Progress and process in mental healthcare: A discourse on Jaime Lannister from Game of Thrones

jaime2-e1562088651185.jpg

Warning:

As a disclaimer, this post covers detailed content up to the season 8 finale of Game of Thrones. Please do not read further if you want to avoid spoilers. As another disclaimer, this post discusses material exclusively from the Game of Thrones HBO TV series, and it does not draw from any content from George R. R. Martin’s books. I also want to mention that this post explores substance use disorders and themes of addiction, and I would like to include a trigger warning because of these sensitive topics. Additionally, even if you do not watch or read Game of Thrones, this case study is a broad overview about the character of Jaime Lannister, followed by a generalized discussion on mental health practice as a whole.

Overview:

Jaime Lannister, also known as the Kingslayer, is a knight from House Lannister and one of the main characters in Game of Thrones (Benioff & Weiss, 2012). As a brief overview, Jaime is one of three siblings in the Lannister family: he is a brother to both Tyrion Lannister and twin sister Cersei Lannister. Throughout the series, Jaime is involved in an incestual romantic relationship with Cersei, having fathered her three children, this being unknown to most characters in the show. Pertaining to the complexity of his character, Jaime undergoes a significant character development arc throughout Game of Thrones centering around this relationship.

“So many vows. They make you swear and swear. Defend the king. Obey the king. Obey your father. Love your sister. Protect the innocent. Defend the weak. Respect the gods. What if your father despises the king? What If the king massacres the innocent?”
-Jaime Lannister, A Clash of Kings 

Jaime’s arc begins with his betrayal of the Mad King Aerys Targaryen upon threat of burning down the entire city of King’s Landing, an act which earns him the nickname of Kingslayer. Throughout the show’s seasons, Jaime finds himself consistently challenged by themes of honor, love, duty, and loyalty. Arguably the most striking component of Jaime’s journey would be his romantic relationship with his twin sister. Ranging from pushing young Bran Stark to his presumed death to avoid being caught with Cersei (“The things I do for love.”—Jaime, Season 1, episode 1), to taking a stand against Cersei’s tyrannic leadership and scheming to betray her, Jaime undergoes a significant emotional transformation throughout Game of Thrones.

It is pertaining to this emotional journey that Jaime meets his end. In the show’s final season, Jaime initially rides out to Winterfell with plans to fight against Cersei, even beginning an intimate and deeply fulfilling relationship with his good friend Brienne of Tarth (see Discussion). However, he ultimately returns to King’s Landing to find Cersei in the midst of Daenerys’s siege, returning to the woman that he has both loved the most—and hated loving the most—throughout his life. He then dies with her, protecting her.

jaime5

On Substance Use and Addiction:

Central to Jaime’s arc are the themes of relapse and regression in the pursuit of redemption. In the DSM-5, substance use disorders are defined by the abuse of a substance (clinically significant intrusions upon an individual’s daily functioning or causing significant distress due to use of a substance) and dependence on a substance (the experience of increased tolerance for achieving the same effects from a substance or significant withdrawal upon stopping the use of a substance) (American Psychological Association, 2013). Thrones fans have speculated that Jaime’s complex relationship with Cersei can be comparable to an addiction. Though this would not currently meet diagnostic criteria for a substance use disorder, I believe that Jaime’s recurring gravitation towards Cersei throughout the show can serve as a figurative comparison for what addiction may represent.

Though traditionally defined as the reliance and often harmful use of a substance (American Psychiatric Association, 2013), the term “addiction” more abstractly represents a pattern of behaviors and habits that impacts an individual’s life in a harmful way, which an individual may struggle to stop or reduce (Melemis, 2015). Jaime’s arc can symbolize an individual’s struggle with an addictive or maladaptive behavior because of his consistent internal battle to leave Cersei. This therefore serves as a thought-provoking point of discussion because Jaime’s struggle illustrates the conflict of cognitive dissonance that so frequently accompanies any kind of behavior that one might want to stop or change.

For one, it is important to mention how stigmatizing the use of the word “addiction” is for many. It is imperative for practitioners to be sensitive to how challenging the process of living with, or recovering from, addictive behaviors can be. In Alcoholics Anonymous (AA) programs, as well as other similar models (i.e. Narcotics Anonymous, Overeaters Anonymous, et cetera), members are treated with unconditional respect, and it is inherently understood that recovery from an addiction is rarely a linear or simple journey, and it is certainly not easy.

Additionally, in recent years, practitioners and researchers have come to recognize a broad range of ways in which addiction can be clinically presented, including, but not limited to, gambling, caffeine and Internet usage (Sinha, 2011). That being said, if a relapse of an addiction of any nature happens and someone does not end up recovering, what then? Jaime’s incestual relationship with Cersei implicate similar threads of trying to quit an addiction, and albeit notable progress towards redemption and “recovery”, Jaime ultimately “relapses” by returning to Cersei and to his consequently ultimate death. Not only does this pose abstract points of discussion for Game of Thrones fans, but this also touches on larger global issues about progress and change.

jaime

Defining Progress in Mental Health Treatment:

When it comes to mental health practice, defining outcomes of treatment can be one of the most challenging aspects of the field. As clinicians, we are both honored and challenged by a career working with the complexities of human nature. With something so subjective and dynamic, how do we truly measure successful change? In Jaime’s case, given how his arc ends, would a therapist working with him deem his case to have been a failure? Would an agency close his file and summarize Jaime’s 8 years on Game of Thrones simply as someone who ended up failing to successfully alter his maladaptive behaviors and ended up reverting back from his progressions towards change?

It is challenging to think about how much the process defines an individual’s journey towards change. In closely reviewing Jaime’s character arc, this protagonist has undergone significant character development, has struggled with heavy challenges, and has experienced a considerable amount of fluctuation in his journey. Just to list a few examples, in the first episode of Season 1, Jaime pushes Bran Stark out of a window—presumably to his death—because he wants to keep his relationship with Cersei a secret. However, in the coming seasons, Jaime would come to stand up against Cersei’s various acts of tyranny, where it was even speculated by fans that he may be the one to end up killing her. Another example is that Jaime establishes a respectful and deeply trusting friendship with Brienne of Tarth, even sharing a brief romance with her during the last season of the show. Despite his best efforts and despite a mutually loving relationship, he still finds himself pulled back towards Cersei, and he leaves Brienne to ride back to King’s Landing. I hereto reflect on the dynamics of the human spirit, and how true journeys of personal growth are rarely linear in reality.

Evidence-based practices (EBPs) are thus a relevant point of discussion. Measuring the success of a treatment or intervention is a key component of efficient mental healthcare. That said, the concept of EBPs highlight evaluating the success of a specific program or treatment model based on pre-determined data collection measures that can suggest change pre- and post- treatment, or follow up with a client after the treatment has ended (Black et al., 2015). For more on EBPs, see this NASW practice snapshot.

It is frequently discussed in social work and psychology courses that despite the importance of EBPs, validity can often be challenging or questionable. For example, after the completion of a 10-week cognitive behavioral therapy (CBT) intervention, a patient may be discharged with reported decreases in anxiety and depression symptoms, and this would be considered successful for the clinic or agency. However, would that individual maintain that symptom reduction? If we were to follow up with such individuals years from the intervention, what would that look like?

That brings this discourse back to the central question: if an individual doesn’t maintain long-term results, or if relapses and blips in the data take place, how does progress then get measured? The dynamics of human nature do not entail a necessarily linear and straightforward progression towards any type of change—after all, being human means to struggle, to fall down, to get sick, to give in to temptations, to fail. An EBP may suggest a short-term successful treatment towards reducing symptoms or something of the like, but given the fickle nature of humanity, how do mental health practitioners measure lasting progress in their clients and how can we ensure long-term change rather than solely immediate outcomes?

“Most have been forgotten. Most deserve to be forgotten. The heroes will always be remembered. The best. The best and the worst. And a few who were a bit of both.”
-George R.R. Martin, A Feast for Crows 

jaime4.jpg

Discussion:

So, progress is important, but when outcomes aren’t always positive, mental health practitioners must find a way to still feel assured that they did right by their profession. I think about how challenging it must be for crisis counselors who, simply by nature of the population they are working with, work with a number of clients who die by suicide on a regular basis.

  • Strength-based approaches. From a strengths-based perspective, it would be noteworthy to highlight the substantial progress and accomplishments that Jaime had achieved throughout the show.  That said, generalizing this discussion to mental health as a whole, the journey and the process of therapy are arguably meaningful measures of success and movement towards change, despite not ultimately meeting a main treatment goal. The strength of human will and resilience is also imperative to recognize within clients and patients in the mental health field.
  • Trusting the process. As mental health practitioners, we are trained in a variety of foci, including a relational foundation where we build trust with clients, foster a sense of safety, and empathize with our clients. We are also trained in crisis intervention, specific modalities for various presenting contexts, and other such components that comprise “the therapeutic process”. That said, in the case of Jaime, I reflect on all of Jaime’s accomplishments and developments over the course of this series, and I incredibly admire the journey he has had. I would also argue that his arc’s ultimate ending does not take away from the incredible resilience, personal growth, and tenacity that he demonstrated throughout his journey on Game of Thrones.

  • Valuing the human experience. I feel torn in how much I recognize the subjective nature of our work, and how difficult it can be to evaluate “success” or “change” in our clients when that word can simply mean short-term and temporary rather than the aspired goal of long-lasting and “permanent”. I also proceed, thus, with caution in my work, feeling conscious of how our field and its research may place a strong emphasis on measurable change, and tangible outcomes, when sometimes, the reality might be that things are rarely so linear or straightforward when it comes to this work.

“A man of many contradictions, Jaime is a reminder that heroism comes in many different forms and manifests in ways that make us question which figures deserve to be celebrated and which deserve our contempt. We’ve seen Jaime in different lights—as a mournful father, a loving friend, and ultimately a hero.” (Chawdhury, 2019)

Closing Remarks:

It has taken me a long time to finish writing this post because I have been grappling with these very challenges regarding process, progress, change, and evidence-based practice in my work as a developing clinician and researcher. Upon working with clients, I find myself recognizing more and more how subjective distress or a “maladaptive behavior” may look like to every person. In my research, I also find myself frequently pondering the validity of certain variables that we measure, or the longevity of an effective treatment. In trainings, we talk a lot about how there will always be clients who may die by suicide or relapse and overdose, despite a treatment team’s best strategies or a therapist’s best interventions. What does that mean about our work? How do we better respect our clients and hold true to the process of therapy when it may not always be clear whether we are helping? These are large themes and topics that I will continue to grapple with as a developing mental health clinician.

Finally, I’d like to extend a special thank you to my colleagues at the University of Michigan for providing guidance in writing about substance use and addiction. As a disclaimer, this case study is solely my own opinion based on presented cinematic material and my clinical opinions. I recognize that there could be numerous other interpretations, and I am open to discussion or additions to this post. Have questions or want to add on to this assessment? You can reach me via the Contact page.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5) Washington: American Psychiatric Association, 2013.

Benioff, D. and Weiss, D.B. (2012). HBO Entertainment ; co-executive producers, George R.R. Martin, Vince Gerardis, Ralph Vicinanza, Guymon Casady, Carolyn Strauss ; producers, Mark Huffam, Frank Doelger ; executive producers David Benioff, D.B. Weiss ; created by David Benioff & D.B. Weiss; Television 360; Grok! Television; Generator Entertainment; Bighead Littlehead. (2012). Game of Thrones. The complete first season. New York: HBO Home Entertainment.

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of nursing administration45(1), 14–20. doi:10.1097/NNA.0000000000000151

Chowdhury, S. (2019). “An Ode to Jaime Lannister, the Most Compelling Character on Game of Thrones”. Retrieved from https://madison.com/entertainment/television/an-ode-to-jaime-lannister-the-most-compelling-character-on/article_c0cb2af3-2d03-53e6-b0dd-1a81f41ef59e.html

Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine88(3), 325–332.

Sinha R. (2011). New findings on biological factors predicting addiction relapse vulnerability. Current psychiatry reports13(5), 398–405. doi:10.1007/s11920-011-0224-0

Substance Abuse and Mental Health Services Administration. (2018). Mental Health and Substance Use Disorders. Retrieved from https://www.samhsa.gov/find-help/disorders

Click here to subscribe to Juliann’s website and follow posts.

Disclaimer: This character, their photos, and storyline references are all copyrighted by the HBO series of Game of Thrones and George R.R. Martin. All information and content presented in this assessment are solely analyzed for general information and reference purposes. 

© Post material by Juliann Li and The Character Clinic, 2019.
All rights reserved.