As mentioned in my Part 1 article describing narcissism and psychopathy in the Game of Thrones TV series, the characters in this groundbreaking show (Martin, 2015) demonstrate a broad range of issues that would warrant a trip to the psychotherapist. Although, we know that people who manifest far on the spectrum of narcissism (in the range of malignant narcissism or even psychopathy) have personality characteristics that are welded and fused, with very limited capacity for change (de Canonville, 2015). Sadly, these individuals with extreme narcissism possess a lack of empathy, accountability, integrity, reciprocity, or authenticity, in essence, a psychic void blended with volatility, aggression, elements of sadism and self-absorption (Cleckley, H.M., 1988).
**spoilers ahead if you are not caught up with Game of Thrones series**
We also know that in most circumstances, individuals who have been impacted by trauma would benefit most by therapy. Even if the perpetrator of abuse is beyond help (for example, Ramsey Bolton and Joffrey Baratheon, as known psychopaths), the survivor of abuse reels in the aftermath of trauma with a dizzying sense of unreality. Ambushed by the horrific onslaught of physical and psychological abuse, the character of Theon in Game of Thrones shows evidence of cognitive dissonance, hypervigilance, freezing and numbing responses, severe anxiety and panic disorder, and dissociation. Theon historically perpetrated violence and betrayal by seizing Winterfell against his foster family, House Stark. However, in time, he was captured by Ramsey Bolton and subjected to atrocious flogging, flaying, torture, castration and psychological abuse by his vicious captor, Ramsey.
Theon’s Diagnosis: If Theon were to show up in the therapy room, he would likely receive a diagnosis of Complex-PTSD. Although this particular diagnosis is not yet defined in the DSM-5 (Cicarrelli, 2014), Complex-PTSD is a increasingly respected and accurate description in the clinical community for what is currently known as DES-NOS, or Disorders of Extreme Stress, Not Otherwise Specified (Cicarrelli, 2014), falling under a larger umbrella of PTSD (Post-Traumatic Stress Disorder). Complex PTSD, originally coined by Judith Herman in her seminal work, Trauma and Recovery (2015) includes the following symptomatology: problems with emotional regulation, consciousness, and self-perception; distorted perceptions of perpetrator (i.e. trauma bond, Stockholm Syndrome), hopelessness and despair, and relationship fractures…in addition to hypervigilance, hyperarousal, intrusive flashbacks, and avoidance behaviors…all as a result of sustained and continuous abuse over a lengthy period of time.
Intervention for Theon: Psychotherapy for Theon would most definitely need to be trauma-informed and evidence-based. Fortunately for him, trauma is a treatable situation. In circumstances of complex trauma, the road to recovery is a long one, punctuated with cycles of healing, recovery, stabilization, harnessing of resources (both internal and external), self-regulation, grief work, identity formation and reclamation, boundary work, safety planning, and re-establishing trust in safe others via safe community and compassionate/skilled/competent psychotherapy. He may also need medication management and/or medicinal supplementation (omega-3 fish oil, for example). Theon would benefit greatly from the evidence-based work of EMDR (Shapiro, 2002). I could see a blend of mindfulness-based cognitive behavioral therapy and (Hayes, et al., 2011), in addition to Dialectical Behavioral Therapy (Linehan, 2015). Theon might also thrive from expressive arts intervention to release the “held” trauma in the body (van der Kolk, 2015), in addition to other somatic release activities including yoga, deep breathing exercises, meditation, and hiking in nature. His therapy would likely be long-term in trajectory to effectively work through the layers of trauma and help to re-establish safety, self-regulation, and healthy boundaries and relationships.
Prognosis: rocky but fair. It all depends on how motivated Theon is to excavate and heal what looks to be years of buried shame and trauma. Post-traumatic growth is possible. We need to hold the hope for Theon, unless he gets killed by a dragon or some other unsuspecting force.
Ciccarelli, S. K., & White, J. N. (2014). Psychology: DSM 5. Boston: Pearson.
Cleckley, H. M. (1988). Mask of sanity. Place of publication not identified: Penguin Books.
de Canonville, C. (2015). The three faces of evil: Unmasking the full spectrum of narcissistic abuse. Black Card Books.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (2011). Mindfulness and acceptance: expanding the cognitive-behavioral tradition. New York: Guilford Press.
Herman, J. L. (2015). Trauma and recovery: the aftermath of violence, from domestic abuse to political terror. New York: Basic Books, a member of the Perseus Books Group.
Linehan, M. M., & Linehan, M. (2015). DBT skills training manual. New York: The Guilford Press.
Martin, G. R. (2015). A Game of thrones: book one of A song of ice and fire. New York: Bantam Books.
Shapiro, F. (2002). EMDR as an integrative psychotherapy approach: experts of diverse orientations explore the paradigm prism. Washington, DC: American Psychological Association.
(2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, MD | Key Takeaways, Analysis & Review. San Francisco: IDreamBooks Inc.