Psych Ward: Bruce Banner

Doctor Bruce Banner is an underweight adult male. He presents as quiet and withdrawn, especially initially. With time, however, the client can be quite engaging in conversation with a skill for listening and moments of understated humor. Regardless of how involved Banner is in conversation, however, he speaks in a hushed tone and struggles with making eye contact. He is hygienic, but seems largely unconcerned about his personal appearance. This attitude extends to his clothes as well as he favors utilitarian items over any sort of fashion.

It is evident that the client possesses an extremely gifted mind, but he is quite humble in accepting compliments or discussing his intellect. Due to Banner’s areas of expertise he often discusses things that are significantly too complex for the writer. In these instances, the client shows great patience in explaining the information in layman’s terms.

Currently, the doctor is under the care of S.H.I.E.L.D. at an undisclosed location. At this time, no plan has been determined on when and where the client will be transported away from this temporary location. Grounds for discharge have also not been set at this time.

The client’s most prominent diagnosis is Dissociative Identity Disorder. This illness was most likely brought on by the severe abuse that Banner received as a child at the hands of his father. It was further acerbated by patterns that this forced Banner into following his childhood. While never outright abused, he was repeatedly bullied and taken advantage of by those in power. Due to his childhood abuse, the client had, in essence, found that his anger (and other emotions) were ineffectual in protecting him and that simply yielding to his aggressor seemed to provide him the most protection. Thus, in his later relationships, he was unable and unwilling to be assertive because he had “learned” that such tactics would ultimately fail.

However, ignoring or denying emotions does not make them go away and the client’s mind reacted to the undue stress by developing “personalities” that could deal with and express anger. This process was made manifest when Banner was exposed to gamma radiation and his alter ego, the Hulk, was created. (For further information on the Hulk please see my case notes

Since then, much of the client’s life has been dominated by either denial or attempts to destroy his other side, coupled with ever-growing guilt about failing to do so. Eventually, Doctor Leonard Sampson was able to use hypnosis to create a dominant personality that was able to effectively regulate the client’s various identities. The price was, however, the loss of Banner’s body, both literally and psychologically. The “integrated” Banner was, in fact, a Hulk known colloquially as the “Professor Hulk.”

This status has since reverted and Banner is once more capable of taking either form. Either due to choice or the conditions S.H.I.E.L.D. is currently keeping him in, Banner has remained the dominant form since coming into custody.

Recent events, specifically “World War Hulk,” have further complicated the client’s psychological state. While the injustices that occurred concerning his banishment and the death of his alter ego’s wife were primarily Hulk-related, Banner feels them. Thus, he feels betrayed by peers he had trusted for some time and grief stricken at being a widower once again. There are also feelings of guilt churned up by this as both his first wife Betty and his second wife Caiera arguably died because they were a part of his life.

Therefore, the first recommendation of this writer for the client’s treatment plan is monitored mediation sessions between himself and those he blames for his time in space and his wife’s demise. Initially, the sessions should be conducted as a group before progressing to one-on-one meeting as a baseline level of dialogue is established.

The second recommendation concerns Banner’s emotion regulation. It is unlikely that the client will ever be free of this alter ego. Therefore, the client’s hope of

psychological equilibrium lies with his ability to control his emotions and, thus, control his “other.” To this end, it is the writer’s opinion that the mindfulness and distress tolerance skills taught by Dialectical Behavior Therapy would be invaluable. Additionally, the doctor should begin to develop a crisis survival kit made up of items and activities that can soothe him in moments of duress. Finally, the client should be enrolled in assertiveness training to help develop the skills to express his “negative” emotions (fear, anger, etc) in healthy ways that achieve results beneficial to him.

Lastly, it is the opinion of this writer that Banner cannot be treated like a prisoner for his therapy to truly work. With this in mind, the writer strongly urges S.H.I.E.L.D. to release the client to a mental health facility following the first round of peer mediations.

Tim Stevens is a Mental Health Supervisor currently pursuing his Psy D. who has experience counseling those with poor emotional regulation.

http://marvel.com/news/comicstories.5435

Psych Ward: The Hulk

From the outset, it should be noted that the majority of this report is based on naturalistic observation of the behemoth creature known as the Hulk. As such, any opinions or diagnoses presented should be taken with some skepticism as for most of the creature’s existence, personal interviews and/or sessions were not a possibility or were rejected by it.

The Hulk is a humanoid of immense size. His skin tone has fluctuated, over the years, between green and grey. Reports of a red hued Hulk are being ignored for the sake of this report as a colleague, Dr. Leonard Sampson, reports that the green/grey Hulk and the red Hulk are not one and the same. The writer defers to Dr. Sampson in this area as he is considered to be the leading expert on the Hulk, with the exception of Dr. Bruce Banner.

In addition to his varying skin color, the client has also exhibited a wide range of dress and personal hygiene. In early sessions, it favored little by way of grooming and was most often dressed in a seemingly endless supply of purple pants. Upon resuming the grey skin tone it initially possessed, the Hulk began to favor finer clothes, such as tailored suits. Eventually, the Hulk once more returned to green. This time, however, he seemed to be more aware of himself and, while not embracing the fashion forward stylings of his grey side, he was significantly more likely to wear appropriate amounts of clothing in the proper size. There were noted fluctuations with this until the Hulk disappeared for several weeks. Upon the client’s return, during the invasion of New York that has been dubbed “World War Hulk,” it favored armor and tribal style dressings.

While these changes in hygiene and attire would, perhaps, not normally rank this in-depth a summary, they are worth noting in the case of the Hulk. This is due to the fact that these changes often indicated changes in the creature’s personality and behavior as well. Its initial period, which was dominated by the green-skinned, unhygienic appearance, is the one that is must often associated with the client. During this time, it could be remarkably

child-like and full of wonder, before, inevitably, swinging into uncontrollable dangerous rages that threatened everything in the creature’s path. The main objective of “this” Hulk seemed to be to escape and be left alone.

The client’s longest time as grey marked a significant departure. Gone were the childishness and the uncontrollable rage. In their place, many reports indicate cunning and ruthlessness were the creature’s dominant personality traits. This particular incarnation referred to itself as “Mr. Fixit” and worked as an enforcer for the mob.

Following this, the green shade returned, but the historical trappings of it did not. Now, it exhibited all the traits of previous incarnations, plus those of Dr. Bruce Banner, the creature’s alter ego. Dr. Sampson nicknamed this version “Professor” and initially reported that it represented the merging of three disparate parts. Later, however, he admitted that it was, in fact, a fourth part that he introduced, via hypnosis, into the creature’s consciousness and subconscious. This is the personality that has been most often observed in recent times.

Knowing that, throughout this process, the creature was always the same creature, leaves the writer confident in diagnosing with the Axis I malady Dissociative Identity Disorder. The variety of personality traits that the Hulk exhibited over the years cannot be written off as simply a maturation process. They were, simply put, too drastically different from one another. Additionally, previous manifestations would, from time to time, reappear. This was most notably the case with the early or “Savage” Hulk. Any study of the Hulk over a prolonged period of time reveals several noted regressions to the behaviors and mentalities associated with that personality.

The Savage Hulk personality also exhibits the black and white thinking and difficulties with emotion regulation that are common with sufferers from the Axis II illness Borderline Personality Disorder. However, it is not recommended that, any point, staff attempt to use Dialectical Behavior Therapy (DBT), the typically recommended approach for those with BPD, to treat the creature in this state. This personality seems to be

operating at the intellectual level of no more than a 3-year-old child. Therefore, in much the same way that severally developmentally disabled individuals are unable to grasp the concepts of DBT, the Hulk will not be able to process the information. Given this personality’s volatility, it seems likely that this would cause confusion and frustration, leading ultimately to an enraged outburst.

The only treatment plan the writer can recommend at this time, if ever the creature is brought into custody, is the one that Dr. Sampson has had so much success with previously: a mix of hypnosis and psychotherapy. The opinion of this writer is that it is now impossible to put the proverbial genie back into the bottle and thus, the best case for “cure” is build up the Professor personality until the Hulk has enough confidence in its ability to provide all the Hulk needs, be it protection or intellect, and can let go of the other personalities.

Tim Stevens is a Mental Health Supervisor currently pursuing his Psy D. who has experience dealing with those with developmental disabilities.

http://marvel.com/news/comicstories.5300