Portrayal of mental health in
popular culture

 

Introduction

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The
following paper shall examine how correctly a mental health disorder is
portrayed in popular culture, in this case, American television culture. Using
an example from US broadcaster Showtime’s
hit TV-series Shameless, the
discussion will aim to contrast main character Lip’s addiction to alcohol with
a framework developed by real-world experts, relating the symptoms and
aetiology of alcoholism to those portrayed in the show. Additionally, a comparison
between fictional and real-world cause and maintenance of the disorder shall be
made and finally a critique of  the
character’s treatment whilst being compared to a selected real world treatment.
This method shall lead to an overall critique of how well Showtime portrays the mental health disorder of addiction.

 

Character
& Disorder

In its
most general terms, addiction is the physical or mental state of being
dependent on a substance or activity. In psychological terms, addiction is a
mental health disorder in which the individual has irresistible and uncontrollable
urges to receive rewarding stimuli via a substance or activity, regardless of
any potential negative consequences. In our example the individual, Phillip
Gallagher, (referred to in Shameless as
Lip) is addicted to the substance of alcohol. Alcohol addiction, or alcoholism,
is an umbrella term for a drug addiction in which the use of alcohol causes
physical or mental health issues.

 

Framework

The
framework to be examined is George F. Koob’s “Alcohol addiction as a reward
deficit disorder”.  The framework
essentially explains that some individuals may have a disorder in which the
reward areas of the brain fail to reward regularly or effectively enough. Part
of the framework explains that some individuals are born with a disorder which
means much of life is not as thrilling or exciting as those with fully
functional reward systems.

 

Koob continues, stating that highly
addictive activities like use of drugs and gambling are the only
“rewards” effective enough to pleasure individuals with a reward
deficit disorder. This basic lack of a rewarding system is what leads to
addiction, Koob explains. Whilst living with a lowered neurological ability to
reward oneself, Koob hypothesises the ultra-pleasurable activities (gambling
and drinking) are the only solution to rewards when negative emotions are experienced. Individuals will therefore
negatively reinforce themselves to drink, as alcohol helps remove negative
emotions like stress, shame and hopelessness that arise through limited neurological
reward. Therefore, after multiple cycles of this process, the individual learns
that the negative phase is always associated with no alcohol, that is, being
sober. Therefore, sobriety is now the reason for negative emotions and hence
needs to be avoided via the pleasure that alcohol provides. Effectively at this
point, individuals can be deemed addicted. Addiction in the case is in essence
“learned behaviour to avoid discomfort”.

 

Cause &
Maintenance

Contrasting
this framework to the scenario in Shameless,
it would appear Showtime have
portrayed this limited reward disorder particularly well, regardless of
intention.

 

Prior to
his addiction, Lip initially constantly expresses his negative feelings of
uselessness and stress, growing up in a poor region of Chicago with no mother
and an alcoholic father.

 

It is
these poor environmental factors, along with the expression of a lack of intrinsic
reward, that prompts Lip to remove these negative stimuli through alcohol. As
the process of living in this environment is almost never-ending for Lip, the
drinking cycle continues and addiction comes into play. This is also reinforced
where Lip quotes: “I drink to numb the feeling”, suggesting he experiences a
lot of negative emotion, which works in line with Koob’s hypothesis.

 

Additionally,
there is also a scientific theory that the gene associated with determining the
effectiveness of the brain reward centre is passed down in alleles from one
generation to another. Coincidence or not, this would also fit in line with Shameless’s depiction – Lip’s father is
also an alcoholic – perhaps he experiences the reward deficiency disorder also.

 

Symptoms

Taking alcohol
dependency symptoms from the Diagnostic
and Statistical Manual of the American Psychiatric Association, Koob
explains those addicted to alcohol will
chronically and compulsively seek to take the drug, followed by a loss in control
of limiting intake, with the final stage being the individual emerging in a
negative emotional state when access to alcohol is prevented or limited. It
appears that Showtime’s portrayal of
alcohol addiction fits with these symptoms then. Lip will first seek to
purchase/access alcohol regularly, nor decline the offer to drink. Secondly, Lip
will lose control limiting his intake – depicted by the numerous scenes of
vomiting and unconsciousness – indicating an inability to stop drinking.
Finally, Lip will demonstrate often violent, self-destructive behaviour when
access to alcohol is prevented, running in accordance with the definition
provided by the Diagnostic and
Statistical Manual and Koob’s framework.

 

Treatment

As the
storyline develops and Lip has repeated enough cycles to be declared an alcohol
addict, he is made to attend a sobriety school in order to stop his initial
repetitive drinking. This would satisfy Koob’s theory that addiction is caused
by a repetitive negatively reinforced cycle, where this cycle needs to be
stopped in order to prevent addiction. This form of treatment would initially
help Lip to understand that feeling sober is normal, and help break his learned
behaviour and belief that being sober is associated with negative emotions,
preventing his motivation to drink in order to escape these negative emotions.

 

Lip’s
next stage in treatment works with Koob’s idea that the reward centre needs to
be stimulated in order to prevent negative emotions being experienced. Lip is
told to find a sponsor who is also dealing from addiction, who in turn teaches
Lip to look for alternate forms of reward. Whilst Koob explains that drug use
and gambling are the most pleasurable forms of reward, excessive amounts of
basic human needs (food, water, socialisation) can act as an alternate. Lip
essentially aims to replace the pleasure of alcohol with repeated use of basic
human needs, in order to desensitise his need for a greater reward (in this
case the removal of negative emotions through the medium of alcohol). The basic
human needs Lip aims to utilise to excess include food, socialisation and a
vocation. During his recovery, Lip is forced by his sponsor to consume high-calorie
sugary meals, fix motorcycles as a long-term hobby and run long distances.
Respectively, Lip undertakes these activities in order to provoke the rewarding
hormones that are induced by high-calorie eating, goal accomplishment and exercise.
It seems then that Shameless has portrayed
treatment in a way that would align with the disorder described by Koob.

 

Conclusion

It should
be noted there are many other frameworks, theories and approaches for
explaining alcoholism, and whether it is a correct hypothesis or not, it is
simply Koob’s framework of reward deficit disorder that aligns best with Showtime’s depiction of Lip’s alcohol addiction.

 

Overall,
it can be said the Showtime’s
depiction of addiction through their character Phillip Gallagher is a sound
one. Showtime correctly portray
Phillip’s symptoms, causes and treatment with those explained by George F. Koob’s
“reward deficiency disorder”.