Disney Plus Dream Job: 'Beauty and the Beast'

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. This blog is day 2! Course directors 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 second blog is on the 1991 film, Beauty and the Beast.

Synopsis

Beauty and the Beast is a 1991 animated Disney classic based on the French fairytale of the same name by Jeanne-Marie Leprince de Beaumont. The film is about a prince who is magically transformed into a beast as punishment for his arrogance and Belle, a young woman whom he imprisons in his castle (1).

What it has to do with psychiatry

If we take the prince-turned-beast’s talking to cups, pots, and candelabras as his attending to perceptual disturbances, the film then demonstrates psychosis in its main character: specifically, alcohol-related psychosis.

There are three primary mechanisms where alcohol can induce psychotic features.

We’ll examine these potential etiologies to investigate what truly afflicts the arrogant prince.

1. Alcohol Intoxication

Acute intoxication from liquor that has a high alcohol by volume (proof) may induce psychotic symptoms, such as hallucinations and delusions. Might then the eponymous beast be a reimagined Mr. Hyde? If so, we would expect to observe additional signs of alcohol intoxication in the film.

To this end, the beast does demonstrate an unsteady gait. Since Alcohol Intoxication (AI) is defined as clinically significant maladaptive behavioral or psychological changes that develop during or shortly after alcohol ingestion as evidenced by at least one sign, his ataxia alone may be indicative of AI. This is admittedly a low threshold, so we’ll continue to explore other clinical possibilities.

2. Alcohol Withdrawal

Individuals who stop drinking (e.g., if they stop drinking abruptly, and especially if alcohol use had been heavy and prolonged) are at risk to develop alcohol withdrawal. The Alcohol Withdrawal Syndrome (AWS) can be uncomplicated or complicated.

Complicated withdrawal states include two that are characterized by psychosis: Alcohol Withdrawal Delirium (formerly known as Delirium Tremens or DTs) and Alcoholic Hallucinosis. While the former is characterized by acute confusion and clouding of consciousness, the latter predominantly manifests as auditory hallucinations, but visual hallucinations may occur. In either case, these complicated states of alcohol withdrawal confer a risk of death in about 5 percent of cases. Since the beast does not appear confused, his perceptual disturbances may be due to a rare case of Alcoholic Hallucinosis.

3. Wernicke-Korsakoff syndrome

Also known as “dry beriberi,” Wernicke-Korsakoff syndrome is a neurological syndrome caused by thiamine (B1) deficiency, often due to chronic alcohol ingestion. In later stages (called Korsakoff psychosis), individuals may experience hallucinations and delusions. This condition is a late manifestation of chronic alcohol use, and unlike the above scenarios, affected individuals do not have to be actively drinking in order to experience psychosis. In addition to perceptual disturbances, Korsakoff psychosis is hallmarked by amnesia and confabulation. In the film, the young prince’s age is inconsistent with someone afflicted with Korsakoff psychosis.

With Beauty and the Beast viewed as a fictional case account of Alcohol Use Disorder, there are three scenarios where his psychotic symptoms may be attributed to the underlying substance use disorder. Of these, the complicated withdrawal syndrome of Alcoholic Hallucinosis appears to be the most likely. It should be no surprise then that Walt Disney Productions has given us the DSM-5 criteria for Alcohol Withdrawal:

(a) Blood pressure and pulse elevations

(b) Emesis or nausea

(c, d) Anxiety; Agitation

(e, f) Seizures; Sleep disturbance

(g, h) Transient visual, tactile, or auditory hallucinations or illusions; Tremor