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Diagnostic Assessment Of Christine Daae

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The Phantom of the Opera is a story about a girl named Christine Daaé who grew up in the Paris Opera House. After her father’s death, the Angel of Music, who is later to be discovered as the haunting figure the Phantom, visits her. The Phantom is a disfigured and troubled man who lives beneath the opera house and terrorizes it.

After becoming her tutor, he quickly becomes obsessed with her and demands that she be given all the main roles in the operas. She ends up falling in love with her childhood friend, Raoul, angering the Phantom. As the story progresses, she battles between her love for Raoul and her desire to keep the Phantom in her life.

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Based off of the symptoms seen throughout the movie, it could be hypothesized that Christine is suffering from Major Depression Disorder (MDD). According to the DSM-5, MDD is characterized by “at least one major depressive episode and the absence of manic or hypomanic episodes before or during the episode”. The features of a major depressive episode include the following occurring most of the day nearly every day for at least two weeks:

  • Depressed mood
  • Markedly diminished interest or pleasure in most daily activities-Significant weight loss when not dieting, weight gain, or significant decrease or increase in appetite
  • Insomnia or hypersomnia
  • Noticeable psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Diminished ability to think, concentrate, or make decisions
  • Recurrent thoughts of death, suicide ideation, or a suicide attempt
  • Clinically significant distress or impairment
  • Symptoms are not due to the effects of a substance or a general medical condition

A number of triggers can bring on a major depressive episode, and ultimately MDD, such as the loss of a loved one. Throughout the movie, Christine mourns the loss of her father. It appears that she suffers from complicated grief, in that she experiences persistent symptoms of acute grief (her father died several years before we meet Christine), and thoughts, feelings, and behaviors that show that the circumstances or consequences of her father’s death worry her (Durand & Barlow, 2015). Complicated grief can lead to suicidal thoughts or tendencies, as presented in her song “Point of No Return”, in which she contemplates suicide with the Phantom, to once again be with her father. Socially, she mainly associates with Madame Giry, who raised her once her father had passed, Madame Giry’s daughter, Meg, her childhood friend, Raoul, and the Phantom. It is obvious that the Phantom is a very detrimental figure in her life, causing her more stress and harm than anything.

There’s one scene in which Christine mentions her hallucinations of her father visiting her as the Angel of Music, to which Meg looks concerned for her and tells her, “Christine, you’re talking in riddles, and it’s not like you!” Once again, Christine tells Raoul about the Angel of Music visiting her, and he doesn’t take her seriously and ignores her fear of this angel. With these scenes, one can assume that Christine feels unable to really reach out for help with her depression, because those of whom she has mentioned her delusions to don’t take her seriously, thus, her turning more to the Phantom to ease her mind and keep her from facing her sadness. However, in the end, Raoul seems to bring her out of her major depressive episode, showing that social support was effective in her treatment. Biological factors of her depression aren’t shown very prominently in the movie, however.

One instance is her possible insomnia as she escapes to the cemetery to visit her father’s tomb at what appears to be dawn. This suggests that she’s unable to sleep with the thought of her deceased father looming over her. Another instance is in the Phantom’s underground lair, when he shows her the wedding dress he has for her, and she faints and sleeps in his bed for what seems to be hours, depicting fatigue. All together, her initial lack of social support along with her psychological vulnerability resulting from the stress of losing her father led her to the depressed state that we find her in.

Before her father had passed, he told her that an angel would visit her when he reached heaven. The Phantom, or rather, the Angel of Music, can be seen as the angel of her father since he didn’t appear until after her father’s death. He’s the voice inside her mind telling her to hang onto his memory and shy away from the feeling of sadness and loss, prolonging her grieving process. By hanging onto the Phantom, she is in turn hanging onto her father, and is, thus, unable to let him go. Raoul is seen as a figure of love and life, enticing her to relive old, happy memories from their childhood. Christine struggles with choosing between Raoul and the Phantom for fear of losing the Phantom and having to face grief and sadness, but also longs for Raoul’s love and support. Together with Raoul, she is able to take a stand and face the Phantom and tell him that she no longer needs him, allowing herself to accept her father’s death.

Tobia et al. reiterate this by their exploration of Elisabeth Kübler-Ross’ five stages of grief and how they are associated with the different scenes and songs in The Phantom of the Opera. The first stage, denial, is apparent in the beginning of the movie with Christine believing that she’s being visited by her father, or rather the Angel of Music, which could also be seen as a delusion within her depression disorder, and she even exhibits auditory and visual hallucinations. She sings “The Phantom of the Opera”, saying, “And do I dream again? For now I find the Phantom of the Opera is there – inside my mind”. Bargaining, the second stage, comes about when she sings the song “Wishing You Were Somehow Here Again”, in which she basically begs her father not to haunt her anymore. Once more, the Phantom appears to her, and Raoul reassures her that he isn’t her father, stressing that it is only in her imagination. She enters the depression stage during the Don Juan Triumphant scene. “Point of No Return”, which is representative of suicide and her understanding of the certainty of death, is sung. She then experiences the anger stage when the Phantom kidnaps her. As Raoul comes to save her, the Phantom captures him as well, and gives her the ultimatum to stay with him or Raoul dies. Christine is shown to be angry at the Phantom, or rather her father figure, singing, “The tears I might have shed for your dark fate grow cold, and turn to tears of hate. ” The three characters then all sing different lyrics simultaneously, depicting the clashing thoughts one may have when considering suicide. The last stage, acceptance, comes at the end of the movie, when Christine is seen to show some resolution in choosing her fate to save Raoul, to which the Phantom responds by freeing them both. This action allows her father’s soul to “take flight” (Tobia et al. , 2017).

Recurrence is common with major depressive disorder, in which the individual experiences multiple major depressive episodes separated by at least two months without showing signs of depression (Durand & Barlow, 2015). Upon meeting Christine in the beginning of the movie, she’s obviously experiencing a major depressive episode, crying over her father, and imagining that his angel is there teaching her to sing. The movie spans over about a half a year, and we see that she continues to experience her depression. In the time lapse of those months, her depression may have lessened, but it’s apparent that she is still suffering toward the end of the movie when they finally face the Phantom.

A study performed by Kessler and colleagues found that 24% of emerging adults studied, ages 18 to 23 (Christine is estimated to be 20), had experienced major depressive disorder (Durand & Barlow, 2015). These findings had the highest rate of occurrence compared to the different age groups. This suggests that Christine was potentially more susceptible to experiencing MDD. The duration and recurrence of MDD can vary. Thus, treatment plans should be made while keeping in mind that depressive episodes are recurrent and, as always, should be individualized. Parikh et al. explored the different types of psychological treatments for MDD. They stated that there are seven components to these treatments: (a) the goal of the treatment is to alleviate depression symptoms, (b) there’s typically a manual with specific methods of therapy delivery, (c) current problems are the focus, (d) both the patient and therapist are expected to be very active during therapy, (e) there is symptom monitoring, (f) illness education is provided, and (g) the treatment is time-limited (Parikh et al. , 2016). Of the types of psychotherapy explored by these researchers, as far as for acute therapy, it would be most effective to administer cognitive-behavioral therapy (CBT), interpersonal therapy (IPT) and/or behavioral activation (BA) to Christine for her depression. CBT is an intensive therapy and is symptom focused. The interventions conducted focus on encouraging a patient’s participation of activities that are meant to boost their mood through a heightened sense of pleasure and achievement (Parikh et al. , 2016), and to focus on maintaining and correcting depressed thinking (Durand & Barlow, 2015). This type of therapy has been shown to be as effective as antidepressants.

Of course, antidepressants in combination with any of these methods of psychotherapy, is the most effective treatment route. This would be a helpful type of treatment in that she would be performing positive tasks unassociated with the Phantom. CBT would also be a useful mode of maintenance therapy in preventing future major depressive episodes. IPT ultimately works to ease suffering, address symptoms and improve functioning, as the therapy is focused more on the patient’s stressors, such as loss, change or interpersonal sensitivity. In this type of psychotherapy, there are four interpersonal problem areas outlined, each with their own specific therapies: bereavement, social role transitions, disputes, and social deficits with interpersonal sensitivity (Parikh et al. , 2016). For Christine, this would be a good choice of therapy because it would require her to face her father’s death and confront it, as opposed to her normalcy of hiding from it and believing he is still around through the Phantom.

The idea behind BA is, basically, that the patient avoids unpleasant emotions, so behavioral techniques are applied to appropriate positive reinforcement of behaviors that are not depressive (Parikh et al. , 2016). Christine could also benefit from this type of psychotherapy in that she, like CBT, would be performing tasks unassociated with the Phantom, or rather her father, showing that she can behave and go on without him around. IPT may be the most effective acute psychotherapy treatment for Christine, as she suffers from the bereavement of her father, while for maintenance and prevention of further episodes of depression, CBT therapy might be most effective for her.

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