Sharp Objects (The Novel and the Series)

In both a literal and a figurative sense, Sharp Objects is a story of homecoming and resolution. The narrative of both the 2006 novel and the 2018 HBO series adaptation follows journalist Camille Preaker as she returns to her childhood home, and to the bleak and twisted psychological landscape of her youth, to investigate the murders of two young girls.

In the novel Sharp Objects, Gillian Flynn, author of Gone Girl, portrays various themes encountered by forensic and clinical psychiatrists, including personality disorders, Munchausen's by proxy, trauma, grief, relationship struggles, self-injurious and self-defeating behaviors, psychiatric hospitalization, and alcohol-use disorder. The murders of two young girls, which occurred a year apart in a small town in Missouri are being investigated by law enforcement and by a young journalist, Camille Preaker (played by Amy Adams). Casting Amy Adams in the lead role was an act of genius in that there is something viscerally shocking in seeing one of America's sweethearts, who rose to fame as a Disney princess in the film Enchanted, defiled and brought low in a way that is wholly consistent with the themes of the story, highlighting the dichotomous sociocultural view of women as either Madonna or whore.

In Sharp Objects, Camille Preaker comes back to her hometown of Wind Gap, Missouri as an investigative journalist, from Chicago (in the novel), and St. Louis (in the series). Because she grew up in Wind Gap, her boss decided that this would be a good opportunity for her. We soon learn some of her back story. She fled the gossipy, Confederate-hero-revering, small town in large part due to her engulfing, dramatic, conditional love–giving mother. Her mother's underlying pathology is revealed slowly over the novel, even to Camille. The reader only knows what first-person narrator Camille knows.

We also learn that Camille had a younger half-sister, Marian, who died when Camille was young, and another living half-sister, Amma, age 13, whom Camille had not seen since Amma was a baby. Camille is haunted by her childhood, which included gang rape, the sickliness and ultimate death of her sister, and her attention-seeking mother. She attempts to drown all of this out through cutting and alcohol use. One of her first stops in her hometown is to a local bar, where she drinks bourbon prior to interviewing the parents of the murdered girls.

When Camille finally knocks on the door of her giant Victorian childhood home and explains why she is there, her mother, Adora Crellin (impeccably played by Patricia Clarkson, who recently won the Golden Globe for the role) responds with dismay, “Aren't those parents having a difficult enough time without you coming here to copy it all down and spread it to the world? ‘Wind Gap Murders Its Children’! Is that what you want people to think?” (p 26).

Adora is mainly concerned with appearances, from her own flawless grooming and hygiene to her house, her marriage, and her daughters. She had given up on Camille, whose self-injurious behavior included cutting words such as “baby doll,” “kitty,” “wicked,” and “petticoat” into herself. Camille's younger sister Amma knows that her mother only cares about appearances, and so when she is at home, she wears dresses, keeps her hair back with a ribbon, and plays with her doll house that is a miniature version of her real house … a tiny world over which Amma has absolute control. She tells Camille upon officially meeting her, “I wear this for Adora. When I'm home, I'm her little doll” (p 43). Camille had already met Amma outside the home, however, and Amma had been wearing makeup, drinking, and hanging out with girls who also looked older than their 13 years.

Camille finds her own etched skin a source of both shame and relief. She wears clothes to hide the scars, but she also feels the burn of the words, which still gives her a sense of control over her environment. She hides the scars from the detective (and her romantic interest) Richard Willis (well played by Chris Messina who also played opposite Amy Adams in the movie Julie and Julia in 2009), who was brought in from Kansas to investigate the murders. This relationship is fraught with power plays, insecurity on Camille's part, and her unresolved trauma.

The small-town mentality, the apparent psychological issues on the part of both Camille and Amma, Adora's constant thwarting of the investigations, and the multitude of interpersonal relationships in the town create escalating tension and suspense while the characters try to figure out who murdered the young girls.

Adora's own upbringing is characterized as being isolative and lacking in affection. This lack of pro-social modeling may have contributed to her dysfunctional relationships with her own children. Adora was incapable of engaging in a normal manner with her children and therefore resorted to aberrant means to feel, and to appear, connected with them. She achieved this by evoking symptoms of physical illness in her daughters through poisoning. This allowed her to take on a nurturing role for her children who, by way of physical illness, became completely dependent on her. At the same time, she projected an image of a caring mother in unfortunate circumstances, garnering sympathy and admiration from others. The ultimate expression of this came in Marian's eventual death and the public outpouring of sympathy engendered. That Camille was born out of wedlock threatened Adora's public persona; this, coupled with Camille's resistance of Adora's dubious care, contributed to the lack of affection between them.

While Munchausen syndrome by proxy (MBP) is the name most commonly associated with this condition, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, calls it factitious disorder imposed on another. This is a rare condition in which an individual deliberately falsifies physical or psychological symptoms, or induces injury or disease in another person, and presents that person to others as ill or injured. This commonly involves suffocation, poisoning with medications, or falsifying laboratory results.¹ Most often, the individual is the primary caregiver for the victim, typically their mother.² MBP can be motivated by a broad range of psychological needs, including a need to form a relationship with the treating physician or for attention. Etiological factors contributing to the development of MBP in later life are thought to include maternal rejection and lack of attention in infancy.¹

Recognition of MBP is challenging, and victims of this abuse are often not identified in a timely manner.¹ This problem is illustrated in Sharp Objects, when Camille approaches a pediatric nurse, Beverly Van Lumm, who had cared for Marian. Beverly had penned a report outlining her concerns about Marian and Camille's welfare, noting that Marian showed symptoms after spending time alone with Adora, and that Adora did not display affection unless Marian was sick and crying. Beverly's concerns were disregarded as a “childless, jealous nurse's pettiness” (p 229) by the medical patriarchy, and no action was taken, with catastrophic consequences.

Sharp Objects is cleverly titled, tying into themes including Camille's self-injurious behavior and the murders of the young girls. The psychological themes explored in both the book and the HBO series will likely be of interest to many forensic psychiatrists.

• © 2019 American Academy of Psychiatry and the Law