Can you psychoanalyze a psychotic person? Yes. At certain extent it can get you some kind of insight in the background of ones suffering. The unconsciousness is flowing with ease through the mind. No boundaries. Self is dispersed. Does it help you in any way to treat a person? Hardly, I'm afraid.

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TRAVIS BICKLE

SCORSESE enters THE SHADOW

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Scorseses master piece brings us precise modernistic directing, focusing on the main hero/antihero's psychic disturbances. While discarding the classical narrative in story telling Scorsese brilliantly envisions the main characters state of mind.

ROUGH ANALYSIS OF TRAVIS'S MENTAL STATUS (I've pin pointed few features, not the whole status)

Who the F..k is he??

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Travis Bickle, a cab driver from NY.
The background of the main character remains unknown.
We know that he has been serving in the toughest US navy forces these days, but he doesn't show any signs of PTSD elements. He doesn't ruminate about the horrific events he had to whiteness in his war days. He doesn't have flashbacks. Doesn't seem he has been to war altogether.

APPEARENCE

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At the end of the movie we can see the acute psychosis in a full form. Taking into a contest his evolution throught the movie.

THOUGHT PROCESS

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In certain scenes (when he is running his dictionary) we can see that the flow of his thoughts, at times, becomes dissociated. Meaning that it doesn't have a determined tendency, which is usually a sign of a psychotic disorder (or intoxication). He is clearly delusional. Content of his delusion is a grandiose idea about him. Its the delusion of a messian significance with the will to provide serious actions according to his psychotic reality. His verbal expression is reduced, he answers after long pauses, possibly due to the block of thoughts.

AFFECT, PSYCHOMOTORICS AND MOOD

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Affect is blunted, far far away. You can see he is never relaxed, very tensed, overly suspicious. Shows sings of depression in some ways. Sleep disorder, lack of self care in terms of bad nutrition. Insomnia in this case is a symptom of his primary disorder. You can't say his sad though. Empty I'd say. The main difference in diagnostics. He doesn't suffer from a depressive disorder, rather depressive symptoms in this case are a small block in the whole clinical feature.

WILL, FUNCTIONALITY

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He doesn't seem over passive through the day, works during the night... Seems to be motivated enough, even though driven by his delusional ideas. Hi is employed, doesn't seem that his state affects his working ability in any way.

INTERPERSONAL RELATIONS

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Socially isolated. After the rejection of a woman he was „overly attached“ , the only bridge between his reality and outer world was crushed down. He dug deeper in his autism, forming delusional ideas about his messian purpose to save the world (to clean the filthy streets of NY). His limbic system is going crazy, overly averting his mental mode to a „fight state“ (fight or flight is the main function of a limbic system in temporal lobe of the brain) showing how his perception of reality is impaired.

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COGNITIVE FUNCTIONING

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Is he organaZIZed?
I'd say he is organized to a certain extent and his memory seems well reserved. No signs of organic deterioration in his psychic status.

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INSIGHT

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Its obvious that he doesn't have any at this point. But in this case you can be more optimistic as the pharmacological therapy can be very useful. Primarily psychotic patients can react to a pharmacological agents in a great way. Yet, from all psychotic disorders, the persistent mono delusional disorder can be hard to treat in sense of a great effect on the insight of the patient. „Hard coded“ delusions that are untreated for years can be resistant even to an electroconvulsive therapy.

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Its clear in so many ways that Travis is suffering from some form of psychosis. Delusion and impaired perception drives him to a killing rampage of (from his point of view) morally crippled people. It would be nice to see how did they started with the treatment of Travis after the whole event, since i presume that he had to be checked out by a psychiatrist when he was physically recovered.

DIFFERENTIAL DIAGNOSIS

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Is he schizophrenic?
Maybe. But to establish the diagnosis of schizophrenia you need a continuum of several months, or even years. As far as we know this is his first psychotic episode. We'd need an info from his parents about his previous life. As well as some family history of mental illnesses. MRI brain scan would be useful to exclude some organic substrate of his condition.

The main symptom in Travis's case is mono delusion of his higher purpose so we can consider a persistent delusional disorder. If he starts to deteriorate in cognition, or starts developing more bizarre elements in his delusions and maybe even hallucinating, we could say that it's a clear form of paranoid schizophrenia.

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DIAGNOSIS

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His diagnosis would be somewhere in the spectrum of Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders.

Diagnosis according to ICD (International Statistical Classification of Diseases ) - 10th revision

F29 Unspecified psychosis not due to a substance or known physiological condition

vs

F22 Delusional disorders

F25 Schizoaffective disorder

TREATMENT

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Approach in treatment in of Travis would be mainly pharmacological, at least at the acute state of his illness. He'd have to be treated in a locked psychiatry department until you can be sure that he is harmless for others. I'd treat him with combination of antipsychotics. Flufenasine for his sever delusions and aripiprasole for the so called negative features of a psychotic disorder, including his depressive symptoms. Psycho-education end behavioral psychotherapy could help keep his feet on the ground.

Prognosis would depend on his adherence to the therapy.

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Is there any other character you'd like to dissect?

Psychologically of course! ;)

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Feel free to Upvote and comment, suggest for movie analysis :)

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