March2Madness: Carrie

Introduction

I provide an annual didactic at Rutgers Robert Wood Johnson Medical school called “March 2 Madness” where participants pick the winners of head-to-head match-ups from a 64-team bracket that parallels the NCAA Division I Men's Basketball Tournament (March Madness). We have replaced the 64 basketball teams with our field of 64 of the top monsters in movie history. During each round of the NCAA Basketball Tourney, we post our corresponding regional match-ups for learners to select the winner over Twitter Poll or on my website (see my profile for more details). Those who vote on the website can click on the monster to access a pdf that relates the film to the field of psychiatry. After each round, I choose a Most Valuable Pariah (MVP); a profile of one of the "monsters" who have been eliminated. The following post is a blog on the MVP from the round of 32 (second round).

Synopsis

The original adaption (1976) of Stephen King’s novel depicts a misfit high school girl, Carrie White, who discovers that she has telekinetic powers. Repressed by a domineering mother and bullied by her peers at school, her efforts to fit in lead to a dramatic confrontation at the senior prom. [Spoiler alert] Following a mass murder in the high school gymnasium, Carrie breaks down in her mother's arms at home; longing for the empathy she’s searched for throughout her childhood.

How it relates to the field of psychiatry

The Feeding and Eating Disorder section of the DSM-5 includes feeding and eating disorders of infancy and early childhood as well as three specific diagnoses including Anorexia Nervosa and Bulimia Nervosa. The dissemination of preliminary criteria for Binge Eating Disorder (Ap­pendix B of DSM-IV) was followed by research that supported the clinical utility and its subsequent inclusion in the DSM-5.

Films that depict possession serve as a metaphor for dissociation. Accordingly, these films may be viewed as illustrations of mental disorders including dissociative and related disorders such as feeding and eating disorders. Anorexia Nervosa (AN) is a mental disorder characterized by a fear of gaining weight despite being underweight (BMI < 17.5).

Relating Carrie to Eating Disorder Criteria

Source: Anthony Tobia, MD

AN may be conceptualized in psychodynamic terms as a reaction to the demand that adolescents behave more independently and increase their sexual functioning. Patients then replace preoccupations about eating for these other age-specific pursuits.

A character analysis of Carrie reveals an adolescent who is unable to separate psychologically from her mother. Her body is perceived as possessed by an introject of an intrusive, domineering, and unempathic mother. Starvation serves as an unconscious means of destroying the internalized mother-object. The tension between Carrie and her mother is evident throughout the movie and begins to crescendo right before the senior prom. As Carrie gets ready for the evening, her mother tells her that everyone will laugh at her. Despite this, Carrie defies her mother, leaving with her boyfriend, Tommy. In the movie’s penultimate scene, Carrie kills her mother in the kitchen by impaling her with knives, an act symbolic of her unconscious wish to destroy her intrusive mother. The setting (kitchen) and means (cutlery) are metaphorical for Anorexia Nervosa.