As Good As It Gets is a movie that portrays the life of a person with a psychiatric disorder called obsessive-compulsive disorder (OCD). The protagonist Melvin Udall (played by Jack Nicholson) is a novel script writer who lives in an apartment with Simon Bishop (played by Greg Kinnear) as his neighbor. Melvin’s odd behaviors make his life difficult when dealing with people around him. He is preoccupied with too many compulsions that he did not have time to build a healthy relationship with other people. He is not sensitive to the words he say not knowing that he is already hurting the person’s feelings.
His life starts to change when Simon was hospitalized and Melvin was forced to take care of Simon’s dog, Verdell. The dog acted as a bridge for Melvin and Simon to become friends. Melvin also became close acquaintances with Carol Connelly (played by Helen Hunt), a waitress in the restaurant where he always dine. He falls in love with Carol but due to his unpredicted odd behaviors, Carol moves away from him. Thanks to Simon, he helped things become okay between Carol and Melvin. Deeply in love with Carol, Melvin tries to change his ways and the movie ended with a bright yet uncertain future.
As the psychiatric disorder progresses, the patient as well as the people surrounding him starts to complain about his behavior. Below are several complaints the patient and his significant others have in the movie “As Good As It Gets”: Melvin to Simon: “I’m clearing my head, don’t like myself anymore…. I’m tired. ” Melvin to Dr. Green: “Dr. Green, how can you diagnose someone with an obsessive- compulsive disorder and act as if he have some choice? Are you teasing me? ” Carol to Melvin: “ Don’t you have any control of how creepy you are about to get? ”
“I want my life for just one minute but my biggest problem is somebody else has a free convertible so I can get out of this city! ” “Stop it! Why can’t I just have a normal boyfriend? Why? A regular boyfriend who doesn’t go nuts on me! ” Simon to Melvin: “You’re sick. Everything looks distorted and everything inside you. You hate everything so you can barely find a way to complain. ” Generally speaking, the people are complaining about Melvin’s attitude. His attitude is so bothersome that it prevents him from building a healthy relationship with other people.
Melvin tries to be nice to some people but his present attitude serves as a bias why most of them consider his kindness as an act of insult or deceit. He somehow develops an obsession with Carol. In order to know the problem of the client, it is better if the health provider would take some sort of history taking. History taking is important since it serves as a baseline to know the roots of a certain disorder. The history taking can be started with simple questions regarding the patient’s name, age, occupation and the like.
Taking OCD into consideration, the health provider should ask specific questions that will help in understanding the disorder of the patient. If a patient is asked to describe his/her past childhood experiences, the client may state that he/she has experienced rigid toilet training. Toilet training is an important aspect that must be accomplished during toddler years. Considering the fact that autonomy must be favored more than shame and doubt, toilet training must be done in way the child practices his autonomy.
The client may also say that whenever he/she experiences anxiety, he/she begins performing repetitive actions. Exploring deeper into the question, the client may also say that his compulsions or rituals take him several minutes or hours to accomplish. Attempts to stop these compulsions are reported to be unsuccessful. If asked about his/her relationship with other people, the client may say that he/she finds it hard to build a healthy relationship because his compulsions prevent him from doing so.
In the movie, As Good As It Gets, actor Jack Nicholson portrays the role of a person with an obsessive compulsive disorder. Obsessive compulsive disorder is an anxiety disorder wherein the person has recurrent unwanted thoughts called obsessions. To relieve the anxiety brought by these thoughts, the person is involved in repetitive behaviors such as hand washing, checking and counting. These so called rituals or compulsions reduce a person’s anxiety while deprivation from these rituals increases the person’s anxiety. However, the action only provides temporary relief.
Jack Nicholson shows odd behaviors which add humor to the movie. Whenever he washes his hands, he always uses a new soap then throws it away. He also avoids stepping on the cracks on the floor whenever he goes outside his apartment for a walk. At the same time, he feels that he should eat on the same table in his favorite restaurant and even bring along his plastic utensils whenever he dines there. The way of locking and unlocking the doors of his apartment is complicated as well as turning the lights on and off. He needs to follow certain number of times before getting over with it.
He is characterized as verbally abusive which offends people most of the time. He also lives in solitary and has no friends at all, although he is considered as a famous novel writer. Those living with this kind of people find themselves in a state of frustration. The obsessions as well the compulsions make the lives of these people difficult. To support the diagnosis of OCD on Melvin Udall, certain criteria must be met with DSM TV IR. Obsessions of a client with OCD must be intrusive, inappropriate, recurrent, and persistent, and causes distress and anxiety.
There are unsuccessful attempts to ignore the obsessions with positive adaptive actions and thoughts. People with this disorder are not excessively worried about real life problems and they usually recognize that these obsessions are produced by their own thoughts. On the other hand, the compulsions of a person with OCD are converted to repetitive behaviors such as hand washing, counting, and arranging things according to color, height, and the like. They display these excessive behavior or mental acts for them to prevent distress or frightening events.
At some point during the course of the disorder, the client will recognize that these excessive thoughts and behaviors are inappropriate or unreasonable. The compulsions themselves are time consuming and they interfere with the client’s ability to perform for their daily needs. Such needs would include food, occupation, social activities, and healthy relationship with other people. Lastly, these obsessions and compulsions are not side effects of other substances such as alcohol or medications. They are merely coping mechanisms for a person to relieve anxiety.
Considering that the patient has obsessive compulsive disorder, sets of treatment are planned to help relieve the patient’s anxiety. Treatments or interventions can be divided into three: therapeutic relationship, psychopharmacology, and milieu management. Starting off with the therapeutic relationship, the nurse must ensure that the basic needs such as food, clothing, grooming, and the rest are met by the client. Client has less time in dealing with these activities since they are preoccupied by their obsessions and compulsions. Provide time for the patient to finish the ritual.
Setting limits has more advantage than stopping the ritual abruptly because it may ensue panic than relief. Prepare simple yet structured activities for the client. This is a good and productive diversion for the client’s obsessive compulsive behavior. Whenever the client demonstrates a non-ritualistic behavior, give praise or recognition. This will increase self-worth and self-esteem. Be empathic with the client and be aware of the need in performing the rituals. It will convey acceptance and understanding on the client’s situation. Certain drugs also help the patient deal with OCD.
Clomipramine is considered as the drug of choice in dealing with these clients. However, a certain group of drug is said to be effective for this kind of psychiatric disorder. They are called Selective Serotonin Reuptake Inhibitors (SSRI). SSRI is a kind of antidepressant that treats depression, anxiety disorders, and some personality disorders. As the name suggests, it prevents the reuptake of serotonin whose action is to elevate the mood. Since OCD is an anxiety disorder, it is proven to be effective and helps in dealing with the anxiety of the patient.
Some of SSRI drugs commonly used are fluoxetine, fluvoxamine, paroxetine, and sertraline. However, one should watch the side effects of these drugs. SSRIs are known to cause gastrointestinal symptoms like nausea and diarrhea. They are also known to cause anticholinergic effects as well as sexual dysfunction. Milieu management also helps in the treatment of anxiety disorders particularly the cognitive behavior therapy (CBT). Although rooted in two different theories, it is found to be effective in treating patients with anxiety disorder.
The basic concept of using the CBT in anxiety disorders is systematic desensitization or in vivo approach. It is believed that fear is learned and continued to be learned unless the client is exposed to certain stimuli. Initial exposure causes an increase in physical and emotional distress. As the desensitization therapy progresses, the client then will learn how to unlearn hi/her fear. In OCD, there is what we call exposure with response prevention which is directly under the CBT. The aim of CBT is the same with systematic desensitization.
Nonetheless, as anxiety is relieved, so is the ritualistic behavior of the client. Others would also consider thought stopping, a technique wherein the client’s intrusive obsessions are substituted with adaptive ones such as deep breathing or walking. As the treatment goes, several outcomes must be predicted in order to evaluate whether the treatment is effective or not. It can be short term or long term. Short-term outcomes would include the following: 1. Patient will be able limit the time needed in performing rituals. 2. Patient will report and identify strategies and actions that will be substituted for compulsions.
3. Patient will be able to finish and focus on the structured activities given to them by their health provider. These short-term outcomes must be followed in order for the client to achieve long-term outcomes. Nonetheless, long-term outcomes would include: 1. Patient will be able to develop strong and healthy relationship with the people surrounding him/her. 2. Patient will be able to substitute compulsions with positive adaptive behaviors and thoughts. References Ziskin, L. (Producer), Brooks, J. L. (Director). 1997. As Good As It Gets [Motion Picture]. United States: TriStar Pictures