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samwenahetbait · 3 years

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Supernatural, Season 7, and the Positive and Negative Symptoms of Schizophrenia/Psychosis

I just finished season 7 of Supernatural. Season 7 and Sam’s arc, and later Cas’ arc, interested me a lot because I’m schizoaffective (schizoaffective being schizophrenia plus a mood disorder, either bipolar or depression, in my case depression).

I’ve done a lot of research on the disorder and spectrum of disorders and when watching the beginning of honey!Cas I thought this would be a really interesting way to show the ways the show does and doesn’t portray psychotic disorders well.

I’ll be using both Sam and Cas, Sam for positive symptoms and Cas for negative symptoms, and evaluating them for how accurate they are to DSM 5 criteria for psychosis, criteria for schizophrenia (understanding that neither of them could be diagnosed due to duration and the magical nature of their problem), and accuracy to personal experience (not all psychotic experiences are the same, obviously, so this is not the most accurate test, but lets do it anyways lol)

This is gonna be long, so more under the cut!

So a bit of background of the DSM 5 criteria for schizophrenia and DSM 4 criteria for psychosis not otherwise specified, which is still in use in hospitals and doctors offices and would definitely still be used in 2012. The DSM 5 criteria for schizophrenia includes two or more of the following, with one having to be one of the first three: hallucinations, delusions (things that you believe as true even when presented evidence you’re false), disorganized speech, grossly disorganized or catatonic behavior, negative symptoms. The duration must be for six months including prodrome (mostly negative symptoms), with at least one month of active symptoms.

The DSM 4 says psychosis not otherwise specified includes delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior about which the doctor cannot make another, better diagnosis.

Positive Symptoms

“Positive” and “negative” symptoms are a bit misleading. what they really mean are positive symptoms are things the disorder adds that aren’t there originally (hallucinations, delusions, disordered speech), and negative symptoms are things that are taken away (blunted affect, poverty of speech, avolition or lack of energy)

[ID: Sam looks to the left. He says “he’s singing “stairway to heaven” right now.” End ID]

Sam is our character who experiences positive symptoms with Hallucifer. There are multiple types of hallucinations, the most common being auditory. Combination auditory and visual hallucinations are possible but they’re more rare than the media makes you believe.

Sam has a stereotypical case of what an outsider with no research may think psychosis or schizophrenia is - he has a voice that will not let him sleep, that constantly bothers him. Sam qualifies for Psychosis Not Otherwise Specified in that he has a prominent hallucination and does not qualify for another disorder.

What’s interesting about Sam’s psychosis to me watching, though, was the hallucination was the only sign of psychosis he had. It was severe and caused depression, derealization, dissociation, and insomnia but he never had delusions outside of the hallucinations, never had disordered speech outside of sleep deprivation, never had bizarre movements or disorganized behaviors. The only way to get a schizophrenia diagnosis with only hallucinations is if you have two or more voices who talk to each other, which he does not have. Sam would absolutely not qualify for a schizophrenia diagnosis.

As for personal experience - I’ve been hospitalized because voices have made it impossible for me to sleep so this arc hit close to home. I thought at times he was a little too well put together and honestly think there were moments in the season the writers forgot he was actively hallucinating. I thought that besides only having hallucinations and it being the Hollywood hallucination Sam’s arc with his “voice” was fairly easy for me to empathize with - but not easy for anyone else to treat him with respect. Here’s a link to a quiz I made about which ableist phrase used against Sam in season 7 you are

Negative Symptoms

[ID: Meg, in a nurses outfit, crosses her arms. Castiel’s profile is seen. Meg says “He’s been like the naked guy at the rave ever since he woke up.” End ID]

Cas, when absorbing Sam’s hell trauma, originally has his one positive symptom - hallucinations of Lucifer. However, after he wakes up from his coma he has one and a half noticeable positive symptoms and one and a half marked negative symptoms.

Cas experiences some form of hallucination (he tells Sam that he “sees everything” when asked what he sees) but it’s unclear what he means by this. He has noticeable disorganized speech however in that he will end conversations during important discussions and change the topic, which is an aspect of disorganized speech.

I would also argue Cas experiences a negative symptoms known in disorganized schizophrenia particularly, although anyone with psychosis can have it: inappropriate affect. Some people with schizophrenia will laugh during moments when they should be crying or show inappropriate emotional responses, uncontrolled. Cas doesn’t seem to have control over his emotions and will make jokes and laugh during tense or upsetting situations. Part of that is also due to his complete disconnect with reality and what is happening in the situation. It could also be argued he experienced disorganized movement or catatonia, as we see him staring blankly and sitting still at the end of 7.17.

Castiel definitely qualifies for PNOS through his disconnect with reality, possible hallucinations, and disorganized speech, as well as with inappropriate affect and possible catatonia. Despite having more on the list than Sam he still doesn’t qualify for schizophrenia.

This is getting longer than anticipated so I’ll try to make this section shorter. I don’t think honey!cas was written to be psychotic. I don’t think he was written with an illness in mind. I don’t think either of them were. I think Cas was written to be funny crazy and Sam to be scary crazy. But in writing a funny crazy character the writers accidentally hit somewhere personal as someone living with the cognitive and neurological effects of schizoaffective. I watched honey!cas on a bad cognitive day and sobbed when they were mean to him because I related to the disorganized speech and the inappropriate behavior. Is it good representation? No. It’s exaggerated and ridiculed. It’s deeply ableist. And the way the writer’s treat him and have others treat him is deeply ableist. But I did find myself relating and rooting for him.

Fandom Response

I haven’t been in Supernatural fandom long (four months) and being involved with fandom while watching the show has been interesting. I’ve had pretty much everything at least somewhat spoiled so I was excited to see honey!cas and psychotic Sam in something other than gifs. I’ve seen maybe three people talk about sam’s psychosis, maybe because I don’t follow enough sam blogs, but it’s not something I’ve seen a lot of. everyone i’ve seen has been psychotic and made it clear he’s a psychotic character or been supportive of viewing him as psychotic. But honey!cas is very popular and...sexualized?

I’ve seen two responses to honey!cas: he’s so crazy or he’s so slutty. I’m going to ask both of those groups of people to see the character as a person experiencing cognitive issues and a break from reality. Not saying not to talk about honey!cas - he’s interesting, but please don’t sexualize him for being quirky when by quirky you mean delusional and please don’t do the opposite and demonize him for being vulnerable (and if that’s crazy. you should see me off my meds)

#supernatural #spn #sam winchester #sam #castiel #cas #sam safe space

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