Author Archive: Anthony Tobia, MD

THE BEAST WITHIN (1982)

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SYNOPSIS

The Beast Within is a horror film loosely based on Edward Levy’s 1981 novel of the same name. The film opens in 1964 Nioba, Mississippi with newlyweds, Caroline and Eli MacCleary, stranded on a deserted road. Caroline is knocked unconscious and raped by an unknown entity. The film then picks up 17 years later in Jackson, Mississippi, and depicts the trials of the MacCleary family as it deals with unexplained symptoms of their 17-year-old son, Michael.

THE NEUROPSYCHIATRY OF THE BEAST WITHIN

The Beast Within may be viewed as a case study to review the signs of Neurofibromatosis type 2 (NF2), a hereditary condition most commonly associated with bilateral vestibular schwannomas, also known as acoustic neuromas. These benign tumors grow on the nerves of the inner ear and commonly cause tinnitus which is experienced by Michael throughout the movie as a cicada-like ringing. In the film, Eli and Caroline decide to confront their past and return to the small town of Nioba, Mississippi to hopefully discover some information about the man (Michael’s biological father) who sexually assaulted Caroline. The timing and nature of their search underscores 2 important facts; a) signs of NF2 usually develop in the late teenage years and b) NF2 is a hereditary condition.

Interestingly, Michael may also demonstrate mucosal neuromas (fattened lips of the beast), which along with his pituitary gland “going out of control” (adenoma), is consistent with Multiple Endocrine Neoplasia (MEN) syndrome type 1.

Last week’s movie: Laid to Rest (2009)
Next week’s movie: Skeleton Key (2005)

LAID TO REST (2009)

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SYNOPSIS

Laid to Rest is a 2009 slasher film depicting the “amnestic protagonist.” It follows a young woman who awakens in a casket with amnesia, and her attempts to recover her lost memories, the most disturbing of which is that she’s a victim of a serial killer who taunts the police by videotaping his victims.

THE PSYCHIATRY OF LAID TO REST

An unnamed woman awakens to find herself in a casket, without any knowledge of where she is or how she got there. In fact, she demonstrates retrograde amnesia, unable to recall any long- term memory (episodic or semantic). She complains of a headache, and appears confused as she tries to escape the mortuary and its video-taping, sadistic inhabitant, ChromeSkull.

Locked in the embalming room, she is nearly rescued by an elderly mortician with a “lazy eye” (cranial nerve palsy) before ChromeSkull impales him. We later learn upon discovery of one of the video tapes that Mr. Jones was an accomplice, Chrome Skull’s Renfield, who regained compassion for the girl before being killed in an attempt to rescue her.

Upon her escape, the woman flags down a lone passer-byer, Tucker, who refers to her as “Princess.” As the story unfolds, Princess’s psychiatric symptoms (amnesia) combine with Tucker’s physical deficit (impaired gait) to derail their multiple attempts to reach safety.

Finally, we discover that ChromeSkull is a psychotic serial killer who has been abducting young women beginning in south Florida. He posed as a “john’ to abduct Princess, a prostitute who is seen on a video tape snorting cocaine just before being assaulted with a baseball bat (and ending up in a casket). While the details of Princess’s history explain her recent experiences including the headache, an alternative interpretation (scar notwithstanding) allows for an interesting psychiatric synopsis.

It may be reasonable to assume that Princess likely abused alcohol in addition to cocaine. Taken together, Laid to Rest may be interpreted as a case study of Alcohol Withdrawal, which can be reviewed in 3 phases. The first phase, uncomplicated withdrawal, results from cessation of alcohol thats use has been heavy and prolonged. Interestingly, the one criterion from the Clinical Institute Withdrawal Assessment (CIWA is the gold standard for symptom-triggered therapy) that is not included in the DSM-5 diagnostic criteria is headache.

The second phase, complicated withdrawal, is hallmarked by either seizures or hallucinations. The latter may be due to a) Alcoholic Hallucinosis or b) Alcohol Withdrawal Delirium (Delirium Tremens, DT’s). The third phase, Wernicke-Korsakov syndrome, may begin with a triad of confusion (Princess), ataxia (Tucker), and eye findings (Mr. Jones). If left untreated, Wernicke’s encephalopathy (confusion) may evolve into Korsakov psychosis (KP). KP is a likely irreversible neurologic syndrome characterized by amnesia (while Princess demonstrates retrograde amnesia, KP more commonly presents with anterograde amnesia/difficulty with encoding new memories), confabulation (the creation of false memories), and perceptual disturbances (psychosis). While ChromeSkull may represent “a psychotic serial killer,” he may only be a figment of Princess’s imagination; a product of her delusional belief system resulting from years of alcohol abuse and subsequent Wernicke-Korsakov syndrome. While the 3 forms of alcohol withdrawal are presented here as 3 distinct phases, they need not appear in any particular order. As confabulation is not depicted in the film, so too may alcohol withdrawal not include specific symptoms..

Last week’s movie: Jeepers Creepers (2001)
Next week’s movie: The Beast Within (1982)

JEEPERS CREEPERS (2001)

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SYNOPSIS

Jeepers Creepers is inspired by actual events (Unsolved Mysteries). Since this blog was started on Easter Sunday 2015, exactly 25 years ago, Ray and Marie Thornton were terrorized by a motorist while playing “the license plate game” in Cold Water, Michigan. Also, like their counterparts in the movie, they later came across the van and discovered a bloody sheet. While the Thornton’s experience remains unsolved, the 2001 horror movie it inspired depicts the fate of siblings a 2001 horror film written and directed by Victor Salva that takes its name from the 1938 song first premiered by Louis Armstrong. The film is is Trish and Darry Jenner on their travels homefrom college during spring break in the Florida countryside.

On their way home, a mysterious driver attempts to run Trish and Darry off the road with his truck. After barely escaping a second time, Darry convinces Trish to double back to investigate
what they saw earlier at the “psycho version of the Sistine Chapel.” The two find an old woman (an oracle) who tells them of “The Creeper,” a demonic keeper of a “house of pain” who hunts
every twenty-third spring for twenty-three days by striking fear into its victims in order to smell if there’s something it likes. It then feasts on the terrified victims’ body parts to reconstitute and strengthen itself.

The eponymous “Creeper” is the reincarnation of Spring-heeled Jack, a supernatural entity of English folklore of the Victorian era (sightings were especially prevalent in London). The
cyclical nature of his hunting sprees parallels that of other geographically isolated mythical characters such as the Mothman (West Virginia) and It (Maine).

THE PSYCHIATRY OF JEEPERS CREEPERS

Beyond the role urban legends play in the psychology of a culture, Jeepers Creepers is useful in reviewing the harmful effects of two drugs: alcohol and phencyclidine (PCP). In the opening scene, Darry recounts the cautionary tale of Kenny and Darla (class of ’78), a prosocial warning of the dangers of drinking and driving on prom night (Weird New Jersey’s Annie’s Grave in Totowa and The White Lady Tree in Branch Brook Park).

Later in the movie, Darry and Trish are trapped in the police station when the Creeper’s rampage is reminiscent of the scene from The Terminator. Similar to the cyborg portrayed by Arnold
Schwarzenegger, the Creeper demonstrates the behavioral (belligerence and agitation) and physiologic (diminished pain response when it’s described as wearing body armor by police)
manifestations of PCP intoxication.

It’s only right that the final thought in this blog parallels the final scene in the film. Co- occurring use of alcohol and PCP may lead to suicidal behaviors and other symptoms including (ironically) rapid eye movements (nystagmus), eyes rolled to the back of the head, and a vacant stare.

Last week’s movie: Deliverance (1982)
Next week’s movie: Laid to Rest (2009)

THE NEW DAUGHTER (2009)

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SYNOPSIS

Based on a short story of the same name by John Connolly, The New Daughter tells the story of a novelist, John James, and his two children who encounter a malevolent presence when they
move into their new house. One day, while exploring the surrounding fields of their new home, the James children come across a large mound to which Louisa is strangely attracted. John soon learns that his new home is an urban legend; locally infamous for the disappearance of a woman who previously lived there.

THE PSYCHIATRY OF THE NEW DAUGHTER

The burial mound, Louisa’s strange attraction to it, and her consequent symptoms all support a case of ghost sickness; a culture bound syndrome that occurs among Native American tribes, originating from the Navajo. First, the sufferer is obsessed with death or a certain deceased person (many Native Americans with ghost sickness may actually be suffering from a complicated bereavement). While we don’t know the ancestry of the James family, ritualized mound burials link cultures across the globe, explaining why Louisa would be at risk for developing ghost sickness. Furthermore, the woman who previously lived in the home (the object of Louisa’s obsession) may have been of Native American heritage. A common belief among the Kwakiuti tribe is that a child’s soul is weaker than that of an adult. Taken together, children such as Louisa would be more vulnerable to develop ghost sickness than adults. An alternative theory is that John killed his ex-wife and buried her under the mound on his new property, thus explaining Louisa’s pathological grief process.

In any case, the sufferer begins to have nightmares and dreams, then later feels queasy when the physiological and psychological symptoms set in. Louisa has nightmares and sleepwalks the
night after she lies on the mound. The next day, John is called by the school to pick up Louisa who is nauseous. Thereafter, Louisa demonstrates additional symptoms of ghost sickness
including a change in appetite, depression, and irritability.

Last week’s movie: Pumpkinhead (1988)
Next week’s movie: Deliverance (1972)

PUMPKINHEAD (1988)

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SYNOPSIS

Inspired by a poem by Ed Justin, Pumpkinhead is a cult classic horror film about Ed Harley’s inner demon manifest as one of the most Underrated Horror Killers of all time (Tyler Doupe, 2013).
The supernatural Scarecrow Folk is introduced in the movie’s opening scene, and returns about 30 years later when Harley swears revenge on a group of teenagers who mortally wound his son
while operating a motorcycle under the influence of alcohol. Upon consulting a witch in a cabin in the woods, Harley goes to Razorback Hollow to exhume the eponymous legend, revenge
incarnate.

THE PSYCHIATRY OF PUMPKINHEAD

Pumpkinhead shares the same archetypal warning (trope) with January 23’s film, A Nightmare on Elm Street; there’s a steep price to pay for exacting revenge. The film revisits the internal conflict between what “we would like to do” versus society’s prohibitions about what we should do, and applies this to a case of child murderers. With superego (frontal lobe) dysfunction, people like Harley lose the protective cortical effect and succumb to the impulsivity of the id which is driven by the pleasure principle.

When bent on revenge, one can lose oneself, as evidenced by Harley experiencing the deaths of the teenage campers through the eyes of Pumpkinhead, then ultimately taking on the image of Pumpkinhead, itself. The film, then, is analogous to the infamous Stanford prison experiment that investigated how readily people would conform to the roles of guard and prisoner in a role- playing exercise that simulated prison life (Zimbardo, 1973). A depiction of the experiment that’s less metaphorical than this week’s movie is Paul T. Scheuring’s The Experiment (2010). Similar to Zimbardo’s findings, Harley isn’t hardwired to be sadistic, but instead is influenced by environmental stress to do what he does; an action for which he pays the ultimate price.

Last week’s movie: Mama (2013)
Next week’s movie: The New Daughter (2009)

MAMA (2013)

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SYNOPSIS

Mama is a supernatural horror movie by AndreI?s Muschietti that is based on his 2008 Argentine short film MamaI? about two feral children abandoned in a cabin in the woods who are fostered by a ghost that they affectionately call “Mama.” Victoria and Lilly are abandoned in Helvetia (the name of the cabin) by their father after his attempted murder-suicide is thwarted by the cabin’s supernatural resident. The film depicts the plight of the children upon their discovery, as their new family must battle Mama when it follows the children to their new home.

THE PSYCHIATRY OF MAMA

With his film, AndreI?s Muschietti has inserted himself among attachment theorists such as Klein, Bowlby, Thomas and Chess.

The D’Asange children were 3- and 1-years-old when they were abandoned. Upon getting kidnapped, the older Victoria drops her stuffed animal on the living room floor. The transitional object is a symbol of the girls’ vulnerability during the critical period of language development. Once discovered, Victoria assimilates to her new family much
easier then Lilly, whose attachment to Mama is tested right up to the movie’s cliffhanging summit.

At Rutgers Robert Wood Johnson Medical School, the first module ‘ titled Necromancy ‘ of our year-long resident Psychopathology course focuses on ghosts (wraiths) and demons. While the latter reinforce teaching points of chronic and persistent illnesses, ghost stories are told to review disorders that are episodic in nature such as Major Depressive Disorder.

“A ghost is an emotion bent out of shape…until it rights a wrong.”

Despite Dr. Dreyfuss (a psychiatrist) diagnosing Victoria with Dissociative Identity Disorder (misstated as Dissociative Personality Disorder), Mama’s true affliction is later revealed by Victoria, “It was a long time ago. A lady ran away from a hospital for sad people. She took her baby. They jumped into the water.” As such, Mama is a case study about Major Depressive Disorder, with Peripartum Onset (postpartum depression).

Last week’s movie: Mama (2013)
Next week’s movie: The New Daughter (2009)

THE EXORCIST (1973)

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SYNOPSIS

The seminal movie of the “demonic possession’ subgenre is William Friedkin’s 1973 film adaptation of The Exorcist. Like our trip through Connecticut (The Conjuring) in Week 5, the film and its novel are based on true events. In a 1972 New York Times article titled “Everyone’s Reading It, Billy’s Filming It,” Chris Chase reported that Blatty based his novel on the 1949 Washington Post story, “Priest Frees Mt. Rainier Boy Reported Held in Devil’s Grip.” Details are provided in the personal diary of Fr. Raymond Bishop who performed over 30 exorcisms on 13-year-old Roland Doe. Supernatural occurrences noted in the diary included, but were not limited to, distortions in Doe’s voice (1). It has been speculated that Doe’s behavior may have been the result of a Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal (PANDAS) infection.

THE PSYCHIATRY OF THE EXORCIST

At Rutgers Robert Wood Johnson Medical School, the first module ‘ titled Necromancy ‘ of our year-long resident Psychopathology course focuses on ghosts (wraiths) and demons. While the former references disorders that are episodic in nature, tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses such as the Dissociative Disorders (DD). At the completion of the DD block, participants should appreciate that movies about demonic possession may be metaphorically interpreted as case studies of dissociation. For example, the hallmark characteristic of Dissociative Identity Disorder, a disruption of identity, may be described in some cultures as an experience of possession (DSM-5).

Another pedagogic lesson of The Exorcist references Holotropic Breathwork (HB). HB combines music with accelerated breathing to reach an “altered state of consciousness” as a form of self-exploration and psychotherapy. In their book (2), the Grofs describe the experience of demonic energy as “a change in facial and vocal expression…their voice is deep and raspy…spastic contractions make their hands look like claws, and their entire body tenses. [They] can muster physical strength.” After an outburst, everything quiets down and there is an eerie silence.

Regan demonstrates the pathognomonic description of demonic energy, which is associated with reliving memories of severe childhood trauma. The absence of her father and nocturnal enuresis (urinates coming down the stairs) lends further support to the etiology of her “possession.”

Last week’s movie: The Blair Witch Project (1999)
Next week’s movie: Mama (2013)

THE BLAIR WITCH PROJECT (1999)

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SYNOPSIS

The Blair Witch Project is a “found footage” docudrama about 3 student filmmakers who investigate the Legend of the Blair Witch. The urban legend tells of the 1940’s deaths of numerous children in Blair (present day Burkittsville), Maryland. In true Stephen King fashion, the small town values are a facade over Burkittsville’s sinister secret; a secret of an “old hermit” who lives in a cabin in the woods who is somehow tied to “an old woman whose feet never touched the ground” (a.k.a. the Blair Witch). The Blair Witch Project is about 2 intertwining legends, and therefore may be depicted as “The Sandman meets Home Alone.”

THE PSYCHIATRY OF THE BLAIR WITCH PROJECT

Like all urban legends, the Legend of the Blair Witch reinforces a taboo so that a culture can maintain social order. The legend likely reinforces the prosocial value of “early to bed, early to rise.” As an interview with a “townie” in the beginning of the film discloses; if you try to stay up late, the Blair Witch will get you. There are parallels with this legend and similar prosocial warnings of the Sandman (sleep with one eye open, holding your pillow tight) and Santa Clause. While the latter promises gifts if you go to bed early (positive reinforcement), the Sandman sanctions (positive) punishment to little boys and girls who get up once they’re tucked in.

On their second day, the hikers locate an old cemetery with seven small cairns. The rock formations are metaphors for their having found the “old hermit.” Translations of the term
include “stone man” (German steinmann), “imitation of a person” (Inuit inuksuk), and “small man” (Italian ometto).

Their discovery is that of the “small man,” Mr. Parr, an old hermit and outcast likely afflicted with Schizoid Personality Disorder. Characterized by social inhibition, the detachment from meaningful relationships usually leads to the afflicted being deemed a loner. It’s often human nature to impart meaning to people who don’t otherwise share who they are. Individuals with Schizoid Personality Disorder then may become the focus of town folklore such as a man who moves into the Black Hills to avoid human contact (also, Kid Lester in The Best of Times; Old Man Marley in Home Alone; and the Witch in Big Fish).

Last week’s movie: I Can See You (2008)
Next week’s movie: The Exorcist (1973)

I CAN SEE YOU (2008)

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SYNOPSIS

Somehow the United States of Horror Films map earmarked Carnival of the Dead for this week’s
destination movie. Unfortunately, efforts at Rutgers Robert Wood Johnson Medical School to find the film were unsuccessful. Alternatively, we arbitrarily chose I Can See You as the film to represent the First State. The 2008 horror film depicts a camping trip of Ben Richards, Doug Quaid, John Kimble, and Sonia Roja; advertising workers who are seeking inspiration for an ad campaign. When a camper mysteriously disappears, reality testing breaks down, and everyone’s safety is put in imminent jeopardy.

THE PSYCHIATRY OF I CAN SEE YOU

On the way to the campsite, Kimble receives a phone call from Ivan, who invites the group to a barbecue. When they arrive, Richards sees Summer Day, a former crush, who Richards refers to as a hippie. As the two rekindle their relationship, the pictures Richards takes of the wilderness come out distorted and parallel his difficulty focusing his vision (accommodation). When he goes swimming in a stream with Summer, Richards removes his glasses, and has as much difficulty with his speech as with his sight. Summer leaves, but with his vision blurred, Richards doesn’t see where she goes. Having been the last one to talk with Summer, Quaid is sought by Richards and Kimble when they uncover his camera (and see pictures he took of Summer). They find him disoriented, and after Quaid runs off, Richards discovers his body at the bottom of a cliff. Richards then hallucinates when he see Hauser who tells him to take a second look at the cliff without his glasses (Richards then throws his glasses over the edge).

Summer’s background, the pervasive theme of having difficulty with accommodation, jumping from a cliff (believing he can fly?), and hallucinations all point to LSD intoxication as the source of the campers’ horror. Additionally, the plot may also incorporate Dimethoxybromoamphetamine (DOB) as an adulterant. Also known as brolamfetamine and bromo-DMA, DOB is a substituted amphetamine that has a different dose response curve than LSD. Specifically, DOB takes up to 6 hours to take full effect. Consequently, unsuspecting users, such as the campers, who believe they are taking LSD may re-dose after 3 hours (and accidentally overdose). Additionally, the amount of time it takes for the DOB effects to begin increases when used in conjunction with alcohol, which the campers drink throughout the movie.

Last week’s movie: Friday the 13th (1980)
Next week’s movie: The Blair Witch Project (1999)