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Kari Bowman, PharmD Candidate
Lipscomb University College of Pharmacy
Nashville, TN

J. Michael McGuire, PharmD, BCPP
Assistant Professor of Pharmacy Practice
Belmont University College of Pharmacy
Nashville, TN

Clinical Pharmacist
Rolling Hills Hospital
Franklin, TN

After being hospitalized for the summer after his best friend commits suicide, Charlie who suffers from Post Traumatic Stress Disorder (PTSD), is about to embark on his first year of high school. He fears being known as the weird kid who was hospitalized for the summer and not having any friends. Charlie’s anxiety goes back to the first traumatic event in his life, the death of his Aunt Helen. Charlie’s Aunt was killed in a car accident when he was a young boy. She was on her way to get him a surprise and he has always felt it was his fault that she was in the car.  He idolized his Aunt and wishes she were there to comfort him as he struggles with starting high school. On his first day of school, he meets Mr. Anderson, an English teacher, who becomes his mentor and gives him books to read.  Many of his old acquaintances act as if he doesn’t exist and he eats lunch alone every day until he goes to a football game where he meets Patrick and Sam, two seniors.  Charlie is instantly attracted to Sam.

Patrick and Sam introduce Charlie to their group of friends and he starts to feel like he belongs. His new group of friends introduce him to drugs and alcohol. He eventually starts dating Mary Elizabeth, a friend of Sam and Patrick’s, after she asked him to the Sadie Hawkins dance. One night, while playing truth or dare, Charlie is dared to kiss the prettiest girl in the room. Instead of kissing Mary Elizabeth, he kisses Sam, which results in Charlie being ostracized by the entire group.

Throughout the movie, Charlie has flashbacks of his Aunt when something upsetting happens such as his sister getting hit by her boyfriend. Charlie’s flashbacks more closely resembled dissociations rather than what one would consider a true flashback. After being shunned by the group, he begins to have more flashbacks of his Aunt and his mental health begins to deteriorate rapidly.  While sitting at lunch one day, Patrick gets in a fight and Charlie steps in to help. Since he protected Patrick from being beaten by a member of the football team, the group forgave him for kissing Sam and they all become friends again.

Charlie feels better after being reunited with his friends and the flashbacks of his Aunt Helen stop. It isn’t until Sam leaves for college after they have sex together that the flashbacks come back and Charlie has a breakdown. He calls his sister rambling about how his Aunt’s death is his fault and he has a blackout. This episode results in him being readmitted to the psychiatric hospital where he meets Dr. Burton.  With the help of Dr. Burton, Charlie is able to revisit the memories he has been suppressing about how his Aunt sexually abused him when he was a small boy. Charlie doesn’t go in to detail about being hospitalized but he says the worse day is when the doctor told his parents what Aunt Helen did to him. He returns home to his family and continues to see Dr. Burton in outpatient care. Sam and Patrick visit Charlie and Sam tells Charlie that it gets better.

Throughout the movie, we see Charlie develop friendships. It is when his support group is the strongest that his symptoms subside. When his support group leaves him, we seehim struggle the most with flashbacks.  Charlie felt closest to Sam because it appears that she was sexually abused as a young girl. Thus, the sexual relationship with Sam most likely triggered the memory of what his Aunt did to him that resulted in his blackout and hospitalization.

The DSM-5 diagnostic criteria for PTSD requires that an individual personally experience or witness a traumatic event.  Diagnosis requires the presence of the following clusters of symptoms: intrusive symptoms (i.e., dissociative reactions), avoidance symptoms, negative alterations in cognition and mood (i.e., difficulty remembering aspects of the trauma) and marked alterations in arousal and reactivity associated with the trauma.  Charlie experienced intrusive symptoms associated with the trauma that he experienced as a child including distressing memories, dissociative reactions (e.g., flashbacks), distress at exposure to cues that resemble his trauma, and physiological reactions.  Charlie also displayed avoidance of stimuli associated with the event.  He avoided situations in which he had to discuss the trauma.  He experienced alterations in cognition and mood including an inability to remember aspects of the trauma and negative beliefs about himself related to his aunt’s death and feelings of detachment from others.  Lastly, Charlie displayed alterations in arousal and reactivity including anger outbursts and exaggerated startle response.  PTSD is a chronic and debilitating disorder which may be associated with substance use disorders.  Throughout the movie, we see Charlie experiment with a variety of drugs.  Charlie is treated with psychotherapy at the end of the movie leading him to regain control over his life.  

Overall, Perks of Being a Wallflower accurately portrays the symptoms of PTSD in an adolescent who experienced the trauma of sexual abuse as a child.  It also provides a positive image of psychiatry and a psychiatric hospital which is rare in Hollywood.  Films providing this kind of insight into psychiatric conditions help eliminate the stigmas we still see today. Overall, the movie was well done and touching.


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