Psychological Conditions

There are many psychological disorders brought up in DM. OCD is the one that appears in two characters. In season 2, episode 5 Tricia Soames, a teacher Louisa has hired, shows signs of having OCD and eventually admits to DM that she has many of its symptoms. Then in season 6 Mike, the nanny, clearly exhibits typical traits of the disorder, e.g. excessive need for order, feeling unsettled if colors or pens are not lined up, etc. Although Martin is supposed to have Asperger’s, he appreciates Mike’s orderliness and has some signs of OCD as well. Asperger’s is often combined with some OCD traits and would also make it hard for anyone to have a close ongoing relationship (Note: I chose this particular performance because he does such a good job of beautifully describing what it’s like to have a severe case of OCD and also have a relationship.) OCD is often a method of managing feelings of anxiety and is listed under the constellation of anxiety disorders in the DSM IV (I haven’t seen the DSM V yet.) Whether Martin has Asperger’s was cleared up by Dominic Minghella on his own blog where he states that he intended Martin to have this affliction. The writers have done a good job of giving Martin many of the characteristics of Asperger’s. He has impairment of social interaction with a tendency to stiff body postures and facial expressions, very few peer relationships, lack of effort to share enjoyment, interests, or achievements with other people, and lack of social or emotional reciprocity. His keen interest in medicine as well as in clocks fits the criterion of abnormal intensity or focus on a particular activity. His intense interest in medicine makes him a fabulous doctor, but it also makes it harder for him to empathize with his patients. Added to these are Martin’s need to always wear a suit and tie no matter what he’s doing (except sleeping). Then there are his hyperosmia (or heightened sense of smell) and his clumsiness, both typical criteria. Of course, some of these behaviors are used for comedic value — it’s funny when Martin doesn’t understand how to react to what people say or when he doesn’t smile at anything or get jokes. It’s also funny when his height and clumsiness have him hitting his head on low door frames or ceilings, falling up or down stairs, tripping into gulleys or other natural settings, etc. I would also argue that his clumsiness makes him somewhat more endearing. It’s hard to be austere when you’re bumping into things and falling down regularly. None of the above actually keeps him from handling medical instruments dexterously or from kissing Louisa lovingly, or even from being sexually compatible with her. And he somehow manages to run down narrow streets with only rare moments of bumping into people or things along the way.

There are several other anxiety disorders presented in this series: hemaphobia, agoraphobia, panic disorders, trichophagia/trichotillomania (or hair eating and pulling), and PTSD. There are also a variety of methods of treatment mentioned for these, including cognitive behavior therapy, medications like Fluoxetine (better known as Prozac), and simply allowing the afflicted person to act out. Penhale has success with getting cognitive therapy for his agoraphobia, but Martin is only temporarily relieved of his hemaphobia by this therapeutic approach. We might think that Penhale is more open to any therapeutic approach and finds success as a result, while Martin is more conflicted about the efficacy of the treatment and whether he really wants to move to London and, therefore, the treatment isn’t as successful. Of course, no treatment works for every patient and it may be that the difference in outcomes is only because of that variability. (Mrs. Tishell has also been treated by cognitive behavior therapy and the rubber band she snaps on her wrist in series 6, episode 5 is a technique to pair a painful stimulus with being attracted to Martin. The fact that she has to snap it so often makes one wonder if the therapy hasn’t really been effective enough. Also, she has not voluntarily decided to do CBT and that markedly reduces the chances of its success.) CBT appears to be a popular treatment strategy in England and may be used more partially because it is less costly. (Just a guess.) Also, writer Julian Unthank sure knows a lot about CBT. Mrs. Tishell mentions guided discovery, validity testing, and keeping a diary – all methods used with CBT.

Ted’s trichophagia isn’t treated by any more than a possible procedure to remove the hair ball in his gut and moving to live with his daughter. Mrs. Cronk’s panic disorder is generally handled as hyperventilation and a personality quirk. And Stewart’s PTSD is accepted by the village and tolerated as understandable considering his military service. On the other hand, Dr. Dibbs treats her anxiety disorder with Fluoxetine, and that doesn’t seem to reduce her anxiety, but her condition is complicated by the fact that she has Cushing’s disease which can be accompanied by anxiety symptoms. In season 6, episode 4 we have Mr. Moysey and his hoarding due to depression but also the anxiety accompanying living on his own after many years of being taken care of by his wife. I know Ruth is quite perceptive when she tells Mr. Moysey that he probably started hoarding after he lost his wife and sister in one year and wanted to protect against any further loss by keeping everything. Nevertheless, I would postulate that he also has some anxiety issues. I should note that Ruth, as a psychiatrist who treats the criminally insane, would be accustomed to using psychotropic drugs. Criminals are not likely to be willing to undergo cognitive behavior therapy! Once again the inclusion of these anxiety disorders and the many forms of treatment is, to me, very insightful and demonstrates some in depth understanding of anxiety disorders by the writers.

Other psychological conditions mentioned in the first 5 series are psychoses either related to medication or genetic disease or poisoning, addiction (to gambling), hallucinations (probably due to Lyme disease and grief), bipolar disorder, and two hard to define but clearly abnormal behavior patterns. Mrs. Tishell brings on her psychotic break by taking a combination of medications, Mr. Strain the headmaster has porphyria which causes his psychotic break, and Mr. Coley has carbon monoxide poisoning that affects his ability to behave normally. Pauline falls victim to gambling and its addictive qualities. Mrs. Selkirk first appears to be suffering from hallucinations brought on by grief but actually has Lyme disease. Louisa’s father’s friend who ends up tying them all up and holding them at gunpoint is very unstable and clearly not taking his medication. His behavior is a pretty good example of what can happen when a manic-depressive has a manic episode and won’t take his Lithium. The two who are hard to pin down are Michael, the strange young man who steals Ruth’s hubcaps, and Victor Flint, the father who dresses like a woman and can be violent at times. They both have symptoms of mental disorders but their behaviors are not specific enough to clearly identify them. Victor’s symptoms are called a psychosis by Martin, but they appear to have elements of many different psychological disorders. It’s not really that important to pin it down exactly. Suffice it to say he’s got some mental derangement.

The plethora of psychological conditions in this show probably is representative of most locales. Mental disorders are surprisingly common in society. I don’t know exactly what’s in store for the final episodes of series 6, but I’d like to think that Louisa can be the sort of woman/wife who will recognize how to sympathetically deal with Martin’s continuing difficulties, especially his hemaphobia. As far as Mrs. Tishell, who knows? And nanny Mike is not likely to change much since his OCD doesn’t keep him from functioning well-at least so far.

Originally posted 2013-09-29 17:54:13.

3 thoughts on “Psychological Conditions

  1. Santa Traugott

    Series 6 had a big focus on Martin’s psychological (psychosomatic?) deterioration. Maybe it was the main focus. Do you feel that it was adequately explained? That is, I think many fans puzzle over what happened to him. Ruth’s pithy explanation that he felt he didn’t “deserve” Louisa and so pushed her away, or let his worries about imaginary physical issue sabotage his marriage, comes in quite late and to me, feels somewhat tacked on — as if they realized they had to say SOMETHING. It does make a certain sense, but it isn’t entirely persuasive to me.

    Many camera shots, and a few scenes, attempt to show us, I think, that he feels isolated, cramped, and assaulted by more disorder and more people around him, less control over his environment, than he has known or tolerated previously. One might argue that his way of dealing with all this was to turn inward and away from dealing with it, but at some psychological cost. His psychosomatic symptoms were expressing distress that he had no other way of expressing or dealing with.

    But that explanation means that we are left entirely on our own to sort out what might be going on with him. And Ruth’s summary in E8 doesn’t really fit with it.

    So, do we think that they showed or explained to us, in a plausible way, what happened to him? Should they have done more?

    (I myself think that they did enough, but there are many fans who are still mystified.)

  2. kjacobson@mindspring.com Post author

    S6 is strange in so many ways to me. We have to believe that the arc of the story was planned well ahead because they had two years to work on it. Therefore, even though MC got sick, they wouldn’t have changed the overall plan for the series. They might have adjusted some facets of a few episodes, but the overall arc must have been established. Based on what they’ve said in interviews, they decided to start the series with the wedding and get that out of the way. In my opinion that was how they had to start the series this time after the loving scene at the end of S5. Evidently the plan for the series was to start on a high note both with the relationship between M and L as well as with the humor in the show and then gradually have the marriage and the humor deteriorate. In my mind there is a possibility that MC wanted to showcase his dramatic skills as an actor even at the expense of taking the show in such a serious direction. And, from my point of view, they went too far and did not give the audience much to go on. We are fairly sure that they like to leave many things ambiguous. Ambiguity leads to speculation amongst viewers, which is great for ratings, and reflects real life, which doesn’t always give us clear reasons for how we react.

    I agree with everything you say in your second paragraph and would only add that we have wondered previously if his blood phobia was just never adequately addressed. He appears over it at the outset of S6, but maybe there were residual aspects that remained in his psyche and still needed to be grappled with.

    There is always the possibility that the writers, et. al. were uncertain themselves what to attribute his tailspin to and decided to leave it unexplained because they hadn’t come up with their own strong convictions about it.

    For me S6 was so different from the first 5 that it seemed like they lost their way in an effort to get too dramatic. As I’ve said ad nauseum, I missed the awkward moments, the humor from and between M and L, and the moments of tenderness between these two. When there are only 8 episodes and they try to cram so much downward spiral into such a short span of time, it leaves very little room for good explanations or even convincing evidence to back up the storyline. I think you once speculated that they had always planned to do another series. That’s the best justification for how they handled S6 I can think of. If they had that plan, S7 will provide some sense of how things got derailed so fast.

  3. Amy

    To answer (over two years later) Santa’s question, I for one was totally mystified by Martin’s behavior in S6 when I first watched that series. I had no clue why he was withdrawing from Louisa. I am sure I was reacting much as the character (Louisa) was reacting: confused, annoyed, and ultimately exasperated by him. So no, I don’t think they did a good job of laying the foundation for what was wrong with him or what had set him on that downward spiral. Since he was no longer going back to surgery or London, it didn’t make sense that the return of the hemophobia would get him so depressed. (I also never saw it as gone, so that also made that plot explanation unsatisfying.) If they’d had the behavior start when his mother appeared in E6, then that might have made sense. But it started in E3.

    On rewatching the episodes, I looked more carefully for the clues for his downward spiral. I still think that there was no clear foundation to explain what was going on. That is, even in retrospect knowing what was going to happen, it still doesn’t hold together for me.

    If Martin was supposed to have Asperger’s, then the current writers must have abandoned that as one of his afflictions. It never comes up with Dr T, whereas OCD is mentioned as are hemophobia and failure to attach. Martin rejects it out of hand in S3 when the annoying psychologist neighbor of Louisa mentions it; he would certainly know if he had Asperger’s and would not have denied it. And even in S1 (perhaps especially in S1) which was written by Minghella, Martin is capable of empathy and steps in to help people solve their personal problems—Bert and Al, the colonel and his wife, and Elaine and her father, three situations where there were no medical issues at all, just interpersonal issues. So if Minghella intended for him to have Asperger’s, he didn’t do a great job in S1 of conveying the symptoms, and the writers who followed him seem to have abandoned that diagnosis.

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