Clinical Treatment Plan for Parry

Introduction

When it comes to diagnosing the character Parry, there is certainly more than one verdict that can be diagnosed. Parry’s behavior distributes several types of symptoms that can be identified as either a Major Mood Disorder or Post Traumatic Stress Disorder. Parrys irrational and delusional behavior can be found as a symptom for both of these disorders, and though Major Mood Disorders seem to be a fit for the diagnosis because its behaviors seem to be a direct result of trauma, there’s not enough evidence to confirm it’s the right answer. However, Post Traumatic Stress Disorder seems to be a more solid choice based on the fact that Parry’s onset of mentally unstable indications came after a tragedy struck him.

Considering Major Mood Disorder deals with a few different disorders encompassed under one setting, it would be hard to place Parry in a single category. Though Major Depressive Disorder seems to be the most suitable for Parry. Bipolar Disorder, Cyclothymic Disorder, and Dysthymic Disorder do not relate to Parry’s symptoms and a lot of them are considered to be genetically inherited. This makes it a little less improbable that it would be Parry’s diagnosis considering his behavior changed only after the tragic event of losing his wife. For a definitive mood disorder, it seems that severe depression with psychotic episodes could be the most accepted diagnosis.

Parry and Major Mood Disorders

Severe depression, as far as symptoms go, includes a lower mood, reduced energy, a decrease in activity, difficulty problem solving and making decisions, irritability, hopelessness, sleep complications, loss of interest in activities, and feelings of hopelessness along with thoughts of suicide. The reasoning behind diagnosing Parry with severe depression is supported by the fact that he goes into catatonic states at the beginning and end of the movie. Catatonia can be associated with severe depression, but it can also be associated with bipolar disorder, schizophrenia, and Post Traumatic Stress Disorder. In this particular case, Parry may be diagnosed with severe depression because of the symptoms he portrays, most important to note are his delusions and hallucinations. The fact that he believes he is looking for the Holy Grail certainly ignites something in him that is not of this reality. To support this theory, symptoms involved in severe depression described in the next few sentences may help to distinguish the difference between moderate to severe cases. Severe depression takes on the additional symptoms separate from mild to moderate depression; as described by Doctor Philip W. Long (2011) “the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible.” The addition of hallucinations and depression in the analysis is extremely important when diagnosing Parry. If these symptoms are left out of the equation, the treatment for them could become completely irrelevant.

If severe depression were Parry’s case, the treatment should involve heavy psycho-therapy as well as medication, which would include anti-depressants. There are two types of therapy that could be tested, they include Cognitive therapy and Behavioral therapy. Cognitive behavior is often used to treat anxiety as well as depression, which in Parry’s case may benefit him even more so than a therapy that only aims at depression. This type of therapy oftentimes incorporates medication because it tries to change the dynamic in the brain as well as the observable behavior. Cognitive therapy could be used to supplement the anti-depressants, though this therapy is encouraged to be used more for depression that it is genetically inherited. In which case Parry may not benefit from cognitive therapy, but perhaps behavioral therapy.

Behavioral therapy is meant to focus on the behaviors of a person, rather than how the brain works through depression. This can be supported by evidence from the Mayo Clinic (2013) “Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.” This seems like it would be a very practical way of treating Parry, though it may not be intense enough. However it would most likely prove to be more effective than cognitive therapy, and thus should be the treatment if Parry were diagnosed with severe depression. For Parry to be treated and make any major progress, a strict schedule should be integrated into the therapy portion as well as anti-depressants. As research indicates, anti-depressants seem to be a necessity for treating this mental disorder but with continued therapy the idea of discontinuation of medication may be available for eligible patients. As stated by (Fava et al.,1994) “Cognitive behavioral treatment also resulted in a lower rate of relapse (15%) at a 2-yr follow-up than did clinical management” This certainly implies that behavioral treatment would be an excellent choice for severe and even moderate depression, but in the case of Parry it would be severe.

Parry and Post Traumatic Stress Disorder

When taking a complete look at all of Parry’s symptoms, it seems that the more reasonable diagnosis would be Post Traumatic Stress Disorder. All of the signs indicate this based on Parry’s emotional instability, the fact that he is homeless, as well as his delusions and hallucinations. His immediate response to the tragedy of his wife’s death was to go into a catatonic state, ultimately pushing down his feelings and pretending he was homeless. He literally rendered his life into something that was completely unknown to him, which can only be described as a way of trying to disconnect himself from his life after the death of his wife. His coping mechanism was to create an entirely different world that had nothing to do with the loss he needed to deal with. Parry completely avoided his feelings and did not deal with the reality of the situation in any way, which is common for Post-Traumatic Stress Disorder victims. By not dealing with the reality at hand, the victim is pushing away what must be dealt with and replacing it with a new situation; in Parry's case, he has created an altered world for himself, sending himself on an outrageous and completely unattainable mission.

After investigating the symptoms of Parry and comparing them with other victims of PTSD, it seems like a promising diagnosis to confirm him with. Parry is so utterly determined to erase the past and his wife’s murder that he creates a new world for himself, one that is entirely different from the one he had known. This indicates a strong resemblance to others who suffer from PTSD. As stated by Ozer and Weiss (2004) “The consequences of this exposure (traumatic events causing PTSD) are manifested in three symptom clusters required for diagnosis: involuntary re-experiencing of the trauma, avoidance of reminders and numbing of responsivity, and increased arousal.” Parry’s most obvious symptom may be his avoidance and his involuntary actions of re-experiencing the trauma. Perhaps Parry felt that if he could make a new life for himself he would be able to avoid any type of reminder of his wife or the life he had before. In trying to find a treatment for this type of disorder, many therapists would suggest using cognitive therapy. However most cognitive therapies that are aimed toward PTSD involve the patient to be dealing with substance abuse as well. Though Parry is not dealing with this type of abuse, incorporating cognitive therapy may be beneficial. The better choice of therapy though may be Psychodynamic Imaginative Trauma Therapy and EMDR. This seems like a good choice because it is a more natural way of approaching such a terrible disorder. In order to confront the demons that Parry faces, this method incorporates natural ways, but at a slower pace, of dealing with trauma head-on. A more specific idea comes from Medizin (2004)

“PITT combines psychodynamic understanding with hypnotherapeutic and imaginative methods. Crucial points are an active and supporting therapeutic relation, safety and reduction of stress, focus on all individual resources and use of imaginative ways for stabilization and later trauma-confrontation work.”

The approach taken to Parry should be very similar to the style of treatment that Medizin explains. The hardest part about Parry’s diagnosis is truthfully not incorporating the correct anti-depressants, though that is a major part, but the therapy that he must commit to. The therapy should span for quite some time as there is a lot of work to be done in assessing and then treating him.

Parry and Change

Parry’s willingness to change does not seem evident until the end of the movie. Obviously, he comes out of his catatonic state and seems to be more stable. However when focusing on Parry as a whole and assessing him as a patient rather than his character as a whole, he seems to want to change simply based on his willingness to find the Holy Grail. As simple as it sounds, his need to find the Holy Grail announces in a certain way that he is motivated and inspired to achieve something. In depression or PTSD, motivation and inspiration are at low points and so his willingness indicates that he does want some sort of change. If he were to find the Holy Grail, he would be accepting change into his life because the Holy Grail would change his life. The only hindrance that would affect Parry’s recovery would be his strength in continuing his charade of life. He is not ready to part with the new reality he created for himself and this could prove difficult to manipulate into something more true for him.

Conclusion

To conclude, Parry’s diagnosis should not be held strictly at Post Traumatic Stress Disorder. If he were treated for Mood Disorder it would certainly benefit him, but the real benefits would come if he were treated properly for PTSD. This would make Parry’s life much more manageable and hopefully happier in allowing him to move on from such dark trauma.

References

Cognitive Behavioral Therapy. (2013). Mayo Clinic, n/a, 1.

Fava, G., Silvana, G., Zielezny, M., Canestrari, R., & Morphy, M. (1994). Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. American Psychological Association, 151(9), 1259-1299.

Long, P. W. (n.d.). SYNOPSIS. Major Depressive Disorder. Retrieved November 23, 2013, from http://www.mentalhealth.com/dis/p20-md01.html

Medizin, K. (2004). Integration of psychodynamic imaginative trauma therapy in a modified psychoanalytic concept of an inpatient psychotherapy unit. PubMed, S88-90, n/a.

Ozer, E. J., & Weiss, D. S. (2004). Who Develops Posttraumatic Stress Disorder?. Current Directions in Psychological Science, 13(4), 169-172.