So… what’s Jean diagnosis???
At the end of the game Jean mentions having clinical depression. In addition, the Disco Elysium team has spoken on several occasions about his mental health.
I would like to discuss one by one the possible diagnoses and their implications.
Starting: He definitely has a depressive disorder, but within this category there are several.
Depressive disorders: which one applies to Jean?
The common feature of all depressive disorders according to the DSM5 is the presence of a sad, empty or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s functional capacity. What differentiates them is the duration, the temporal presentation or the supposed etiology.
Among these disorders we find the following:
• Disruptive mood dysregulation disorder: Only occurs in children under 12 years old with outbursts and chronic irritability.
• Major depressive disorder: episodes of at least 2 weeks, with intense sadness, problems sleeping, thinking or feeling pleasure. It can be a single episode, but it usually recurs.
• Persistent depressive disorder (dysthymia): what is commonly called “chronic depression,” with milder but longer-lasting symptoms (minimum 2 years).
• Premenstrual dysphoric disorder: occurs in relation to the menstrual cycle, with strong emotional and physical impact.
• Substance/medication-induced depressive disorder or depressive disorder due to another medical condition: caused by medications, drugs or illnesses like hypothyroidism.
Now what we know about Jean: He was diagnosed at 27 years old with depression and currently at 34 he maintains depressive symptomatology. I dare to say he probably has Dysthymia. With this I’m not insinuating that Jean hasn’t had major depressive episodes—of course not—these depressive episodes are totally compatible with the diagnosis of Dysthymia.
Dysthymia is chronic depression, often described as functional depression which is longer (minimum 2 years), of lower intensity and “well-being” moments don’t last more than 2 months. The diagnostic criteria for dysthymia are the following:
Summarizing, dysthymia is characterized by a depressed mood most of the day, present more days than not for at least two years in adults or one year in children and adolescents (in the latter, it may manifest as irritability).
During this period, at least two of the following symptoms must be present:
Appetite changes (decrease or increase).
Insomnia or hypersomnia.
Fatigue or low energy.
Low self-esteem.
Difficulty concentrating or making decisions.
Feelings of hopelessness.
Also:
• Symptoms should not disappear for more than two consecutive months.
• It may coexist with criteria for major depression during the two years.
• There must not have been manic, hypomanic or cyclothymic episodes.
• It is not better explained by psychotic disorders such as schizophrenia or schizoaffective disorder.
• It is not caused by substances or medical conditions.
• It causes clinically significant distress or functional impairment.
Which criteria does Jean meet?
From what we know or can infer: Low self-esteem, insomnia, feelings of hopelessness, fatigue (this would explain his use of speed), for 7 years he has maintained a depressed mood.
He very likely has suicidal ideation; thanks to statements by Argo Tuulik we know the only reason he hasn’t killed himself is because of his job, which he feels is the only good thing he does.
Something I’d like to highlight is that in the diagnostic criteria, criterion F states: The alteration is not better explained by persistent schizoaffective disorder, schizophrenia, delusional disorder, or another specified or unspecified disorder of the schizophrenia spectrum and other psychotic disorder.
This leads us to the statements of Martin Luiga
He mentions that Jean is “likely Schizoid” and has a codependent personality.
If Jean is schizoid, we couldn’t diagnose dysthymia so we’re forced to ask ourselves:
Does Jean really fit the schizoid diagnosis?
Schizoid personality disorder is a pattern of detachment from social relationships and a restricted range of emotional expression. This disorder belongs to Cluster A of personality disorders which describe “weird and eccentric people.” According to the DSM5 these are the diagnostic criteria for Schizoid disorder:
To be diagnosed, at least four of the following criteria must be met:
Does not desire or enjoy close relationships, including being part of a family.
Almost always chooses solitary activities.
Shows little or no interest in having sexual experiences with another person.
Takes pleasure in few, if any, activities.
Lacks close friends or confidants other than first-degree relatives.
Appears indifferent to the praise or criticism of others.
Shows emotional coldness, detachment, or flattened affectivity.
Additionally, these symptoms must not be better explained by schizophrenia, mood disorders with psychotic features, other psychotic disorders, autism spectrum disorder, or a medical condition.
Which ones does Jean present?
• Point 4 and 7: he shows flat affect and little enjoyment, but this can be better explained by depression and the fact that he’s really pissed off at Harry.
• Point 5: we rule it out, since Jean does have a very close friendship with Harry.
• Point 6: indifference to praise or criticism. This doesn’t apply to Jean. If we notice, something he really reproaches Harry for is that he told him he “ruined his style” and told him to fuck off. Jean is very affected by what people think of him and his work (his only good quality in his own eyes).
• Points 1, 2 and 3: we don’t have enough information, but even if he met them, they’re better explained by his depressive state.
Jean is not schizoid, he’s just very depressed and without enough support system or resources to build a healthier life.
And the codependent personality?
Now we move on to the other possible diagnosis: codependent personality.
The correct term would be dependent personality disorder, which is a pattern of submissive and clingy behavior related to an excessive need to be taken care of. It belongs to Cluster C, where the predominant symptoms are anxiety and the need to avoid catastrophes. These are the diagnostic criteria according to the DSM5:
To be diagnosed, at least five of the following criteria must be met:
Difficulty making everyday decisions without advice or reassurance from others.
Needs others to assume responsibilities in most major areas of their life.
Difficulty expressing disagreement due to fear of losing support.
Difficulty initiating projects or doing things on their own (due to lack of confidence, not motivation).
Goes to excessive lengths to obtain support or acceptance, even doing unpleasant things.
Feels uncomfortable or helpless when alone, due to exaggerated fears of being unable to care for themselves.
Urgently seeks another relationship when one ends, to get care and support.
Unrealistic preoccupation with fears of being abandoned and having to take care of themselves.
Which ones does Jean meet?
None!
Jean doesn’t hesitate when firing Harry in the bad ending. He doesn’t pass on his responsibilities to anyone else. He isn’t afraid to say what he thinks.
If he met the criteria, he wouldn’t be so aggressive with Harry, he wouldn’t have fired him in the bad ending, he couldn’t be Harry’s right-hand man or take charge of wing C. Jean is not afraid to take care of himself.
He doesn’t have this disorder, but we can’t deny he has a codependent relationship with Harry, which is maintained by many things: substance use, work, the fact that as a satellite officer his job is literally to support his assigned lieutenant, and very likely the good moments they’ve had together, both personally and professionally.
What does his Dysthymia diagnosis entail?
A hard life, a family with a predisposition to depressive disorders, higher probability of major depressive episodes, comorbidities with other personality disorders (commonly Cluster B and C).
Dysthymia often begins early and insidiously, generally in childhood, adolescence or youth, and has a chronic course. Onset before age 21 is related to greater probability of personality disorders and substance abuse.
We don’t know since what age Jean had symptoms, but it’s safe to say he’d been living with them for a long time before his diagnosis.
This disorder affects the prefrontal cortex, anterior cingulate, amygdala, and hippocampus, which are responsible for emotional regulation, decision-making, planning and judgment, memory, emotional learning, conflict detection and stress regulation.
So we can say that Jean likely has difficulty regulating negative emotions (emotional dysregulation), rumination (repetitive negative thoughts), problems with concentration, memory or problem solving, and a very low stress threshold (this is related to memory problems).
This disorder also manifests with polysomnographic alterations or sleep problems, with high comorbidity with sleep-wake disorders.
On top of that, it creates vicious cycles that perpetuate distress, such as:
I feel bad → I sleep badly → I perform worse → I feel worse → I sleep even worse…
This makes people with dysthymia resistant to change. It’s not enough that they know they’re unwell or what’s not working.
This disorder has high comorbidity with anxiety disorders and substance abuse.
In Jean’s case, substance abuse is already present, and if we talk about anxiety disorders, I wouldn’t be surprised if he had comorbidity with generalized anxiety disorder.
After all this all we have left to ask is… what is Jean diagnosis?
Jean’s diagnosis is dysthymia.
