Abstract
The purpose of this academic paper will be to examine and analyze one of the main characters, Rachel Watson, of Paula Hawkins’ 2015 novel, The Girl on the Train. Various scientific journal articles along with the DSM-5 will be utilized in coming to my “best guess” as to whichever diagnoses I see fit for the character(s); I am in no way qualified to give any sort of diagnosis. Unfortunately, Rachel is undiagnosed with any sort of disorder, but shows clear signs of severe substance abuse and depression, yielded by indisputable PTSD as a result of her horrific marriage to her now ex-husband. Substance-Related and Addictive Disorder is exhibited by a person having “an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life” (American Psychiatric Association. 2017. Web.). The American Psychiatric Association also defined depression as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act” (APA. 2017. Web.). In my best opinion, these two disorders were developed alongside some PTSD brought on as a result of the years of neglect and abuse from her ex-husband Tom. “Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as … a serious accident, … rape or other violent personal assault” (APA. 2017. Web.).
Summary
Paula Hawkins published The Girl on the Train in 2015 and debuted in the number one spot on The New York Times Fiction Best Sellers list of that year; it is written as a first-person narrative following three main characters. The novel begins in July of 2013, by following Rachel Watson: a recent divorcee with alcoholism. She is taking her local commute on the train to London and from the window watches a couple she perceives as perfect: Megan and Scott Hipwell, otherwise known as Jess and Jason in Rachel’s fantasy. This couple is far from the perfect picture that Rachel painted in her mind. Days later, Rachel witnesses from the train’s window “Jess” kissing a man, one whom isn't her husband; a few days later, Megan is reported missing. No newspapers were reporting on Megan’s infidelity, so Rachel took it upon herself to contact Scott and inform him and the police of his wife’s indiscretions.
Together, they found out the man's name: Dr. Kamal Abdic, a therapist who Megan saw often. He was called in for questioning by the police but denied any sort of relationship with Megan outside of his office and was released. Rachel and Scott were still skeptical, so they devised a plan for her to see him as a therapist to catch him acting guilty. However he didn’t act guilty at all; in fact he helped Rachel confront her severe alcoholism and subsequent memory loss. After this meeting, Rachel decided to abstain from alcohol and was doing well for a few days until she relapsed. The unfortunate relapse came as a result of news reports claiming that investigators found Megan’s body and she was newly pregnant at the time of her death.
By this time in the novel, Rachel was arguably at rock bottom; her family and friends were all finding things out about her life and it seemed like she would never be able to recover. Piece by piece, Rachel starts to regain parts of her memory, but very slowly and in such vague increments that she’s left just as puzzled as before. Since Dr. Adbic was able to help Rachel come to terms with her drinking and memory problems before, she sees him again in hopes that he can aid in trying to make sense of the drunken flashbacks that have plagued her mind. More and more details about Megan’s troubled past are brought to light as newspapers and tabloids dig up her hidden secrets. During a time of weakness, Rachel runs into Scott once again and ends up spending the night at his house. In the night, Rachel accidentally reveals that she did not previously know Megan, and Scott became so angry at feeling deceived, that he attempted to attack Rachel. Her suspicion as to who killed Megan then shifted onto him rather than Dr. Abdic. A vivid memory that crept its way back to the front of Rachel’s mind is that of Tom, her ex-husband, hitting her repeatedly in the face and then getting into a car with another woman. Was the other woman his new wife? Once she remembered that night, Rachel no longer knew who she could trust and as these horrible memories started coming back to her mind, she pleaded Tom’s wife Anna to run away with her because there was no doubt in her mind that he was also abusive towards her and their daughter. In the midst of this, Tom comes home and is confronts the two women. It’s revealed that Tom was the one behind Megan’s death, because he was the one who impregnated her and when she threatened to tell everyone that it was his baby, he thought there was no other option to keep her from exposing this secret. Fearing for their lives and angered from being lied to, Rachel and Anna team up against Tom and kill him after multiple attempts to attack them first. The two women put aside their differences and claim their killing of Tom was in self-defense. This experience leads Rachel to achieve sobriety and to get her life back on the right track. Hawkins ends the novel off on a high note by having Rachel say, “I have to get up early tomorrow morning to catch the train" (Hawkins. 2015. p. 620). Choosing to end the novel with this open-ended quote leaves the reader wondering where Rachel’s next destination is; in July she was on the train everyday with no aim or ambition, but now in September she’s been reinvigorated with hope and possibility for the future.
DIAGNOSES
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is a system of classification for mental disorders that is used by professionals all over the world. It consists of all the officially recognized mental disorders, along with their characteristics and various subdivisions. The DSM-5 is useful if a person shows symptoms of a mental disorder, but they must meet specific criteria to get an accurate diagnosis. This system is solely used for diagnostic purposes; it is in no way used as an explanation as to how the person developed the disorder, or how to treat it.
Not long into the novel, it’s clear that Rachel suffers from depression that is unfortunately undiagnosed by a professional, so she receives no treatment for it. During a conversation with Scott Hipwell she admits that she feels depressed, saying to him, “[Tom and I] were trying for a baby and it didn’t happen. I became very depressed, and I started to drink” (Hawkins. 2015. p. 314). Her depression shows quite clearly when Rachel says, “I'm not beautiful, and I can't have kids, so what does that make me? Worthless” (Hawkins. 2015. p. 165). The societal pressure put on Rachel to get pregnant eventually broke her and led to her development of depression. According to the DSM-5, “a recurrent depressive disorder is characterized by repeated episodes of depression without any history of independent episodes of mood elevation and increased energy or mania” (DSM-5. 2013. Web.). Rachel states more than once that she and Tom were perfectly happy together, but it was when they started trying to conceive that their world began crumbling. While this predicament was the source of her depression, it was the unfortunate start of her alcoholism as well. The reader is eased into suspicion about a drinking problem earlier when Rachel thinks to herself, “it's Friday, so I don't have to feel guilty about drinking on the train. TGIF. The fun starts here” (Hawkins. 2015. p. 14) because it’s typically socially unacceptable to drink alone in public. She even admits outright to Dr. Abdic that there is a problem when she sees him for a therapy appointment. She told him that “for four years [she’d] had problems with alcohol, that [the] drinking had cost [her her] marriage and [her] job, it was costing [her her] health, obviously, and [she] feared it might cost [her her] sanity, too” (Hawkins. 2015. p. 337-338). So Rachel openly admits to the therapist, and to the audience that she knows the consequences yielded by alcoholism, but her life has become so dependent on its consumption that she feels helpless in its presence. The current version of the DSM-5 states that a person must meet at least 6 points on their list of criteria in order to be diagnosed with a severe Alcohol Use Disorder. The six criteria that Rachel meet are: drinking more/longer than intended, failure to stop/cut down on drinking, desire a drink so much that one can’t focus on anything else, drinking (and being sick from drinking) interferes with family and/or work, participating in unsafe activities while drunk, and going through withdrawal symptoms when effects of alcohol begin to wear off. All of these symptoms, and more, are telltale and observable signs to watch out for in order to claim a person as an alcoholic. Rachel’s depression and alcoholism go hand-in-hand and it shows when she says, “I felt isolated in my misery. I became lonely, so I drank a bit, and then a bit more, and then I became lonelier, because no one likes being around a drunk. I lost and I drank and I drank and I lost” (Hawkins. 2015. p. 164). In other words: when she felt depressed, she drank, but drinking made her feel depressed in a never-ending cycle.
Rachel admits to Dr. Kamal that when she drinks, she blacks out and “can’t remember where [she’s] been or what [she’s] done. Sometimes [she] wonder[s] if [she’s] done or said terrible things, and [she] can’t remember” (Hawkins. 2015. p. 378). It could be argued that Rachel suffers from a bit of PTSD when considering her past marriage to Tom. She recalls, “I was on the floor, my back to the wall, sobbing and sobbing, Tom standing over me, begging me to calm down, the golf club on the carpet next to my feet … I was terrified” (Hawkins. 2015. p. 454). One night during an argument, a drunken Rachel and livid Tom were screaming at each other. As it escalated, Tom found a golf club attempted to hit Rachel with it, but missed and took a large chunk from the wall in the hallway; an incident that horrific would definitely leave a mark in the minds of both participants. Later on in the novel, Rachel has another flashback to a time when she was drunk once again: “[Tom] was coming towards me, one slap across the mouth and then his fist raised, keys in his hand, searing pain as the serrated metal smashed down against my skull” (Hawkins. 2015. p. 516-517): Tom hit her and then used his keys as a weapon to stab her in the head. Rachel meets all of the DSM-5’s criteria in order to be diagnosed with PTSD, which must be experienced for at least 1 month to be considered PTSD. She directly experienced trauma at the hands of her husband, had nightmares and flashbacks about the incidences, blamed herself saying how she deserved that treatment, thought badly about herself, and participated in destructive/risky behavior, etc (National Center for PTSD. 2018, Web.). Rachel’s work life also suffered because of this treatment. The novel is told from Rachel’s point of view, and she’s quite an unreliable narrator to her audience, so there’s no telling what other horrific abuse she endured during her marriage to Tom that she hasn’t revealed to the readers. “According to the National Institute of Mental Health, [PTSD] can affect anyone who has experienced a shocking, scary, or dangerous event, which includes women who have been through violence or another trauma” (Barnes. 2018. Web.).
RESEARCH
Before the audience is introduced to the gritty details of her current life, Rachel and Tom Watson were happily married for four years. They lived in London, England in a lovely Victorian-style house on Blenheim Road where they would excitedly reunite every night after work. Their life was perfect, and the only thing that could make it even better would be to bring a new life into the world. When the time was right, Rachel wanted nothing more than to have a child with her husband. They tried and tried, but soon their lives became less than perfect because Rachel wasn’t getting pregnant. The couple tried IVF; it didn’t take and was too expensive and invasive to try again. The trials were too much for Rachel to handle, and she began to feel like a failure; blame was always put on her because it was her body that didn’t support another life. She became depressed and turned to alcohol for comfort.
Although a fictional character, Dr. Adbic as well as other mental health professionals might argue that depression was the first mental illness that set root in Rachel’s mind leaving her susceptible to the others. “Heightened anxiety, depression … and developmental crisis was increasingly understood as resulting from infertility” (Leon. 2010. Web.). “The stress of the non-fulfillment of a wish for a child has been associated with emotional sequelae such as anger, depression, anxiety, marital problems, sexual dysfunction, and social isolation. Couples experience stigma, sense of loss, and diminished self-esteem in the setting of their infertility” (Massachusetts General Hospital. 2015. Web.). The Anxiety and Depression Association of America suggests that treatments such as psychotherapies and medications are beneficial; these can be done together or separately depending on the extent of depression. This organization recommends Cognitive Behavioral Therapy (CBT) which “focuses on identifying, understanding, and changing thinking and behavior patterns” (ADAA. 2018. Web.). The way CBT works is, with the help of a trained mental help professional, to make the patient aware of when they are having intrusive and/or negative thoughts, working to change their way of thinking in order to yield helpful and beneficial results through time. This process can usually last between 3 to 5 months depending on the individual’s willingness to participate and/or the severity of their depression. Rachel’s depression did not seem so sever, so it’s possible that she could have recovered relatively quickly with the right professional help. Sadly enough, Rachel did not choose to take the professional route, instead she found comfort at the lips of a liquor bottle, over and over again.
When Dr. Adbic asks how her drinking started, Rachel admittedly says, “I was trying to get pregnant. I couldn’t, and I became depressed. That’s when it started” (Hawkins. 2015. p. 409). Rachel wanted nothing more than to have a baby, incredibly so that she says, “I would have cut off a limb if it meant I could have had a child” (Hawkins. 2015. p. 386). The agony that plagued her barren womb drove her to the bottle and kick-started her downward spiral. Rachel’s depression led her to drink and she liked how the alcohol was able to take away her sadness, even if just for a little while. The depression and alcoholism go hand-in-hand because they surfaced during the same troubling time in her life. However she didn’t like that her hurting was only numbed for short periods of time, so she began to drink more heavily and more often. “For instance, some patients may use alcohol as a form of self-medication for an affective disorder. In these cases, alcoholism may develop secondarily to the affective disorder” (Nurnberger, et al. 2002. Web.). In other words, it was the depression of not being able to conceive that developed her dependence on and addiction to alcohol. Unfortunately, Rachel received no treatment for her alcoholism as well, but living in suburban London, there’s no doubt that there would be dozens of options right at her fingertips had she reached out. “Research shows that about one-third of people who are treated for alcohol problems have no further symptoms 1 year later. Many others substantially reduce their drinking and report fewer alcohol-related problems” (NIAAA. 2014. Web.), so had Rachel decided to be proactive instead of retroactive when treating her alcohol problem, there’s a great chance she would have been able to get over her addiction quickly and effectively. According to the National Institute on Alcohol Abuse and Alcoholism, treatments include counseling, support groups, and personalized approaches to achieving recovery. There are also some medications that can limit a person’s desire for alcohol. However, the excessive drinking cost Rachel her job, so there may not have been any sort of disposable income to commit to adequate treatment. It was the alcohol that lost Rachel her job, and her unemployed status must have just added to her stress and depression. CNN reported that “people unemployed for six months or more often show signs of depression” (Landau. 2012. Web.) and the reader knows that Rachel has been unemployed for at least 8 months. The American Psychiatric Association, the organization that published the DSM-5, also states that “continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression” (APA. 2017. Web.).
Rachel lost her job about a year after her divorce with Tom became final, but a look into their time as a married couple proves more grim than anyone would like. She demonstrates various instances where she gets abused by Tom, psychically, verbally, and psychologically. “Ridicule, a form of emotional/verbal abuse, was identified by battered women as being the most detrimental for their emotional wellbeing” (Street, et al. 2001. Web.). Tom was supposed to be Rachel’s lawfully wedded husband, the one she could confide in no matter the circumstances, and he took advantage of his power over her. He would call her names, and led her to believe that it was her fault she was being treated the way she was, that it was her fault they couldn’t conceive a child, so she drank to let herself feel free from the pain. She drank so much that she blacked out with absolutely no memory of her actions the night before; her only source of security was Tom telling her what she had done and said and she became dependent on him in all the wrong ways. This weakened state left her vulnerable almost all of the time and Tom would get angry that she was putting this burden on his shoulders, so be began to relieve his anger by hitting his wife. When he realized that Rachel formed no memories during that state, he began to do it more. Although there are incidents where Tom physically hits his wife, there was much more emotional and psychological abuse going on in their household. Some time after their divorce, when Tom holds Rachel and Anna hostage in the house, he says to Rachel, “Do you have any idea how boring you became, Rachel? How ugly? Too sad to get out of bed in the morning, too tired to take a shower or wash your f***ing hair? Jesus. It’s no wonder I lost patience, is it? It’s no wonder I had to look for ways to amuse myself. You’ve no one to blame but yourself” (Hawkins. 2015. p. 585). He’s referencing his affair with Anna, whom he later married and had a child with, which tortured Rachel since she wasn’t able to conceive herself. Tom then goes on to say, “I put up with a lot—your drinking and your depression. I put up with all that for a long time before I threw in the towel” (Hawkins. 2015. p. 585). A spouse is supposed to be the one who loves you unconditionally, but Tom made it seem as though Rachel was an unbearable burden that landed in his hands and made her feel guilty for grieving the loss of a child she would never be able to conceive.
The previous publication of the DSM-5, the DSM-IV, stated that “feelings of guilt related to [a] traumatic event are so prevalent that … guilt [is listed] as an associated feature of PTSD. More specifically, Kubany and associates (1995) investigated reports of guilt within a sample of battered women and found that for these women, trauma-related guilt was positively correlated with PTSD symptomatology” (Street, et al. 2001. Web.). Many treatments types for PTSD are excruciatingly similar to those that can treat depression, so it’s possible that Rachel’s recovery could have happened even quicker since she would have been able to apply one tactic to both problems; killing two birds with one stone. Cognitive Behavioral Therapy “can be a very helpful tool in treating mental health disorders, such as depression [and] post-traumatic stress disorder” (Mayo Clinic. 2017. Web.). Once again, this type of therapy works by identifying the troubling situation/thoughts and redirecting your thinking in order to reshape and manage these thoughts with a positive mindset. “Cognitive Behavioral Therapy … can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life” (Mayo Clinic. 2017. Web.). “In this type of therapy the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life.” (ADAA. 2018. Web.). What Rachel needed most in her life is to feel like she had control of something, and CBT would most likely have been the best option for her. She had no control over the inhabitable environment of her womb, there was no control over Tom’s words or actions towards her, and seemingly no control over herself when in the presence of alcohol.
DEFENSE MECHANISMS
Defense mechanisms are defined as “mental processes that are designed to provide psychological protection against the pain that can result from uncomfortable thoughts or fearful situations” (CRC Health. 2015. Web.). In layman’s terms, a defense mechanism is something that people do when they do not want to seem weak or vulnerable to themselves and to others. A defense mechanism adopted by Rachel would be that of rationalization: she finds ways to justify her drinking so she doesn’t feel so badly about her unhealthy and dangerous behavior. She says that “some days [she] feel[s] so bad that [she has] to drink” (Hawkins. 2015. p. 37) which is her way of rationalizing the reasoning behind her drinking. Drinking is okay and good, because they take away her bad feelings and self doubt, and she becomes less depressed because the alcohol has numbed her.
Rachel also uses isolation as a defense mechanism; her drinking led everyone to avoid her because “no one likes being around a drunk” (Hawkins. 2015. p. 164). She even goes so far as to avoid her roommate and even her own mother. “I didn’t admit how bad things were. I didn’t tell her I’ve been out of work for months, or that I was fired” (Hawkins. 2015. p. 346), Rachel thinks when she’s at lunch with her mother, asking for a loan. She’d only told her mother that she was simply laid off due to budget cuts in the company’s headquarters, so a small loan of a few hundred pounds would supposedly hold her over until her next unemployment check comes, only it never would. “I didn’t tell her how bad things had got on the drinking front, and she didn’t notice” (Hawkins. 2015. p. 346). Of course it would be hard to admit, but Rachel didn’t even tell her mother that she suffered from alcoholism because she didn’t want to feel pitied. Rachel says, “I’d never realized … how shaming it is to be pitied” (Hawkins. 2015. p. 73), so if she isolates herself from everyone and keeps them in the dark about the gritty details about her life, then she can’t be pitied. While Rachel’s reasoning behind her self-isolation is understandable, she’s ultimately just hurting herself in the end because the people who would want to help her the most, are not pushed away and left unaware of how desperately she needs help.
BEHAVIOR
When taking Rachel’s behavior into consideration, it’s safe to say that a majority of her choices were made while she was under the influence of alcohol. While in her extremely intoxicated state, she was unable to process the stimuli around her and therefore wasn’t able to learn from any of her mistakes. “Behaviorism is concerned with how environmental factors (called stimuli) affect observable behavior (called the response)” (McLeod. 2013. Web.). This perspective is quite self-explanatory: professionals study the behavior of their patients in order to see if they are either progressing or regressing in their recovery. In the beginning of the novel and throughout the middle of it, Rachel was making absolutely no effort to better her life. She was described as pathetic, boring, ugly, and disgusting by others when she drank; but of course no one wants to be subject to that kind of treatment. There are two methods of action in the behavioral perspective: classical conditioning which “involves learning by association” and operant conditioning which “involves learning from the consequences of behavior” (McLeod. 2013. Web.). It was through the operant conditioning of herself that Rachel decided to get better; she concluded that drinking was only a detriment to her life and she was going to stop. Rachel saw the errors of her ways, through repeated trial and error when trying to get sober, and described that it has been “three weeks exactly: [her] longest dry spell in years” (Hawkins. 2015 p. 628). Eventually, Rachel’s environmental stimulus (reactions she got from others when she drank) drove her to change her behavior (deciding to become sober).
Rachel’s actions also seemed to be influenced by the community perspective, which is the ideology that mental illness is not solely one person’s problem, but rather the fault of their collective surroundings. When considering Rachel’s lifestyle at the beginning of the novel, it seemed like her actions were all completely her fault, but later it showed that her community had failed her also by lacking the presence of a good support system. Of course Rachel lived in the suburbs of a main city in the world so there had to definitely be dozens of different meetings such as AA and other support groups. However, it was Rachel’s closest person who failed to be there for her: Tom. In the toughest time of her life, when she couldn’t have the only thing she had ever wanted ( to conceive a baby), Tom failed to be there for her, so she became depressed and developed an alcohol addiction in the process. Had Tom been a more reliable husband, maybe their marriage wouldn’t have ended. In Rachel’s most trying time of need, Tom strayed off and had an affair with a woman he later married and had a child with. When talking to Tom, Rachel says, “you told me everything was my fault. You made me believe that I was worthless. You watched me suffer” (Hawkins. 2015 p. 585), and Tom’s response was to put even more blame on her by saying, ““I put up with a lot—your drinking and your depression. I put up with all that for a long time before I threw in the towel” (Hawkins. 2015. p. 585) and he made it seem like being married to Rachel had become a burden that just turned into too much to handle. After all, it was their loss of a child, or lack thereof, that made Rachel depressed and turned her to alcohol. “Around 1 in 7 couples may have difficulty conceiving. This is approximately 3.5 million people in the UK” ( NHS England. 2017. Web.). Infertility is something that couples need to face together, and if they don’t then it could ultimately be the downfall of the entire relationship which was the case for Tom and Rachel Watson. Rachel knew that she needed Tom to be there for her, but he acted like he couldn’t be bothered to even look in her direction, so Rachel sought out solace elsewhere, just like Tom did when he began having an affair with Anna.
TREATMENT
Unfortunately throughout the novel, Rachel received little to no professional treatment for any of her problems: her drinking, her depression, and her PTSD after escaping domestic violence. However she did attempt to find help for retrieving her memories during her blacked-out phases; she did research to find hypnotherapists in her area but the idea fell through because “it’s expensive and it’s unclear whether it actually helps” (Hawkins. 2015 p. 207). And although for the wrong reasons, she did make an attempt to get help from Dr. Abdic, Megan’s previous therapist after the first time they met. The first time they met, Dr. Abdic asked Rachel how her drinking started, but she was too hesitant to answer. The second time they met was a different experience: she revealed to him that she became depressed and turned to alcohol after she failed to get pregnant multiple times, disappointment after disappointment. She revealed to him that she was biologically unable to have a child; the only person besides Tom to whom she has ever said that. Personally, I really do sympathize for Rachel; her life was nothing like how she imagined it to turn out. First, she finds out that she can’t ever get pregnant which is the only thing she wanted in the world. Then when she didn’t get comfort from her husband, she started drinking to ease her pain and that’s “why he stopped loving [her]” (Hawkins. 2015. p. 381) and
went off to have an affair and left her devastated and damaged. While I don’t completely agree with most of Rachel’s actions, I could appreciate that by the end of the novel, she had enough character development to see the error of her ways so she could turn her life around for the better. Paula Hawkins also leaves her readers off with some hope for Rachel’s character by having her tell us, “Eventually, I suppose, the nightmares will stop and I’ll stop replaying it over and over and over in my head, but right now I know that there’s a long night ahead. And I have to get up early tomorrow morning to catch the train” (Hawkins. 2015. p. 631). The novel, for me, was a testament that even through the hardest of troubles, eventually everything will be okay, and hope for the future will come soon enough.