This paper will serve to provide a summarization, review, and critique of Misery as it relates to mental health nursing. In order to explore the topic, the paper addresses the context of the mental health illness as presented in the movie, the observations of the behavior of the mentally ill individual within the movie, and provides the DSM-V diagnosis. Following the presentation of this information a treatment plan, complete with the expected outcome, is detailed along with the thoughts of the researcher regarding the movie as a whole.
Keywords: Misery, movie review, mental health, mental illness, diagnosis, criteria, treatment plan, outcomes

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Movie Review: Misery
Introduction
Author Stephen King has made a career out of creating characters that have been described as comparable to individuals that who are known to readers; characters that could be coworkers, family members, or even strangers that they encounter in everyday scenarios. These fictional characters have the same loves, hates, likes and dislikes, problems and issues that the readers and audience members encounter in their daily life. It is the believability of these characters, the reality of these characters, which works to draw the audience in, allowing for the suspension of disbelief necessary to enjoy the tale being woven for them. One of the many characters that Stephen King has penned is Nurse Annie Wilkes, played by Kathy Bates, a central character in the novel Misery, which was turned into a film of the same name by famed screenwriter William Goldman. Goldman’s portrayal of Nurse Annie Wilkes and the subsequent acting of Kathy Bates in that role serves to provide insight into the darker side of mental illness. Through an exploration of her character, it will be possible to identify not only her potential mental health diagnosis, but also how the issues that she experiences contribute to the overall plotline of the story. Additionally, through a diagnosis using DSM-IV criteria, it will be possible to design a treatment plan for this fictional character while at the same time identifying what the likely outcomes would be as a result of the same

Background of Patient and History of Illness
Annie Wilkes is a nurse whose obsession lies in the work of romance novelist Paul Sheldon, an obsession that later extends to his person as well as his work. She is a caretaker who has become obsessed with the attention that she receives from the deaths of infants and other patients who have been entrusted to her care, displaying many of the characteristics of an angel of death. In reviewing the DSM-V, there are several different diagnoses that may be applied to the character of Annie Wilkes. First is that of 297.1 – delusional disorder (American Psychological Association, 2003). Delusional disorder fits with the obsessive compulsions that she displays in her care of others and likewise her affectation for the fictional character, Misery Chastain, the main character in the latest Paul Sheldon works (Reiner, 1990). The secondary diagnoses that would likewise be applied to this character include 300.23 – social phobia, 300.3 – obsessive compulsive disorder, and 301.2 – schizoid personality disorder (American Psychological Association, 2003). The acknowledgement of her obsessive behaviors combined with the lack of evidence presented during her trial for the deaths of the infants that were under her care indicates to the audience that there is great cause for concern when Sheldon gets into her hands; she has already been shown to be wildly cunning and highly dangerous. The argument may be made that Annie Wilkes demonstrates behavior that classify her as an extremely dangerous individual through other, more subtle choices made in her life, such as the choice to live by herself on a farm isolated from the rest of society, a fact that allows her to hold Paul Sheldon hostage for an extended period of time.

Proposed Treatment Plan
Annie Wilkes suffers from major psychological issues, including delusions in addition to the displayed obsessive compulsive behaviors (Findley, 2008). Her need to control a situation, evidenced by the drugging of Paul Sheldon to keep him captive, and the shattering of his ankles with a sledgehammer as a means of displaying her violent tendencies, serve to indicate that Annie will need inpatient treatment in order to effectively address the mental disorders that she experiences. While sometimes outpatient treatment with a licensed, experienced therapist is enough to effectively treat issues, including some of those that Annie Wilkes suffers from, the behaviors displayed within the movie are evidence that institutionalization and a strong medication regimen will be necessary, in conjunction with cognitive behavioral therapy, in order to take the first steps to reverse many of the destructive behavior patterns that she experiences (American Psychological Association, 2003).

If there is marked improvement in Annie Wilkes behaviors and mental cognition following a period of two to three years, or longer, of inpatient therapy, it is possible that she could then be transitioned into an outpatient treatment program, which can include further medication, therapy, and even living in an assisted living facility to ensure that Annie is under observation at all times in case she is confronted with life events that she finds herself incapable of coping with on her own.

Anticipated Outcome
With the above detailed treatment plan in place, it may be safe to hypothesize that, with the cooperation of Annie Wilkes herself, there should not be any reason as to why the treatment for the previously identified mental illnesses could not be successful, allowing Wilkes the tools necessary to be in control of her life once more. The cooperation of the patient, however, is vital to the overall success of the treatment plan (American Psychological Association, 2003). If Annie Wilkes is unwilling to remain compliant with the treatment plan, or if she shows signs of being uncooperative, there is very little hope in the overall success of the treatment plan or her subsequent recovery as a result of the same. Annie Wilkes shows little desire to be compliant, as evidenced in her unwillingness to let go of her fantasies and live in the real world, making such an outcome a bleak one (Reiner, 1990). Still, with the right therapist present, it is possible that Annie may be convinced of the need to seek long-term care for her problems, thus providing her with the tools necessary to get better.

Conclusion
Following the conclusion of the film, it is apparent that the character of Annie Wilkes has some deep-seated issues that will require a great deal of long-term care. At the same time, because of the believability of King’s characters, the skill in which Goldman allowed for those characters to be translated to the silver screen, and the superlative acting skills of Kathy Bates, it is easy to see how a fan obsession could turn down such a dark path in a person with mental illness. The presentation of Bates’ character through the lens of fandom serves to indicate not only a manner in which mental illness may manifest, but also serves to indicate a potential means through which it would be possible for the individual suffering from mental illness to use the literary world as a means of expression. In gaining greater insight to the manifestation of mental illness in Misery, I have been able to identify several books that I could see benefitting individuals with mental illness, using those as a tool not only for expression, but also as a coping mechanism and a means through which it would be possible for them to identify with the physical world once more. I thought Bates’ portrayal of Annie Wilkes was not only graphic, but an accurate representation of the extremes of mental illness, and I will be able to use the information garnered as a result of the same in my continued work with those who experience mental illness.

    References
  • American Psychiatric Association. (2003). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. ManMag.
  • Findley, M. (2008). The Prisoner, the Pen, and the Number One Fan. In The Films of Stephen King (pp. 91-100). Palgrave Macmillan US.
  • Reiner, R. (Director). (1990). Misery [Motion picture on DVD]. United States: Columbia Pictures.