Throughout the movie, one can observe Nic’s substance use disorder wreck many of his relationships and cause his family high levels of anxiety and distress over his substance use. More specifically, Nic struggles earlier on in the movie with crystal meth, and later becomes addicted to heroin; at various points during the movie Nic could have been diagnosed with methamphetamine use disorder, opioid use disorder, or a combination of those two plus another one to two substance use disorders. This is typical for opioid use disorder because it is often comorbid with other substance use disorders. For the purpose of simplifying the analysis of this movie and Nic’s addictions, I will evaluate his prevalent opioid use disorder, which was the most dominant and damaging for himself and his family throughout the movie. There are 11 criteria that are used to evaluate and diagnose people who may have opioid use disorder in the DSM-V, as well as specification directions regarding their remission and therapy status if applicable (American Psychiatric Association [APA], 2013). First and foremost, for an individual to be diagnosed with opioid use disorder they must meet criterion A, which states, “a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within a 12-month period” (APA, 2013, p. 541). Nic meets all 11 criteria for opioid use disorder, and would be specified as either being in early or sustained remission, as well as being specified as either being in maintenance therapy or in a controlled environment depending on what part of the movie is being observed. Nic meeting all of the criteria means that he would be classified as having severe opioid use disorder. Criteria 1-4 consist of impaired control over substance use; criteria 5-7 consists of social impairments due to the substance use; criteria 8-9 consist of risky use of the substance; criteria 10-11 consist of pharmacological criteria, including withdrawal and tolerance (APA, 2013). In this specific clip Nic is clearly exhibiting some symptoms of early withdrawal. He is clearly in a state of agitation and is experiencing anxiety and restlessness, which are all early withdrawal symptoms of opioids. 

This movie and clip very accurately portrays the mental illness/psychological disorder of substance use disorder and opioid use disorder. There are ongoing conversations between Nic and his dad throughout the movie about his symptoms and why he is engaging in the addictive behavior. The clip gives insight into the dynamic Nic’s addiction has created with him and his father. There seems to be little trust left from Nic’s Dad towards Nic, even though it is evident that his dad loves him very much and wants the best for him. Substance use disorders have clear and active negative effects on the individual with the disorder, but it is important to remember how their family and friends are also affected. In this clip, Nic clearly presents some physical signs of opioid use disorder. His very pale skin, how underweight he appears to be, his constant moving around and apparent restlessness, and his regular itching are all indicative of him having recently used heroin and now going through early withdrawal when you have knowledge about his disorder and his past history. What I appreciate about this movie and clip when it comes to substance use disorder is that they do not romanticize it in any fashion and to any degree. Early on in the conversation in the clip Nic tells his Dad that he has been sober for five days, even though it is evident by his behavior that this is not true. He uses the lie of him being recently sober to try to manipulate his Dad for money so that he can "move to New York," even though it is obvious that he is only asking for the money in order to buy more heroin. If you would like to see more evidence of how predictable Nic's behavior had become with asking for money and lying about his sobriety I would recommend you watch the movie (it's on Amazon Prime Video for free)! In the clip alone, Nic meets six of the 11 criteria for opioid use disorder. The six criteria that he meets are: 2) There is a persistent desire or unsuccessful efforts to cut down or control opioid use; 3) A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects; 4) Craving, or a strong desire or urge to use opioids; 5) Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home; 6) Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids; 7) Important social, occupational, or recreational activities are given up or reduced because of opioids (APA, 2013, p. 541).

This clip does support some negative stereotypes about opioid use disorder because of how poorly the interaction went and how in the wrong Nic seems to be. One stereotype this clip supports is that people with opioid use disorder care little for other people that are supposedly important to them. For example, instead of engaging in conversation with his Dad about his family and what is going on with his two younger siblings when his Dad brings them up, he becomes immediately defensive and claims that his Dad is using them to make him feel guilty for "who he is." In some ways, this conversation perpetuates the stereotype that people with opioid use disorder will do anything they possibly can to continue their addiction, even if that includes pushing away the people that love them the most if those people attempt to inhibit their behavior in any way. While this stereotype can occasionally be true with certain people, there are also many people who actively struggle against their opioid use disorder and are much more welcoming to being challenged and encouraged by others throughout their battle with addiction. While there are certainly stereotypes that emerge and can be observed in this clip, I think that the movie does a fantastic job of accurately showing addiction and opioid use disorder and how they affect the individuals with the disorder and their families. 

Noting these songs, the one that I will analyze for this post is called Dry Year by Noah Gundersen. I think that this song does accurately depict major depressive disorder. Even though there are arguably no lines that explicitly describe depressive symptoms, the themes that are articulated in the lyrics circle around hopelessness, sadness, and despair. 

The DSM-V lays out the diagnostic criteria for major depressive disorder as such:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. 

Note: Do not include symptoms that are clearly attributable to another medical condition. 

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

In the song, I connected different parts of the lyrics to meeting criteria A1, A2, A4, A6, and A9, as well as criterion B and C. Noah begins the song with “There's a new day coming up over the east side. There's an unseasonable weight in the air. Hasn't rained here in a long time. It's been a real dry year.” Within the context of the song, these lyrics can be interpreted to be metaphorical in an emotional sense. Essentially, he is trying to convey that he has had a low and dull year that has been relatively void of happiness. I interpret these lyrics to also meet the A2 criterion because much of his life consists of a particular dryness or staleness. In my opinion, the lack of rain over the past year is a metaphor for the absence of positive qualities in his life, indicating that he has experienced reduced pleasure in many of his activities. This sentiment is also echoed in another part of the song where Noah says, “some days it feels like we're dreaming. Moving like shadows in a trance. Are these my feet going through the motions? Are these my feet attempting to dance?” I think these lyrics meet A2 and A6, as it seems Noah would like to be more upbeat and ‘alive’, yet feels as if simply mindlessly going through the motions using minimal effort is all that he can accomplish. The lyrics that I think are indicative of meeting criterion A9 occur during the musical climax of the song, in which Noah says “tell me where all of this is going to, going to” (x2). This lyric represents, in my opinion, suicidal ideation without a specific plan. I think it represents suicidal ideation without a specific plan because it directly follows a tirade within the song in which Noah talks about insecurity and how happy others seem compared to him. To follow this tirade with obvious feelings of hopelessness and despair is incredibly worrisome and something that I consider to be a red flag in regards of suicidal ideation. For criteria A1 and A4, the lyrics “All your failed attempts at inspirational speeches you give yourself at night when you can’t sleep,” seem to meet the insomnia description in A4. Furthermore, the themes that can be heard throughout the song clearly meet criterion A1. 

I think that this source describes the mental disorder in an interesting, albeit accurate way because a fair amount of how it is described is through metaphor. Facially, the song may not appear to accurately depict major depressive disorder, but I think when you put it under a microscope and interpret its metaphors and discern its thematic trends it becomes clear that this song does accurately depict this psychological disorder. The feelings of hopelessness that are clearly present throughout the duration of the song, as well as him crying out that he does not know what the point of his life seems to be, are themes often present for people with major depressive disorder. Furthermore, the last lyric of the same is Noah seemingly hoping that ‘mother earth’ will take back the water in his body when he is gone, indicating that while he does not seem to have a plane to commit suicide, there seems to be some intent to do so, i.e. suicidal ideation. Lastly, the themes of despair, fixating on insecurity and not being able to improve from them, a failure to motivate oneself, and a sense of existential dread are all often things experienced by individuals with major depressive disorder. 

The only stereotype that seems to emerge about this disorder in the lyrics is that people with major depressive disorder can be melodramatic. Other than this stereotype, I do not really observe any dominant attitudes or behaviors that negatively portray depression in a stereotypical way. 

For this post I decided to examine two characters in a show that I liked called shameless that are diagnosed with bipolar I disorder in the show. The characters names are Ian Gallagher and Monica Gallagher. One of the most memorable and monumental scenes from one of the earlier seasons in the show is when Monica Gallagher, the mother of the family whom the show follows, attempts to commit suicide in one of her depressive episodes. Monica had left the family many years ago in what is purported to be during one of her manic episodes when she ran off with another man. When she reemerges into the family’s life, it is clear that she is still relatively mentally unstable, although she claims that she has been mentally healthier since her diagnoses and being on consistent medication. 

A couple of seasons after their mother’s attempted suicide, Ian is diagnosed with bipolar disorder after he spontaneously decides to join the military and does not return to the family until he is discharged for impulsively leaving his post and disobeying orders at times. 

The DSM-V outlines criteria needed to diagnose someone with bipolar I disorder, in which an individual must meet associated criteria for experiencing a manic episode which is followed by either a hypomanic or major depressive episode. Here are the criteria for each:

Manic Episode 

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). 
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 

1. Inflated self-esteem or grandiosity. 

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 

3. More talkative than usual or pressure to keep talking. 

4. Flight of ideas or subjective experience that thoughts are racing. 

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puφoseless non-goal-directed activity). 

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). 

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. 

Hypomanie Episode 

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. 

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: 

1. Inflated self-esteem or grandiosity.

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 

3. More talkative than usual or pressure to keep talking. 

4. Flight of ideas or subjective experience that thoughts are racing. 

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. 

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). 

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. 

D. The disturbance in mood and the change in functioning are observable by others. 

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. 

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment). 

Major Depressive Episode 

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) 

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). 

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) 

4. Insomnia or hypersomnia nearly every day. 

5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down). 

6. Fatigue or loss of energy nearly every day. 

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or another medical condition.

I think that this show actually portrayes bipolar I disorder pretty well in both of the characters throughout the show. Another clip that I found that showed the disorder very well in live action, rather than through questioning by a mental health worker, was very vulgar and explicit so I did not attach it to this post; however, it showed that the family had a solid general understanding of some of the symptoms of bipolar I disorder because they were able to distinguish between manic and hypermanic and relate their mother's diagnosis and disorder to some of the symptoms that Ian was exhibiting.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical

condition.

In graphics one, two, and three, I think the article misrepresents how someone with SPD acts to a certain extent. According to the DSM-V and other articles I have read about SPD, the individual with the disorder will most likely not be antagonistic towards social relationships, but rather so apathetic and disinterested that others learn–for the most part–to not choose them as a friend. The first three graphics show someone who is more animus towards others, which I do not think is a completely accurate portrayal of someone with SPD, albeit the sentiment within each description of the first three graphics is accurately portraying SPD. On the flip side, graphics four, five, and six are very accurate portrayals of SPD, even though they are very short. Individuals with SPD choose to partake in solitary activities almost exclusively and have flat emotional affect. 
The one stereotype I think the article portrays is that people with SPD are typically more rude. This is not necessarily the case, although disinterest in social activity can occasionally be perceived as rudeness. Other than this slight misconception of SPD, I think the comic does a great job at briefly laying out and summarizing SPD. One thing that I wish the author would have been able to find a way to include would be the struggle with a sense of identity and self that individuals with SPD perpetually experience. I wish the author had included this because in virtually every case study example I have read about someone with SPD, there is a relative tension between feeling a lack of a sense of self and not understanding what a 'self' is even supposed to mean.