background? 

4. Are you affiliated with any professional organizations? 

5. How do you believe people change? 

6. Have you ever treated anyone with my symptoms? 

7. What did you do? 

8. Did it work? 

9. What did you learn from it?

10. Why are you working in this field? 

11. What do you consider your strengths as a therapist? 

12. What are some areas in which you would like to improve in your practice? 

13. What do you consider the most important factor for healing and improvement? 

14. What are your expectations of a client? 

15. If something comes up between sessions, what would the best thing for me to do? 

16. Have you ever had any disciplinary procedures? (In the U.S., this can be verified by searching “license lookup [state].”)

17. If yes, do you believe you were in the wrong? 

18. What have you done to rehabilitate from disciplinary procedures?

19. Would you be able to recommend additional resources (books, support groups, physicians, complimentary treatments, etc.)?

20. Do you believe you can help me?

Don’t be afraid to ask for any information relevant to your treatment. You have a right to ask questions. Any therapist unwilling to answer such questions should probably not be in practice.

What questions have you had about starting therapy? Let us know in the comments.

Are antidepressants safe for youth?

Antidepressants are used both as first line and adjunct treatment for depression. The most commonly used type is selective serotonin reuptake inhibitors, or SSRIs. A simplified explanation of how SSRIs work can be found here. These drugs are also used to treat other mental health conditions, mostly anxiety disorders. It does takes several weeks for the positive effects of the medication to manifest, at least with depression.

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All medications come with certain risks and side-effects. SSRIs, however, can be extra hard on children, teens and young adults. The FDA has issued a black box warning on all SSRIs, which is its strongest warning. It states that taking these medications can cause an increase in suicidality in those up to age 25. 

This warning is issued because 4 percent of children treated with SSRI medication experience suicidal thinking and behavior (including attempts). This is twice the rate of those who took a placebo (sugar pill). So while the odds of having this reaction to an anti-depressant are low, it is important to watch for, especially in the first month or two and around dosage changes. 

It is believed that the benefits of taking an SSRI outweighs the risks. And it is true that it is a fairly rare reaction. But without discouraging antidepressant use, I want to stress how real that suicidality can be. I was 20 the first time I took an SSRI and there was a marked difference in my level of suicidality. I went from thinking about dying to planning on it. As soon as I realized this, I contacted my psychiatrist and he reduced the dosage. I had to be watched for a few days, but it got better.

What I learned from that is to not go through medication changes alone. Let important people in your life know about the change. These include family, significant others, therapists and other healthcare providers. When symptoms become worse, it can be hard to reach out for help. If others are looking out for you, it is much safer to go through medication changes. They can notice if you change and help make sure you talk to your healthcare provider.

Suicidality isn’t the only side effect of medications. Even in adults, SSRIs can make you more depressed before you get better. I’m now 26, but I let my mom, boyfriend and therapist know every time I go through a medication change, even if it’s just changing the dosage of something I’m already on. No matter what you are taking – whether it’s for a physical condition or a mental one – I think it’s good to tell those who will be around you the most. 

So are SSRIs safe for those under 25? For the most part. Just monitor any adjustments very closely. If you are thinking of taking or having your child take antidepressants, mention any concerns you have to your prescribing physician. She can help you make a plan for how to handle any side-effects that might come up.

Have you taken antidepressants while under the age of 25? What was your experience? Let us know in the comments.

Cut your med costs in half (really)

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Here's a quick tip that can potentially cut the cost of your prescription medications in half! I don't use exclamation points often, so this is cool. I learned this trick from a pharmacist, actually, even though it's not necessarily to their advantage. This saved me when I was on a $100/mo. medication without insurance. 

The next time you visit your health care provider, ask if any of your medications are available in pill (not capsule) form. Then see if there's a pill that's double the dose you need. If there is, ask to have that one prescribed instead and then take half a pill instead. This isn't possible with every med; if you have a time-release prescription, it won't work. Your doctor could say no, but it's definitely worth trying – especially if you don't have adequate insurance. I know that you can do this with a fair amount of medications.  

Outside of that, check if your preferred pharmacy does price matching. In general, at least in my area, Costco has the lowest prices (and you don't have to buy in bulk). You can, of course, switch pharmacies. But there are sometimes reasons to stay with the one you use. Making a few calls around town, though, could be a big saver.

Do you have any other money-saving tips when it comes to meds? Share your tricks in the comments.

15 Best Picture winners about mental illness

The entertainment industry has a tremendous power in shaping the public view of mental health topics. With Silver Linings Playbook, a romantic comedy featuring a protagonist with bipolar disorder, up for eight awards at tonight's Academy Awards, attention is currently being focused on the challenges faced by those affected by mental health conditions. 

It is the first movie nominated for all of the "Big Five" awards (Best Picture, Best Director, Best Screenplay, Best Actor and Best Actress) and all four acting awards (add Supporting Actor and Actress). While it is highly unlikely that it will receive all of the awards, Jennifer Lawrence is considered a frontrunner for Best Actress for her portrayal of a young widow facing a her own set of complications following the traumatic death of her husband. After seeing how the film fares tonight, I intend to write a commentary on it in the coming days. It has a lot of interesting implications.

Looking back, however, mental health conditions have definitely had their place in creating award-winning movies. Starting with the early days of the Oscars, here are fifteen films that emphasize a variety of aspects mental health and illness.

All Quiet on the Western Front (1929/30)

Showing World War I from the perspective of the Germans, this film deals with the expectations and realities of war, including the psychological aspects. Well before PTSD was officially defined, elements of it can be gleaned from previous wars, as demonstrated in this production.

Gone with the Wind (1939)

In this epic, the effects of personality disorders on oneself and others can clearly be seen. Critics have noted that heroine Scarlett O'Hara displays characteristics of narcissistic, histrionic, anti-social and borderline personality disorders. In other words, she's the epitome of the cluster B subsection. In addition, leading lady Vivien Leigh, who played O'Hara, struggled with bipolar disorder.

Rebecca (1940)

Hichcock's psychological dramatic noir thriller (thank you, Wikipedia) features characters who certainly have some significant problems. Based on the novel by Daphne du Maurier by the same name, it also handles themes such as grief, manipulation and suicide.

The Lost Weekend (1945)

With its plot centering on a writer's struggle with alcoholism, The Lost Weekend is, according to the Library of Congress, "a landmark social-problem film" with "an uncompromising look at the devastating effects of alcoholism." While the premise might seem like a cliché nowadays, it received significant opposition when it was being produced.

The Best Years of Our Lives (1946)

In the wake of World War II, a new group of veterans had to learn to adjust to civilian life. This movie follows three of them as they struggle to find normalcy. One of them, Homer, lost both hands in the war (which actually hard happened to the actor, Harold Russell). His struggle to deal with a physical handicap that he believes makes him unfit for his fiancée is metaphoric for a lot of the psychological aspects of living through a prolonged trauma like combat. Part of this film's strength is in how it shows the role of social support, both between fellow veterans and those around them.

One Flew over the Cuckoo's Nest (1975)

Because the film takes place in a mental institution, there is a lot of psychological material to draw from. The characters struggle with different conditions, but they also develop a community. The tyrannical Nurse Ratched is a legendary villain and under her reign, the viewer is exposed to a lot of the treatments that have historically (and presently) been used to treat mental illnesses. It's also one of only three movies to win all of the "Big Five" Academy Awards.

Annie Hall (1977) 

Considered one of Woody Allen's greatest and most influential films, Annie Hall follows the anxious and neurotic Alvy Singer as he tries to find out why his relationship with the title character failed. This film is worth noting because while Alvy has what appears to be a clear case of generalized anxiety disorder, he has actually lived a relatively normal life. This helps show that mental illness is not just reserved for those with traumatic histories or psychotic symptoms.

Ordinary People (1980)

An upper-middle class family struggles with the accidental loss of one son and attempted suicide of another. It tackles family dynamics in a stressful environment where each individual handles grief in his own way. Since one person with mental health issues will impact the entire family, this film is important in its portrayal of the struggle for normalcy without clear direction.

Amadeus (1984)

While Amadeus is not very historically accurate, it does tackle the interesting issue of delusional obsession. As contemporary composers, Antonio Salieri cannot overcome his jealousy of Mozart's talent. The film shows how Salieri creates a worldview in which he feels justified in using a vengeful plot to gain some sort of "victory" over both Mozart and God Himself. Obsession is usually portrayed in a romantic context, making this film all the more fascinating.

Rain Man (1988)

After his father's death, the narcissistic Charlie finds out that he has a brother, Raymond, who is more or less inheriting everything from their father. An autistic savant, Raymond lives in a mental institution. The question of why Charlie was not told about his brother points directly at the issue of stigma against mental illness, even within families. 

The Silence of the Lambs (1991)

The only horror film to ever win an Oscar for Best Picture, The Silence of the Lambs is the most recent winner of the "Big Five" awards. It features Hannibal Lecter, who is both a psychiatrist and a cannibalistic serial killer. The epitome of genius and (criminal) insanity combined, this character has been deemed the greatest villain in movie history by the American Film Institute.

Forrest Gump (1994)

In this beloved movie, Tom Hanks plays Forrest Gump, a man with an intellectual developmental disability. The film displays a very positive attitude towards Forrest, giving him his own talents and showing how he contributed to a variety of historically significant events. It tackles both the challenges and joys experienced by the title character, offering a glimpse into how society treats those who are intellectually challenged.

A Beautiful Mind (2001)

Based on the Nobel-prize winning mathematician John Nash, this film tackles the role of schizophrenia in the protagonist's life. It follows the onset of the illness, which commonly manifests in early adulthood, its identification and how it affects Nash personally and professionally. It acknowledges the permanent nature of the condition, showing that he could achieve success while still experiencing symptoms.

The Hurt Locker (2009)

The effects of war are tackled again, this time with the Iraq War. The film, which made Kathryn Bigelow the first female to win Best Director, covers the acute stress experienced in a war zone and how it affects decision making. Instead of having the focus on the posttraumatic symptoms likely experience by the characters after the story's end, the movie gives insight into its development. This is a valuable perspective, considering the current public discussion surrounding PTSD.

The King's Speech (2010)

Not all mental illnesses are defined by mood or disconnect with reality. Stuttering is categorized as a mental health condition and can be comorbid with other disorders. In telling the story of King George VI, The King's Speech shows that not even royalty is immune to these challenges. With the help of a speech therapist, George admirably demonstrates the effort that goes into recovery.

Who do you think will win best picture this year? What awards do you think the cast and crew of Silver Linings Playbook might take home tonight?

Psychologist, psychiatrist – what's the difference?

It seems to me that the most mixed up terms in the mental health field are actually two of the most fundamental ones: psychologist and psychiatrist.

There are a variety of types of mental health providers and they all have their purposes. Depending on the issue at hand, it is important to know which practitioner will be of the most help. So whether searching the Internet or checking the yellow pages for someone to help, it's important to know what, exactly, to look for.

There are, of course, other types of practitioners. Therapists, counselors, psychoanalysts, social workers, art therapists – there are a lot. There will be posts about these professionals in the future, but it seems that understanding the difference between psychiatry and psychology is the most pressing.

A psychiatrist is a medical doctor (MD). She will have gone through all of the same medical training as anyone else in medical school, but will have specialized in psychiatric disorders. Although they used to act more like traditional counselors, currently, the primary purpose of psychiatrists is to make diagnoses and prescribe medication. (It should be noted that regular physicians can also, to some degree, prescribe psych meds. This will be discussed in a later post.)

Pros: With a few rare exceptions, psychiatrists are the only mental health practitioners who can prescribe you medication. They also have medical training that might pick up on a physical ailment that is causing mental side effects instead of assuming it is a psychiatric condition. If you have a combination of physical and psychological symptoms, a consultation with a psychiatrist is worthwhile in order to understand the root of your problems.

Cons: Depending on who you're seeing, it is a very real possibility that she will spend ten minutes with you, hand you a prescription for the drug du jour and charge you $200. While a good psychiatrist will at least have an extended first consultation to understand your background and situation, they are usually paid per appointment, not per hour. Do not expect talk therapy.

A psychologist has a doctoral degree (either a Ph.D. or a Psy.D.) in psychology, has passed licensing exams and completed lots of supervised hours. Their training is more or less entirely focused on mental health and other psychological issues. This is the person you see in the movies: the man with diplomas on the wall, sitting in a comfy chair while hysterical clients pour their hearts out. Now, it doesn't always work like that, but it gets to the general idea. It's someone to talk to who has been trained in how to respond to a variety of issues.

Pros: Consulting a psychologist can be a good starting point for receiving treatment. He will be qualified to sort out what, exactly, you are experiencing and will have the academic background to suggest and utilize the optimal treatments. (This could include a referral to a psychiatrist if medication or other health complications should be considered.) Psychologists can also perform certain functions that other counselors cannot, such as administering certain psychological tests. All in all, psychologists are there to listen and to give you a lot more time and attention than a psychiatrist would.

Cons: The most obvious con is that psychologists cannot prescribe medication. (There are a few controversial programs in some states that grant psychologists prescription privileges, but don't count on it.) The field is also more diverse than psychiatry when it comes to treatment options. While a good thing, in practice it means that sometimes it can take a while to find the right practitioner. Additionally, psychologists are generally more expensive than other professionals with similar services, such as licensed counselors and social workers. (These will be discussed in another post.)


All right, there are the basics. Psychiatrists: medical doctors. Psychologists: talk therapists. Often it is a good idea to see both. A combination of antidepressants and counseling has been found to be more effective in treating moderate depression than either on its own.


What has your experience been like with psychologists and psychiatrists? There are so many interesting stories out there.