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Table of Contents

Introduction Characters Summary/ synopsis Psychodynamics Psychopathology Medical Management Roles of the Nurse Implications in the movie

Introduction

There are a lot of psychiatric movies that our professor represented to us. Then, I decided to choose the movie of Jim Carrey entitled The Number 23. This movie was published on the year of 2007. This was an American Psychological thriller film written by Fernley Phillips and directed by Joel Schumacher. it is a belief that all incidents and events in the character of Jim Carrey are directly connected to the number 23, or number that is related to 23. The Number 23 is the story of Walter Sparrow (Jim Carrey), a man with a shattered childhood who has murdered a woman in a jealous rage, then attempted suicide, failed, recovered without memory of his awful past and of the awful things he had done. Years later, he reads a book that he wrote while insane (though he does not know he was the author while he reads it) that contains the key to his past and to the location of the murdered woman's body. The key is the number 23. Only he can use the key to find the truth, of which he is unaware, a truth that can drive him insane once again. The film portrays his obsession with the number 23 and his gradual discovery of the truth from his contemporary perspective.

The number 23 character Jim Carrey has an Obsessive-compulsive disorder. According to Manohla Dargis Walter has an OCD or Apophenia. Apophenia is the experience of seeing connections where none exist. When Walter read the book called the number 23, he always finds himself seeing the number 23 in every combination some other numbers, on the street signs and in his personal name, anniversaries and history. And it all ends up by adding the numbers, even if it doesnt.

Synopsis
Walter Sparrow is a family-man married with Agatha Sparrow, and works as a catcher of dogs in the Department of Animal control at their place. They have a teenager son that was very close to them. On the day of his birthday, Agatha bought a book with a novel entitled Th e Number 23. This book was captivated him by having an obsession with the number 23. He finds a lot of coincidences with his own life. When he read he find a detective called Fingerling, then he started to have dreams of murdering Agatha. Then because of that hed been worried so he decided to find the author of the mystery book that he really find a lot of coincidences with his own life. Walter thinks the professor wrote the book as a secret confession and goes to see him in jail. The man proclaims his innocence of the murder and of being the author, stating he would never choose a pen name like "Topsy Kretts," pointing out that it is an obvious homophone for "Top Secrets."

Upon discovering an address in the book, the family arranges a meeting with Topsy Kretts (Bud Cort), who, upon being confronted by Walter. They arrive at the park late that night and go down a staircase marked "The Steps to Heaven" which consists of 23 steps. At the bottom, they dig deep in the ground and discover a human skeleton, presumably Laura Tollins, but when they return with a police officer, the bones have disappeared. Walter confronts Agatha about taking the bones and accuses her of writing the book. She admits to moving the skeleton to protect him, but tells Walter that it was he who wrote the book, and shows him the contents of the box from the Institute. In the box there is a manuscript of The Number 23 with Walter's name on it and an ankle bracelet that belonged to Laura Tollins. Then Walter returns to hotel room 23, he find the missing chapter 23 and it was written all over the wall. Then he find out that the chapter 23 explains that the story was all about Walters confessions and he remembers why he did everything: his father killed himself after the death of Walter's mother. Agatha finds Walter at the hotel, and she tries to assure Walter that he is no longer the person he was when he wrote the book. He insists that he is a killer, accepting the fact that he murdered Laura Tollins, and tells Agatha to leave before he kills her too. Agatha pushes a letter opener into Walter's hand, saying that if he is indeed a killer, he can easily kill again, and dares him to kill her. She tells him that she loves him. Walter tells her that she can't love him because no one can, mirroring an accusation made by Laura on the night of her murder. He leaves the hotel and runs into the street, where he nearly allows himself to be run over by a bus, but steps out of the way at the last minute when he realizes his son is watching. As he embraces his family, a voiceover by Walter tells the audience that he turned himself in to the police and is awaiting sentencing, having been told that the judge will likely go easy on him since he turned

himself in. A funeral procession takes place in front of Laura Tollins's grave, where it is implied her body has finally been laid to rest, as Flinch observes, finally a free man.

"Be sure your sin will find you out."

Characters
Walter Sparrow / Fingerlin A family man and the Detective that played the role in the book. Agatha Sparrow / Fabriza Wife of Walter Sparrow, she also the one who bought the book titled The Number 23 Robbin Sparrow Son of Walter and Agatha Sparrow Laura Tollins The one who died when she was 23 and her body was never found. A college student who had been murdered by her professor Kyle Flinch. Isaac French / Dr Miles Phoenix Is a member of the acclaimed performing family that also includes father John Huston, sister Angelica Huston and grandfather of Walter Sparrow

Psychodynamic
Obsessivecompulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. It occurs in about 1% to 2% of the population, affecting twice as many men as women. This increases to 3% to 10% in clients in mental health settings. Incidence is increased in oldest children and people in professions involving facts, figures, or methodical focus on detail. These people often seek treatment because they recognize that their life is pleasure less or they are experiencing problems with work or relationships. Clients frequently benefit from individual therapy (APA, Videbeck 2000). The demeanor of these clients is formal and serious, and they answer questions with precision and much detail. They often report feeling the need to be perfect beginning in childhood. They were expected to be good and to do the right thing to win parental approval. Expressing emotions or asserting independence was probably met with harsh disapproval and emotional consequences. Emotional range is usually quite constricted. They have difficulty expressing emotions, and any emotions they do express are rigid, stiff, and formal, lacking spontaneity. Clients can be very stubborn and reluctant to relinquish control, which makes it difficult for them to be vulnerable to others by expressing feelings. Affect is also restricted: they usually appear anxious and fretful or stiff and reluctant to reveal underlying emotions. (Videbeck, 2011)

A condition resembling OCD has been recognized for more than 300 years. Each stage in the history of OCD has been influenced by the intellectual and scientific climate of the period.

Early theories regarding the cause of a malady similar to OCD stressed the role of distorted religious experience. English writers from the 18th and late 17th centuries attributed intrusive blasphemous images to the work of Satan. Even today, some patients with obsessions of scrupulosity still wonder about demonic possession and may seek exorcism.

The psychoanalytic focus on the symbolic meaning of obsessions and compulsions has given way to an emphasis on the form of the symptoms: recurrent, distressing and senseless forced thoughts and actions. The content of symptoms may reveal more about what is most important to or feared by an individual (e.g., moral rectitude, children in harms way) than why that particular individual developed OCD. Alternatively, the content (e.g., grooming and hoarding) may be related to the activation of fixed action patterns (i.e., innate complex behavioral subroutines) mediated by the brain areas involved in OCD.

Freud believed that OCD is the result of fixation at the anal stage of development, when children are going through toilet training. Children at this stage are obtaining their sexual gratification from bowel movements, while their parents are trying to teach them to delay this gratification. If parents overuse punishment, or are too harsh when toilet training children may develop aggressive id impulses and become messy, aggressive and stubborn. If parents deal with this by making the child feel shameful and dirty they will then have a counter-desire to control the id impulses. The result of this is an anally retentive personality (being messy is

equivalent to passing feces being tidy is equivalent to retaining feces). The obsessions, therefore, come from the desire to be messy, while the compulsions come from the need to control this desire.

Signs and symptoms of obsessive-compulsive disorder (OCD)


Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other. OCD signs and symptoms: Obsessive thoughts Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

Fear of being contaminated by germs or dirt or contaminating others. Fear of causing harm to yourself or others. Intrusive sexually explicit or violent thoughts and images. Excessive focus on religious or moral ideas. Fear of losing or not having things you might need. Order and symmetry: the idea that everything must line up just right. Superstitions; excessive attention to something considered lucky or unlucky.

OCD signs and symptoms: Compulsive behaviors Common compulsive behaviours in obsessive-compulsive disorder (OCD) include:

Excessive double-checking of things, such as locks, appliances, and switches. Repeatedly checking in on loved ones to make sure theyre safe. Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.

Spending a lot of time washing or cleaning. Ordering or arranging things just so. Praying excessively or engaging in rituals triggered by religious fear. Accumulating junk such as old newspapers or empty food containers. For many people, OCD starts during childhood or the teen years. Most people are

diagnosed by about age 19. Symptoms of OCD may come and go and be better or worse at different times. OCD affects about 2.2 million American adults. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

Diagnosis
The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. OCD can be accompanied by eating disorders, other anxiety disorders, or depression. First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist.

Obsessive-Compulsive Disorder (OCD) - Prevention


You cannot prevent obsessive-compulsive disorder (OCD) from starting. But the best way to prevent a relapse of OCD symptoms is by staying with your therapy and taking any medicines exactly as they have been prescribed.

Psychophatology
In-depth researches on the psychopathology of Obsessive-compulsive disorder (OCD) have been made in the cognitive-behavioral domain. Cognitive behavioral theory of OCD suggests that dysfunctional beliefs, coping strategies and neutralization are key factors in the escalation and persistence of OCD. The security motivation model considers OCD to stem from an inability to generate a signal that would terminate the security-related behaviors. Based on this model, a recent research indicates that OCD patients use more subjective stopping criteria when making a decision to stop a compulsion. Such criteria causes difficulty in the decision making, therefore the compulsion is prolonged. This paper integrates recent researches in the cognitive-behavioral domain, and claims that approachavoidance conflict, which is salient in some OCD patients, might be another important factor giving rise to OCD.

Medical Management

Treatment
OCD is probably a heterogenous syndrome, and various modalities of treatment have been found to be effective in ameliorating OCD symptoms to varying extent. These include pharmacotherapy, cognitive behaviour therapy, electro-convulsive therapy, and psychosurgery. Generally psychotherapy alone is not effective, but psychological support for the OCD patient and his family is important. 1. Pharmacotherapy The main-stay of pharmacotherapy for OCD is the antidepressants, especially those which act on the serotonergic system. The latter include clomipramine (75mg to 200mg), fluoxetine (20mg to 60mg), fluvoxamine (50mg to 200mg), paroxetine (20mg to 60 mg) and sertraline (50mg to 200mg). Mood stabilizers e.g. lithium has been used in 3augmenting the antidepressant treatment especially in patients with concomitant major depression. Sometimes the very bizarre compulsions or obsessional thoughts in OCD patients almost border on the psychosis. As such, antipsychotic drugs e.g. haloperidol, trifluoperazine, etc. in low dosages have been prescribed in combination with the antidepressants. Benzodiazepines usually only provide symptomatic relief of the anxiety in OCD patients. So far, clonazepam is the only benzodiazepine, which is found to show anti-obsessional effects. 2. Cognitive Behaviour Therapy Exposure therapy is the main behavioural treatment of choice. It involves the deliberate exposure of the OCD patient to some anxiety provoking stimuli e.g. touching contaminated

objects like door knobs, floor, etc. This is usually followed by response prevention i.e. the patient then refrains from washing his "contaminated" hands. Exposure therapy is often carried out in a graded manner, up a hierarchy of feared situations. Modelling involves a demonstration by the therapist on how to handle a feared situation without resorting to compulsive rituals. Finally, chains of repetitive obsessional ruminations may be interrupted, and ultimately discontinued by thought stopping. In cognitive therapy, the patient is taught to challenge the validity of his fears, which are often an over-estimation of risk. Catastrophising and black-and-white thinking are other cognitive distortions, which are disputed (refer to Chapter on Cognitive Therapy). 3. Electroconvulsive Therapy (ECT) and Psychosurgery ECT is generally not regarded as useful in OCD patients who are not depressed or suicidal, while psychosurgery is only resorted to when an exhaustive array of behavioural and pharmacological treatments have failed to relieve the OCD symptoms. 4. Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy called exposure and response prevention is especially helpful in reducing compulsive behaviors in OCD.

Roles of the Nurses


Nurses may be able to help clients to view decision making and completion of projects from a different perspective. Rather than striving for the goal of perfection, clients can set a goal of completing the project or making the decision by a specified deadline. Helping clients to accept or to tolerate less-than-perfect work or decisions made on time may alleviate some difficulties at work or home. Clients may benefit from cognitive restructuring techniques. The nurse can ask, What is the worst that could happen? or How might your boss (or your wife) see this situation? These questions may challenge some rigid and inflexible thi nking. Encouraging clients to take risks, such as letting someone else plan a family activity, may improve relationships. Practicing negotiation with family or friends also may help clients to relinquish some of their need for control. Nurses are also involve in the approach of teaching the client to recognize and change certain negative or faulty cognitions, and acts by using behavioral techniques to desensitize fears or anxiety. Nurses also teach client about relaxation exercise such as deep breathing exercise and exhaling while imagining a peaceful scene before doing such exercise. Nurses also practice the use of therapeutic touch and healing touch. A nurse also teaches the client about exercises, meditation, desensitization, visual imagery, and response prevention and other alternative and behavioral therapies.(page 297, Basic Concepts of Psychiatric-Mental Health Nursing 7th Ed. Shives)

Implication in the Movie


As a future nurse, we all know that OCD is characterized by unreasonable thoughts and fears that lead the patient to do repetitive behaviours. We approach the client in a gently manner, we should not force the patient to stop immediately their obsessions. We treat them by giving limitations that is enough, but not too harsh. As a future nurse we give medications that are prescribe to them and give them appropriate care for them to have faster recovery.

In the nursing services, in the community and in the nursing education, they should have to give more attention to the patient who was suffering in OCD. To help them to cure and mostly to prevent of having OCD. And they should have provided knowledge especially to the people who lived in the community, to be aware to their environment.

To the researches, OCD is much more prospective completion of the researchers, such as their coping skills, and how they come up of having an obsession, how they can help themselves through out of the therapy.

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The Number 23
(Movie Analysis)

Submitted by: Pastores, Flora Angeli D. BSN 3-1 Submitted to: Mr Rolando Antonio