Game of Thrones: The Bells

Viewing Game of Thrones through a psychiatrist's lens.

Posted May 13, 2019


Each Monday, I will post on the Season 8 Game of Thrones episode that premiered on HBO the night before. Each entry will be constructed in three parts: a synopsis of the selected episode, the hidden (or not-so-hidden) motifs, and how it all relates to the field of psychiatry (e.g. anxiety disorders). WARNING: This post contains spoilers.  


The Bells is the fifth episode of the 8th season of Game of Thrones (and the 72nd overall). From Wikipedia:  

[As 99.99% of those reading this blog will likely have seen the episode, feel free to skip this section]

“Varys attempts to convince Jon to take the Iron Throne, but Jon refuses to betray [Daenerys]. Tyrion informs Daenerys of Varys' plot and she has [Varys] executed. Daenerys decides to burn down King's Landing at daybreak, but Tyrion tells her he has a plan to stop Cersei. He meets with Jaime and tells him he has a plan to smuggle him and Cersei to Pentos after surrendering King's Landing, but it must be Jaime to convince her to agree to it. The next day, both sides prepare for battle as Jaime, Arya, and Sandor infiltrate King's Landing. Daenerys arrives with [her dragon] Drogon and destroys both the Iron Fleet and the Golden Company, allowing her army to breach the gates and enter the city. The remaining Lannister forces surrender, but Daenerys refuses to stop and attacks the city itself, burning both soldiers and civilians. The allied army follows her lead, slaughtering everybody in their way much to Jon's horror. Jaime kills Euron and enters the Red Keep. Sandor convinces Arya to give up on killing Cersei and proceeds alone. Sandor sacrifices himself to kill the Mountain while Cersei and Jaime reunite. They attempt to escape but are crushed when their escape tunnel collapses. Arya witnesses the destruction of King's Landing firsthand and is barely able to escape the city alive.”


The Beginning: The Founding of Rome (753 BC)

I think it’s safe to say that one major theme of episode 5 is the twins reuniting in King’s Landing, the capital of the Seven Kingdoms located in the Crownlands on the east coast of Westeros. However, Cersei and Jaime aren’t the only siblings to rediscover one another; as Sandor (The Hound) and Gregor Clegane (The Mountain) also meet their destiny. The two storylines merge (twins + fratricide) in the founding of Rome, the historical King’s Landing.

According to legend, Romulus and Remus were involved in a dispute over the throne of Alba. After Numitor was reinstated as King of Alba, the twins set out to build a city of their own. After arriving at the seven hills, they disagreed about the hill upon which to build. In the aftermath of their quarrel, Remus was killed by Romulus who then went on and founded the city of Rome on the Palatine Hill. We can also rearrange the popular mnemonic to remember the Seven Hills to: Can Queen Cersei Eat Victory Apple Pie?

One must wonder if Cersei and Jaime will eventually be discovered a la the Zagreb mummy, yet another theory about the founding of Rome. There originally was speculation that the mummy may have had some connection to the Etruscan civilization (ancestors of Rome).

The Middle (68 AD)

Daenerys Targaryen’s realization that she will not fulfill her destiny results in the sack of King’s Landing by dragon fire. As the city-state burned, Cersei is an allusion to Nero, the last Roman emperor of the Julio-Claudian dynasty.

The End (476 AD): The Fall of Rome    

In September 476 AD, the last Roman emperor of the west, Romulus (hmm, that name again) Augustulus, was deposed. The Roman empire in western Europe which had been in existence for 500 years had ceased to exist, ushering in what western scholars often refer to as the Dark Ages.

How it relates to the field of psychiatry

When we look at the two sets of siblings who dominate the narrative in The Bells, the common variable is their obsession with the other who resides in King’s Landing. The main teaching point to take away from this episode then is that arguably the easiest mental disorder to define is one of the most difficult to fully understand and manage: Obsessive Compulsive Disorder (OCD).

The definition of OCD focuses on the occurrence of clinically significant obsessions and/or compulsions (DSM-5). As far as defining this condition to learners, few mental disorders require less PowerPoint bullets than OCD. If therapy for OCD was 10 times as difficult as defining it, we would still have our clients/consumers/patients cured within a single session. As a pedagogical tool, course directors can reference Game of Thrones as an example of the complexity of human behavior in general, and that of the etiology of OCD in particular.

Beyond the sophistication of the root cause of one’s (e.g. Sandor and Jaime) obsessions (and perhaps related to it), both characters appear to be afflicted with co-occurring mental disorders further complicating the diagnosis of OCD and its treatment. For The Hound, the intrusive thoughts about Gregor may be due to the development of PTSD after his brother held his head in the fire for playing with one of his toys. While intrusive thoughts are a diagnostic criterion of PTSD, recent epidemiologic evidence has pointed to a disproportionate rate of OCD among trauma survivors (1) further complicating the clinical picture. Are Sandor’s obsessions part of his post-traumatic stress or are they defining of a secondary condition (OCD) that requires individual clinical attention and treatment planning? The answer is often not a simple one.

As for Jaime, we must first examine behaviors that are culturally sanctioned in Westeros. Even Daenerys attempted to seduce her nephew “one last time” in this episode. Jon spurning her advances directly influenced her razing King’s Landing. Despite Daenerys’ actions, it’s reasonable to assume incest is not culturally sanctioned in George R. Martin’s universe. In Season 1, Episode 1 (Winter is Coming), Bran climbs an abandoned tower and stumbles upon Jaime and Cersei having sex. To keep the incestuous relationship a secret, Jaime shoves Bran off the tower. If such incestuous behavior was culturally sanctioned, Jaime would not have been so compelled to silence Bran. Since Jaime’s behavior then is interpreted as occurring outside of (para) normative love (philos), his sexual behavior is defined as a paraphilia. Since his sexual deviance does not include recurrent intense sexual fantasies involving a) nonhuman objects, b) the suffering or humiliation of oneself or one’s partner, or c) children or nonconsenting adults, Jaime’s most likely diagnosis is Paraphilia Not Otherwise Specified (i.e. incest is not an established DSM diagnosis).

Unlike PTSD, Jaime’s obsessive thoughts appear to be well-defined within the context of his sexual disorder. Nonetheless, his is another example of the complexity in understanding the role intrusive thoughts play in guiding and governing human behavior.               


Pitman RK. Comprehensive Psychiatry, Volume 34, Issue 2, March–April 1993, Pages 102-107.