psychotherapy

22
APR
2015

Anxiety, simplified

I thought it would be good to return to a more “bread and butter” informational psychiatry post for once.  Consider this a drastic reductionism of a complex field.

Following the prior post about avoiding benzodiazepines, many have asked — What else can I do to feel less anxious besides take benzodiazepines?

The short answer is other (safer) medications, and/or psychotherapy.

Like any other blog post, this isn’t a substitution for medical advice, since there can be causes of anxiety that require medical intervention, such as hyperthyroidism. Make sure you get evaluated properly before trying to chalk your anxiety up to a “mental” problem. Even after that, it’s useful to see a professional who can help you tease out what’s contributing to it and the options to change how you’re feeling.

Anxiety usually refers to a common cluster of symptoms, such as shakiness, sweating, heart racing, panic attacks, restlessness, and just an internal feeling of nervousness. These are physiological aspects of anxiety. They occur during an activation of the sympathetic nervous system, the “fight-or-flight” response.  What evolved to protect us from something life threatening (Bear attack!) now activates to things that feel life threatening.  And then there are of course the emotions that those sensations add up to (e.g. nervous, anxious, worried, etc), and the thoughts we think in response to them as well (“I’m dying,” “this will never end,” “there’s something wrong with me”).

There’s different anxiety diagnoses, from panic disorder to generalized anxiety disorder to PTSD (sorta). A simple way to lump them, though, is to ask if the anxious feelings go on throughout the day, or only in short bursts (situationally or episodically). Of course people can also feel a baseline level of anxiety all day with short bursts of worsening (such as panic attacks) as well.

So let’s talk about Jack and Jill.

Jack was born anxious. He was a nervous kid, and he grew up to be a nervous adult. People just wrote him off as “that’s the way he is,” so he never explored if he could do things to feel different. Now as an adult he’s nervous all day long and his new girlfriend is telling him this isn’t “normal.” Jack comes in for an evaluation wondering if it’s “normal” or not. I tell him that “normal” is less useful than thinking about the terms “common” and “’healthy.” Anxiety is common. It isn’t necessarily healthy.

I go on to tell Jack about how meds work for someone with anxiety all day long, which is to lower the baseline level of nervousness, like turning the volume down on it. But it means taking a medication every day. Usually this is an SSRI (prozac, zoloft, lexapro, etc), considered the first line medication by most psychiatrists for anxiety. It’s taken at a scheduled time, and gradually the anxiety comes down. It’s not an instantaneous fix, but it lasts.

Jack and I go on to discuss ways that therapy can also help him, from challenging his thoughts that there’s something wrong with him or that bad things will continue to happen, to practicing ways to relax, to learning to control feelings that feel out of control. He might even try therapy where he thinks about his family relations as a the “cause” of anxiety (though I have a little less confidence in that). Over time Jack feels like he has more space to breathe and think, as his anxiety decreases. It takes some time and patience, though.

Jill is a young working woman who has never had any problems with anxiety or depression, but has never been particularly introspective, either. She just moved to a new city and after hearing about the dangers of some areas, finds herself wracked with anxiety whenever she steps outside. She just had her first panic attack, and is especially worried about having more. Even worse she’s been tasked to do public talks for her new job, and has a lot of worry about public speaking.

If someone has anxiety only episodically and feels completely normal in between these episodes, they might be able to get by with an as-needed medication. These are medications like vistaril (hydroxyzine), or in the case of phobias something like propranolol (a beta blocker).

Jill and I sit down for a talk, and we discover that anticipation is a big part of her anxiety. She anticipates how bad things could be. As do many people with anxiety. In many ways this is about fearing what might happen, which feeds the anxiety itself. So we have a talk about therapy, and how an approach like CBT might be able to challenge this anticipation, and break the habit of anticipating every bad thing that might happen.

There are of course exceptions situations where meds should be used more cautiously. Such as situational anxiety. As in someone didn’t have anxiety, and then something in their life changes, and now they’re feeling so much “stress” that they’re feeling anxious. I have several patients who have been in jobs that they hate, are overworked, but don’t have an easy way to leave it. The demands on them are overwhelming, from the hours to the workload to quotas. They are in a situation without an escape. So they tell themselves that they’ll just deal with it until things change. They don’t change their job, they just hope things resolve on their own. This is not usually a successful strategy. Anxiety can be taxing emotionally, and can lead to burnout. So in this case I’m a bit more cautious about prescribing a medication. I believe in relieving suffering, but I’m upfront with the person that it might just lead to tolerating an intolerable situation, which removes the pressure to figure out a better lifestyle. So in that case it’s their choice, and I encourage to look deeper at all of their options and make sure they’re not staying in a terrible situation.

PTSD is its own animal, though I still think about it in the anxiety spectrum. I’ll be writing a more complete post on PTSD soon.

For every kind of anxiety, medication can help. For every kind of anxiety, therapy can help. Using both together can help all the more. It’s just a matter of finding the right balance for the individual, something in line with what they’re willing to try.  We want to be able to engage the parasympathetic system, or challenge the sympathetic from taking over and snowballing in a way that’s hard to break out of.  This of course then should include meditation, relaxation exercises, even hypnosis, since they can all help with relaxation.

I may include some easy exercises in future posts that can help.

07
APR
2015

Digesting Hannibal – Season 1, Ep13

 Episode 13 – Savoureux

Will walks through the woods at night with a scoped rifle, hunting a stag.  It runs off, and then Will fires a shot.  We kind of know, already, that this is going to be a dream sequence.  And knowing the stag represents Hannibal much of the time.  He runs after the body, and we see the stag in shadow, on the ground, then turns to face him.  For a moment it looks like a man with antlers.  And then it’s gone.  He follows a blood trail.  And sees a man with antlers, and glowing eyes.  He wakes up.  Will has been on the trail for a while now.  Finally he’s catching up and seeing the stag for what it really is.  

Will is home, but clearly still sick and sweaty.  His legs are dirty, as if he’s been running in dirt.  The world seems to shudder.  He heads to the kitchen and gulps down water and a pill.  Then he vomits.  He should still be in the hospital.  Anti-NMDA encephalitis can be hard to catch.  If you don’t look for it you won’t find it.  It’s relatively new as a diagnostic entity, and isn’t looked for much.  He probably needs supportive care, IvIG, plasmapheresis, etc.  Most importantly this can occur as a secondary condition caused by cancer, known as a paraneoplastic syndrome.  The immune system attacks the cancer, but the cancer has some overlap with regular cells so the immune cells make antibodies that cause their own problems.  Will looks in the sink, and looks like he vomited an ear.  We don’t know if it’s real.  

Hannibal shows up to Will’s home, finding him shaking on the stairs.  Will tells him about the trip to Minnesota.  Hannibal checks the sink, and the ear appears to be real.  Will doesn’t remember going to bed, and last saw Abigail the day before.  The question is laid — is it her ear?  And if so, how did he swallow it?  We presume Hannibal killed Abigail, so he would have fed it to Will in his fevered sleep, which might explain part of the dream.  Will remembers that she got scared at the cabin and then ran away.  We know she made it to Hannibal.  Will remembers hallucinating that he killed her, but it wasn’t real.  Hannibal looks at the ear in the sink, seemingly upset by this.  Hannibal is most likely feigning being upset, and doing a fantastic job of it.  If we didn’t know better, Will really does seem guilty.  How Hannibal fed him an ear will be an interesting discovery.  Hannibal tells him they have to call Jack.  The frame is nearly complete.

The team arrives at Will’s home.  Jack asks Will what they will find in Minnesota.  He doesn’t know.  Jack takes him in for processing  The team can’t make eye contact with him (well, Katz can, briefly).  Will is taken to a car, and he sees one of his dogs whimpering outside.  We’re reminded that Will at his core is humane and merciful — a dog rescuer.  He isn’t a killer.  Zeller and Price process him and his clothing.  They find a folding knife on him.  Katz scrapes his nails and digs out blood.  She tries to engage with him to get his side of the story.  He doesn’t know where it came from.  She pushes him to think about the evidence.  He can’t come up with an alternative conclusion than that he killed Abigail.

Jack tells Alana about the forensic findings, that the blood and ear all belong to Abigail.  She’s crying, hurt that Will was pushed this far.  Jack justifies it, since he was saving lives.  She believes Hannibal must have seen something was wrong.  “Not until it was too late.”  We know the truth.  Jack notes Hannibal told him Will had symptoms of dementia.  She rebuts that it isn’t a disease, but a symptom of a disease.  That’s mostly right.  Dementia means there’s an impairment in cognitive functioning, due to some underlying process.  In someone his age, there must be some other cause.  Plus he doesn’t have dementia.  He has had delirium.  Dementia is progressive, meaning it doesn’t come and go.  Delirium waxes and wanes.  Alana advocates that they need to find the cure and treat it.  Jack thinks there might not be a cause, since he had a normal brainscan.  “Then they don’t know what they’re looking for.”  She nails it, there.  If you don’t look for it, you won’t find it.  All too often a cursory head scan like a CT without contrast is done, but really doesn’t rule out anything besides large tumors or head bleeds.  They both struggle with guilt over the situation.

In her car alone, Alana grieves in frustration.

Alana visits Will in an interrogation room.  They’re both frustrated.  Will is surprised Jack let her in, considering they were romantically interested.  But Jack doesn’t know about that.  Until now.  She lets him know she’ll take care of his dogs.  This is like saying goodbye.  They’re both grieving his passage into prison.  She’s there to do some tests.  He asks if she’ll make him draw a clock.  She asks if Hannibal had him do this.  She knows that a clock drawing is a standard part of a cognitive screening test.  And if he did, he might have found something, or at least suspected something.  Will describes Hannibal’s rationale.  She has him do another one.  This one isn’t as severe, but still has all the numbers crowded on the right.  He still has Left sided spatial neglect, indicating that at least his Right parietal lobe is impaired.  

Hannibal sits in therapy with Du Maurier.  He seems sad, even glassy eyed.  She talks about grieving, that it’s an “individual process with a universal goal — the truest examination of the meaning of life and the meaning of its end.”  I’m not sure much of that is true.  Many people grieve just by missing the person they’ve lost.  They may or may not ever think about the nature of life.  It’s a nice idea, though.  Hannibal maintains he already knows what life is.  And yet he’s near crying.  Or faking tears.  If he’s faking it, it would mean that the presentation to Du Maurier is so important that he would go to this length to show her how human he is.  If he’s really feeling it, it must be novel for him.  He talks about Abigail making him appreciate what having a child would be like.  Perhaps.  Perhaps he really did care, but he cared about himself much more.  She reflects on living on through children, and he never thinks that way.  “I haven’t given up on Will.”  He wants to continue to be involved in Will’s life, and she recommends against it.  Is Will just a toy he wants to keep playing with for his own curiosity?  The difficulty with such a well constructed psychopath is that we can never be certain when we’re seeing the real him, aside from when he thinks he’s alone.  Every conversation with another must be interpreted with a large grain of salt.  “It’s hard to imagine that I could fail them both, so profoundly.”  It’s statements like this that makes it seem that every moment is a ruse, him trying out playing a part as a human, during which he’s orchestrating his own pretend misery to see if he can experience loss.  

Price describes some findings to the team.  His homemade fishing lures appear be trophies of his victims, made with body parts from the copycat murders.  Alana maintains he has some neurological problem.

Will stands in the interrogation room, looking in the one-way mirror and seeing the man/stag.  Is Hannibal back there?

Jack tells Will he’s sick.  Will says he wasn’t consistent with his antibiotics.  Antibiotics definitely wouldn’t help.  Jack tells him they’re moving him to a medical ward for treatment.  Jack wants to be hopeful, but all the evidence goes against that.  He tells Will about the lures.  We saw Hannibal checking out the lures early in the season.  Will maintains that he wasn’t sick back then.  He means he didn’t notice the symptoms back then, such as fever.  He may still have been symptomatic, though in other ways.  If Will wasn’t sick back then (and he did it), it might mean he’s a psychopath.  If so, he’s even more convincing at appearing like a person with feelings than Hannibal is.  Will warns Jack that he’s being set up, and to be cautious about someone close to him.  Jack reads him his rights.

In the medical transport, Will watches and waits.  Then he breaks his own thumb, and breaks out.

Alana, Jack, and Hannibal discuss the escape.  Jack thinks this means he’s guilty.  Alana thinks he’s sick, and shows the clock (with L spatial neglect).  Hannibal produces a (fake) drawing that he says Will made before.  She asks about a disease that progresses but plateaus.  That is not what is happening with him.  Hannibal talks about how sometimes Will is lucid, sometimes impaired.  This is the definition of delirium — a waxing and waning level of consciousness and impairment, including hallucinations and disorientation.  She offers the possibility of encephalitis.  Hannibal asks about autoimmune, as if that’s the only kind.  Anything ending in -itis means inflammation of.  Enceph- refers to the brain.  His brain is inflamed, and that can be from a variety of causes including infection (bacterial, viral), or autoimmune.  She offers that if immune it wouldn’t show up on a brainscan unless looking for it.  Jack just wants to know if this could make him kill and not remember.  Definitely maybe.  Jack says it doesn’t sound like dementia.  There is nothing medically about this that fits with dementia, nor has it ever.  Jack still thinks it’s a psychopath, and even that he could have faked the clock test.  Yes it could be faked, but it shows a specific area of impairment that itself wouldn’t explain the killing.  

Hannibal sits in his office.  He realizes Will is there, hiding.  They discuss him.  Will wonders if Hannibal thinks he’s guilty.  Hannibal says he is skeptical, though the evidence is clear.  All of which he planted.  Will says he knows who he is.  Hannibal disputes this, pointing out that that’s temporary.  This is actually true.  Even his moments of clarity are only moments.  He’s still very sick.  Visiting Hannibal never actually helps, though.  Ultimately it just confuses him more.  Will maintains his innocence.  Hannibal offers to help, with the Devil’s bargain – “if we’re  to prove you didn’t commit these murders… perhaps we should consider how you could have.”  He’s now tasking Will to convince himself he’s guilty.  Very clever.  It also uses Will’s superpower to figure out what breadcrumbs were left that could incriminate Hannibal.  

Will imagines it, starting with Cassie Boyle, the first victim.  It told Will everything he needed to catch Hobbs.  Hannibal suggests he might have killed to better understand Hobbs.  Just as it might have been for Hannibal.  He’s really talking about himself, and seeing if Will can join into that logic.  But Will wasn’t in the state at the time.  Hannibal tells him how it was possible.  Will remembers the man/stag.  He fights the idea — “I know I didn’t kill her.”  Hannibal pushes further, asking about Will’s first thoughts about Marissa.  He even suggests the similarities to Abigail.  All Will sees is the memory of the body, mounted on antlers in the office.  “How could I resist.”  The suggestions seem to be working.  And we can notice Hannibal’s voice get raspier, perhaps his evil side emerging.  Hannibal suggests further that the imagining being a killer brings the killer into his head.  Will sees a memory of Hannibal at his desk, with a shape like antlers behind him.  The source of the image, perhaps.  He really is starting to think clearly.  Will wants to go back to Minnesota.

In the night, they drive together.  Does Will fully realize now?  Probably not, but he’s close.

Jack and Alana pay a visit to Du Maurier.  He missed his appointment with her and didn’t call, which is unusual.  Plus he didn’t call.  They believe Will has taken Hannibal to Minnesota.  Alana even believes that Will is slipping “in and out of delusion.”  Well the very definition of a delusion is that it is fixed, meaning it’s stuck and doesn’t come and go.  They misuse psych jargon a lot, unfortunately.  It muddies the importance of the real words.  She goes so far as to offer that he could kill Hannibal and not even remember.  For the most part every lost period of time for Will has been non-violent, so the likelihood is low for this.  Du Maurier believes Hannibal may still be trying to help Hannibal.  Optimistic, considering she knows how Hannibal at best wears a “person suit.”  

Hannibal and Will arrive at Abigail’s house.  Will walks in and sees himself as Hobbs on the day of Hobbs’ death.  Abigail hands him the phone.  He hears Hannibal’s voice, but it’s Hannibal waking him up in the car.  He’s putting together all the hints now that Hannibal is the copycat.  Hannibal was the man on the phone, and Will finally seems to know it.  They get into the kitchen, with blood all over the floor.  Hannibal suggests that if he was thinking like Hobbs, they might never find the body.  He even raises that maybe Will came there to find himself, as this seems to be the start of his departure from himself — the location where he first killed someone.  Will talks about seeing Hobbs as like flies.  He sounds almost non-sensical.  Hannibal goes on to now really push as the devil on his shoulder.  No more indirect suggestion.  He tells will that if he cultivated those urges as “inspirations,” he would become someone other than himself.  He’s dropping his voice, and using elevating language like “inspiration.”  

Will takes a step — saying who knows who he am, but not so sure about Hannibal.  And one killed Abigail.  And whoever did that was the copycat.  Will draws his gun.  Hannibal now questions if he’s a killer, appealing to his better nature.  Will knows that he called, but isn’t sure how deep this rabbit hole goes.  Hannibal picks at the logic of it.  Jack slowly creeps in through the front door.  Will knows there’s no motive, “which is why you were so hard to see.”  Yes.  Plus the skilled manipulation.  “You were curious what I would do.”  Now he’s able to think like Hannibal, finally. 

Even as Will gets worked up, Hannibal appears calm.  Totally appropriate for a psychopath.  Jack steps in to talk Will down.  Hannibal gets a smug look on his face.  Will goes to shoot, but Jack shoots first.  Will collapses in the exact spot where Hobbs was shot.  That chapter is now complete.  As Will bleeds on the floor, he sees Hannibal as the man/stag.

Jack visits Will in the hospital.  Hannibal sits at the bedside.  The right side of his brain was inflamed, and they’re treating with antivirals and steroids, in a medical sedation.  That might be expected, since they might not be able to rule out viruses that early in his workup.  He’s getting better, unclear how much better.  Jack asks if Hannibal would have gone to Minnesota if Will didn’t have a gun. Hannibal says he would have wanted to.  We know that’s true, since Will didn’t have a gun on him until the end.  But most interestingly he’s willing to tell this to Jack.  It paints himself as someone who cares undyingly for Will.  

Hannibal visits Du Maurier, bringing her a meal of veal.  They’re having a full meal together, including wine.  This is not doctor/patient.  It could be colleagues.  It also raises the possibility that she is like Hannibal, a psychopath that he found but that hasn’t been shown to us, yet.  That would be unlikely, but so is a totem pole of bodies.  Hannibal brought this as a way to initiate a conversation.  He’s going to say goodbye to Will.  Is the game over?  

She warns him that others are starting to see his pattern of developing relationships with others prone to violence.  Perhaps.  I suspect it’s more that he develops relationships with people he thinks he can coax into violence.  She believes it might get him caught.  And yet she warns him about it.  

Hannibal walks through the prison until he reaches Will’s cell.  Hannibal smiles a little.  Onto round 2.

 

Return to index

07
APR
2015

Digesting Hannibal – Season 1, Ep12

Episode 12 – Relevés

Will walks through a hospital in a robe, pulling his IV line along on a cart.  He enters Georgia’s room, with her still in the hyperbaric chamber.  She looks close to normal.  They talk for a bit, and it’s clear they’ve been talking regularly.  She now seems able to recognize him, somehow.  Will reports that they’ve only found that he has a fever, but not why.  She gets pessimistic about what’ll happen — they won’t find a real cause, just give wrong meds and wrong diagnoses.  Well that was her experience, after all.  She also says she’s going to get ECT.  “Shock treatment sounds nicer.”  Does it?  The convulsive part of electroconvulsive therapy means they will put her under anesthesia (unconscious) then induce a seizure briefly.  It’s especially effective for depression that has failed every other intervention.  We’re talking severe not shower/eat/get out of bed for weeks depression.  Side effects can involve some memory loss.  She’s skeptical, since she’s been many-a-times that she could recover, and remember what she did.  “But I don’t want to remember.”  She doesn’t remember killing the doctor, and thinks it might have been Will, “but I couldn’t see your face.”

Hannibal stands in Will’s hospital room, uncovering a meal he made for him — a chinese recipe chicken soup, with healing herbs.  They sit to eat together.  They discuss his visiting Georgia, and how it helps him to feel supported.  Will asks if all his symptoms could be caused by the fever.  Hannibal responds with a completely inaccurate statement.  “Fevers can be symptoms of dementia.  Dementia can be a symptom of many things happening in your body or mind that can no longer be ignored.”  So let’s parse that out.  Dementia refers to a degree of cognitive impairment, such as impairment in concentration, memory, verbal fluency.  There are causes of dementia, such as Alzheimer’s disease or Lewy Body dementia.  What Will had is almost certainly delirium, which many non-psychiatrists mix up with dementia.  Dementia is usually non-reversible.  Delirium is a temporary brainstate caused by a medical condition, like an infection.  Clear up the infection, and the delirium improves.  So dementia doesn’t cause fever, nor does delirium.  Fever can cause delirium, though.  Aside from all of that, there are few solely mental illnesses that cause dementia or anything that looks like dementia.  The primary one is pseudodementia, which is someone so depressed that they can’t think or speak well, and so look like they have dementia.  Treating the depression improves this. 

That’s all a long-winded way of saying Hannibal is wrong.  I suspect this is an issue of the medical technical advisor for the episode.  Other types of physicians don’t always understand these differences.  Neurologists and psychiatrists usually do.

Will inquires if Jack knows of the rest of the symptoms.  Hannibal says he hasn’t told him, and won’t until they know what this is.  So the implications that are trying to be made here is that this is a chronic or permanent condition.  Hannibal would be obligated to report to Jack since confidentiality has never seemed to be part of their relationship, with this so loosely defined as a therapeutic relationship, and their relationship being initiated to keep an eye on him for Jack.  It’s a bit more like a work-mandated therapy, where confidentiality wouldn’t be expected to apply.  So Hannibal is again bending the rules.  They pivot to talking about Georgia, and Will thinks she doesn’t want to get better.

Georgia lays in her hyperbaric chamber.  She hears a noise.  In reality she wouldn’t be living in the chamber, but getting treatment for a couple of hours a day for weeks.  She combs her hair, lights a spark of static, and an explosion ignites which burns her alive.  This kind of thing actually happens.  What isn’t clear is how Hannibal could have rigged this, since she is a loose end.  

The team reviews the body and crime scene.  Georgia’s body is a scorched mess.  Much worse than death by toilet seat.  She wasn’t wearing her grounding bracelet.  They postulate if she was suicidal, but Will doesn’t think so.  He admits he talked to her, which perks everyone’s eyebrows.  Could compromise the case — but it doesn’t matter anymore.  This just adds another question mark to Will’s judgment.  

Abigail Hobbs meets with Freddie Lounds, discussing their upcoming book.  Chapters for each of the girls her father murdered.  Abigail asks about the title.  Her body language suggests she’s still conflicted about the whole process and doesn’t trust Lounds.  Justifiably.  They play with the title “The Last Victim,” which opens up the conversation as to who was the Last Victim.  Abigail thinks the last victim was Marissa Schuur, who was killed by the copycat killer. She still holds her father responsible.  They debate if Nick killed Marissa.  Lounds doesn’t think he did.  “I’ve interviewed enough killers to know one when I see one.”  Well, that sounds like definitive proof.  That line also of course applies to Abigail.  Does she know that Abigail killed Nick?  Lounds claims they give themselves away by “a very specific brand of hostility.”  Her messages seem to be – “If you’re a killer, I don’t care.  If you don’t want me to think you’re a killer, stop being so hostile towards me.”  But I could be overly reading into that one.  Lounds sees these characteristics in Will, and that she believes Will is the copycat.  She really doesn’t understand severe psychopaths very well, or her own role in provoking people.  Or this is all about her own endgame — to get Abigail to confess to murdering Boyle.  “Whoever killed Nicholas Boyle killed an innocent man.”  We see how conflicted this makes Abigail.  If that’s Lounds’ endgame, it’s working.  

Will dreams he’s at home.  He sees Georgia walk into his bedroom and out.  He follows her outside.  She says “See?” twice.  She’s then skewered on antlers (like Marissa Schuur) and bursts into flames.  All that’s left is the stag.  The message seems to be that whoever killed Marissa also killed Georgia.  And the stag is that killer.  

Of course the stag has also led Will to many clues, including when he walked to Gideon’s car.  So the stag has multiple roles, and doesn’t seem to just represent Hannibal.  

Will shows up in Jack’s office, having checked himself out of the hospital.  The fever broke.  Interesting that this happened after the dream.  Perhaps because of the dream?  Could the fever and the auto-immune condition be symbolic in some ways, as Will turning against himself (because of Hannibal)?  If so, as he undoes this his condition would get better.  Will proffers that Georgia didn’t kill herself, and was in fact murdered by whoever killed Sutcliffe.  The evidence doesn’t support that, though we know different.  Jack thinks he’s not thinking clearly on the subject, looking for an theory to explain what doesn’t need an explanation.  Will just thinks she was misunderstood.

Jack and Will review the evidence with Zeller and Price.  They discuss the remnants of plastic, which Will guesses was a comb.  Sutcliffe was killed similarly to Georgia’s victim, which Will believes was the copycat.  This is a jump. Just because there’s two copycats, doesn’t mean they’d be the same killer.  Except his dream told him so, so it must be true!  ;)  The debate leads Will to conclude that Boyle wasn’t the copycat.

Jack sits with Hannibal to discuss Will, and if Will’s thoughts could be valid or evidence of his illness.  Hannibal needs to play it very carefully here, so as not to tip his hat to Jack.  Jack asks about Will’s relationship to Abigail.  Hannibal elicits that Jack suspects Will is protecting Abigail.  Hannibal defends Will, that he wouldn’t hide anything criminal.  Hannibal is playing the good guy, seeing that Jack is going down the road of suspecting Will all on his own.  He doesn’t need to plant a whole lot of seeds here.  Hannibal offers that Will needs their support, whether or not mental illness is involved.  A subtle planting that Will could be mentally ill still.  An alternative interpretation would be that Hannibal does care about Will as a friend, and so wants to loosely speak up for him, while not incriminating himself.  Jack questions if Will is mentally ill, or if he’s just so unique we don’t have a name for it.  There are clear ways to define mental illness, and one of the criteria is an impairment in functioning.  Some wouldn’t even diagnose hallucinations as part of an illness if it doesn’t impair the person.  

Jack shows up at Du Maurier’s front door, in the middle of the night, wanting to discuss Hannibal.  She asks him for a court order.  She susses out that it’s unofficial at this point, but that Jack thinks Hannibal is withholding important info about a murder.  She invokes confidentiality.  He pivots to talking about her being attacked by a patient previously, who had been referred by Hannibal.  He then raises the recent deaths.  She points out his strategy, making subtle accusations about the deaths of Tobias/Franklin and thus her in the position of needing to defend Hannibal.  She’s a bit too savvy for Jack’s pressure, but she also secretly wants to talk.  

Jack raises that he’s had “complicated” relationships with patients, which she sidesteps as being related to complicated patients.  She admits that Hannibal calls Will more of a friend than a patient.  This is already disclosing too much.  I’m a little surprised they didn’t talk hypotheticals about hypothetical people.  That would have been in line with their usual dialogue on the show of double entendres.  She offers that he doesn’t have many friends, so he’d probably be loyal and try to help him.

Jack talks out the copycat with Zeller and Price, remembering that Will believed the copycat had insight into Hobbs.  Zeller and Price banter about theories vs. hypotheses.  Scientifically this is absolutely correct.  Jack tasks them to dig up all the travel and any extra information about Hobbs.

Abigail and Will chat in her hospital.  Abigail confesses that she felt good when she killed Boyle.  Challenging this a little bit, she seemed pretty shocked and upset in the moment.  She digs at how Will felt when he killed her father — terrified, and then powerful.  “I don’t think either of us have gotten away from your father.”  Certainly.  “It feels like my dad is still out there.”  This is probably her approach of attempting to elicit from Will if he’s the killer, trying to get him to confide in her by confiding in him.  Will conveys that he thinks he can catch the copycat, but he’ll need her help.  This probably confuses her, because she’s buying into Lounds’ hypothesis that Will is the copycat.  

Du Maurier tells Hannibal that Jack visited her to try to get information.  Hannibal conveys Jack’s belief that Abigail was involved with her father’s crimes, Will’s protecting her, and that Hannibal is protecting Will.  “I’m stepping out of my role as your psychiatrist, and talking to you as your colleague… Whatever you’re doing with Will Graham, stop.”  Most likely, she presumes he’s emotionally involved with Will, rather than the real truth.  Few could really anticipate the depths of what Hannibal has been doing, and he’s been protecting her from having enough information to even guess such a thing.  And Jack didn’t reveal much more, aside from the deaths.  But as his “colleague” she’s advising that he’s pushing outside of traditional boundaries, rather than this being dangerous to his personal well being.  He rationalizes (justifies) that Will needs his help.  She challenges this — he can’t help someone as a friend when neither of you knows what friends are.  She butting up on a big issue in therapy, which is dual relationships.  It’s difficult to have a therapy relationship when also having another kind.  An example might be having a therapist and being in business with them.  Someone might feel obligated to behave in the business deals a certain way because of the therapeutic relationship, and vice versa.  Ideally relationships have one mode.  Some people do transition from therapy relationship to a “friendship,” especially in small towns where it’s impossible to not run into people, but that should only occur once the therapy has ended, and then only cautiously.  One has be very careful, especially as there’s risk with romantic relationships, which are always a no-no (it’s way too risky of a predatory relationship, and people playing into their roles as rescuer and rescued, with dramatic potential consequences).  Will and Hannibal have been flirting with a non-sexual romantic relationship.  It’s all a twisted love story, in a sense.

Hannibal believes he’s protecting Will.  She challenges his ability to do that, since he isn’t objective, and encourages him to pull away.  She also raises the issue of her attack, and that she only told Jack “half-truths.”  Ah, a new mystery.  Something else happened there.  I might guess that Hannibal did refer a patient to her who was violent, and he intervened to protect her.  This might then have been a manipulation to play protector, reverse roles, as an attempt to get closer to her and become a friend (or more).  Her lying to Jack protected Hannibal in some way.  Hannibal paces throughout this conversation, one of the few times we see him uncomfortable.  She pressures that even the best psychiatrists are human.  He can’t accept that.  Maybe because he doesn’t fully view himself as human.  He ends the conversation saying that whe the pressure is too great from his relationship(s) with Will, “I’ll find a way to relieve them.”  Of course this opens the door for further sabotaging or even killing Will.  We haven’t seen him entertain this idea before.  

Will sits with Hannibal, in therapy.  Will feels clear, “about the copycat.”  This is a threat to Hannibal.  Hannibal points out he’s dismissing the evidence that does exist, pointing to others.  Will takes it further, believing the copycat initially intended to frame him.  Will is now hot on the trail.  He knows where to look.  In response, Hannibal points out this is getting paranoid.  Will feels clear, though.

Zeller and Price review their findings with Jack.  It seems that Abigail accompanied his daughter when they identified victims.  She was the bait.  They take this further, hypothesizing that she’s the copycat.  It really isn’t a huge leap of logic, except Will’s perception that the copycat needs access to the investigation and she doesn’t really have that.  Jack could only explain the new murders as trying to impress someone new.  Such as Lounds.  More likely IF she did that, she’d go for a new father figure, such as Will or Hannibal.  Lounds is a leap that negates the nature of Abigail’s relationship with her father.  

Jack shows up looking for Abigail, finding only Lounds.  She relates that Will snuck Abigail out, which is strange since he’s registered as her guardian.  Guardian?  She’s an adult, and as far as we know hasn’t had a surrogate decision maker appointed by a court.  But the plot point that this aims for is clear enough.  Lounds reveals she suspects Abigail killed Boyle, and that Will is hiding something.

Jack barges in on Hannibal, wondering where Will is.  Hannibal starts planting that Will has had lost time, and that it’s due to a “dissociated personality state.”  Now this is possible, theoretically.  Dissociation involves a splitting off of awareness, where someone could do something that is seeming involuntary.  In the simplest form someone might feel their body is acting on its own, such as in a conversion disorder.  Hannibal is suggesting that Will has dissociative identity disorder, previously called multiple personality disorder.  While this has been maintained as a real entity in the DSM, all of the index (original) cases that established such a thing exists have later been disproven.  If it exists it’s really really really rare.  Jack asks about where Will took Abigail.  Hannibal plays a recording about Will feeling like he killed Marissa Schuur.  This was because he imagined himself as the killer.  Jack puts together the pieces for himself, that Will always was the last one to see most of the victims, and thus must be the suspect.  Jack inquires about “who” the other personality might be.  Usually it would be a split off version of the person.  For Will the idea is he’s internalizing other killers, especially Hobbs.  We have seen that he has internalized Hobbs, seeing him all the time.  But seeing him is quite different than becoming him.  And if it’s Hobbs, he intended to kill Abigail.

On a plane, Abigail comments on Will still looking kind of sick.  She remembers her mother’s birthday is coming up, and they planned to climb the highest peak in the state.  Will offers to take her.  A parental gesture.  She declines.  Thus rejecting him ever so slightly in the role of parent.  They arrive at the cabin.  She looks scared.  She insinuates that Will is the copycat.  He plays defense, just stating he was trying to understand her father.  He’s lost touch with his original reason for being there already, tracking the real copycat.  She finds out he fishes, and compares it hunting — luring vs. stalking.  Will starts pushing at her on it.  He’s suspecting she is the copycat, or at least involved in her father’s murders.  She reveals she helped her father lure, and that Hannibal should have told him.  Hannibal promised to protect her.  Will gets upset and slams her against the wall.  And he suddenly snaps out of it and he hasn’t grabbed her at all.  He is dissociating, losing time.  It’s just not clear that this is him embodying Hobbs, since in his imagination there he wasn’t Hobbs, but a more aggressive version of himself.  Now they fully start accusing each other of being the copycat.  She also calls out that he’s sick, as he clutches his head.

Suddenly he has lost time, and finds himself on a plane, having arrived back in DC.  Marissa is back in Minnesota, still, going into her old home.  She finds Hannibal there and hugs him immediately.  She says she left Will at the cabin, since she didn’t feel safe with him.  Interesting.  We don’t completely know if this is true.  The intervening time is omitted, leaving other possibilities like her having done something to him.  She tells him Will knows what she did, and he informs her Jack does, too.  Will will be arrested for the copycat crimes, though Hannibal says they’ll “think” he did it.  Meaning he knows Will didn’t.  Abigail intuits that Hannibal is the killer.  Hannibal admits it, and that he kills and manipulates because he’s “curious what will happen.”  Creepy.  In it’s impartiality.  

He admits that he set her up to kill Boyle, and the effect that kill had on her is more important than Boyle’s life would have been.  Only to Hannibal is it so important.  Hannibal admits to killing many more than her father, and that he’s going to kill her.  This further sets up Will for her murder, since no one knows Hannibal is there, and Jack expects Will to try to kill Abigail.

Anytime Hannibal comes out from behind his mask is super-creepy.  It’s like looking at the devil.  He knows what he is.  Which twists at the other question of why be in therapy or try to have a friend.  I think he revealed it here — it’s to satisfy his curiosity, as to if he’s capable of doing/being these things.  It’s a removed curiosity, though, without conscience.  Yet he is able to fake the value of life, so he knows others value it.  

 

—–

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07
APR
2015

Digesting Hannibal – Season 1, Ep11

Episode 11 – Rôti

Hannibal serves dinner with Dr. Chilton.  They discuss Abel Gideon, and how Chilton tried to convince him that he was the Ripper.  Hannibal points out how that primarily works with those without a stable sense of self (Will), rather than with psychopaths.  This reflects on much of the series, with Hannibal attempting to control Will, who has the ultimate unstable sense of self.  I watch this always on guard that anyone could be Hannibal’s next victim, especially Chilton.  It turns out that Gideon is accusing Chilton of making him kill.  Chilton asks for advice, and Hannibal instructs him to deny everything.

Chilton talks about his hopes that psychic driving would work to break him down.  Hannibal corrects him, noting how manipulation must be hidden or else it’s ineffective.  He should know, of all people.  So Gideon “pushed back” once he was aware he was being manipulated.  Yes, most people don’t like being manipulated into thinking they’re a serial killer.  It even seems possible that the murder of the nurse itself could be part of him retaliating against Chilton.  

Will sleeps, sweating with not to be unexpected intense dreams.  It includes the totem of the bodies, washed away by a tidal wave.  He awakens, only to see the clock melt, and himself wash away.  Still a dream.  It’s difficult to tell how much of his dreams are from his trauma vs. Part of his encephalitis.  Either way, Will needs help with someone he can trust.  

Gideon is led away from the hospital by guards into an armored transport, on the way to court or something.  He’s suing Chilton.  Not clear how he got an attorney to take that one on, but it does have merit.  Gideon tells him he’s going to tell the world that Chilton tried to convince him he was the Ripper.

In the transport, Gideon talks at the guards.  He killed his family because it was easier than getting a divorce.  There’s still something comical about hearing this out of Eddie Izzard’s mouth, even though it’s supposed to be creepy.  He kills them both, sight unseen.  Sometimes it’s creepier to not show the act, but just allude to it.  

At the crime scene, Gideon has escaped.  Will metronomes the murder, as usual watching himself enact it.  Jack inquires if Gideon still believes he’s the Ripper.  Will says he’s having “a differing of opinion.”  This is opening up questions to be answered in the episode.  

Hearts and other organs hang from trees near the scene, like Christmas ornaments.  Katz lists off a slew of weapons that Gideon now has.  The Ripper wouldn’t have left organs behind.  So Gideon is sending a message with this, possibly to the Ripper himself.  The ornaments approach clearly puts the organs for viewing, to attempt to show the murder in a different way, to contrast with the Ripper and for all to appreciate.  

Will and Alana talk with Chilton.  They point out that the escape is beneficial to Chilton, in avoiding the lawsuit and humiliation.  True.  They might be insinuating that Chilton was involved.  Which Chilton then inquires if they’re accusing him of, and they deny it.  Chilton denies any involvement in manipulating Gideon.  He goes on to say that Gideon “wasn’t insane when he murdered his wife.  Killing her drove him insane.”  There isn’t a whole lot of rationale to that, unless the murder was done by accident and the guilt tormented him.  But using the legal definition of insanity as mental illness causing inability to discriminate right from wrong (a simplified definition I grant you) or even to have out of control impulses, there’s no clear evidence that killing his family caused him to lose the ability to distinguish right from wrong, or to lose control of impulses.  So that just makes no sense.  Blame is thrown back and forth.  Alana make the case that whether he believes he’s the Ripper or is even confused by it, he’ll kill again.  I’d say his identity is really immaterial as to whether he’ll kill again.  He didn’t kill those guards because he’s confused about his identity, but to escape.  Chilton pushes the blame onto them, baiting them into a fight.  This keeps the focus off of him, and makes it about the fight in the room rather than the past.  

Jack preps the FBI on Gideon.  A transplant surgeon, armed and dangerous.  As Will listens, Jack’s voice fades a bit.  The room appears filled with antlers, and Jack appears to be talking to Will about Will.  “You are armed and extremely dangerous.”  I have had occasional patients who really do dissociate like this, hearing everything said as being about them, when it isn’t.  That can also be a characteristic of psychotic disorders, called ideas of reference.  Will is actually hearing You when Jack is saying He.  Will really is imagining all this, but losing touch with reality.

Will sits with Hannibal, recalling this episode.  “I don’t know who I am anymore.  I don’t feel like myself.”  In the context of Hannibal’s conversation with Chilton in the beginning, it thus seems that this is a clear invitation to Hannibal to manipulate Will, even to do psychic driving (though again their definition seems incorrect), if he hasn’t already been doing it (without showing us).  “I feel crazy.”  I have blogged about this feeling, which often involves a loss of sense of agency or control.  Will notes his biggest fear is not knowing who he is.  He believes that this is Gideon’s fear too, and that he has been changed.  Unless Chilton was really using psychic driving, like the full sleep deprivation brainwashing mental torture approach, it’s unlikely to really be able to disturb his sense of self so completely, mainly because Gideon is a psychopath.  Hannibal thinks Gideon will seek out the Ripper, to gauge who he is.

Will and Jack review Gideon with the team (Katz, Price, and Zeller).  They are reviewing all his communications.  Will doesn’t think they’ll find anything.  Zeller notes bodies had organs removed post-mortem, and they had lobotomies.  Katz corrects him that it wasn’t a lobotomy since he only scrambled the brain not removing any of it.  Actually Zeller was right, it’s a lobotomy.  A lobectomy is removal of a lobe of the brain, lobotomy is just cutting it.  Will begins hallucinating water leaking out of one of the storage lockers.  Will raises that the lobotomy (again, that’s what it is) was what was done to him.  They scrambled his brain.  True, to a degree.  Therapy hopefully doesn’t brainwash people, but helps them be more comfortable with who they are, and maybe closer to who they want to be.  That wasn’t what anyone did here.  And again therapy for psychopaths largely doesn’t work.  Jack suggests they get a list of everyone that tried to treat Gideon, which will include Alana.

Will visits Alana.  They have a little flirting about getting closer, and he invites the idea, when he’s more stable.  His head feels warm to her.  And he’s already on aspirin.  Then how about a tylenol?  She expresses some worry for Gideon’s wellbeing.  She believes he can’t be completely held responsible for his actions because he was subjected to “an outside influence.”  If he really was brainwashed (they seem to value the aesthetic on this show, and that must be viewed as a crude word), then “outside influence” is understating it a bit.  But the suggestions about what was done to him, even by Chilton, repeating an idea thousands of times, isn’t quite brainwashing, nor is therapy.  They hypothesize what would happen if Gideon finds the Ripper.  Will believes the Ripper would kill him for rudely taking credit for his work.  This is obviously setting up our expectations for a showdown this episode.  

Freddie Lounds gets a call from Gideon, who’s pretending to be a psychologist Dr. Carruthers, and wants to work with her on an article.  We can presume the psychologist he’s pretending to be is one of his former evaluators, and now a victim.  

Lounds walks into the Carruthers’ office, only to find Gideon having killed the man and given him a Columbian necktie.  Yep.  Could see that coming.  

Jack and Will look over the crime scene.  Jack reviews that Carruthers had diagnosed Gideon as being a “pathological narcissist who suffers from psychotic episodes.”  So let’s pick that apart.  Yes, he’s a narcissist, as he believes he’s superior to others.  He’s pathological because this has caused problems in his life, such as killing people and believing he could get away with it.  Psychosis, though, we haven’t seen any evidence of.  No clear evidence of hallucinations, paranoia, or even magical thinking.  Will thinks this is about surgically operating on those that messed with his mind.  But he still thinks like a doctor, draining the blood a leaving it to be donated to the red cross, with a note.  They think he’s also showing off before meeting the Ripper.  The motives have been really muddied now.  Is it revenge?  Is it an identity crisis?  Is he trying to court the Ripper?  Does he plan to kill the Ripper?  I would opine that the identity thing is crap.  He might be vengeful towards those who tried to mess with his head, but not likely he is actually confused, based on the little character info we know (that he’s a psychopath).  They click on the computer, and find a tattlecrime article by Lounds about this very murder.  Will knows Gideon must have Lounds.

Gideon has Lounds tied up in the observatory.  She offers to write a big story about him.  She even feigns believing that he’s the Ripper.  He calls her out on that.  “It’s like remembering something from your childhood… and then you realize sadly it’s just some photo in an old book.”  Now this I would buy, that memory is plastic and malleable, even in psychopaths.  But that’s different I might say than altering someone’s reality.  The false memory syndrome of the 80s showed that people could construct very vivid false memories.  Some hypothesize though that there’s always a part of a person that knows what’s true and what isn’t.  Gideon seems to have just such a part.  Lounds realizes the article is aiming to draw out the Ripper.

The team reviews another body, a psychiatrist with the same Columbian necktie, but this time with a severed arm.  Will intuits that the Ripper isn’t going to risk exposure, and that he killed this psychiatrist to tell Jack where Gideon is hiding — in the observatory where the last severed arm was.  Interesting to communicate through dead bodies.  Apparently a letter or email  wouldn’t suffice.

Back in the observatory, Gideon now has Chilton on the surgical table.  A trade again – you messed with my mind, I get to cut open your abdomen.  We watch him made a midline incision, sans general anesthetic.  Gideon of course doesn’t use gloves, since infection isn’t really a concern of his.  Gideon removes what is probably a big appendix, followed by a kidney and philosophizes with it in hand.  He slaps Chilton with his hand, smearing his face with his own blood.  Gideon holds his hands up as if he’s maintaining the sterile surgical field, even though he isn’t.  Force of habit, if we needed a reason.  He’s also removing non-vital organs so far, which to me means the writers probably aren’t going to kill off Chilton, just put him in a little false jeopardy.  

Will and Jack drive to the observatory.  Jack tells him he should wait outside, and that he looks like hell.  Will says he feels “fluid, like I’m spilling.”  He knows he’s sick, but presumes it’s a cold.  Jack scolds him to take better care of himself.  So now the dynamic has flipped, with Jack pulling him back, and Will pushing himself.  If we trace back, this seems to have transitioned around the time Bella got sick, which presuming that’s deliberate, would explain the shift in his behavior towards Will (plus Will getting as sick as he is) as his priorities change.  “It’s hard to shake off something that’s already under your skin.”  He nods off to sleep.  Will is suggesting the seeds have been planted by Hannibal, it’s hard to reverse that.  

A tactical squad moves in on the observatory.  Jack advances with a shotgun.  Will leaves the car and watches from a distance, but sees a stag in the woods.  He follows it.  The squad finds Chilton with his bowels exposed.  Lounds bags him.  Bagging someone refers to a manually worked ventilator, called an ambu bag.  Gideon watches from afar, outside the building.  He gets in his car.  He talks to the backseat, saying he was expecting the Chesapeake Ripper, or are you he?  It’s Will.  Interesting that the stag led Will to this car.  We could imagine then that the stag isn’t just a meaningless hallucination, but has purpose.  In a show as well thought out as this, most things have meaning.  Will points a gun at Gideon, telling him not to turn around.  To Will, Gideon looks like Garrett Jacob Hobbs.  Is this another opportunity to kill a killer?  Will is clearly sick, and Gideon recognizes it.  He asks who Will’s doctor is.

Hannibal opens his front door to see Will and Gideon.  If someone was as medically ill as Will is, he should be in a hospital.  Encephalitis can kill.  I wouldn’t want someone in this state showing up at my front door.  I’d just call 911.  Will talks about not being able to tell what’s real.  Gideon sits nearby.  Hannibal tries to reorient him, but Will only cares about if Hobbs is real.  Hannibal tells him there’s no one there, and that Will came here alone.  Now this is a bit of a stretch to have him not remember driving, though in Will’s delirious state it might work.  This tells to Gideon that there’s some manipulation going on.  Will’s eyes roll back and he starts shaking.  This is probably supposed to be a febrile seizure, though if his whole body is convulsing it’s unlikely he would still be standing.  On a side note, Hugh Dancy appears to have a great ability to roll up his eyes, which per the hypnotic induction profile (Siegel), is one indicator he may be capable of responding well to hypnosis.  

Hannibal recognizes it as a “mild” seizure.  Seizures are risky, particularly if they lead to status epilepticus, which is a continuous seizure where someone stops breathing.  Gideon identifies that Hannibal doesn’t seem worried about this.  Hannibal inquires if he’s that man that claims to be the Ripper, stating as fact that he isn’t the Ripper.  Gideon asks if Hannibal is the Ripper.  “A terrible thing to have your identity taken from you.”  A beautiful double entendre, rich with subtext.  It speaks to Gideon’s situation, while revealing Hannibal’s alter ego as the Ripper.  Gideon says he’s taking back his own identity, “a piece at a time,” including his psychiatrist.  Hannibal furthers this line, asking if Alana was one of his psychiatrists.  Gideon says she was.  Hannibal offers up her location.  A curious twist.  One would think that Hannibal would want to finish off Gideon over the grudge of taking credit, but instead offers up Alana.  The only seeming explanation for this is that he doesn’t want to take out Gideon himself, but give him a way that the FBI can dispose of him.  Knowing that Alana has a protective detail means he’s sending Gideon into a trap.  More manipulation from Hannibal.  

Hannibal gives a super-brief neurological test to Will.  He really just tested his motor ability, ability to speak and follow one-step command, and his facial nerve (one of the cranial nerves in the medulla).  This definitely doesn’t rule out a stroke, but covers a couple of basics for a mini-screening exam.  Plus no one wants to watch a five-minute neuro exam on TV, as it isn’t story.  He tells Will that he had a seizure, that he has a fever and was hallucinating.  Will insists he saw Hobbs.  “He’s a delusion disguising reality.”  Kinda.  He’s insisting on a hallucination.  It’s true, he DID see him, it’s just that it wasn’t real.  So a delusion (fixed false belief) isn’t quite the right term here.  Hannibal leaves, stating he’s worried about Alana, and that he’ll call Jack to take Will to the hospital.  He even tells Will that he killed Hobbs once, and can do it again.  The normal protocol would be to call 911, communicate everything to the paramedics, and call Jack to go protect Alana.  But Hannibal is just playing a cover story.  He leaves, leaving car keys, which Will snatches up.  Will, still pushing himself, must be going to Alana.  Hannibal returns to the same dining room and now removes his coat.  As usual, his manipulation plan works well.  

Gideon watches Alana from outside her home.  Will limps up behind him and draws his gun, but doesn’t shoot.  He instead walks up next to Gideon.  Gideon talks about not being sure if he’ll ever be himself again, after thinking he was someone else for so long.  I’m not gonna go into the brainwashing thing anymore.  We just needed more to establish how severe it was.  It was never shown, and the amount explained isn’t sufficient.  To Will, Gideon is still Hobbs.  Gideon wonders “if I kill her, how he would kill her, then maybe I can understand him better.”  It’s a very interesting idea, this loss of identity and wanting to figure it out.  It just doesn’t connect for me with the way it’s explored here.  There’s a little gap, which I think could be fixed if we saw him killing and actually exploring his own identity during the process.  

Gideon also says “I’m you.”  And as he talks about killing Alana, asks rhetorically “I wonder if then you’ll finally realize what you’ve become.”  Hannibal must have fed him information on this game, to turn Will into a killer.  Alana hears a shot, and looks outside to see Will having shot Gideon.

Jack and Will discuss the outcomes over a drink.  Chilton is getting surgery but might survive.  Will is alive, but has 105 degree fever.  That’s severe, and heading to brain damage territory.  White blood cell count is double the normal level without an infection source.  White blood cells indicate an immune overactivity, most commonly with infection but not necessarily.  Jack isn’t worried, since even with the fever he was able to take out Gideon.  A strong constitution.  Hannibal recommends that Jack take away Will’s gun.  Jack disagrees.  He made a direct suggestion that hit resistance, so he tries an indirect approach.  1.  Experience shapes us.  2. Will had extreme and dangerous experiences.  3.  How might that change Will?  The question is left unanswered for Jack to fill it in, which is a therapy (and hypnosis) approach to planting ideas.  Unlike Inception, where it’s difficult to plant ideas, it’s actually deceptively simple.  In this case the question is also opened for us, the audience, making us wonder what will happen to Will from this.  There will be consequences.  

Will lies in a hospital bed, on oxygen.  Doubtful he’d really need oxygen unless he isn’t breathing or has a problems with his lungs.  Alana sits next to him.  Him being actually sick reveals who really cares about him.  In certain family systems models this shows who he’d have the healthiest relationship with, by being able to switch roles (he’s now one-down in the sick role, when before with her he wasn’t).  

Hannibal sits with Du Maurier in therapy.  He notes that Will is troubled, and that he wants to contain it.  She counters that based on the metaphor he chose (containing an oil spill) that Will has some value to him.  She suggests that he might be more interested in Will’s “madness” than in Will.  He doesn’t go for that, though.  He volunteers that he identifies with Will — someone who knew from a young age that he saw the world differently, felt things differently than others.  This seems to give us hope that Hannibal is a monster who wants to be human, who wants to not feel alone and to connect to another who is different.  And yet there’s the nagging fear that everything is a facade, including everything he says in his own therapy.  That doesn’t seem to make sense, though, since he has no reason to have to be in therapy unless he wants to be — there’s no external benefit from it.  

She inquires if he identifies with his “madness” also.  He basically says yes indirectly, through talking about the benefits of madness for the world (like a medicine), since she seems to describe it like madness is a bad thing.  He notes the main benefit is the “opportunity for friendship.”  This still seems muddled – he says he wants that, and yet manipulates.  The best explanation I could imagine is if a monster had its monster-like nature, yet aspired to be human, it might try to do things human-like, yet often default back into it’s monster-like nature.  That is giving Hannibal the benefit of the doubt, though.  She sets boundaries, noting that Will is a patient, and if he feels an impulse to move forward, he must instead pull away.  So now he’s a patient again.  Hannibal says he doesn’t want to just watch Will lose his mind.  “Sometimes all we can do is watch.”  Hannibal has never really watched.  Ever.

—–

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07
APR
2015

Digesting Hannibal – Season 1, Ep10

 Episode 10 – Buffet Froid

A car drives up to a house at night.  A girl (BETH LEBEAU) gets out, and enters the house.  She plays with a cage bird.  We see her getting ready for bed.  As she tries to sleep something drips from her ceiling. She turns on the light to see multiple leaks coming through across her ceiling. She investigates the attic to find a hole in the roof, Big enough for a person to come through.   In fact we see what she doesn’t, footsteps in the snow, on the outer roof.  A good use of the Hanging Elevator technique — give info that the audience knows that the character doesn’t, which involves danger.  She finishes patching it up and returns to bed.   She sees water streaks towards her bed.  As she approaches her bed, she gets pulled under it, clawing for life.  A spray of blood tells us what happened.  Terrifying.  

Will sits in “therapy” with Hannibal.  I used quotes because it’s gone back and forth between defining it as therapy, conversations between friends, and sequestered conversations about a collective conspiracy.  Will takes issue with Abigail killing Boyle.  Hannibal tries to normalize it, since each of them have taken a life.  Will moves on to objecting to the coverup.  I love the dialogue.  It moves through issues and unlayering complaints one at a time.  Hannibal furthers that these deaths happened when there weren’t alternatives.

Hannibal questions if will has had any further losses of time, or hallucinations.  Will admits he has.  Hannibal asks him to draw a clock face.  This is part of a cognitive or neurological exam, looking at many complex functions in the brain.  It’s looking for constructional apraxias, or difficulty doing certain complex tasks.  The various ways this can go wrong are each revealing.    Will draws a clock that seems normal.  When he presents it, all of the numbers are on the right side, and some aren’t even in the circle.  The crowding to the Right with nothing crossing the midline suggest Right parietal lobe impairment, and it might even be expected to have hemineglect (where half the body is ignored).  He’s ignoring the left side, so the right side must be impaired.  There’s other areas of the brain impaired, but it would probably need other testing such as drawing tests to further elucidate it.  Hannibal of course doesn’t comment on this.

Will enters a house with a fish.  He cuts it open on the counter, and it gushes blood.  He blinks and suddenly is watching Beth bleed out, in real time.  He’s getting lost in his imagination, and now acting it out.  Previously it stayed in his head.  He stumbles out of the room, bloody and disoriented, having held the body and the blood.  Jack confronts him, noting he was uncharacteristically afraid.  “I just got disoriented.”  Disorientation is a symptom of delirium, a medical condition indicating global toxicity to the brain.  It may come and go, or wax and wane.  All the more evidence that he needs to get checked out medically.  He admits to having trouble finding the words for his experience.  Jack challenges him with the severity of the situation, that he contaminated the crime scene.  Will attempts to blame his process as making him feel like he killed Beth.  Jack tries to be rational, explaining to him that he should be taking the evidence and extrapolating the thinking of the killer.  That has never really been what he does.  At least not from what has been shown.  Jack explains his concern that he has “broken” him.  Will retorts that even when broken he’s better than any healthy person out there.  “Fear makes you rude, Will.”  Yep.  Fear and anger.  I think he blames Jack.  Maybe just because fear has never made him rude, before.  This also references the Hannibal motto — Eat the Rude.

Will and Jack rejoin the team as they reconstruct the crime scene.  Blood everywhere.  The killer seemed to care about her.  Based on broken photo frames.  Really that seems to indicate it didn’t like something about the images.  Not sure the leap to “caring” is clear.  There’s some skin on the knife, presumably the killer’s.  Beth scratch the killer enough to get skin, but didn’t draw blood.  The killer also tried to pull of the face, post-mortem.  Interesting clues.  

Will talks with Hannibal, and the issue of losing himself in the experience.  Hannibal has clearly now become the confidante.  Will complains of the intensity of the experience, so much that he now has memories that feel real.  This is a subtler form of him disconnecting from reality, and also shows the malleability or “plasticity” of memory.  Our memories are very changeable, even in the healthy.  Hannibal urges him to overcome the delusions that this is real.  This isn’t an issue of willpower (pun intended).  Will conveys that the killer was sad, not cruel.  Lonely and transparent.  Hannibal tries to remind him of the toll that his work has on him.  Will rebuffs this, saying it doesn’t fit his type of “crazy,” believing it’s medical.  Yes yes yes.  Probably not a tumor as his impairments seem to involve multiple areas of the brain.  Seizures are possible.  Hannibal says he’ll recommend a neurologist, but if it isn’t “physiological” (we usually say organic), he’ll have to accept it’s mental.  Well, yeah.  He should have been ruled out for medical causes several episodes ago.  But that wouldn’t be as interesting to watch play out here.

Will and Hannibal sit down with a neurologist, Dr. Sutcliffe.  He was a resident with Hannibal at Hopkins.  So we don’t know how trustworthy he is.  The off-white sportcoat, in contrast to Hannibal’s black suit seems to suggest he’s more trustworthy, though it appears to be a grayed doctor’s white coat.  Will conveys the history a little.  They put him into a scanner.  Hannibal tells Sutcliffe he believes it’s encephalitis.  Which really speaks volumes.  Hannibal needs to be honest with Sutcliffe, and probably only brought in Will because he couldn’t convince him otherwise.  Plus Hannibal has known all along.  Hannibal goes on to admit he’s known, but that he wanted to be sure, and the onset was gradual.  Sutcliffe doubts him.  Hannibal shows him the clock.  He also remarks about how rare it is to be able to study the psychological effects of this.  Sutcliffe responds it’s rare to study the neurological.  Is this a conspiracy brewing to hold back the truth and let him be sick?  Sutcliffe furrows a little, which makes it questionable that he’s really on board with that.  In the machine, Will suddenly starts seeing himself under the bed, witnessing the murder.  He can’t escape.

Sutcliffe sees inflammation across the right hemisphere of the brain, and makes a diagnosis of anti-NMDA encephalitis.  One could call this encephalitis, but I don’t think the cluster is specific enough to make this diagnosis without blood tests looking for anti-NMDA antibodies.  Sutcliffe’s prognosis is it will get worse.  He’s impressed that Hannibal could smell it, and asks what he smells on him.  “Opportunity.”  Hannibal knows he can get him to go along with this.  Sutcliffe presents false results to Will, telling him everything was normal.  This is wholly unethical, and the level of lawsuits this would bring down boggles my mind.  Not to mention criminal charges.  But amusing to watch another little conspiracy brewing.  This really continues to represent Hannibal as the devil — he brings out the worst in people, and brings them into little conspiracies that betrays their better nature.  Will accepts this, reluctantly.

Hannibal and Jack talk over a drink.  Hannibal emphasizes the toll this is taking.  Jack says it was worth it, for what Will has done.  Hannibal retorts that he caught the “killer’s disease” — to not stop thinking about taking a life.  This is one of the leaps of logic that will be done on the show now and again.  Sometimes a lot.  The problem of a violent psychopath, namely a drive to hurt or torture, is very different than thinking about murder and having a terrified reaction to it.  Will’s response to viewing himself as the killer has involved more and more fear and terror.  He’s not getting used to it, he’s getting more upset.  So in some ways this is going against Hannibal’s plan.  The only way his plan of turning Will into a killer is working is because of Will’s disorientation from his encephalitis.  Hannibal speaks up for Will, that he’s “an innocent.”  This is part of Hannibal’s approach to get Will off his trail.  Either he gets him out of the field, or he discredits him when he’ll get too sick.  Hannibal tells Jack about the neurologist and normal findings, and that he thinks Will is more or less “mentally ill.”  Hannibal goes on to explain the problem as Will having too many mirror neurons.  That’s a way of attempting to explain empathy in terms of neuroscience.  Mirror neurons are really only theoretical, though.  

Will returns to the crime scene in the middle of the night, armed with a flashlight.  He talks to himself, reminding himself of the date/time.  He sees someone under the bed, who hides when he looks closer.  Obviously he fears he’s hallucinating again.  This would be very different than all of his others, and thus unlikely.  As he looks below it, the bed flips over and a girl runs past him.  He grips at her arm, and the skin sloughs off in a sheet as she gets away.  Will blinks and finds himself in the woods.  More lost time.  He checks his watch and he seems to have lost almost three hours.  He speaks aloud about the time/date/location, and shouts to the girl that she’s alive.  He knows somehow that she doesn’t believe she’s alive.  It’s not clear how he knows this from the limited evidence available.  It’s a big leap of logic.  

Will returns to the crime scene, this time with Katz.  She questions why he called her.  They haven’t had a particularly close relationship, but they are honest with each other.  He admits that he isn’t sure the girl under the bed was real.  He says he figured out the skin has no direct circulation.  He doesn’t remember what happened to the skin.  His quick observations are that she had discolored eyes, jaundiced (yellowing of skin and eyes), malnourished, and appeared “deranged.”  I think we should count the number of synonyms used on this show for “crazy.”  Will intuits that she can’t see faces, and might not ever recognize she’s a killer.  This killer “can’t accept her reality.”  Again, this isn’t really established in the facts or the data.  At worst he’s projecting his own issues.  This is a superpower, though, so of course he’ll be right.  

Will joins Hannibal in his office, and draws another clock.  It’s the same pattern.  I consulted with a neurologist friend/colleague, who said this definitely evidences spatial neglect, but in such cases the perfect circle of the clock face would likely also be deformed.  The deficits seem a bit too focal, was his description.  Will talks about the killer as like “seeing a ghost.”  Hannibal affirms this is real.  Will tells him about losing time, again.  Hannibal offers to keep looking for answers.  Will questions if Hannibal would write a paper about him.  Hannibal states that if he did, he would anonymize it.  That isn’t a no.  Hannibal suggests the killer might have Cotard’s syndrome.  This syndrome involves someone believing their body is dead, or rotting.  It’s a delusional disorder, which is a kind of psychotic disorder.  Delusions are considered fixed false beliefs.  I’ve only seen a case once.  Hannibal talks about how inability to recognize faces is associated with Cotard’s.  That’s true.  It has some connection to Capgras, where people believe others are actually imposters (think of Invasion of the Body Snatchers).  Will hypothesizes that she reached out to someone she trusted, but felt betrayed.  Per Hannibal “She can’t trust anything… she once knew to be trustworthy.  Her mental illness won’t let her.”  He’s referencing Will as much as anyone else.  Sometimes I think this show is just the most twisted buddy cop show, ever.  

Will shivers in bed, asleep.  Outside, the girl watches his house.  She creeps to his window.

Jack and Will talk with the girl (Georgia)’s mother, after matching tissue samples.  Georgia apparently had a mental illness.  At nine she was threatening to kill her mother, and that she (Georgia) was already dead.  Apparently she had seizures, hallucination, psychotic depression.  Cotard’s, which is already uncommon, as a psychotic disorder usually doesn’t go with seizures.  She would be expected to have a medical cause of seizures, or even that he seizures might be causing some of her other symptoms.  Thus, it might be very treatable.  And none of this fits her skin issues.  So far.  Georgia’s mother said all the tests by the doctors were inconclusive.  “Mostly I learned… how little is actually known about mental illness.”  Yes and no.  I do like that by keeping it non-specific, they can make a commentary about the field as a whole. “It’s rarely about finding solutions.  It’s more about managing expectations.”  That’s true for some disorders.  And there’s a level of truth that many conditions should be expected to be chronic and lifelong.  But that’s true for most of medicine.  There’s very little that we “cure” aside from infections and cutting out certain diseased organs (which aren’t really cured either).  Everything else is managing chronic conditions with the limited tools we have, and getting things into “remission.”  At least that the way we describe them all now.  It prevents people from stopping meds because they feel better, thinking they’re cured and then getting worse again.  

Jack and Will talk alone.  Jack carries a lot of responsibility, starting with Miriam Lass, and now with Will.  They both know that the work is bad for Will, but neither actually wants him to quit.  Jack lets him know that he will be a foundation for him, to keep him stable.

Hannibal serves diner to Sutcliffe.  They discuss food, and Will.  Hannibal admires Will for having a pure imagination, pure empathy.  He still calls Will his friend, though, and that they will “put it out when it’s necessary.”  But he still has the intention of hiding it from him in the future.  Such a mixed message.  If this is how he treats friends, remember how he treats enemies.  We can assume Hannibal picked Sutcliffe because he knew he would go along with it.  

Will goes back into the scanner.  When he comes out, no one is there.  We wonder, is he dreaming?  He gets dressed and walks the hallway, seeing blood on a door handle.   He finds Sutcliffe, dead.  The team arrives and studies the room, finding the same tissue as on the other knife, from Georgia presumably.  The lack of blood on Will means he’s innocent.  Yet he feels guilty since there’s no other reason this happened.  We are not given a clear reason to suspect that Hannibal did this, since no motive was revealed.  Sutcliffe did furrow his brows a couple times, maybe indicating a little conflict over their conspiracy.  

Jack grills the subject.  Why him?  Maybe he thought Sutcliffe was Will, since unable to see faces.  Then why Will?  Maybe because he told her she was alive, and no one had said that in a while.  Worthy of murder?  

Will back in bed, sweating and shaking.  He hears the dogs growling.  He looks under his bed and sees Georgia under it.  Freaked out, he stills talks her down, letting her know she’s not alone.  She reaches out her hand, asking “am I alive?”

Georgia is put into the hospital, into hyperbaric oxygen.  Jack asks Hannibal if she’ll recover.  He gives the prognosis, which is fair.  Most of her problems are treatable.  Jack wonders how much she’ll remember.  Hannibal says “I hope not much.”

Flashback of Georgia walking in on Hannibal killing Sutcliffe.  He gives her the scissors.  She can’t recognize him.  We’re not really let in on the why he would kill Sutcliffe, but presume he was a little conflicted over continuing to withhold info from Will.  Or maybe it was just on a whim.  Or some unspoken old sleight.  Or maybe he was just tying up loose ends.  

It was also never explained why her skin would slough off that way, like a glove.  I’m not sure that’s explainable through dehydration alone.

I particularly love this episode (and a later one) for using Ellen Muth, particularly for this character.  On Dead Like Me she played Georgia Lass, a girl killed prematurely who was turned into a grim reaper.  Georgia on Hannibal is a brilliant callback to that, turning the fantasy into a Hannibal pathology.  I’m just waiting for Alana Bloom to start talking to inanimate objects.

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07
APR
2015

Digesting Hannibal – Season 1 (complete)

As a psychiatrist and a writer, I thought it might be fun to put together a commentary on this great show.  I know very little about their development process, including if they have any professional consultants.

So this blog series is for play.  Consider it a companion piece reflecting my professional thoughts with each of my professional hats (mostly my psychiatrist hat).  It’s intended to be read while watching the show.

It’s a dense show, so sometimes the analysis can be quite extensive.  Sometimes it’s just me waxing as well.

Warning: There will be spoilers, so it’s useful to watch while reading.  It’s available on amazon prime, iTunes.

And yes, it’s intended to be a gross title, fitting with some of the devices of the show.

 

SEASON ONE

Episode 1 – Apertif

Episode 2 – Amuse-Bouche

Episode 3 – Potage

Episode 4 – Ouef

 Episode 5 – Coquilles

Episode 6 – Entrée

 Episode 7 – Sorbet

Episode 8 – Fromage

Episode 9 – Trou Normand

 Episode 10 – Buffet Froid

Episode 11 – Rôti

Episode 12 – Relevés

 Episode 13 – Savoureux

07
APR
2015

Digesting Hannibal – Season 1, Ep8

Episode 8 – Fromage

The episode opens on Will fixing something at home, while hearing something like scream or whimper, faintly.  He runs outside trying to find it.

Elsewhere, Tobias teaches a boy to play Cello, who complains that the strings are tougher to play.  Tobias admits that these “authentic” strings aren’t always made from cat guts.  Well what else could they be made of?  That’s the opening question for the episode, and we can already know where this is going.  It’s revealed that Tobias appears to have taken human guts and carefully worked it until he can make strings for his instruments.

In the fields, Will walks with Alana, looking for the noise.  They expect it to be dead, whatever it was.  Will claims he asked her to help in case he does find it, and would require assistance to carry/restrain it.  There’s a playful banter her, and we’re now starting to feel the development of a Will-Alana-Hannibal triangle.  He asks if she thought it would be a date, and she denies this, since Will doesn’t seem like he dates.  Though she doesn’t, either.   She says she thinks too much to date.  They’re not finding any tracks, “except for the ones we made.”  I love how poetic the dialogue can be on this show.  

Hannibal meets with Franklin, who hints at still wanting to be friends, but instead looking at his own friends as he believes Hannibal might.  Hannibal plays along, as if he’s a psychoanalyst.  A psychoanalyst is a specific type of therapist, and usually involves training at a psychoanalytic institute after licensure and training as a psychiatrist or psychologist (or masters level therapist).  There’s a long twisted history around psychoanalysis which we won’t get into here.  This is the first time it seems they’ve used the term, though, on this show.  Franklin believes Tobias may be a psychopath, as he’ll say “crazy” things and then retract them with a “just kidding.”  Hannibal explains that psychopaths are not crazy, and are aware of what they do and the consequences of that.  Of course he’s talking about himself, but interestingly he’s implying “crazy” means not being aware of one’s actions or the consequences of them.  This is closer to the legal definition of insane.  But neither clinical psychiatry nor the legal system uses the term “crazy.”  

Franklin probes if Hannibal is bored with him.  Hannibal says he can’t analyze Tobias, but only Franklin’s perception of him.  Some therapists allow for a patient to talk about anything, others try to keep the focus on the person, to prevent avoidance.  Hannibal uses this as a lens to look at Franklin.  This is similar to a projective test, like a Rorschach.  However someone views something, if “free associating” about it, can reveal something about the person.  Hannibal coyly clarifies that Franklin isn’t a psychopath, but may be attracted to them.  Clear enough without directly admitting what he is.  

On the orchestra stage is a dead body, a trombone player but impaled with a cello through the throat.  Will and Jack examine, and Jack comments how the process seems easier for Will now.  Will denies it’s easier, but he’s able to shake it off a bit more.  Will metronomes it, experiencing the construction of the scene.  “I wanted to play him… to create a sound.”  Will imagines playing him, but is interrupted by Garrett Jacob Hobbs applauding in the audience.

Hannibal in Therapy with Du Maurier, complaining that he might be disempowering his patient because of his obsession.  This is half a step away from an indirect suggestion to her that he (Hannibal) worries his own obsession interferes.  One can view every line he says about his relationship with Franklin as an attempt to get Du Maurier to think about their relationship differently, to treat him (Hannibal) differently.  She notes that she tried to refer Hannibal to another psychiatrist, and he refused to go.  He claims he stayed out of wanting to protect and support her, “after what happened.”  This is implying that a psychopath can have a sense of loyalty to others.  This isn’t really known whether it’s true, though evolutionarily it should be.  She was attacked by a patient.  She clarifies the roles — “I’m your psychiatrist, you’re not mine.”

In the lab, the team reviews the body and how the killer altered the vocal cords to make them playable.  Will feels the precision means he’s done it before, and that this must be a skilled musician “trying a new instrument.”  That tracks with the evidence available.  

Will discusses the case with Hannibal.  Hannibal identifies that the killer was trying to make an authentic sound, based on the chemicals he used on the vocal cords.  Will feels he was playing for someone else, but usually doesn’t kill this way.  There’s really no way to know that, since there’s nothing to compare it to, no frame of reference such as another murder.  Will believes he wants to show someone how well he plays.  The best guess is that if this is Tobias, he would be serenading another psychopath.  Since Tobias has a fixation on Franklin, who better to serenade than the psychopath that Franklin is obsessed with?  This is all for Hannibal.  

Franklin back in therapy, talks about his suspicion that Tobias did the murder.  These therapy sessions have a much more psychoanalytic approach, using much more questions without hardly any content.  Franklin thinks he was told about Tobias’s fantasy of playing someone’s throat so that he would tell Hannibal.  Baiting him all the more.  

Hannibal sneaks into Tobias’s workshop.  He’s caught, but plays along.  They banter a little about catgut, and Hannibal talks literally (and metaphorically) about playing the Theremin (an electronic instrument that can play between normal notes).  Tobias counters that traditional instruments can do that as well.  Hannibal states with a double entendre “it seems we’re both comfortable playing between conventional notes.”  I know what you are.  But I’m not going to turn you in.  “My harpsichord is making an awful noise.”  A great scene for subtext. Unclear but he may be propositioning Tobias to help him kill Franklin.

Will works on a fishing fly.  He hears the animal noises again, this time through the walls.  The story jumps to Will having broken through the wall looking for it, and then having to discuss it with Alana.  So now we’re establishing that Will is having auditory hallucinations.  This is truly beginning to creep into psychotic symptoms, with now auditory intrusion rather than the visual hallucinations before, which we might have attributed just to a sleep disorder.  In short, Will is losing his grasp on reality and manifesting a real psychotic disorder.  This would likely not be “caused” by his work, though it’s so early that even the disorder itself and its cause is quite unclear.  

Alana has come by to visit, which Will questions in the middle of the night.  He kisses her.  She questions if it should move forward.  “I wouldn’t be good for you.”  And then they kiss again.  And she talks herself out of it.  This is a hint that Alana has her own complex issues, which we have not gotten a peak into, at all.  Hers appears to be more of a fear of intimacy, though we don’t know much more than that.

Hannibal and Tobias sit over dinner.  Hannibal questions about the killed musician.  Tobias welcomes the FBI trying to catch him, and that he’ll kill the agents, and then later Franklin, and then plans to “disappear.”  He also admits to wanting to kill Hannibal, but he stopped when he found out that Hannibal is a killer.  “I could use a friend.  Someone who can understand me.”  Hannibal declines, and tells him he has planned to kill him.  Clearly this ratchets up the tension in the scene as to who would act first.  It’s not clear that Hannibal would really do this, as he has always been so strategic.  Unless he’s looking for a challenge.

Will shows up unexpectedly, and Tobias quietly escapes.  Will discusses that he kissed Alana, and that they wouldn’t be good for each other, per her.  Hannibal agrees, stating that she will be obligated to observe him as a professional obligation. I wholly disagree. While it can be tough for some to put aside the clinical lens when with other people, most psychiatrists don’t want to be “on all the time.”  Those that choose to analyze everyone tend to have difficult relationships.  Will knows that she looked at him differently after seeing the hole in the wall, in that it was all a hallucination.  At this point will still has insight into his condition, and thus wouldn’t’s meet criteria for a psychotic disorder, probably.

Will identifies his own symptoms — sleepwalking, headaches, and now auditory hallucinations.  Every new onset psychotic disorder, especially with this cluster of symptoms and in someone his age, should have a full medical workup to make sure it doesn’t have a primary medical cause.   Hannibal tells Will that Franklin suspects Tobias.  Just indirect enough to be plausible.  Plus it is true, and hopefully uses the FBI to eliminate the risk to Hannibal.  

Hannibal sits with Du Maurier and discloses to her that may want a friendship with Will.  He views his relationship with Will to be like Du Maurier’s relationship with him (Hannibal).  This is very revealing.  The desire or want that Hannibal has, unrequited, is much more similar to Franklin.  Yet Hannibal wants to view himself as Will, the super-capable pupil underappreciated by the teacher/therapist.  He’s trying to communicate to her that he’s more capable than he gets credit for.

Tobias in his shop is approached by Will.  Apparently serial killers wear a lot of vests.  Tobias tries to play dumb.  Will reads him.  Will begins hearing things.  He really needs to get checked out.  He runs out, panicked, and takes a pill.  When he re-enters, the police officers are gone.  He cautiously searches the building, weapon drawn.  He finds all the gut in process of becoming strings.  Tobias tries to strangle Will, who gets a shot off next to his own ear, but shooting off Tobias’s ear.  Tobias runs off, while will takes a couple of shots.

Back in Hannibal’s office, Hannibal is “terminating” with Franklin.  This is the term for ending therapy.  Tobias enters, confessing that he killed two men.  Franklin tries to talk him into turning himself in.  Hannibal tries to leave.  Franklin keeps gabbing, and Hannibal snaps his neck (stealing the kill from Tobias).  Tobias pulls out razor wire.  They fight (great fight), and ultimately Hannibal kills him.

The team investigates afterward.  Jack is a bit skeptical.  Hannibal’s logic makes sense, though.  Hannibal is gracious to Will, and we feel their bond growing.

The episode closes with Hannibal in a therapy session, reflecting on his own experience, and attempting to use it to get Du Maurier to disclose things about herself.  It appears at moments like Hannibal is legitimately contemplating himself.  We’re also left with a hint that Hannibal may be responsible for her previously being attacked by a patient.  

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07
APR
2015

Digesting Hannibal – Season 1, Ep7

Episode 7 – Sorbet [the palate cleanser]

Will lectures his class on the Chesapeake Ripper.  The Ripper kills in groups of 3 at a time, every 18 months, and views his victims as pigs.  He claims the removal of organs and mutilation of the abdomen suggests someone with anatomical or surgical know-how.  Yes and no.  I’d say it would be more certain if the way organs were removed was important, or that the mutilation avoided any of the vital organs.  That would make the case more convincing that it’s a surgeon or a physician.  Will mentions that Lass’s severed arm was found, because he wanted it found, and that Ripper has been “consistently theatrical.”  Theatrical, perhaps.  Meticulous in presentation, almost artistic, I would also say.  Similar to Hannibal’s meal preparations.  

Hannibal is at the opera, savoring every sound.  He’s a hedonist, savoring all his senses.  Franklin watches him applaud.  After the show, Hannibal is critiqued by a woman for not cooking for her.  “It’s a whole performance.”  Indeed.  He states he will, when the inspiration comes.  “A feast must present itself.”  And now we’re leading into the twisted logic of Hannibal, that his victims are presenting themselves as the future main course in a dinner party.  And so it does.  Franklin interrupts and introduces his companion Tobias.  Hannibal is reticent to state their relationship, and Franklin proudly proclaims that he’s a patient.  This is actually proper etiquette.  Unless a psychiatrist has gotten permission beforehand to acknowledge a patient, they’re often removed.  Many people do not want it known that they are a patient or in treatment.  Franklin actually pursues it, and there’s an uneasiness in admitting the relationship, as if it’s a bit of a power play.  Tobias reveals that Franklin watched Hannibal more than the show.  So we have the seeds that Franklin could be a bit too much of a fan of his doctor.  Hannibal shakes hands with Tobias and smiles.  The next feast has presented itself.

Jack walks through the lab, hearing a phone ring in the morgue lockers.  Lass’s severed arm with the phone in hand.  A dream.  Jack answers a call, waking him from sleep.  Cut to Jack and Will driving to a crime scene.  Will accuses Jack of trying to get him overly invested in catching the Ripper.  Jack expects more bodies if this is the Ripper.  Will thinks the Ripper is just taunting Jack with Lass’s arm.  They speculate about the Ripper, how he might be killing, how he would reach out to Jack, and why he didn’t display Lass’s body.  Maybe he respected her.

They discuss the body as they examine the scene.  He was operated on, kidney removed and then sewn up.  He got to the bathtub and apparently tore open his own sutures.  The killer apparently was going for his heart too, but didn’t get it.  Will metronomes the experience, but sees the stag in the reenactment, strangely.  The victim woke up with his wound, freaked out, and attacked someone.  But the time the fight got to the tub, his heart has stopped.  The individual cut open the chest to try to massage his heart.  A little more direct than just CPR.  So Will concludes it wasn’t the Ripper.

Will argues with Zeller, who believes it’s the Ripper.  Jack presses Will on it.  Will thinks some trainee did this, in a botched organ harvesting surgery.  Jack asks Will of how he conceptualizes the Ripper.  Will describes someone who started out as a baby, but was never put on the machines to keep it alive.  The implication that through that neglect, part of it died.  But the baby survived to look normal, and no one knows what he is.  A chilling description of a psychopath.  Many (not all) psychopaths have histories of neglect or abuse (very different), sometimes head trauma, and they can stay under the radar.  They can be superficially charming and appear quite normal.  

And so Hannibal welcomes his patient Franklin.  They sit down for therapy.  Hannibal raises the issue of their “chance” encounter.  Franklin admits he went there with the hope of running into Hannibal.  Starting to creep towards stalking.  Franklin obviously wants a bigger relationship with Hannibal.  Frankyn attempts to show how well he knows Hannibal.  Hannibal explains the “ethical” rules about talking to a patient in public.  It’s not really an ethical issue, in terms of the normal bioethical principles, but a matter of confidentiality.  I suppose one could twist it into terms such as beneficence and non-malefiecence, but most psychiatrists just think about plain old rules like confidentiality first.  Franklin wants to know about Hannibal and his life, though asks indirectly — “I don’t know who you are outside this room.”  Hannibal maintains the therapeutic “frame.”  “I’m your psychiatrist.”  Franklin admits he wants Hannibal as his friend.  Hannibal coolly rejects this, attributing it to the nature of the relationship.  By knowing someone’s secrets, there’s a level of trust that can go with that.  And so some patients want more of a relationship.  “It makes me sad that I have to pay to see you.”  Franklin is pushing the therapy boundaries.  

Hannibal sighs.  He has to be firm.  “I’m a source of stability… I’m not your friend.”  Franklin tells a story of feeling sad that Michael Jackson is dead, and that if he had known him he could have helped save him from himself.  Indirectly Franklin is asking to not just be friends, but to reverse roles extremely.  He could then be the saviour, if given permission to have that level of closeness.  As viewers we might even feel a sense of suffocation from Franklin.  He pushes and he wants, and he doesn’t seem to listen to normal social cues to back off.  Even when it’s said directly to him, he doesn’t back off.  In some ways he’s communicating that he believes his gift of friendship is so important, that a person’s refusals are worthless.  Franklin admits he just wants to “touch greatness.”  Flattery.

Hannibal is greeted by Dr. Du Maurier.  They sit down for Hannibal’s therapy.  She begins by stating she’s going to be “perfectly honest,” because one of them needs to be.  Hannibal claims that he’s honest.  She states that  she has a conversation with a version of him, with the hope that other part gets what it needs.  This is fantastically written insightful dialogue.  In ego-state therapy, as well as some other models, it could be expected that there’s different versions of us.  Du Maurier though speaks about the level of meticulous construction and really how defended and locked away it is.  For a psychopath to seek therapy for anything other than to be told he’s right is already fascinating to me.  And so we must presume that Hannibal actually respects the process of therapy, enough to want to develop himself.  Or there’s an ulterior motive we have yet to discover.  She describes him having a well-tailored “person suit.”  She also reveals that he “ignored” her retirement.  She’s a little young to retire.  Many psychiatrists practice into their 70s or later, especially in private practice.  She mentions he must be lonely.  Hannibal claims he has friends, “and the opportunity for friends.”

He makes advances toward her, to be friends.  Obviously this parallels Franklin’s advances.  Of course this raises the artificial nature of the therapeutic relationship and therapeutic boundaries.  They exist for reason that make sense, but it’s not like 500 years ago anyone thought about such a thing.  They are a modern construct for a modern profession.  She rebuffs this, setting boundaries.  And yet she says at the end of the session she’ll pour him a glass of wine.  Um, no.  If you’re maintaining therapeutic boundaries, you usually don’t drink with your patient.  And you especially don’t pour it for them.  Not to say that therapy relationships always stay therapy relationships.  Anecdotally, many psychoanalysts, the most rigid of all therapists, ended up marrying their patients in the 60s and 70s.  Nowadays such a thing could cost someone their medical license, or even bring on criminal charges.  

Hannibal sees Will into his office, and Will knows he’s been drinking.  Hannibal just notes he has “an unconventional psychiatrist.”  We aren’t really shown yet why she’s unconventional, aside from that.  But my curiosity is piqued.  Hannibal asks straightaway if he’s Will’s psychiatrist, or if they’re just “having conversations.”  In prior episodes Hannibal has specifically stated they’re only having conversations.  In this episode he seems a bit more invested in making himself human, and so wanting a friend.  Hannibal goes on to pour them a bottle of wine, stating it’s “conventional” before seeing a patient.  Um, not so much.  This was the first lecture of the first week of med school — don’t drink and be around patients, even when only a student.  Hannibal has ulterior motives, though.  He’s hoping to develop the kind of relationship with Will that he wants to have with Du Maurier.  They discuss the new murder, and the Ripper.  Maybe it’s an organ harvester.  This would make sense for the killing of the episode.  Removing a kidney might not be expected to kill someone, so if death was not intended they might try to save them.  

Hannibal flashes back someone doing an insurance physical on him who was dismissive and rude.  Hannibal asks for his card.  In modern day, he pulls that card from a Rolodex, and a recipe from a recipe bin.  The implications are clear.  Eat the rude.   This medical examiner pulls to the side of the road, his gas tank leaking.  Hannibal pulls up behind him.

The story moves to the lab, discussing this new victim.  Missing a heart and kidney.  We see Hannibal prepping his meal.  Now, though, he has planted the idea of organ harvesters, which gives him cover for taking organs that are worth harvesting.  So now the team is trying to tell which killer is which, and if they’re impersonating the other.  Interesting twist, to throw Will off his trail and yet give him space to keep killing.  

Hannibal preps a meal with Alana.  They discuss food, her palate, and eventually how she doesn’t want to talk about Will.  We learn that Hannibal and Alana have a history, that maybe she trained under him, but don’t have a romantic relationship.  Yet.  She offers that she wants Will left alone, but Jack is grooming him to catch the Ripper.  Hannibal gulps while Alana isn’t looking.  Here we have the briefest insight that Hannibal probably fears Will.  Hannibal is very smart and has evaded everyone through his intellect.  Will’s instincts, though, may rival Hannibal’s intellect, at least enough to worry Hannibal.  

Another Jack dream of walking through the lab (a waking dream).  Only this time he finds Will sitting up on a slab, stitched up post autopsy, minus an arm.  This appears to show Jack’s fear of sending Will to his death the same way he did Lass, when he tasks him to catch the Ripper as he did her.  

A cooking montage.  Hannibal pulls recipe cards, and business cards of the next victim to supply the organs for that recipe.  We go on to see the organs in the meal prep, indicating he’s killing again and again.  The team tries to make sense of it, and even jokes that he might be “making sausage.”  Will believes there’s still two killers, just not sure of much else.

Another session with Franklin.  “I discovered that we are cheese folk.”  Franklin is again attempting to make the session about Hannibal, rather than about Franklin, and thus change the nature of their relationship.  Franklin even taps Hannibal on the leg, clearly making him uncomfortable.  This violates Hannibal’s meticulous boundaries, which we all know aren’t really that meticulous.  Franklin comments that Tobias doesn’t eat dairy.  Hannibal questions the nature of their relationship, including that Franklin is Tobias’s best friend, but not vice versa.  Franklin can only admit he doesn’t like the dull ache of loneliness, and reaches out to Hannibal that he understands that feeling.  We don’t really know he does.  His person suit might.  Maybe.  And then Hannibal’s next appointment doesn’t show, which is Will.  That might actually bring out that ache, if anything can.  

Will is lost in a daydream, sitting with Abigail Hobbs, as her father.  Hannibal wakes him from his dream.  What’s clear here, though, is that this is occurring with his eyes open, which is distinctly different than nightmares or even common hypnopompic/gogic hallucinations.  This is suggesting that something else is going on with him, possibly organic.  Will’s unique psychology, though, puts an organic (physical) cause only on a long list of possibilities.  

Hannibal wakes him, and they review the photos.  Will knows the mutilation is a “public shaming,” to disgrace them.  Ever so slightly we see Hannibal’s surprise that Will knows this.  In the process he learns that Lass’s arm was very effective at humiliating Jack.  Stiffly, it almost seems like Hannibal is satisfied with that.  

Katz found a lead — an ambulance that drove away from an emergency, which would be a good place for a surgery.  They bring this to Will and Hannibal.  The group heads to the ambulance company, narrowing the suspect to Devon Silvestri, and find the ambulance is gone.  Katz learns about a tracker on it.

A tactical team moves on the ambulance, to find Silvestri in the middle of a surgery.  If he removes his hand, the person will die.  Jack calls in Hannibal to help.  Hannibal holds the bleeder.

As Hannibal finishes the prep of his feast, he discusses his transition from surgeon to psychiatrist with Will.  He claims it was because of not being able to save someone, and that it felt like killing him.  “Now I save minds instead of bodies.”  I heard from a colleague that a mentor of theirs switched from surgery to psychiatry, because surgery “wasn’t invasive enough.”  

The ep ends on serving the feast.

—–

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07
APR
2015

Digesting Hannibal – Season 1, Ep6

Episode 6 – Entrée

The episode opens with Dr. Abel Gideon (Eddie Izzard), on the floor of a maximum security ward.  The guards stand outside his cell, warning him to comply, or they will be forced to “restrain him.”  The imagery is a clear reference to the cells of Silence of the Lambs.  He’s clearly dangerous, and the fear is that he’s playing possum.  They check his pulse and call for a gurney.  The tension increases, now that he’s out of his cell.  Who is this guy?  Is he playing possum?   A nurse, now alone, puts him on a monitor.  She turns away for a moment, and he’s standing in front of her.  Especially impressive since we can see he’s handcuffed to the bed.  

Jack and Will approach the hospital.  Will articulates the fear that he belongs in a place like this, a forensic psychiatric hospital.  Usually forensic hospitals are for those considered to have a mental illness and a criminal history.  Psychopathy (being a psychopath or a sociopath) isn’t necessarily considered a mental illness on its own (though some believe it should be).  There are gray areas such as if someone has been deemed NGRI (not guilty by reason of insanity), and placed in a forensic hospital for “treatment.”  Being insane in the legal sense doesn’t specify a particular mental illness, and there are plenty of cases where it’s not entirely clear there’s any mental illness aside from psychopathy, yet the court rules what it rules.  Another gray area is if someone gets placed for “evaluation,” such as if a judge finds someone not competent to stand trial.  They might be placed in a hospital for treatment to “restore competency.”  I am not a forensic psychiatrist, but I try to keep up on the field.  

Jack and Will meet with Dr. Chilton, the head of the hospital.  He notes that Gideon was on good behavior for two years, so security was downgraded.  Jack wants Will to see the crime scene.  Chilton offers a creepy curiosity at Will’s process, stating that psychiatric circles have been discussing him.  They really nailed making Chilton a creeper, in how he treats everyone like a lab rat to be dissected.  Even when sitting in front of them.  In that way Chilton has his own level of psychopathy, without an apparent conscience and enjoying psychologically dissecting other people.  He is just not as calculated as Hannibal.  Chilton has done an assessment of Will.  Psychiatrists usually don’t do such formulations or at least don’t talk openly about them, because of the Goldwater rule.  And yet Chilton wants to analyze Will further.  He pushes harder.  This plays right into Will’s fear that he belongs there.    Chilton leads them to the cells, describing the mutilation as consistent with the Chesapeake ripper, but Jack counters that the ripper is still out there.  This will be important later, obviously.  Gideon picked his handcuffs, we learn, and yet didn’t escape the facility.  We see the body of the nurse, skewered with many tools, eyes removed.  Chilton tells them they’ve failed to capture the ripper. “Because I already had him.” This really shows Chilton’s narcissism.  Not only does he want to prove the FBI wrong and him right, but it’s all about him.  “I had him.”  Not we.  It’s all about him.  This is his playground, and he’s the master.

We follow Will reimagining Gideon’s experience, including the spike in heart rate prior to killing.  Interestingly, psychopaths have been found to have a deceleration in their heart rate prior to violence, namely predatory violence.  This may even be a biological characteristic of them, and lends to the hypothesis that psychopaths are “intraspecies predators.”  We watch a pretty gruesome stalking and murder.  It takes a toll on Will.  Exposition — The Chesapeake Ripper last killed two years ago, and that was when Gideon was admitted.  Correlation, not causation.  

Moving to a flashback, we find Jack interviewing a young FBI agent Miriam Lass.  She’s wanted to work with the BAU since a trainee.  They discuss the Ripper and her formulation that he will have no conscience, but not have the legal/criminal history on his record.  She’s a prototype for Clarice Starling, just as Gideon is a prototype for Lecter in Silence of the Lambs.  There is not clear reason to think he’d be careful to not have a criminal history, aside from his meticulousness at each crime scene so as to not get caught.  Jack lists her credentials (for us), and wants her assigned to the case.  We return to present day, with Jack remembering.

Chilton talks with Will and Alana Bloom about Gideon.  “Sometimes I feel like his secretary rather than his keeper.”  Another reveal that Chilton views others like objects, to be kept.  They discuss Gideon’s fans, and how he impulsively killed his wife, unlike the Ripper who was careful and meticulous.  Alana had interviewed him when he was first institutionalized.  Chilton comments that her notes were “more or less helpful,” as he interviewed Gideon on his own.  Chilton as a true narcissist, sees himself superior to others, even his own colleagues.  At best others can be helpful to his work, but never the reverse.  He would presumably have difficulty seeing any fault in anything he does, even though it immediately turns off Alana and Will.  He has no insight.  

Alana heads in to meet him.  She stands with a slight smirk on her face.  Curious.  He remembers her, because she was “sublime.”  A little flirty.  She sits down to talk with him, and he inquires as to the purpose — he admits to the murder, so what’s the point?  On a sidenote, I love love love Eddie Izzard (in general, but also in this show).  The scene cuts between Will and Alana doing interviews, presumably asking the same questions.  Gideon states he doesn’t like the name Chesapeake Ripper.  This isn’t to say he did or didn’t do the crimes.  Subtext.  Gideon pushes them to do something other than “inventorying” his personality with the “psychopathy checklist.”  This is presumably referring to the PCL-R (by Hare), which has had some controversy.  Gideon and Alana trade witty barbs about assessing him.  He’s had the MMPI (a standardized psychological instrument).  She taunts that he’d prefer the Rorschach.  The inkblot test is a projective test, which allows for more free association about the meaning of the shapes.  He counters talking about a pressure cuff around his testicles.  This alludes to an actual procedure performed on sex offenders call penile plethysmography, AKA phallometry.  This measure any changes in blood flow to the penis, and can monitor even low level stimulation.  One might even wonder if Chilton did such tests on him.  I wouldn’t put it past him.  

Will questions the purpose of killing the nurse.  Gideon claims the killing was itself the purpose.  Will points out he mutilated the body after she was dead, whereas the Ripper did it while alive.  Some displacement in the language reveals that maybe Gideon isn’t trying to convince anyone he’s the Ripper, but Chilton is.  Presumably for his own fame and ego boost, rather than the truthfulness of it.  They may also just be referring to Lounds.  Both profit from the discovery.

The story moves to Hannibal leaving his office at the end of the day, finding Jack waiting for him.  Jack wants  Hannibal to tell him what’s happening with Bella, since she isn’t telling Jack anything himself.  Hannibal plays the confidentiality card.  Jack counters with Will, where confidentiality doesn’t seem to apply.  Hannibal doesn’t consider Will a patient.  “We have conversation.”  Kinda bullshit.  Hannibal treats Will like a patient in everything but name, yet not making him officially a patient allows him to pretend to be Will’s “friend.”  Even if he isn’t fully aware he’s doing it himself.  Jack is distressed about her dying and her distance, and is reaching out to Hannibal for help.  Jack admits he’s dreading the loss of Bella, and the loss of Agent Lass (in flashback).

In flashback, she’s examining a body with Jack and finds that the Ripper removed the liver and thymus but left the heart.  I can’t see clearly, but it looks like he did not take the thymus, actually.  The more important hint is that these are organs we eat (thymus — shortbread).  Lass guesses that Jack believes the Ripper is a medical doctor.  Jack pushes her to state her rationale.  She notes psychopaths are attracted to surgery (true), but that’s the extent of the rationale she offers.  Easy additional reasoning might be the meticulousness with which organs are removed, or the process by which they’re removed shows awareness of the anatomy so as not to damage them.  Stuff like that.

In the forensics lab, the team reviews the body and the MO of the Ripper.  No clear consistency in victims, but the nurse has same wounds as the last victim they found of the Ripper.  Jack interjects that they never found the Ripper’s last victim.  Miriam Lass.  Will “sees” the Ripper but doesn’t “feel” the Ripper, calling it plagiarism (copycat).  A beautiful line of dialogue, psychologically.  Will is guided by instinct, by his gut, by what he feels.  His metronome imaginations are not just visual, they’re experienced viscerally, intuitively.  And this doesn’t fit.  Will thinks the Ripper won’t let an imposter get away with it.

Jack’s in bed, alone.  He gets a call from Miriam, who says she doesn’t know where she is, and can’t see anything.  “I was so wrong.”  She pleads, then hangs up.  The story jumps to the BAU team, where Katz can’t find any trace of the phone call in any phone company database.  Some doubt him.  Jack believes it was a recording that the Ripper made, which proves the Ripper isn’t Gideon.  Will questions if Lass might be alive, and Jack adamantly believes she’s dead and this is just a comment by the Ripper about the plagiarism.  Interesting that it’s Jack that now makes the point about the Ripper trying to comment about the plagiarism.  It’s portrayed in a way that’s supposed to show his guilt about Lass.  Dr. Zeller continues to push the case that he might have been asleep, but Jack maintains he knows when he’s awake.  A clear lead-in to Will’s sleep/wake issues, and possible hypnogogic/hypnopompic hallucinations.  

Will sits at his desk, probably drifting off.  The stag walks in.  Will can’t believe his eyes, as if he’s fully awake.  Instead of Hannibal arriving, though, it’s Alana and Jack.  They want to provoke the Ripper into showing himself.  Will thinks it might provoke the Ripper to kill again.  Jack wants to be on the offense, by using Freddie Lounds.

Jack, Will, and Alana sit down with Freddie.  Will opts to not shake hands.  They point out her credentials, but that she’s a tabloid journalist.  This plays a little to her ego.  As if saying “you could be so good, but you do this crap, so let me help you be more reputable.”  He offers to help her confirm an unconfirmed story that Gideon is the Ripper.  This factoid was dropped very quickly, early in the episode.  She wants it, an exclusive with Gideon.  They use the opportunity to insult her and her work, since they have on the hook.  The show clearly plays with themes of predators, in their various forms.  Freddie Lounds is predatory, and they’re counting on that.  They go on point out the rationale that Gideon is a psychopath (as a surgeon), as might be others in the room.  “Here we are, a bunch of psychopaths helping each other out.” Hardly.  To call anyone opportunistic a psychopath is to not really understand the nature of it.  Of course there are questions of ethics for Lounds, but she doesn’t have the stomach for violence.  Probably.  

She meets Gideon, and writes an article supporting her previous hypothesis.  The story moves to Hannibal reading her story.  And he’s not so happy with it.  The implications have always been there, that he’s the Ripper.  What has never quite been fleshed out (pun intended) is the WHY he kills.  As a psychopath, is it the rush of killing?  The ego?  The food?  This episode adds a new side to Hannibal, that he takes pride in his work as a killer, which we’ve never seen.  The closest we’ve glimpsed is perhaps some satisfaction in his layered manipulation of others.  Not quite the same.  

Jack grills Gideon.  Gideon maintains he’s the Ripper.  Jack casts doubts — no trophies with the nurse or his family.  Gideon gets to the core, though, by using Miriam’s name.  Jack digs deeper, wondering if this is all true, why open up now?  Gideon says that at this point he has nothing to lose, while qualifying his answers.  “I didn’t mean to kill her.  Don’t be mad at me.”  Not a particularly convincing rationale.  And it appears like he’s playing the one-down position a little bit, which encourages the other person to be in the one-up position, and thus the other person not try so hard to dominate.  It’s playful, though.  Jack gets a call from home, presumably Bella, but hears instead a nearly identical recording from Lass as his last phone call.

Jack and the team pick apart Jack’s bedroom for evidence.  They find Lass’s fingerprint on the phone, and likely her hair on their bed.  Will hypothesizes that this is an attempt to poke at Jack’s guilt over her death.  Yet we’re left wondering could she be alive?  

In flashback, Jack scolds Lass for her proposal to examine medical records of each of the deceased.  He indirectly tells her to do it off the books, and that it’s easier for her to do it as a trainee than him as a “guru.”  So she does.

Alana chats with Gideon, hypothesizing that he might have been manipulated by someone.  The supposition is it was Chilton.  Or Lounds.  Gideon sidesteps but doesn’t say no.

Alana, Hannibal, and Chilton sit down for dinner.  Chilton remarks how “rare it is” to have a true sociopath in captivity.  As if Gideon is in a zoo, there for study.  Furthermore it’s probably quite common.  The penal system probably has a great number of sociopaths locked up.  Not all, but a far jump from “rare.”  They sit down to their entree of tongue (from a lamb), and Hannibal jokes about Chilton giving him ideas of cutting out his tongue for a future meal.  “It’s nice to have an old friend for dinner.”  Wonderful callbacks to the movie Silence of the Lambs.  Even the tongue itself is from a “chatty lamb.”  It’s silent, now.  

As the dinner continues, they question Chilton as to whether he might have planted the ideas in Gideon’s head that he was the Ripper.  Chilton denies that he would have done anything deliberately, and Alana maintains it was at most unintentional.  Chilton responds that “psychic driving is unethical.”  Here we have an apparent jump.  Psychic driving is a form of basically brainwashing through repeated messages on a taped loop, thousands and thousands of times.  That’s a clear deliberate procedure.  They aren’t proposing that.  So his denying that he did it is either a misunderstanding of what psychic driving is, or an unconscious conveyance of what he did do.  The conversation seems to use an inappropriate definition, that of suggestion and manipulation covertly.  That happens every day in advertising.  Psychic driving, however, is considered a form of medical torture.  

Hannibal defends psychic driving as defendable sometimes, such as reminding someone if they’ve repressed a memory.  This is actually a big big BIG no-no.  Coaxing or encouraging memories that might have been repressed can very easily leading to suggesting and creating false memories that were never there, which was what was believed to have caused so many false memory syndromes in the 1980s, such as the surge of people with “repressed” [false] memories of being in satanic cults as children.  It was an epidemic all believed to be false, through the unintentional misuse of hypnosis.  Memory is very malleable.  It does NOT make sense, though, for a sociopath to repress memories of being a killer.  It just doesn’t.  

Hannibal goes to the kitchen with Chilton to prepare dessert.  He openly tells Chilton that he would have himself tried psychic driving on Gideon.  He’s trying to make it acceptable for Chilton to open up about what he did, obviously.  

Jack gets one more call from Miriam, which they trace to a cell phone in an observatory.  It’s held in a severed arm.  We presume it’s Lass’s arm.

Jack joins Hannibal for a drink in front of the fire, attempting to dissect out the Ripper’s motive for trying to make him think Lass was alive.  He was given hope.  Hannibal asks about Lass, and we flashback to Hannibal being interviewed by Lass.  She asks about a former patient, “when you were a practicing physician.”  He responds that he “hasn’t practiced medicine in some time.”  A sore point for psychiatrists here about this inaccuracy, since it’s so common and disregards the foundation of how psychiatrists become psychiatrists.  Psychiatry is technically a branch of medicine, and psychiatrists are physicians first.  We go to medical school and then specialize in psychiatry.  So this is all inaccurate.  What she really means is when he was practicing a surgeon.  Hannibal trained in surgery before he trained in psychiatry.  

Lass asks about a patient he saw as a surgical resident.  He doesn’t recall, but states he kept journals at the time.  As he goes to find them, she notices sketches on his desk, including of a body skewered like the last victim.  He comes up behind her silently and chokes her out.  Quite a different fate than Clarice.  

—–

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07
APR
2015

Digesting Hannibal – Season 1, Ep5

Episode 5 – Coquilles

We open with Will walking barefoot down a two-lane highway, in only his underwear.  The stag walks behind him.  He’s sleepwalking.  A police car pulls up to him and the two officers question him.  He doesn’t know where he is, and still isn’t sure he’s really awake.  This tells us Will questions his own reality.  This doesn’t quite reach the point of Zhuangzi, but there’s clearly a similarity.  

Will visits Hannibal in his home, early the next morning.  Hannibal remarks that sleepwalking is less common in adults than children.  True.  Will wonders if it could be a seizure.  Hannibal suspects it’s PTSD, from the work they do.  He blames Jack, and that Jack “manipulated” Will into going back into the field.  Perhaps, though this is more likely Hannibal using “splitting,” by creating an alliance with Will while simultaneously creating a divide between Will and Jack.  If so, we would expect Hannibal to later do the same with Jack, badmouthing Will behind his back.  Hannibal hypothesizes that the intensity of the experiences have just overwhelmed Will’s defenses, leading to a “loss of control.”  He also says that sleepwalking is associated with difficulty handling aggression.  This was a finding when testing sleepwalkers using the MMPI (Minnesota Multiphasic Personality Inventory), and found an association with outwardly directed behavior patterns, suggestive of problems with aggression.  Hannibal continues to blame Jack as pushing Will too far, which presents Hannibal as Will’s ally, the only one who cares about his wellbeing.

Outside a motel, we meet a man scooping ice, trying to hide fear as he watches a couple walk by.  To him, this couple seems to be on fire.  He’s upset but not alarmed.  As if he’s seen this before.  Cut to Title Sequence.

We return to motel, with authorities investigating.  Jack presents the info they have — nondescript name, paid cash, no cameras.  Jack warns Will to prepare himself.  Will brushes it off.  Jack reiterates it to him.  This is not in line with Hannibal’s characterizations of Jack.  Jack seems to care about Will.  And the case.  

The couple previously on fire have been cut up and posed as praying angels.  The forensics team discusses similarities to other rituals, such as the vikings.  Will intuits that the killer did this to “transform them.”  As usual, we aren’t let in on the evidence he’s using to deduce that.  Katz notes that the killer slept there, leaving hairs and sweat.  She also finds vomit, and Jack deduces that he couldn’t stomach what he did.  Will believes the killer felt he was “elevating” his victims.  Will lays down on the bed to do his metronome regression.  He imagines that this killing is a way of helping the victims, and that it gives the killer a sense of peace.

Meanwhile, Hannibal brings out a carefully prepared dinner to Jack and his wife.  She declines the foie gras due to the cruelty to animals.  Hannibal relates that he uses an ethical butcher.  “No need for unnecessary suffering… Human emotion is a gift from our animal ancestors… Cruelty is a gift humanity has given itself.”  There isn’t quite a value judgment in that statement, but it implies that being cruel is something uniquely human.  As a psychopath this must help him to feel elevated from others, by the ability to cause suffering when he chooses.  Hannibal pours wine, and detects Bella’s perfume.  She notes his keen sense of smell.  Hannibal tells a story of being to smell that a teacher of his had cancer.  This may actually be legit.  http://www.nytimes.com/2013/11/24/magazine/what-does-cancer-smell-like.html  It is also a hint for the episode.  

The team performs autopsies.  They discuss whether the killer might be christian/religious.  They learn that the woman lived while she was cut up, and that the killer used vecuronium to paralyze her.  “They weren’t praying to him.  They were praying for him.”  Based on the drugs they found in the vomit (chemotherapy, steroids, and an antiepileptic [keppra]), the team deduces he has a brain tumor.  Will takes another leap that he is afraid of dying in his sleep.  This seems less substantiated.  Their guess about the medical condition at least makes sense.  As does the vomiting — brain tumors can cause nausea and vomiting from pressing on the vomition center of the brain, in the medulla.  “He’s making angels to watch over him.”  Now unless he has a particular religious preoccupation or a staunch belief system, few would attribute their problems to the devil, and even fewer could justify killing to create angels to protect themselves, unless perhaps they had a hallucination or delusion that pushes such a belief.  That a normal person could become both hyperreligious and kill to create angels to protect from dying would be a particularly bizarre delusional system.  

Bella goes to visit Hannibal for a session.  Typically this would not be done, especially by someone as psychodynamically oriented as Hannibal.  It would be considered a conflict of interest, and that Hannibal would have trouble being “neutral.”  Bella implies she’s having an affair, and doesn’t want to tell Jack.  Not clear why she would go to Hannibal for advice on this.  She questions whether there’s a conflict of interest, and Hannibal minimizes it as only “unorthodox.”  Unclear who requested the meeting.  She resents Jack and his work responsibilities.

Hannibal meets with Will, and relates that there’s no single center of the brain that’s religious.  Indeed.  Thus the unlikelihood that this symptomatology could come from only a single tumor.  “How do you profile someone who has an anomaly in their head changing the way they think?”  This is foreshadowing of what is to come for Will.  Hannibal believes it’s more likely due to a sense of mortality rather than hyperreligiosity.  Will believes the killer feels abandoned.  Hannibal attempts to direct this at Will, asking if he himself ever feels abandoned.  This could be a valid line of questioning.  Since we never see the evidence by which Will is making his deductions and leaps in logic, it’s quite possible for him to be projecting his own issues into the case.  By imagining himself in the shoes of a killer, he would likely bring in the issues that he himself suppresses or struggles with.  Hannibal continues to push that Jack has abandoned Will.  Will picks up on this — “Are you trying to alienate me from Jack Crawford?”  I’m surprised it took him this long to notice.  Hannibal evades, claiming he’s trying to help the profiling of the killer.

Jack tries to have a conversation with Bella, in bed.  She doesn’t want to talk.  He offers support, she declines and mainly wants to be left alone.  “I won’t insult you by asking if there’s someone else.”  A test.  He’s asking.  She evades and they pretend that everything will be fine without ever talking about it.

In Cleveland we see the killer in an alley, watching a security guard appear to be on fire.  We cut to after, when with Will seeing that same guard now posed as an angel and hung from a scaffolding.  They find human testicles, and deduce that the killer castrated himself.  They take this further to infer that the killer is now turning himself into an angel.  Which in my opinion doesn’t track with his supposed fear of death and need for protection, nor the ignoring of the religious consequences of murder.  If it was explained that his hallucination led to a belief that he’s killing demons, that might track.  But we aren’t shown that only some people are on fire.  Nor that he believes he’s saving souls.  So the logic jumps don’t make sense to me in their profile.  But they’ll get to that.  The writer is purposely withholding some information.  Will takes this further that he’s now accepting his impending death, or “bargaining.”  Not really clear to me how castrating himself becomes a bargain.  Jack asks for more, and Will pushes back, telling Jack to basically do his own profile if he doesn’t like Will’s.  Hannibal’s divisiveness is taking hold.  

Katz challenges Will on his backtalk to Jack.  Will admits he was out of line.  They find out that the dead couple were serial killers, and that the security guard was actually a felon.  He’s making demons into angels.  A twist on Frailty, a fantastic little movie with Bill Paxton.  Will states that the killer doesn’t need to know that his victims are demons, he just has to believe it.  That still leaves a hole in how he deduces who are demons.  Because somehow he knows.

Bella meets with Hannibal again, and she brings him up to speed on Jack’s suspicions.  Hannibal interprets that she feels more betrayed by Jack than her own body.  Bella reveals she has cancer, not that she’s having an affair.  And even moreso, it’s terminal.  Hannibal identifies that she holds Jack responsible somehow.  He also points out she’s withdrawing from Jack.

Elsewhere, Will has trouble sleeping in the middle of the night.  He blinks and finds himself on the roof of his house.  It’s morning.  Sleepwalking again.

Will tries to process this with Hannibal.  Hannibal goes back to the case, about how the “Angel Maker” chooses his victims.  Will sees a statue of a stag.  A hint as to who the stag symbolizes in Will’s mind.  Will carries the influence and manipulation of Hannibal with him all the time, even in his dreams.   Hannibal believes Will is similar to the killer, in that they both want peace.  Hannibal smells Will.  We now wonder what he smells on Will, namely his illness (to be revealed as season continues).  Hannibal asks about the headaches.  Hannibal clearly can tell that he’s sick.

The team identifies the killer, Elliot Budish.  Jack and Will interview the wife, who talks about how he withdrew, paralleling how Bella has been withdrawing from Jack.  They learn that Budish wasn’t religious, did have anger problems but not a history of violence, and had a near death experience when young, when he survived a fire as a child, and was told he must have had a guardian angel.

They go to the farm where this happened to investigate.  They find Budish hung up in the barn like an angel, just as he’d done to others.  I would presume he had an accomplice, since such a feat is difficult to do on one’s own.  It would be like nailing yourself to the cross (as poet Alan Dugan portrayed in his Pulitzer poetry).  Will remarks that he might not be useful much longer.   They argue, with Will conveying that it’s all taking a toll on him.  Jack rebuffs the role as his father, to tell him what to do.  Will still thinks he’s doing it.  Jack tells him that he won’t be able to stay away, when he knows he could prevent the next murder.  Jack tells him to go ahead and quit.

As Jack leaves, Budish stumbles up to him.  He says he can see who Will is on the inside (on fire).  But strangely this is all in Will’s imagination, as Budish is still strung up, dead.  Will is hallucinating while still awake.

Jack confronts Bella.  She admits she’s known for 3 months.  Lung cancer.  Stage four.  She doesn’t want chemotherapy.  Stage four means it has metastasized to a distant part of the body or the other lobe of the lung.  She still feels distant, and can’t let herself be comforted.

We end on Will offering Jack support.  In that way Bella served to keep Jack and Will together, despite Hannibal’s efforts. 

—–

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