**Spoiler Alert for the TV show! If you are behind on the series, consider this spoiler alert fair warning for what follows!

If you’re anything like me, you’re still huddled in a corner somewhere recovering from last week’s episode of Game of Thrones. The show is infamous for ruthlessly killing off its characters, especially the ones you find yourself rooting for. While I don’t spend all my time in life thinking about mental health (really, I don’t!) I sometimes can’t help but wonder about my favorite characters’ mental health issues, lifting diagnoses straight out of the DSM-V, the official mental health handbook for psychiatrists and psychologists and other mental health professionals. Game of Thrones may be a show about war, power and politics in an age of dragons and knights, but it’s impossible to ignore the destructive influence of what can be perceived as severe mental health issues of the characters on their families and on society.

In fact, I would say the majority of the characters on Game of Thrones can be diagnosed with some form of mental illness. And while winter may be coming, Seasonal Affective Disorder is the least of the worries of the thoroughly troubled inhabitants of Westeros.

We can easily label Joffrey as sadistic, or dismiss Lady Arryn’s paranoid behaviors, but perhaps we should take a step back and examine the diagnoses of the characters we love, and those we love to hate.

Joffrey Baratheon


"Everyone is mine to torment!"

 

Patient History

Joffrey is, without a doubt, one of the most hated characters on the show (there are even videotaped reactions of public joy at his death) but there may be something diagnosis-worthy behind his unrelenting cruelty. 

As king, Joffrey quickly gains a reputation for being violent, callous, and arrogant. After publicly executing Eddard Stark, the father of his queen-to-be, he takes her to the top of the red keep where he forces her to take a close look at her father’s head on a stake, and promises that her brother’s head will be next.  Joffrey’s violent nature can be seen in his early childhood.  In the books, George R. R. Martin  reveals that as a child, Joffrey once killed a pregnant kitchen cat and cut open its belly to see the kittens inside.

Diagnosis

Antisocial Personality Disorder. According to the DSM-V, APD is “a pervasive pattern of disregard for and violation of the rights of others.” Relevant diagnostic criteria include: a longstanding history of deceitfulness, a reckless disregard for the safety of others, and above all a lack of remorse in response to having hurt or mistreated others.

Joffrey’s cruelty to those around him, his willingness to commit heinous acts for his own personal gain or even entertainment, and his complete and utter lack of remorse all single him out as an antisocial personality from the word go.

The one caveat here is that typically, Antisocial Personality Disorder is a diagnosis for adults—one of the criteria is that the patient must be above the age of 18. Realistically, Joffrey would have been diagnosed with Conduct Disorder, which would serve as a “red flag” to pay attention to in the future.

Theon Greyjoy


"Only a fool humbles himself when the world is so full of men eager to do that job for him."

Patient History

Before his capture by Ramsay Snow, Theon already was already riddled with insecurity. After his father Balon offered him to the Stark family as a ward and gesture of peace, Theon was raised alongside the Stark children, but was constantly reminded that he himself was not a Stark, and was therefore not the equal of those around him.  This distinction fostered in him a fierce desire to prove himself.

Perhaps Theon’s early longing to belong fueled his psychological transformation into “Reek,” the identity given to him by his cruel captor. After being tortured and castrated by Ramsay, Theon is slowly broken down into a person with little to no sense of self. So deeply does he lose himself in his new identity that he does not recognize his own given name if he is referred to by anyone as Theon.

Diagnosis 

Theon Greyjoy poses an interesting dilemma. On the one hand, his grandiose sense of self-importance, his preoccupation with fantasies of success, and his overwhelming belief that he is “special” and “unique” all point to Narcissistic Personality Disorder.

But what is fascinating about Theon is the effect wrought on him by his capture and psychological breakdown at the hands of Ramsay. Torture and castration are, needless to say, very traumatic events. Theon has abandoned his, very valued, old self. Some experts on NPD think that Narcissism may develop as a result of a childhood trauma—but what will be the result a severe trauma on someone who has NPD, we’ll have to wait and find out!

The fierce loyalty that Ramsay now evokes in Theon—sorry, in Reek—suggests what is informally known as “Stockholm Syndrome”. This is the famous psychological phenomenon where captives bond with their captors over the course of their captivity. The tricky consideration here is that the words “Stockholm Syndrome” never actually appear in the DSM-V. It’s not “really” a mental illness.

So I would suggest instead that Theon may be suffering from trauma which manifests as Dissociative Disorder, which in the DSM-V is characterized by “identity disturbance”—the presence of an alternate personality—which is due specifically to either “prolonged and intense coercive persuasion”—such as, say, castration and ritual psychological evisceration—or “stressful events”. Theon has no shortage of those.

Sandor Clegane (The Hound)


“If you can't protect yourself, die and get out of the way of those who can. Sharp steel and strong arms rule this world."

Patient History

Sandor Clegane, also known as The Hound, is one of Westeros’ most savage warriors. He is seconded in notoriety only by his older brother, the Mountain.

We’re often led to believe that there lies a compassionate underside to the Hound’s scarred, callous exterior. But of course, every time we catch the Hound in a moment of kindness directed towards his hostage, Arya Stark, The book and TV series both quickly turn our attention towards Clegane’s casual attitude towards violence, thievery and even murder.  

Underlying Clegane’s nonchalance towards killing and stealing is an extensive history of familial conflict. The scar on his face comes courtesy of his older brother. When they were children, The Mountain pushed The Hound into a fire, holding his face to the flames after a dispute over toys.

Diagnosis

Like so many others in Westeros, the Hound was dealt a very bad hand in life. One feature of his history that would leap out to any mental health professional is the pervasive, deep history of child abuse and neglect— including not only his marked suffering at the hands of his brother, but his father’s refusal to sympathize with him. It’s worth nothing that his fire-related injuries as a child result in an extreme emotional disturbance whenever he confronts fire as an adult—a reaction which is ultimately consistent with Post-Traumatic Stress Disorder. Personally, I have always had a bit of a problem with the way in which PTSD is phrased. It has always seemed unjust to call the experience resulting from a trauma a disorder. When I recently spoke with the famous horse trainer Monty Roberts,  I was really fond of how, in his work with traumatized horses and soldiers, he named this constellation of symptoms Post Traumatic Stress Injury.

A secondary diagnosis would have to take into account Sandor’s unhealthy relationship with alcohol—specifically his penchant for using it as a coping mechanism for any uncertain situation or moment of emotional unrest. His recurrent alcohol use, which often leads to significant impairment, and his abnormally high tolerance all point to a secondary diagnosis of Alcohol Use Disorder.  

This combination is sadly not so unusual. People with PTSD often use alcohol or drugs to cope with the flashbacks, startle responses and other symptoms of the trauma. There are other more effective ways to treat PTSD, but that is for the next post, where I will suggest treatment plans for these characters. For now, the Hound is using alcohol to get by.  As the prominent psychatrist Dr. Robert Glick once said at a case conference, “People’s problems are their best solutions until now”.   If the Hound were to read this (and by the Seven Kingdoms, I hope he doesn’t!) perhaps he would fire back with the Scottish Proverb, “They speak of my drinking but never of my thirst”.

Daenerys Targeryen


“I will answer injustice with justice.“

Patient History

Daenerys and her brother Viserys were orphaned when Daenerys was just an infant.  Her father, King Aerys, and the rest of the royal family were killed in Robert’s rebellion.  Daenerys and her brother were smuggled out of Westeros to the free cities for their own safety.  As a child, Daenerys was weak and timid, and had little self-esteem.  She lived her early life simultaneously dependent on and terrified of her older brother, Viserys.  As her only living family, Viserys was sometimes a cruel guardian, given to bouts of violence and sexual abuse.  

Reluctantly, Daenerys’ marries Khal Drogo who promises an army of soldiers to Viserys in order to take back Westeros.  During this time she develops from a meek and timid little girl into a strong, courageous, and brave woman, who is able to find her independence from her brother.  This becomes abundantly clear as she begins to conquer the free cities one by one, freeing all the slaves in her path.

Those that she frees call Daenerys mother, and she takes immense pride and even comfort in knowing that her “subjects” refer to her in that way. She feeds on their dependence in a way that most rulers on the rise would not.    

Diagnosis

Daenerys is a difficult one to characterize, for sure. Far from suffering from a mental illness, she is one of the most stable, well-adjusted characters in the Game of Thrones universe—a brief spell of light surrounded by darkness on all sides. She isn’t overly anxious, doesn’t have multiple personalities, and doesn’t suffer too much from her past trauma. So I have a confession to make: try as I might, the DSM-V doesn’t give me anything to work with.

But I can still diagnose her using another guide: the Character Strengths and Virtues Handbook, created by Christopher Peterson and Martin Seligman, two of the most famous pioneers of “positive psychology.”

Why this book? Because in a way, it’s the “anti-DSM-V”. Rather than diagnose the negative, troublesome aspects of human behavior, it diagnoses the positive and prosperous qualities of successful people. Using the VIA-IS, I can diagnose Daenerys with Strengths. Of the Strengths in the VIA-IS, I would “diagnose” Daenerys with Justice (underneath which fall qualities like teamwork, fairness, and especially leadership) and Courage (which includes bravery, perseverance, and honesty). Daenerys is a pitch-perfect example of how to react to adversity and setbacks: by challenging them to fuel your own personal growth.

When you have stressful situations in your life (and I think being orphaned,  losing your husband, parenting dragons and leading an army of freed slaves to raid King’s Landing counts) you can see them as threat or a challenge. Daenerys chooses challenge, each and every time.

Final Thoughts

I have to admit that I had a great deal of fun writing this post. The clinical psychologist side of me was happy to put his expertise and energy into classifying a group of well-developed, complex characters into pre-existing categories. I’ll also admit that when I talked to my coworkers about this, they were happy to chime in with their own insights—the debates we had were lively, engaging, and above all, just plain fun. We all enjoy diagnosing and telling others what’s wrong with them. Why? I’d say it makes us feel better about ourselves. In fact, Carl Jung once said, “Everything that irritates us about others can lead us to an understanding of ourselves”.  

We were all so happy when Joffrey died. Why? Because a part of us that identified with him died too. We all have dark parts to our personalities and when we can hate a character, it somehow helps us reconcile that dark part and accept ourselves. The simple version of this idea is:  “Well at least I’m not as bad as that guy”.

As I wrote this article, It made me think about the nature of diagnosis itself. Some characters had strong features of one diagnosis but also minor features of another. Some, like Daenerys, don’t seem to have a diagnosis.  She is so well-adjusted that there is no section for her in the DSM-V, though she is clearly troubled in many ways that are made plain to us as viewers and readers. To diagnose these characters is to limit them. Each time I put down a diagnosis, a tiny voice in my head would remind me that a label like “Post-Traumatic Stress Disorder”, no matter how significant, doesn’t encapsulate an entire person.

One of my deepest beliefs as a psychologist is that each person is wonderfully complex and irreducible. The real work and wonder of therapy lies in recognizing what makes each person a unique human being, and my job as a mental health practitioner is to work with those unique qualities, not against them.

Diagnostic guides like the DSM-V have their purpose, of course. Yet if Game of Thrones has taught me anything, it’s that I need to continue to move beyond the diagnostic model in favor of a more holistic, humanistic approach.

Next post, I will develop a treatment plan for these characters!  If you have any characters you’d like me to diagnose, let me know via Twitter @drfader! Till then, I’ll be biting my nails for the last episode of the season!

About the Author

Jonathan Fader, Ph.D.

Jonathan Fader, Ph.D., is a psychologist and an assistant professor of family medicine at the Albert Einstein College of Medicine.

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