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Roxanne Musharrafeia
PharmD Candidate 2016
Belmont University College of Pharmacy
Nashville, TN

J. Michael McGuire, PharmD, BCPP
Assistant Professor of Pharmacy Practice
Belmont University College of Pharmacy
Nashville, TN

Speak” is a film directed by Jessica Sharzer and is based on the novel written by Laurie Halse Anderson.1 The story focuses on Melinda Sardino, played by Kristen Stewart, as she not only struggles with being a freshman in high school, but also with having been raped the previous summer. “Speak” illustrates various manifestations of Post-Traumatic Stress Disorder (PTSD) through Melinda, and shows the viewer how high school can be the perfect environment to foster a psychological illness.

The film opens with Melinda drawing stitches across her lips, a symbol for a recurrent theme throughout the movie. The theme, after which the story is named, is Melinda’s reluctance to speak. This, coupled with her depressed mood, clues the audience in that Melinda is struggling with some internal battle. It isn’t until her flashbacks of the previous summer that we begin to understand the source of her struggle. Melinda was raped at a party she had attended that summer. After the rape occurs, in her hysteria, Melinda calls the police and the party is busted. Her traumatic experience causes her to lose the one thing which could be the most therapeutic for her: communication. She tells no one what happened, and as a result, is labeled by her future classmates as a “squealer.” Her three best friends, unknowing of the truth behind the circumstance and wishing to begin high school without stigma, avoid her and treat her harshly at times. All of these elements contribute to Melinda’s development of what can be diagnosed as PTSD.

Many of Melinda’s behaviors are consistent with the DSM-5 diagnostic criteria for PTSD.2 The first and most obvious requirement is the exposure to some type of traumatic event. This is obviously represented by Melinda’s rape. Afterward, she is constantly reminded of her experience due to her classmates’ consistent bullying. The primary reminder, however, is her horrific realization that her rapist attends her high school. These reminders manifest as flashbacks and nightmares and constitute what the DSM-5 labels as “intrusive symptoms.”2 In the film, these intrusive symptoms are a tool used to help relay the story. For Melinda, they are a horrific reminder of everything she has been through and cause her noticeable distress. This distress manifests as negative alterations in her mood.2 Melinda never smiles, she rarely speaks, and nearly all of her free time is spent alone. She disdains the brighter, more cheerful clothes her mother chooses for her, and a lot of her internal dialogue throughout the movie is negative. Melinda’s anxiety is openly displayed when she literally runs from the cafeteria when forced to be near her rapist, and upon arriving home, when she muffles a scream into a shirt in her closet.

Naturally, Melinda begins avoiding all of the things that trigger her negative emotions. She stops communicating, neglects to participate in extra-curricular activities, and avoids reaching out to her family. A more concrete representation of her avoidance is her adoption of the abandoned janitor’s closet at school. This closet becomes a sanctuary within a place she considers hell. In the closet, Melinda doesn’t have to hear the names she is being called, and she doesn’t have to feel threatened by her classmates. Here, she is able to not only avoid all of the negatives associated with her experience, but is able to heal in any way she can. Patients with PTSD may also experience alterations in arousal and reactivity.2 We can see alterations in arousal manifested in Melinda zoning out and daydreaming. Though she is physically at school, her mind is constantly elsewhere.

Many of Melinda’s symptoms could simply be interpreted as adjusting to a new high school environment. This, in a large part, allows her illness to go undiagnosed. Thus, in terms of direct treatment for PTSD, Melinda never receives treatment. For Melinda, drawing is a mechanism by which she chooses to heal. The largest comfort is afforded by her art professor in the form of multiple projects centered on a randomly assigned object. Melinda is assigned a tree. Initially, this object is distressing for her, because a tree was her focal point as her rapist was taking advantage of her. However, as the year progresses, this assignment would prove to be the most therapeutic for her PTSD. Eventually, Melinda finds her voice, exposes her attacker, and begins communicating with those around her. While this is not the end of her disorder, it is certainly a start and affords a brighter hope for the future.

“Speak” is not only a movie that affords great insight into PTSD, but it relays a story which is highly relatable. Many individuals with a psychiatric illness, no matter the extent, have found it difficult to communicate, or speak. Many find their own methods of healing, and some never find it in them to open up. High school can foster this atmosphere of avoidance, and “Speak” allows us insight into the manifestations of PTSD in this environment. In relation to many movies regarding psychiatric disorders, “Speak” is not overly dramatic, and in my opinion, emotionally accessible to the audience. In terms of reference material for depicting manifestations of PTSD, Melinda’s character is realistic. In my personal opinion, “Speak” would be an excellent source to utilize in a classroom setting as a reference to PTSD.

References

  1. Sharzer J. Speak [Digital]. United States. Speak Film Inc. 2004.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013.
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