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Tuesday, April 19, 2011

Movies & Madness Treatment Tuesday: Lars and the Real Girl

I still have an empty queue, although several little birds have told me some are on the way. :) So until then, another movie review! When Lars and the Real Girl came out in 2007, my husband and I thought it one of the most bizarre we'd ever seen. Here's a brief synopsis:

Lars Lindstrom is a loveable introvert whose emotional baggage has kept him from fully embracing life. After years of what is almost solitude, he invites Bianca, a friend he met on the internet to visit him. He introduces Bianca to his brother Gus and his wife Karen and they are stunned. They don't know what to say to Lars or Bianca--because she is a life-size doll, not a real person and he is treating her as though she is alive. They consult the family doctor Dagmar who explains this is a delusion he's created--for what reason she doesn't yet know but they should all go along with it. What follows is an emotional journey for Lars and the people around him.

Lars is diagnosed in the movie by a family doctor/psychologist as having a delusional disorder. In my world, a delusion is defined as a fixed false belief. For a diagnosis to be made, the person has to 1) experience the delusion for at least a month, 2) can't experience them a direct result of being under the influence of a substance. The other requirement is 3) that the person's behavior not be odd or bizarre apart from the delusion. Lars actually manages to support himself by going to work, attending church, etc., so he meets all these qualifications.

The delusion Lars suffers from is "non-bizarre," that is, it could be plausible, as opposed to bizarre. While we might all think Lars is off his rocker, his frame of mind around Bianca as his girlfriend is logical, other than being based on an improbable foundation. 

Let's look at Lars most closely. He's socially inept but very sweet and likable. He runs from his interested co-worker Margo, doesn't like to be touched, and is basically happy living in the converted garage of the house he and his married brother inherited from his father. When Lars announces that he's met a wheelchair-bound missionary on the Internet, he introduces Bianca, a RealDoll sex doll (who he shows no sexual interest in at all). They convince him to take Bianca in to the doctor in order to get Lars' mental health checked out. Funnily enough, the doctor diagnoses Bianca with "low blood pressure," and advises Lars to bring her in weekly for treatments (pretty dang slick of the gal).

The townspeople accept Bianca as a real woman because they love Lars. If it wasn't so crazy, it would actually be quite touching. As a result, Lars becomes more social. He still meets with the doctor weekly, and his painful past becomes apparent in that his father changed and became very distant when his mother died (as a result of giving birth to Lars). The viewer can even see that Lars still carries a baby blanket around with him....clearly he isn't okay.


Eventually, Lars' delusional dependence on Bianca as an emotional crutch dissipates. Margo had begun to date another guy, and this bothered Lars. He comforts her when they break up, and even touches her hand without his gloves on, which is very symbolic. By the end of the movie, Lars had broken up the delusion in his own time in his own way (Bianca is "unresponsive" one morning and has to be taken to the doctor...eventually she "dies"). At her funeral, Margo and he seem to be connecting on a deeper level.

As crazy as this flick was, Ryan Gosling did a great job acting. He had several scenes alone with a non-responsive sex doll. I mean, how hard would that be to do and not crack up?

But it does show the way a delusional disorder check it out.

Wordle: signature


A.M. Guynes/Annikka Woods said...

Hey Jeannie. This is very interesting. I haven't seen this movie but I think now I want to. It doesn't sound like it's usual fare for me but I'm still curious.

By the way, I gave you a blog award!

Anonymous said...

I'm having a difficult time agreeing that his delusion is non-bizarre. The doll is an inanimate object and could therefore never be "real" or alive as Lars believes her to be. Because of this, he could not have Delusional Disorder and the delusion would be a symptom of something else.

Jeannie Campbell, LMFT said...

to a person not in the field, i totally understand why you are saying what you are saying, anonymous. of course it seems bizarre that he's carrying this doll around and treating her like a human. but according to the definitions given above, he actually does fit into the non-bizarre category. for an example of bizarre, it would be belief that aliens had inserted a probe in your body or something like that. i hope that clarifies it a bit. :)

Anonymous said...

Actually, I am in the field. I am a Licensed Professional Counselor. My training and experience does not allow me to believe in the plausibility of this object being a living human being. I have worked with many clients that have Schizophrenia and other psychotic disorders. To me, non-bizarre refers to things that could actually happen in real life, ie being followed by someone, or being poisoned by someone. In no way could this doll be alive. I would, however, welcome more thoughts on this.

Jeannie Campbell, LMFT said...

I really appreciate the the interaction on my blog from other professionals, so thanks for that. I see your point that in no way could Bianca be real. I looked up some definitions of non-bizarre delusions and I'm now inclined to think you're right.

Would you be more comfortable with a diagnosis like schizophrenia? Lars did have significant social dysfunction, and the delusion about Bianca. Would you say that he had alogia/poverty of speech? I didn't get the sense that he really had any other traditional negative symptoms, and he'd have to have at least one more symptom to fit that criteria. I would not say that he had a severe mood disorder with delusions. Doesn't fit schizoaffective. What are you thinking?

Anonymous said...

Based on the film's indication that the delusion resolved within the course of the film (I'm guessing less than 5 months based on season change and progression of sister-in-law's pregnancy), I am leaning more toward Schizophreniform. I may even consider Schizoid Personality Disorder since his relational detachment and other behaviors seemed to already be in place as the movie began.
I agree that he probably did not have Schizophrenia, however, with a bizarre delusion he would only have to have one criterion for section A. I didn't see that he had that level of impairment though, especially since he made so much progress throughout the film. Thoughts?
I appreciate your blog and the light you are shedding on our field. I think it helps dispel some of the negative stereotypes about mental illness at the same time educating people on the complexity of the human mind. Thanks!

Jeannie Campbell, LMFT said...

i'd be more apt to go with schizophreniform with good prognostic features, given that schizoid would be much more pervasive, lifelong type of disorder. lars seemed to be emerging a bit from his isolated cocoon by the end of the movie.

thanks for your kind words and for your professional interaction! i don't get much of that, and i oh-so-enjoy it. :)

Anonymous said...

Funny cause I'm doing a mock intake assessment on Lars for my psychodiagnosis class. I watched it with 5 other students and we couldn't all agree. Most chose delusional disorder. My issue was the "non-bizarre" criteria and then that he seemed to have social issues before the delusion and could still have them after the delusion. Could there be both an Axis I and Axis II diagnosis? Why would it not be a personality disorder? Im wondering about an Axis I Schizophreniform with Good Prognostic and/or an Axis II Schizoid Personality Disorder(Premorbid) diagnosis or something. Basically I think his social behavior and seemingly flattened affectivity before the delusion need to be accounted for. Blessings!!

mink787 said...

Anonymous, it could very well be the case that Lars could be suffering from several disorders. In my opinion and based on what I saw in the film, Lars could be diagnosed with Schizoid Personality Disorder. Additionally, based on his delusion which is in fact a bizarre delusion, I would suggest that Lars could have a Psychotic Disorder NOS (not otherwise specified), as he does not formally suit the criteria for Delusional Disorder.

Ana said...


Wait for DSM-5 and you'll find the perfect diagnosis and the pills to treat Lars.

I'm glad that Lars didn't find a psychiatrist and found someone who can see beyond the labels, check-list diagnosis and all the paraphernalia psychiatrists have to prescribe in 15 minutes their pills.

The support from his family and the town is touching.

Unfortunately Lars in real life are taking cocktails of psychiatric drugs that only make them worse.

The side effects are terrible and add more problems to those who need help.

In the end after taking all the drugs available on the market they are prescribed ECT.

The good news is that some of them recover or reach a balance.

Iatrogenesis is the third cause of death in America.
Psychiatric drugs are among them and most of them should be out of the market.


The withdrawal process of some of them is painful and long.

Anonymous said...

I am writing a psych paper on this movie, and I am using the DSM V. I did say that he had a delusional disorder because of the presence of his delusion (relationship with Bianca) and because it lasts for longer than one month. He does present hallucinations, auditory hallucinations specifically because he is having conversations back and forth with Bianca. In addition, he doesn't present impaired functioning in his everyday life. He goes to work and other social contexts as he normally would. This delusion is also not a direct result of a substance.
DSM V also has different subtypes for the delusion. I chose erotomanic type because this subtype applies to individuals who are in love with another.

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.