PSYC 3350 Abnormal Psychology On-Line What About Bob "Multi-phobic personality characterized by acute separation anxiety . . . " This is Dr. Leo Marvin's diagnosis of Bob Wiley in the movie What About Bob. But exactly what does this mean? We all seem to have a vague understanding of what a phobia is, whether is be from watching movies or our own personal experiences. But what exactly constitutes a phobia, and how does acute separation anxiety fit in to the diagnosis of this character?
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was designed to provide a classification system and means of diagnosis for over 400 mental disorders. By evaluating a client based upon the five separate axes of the DSM-IV, the therapist can come up with a complete diagnosis of a client and use that diagnosis to determine what type of therapy will work best for that client.
A diagnosis of Bob Wiley under the DSM-IV criteria would probably read something like this: Axis I - agoraphobic accompanied by multiple specific phobias, Axis II - of dependant personality disorder characterized by acute separation anxiety, Axis III - unknown, Axis IV - lives alone. But what exactly does this mean? Under Axis I, agoraphobia is marked by anxiety about being in places where escape may be difficult or embarrassing if panic-like symptoms occur.
Bob's agoraphobia is "classic" as defined in DSM-IV, and is alluded to in his working out of his house, his difficulty leaving his home, and his telling Dr. Marvin that "public places are impossible" and he fears that "his bladder may explode" while he is out and looking for a bathroom. Bob even describes his symptoms when he wants "to go out" as being "dizziness, cold sweats, hot sweats, fever blisters, difficulty swallowing, involuntary trembling, numb lips . . . " and so on.
Bob Wiley is a severe multi-phobic; he seems to be afraid of almost everything. In their first interview session, Bob tells Dr. Marvin "I worry about diseases. I have trouble touching things. . . . " This description highlights Bob's main specific phobias: nosemaphobia, the fear of illness, probably accompanied by spermaphobia, the fear of germs. We see other examples of these phobias throughout the movie in Bob's constant use of Kleenex to touch things and spraying disinfectant on telephones and other public areas.
We do see highlights of some other possible phobias: the fear of elevators as evidenced by Bob climbing 44 flights of stairs to avoid riding the elevator, acrophobia or fear of heights we see when Bob looks out the 44th floor window, fear of buses evident in Bob's difficulty getting on a bus, as well as possible hydrophobia - fear of water, achluophobia - fear of darkness, and tonitrophobia - fear of thunderstorms. Axis II of the DSM-IV talks about Bob's personality disorder. Bob has a dependant personality disorder and it seems to be characterized by acute separation anxiety.
We see evidence of the dependant personality when we are led to believe that Bob's dependence on his previous therapist drove that man out of practice. When Bob makes up stories, impersonates Dr. Marvin's sister, and fakes his own suicide to find out where Dr. Marvin is vacationing, these are all signs of Bob's increasing dependence on the doctor. These actions follow the criteria of DSM-IV of deviation in normal impulse control and interpersonal functioning. We even see Bob lying in bed in a state of panic when he first begins looking for Dr. Marvin, which evidences his acute separation anxiety, brought about from his dependent personality.
Axis III involves general medical conditions, of which we know of none in Bob's case. Finally, Axis IV involves psychosocial or environmental factors. Although we are not directly told of any problems in this area, we could infer that Bob's living alone does affect his mental status given his history of problems. Before seeing Dr. Marvin, Bob has been subject to a variety of therapies. The most noticeable therapy being drug therapy. Bob talks about having Valium, Halcyon, and Seconol, all anti-anxiety drugs and all indicative of biological therapy.
Bob also seems familiar with psychodynamic therapy from his "free associations from childhood" he does for Dr. Marvin. The main therapy focus seems to be on "Baby Steps" therapy, which is similar to desensitization - take small steps in order to overcome big fears. Dr. Marvin also attempts some cognitive therapy by giving Bob a prescription to "take a vacation from his problems. " This is supposed to allow Bob to change the way he thinks about his problems so that they are not a crisis any longer and he can just forget about them, because he is on vacation from those problems.
Bob also attempts some of his own therapies. "I feel good, I feel great, I feel wonderful" repeated over and over again by Bob is his own attempt at cognitive therapy and changing the way he thinks about how he feels. Bob also uses behavioral therapy in exposing himself to water by sailing. Granted, he is chained to the boat and is wearing a life preserver, but he is learning to desensitize himself. Bob's problems seem to stem out of the cognitive model; Bob misinterprets feelings and is filled with negative thoughts and errors in logic that affect the way he lives his life.
Throughout the movie we see glimpses of phobias that Bob has, but in one conversation with Sigmund, Dr. Marvin's son, I believe the whole underlying basis of Bob's problems are reveled. Sigmund asks Bob if he is afraid of dying and Bob responds that he is. All of Bob's phobias have the potential to bring on death - falling from a high place, drowning, being struck by lightning in a thunderstorm, germs and diseases that can kill you, or being involved in a bus accident. The question is, what is the best way to treat Bob's problems.
It is this underlying fear that leads me to believe that when Dr. Marvin performs his "Death Therapy," this near brush with death is what seems to finally cure Bob. If this train of logic is true, then this "death therapy" would be the equivalent to flooding therapy from the behavioral model. While this is a stretch, as Bob is not exposed to his unreasonable fears but is exposed to a very real threat of death, it is, nevertheless, a very interesting perspective and one possible explanation to why "death therapy" worked.
Regardless, desensitization and exposure therapy seem to be what works for Bob, for example "Baby Steps" and sailing, which both fall under the behavioral model. What About Bob is a hilarious movie and offers us a chance to laugh at some of our biggest fears. It also gives us a chance to look into the very real world of phobias and personality disorders. By looking at films and analyzing the characters in them, it affords up the opportunity to evaluate the mental illnesses of the characters to gain a better understanding of mental illness in real life.