The Machinist: Movie Reviee
The machinist is one of the movies that treat some mental health diseases and disorders. Christian Bale is the main character that played the role of Trevor Reznik. Trevor Reznik is a machinist in a factory, a repetitive, exhausting craft, in the middle of a deafening noise, where the slightest inattention can have dramatic consequences. Attention that Trevor is struggling to maintain because he is very tired. In fact, Trevor has not slept in a year. He shares his nights between the cafeteria at the airport, where he meets Marie, the waitress, and the flat of prostitute Stevie.
For some time now, Trevor's life has become more and more strange. Who leaves coded messages in his apartment? Why does Mary look so much like her mother? As for Stevie, she seems to know the new employee of the factory, Ivan. Why did not she tell him anything? He is disturbing; he seems to be constantly watching Trevor. Trevor Reznik does not sleep anymore and he becomes thin unhealthy, he starts to doubt everything, everyone surrounding him, even himself. Hi is strangely quiet and withdrawn. Even his relationship with his colleagues had obviously deteriorated, and these conditions are due to the fact that a year ago he was responsible for an accident with his car that caused the death of a child with in addition to a hit and run. So, he was not arrested by the police, but this tragedy affected him all. This explains his lack of sleep and his considerable weight loss. But his troubles do not stop there, they are also psychological. Always because of his insomnia, is added losses of occasional memories and hallucinations. These visions have a name: Ivan. It represents Trevor's conscience, it is all the shame he feels for himself that are concentrated in this unpleasant character. Also, his disturbing appearance and strange behavior keep his colleagues out. Finally, they turn to him after he has been involved in an accident that will cause the loss of his colleague Miller's left arm.
In parallel with all of these events another significant story took place in the movie that to celebrate the Mother’s day, Marie asked Trevor to go to an amusement park with Nicholas; her son. Nicholas wanted to go on a ride on Route 666; a well designed funhouse which will shadow Trevor’s denial and guilt about the car accident. The ride came to a crossing road; either to choose the pathway to salvation or the path to darkness. Their cart went towards the dark path and then Nicholas had an epileptic seizure.
After all those events Trevor’s puzzle began to be clearer as Ivan, Nicholas and Marie were fictitious characters, and were made after the hit and run accident that resulted in the death of Nicholas. Ever since that tragedy, Reznik lived in denial and skipped it as if it never happened. Thus, he became paranoid, insomniac, with an urge to wash his hands with bleach to clean his consciousness and remove the feeling of guilt, and to swipe from a social personality to a psychotic introvert. Towards the end of the movie, Trevor confronted Ivan and killed him, and to get rid of his dead body he wrapped it in an old carpet and pushed it down a harbor. What the protagonist was experiencing was likely a snowball effect as a coping mechanism of his post trauma state. According to the diagnostic and statistical manual of mental disorders fourth edition (DSM-IV), this psychological impairment or post traumatic stress disorder (PTSD) is a result of an inability to cope with undesirable events which an individual experience or witness. In this paper the author will utilize the movie the machinist to outline this disorder, to explore its associated signs and symptoms, nursing diagnosis and interventions, therapy used to treat it, and finally suggests some recommendations to optimize the outcomes of the therapy (APA, 2013).
Trauma is a physical, psychological or emotional threat to an individual safety and security, resulting from the exposure of a subject to an extreme situation of which he or she has been the victim or only the witness: rape, scenes of war, attacks, and serious accidents. This syndrome is diagnosed when the patient is significantly disturbed by obsessive memories that have a direct impact on his social, emotional and professional life. Reaction after traumatic events differs from person to another and how the individual perceive these events. Post traumatic stress is most often expressed by feelings of fear, horror and helplessness. It manifests itself in symptoms of intrusion: the person relives the traumatic event with nightmares, repetitive and invasive memories, and distress with elements recalling the event.
Symptoms of avoidance of memories and people or places reminiscent of trauma can also occur, as well as emotional alterations: decreased interest in everyday activities, decreased concentration, and difficulty in experiencing tenderness or desire sexual intercourse, sleep disorders, irritability, hypervigilance and guilt. These symptoms usually have repercussions on social life, family life, and professional life. They vary in intensity depending on the person. The onset of symptoms varies among individuals, they can manifest soon after the event or later. Generally, this happens within the first three months. It also happens that the symptoms do not appear until several years after the event. In all cases, it is common to observe a persistence of symptoms over time. When the symptoms persist, it can doubt a post traumatic stress disorder (PTSD) or an acute stress disorder (ASD) (McLaughlin et al, 2013). The proportion of 3. 6% of the world’s population has suffered from PSTD as estimated. According to a report study of the world health organization (WHO) published in 2013, among 21 countries a proportion of 21. 8% reported that they had witnessed violence, 18. 8% had experienced interpersonal violence, accidents (17. 7%), and exposure to war (16. 2%). In Morocco among 800 subjects, 25. 5% of anxiety disorder: panic disorder, PTSD 3. 4% (WHO, 2013).
The key factors that trigger PTSD include: experiencing a horrifying traumatism, witnessing a violent accident or death, violence towards self or others, childhood trauma, substance abuse, lack of support post trauma or living extra stress after the traumatic incident (Harvey et al, 2015). Additionally, most of the individuals who have witnessed a traumatic event experience some intrusive memories and flashbacks from the trauma, that point after the traumatism make the individuals recall the terrifying event, and their emotions shift to be frozen with people who used to be once closed too, which is clearly pictured in the movie, in which Trevor had not initiated nearly any conversation with his colleagues during the whole movie. Also, they manifest an arousal reaction; they become very alert, unfocused and easily distracted within the early hours or days of the trauma. As it is said earlier, the reaction remains spontaneous within the first month of the event as long as the person interested is able to process it and can come to term to cope with what happened. However, the mentioned symptoms will meet the criteria needed to confirm the PTSD if they exceed one month. Otherwise, within the first month, these symptoms will match the criteria of an acute stress disorder, and their intensity and recurrence depend on the reminders of the original event, the life stressors, or when experiencing a new trauma (Fry, 2016).
According to DSM 5, there are four main clusters of PTSD’s symptoms, which are: involuntary recollection of intrusive memories of the trauma, avoidance of any stimulant of the trauma, numbness or altered cognition related to the event, and hyperarousal in which the person is highly alert and sensitive to any potential threat (Toussaint, 2017). In the first cluster, the involuntary reminders that follow the horrifying event are composed of nightmares, flashbacks, frightening ideas and thoughts. As a result, this weakening condition causes different problems in the traumatized person’s daily routine such as: disturbed sleep pattern, difficulty to think clearly, anger, aggressive attitude and disturbed nutrition as the main character was described previously. Second cluster is the avoidance symptom which is triggered by the reminders. At this stage the persons becomes depressed, emotionless, demotivated and disconnected from his surroundings and even oblige them to shift their routine, drift away from their family and friends; which prompt the viewer to wonder is that similar to the machinist who appears lonely and has roughly few friends; Stevie and the imaginary Marie. Mood and cognition cluster includes difficulty remembering major features of the incident, developing negative self image and thoughts about oneself and the world, indifference in enjoying habitual activities, and unclear, distorted feeling (blame and guilt). As previously described in the introduction, the post traumatic protagonist in this movie, had suffered from similar symptoms, especially the recollection of the accident memories while riding the cart in the Route 666; the whole pathway of that funhouse was full of crashed cars and dead or injured people. Also, he was completely indifferent about his hygiene and nutrition. To avoid recalling the trauma, he used to spend his time and money on Stevie; the prostitute. The last cluster is the hyperarousal, where the person become more alert, tensed, on the edge of breaking down, cautious, and easily manifest anger outbursts. Usually those symptoms; instead of being provoked by the reminders, are constant. Which unable the individual from accomplishing one’s daily tasks, eventually changing into a disinterested person (Iribarren et al, 2015).
PTSD is showing naturally a substantial recovery in the earlier months and years after the trauma. Whereas a significant proportion of the incident survivors will manifest the initial PTSD’s symptoms, a small part of it will recover spontaneously without any treatment or interventions in the following periods. On the other hand, the estimations predict that the third of the individuals who develop initial signs of PTSD remain symptomatic after the trauma for 3 years or even more, and are under a high risk of misusing or abusing substances, trying to overcome and forget the traumatic experience (Atwoli et al, 2015). Therefore, to confirm the diagnosis the person must show at least the above symptoms from each of the four clusters for one month. These symptoms must not be attributed to other conditions or substances, in order to correctly diagnose the patients instead of confounding the diagnosis with a state of being normally unhappy or overly stressed (Pitman et al, 2015).
Psychosocial, psycho physiological factors such as: culture, stigmatization and discrimination make PTSD a strongly challenging and complicated disorder to be treated effectively. Those cultural and social barriers create a feeling of fear; fear of being mentally ill labeled in their community or society; which stop the patients from seeking help from health care givers (Shalev et al, 2017). In this movie, the author had not notice any sign of label or stigma of the main character. However, it was observed during the whole movie that this protagonist has strangely put his life and his colleagues into danger, as an example, when he was in the factory while his colleagues were fixing the broken machine, he harmed his colleague unwillingly making him loses an arm because of distraction. Which directly guide to the broken ethical principle non maleficence.
To overcome the main character’s psychiatric disorders nursing diagnosis can be as follow: disturbed sleep pattern related to anxiety as evidenced by insomnia for a year. As mentioned earlier that the protagonist spend his night in the airport with imaginary Marie and Stevie. Imbalance nutrition, less than body requirements related to lack of interest in food as evidenced by weight loss. As independent nursing interventions the care givers should maintain the main character’s needs in terms of using effective therapeutic communication, establish trust with the patient. Encourage patient to take rest and try to sleep, the care givers should provide medications if needed. The care providers should wisely deal with PTSD patients, they rather teach the patients the skills needed to manage their symptoms, involve them in the care to avoid any stigmatization’s concerns, adopt peer support with the team members and family support to manage effectively this disorder, help them to participate and enjoy the activities they used to do before the traumatic event. Finally, the health professional must notify any ongoing or continuous trauma such as: substance abuse, domestic violence that the patient may have, because it is very important to solve the initial problem so that any intervention would be effective (Gene-Cos et al, 2013).
There are various forms of psychotherapy and medication to treat PTSD which showed a quite promising effect on the patient, especially, cognitive behavioral treatment (CBT) that includes multiple techniques such as: cognitive restructure (CR), Eye Movement Desensitization and reprocessing (EMDR), and exposure therapy (ET) (Hamblen, 2013). As it is known, every individual is unique so a treatment that works on one person might not likely work on another. In other words, some PTSD‘s patient must try a variety of treatment to find the exact one that work for them. Anyone with PTSD is strongly advised to be treated by a competent health professional experienced with this disorder (Gillies et al, 2013). Latest studies have shown the pharmacotherapy used to treat PTSD is antidepressants which are helpful to ease and control its symptoms (depression, anxiety, disturbed sleep pattern and numbness). The widest drug treatments approved by the food and drug administration used are the selective serotonin reuptake inhibitors (SSRI), for example: Zoloft and Prozac.
On the other hand, the psychotherapy or the talk therapy consists on talking with the mentally ill patient to treat the disorder. It can occur in groups or one on one talk therapy, it usually lasts for six to twelve weeks or in some cases longer. Their prior tendency is to emphasize the key components including identification and education about the symptoms, the triggers behind the symptoms and the skills needed to cope and manage them. The therapies are comprehensive and focus on social issues, family problems or job related issues, and they may combine different therapies depending on the specific needs of the patient (Foa et al, 2014). CBT’s techniques were found helpful in improving PTSD symptoms: CR is about guiding the individuals to identify and challenge realistically the problem to suppress the distress. The second form of CBT is the ET, it consists on reliving the trauma in a safe controlled context to help the individuals cope and gain control on their fear and distress. And lastly the EMDR, during this session the therapist asked the patient to recall the incident memories while following the therapist’s finger, this dual attention will help the patient to process the memories and thoughts stored.
To sum up, the Machinist offers a brilliant opportunity to consider the diagnosis of PTSD, nearly every image and word; no matter how small, is important to understand the story. In fact, with the dramatic increase of crimes, terrorism, and natural disasters; the currency of PTSD is increasing each day to become a known disorder in this century. As it has been discussed the therapies have a great importance to treat the disorder along the self help and family support to prevent it from developing. This paper has looked at PTSD; history, epidemiology, different clusters of symptoms, nursing interventions, treatment, and some interventions to reinforce and empower the PTSD patients in Morocco.
In closing, the author highly recommends a successful partnership which is an essential mainstay intervention to prevent and deal with PTSD. This partnership is a combined effort of the government, the ministry of health and the health providers. Initially, the government should support the ministry by providing financial resources to fund the health programs designated to enhance mental health in Morocco, to fund the nursing research field by encouraging charitable event and organizations and insure a national coordination between the provinces and the ministry of health to elaborate a comprehensive action plan on PTSD. After that, the ministry of health which is responsible of the implementation of the PTSD plan, which will guide how the care givers will manage this disorder in a way that protect the staff and patient. Also it will put into action a prevention plan for PTSD victims as an early intervention that will strengthen the mental health resiliency. Moreover the minister of health should guarantee an equal access for all the patients that seek help by creating new facilities all over the country and provide the human and financial potential needed.
