1

VISION
A premier university in historic
Cavite recognized for
excellence in the development
of morally upright and globally
competitive individuals.
MISSION
Cavite State University shall provide
excellent, equitable and relevant
educational opportunities in the arts,
science and technology through
quality instruction and relevant
research and development activities.
It shall produce professional, skilled
and morally upright individuals for
global competitiveness.



Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite


College of Nursing

MOVIE ANALYSIS
Of
The ward

Submitted by:
Jenivic E. Puedan
BSN 3-1
Submitted to:
Mr. Rolando Antonio RN, MAN

Date:
March 05, 2014
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The ward
(Psychological Horror Film)
Multiple personality
disorder (MPD) now known
as DISSOCIATIVE IDENTITY
DISORDER (DID)
Personality 1: Emily The Id
Personality 2: Iris The Artist
Personality 3: Sarah- The Seductress
Personality 4: Tammy The Agressor
Personality 5: Zoey The Infant
Personality 6: Kristen The Protector, Survivor, Intelligent, Highly Aggressive
Construct

Directed by: John Carpenter
Year: 2010 | Duration: 88 min
Genre: Horror, Thriller
Starring: Amber Heard, Mamie Gummer, Danielle Panabaker



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Table of Contents

I. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
II. SYNOPSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
III. MOVIE CHARACTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
IV. PSYCHODYNAMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
V. PSYCHOPATHOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
VI. MEDICAL MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
VII. ROLES OF THE NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
VIII. IMLPICATION IN THE MOVIE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
To you as a future nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
To the nursing service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
To the community/public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
To the nursing education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
To the researchers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28





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INTRODUCTION
The Ward is a 2010 American psychological horror film directed by John Carpenter. It stars
Amber Heard, Mamie Gummer, Danielle Panabaker and Jared Harris. It is Carpenter's first full-
length feature film since Ghosts of Mars in 2001.
The Ward was a movie that talked about Alice who was suffering from Multiple
Personality Disorder (MPD). The movie begun with a young lady-Kristen that caught by polices
after burning down an old farmhouse and then was sent and locked in the North Bend Psychiatric
Hospital. At there, Kristen met Dr. Gerald Stringer-a psychiatrist and also Emily, Sarah, Zoey and
Iris-other personalities. After some procedure of body checking, Kristen was put into a room that
belonged to Tammy-a personality that already disappeared on the night before Kristen came; in
that room, Kristen found some uncombined bracelets pieces with alphabet on them but Kristen
could not solve the combination until she met Alice Leigh Hudson- the original personality. The
bracelet was belonged to Alice. After that, all personalities were disappeared or killed by Alice
one by one and Kristen was trying so hard to run away from being killed; so, she seeks help from
Dr. Gerald Stringer. Dr. Stringer told Kristen the truth that she was one of the personalities of
Alice as Alice was suffering from DID due to her sexually abuse experiences where she was
kidnapped by a stranger and imprisoned in the farmhouse that Kristen burned down and was
raped by the kidnapper for 2 years during her childhood (Carvalho, 2010). At the end of the
movie, Kristen disappeared and Alice was fully recovered from DID but
DID was a psychological disorder where the patient will have at least two identities that take turn
to control the patients behavior (Barlow & Durand, 2009).

For horror fans, it's best to look at The Ward as a slasher with a mystery element than as a
scary ghost story, because as a haunted house (or hospital) pic, the scares are so limp and matter
of fact, you start to wonder if you missed something. It certainly lacks a Carpenter-esque flair,
without the sense of foreboding that made for such delicious atmosphere in films like Halloween,
The Thing, The Fog and Prince of Darkness. Scenes just end without any sense of drama or tension
or any sort of "button" to wrap them up.

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SYNOPSIS
At the North Bend Psychiatric Hospital in 1966, a young patient named Tammy is attacked
and killed by an unseen force during the night.

The next day, Kristen (Amber Heard), a beautiful but troubled young woman, finds
herself bruised and cut, whilst setting fire to an abandoned farmhouse. The local police find her
and take her to the psychiatric hospital.

She is taken to the ward where she meets the other patients that reside there, Iris (Lyndsy
Fonseca), Sarah (Danielle Panabaker), Emily (Mamie Gummer), and Zoey (Laura Leigh). She is
given Tammy's old room and is given medication so that she can rest for the night. While Kristen
sleeps, her blanket is mysteriously pulled under the bed. Waking up to retrieve her blanket,
Kristen finds a broken charm bracelet.

The next morning, she meets Dr Stringer (Jared Harris). In his office, Dr Stringer tells
Kristen that she had the address of the farmhouse written on her hand and asks about the fire
and what she remembers. Kristen is unable recall anything and insists that she is not crazy. Later
that night, she attempts to escape only to be caught by one of the orderlies and returned to her
cell. Waking up in the middle of the night, Kristen catches a glimpse of a horribly disfigured figure
who was staring at her through her door window.

While in the courtyard with Iris and Emily, Kristen sees two people looking at her from Dr
Stringer's office. The girls give no clue as to who they are, only to tell Kristen that they have been
there before many times. Whilst taking a shower, Kristen is suddenly attacked by the disfigured
figure. However, upon telling the nurse this, she is drugged and put through intense electroshock
therapy.


Dr Stringer runs a therapy session with all of the girls, where Tammy's existence is briefly
mentioned but quickly dismissed. Iris attends her last therapy session with Dr Stringer where he
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uses hypnotherapy to unlock Iris' hidden memories. After the session, Iris is kidnapped and killed
by the disfigured figure.

Kristen, concerned about Iris, confronts the girls and staff about her disappearance but
everybody keeps quiet. Kristen finds Iris' sketchbook and looks through all of the drawings to find
a picture of a girl named Alice and another picture of the ghostly figure that had attacked her
previously, with the name Alice Hudson at the top of its page. Retrieving the broken bracelet,
Kristen pieces together the letters, which spells out the name "ALICE".

Kristen confronts Dr Stringer and tries to convince him that the ghost of Alice Hudson is
haunting the girls. Dr Stringer denies the existence of a ghost and cryptically tells her that she
needs to find the answers out for herself. Kristen confronts the girls about Alice where Emily
confesses that Alice was once a patient at the hospital but that she got out. That night, Kristen
and Emily attempt to escape the ward. Their escape is discovered and the alarm is raised. Kristen
makes it to the front entrance of the hospital but Alice's ghost appears in front of her, causing her
to fall over in fright. Kristen blacks out and awakens back in her room the next morning. It is
revealed that Emily was caught by the orderlies during the escape.

On her way to her final appointment with Dr Stringer, Sarah is attacked and killed by
Alice's ghost. Kristen finds out from Zoey and Emily that all of the girls killed Alice Hudson because
she did bad things to them all and her ghost is now after them for revenge. Emily breaks down
and, with the help of Alice's ghost, commits suicide. Kristen plans a last ditch attempt to escape
by holding Zoey hostage. Her attempt is thwarted by an orderly and Dr Stringer. Kristen is drugged
and placed in a straitjacket inside her room. However, she manages to escape and takes Zoey with
her. They are both pursued by the orderlies and the ghost throughout the hospital. Zoey is
captured by the ghost in a service lift.

After pursuing Kristen through Dr Stringer's office, Kristen manages to kill the ghost.
Returning the the office to look for Zoey, Kristen finds a file on Alice Hudson, which details her
treatments and all of the girls names, including Kristen's.

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Dr Stringer enters and reveals the truth to Kristen: Her real name is Alice Hudson.
Throughout the film, various flashbacks are shown of a young girl in chains, about to be abused by
an unknown man. It is revealed that the girl in the flashback is Alice herself, who was kidnapped
from her home 8 years previously. Alice was left chained up for months in the basement of the
same farmhouse "Kristen" had burned down. It is then revealed that Alice is suffering from
multiple personality disorder, creating Zoey, Sarah, Iris and Emily. Over time Alice's own
personality became so overwhelmed by that of the others that she became lost. Through
experimental techniques, Dr Stringer explains that her treatments were working until "Kristen"
appeared. "Kristen" is yet another invention of Alice's mind to protect itself from reliving the
trauma at the farmhouse. Dr Stringer had used hypnotherapy in an attempt to reawaken Alice's
memories. After this revelation, Alice's ghost reappears and throws herself and "Kristen" out of
the window, reawakening Alice.

It is revealed that the people who were looking at "Kristen" earlier were in fact Alice's
parents and have come to take her home under supervision. After gathering her belongings, Alice
takes one last look around her room. Upon opening her wall cabinet, "Kristen" suddenly comes
out and attacks her.








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Movie Characters
Amber Heard Kristen, the main protagonist. A girl with no memories of her life but
the strong belief that she is not crazy. She feels the constant need to escape the ward no
matter the cost. She is the first in noticing the other girls are disappearing and that a
vengeful ghost might be the one behind it.

Mamie Gummer Emily, She is tough and free-spirited but also the one who mostly
acts in wild, insane manner, annoys the other patients, and calls everyone crazy, which
often starts conflict among girls especially between her and Sarah. Initially, she tries to
intimidate and scare Kristen, but eventually, Kristen's strength makes her admire her. She
hides a guilty feeling inside her though it seems unlikely she will open to it.

Danielle Panabaker Sarah, a vain, beautiful redhead and the flirtatious one of the
group. She flirts with a male nurse but is turned down because she is a mental patient. She
often puts down the other girls through her snobbish and snooty disposition.

Laura Leigh Zoey, a girl who has suffered emotional trauma so severe that she keeps
acting and dressing like a little girl. She carries around a stuffed rabbit everywhere she
goes. She seems oppressed by the others due to her instant trust in Kristen.

Lyndsy Fonseca- Iris, artistically talented and prim and proper, she is the first of the
girls in befriending Kristen. She is nice and kind to everyone. She also carries a sketchbook
where she likes to draw. She seems to be the most aware of their situation in the ward
since she explains Kristen everything about their seclusion.

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Mika Boorem- Alice, a girl who used to be a patient at the ward but is nowhere to be
found anymore. Kristen tries to find out what happened to her during her time at the
Ward.

Sali Sayler as Tammy - a girl who disappears from the ward unexpectedly. Her
disappearance upsets the other girls. Her empty room is later occupied by Kristen. She is
the mastermind behind Alice's "death" at the hands of the girls.

Sydney Sweeney as a Young Alice, a young girl who Kristen sees in flashbacks, both
hands chained in a cellar. Nothing is really explained about her in the beginning.

Jared Harris as Dr. Stringer, the girls' psychiatrist. He seems hopeful in curing Kristen,
though his real intentions seem mysterious the whole time.

Dan Anderson Roy, the chief orderly at the ward. Serious and unpredictable, tries to
maintain order inside the ward. He is the main target of Sarah's flirting.

Susanna Burney as Nurse Lundt, the chief nurse at the ward. Tends to consider
Kristen a loose end, and constantly tries to act without the authority of Dr. Stringer.

Mark Chamberlin as Mr. Hudson, the sad man (as Emily describes him and his wife).
They constantly visit the ward and are often seen watching the girls from a window.

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Jillian Kramer as Monster Alice, the ghost responsible for the disappearances. Using
surgical tools as torture means on her victims. Not much is clear about her rather than the
fact that she is getting rid of the girls one by one.

















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PSYCHODYNAMICS
Abstract
Academic psychologists have moved away from psychoanalytic and psychodynamic
explanations of human functioning and pathology and have instead embraced neuropsychology
and cognitive science. This trend has kept many psychologists and researchers from more fully
understanding some of the important phenomena they chose to investigate. One area about
which psychologists can learn in the psychodynamic literature is multiple personality disorder
(MPD). A thorough knowledge of the psychodynamic perspective with regards to MPD is
important to all those in psychology who deal with MPD patients or who study the phenomenon.
By understanding the abuse most of these patients suffered and the resulting impact this has had
on their personality development, psychologists can begin to create effective and promising
assessment tools and intervention programs. In this article, I review MPD and its treatment from
a psychodynamic perspective in hopes that those in psychology (researchers and clinicians alike)
may benefit from such a discussion and will utilize this information in their attempts to
understand MPD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Introduction to Dissociative Identity Disorder (DID)
Dissociative Identity Disorder (DID) is a fascinating disorder that is probably the least extensively
studied and most debated psychiatric disorder in the history of diagnostic classification. There is
also notable lack of a consensus among mental health professionals regarding views on diagnosis
and treatment. In one study involving 425 doctoral-level clinicians, nearly one-third believed that
a diagnosis of Borderline Personality Disorder was more appropriate than DID. While most
psychologists demonstrated belief that DID is a valid diagnosis, 38% believed that DID either likely
or definitely could be created through the therapists influence, and 15% indicated that DID could
likely or definitely develop as a result of exposure to various forms of media (Cormier & Thelen,
1998).


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Dissociative Identity Disorder (DID), as defined by the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), is a mental condition whereby
a single individual evidences two or more distinct identities or personalities, each with its own
pattern of perceiving and interacting with the environment. The diagnosis requires that at least
two personalities routinely take control of the individual's behavior and that there is associated
memory loss that goes beyond normal forgetfulness, often referred to as losing time or acute
Dissociative Amnesia. The symptoms of DID must not be the direct result of substance abuse or a
more general medical condition in order to be diagnosed. DID was originally named Multiple
Personality Disorder (MPD), and, as referenced above, that name remains in the International
Statistical Classification of Diseases and Related Health Problems.

This condition is not an equivalent for schizophrenia (DSM-IV Schizophrenia and Other Psychotic
Disorders), as is a common misconception. The term schizophrenia comes from root words for
"split mind," but refers more to a fracture in the normal functioning of the brain than the
personality.
Dissociation is a demonstrated symptom of several psychiatric disorders, including Borderline
Personality Disorder (DSM-IV Personality Disorders 301.83), Post-traumatic stress disorder (DSM-
IV Anxiety Disorders 309.81), and Complex Post Traumatic Stress Disorder, to name a few.

As a diagnosis, DID remains controversial. For many years DID was regarded as a North
American phenomenon with the bulk of the literature still arising there. However, research
demonstrates a lack of consensus belief in the validity of DID amongst North American
psychiatrists. Practitioners who do accept DID as a valid disorder have produced an extensive
literature with some of the more recent papers originating outside North America. Criticism of the
diagnosis continues, with Piper and Merskey describing it as a culture bound and often iatrogenic
condition which they believe is in decline.
Client characteristics, course, & prognosis
The course and prognosis of untreated DID is uncertain, and for individuals with comorbid
disorders, prognosis is less favorable. Other factors influencing a poor prognosis include
remaining in abusive situations, involvement with criminal activity, substance abuse, eating
disorders, or antisocial personality features. Although DID occurs more frequently in the late
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adolescence or early adult age groups, the average age of diagnosis is thirty, with most diagnoses
occurring 5-10 years after the onset of symptoms. A risk factor involves having first-degree
relatives who have received diagnoses of DID (Kaplan & Sadock, 2008).
Risk factors
One study found that the risk of developing a dissociative disorder (DD) increased seven times
with a childs exposure to trauma. A later diagnosis of DD was twice as likely when the childs
mother had experienced trauma within two years of the childs birth (Pasquini, Liotti, Mazzotti,
Fassone, & Picardi et al. 2002). Dissociative Identity Disorder is linked to childhood abuse in 95-
98% of the cases (Korol, 2008). However, other factors in addition to a history of abuse, such as
disorganized or disoriented attachment style and a lack of social or familial support best predict
that an individual will develop DID (ibid).
Studies on genetic factors contributing to DID present mixed findings. However, one study
involving dyzogotic and monozygotic twins found that considerable variance in experiences of
pathological dissociation could be attributed to both shared and non-shared environmental
experiences, but heritability appeared to have no effect (Waller & Ross, 1997). Another study
utilizing objective ratings of dissociative behavior found that shared environmental factors had
little effect in both adopted siblings and twin pairs (Becker-Blease, et al, 2004). However,
dissociative behavioral correlations of r = 0.21 for fraternal twins and r = 0.60 for identical twins
suggests the presence of a genetic effect. As this study did not specifically investigate pathological
dissociation, more research is needed to determine if the genetic tendency to experience
dissociation varies according to type of dissociation (pathological or non-pathological), and
whether trauma influences the pathological development of a pre-existing tendency to dissociate.
Causes

Dissociative Identity Disorder (DID) is attributed to the interaction of overwhelming stress
(typically extreme mistreatment), insufficient nurturing and compassion in response to
overwhelmingly hurtful experiences during childhood, and dissociative capacity (ability to
uncouple one's memories, perceptions, or identity from conscious awareness).

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Children are not born with a sense of a unified identityit develops from many sources
and experiences. In overwhelmed children, many parts of what should have blended together
remain separate. Chronic and severe abuse (physical, sexual, or emotional) during childhood is
frequently reported by and documented in patients with dissociative identity disorder. Some
patients have not been abused but have experienced an important early loss (such as death of a
parent), serious medical illness, or other overwhelmingly stressful events.

In contrast to most children who achieve cohesive, complex appreciation of themselves and
others, severely mistreated children may go through phases in which different perceptions and
emotions are kept segregated. Such children may develop an ability to escape the mistreatment
by going away or retreating into their own mind. Each developmental phase may be used to
generate different selves.
T Too many people were thinking of it as one of the Axis Two personality disorders. DID is an Axis
One condition. DID is caused by violent and prolonged trauma in early childhood, usually
including rape, incestuous or otherwise. People who are able to dissociate create alternate selves
to take the abuse and trauma. Over time, these selves develop personality patterns (and
sometimes personality disorders!) of their own.

It is possible to integrate these parts together with therapy, but it requires an excellent
therapist who is able to deal with hearing descriptions of horrible abuse. Many are not able to do
this. The abuse experienced by DID survivors is far outside the usual, and some people aren't
strong enough to let themselves admit such abuse of children can even happen in America. But it
can; the evidence is overwhelming and incontrovertible.

The insensitivity shown to these people is often appalling -- and widespread -- at mental
health clinics all over the country.

Many people with DID pick up ten or a dozen incorrect diagnoses -- including of ASPD
(antisocial personality disorder) -- before finally being correctly diagnosed, and it's true that
repeatedly being bitterly accused of inventing the abuse is another form of abuse on top of and
compounding the original.
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More people need to be educated about the devastation caused by pedophiles and other
child abusers so as to prevent this affliction and others like it.

All people with DID also have PTSD (post traumatic stress disorder).
Signs and symptoms
Apses in memory (dissociation), particularly of significant life events, like birthdays,
weddings, or birth of a child
Experiencing blackouts in time, resulting in finding oneself in places but not recalling how
one traveled there;
Being frequently accused of lying when they do not believe they are lying (for example,
being told of things they did but do not recall, unrelated to the influence of any drug or
medical condition)
Finding items in one's possession but not recalling how those things were acquired;
Encountering people with whom one is unfamiliar but who seem to know them sometimes
as someone else;
Being called names that are completely unlike their own name or nickname;
Finding items they have clearly written but are in handwriting other than their own;
Hearing voices inside their head that are not their own;
Not recognizing themselves in the mirror;
Feeling unreal (derealization);
Feeling like they are watching themselves move through life rather than living their own
life;
Feeling like more than one person.




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Medical Management

The most common approach to treatment aims to relieve symptoms, to ensure the safety of
the individual, and to reconnect the different identities into one well-functioning identity. There
are, however, other equally respected treatment modalities that do not depend upon integrating
the separate identities. Treatment also aims to help the person safely express and process painful
memories, develop new coping and life skills, restore functioning, and improve relationships. The
best treatment approach depends on the individual and the severity of his or her symptoms.
Treatment is likely to include some combination of the following methods:
Psychotherapy: This kind of therapy for mental and emotional disorders uses
psychological techniques designed to encourage communication of conflicts and insight
into problems.
Cognitive therapy: This type of therapy focuses on changing dysfunctional thinking
patterns.
Medication: There is no medication to treat the Dissociative Disorders themselves.
However, a person with a Dissociative Disorder who also suffers from depression or
anxiety might benefit from treatment with a medication such as an antidepressant or anti-
anxiety medicine.
Family therapy: This kind of therapy helps to educate the family about the disorder and its
causes, as well as to help family members recognize symptoms of a recurrence.
Expressive therapy such as art therapy, dance/movement therapy and music therapy:
These therapies allow the patient to explore and express his or her thoughts and feelings
in a safe and creative way.
Clinical hypnosis: This is a treatment technique that uses intense relaxation, concentration
and focused attention to achieve an altered state of consciousness or awareness
Behavior therapy: As an increasing number of therapists view DID as iatrogenic, or caused
by reinforcing treatment teams, new approaches have emerged. Current standards of care
may involve requiring the patient respond to a single name, and refusing to speak with the
patient if she or he is a different sex, age, or person than initially presented. As the patient
begins to respond more consistently to a single name, and speak in the first person, more
traditional therapy for trauma may begin. Though some dislike this approach or criticize it
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as disrespectful of the client, it is highly effective, and many published accounts confirm
this approach. See Kohlenberg & Tsai's "Functional Analytic Psychotherapy" (1991) for a
more detailed explanation of this approach.
Ego-state therapy: Ego-state therapy is used to help non-dissociative individuals resolve
conflicts among different parts of themselves (i.e. ego states); since DID is an extreme
differentiation among ego states, many therapists find the approach useful in working
with dissociative clients.
Hypnotherapy
Hypnosis -- or hypnotherapy -- uses guided relaxation, intense concentration, and focused
attention to achieve a heightened state of awareness that is sometimes called a trance. The
person's attention is so focused while in this state that anything going on around the person is
temporarily blocked out or ignored. In this naturally occurring state, a person may focus his or her
attention -- with the help of a trained therapist -- on specific thoughts or tasks.
How Does Hypnosis Work?
Hypnosis is usually considered an aid to psychotherapy (counseling or therapy), because
the hypnotic state allows people to explore painful thoughts, feelings, and memories they might
have hidden from their conscious minds. In addition, hypnosis enables people to perceive some
things differently, such as blocking an awareness of pain.
Hypnosis can be used in two ways, as suggestion therapy or for patient analysis.
Suggestion therapy: The hypnotic state makes the person better able to respond to
suggestions. Therefore, hypnotherapy can help some people change certain behaviors,
such as stopping smoking or nail biting. It can also help people change perceptions and
sensations, and is particularly useful in treating pain.
Analysis: This approach uses the relaxed state to find the root cause of a disorder or
symptom, such as a traumatic past event that a person has hidden in his or her
unconscious memory. Once the trauma is revealed, it can be addressed in psychotherapy.

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What Are the Benefits of Hypnosis?
The hypnotic state allows a person to be more open to discussion and suggestion. It can
improve the success of other treatments for many conditions, including:
Phobias, fears, and anxiety
Sleep disorders
Depression
Stress
Post-trauma anxiety
Grief and loss
Hypnosis also might be used to help with pain control and to overcome habits, such as
smoking or overeating. It also might be helpful for people whose symptoms are severe or who
need crisis management.
What Are the Drawbacks of Hypnosis?
Hypnosis might not be appropriate for a person who has psychotic symptoms, such as
hallucinations and delusions, or for someone who is using drugs or alcohol. It should be used for
pain control only after a doctor has evaluated the person for any physical disorder that might
require medical or surgical treatment. Hypnosis also may be a less effective form of therapy than
other more traditional treatments, such as medication, for psychiatric disorders.
Some therapists use hypnosis to recover possibly repressed memories they believe are
linked to the person's mental disorder. However, hypnosis also poses a risk of creating false
memories -- usually as a result of unintended suggestions by the therapist. For this reason, the
use of hypnosis for certain mental disorders, such as dissociative disorders, remains controversial.
Is Hypnosis Dangerous?
Hypnosis is not a dangerous procedure. It is not mind control or brainwashing. A therapist
cannot make a person do something embarrassing or that the person doesn't want to do. The
greatest risk, as discussed above, is that false memories can potentially be created and that it may
be less effective than pursuing other, more established and traditional psychiatric treatments.
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Electro convulsion
ECT is among the safest and most effective treatments available for depression. With ECT,
electrodes are put on the patient's scalp and a finely controlled electric current is applied while
the patient is under general anesthesia. The current causes a brief seizure in the brain. ECT is one
of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It's also very
effective for patients who suffer from mania or other mental illnesses.
ECT is generally used when severe depression is unresponsive to other forms of therapy.
Or it might be used when patients pose a severe threat to themselves or others and it is too
dangerous to wait until medications take effect.
Although ECT has been used since the 1940s and 1950s, it remains misunderstood by the
general public. Many of the procedure's risks and side effects are related to the misuse of
equipment, incorrect administration, or improperly trained staff. It is also a misconception that
ECT is used as a "quick fix" in place of long-term therapy or hospitalization. Nor is it correct to
believe that the patient is painfully "shocked" out of the depression. Unfavorable news reports
and media coverage have contributed to the controversy surrounding this treatment.
How Is ECT Performed?
Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a
general anesthesia. Electrodes are placed on the patient's scalp and a finely controlled electric
current is applied. This current causes a brief seizure in the brain.
Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight
movement of the hands and feet. Patients are carefully monitored during the treatment. The
patient awakens minutes later, does not remember the treatment or events surrounding it, and is
often confused. The confusion typically lasts for only a short period of time.
ECT is usually given up to three times a week for a total of two to four weeks.


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ROLE OF THE NURSE
Those are;
Maintaining a Safe Environment
Precautions should be taken to reduce risk of harm to self or others. Remove items that
may be used as a weapon. Frequent observation should be performed to ensure patient
safety. Awareness of the safety for healthcare professionals should also be priority if
there is a risk of harm to others. For example, stay between the door and the patient,
with the door open whenever possible. Avoid wearing jewelry such as necklaces, and
avoid wearing your hair in a ponytail.
Establish a Written Contract with the Patient
This contract should discuss expected behaviors of the patient. It is also important to
include that the patient will not harm self or others, and will notify a member of the
team if feelings to do so develop.
Establish a Therapeutic Relationship with the Patient
Trust and rapport are important with the patient relationship. Be straightforward in
communications, and avoid use of medical jargon. Empathy and nonjudgmental
attitude is vital.
Maintain Objectivity & Consistency Amongst the Healthcare Team
While empathy is vital, it is equally important to remain objective with the patient.
Some patients with personality disorders will attempt to play on the emotions of
healthcare professionals to manipulate. Consistent information and interactions with
the patient can be assured by developing an interdisciplinary plan of care, and ensuring
that communications between healthcare team members is consistently updated.
Maintain objectivity and consistency.


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Set Behavioral Limits
Let the patient know what behaviors are acceptable, and which are not. Also outline
potential consequences for inappropriate behavior.
Assist the Patient with Reducing Anxiety
Explore breathing and relaxation techniques to assist the patient in reducing anxiety.
Visualization and meditation may also be useful. Medications should be used only after
nonpharmacological methods are tried.
Encourage the Patient to Use a Journal
A strategy to assist patients work through their perceptions, responses, and emotions is
through the use of a journal. This is both therapeutic and assistive in providing
information for the healthcare team.
Recognize Manipulative Behavior
Many persons with PDs attempt to manipulate others, either intentionally or not. Do
not reveal any personal information to the patient. One behavior that is common,
particularly with patients diagnosed with borderline or antisocial PD is splitting. The
patient attempts to split or divide members of the healthcare team by playing one
against the other. They may make statements such as, You are the most helpful out of
everyone or, You know, the other nurse said you werent as good as she is. Identifying
these behaviors and setting limits is essential, as well as communicating the use of these
actions to other members of the healthcare team.

Patient and Family Participation
It is important that the patient participate as a member of the healthcare team. They
should be allowed to make choices and maintain independency, as long as it is within
the limits set. This assists in building rapport and forming therapeutic relationships.
Families should also be encouraged to participate as indicated.
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Encourage Discussion of Feelings
Patients should be encouraged to discuss feelings that they have, rather than act them
out. This assists the patient to cope with their emotions and limit behaviors that result
in ineffective coping. Discussions should be focused and timelimited as appropriate.
Discuss Expectations
All members of the healthcare team including the patient, should know what the short
term and the longterm goals and expectations are. Hospitalizations for patients with
personality disorders are generally short, and are usually related to an acute behavioral
episode (such as selfharm). Outlining the expectations can define measurable
outcomes.
Patient and Family Teaching

It is important to teach patients that recovery is a lengthy process, as their
patterns of responses and perception are a result of development over time.
There may be factors of genetics, social, and personal experiences that have
created the personality disorder, and ongoing psychotherapy is necessary.

Substance use and abuse as well as other addictive traits are both complications of
personality disorders and triggers to aggravating the condition. These activities should
be avoided due to increased risk of harm to self or others, and further difficulties such
as increased anxiety and distress.

Family education is important to address how to set limits, protect patient safety, and
identify destructive behaviors (Bienenfeld, 2010; OBrien, Kennedy & Ballard, 2008)


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. IMPLICATION IN THE MOVIE


To you as a future nurse

The confines of a hospital setting, with its rules and limits, can be quite
threatening to MPD patients. It can feel like a re-enactment of the childhood trauma,
with the nursing staff that enforces the rules playing the role of abuser. The patient will
subconsciously assign trauma-related roles to staff and will react to them accordingly.
For me as a future nurse I will be more approachable and reliable to my patients. In the
movie the nurses are not be so easy to approach. They are always in their stations, and
when they give drugs to the patient theyre not checking if the patient is truly
administering it to their selves. When I saw this movie, i told myself that it would be so
challenge to me if I will be a psychiatric nurse someday.













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To the nursing service

In the movie, there service is good to me. They want their patients look
comfortable and fabulous by giving right dresses and good enough facilities and a good
ventilator. But then sometimes, they do harassment by tighten the patients in bed and
hold it them with pressure.
Primary to the nursing role in working with MPD patients is creating an
environment that is supportive accepting, and protective. Establishing trust is
imperative and is facilitated through consistency and honesty in dealing with the host
and all alter personalities. Alters are encouraged to come out in an environment which
feels safe, accepting and empathetic.
It is important for nursing staff to continually observe and evaluate for potentially
self-destructive or violent behavior and to intervene to keep the patient safe. Getting
the patient to contract for safety may need to be done each shift and with all alters.
Staff must insist upon assurance of safety and control from the patient and if the
contract is not convincing or does not appear to be an agreement of the entire system,
then suicide precautions should be implemented.
For me Im not really satisfied how they handle MPD patients in the movie.







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To the community/ public

To the community we have to be aware who is having a MPD because frankly,
they are harmful sometimes. We have to aware of their behaviour. Based on current
research some precautions should be taken within the legal and mental health systems.
Inmates and psychiatric patients should be screened for dissociative symptoms and
offered appropriate treatment on a regular basis. Staff at prison and psychiatric
institutions should be educated to be able to differentiate the signs and symptoms of
dissociation, with the hope of limiting violent episodes (Moskowitz, 2004). Safety
measures should also be directed toward families and children. Elementary and middle
school staff should also be educated and be able to differentiate signs and symptoms of
dissociation and seek to identify adolescents who might be at risk for aggressive
behaviors. However, efforts should also be targeted toward managing dissociative
symptoms in parents with traumatic childhoods who may be at risk for abusing their
own children (Moskowitz, 2004). Violence can be prevented if potential aggressors are
identified before they strike and could be treated for their dissociative disorders.










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To the nursing education

In the movie, Multiple Personality Disorder, about which there appears to be
little educational literature, introducing important reasons for professional concern, and
ways in which it is involved in the learning process. A survey of the literature reveals
characteristics and range of the disturbance, a brief history of what is known, causal
theory, skepticism and therapy. A deeper appreciation of the disorder, more complex
issues and larger questions arise in the context of a broader knowledge of ways of
knowing; ways personality develops and becomes distorted, in theory, and in relation to
groups of others. This appreciation begins with an examination of the work of William
James, who discusses how we know ways of thinking, what an individual may know of
himself and others, and the limitations of psychology. The paper explores ways in which
personality develops, through the work of Salvatore R. Maddi. The work of R. D. Laing
reveals ways in which the person and others form the Self, and determines the nature of
splitting of personality. Multiple Personality Disorder involves sexuality, whose nature
and involvement in personality development are investigated in a review of the work of
Sigmund Freud, who, though not recent, shows sexuality to be a lifelong and
encompassing element of development. The theories of Emile Durkheim submit ways in
which thought and the person develop in the context of society. Common themes of the
authors related to development, need and coping strategies are categorized in the
conclusion, in order that educators appreciate that development and disorder involve
complexity, context and limitations which may determine educational response.




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To the researchers

The movie entails a description of factors related to diagnosis and treatment of
Dissociative Identity Disorder. Epidemiology, including risk factors and sociocultural
aspects of the disorder are presented, along with recommendations for treatment.
Highlights of current research focusing on neurobiological and psychobiological aspects
of DID provide additional insight into providing accurate diagnosis and appropriate
treatment. Recommendations for future research involve studies that will elaborate on
research already completed, and provide a more detailed analysis of the characteristics
of this unique and complex disorder.