The Therapist Gamer

Red is the protagonist in the Pokémon games.  He is a young boy who collects pocket-sized monsters (or "pokémon") and would like to collect all their varieties and become the best pokémon trainer in the world.  Throughout his travels he uses his pets to fight both wild and trained pokémon in an effort to strengthen his own creatures and capture new ones.  Thoughout the pokémon games Red has battled, collected, and bred hundreds of these animals.  Though not explicitly stated, the character "Ash" from the pokémon television series in based off of Red.  The theme song for this show contains the phrase "Gotta Catch 'em All!" and is characteristic of Red's lifestyle.

 

It should be noted that I have not interviewed Red in person.  However, after examining many hours of data provided over several years by multiple sources, my diagnosis can be made with a reasonable degree of confidence.  

 

My initial diagnostic impressions include:

-Conduct Disorder

 

The following diagnosis has been proposed by others, and it's validity will be examined:

-Obsessive-Compulsive Disorder

 

 

 

 

CONDUCT DISORDER

The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.  I will italicize statements that appear relevant to Red:

 

Diagnostic Criteria:

 

A:  A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

 

Aggression to people and animals

     (1) often bullies, threatens or intimidates others

     (2) often initiates physical fights

     (3) has used a weapon that can cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife, gun)

     (4) has been physically cruel to people

     (5) has been physically cruel to animals

     (6) has stolen while confronting a victim (e.g. mugging, purse snatching, extortion)

     (7) has forced someone into sexual activity

Destruction of property

     (8) has deliberately engaged in fire setting with the intention of causing serious damage

     (9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

     (10) has broken into someone else’s house, building, or car

     (11) often lies to obtain goods or favors or to avoid obligations (i.e. “cons” others)

     (12) has stolen items of nontrivial value without confronting a victim (e.g. shoplifting, but without breaking and entering; forgery)

Serious violation of rules

     (13) often stays out at night despite parental prohibitions, beginning before age 13 years

     (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)

     (15) is often truant from school, beginning before age 13 years

 

B:  The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

 

C:  If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

 

Analysis of Criteria

Though Red does not initiate physical fights between himself and other people, he initiates fights between his and others' pokémon (criteria A2).  Some of these pokémon are very large and extremely dangerous, such as the 1,600 pound Steelix or the aggressive Scyther who has swords for arms (criteria A3).  As noted previously, Red has arranged thousands of fight between pokémon which last until one of the pokémon is no longer conscious (criteria A5).  This behavior appears to impair Red's functioning in school - in fact, he is so busy arranging animal fights that he doesn't even go to school (criteria B).  Red is younger than 18 years old (criteria C).

 

At face value it appears that Red meets criteria for Conduct Disorder.  However, there are cultural factors that should be considered.  For example, school attendance does not appear to be a cultural norm in Kanto and thus perhaps Red's animal fights do not interfere with his academic functioning.  It does not appear to impact his social functioning in any significant way, either.

 

It is difficult to determine whether or not pokémon battles are the cultural norm in Kanto or whether it is simply a tolerated but aberrant activity in a small sphere of people.  For example, dog fights are common among dog fighters in the United States, but it would still be considered inappropriate conduct to the general public.  

 

Pokémon battles being the norm in Kanto is made evident by the fact that "Pokémon Trainer Gyms" are in every city.  These gyms are places for people to train and fight their pokémon, and they aren't in secluded dark alleys, either - they are prominently displayed in the center of town.  This appears to endorse the idea that even though not everyone fights pokémon it is an normal cultural activity.  

 

Red is warned by Professor Oak at the beginning of his journeys that venturing outside of the city is dangerous as one could be attacked by wild pokémon.  It is because of this warning that Red obtains and trains his first pokémon.  It thus appears that Red uses pokémon not simply for his own enjoyment, but as a form of necessary personal protection.

 

With these factors in mind, it appears Red does not meet criteria for Conduct Disorder.  Were Red to engage in these activities in many other cultures then he may warrant this diagnosis, but he appears to be engaging in culturally normal activities in his current environment.

 

 

 

 

OBSESSIVE-COMPULSIVE DISORDER

The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to be time consuming (i.e., they take more than 1 hour a day) or cause marked distress or significant impairment.

 

Diagnostic Criteria:

 

A:  Either obsessions or compulsions:

 

     Obsessions as defined by (1), (2), (3), and (4);

     (1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

     (2) the thoughts, impulses, or images are not simply excessive worries about real-life problems

     (3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

     (4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

 

     Compulsions as defined by (1) and (2):

     (1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts to perform in response to an obsession, or according to rules that must be applied rigidly

     (2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

 

B:  At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

 

C:  The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

 

D:  If another Axis I Disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).

 

E: The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

 

Analysis of Criteria

Obsessive-Compulsive Disorder is anxiety based.  Obsessions are experienced as intrusive and cause anxiety and distress.  A person will perform an act/ritual in order to alleviate the anxiety.  For example, a person who washes their hands hundreds of times per day doesn't do so because they find hand washing enjoyable, they do so to alleviate the anxiety caused by their obsessive thoughts about germs.  A passage from the Diagnostic and Statistical Manual (DSM) says it this way:

 

"The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., a compulsion).  For example, an individual plagued by doubts about having turned off the stove attempts to neutralize them by repeatedly checking to ensure that it is off."

 

According to criteria B, at some point the person realizes that what they are doing is unreasonable.  This can be a confusing criteria, so allow me to elaborate.  A person with excessive obsessions and compulsions may sometimes realize what they are doing is excessive, but at other times they do not realize this.  Criteria B simply states that a person needs to, at any time, have realized what they are doing is too much.  If a person has never realized that their obsessions or compulsions are unreasonable then a delusional disorder may be more appropriate.

 

Criteria C again emphases the distressing and/or dysfunctional nature of the obsessions and compulsions.  Criteria D clarifies that certain obsession make sense in the context of other mental disorders, like a depressed person constantly thinking sad thoughts, and don't count towards an OCD diagnosis.

 

With consideration for the above outlined disorder, Red does not seem to fit in the picture.  Yes, he vigorously collects pokémon.  And yes, he keeps track of each pokémon with almost religious detail in a "pokédex."  But none of this is distressing to him or causes any anxiety or social dysfunction.  In short, none of the statements in criteria A seem to apply to Red at all.  Consequently none of the criteria that follows can apply either.

 

With regard to diagnosing mental health issues it is good to keep in mind that, with certain exceptions, if a person is not distressed then they likely do not meet criteria for a diagnosis (common exceptions are personality disorders and disorders in which the rights of others are violated, such as in Conduct Disorder).  Keep on collecting, Red!

 

 

 

 

Final Diagnosis:

 

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Axis I: V71.09 No Diagnosis on Axis I

Axis II: V71.09 No Diagnosis on Axis II

Axis III: None observed or reported

Axis IV: None noted

Axis V: GAF=96