Fiddling Around with Dolores Claiborne

Viewing Dolores Claiborne (film) through a psychiatrist's lens.

Posted Jan 20, 2019

I provide a monthly didactic at Rutgers Robert Wood Johnson Medical School centered around a feature-length film that we flip as a fictional case study of mental illness. The objective is not to render diagnoses per se as it would run the risk of stigmatizing individuals with mental illness (films universally provide inaccurate portrayals of mental disorders). Instead, the selected film serves to stimulate discussion over social media to educate learners as well as inform the public about mental illness. The following blog is a pre-posting of our discussion.

Synopsis

Dolores Claiborne (1995) is a psychological thriller based on a Stephen King novel of the same name. The movie depicts Selena St. George upon return to her remote island hometown where her mother has been accused of murdering Vera Donovan, an elderly woman for whom she cared. As of this posting, the film holds an 83% rating on Rotten Tomatoes and a score of 7.4 out of 10 on IMDb.

How it relates to the field of psychiatry

The film is told primarily through Selena’s perspective as series of flashbacks which bridge the current murder allegation to a prior investigation into the death of Selena’s father, Joe St. George. The film is rich in psychiatric themes and which mental disorder the viewer formulates may depend on the character they (consciously or subconsciously) identify with. With due respect to Vera (Major Neurocognitive Disorder) and Detective Mackey (cluster B personality traits), this post will focus on the St. George family.    

[Spoiler Alert]

Selena St. George

Selena St. George is a successful journalist who is afflicted with Major Depressive Disorder (MDD) and a co-occurring substance use disorder. Given that the film is told as a series of flashbacks, a differential diagnosis afflicting Selena would include Post-Traumatic Stress Disorder (PTSD). This provisional diagnosis is further strengthened by the character’s co-occurring MDD and substance use. Approximately half of those afflicted with PTSD also suffer from MDD (1). The medical literature also shows that up to 50% of people with PTSD suffer from Alcohol Use Disorder (AUD) (2).

Selena’s substance use disorder is identified as having a biological component given that Joe St. George is also depicted as having AUD. This element of the movie is evidenced-based in that AUD is approximately 50% heritable (3).

Joe St. George

In addition to AUD, Joe is depicted as having a paraphilia: Pedophilic Disorder. Many authors have studied the prevalence of alcoholism in relationship to sexual offenses such as incest, rape, and pedophilia. While AUD and Sexual Sadistic Disorder do show a statistically significant association, no such relationship between AUD and Pedophilic Disorder has been consistently established (4).

Dolores Claiborne 

One of the many remarkable things about this film is that unlike the two discussed above, the eponymous character does not provide as straightforward a case. The ambiguity that defines her role in the Donovan murder as well as the one almost 20 years prior parallels the complexity of her current signs and symptoms. Although it does not appear that Dolores uses alcohol or drugs to excess, her history of physical and emotional trauma confer risk for an anxiety-mood cluster similar to her daughter’s. Analyzing her character juxtaposed with Selena allows for a discussion of the psychosocial factors impacting the respective characters’ illnesses as both were victimized by Joe St. George. The social factors that impact the perpetuation of their illness behavior is represented by Detective Mackey who provides a “blame the victim” milieu when investigating the crimes.

The character of Dolores Claiborne is very complex. For greater detail of her psychiatric formulation, join the conversation on Twitter on 1/23/2019 at 6:00 EST by following the hashtag #FIDLERdolores.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518698/

Bremmer, et al. American Journal of Psychiatry, 1996.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/

Allnutt, S., Bradford, J., Greenberg, D., and Curry, S. "Co-Morbidity of Alcoholism and the Paraphilias," Journal of Forensic Sciences, Vol. 41, No. 2, 1996, pp. 234-239, https://doi.org/10.1520/JFS15420J. ISSN 0022-1198. 

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