Disney Plus Dream Job: 'Finding Nemo'

Introduction

Faculty, residents, and students at my university are participating in the Disney Plus Dream Job challenge to watch 30 Disney films in 30 days. Welcome to our Day 3 blog post!

The course directors have successfully incorporated the 30 films (and shows) into our preexisting curriculum that teaches psychiatry to future physicians through film and other aspects of popular culture. Views Through the Psychiatrist’s Lens will publish daily blogs throughout the Disney Plus Dream Job challenge. Our third blog is on the 2003 film Finding Nemo.

Synopsis

Finding Nemo is a 2003 computer-generated adventure comedy produced by Pixar Animation Studios and released by Walt Disney Pictures about an overprotective clownfish named Marlin who, along with Dory, searches for his abducted son, Nemo. As of this posting, the film holds a rating of 8.1 out of 10 on IMDb and a Tomatometer rating of 99 percent.

What it has to do with psychiatry

There are three teaching objectives inspired by the film that we’ll review in the sequence illustrated in the teaser image. Clockwise from “9:00,” they include the stories of Marlin, Bruce, and Dory.

Marlin: Adjustment Disorder

Adjustment Disorder is defined by behavioral symptoms that develop within three months of a stressor (DSM-5), such as being separated from your son. The symptoms do not persist beyond six months following the termination of the stressor and are not otherwise attributed to the direct physiologic effects of a substance or another medical or psychiatric condition, such as Major Depressive Disorder. Subtypes of Adjustment Disorder may be remembered by the acronym DAD and MUM (1):

Depressed mood. Symptoms mainly include feeling sad, tearful, and hopeless, and experiencing a lack of pleasure (anhedonia).

Anxiety. Symptoms mainly include nervousness, worry, and difficulty concentrating or remembering things.

Disturbance of conduct. Symptoms mainly involve behavioral problems.

Mixed anxiety and depressed mood. Symptoms include a combination of depression and anxiety.

Unspecified.

Mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety, as well as behavioral problems.

In Marlin’s case, the single best diagnosis appears to be an Adjustment Disorder with Mixed Anxiety and Depressed Mood.

Bruce: Alcohol Use Disorder

A five-year follow-up study of individuals afflicted with Adjustment Disorder revealed that 13 percent went on to meet a diagnosis for Major Depressive Disorder or Alcohol Use Disorder (2). The predictive factors of an adjustment disorder evolving to a major depressive episode include a past history of Major Depressive Disorder, limited social support, and maladaptive coping skills. Interestingly, one example of maladaptive coping is self-medicating with substances like blood alcohol, as demonstrated by Bruce.

Dory: Alcohol-Induced Blackouts

An alcohol-induced blackout results when a person is unable to form new memories due to deficits in registration (encoding new memories) while acutely intoxicated. A rapid increase in blood alcohol level (BAL) is most consistently associated with the likelihood of a blackout. However, not all individuals with a high BAL experience blackouts, underscoring the role genetic factors play in determining central nervous system vulnerability to the effects of alcohol (3).

While Marlin may be diagnosed with an Adjustment Disorder, Bruce (metaphorical) and Dory demonstrate behaviors that allow for discussion of substance use and cognitive deficits, respectively. The diagnoses discussed above do not minimize the broad differential diagnoses clinicians must investigate but otherwise serve to inform the general public about these common psychiatric conditions.