Introduction of Topic & Character
The film, The Perks of Being a Wallflower, is a coming of age film based around three high school students who have all formed a friendship out of their need to belong and be accepted. In this story, the main character, Charlie, experienced a profound trauma as a young boy in which his Aunt Helen sexually abused him. She was later killed in a car accident which left Charlie feeling abandoned. As he grew, this trauma seemed to follow him as he experiences episodes of extreme grief and black-outs. Several months before entering his Freshman year of high school, we learn his best friend has committed suicide. This only further sends Charlie into a deeper depression causing him to attempt his own suicide shortly after. This attempt sends Charlie to a psychiatric facility for several months, where upon his release we are first introduced to him and his story. This paper will review the appropriateness of the films portrayal of PTSD, its prevalence and causes, impact, and possible implications for School Counselors. We will also briefly discuss a critique of the film and its overall portrayal of Post-Traumatic Stress Disorder in young adults.
Prevalence & Contributing Factors
Post-Traumatic Stress Disorder is a diagnosis “”defined by the development of a characteristic set of symptoms following exposure to one or more traumatic events”” (Wicks-Nelson & Israel, 2015). In other words, in order to receive a PTSD diagnosis, a child must be exposed to a serious traumatic event. In the case of Charlie, the sexual abuse he experienced as a child was the main cause of trauma, with all the subsequent traumas only contributing further to his PTSD. In fact, one might even argue that had he not developed the PTSD in the first place, he may have not been so susceptible to the later traumas he experienced.
The prevalence of PTSD among school-aged children has been said to affect about one-third of all youths exposed to a trauma (Wicks-Nelson & Israel, 2015). Further, the prevalence of sheer exposure to a traumatic-stressor is substantial and concerning. In a study completed by Costello, Erkanli, Fairbank & Angold in 2002, it was reported that “”one in four children reported one or more lifetime events falling into the high magnitude or extreme stressor category. Of the 25% of children reporting an extreme stressor, the majority (72%) had only one during their lives, 18% reported two such events, and the remaining 10% had three or more.”” With that many children being exposed to such stressors, why is it that some end up with symptoms of PTSD while others do not?
Some contributing factors include; type of trauma experienced, degree and amount of exposures, and individual differences such as ethnicity, gender, awareness and anxiety level, and social supports. When a child is exposed to a ‘lesser trauma’ such as an accident rather than physical or sexual abuse, they are less likely to develop PTSD symptoms. Likely if a child only experiences one incident of the stressor while another child has that experience two or more times, they are far more likely to have the associated symptoms. Differences such as gender, ethnicity and socioeconomic status also play a role in the intensity of symptoms. (Wicks-Nelson & Israel, 2015).
In the DSM-5, there is a cluster of symptoms that one must meet in order to obtain a PTSD diagnosis. These clusters are as follows; reexperiencing, avoidance, negative alterations in cognitions and mood, arousal and reactivity. Reexperiencing symptoms will include intrusive thoughts and reactions. In The Perks of Being a Wallflower, Charlie experiences several flashbacks, reliving the trauma, of his aunt, fights, or other traumatic experiences. His flashbacks also include intrusive physical symptoms; such as a racing heart and sweating. He also has nightmares, or bad dreams about the events, as well as frightening thoughts. His reexperiences are often triggered by certain words, objects, or experiences.
Charlie exhibits several avoidant symptoms throughout the film as well. He often stays away from places, or things that might remind him of his experiences. He also talks about feeling numb, or unnoticed by those around him. He portrays a strong sense of guilt over his aunt’s death and friends suicide, he believes his aunt has died because of him since she was going to get him a gift. His older sister is dating a fellow schoolmate who has exhibited several abusive behaviors, once even hitting Charlie’s sister. Charlie worries about that and feels guilt that he did not help or intervene. Finally, the most apparent avoidant behavior Charlie reveals to the audience is his trouble truly remembering the traumatic events. When recalling memories with his Aunt, they are often choppy bits and pieces. He seems to have trouble remembering that his aunt sexually abused him, as well as forgetting about a fight he was a part of in his school where he asks his friends what he had done.
Going further into Charlie not remembering specific or important aspects of the traumatic event, this is a perfect example of negative alterations in cognitions and mood under the PTSD symptom cluster. Again, Charlie often has flashbacks to the event, however he seems to leave out the most important detail of his aunt, that she sexually abused and raped him. He feels a sense of guilt for her death as she was going to get his gift, but in reality, he probably feels a sense of guilt for wanting her to die, so she couldn’t harm him any longer. Charlie often exhibits a negative emotional state, coming across as depressed, anxious and removed. Until he met his new friends Sam and Patrick, he spoke of not having any friends and not being a part of anything. This not only portrays his diminished interest in enjoyable activities, but also shows us how detached he is from others.
Under the Hyper-arousal cluster category, there are several examples of Charlie being constantly stressed or anxious. He is socially-awkward, which would display his anxiety. He also gets into a fight at school when his friends are being bullied. These symptoms often make a person feel stressed and angry making it difficult to complete common daily tasks. This means trouble sleeping, eating, or even concentrating.
After reviewing the DSM Symptom Clusters, it is evident Charlie meets the criteria necessary for the associated diagnosis of Post-Traumatic Stress Disorder and anxiety. It is also worth arguing that he suffers from depression, which ultimately seems to be a side-effect of the PTSD. After several years of being sexually abused by his Aunt, he developed a mental illness. He avoided and repressed the memory of his Aunt raping him, only to later come to the realization that it did happen at the end of the film. Charlie is quick to blame himself for his problems and the events that happened in his life. He often deals with black-outs, and flashbacks which seem to significantly disturb his mental and emotional well-being. Post-Traumatic Stress Disorder would explain all of this and why Charlie acts and reacts the way he does.
The impact PTSD would have on a student’s academic achievement, social and emotional development and behavior is huge. A 2013 study by Mclean, Rosenbach, Capaldi, and Foa examined the relationship between PTSD and academic functioning and social development. Their result suggested that “”symptoms of PTSD, and avoidance symptoms in particular, are related to decreased social functioning but not academic functioning in adolescent victims…”” Their study suggests that while PTSD has some very serious effects on a child’s social and behavioral development, there is little evidence to prove that PTSD will have a significant effect on their educational and academic success.
Implications for the School Counselor
There are several interventions that would be beneficial for a school counselor to utilize when working with a student who has symptoms of or is diagnosed with PTSD. Psychoeducational and awareness programs are a school-wide approach that can not only help the counselor find those struggling with the issue, but also help the student to realize and understand what it is they are going through. When working with a student, techniques such as modeling, desensitization, contingency plans are all great and have been proven to be successful. Some cognitive-behavioral techniques such as; relaxation procedures, use of coping models, role playing, practicing coping skills in anxiety-provoking scenarios, homework assignments, and teaching problem-solving skills have also proven effective. Finally, when severe enough, it might be necessary to refer the child and their parents to General Practitioner or Psychiatrist as there are pharmacological approaches that prescribe some medications which have shown to be effective in treating PTSD.
As school counselors we have a duty to advocate for our students. While this includes many things, primary we want to focus on consultation and collaboration with protective factors and supports. This includes but is not limited to consultation with the parents and child, informing them of their options and providing them with the necessary tools to work through their diagnosis. We also want to be a collaborative team, working with parents and administration, but also including general education teachers. Our teachers are on the frontlines in our schools, this gives them an advantage to witness all sorts of behaviors. If we are providing a collaborative environment, teachers and parents alike should feel comfortable working with the school counselor to prevent any further trauma or reactions from the trauma. Finally, all the above mentioned coincides with advocacy, but advocacy is such a vital part of what a school counselor must do, that it should be mentioned again. This means providing the school with education, awareness, coping techniques, community supports, and personal referrals whenever it is necessary. If we are not constantly on the offense of anxiety disorders or any other mental disorder for that matter, we are doing an injustice to our students.
There are a few multicultural considerations to be aware of when working with students who may have Post-Traumatic Stress Disorder. Those who experience PTSD is often dependent on the type of trauma exposure. For example, young boys are more likely to develop PTSD from rape, neglect, and physical abuse. While young girls are most likely to develop PTSD from rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse. (Kessler et al., National Comorbidity Survey, 1995). Culturally, there are many things to be aware of. People from some cultures may be more resilient and have better coping skills and protective factors. Some cultures may present symptoms differently. For example, many cultures would present symptoms more somatically rather than showing signs of depression and anxiety. Some cultures may have a negative outlook on mental health disorders and therefore fight proper treatment for the problem. Other cultures might believe PTSD is something to be worked on and fixed within the family and not seek outside help. Whatever the case, school counselors still have options. Connect the families with community resources, be sensitive to individual differences, show respect for the family structure, and ask questions that will assist you in their aide.
School counselors are held to a much higher standard that many other counselors. They have state and federal statutes to comply with as well as possibly city and district requirements. When working with students who had PTSD there is a chance that it might be required to break confidentially in order to maintain the safety of the students and the school. If a student has threatened to harm someone or themselves, that would be ground for reporting. Some ethical considerations to be aware of when working with students with PTSD, as with many disorders are; confidentiality breaching, establishing clear limits on when confidentiality might be broken, keeping a network of peers and mentors that can assist with ethical dilemmas, as well as ensuring all parties involved are aware of the importance of confidentiality. (Kress, Drouhard & Costin, 2006).
Conclusion & Critique
In conclusion, The Perks of Being a Wallflower is a wonderful portrayal of Post-Traumatic Stress Disorder in adolescence. The film addresses many challenges today’s youth might encounter. It presents sexual abuse, bullying, minority issues, violence, and mental health in a very realistic way. The film would be a great tool for school counselors to utilize when working with a student exhibiting PTSD symptoms. It can be shown to parents to help them understand their child better, it could also be shown to the students themselves as a way to connect to the characters and recognize some of the behaviors and issues within themselves. All in all, this film did a great job of thoroughly presenting the aspects of PTSD and would make a great tool for counselors to incorporate into their intervention plans.