The Psychiatric Unit Awards

Watch Miley twerk, twitch and protrude her tongue at weird angles. Examine her public display of compulsive sexual fantasy. We have a diagnosis. Axis II: Exhibitionism with a touch of Frotteurism

You are a celebrity attending the MTV Video Music Awards. What a great night for media exposure and self-adulatory prancing. It is time to fawn for the photojournalists and display the latest Haute couture. So let there be music and let there be dance! Let there be crude obscenity and slutty behaviour! It is a time to applaud for your co-religionists; please applaud vigorously until the palms of your hands tingle with excitement. And then onward to the party circuit to thrust out the chest one more time with carefully positioned feet for this latest Cinderella moment. For there is nothing more invigorating than receiving an award from an event specifically tailored to, well, give out awards.

For the peasants outside the Hollywood moat, it is time to crack open the DSM (Diagnostic and Statistical Manual of Mental Disorders) and figure out what the heck is happening on the stage. I believe a look at Axis II disorders will be a good place to start. To inspire a love for medicine, we will take a look at one performer who has created quite a stir. Naturally, the gaze is cast toward the performance of a young lady with an unusual name: Miley Cyrus.

Miley Cyrus first experienced fame when she was cast as the central character ‘Miley Stewart’ for the Disney Channel television series Hanna Montana. But on the cusp of adulthood and what should be a time where feminine charm and ladylike behaviour are desirable, she gives a shock value performance with her rendition of We Can’t Stop. After watching the MTV performance of Ms Cyrus I turned my gaze to a YouTube video with the same performance. There was strong usage of drug culture hallucinogenic imagery and the vulgarity of her dance movements was also apparent. Subtle sensuality is observed in a beautiful fashion when attending a ballet performance. Ms Cyrus performed a gutter dance.

In cracking open the DSM my gaze fell on Axis II disorders. Exhibitionism or perhaps more apt is the diagnosis of Frotteurism. But a diagnosis of Frotteurism requires that the behaviour cause significant distress to the individual. For Ms Cyrus, this is purely ‘business’. Perhaps Axis II disorders have increased incrementally with the use of YouTube as a means to introduce ourselves to the world. Undoubtedly, ego-driven exhibitionism is flourishing in a digital age. The basic definition is thus: “This disorder is characterised by intense sexual arousing fantasies, urges or behaviours in which the individual exposes his or her genitals to unsuspecting strangers.”

While Miley Cyrus did not expose her genitals, she did plenty of ‘twerking’. I had to look up the word twerking and yes, Ms Cyrus did twerk along during her performance. She also did some rather interesting things with a foam hand prop. As I am a lady, let me decline to describe in graphic manner her blatant sexual exhibitionism.

After the performance, Miley’s mother clapped heartily. You would have thought her daughter had received an Olympic gold medal. The crowd seemed equally enthralled. As for me, the sense was that of shame. This shame is based on a fear that non-Americans who have never visited my great nation will generalise the actions of the Hollywood elite to be normative.

But in the light of Axis II disorders, why did all of the celebrities remain seated? Why didn’t even one individual or one family leave their seats and head for the nearest exit? We know the answer to this question. What Hollywood provides is a world without universal moral boundaries. The world of imagination can create a virtual place, or a stage, where conscience is a remote memory of the past.

But let’s change the stage for a moment. We are not at an MTV awards event. Oink! We are not in search of entertainment. We are psychiatrists evaluating a troubled young woman who has come through the doors of our facility.

We are the new audience. There are no giant dancing Teddy bears. Take away the lights and the sounds. Place this young woman in the day room of a psychiatric unit with her foam hand prop and watch her perform. Watch Miley twerk, twitch and protrude her tongue at weird angles. Examine her public display of compulsive sexual fantasy. We have a diagnosis. Axis II: Exhibitionism with a touch of Frotteurism. Having spent a season of my nursing career locked inside juvenile psychiatric units in close proximity to those under my charge, I have cared for many young women just like Miley Cyrus. The only difference is that I am handing out pills so they will not perform Miley’s dance routine. I am slowing down their brains and muting their responses.

It is interesting how society views an artist or musician, an actor or a playwright, with a liberality free of discernment. A photographer can sink a crucifix in a jar of his own body fluid and it is ‘art’. A hip-hop artist can grab his genitals multiple times and it is choreography. He is not arrested for public obscenity. A comedian can blast through a vulgar routine that is loaded with ‘f’ bombs and he gets a free pass. A female celebrity can use a foam hand prop to simulate sexual acts in such a graphic manner that all that is lacking is for the man to enquire about the price. The performance is labelled award-winning. But is this choreography or is it Axis II?

Miley Cyrus was born with the given name of Destiny Hope Cyrus. It is such a beautiful name. Is this the life envisioned for her when she was first placed into the arms of her mother? Was her father secretly hoping for a daughter who would grow up to be a good mother for his future grandchildren? Did they envision a university degree? Or did Ms Cyrus’ parents envision the sad spectacle seen on the stage with We Can’t Stop?

Her Mama clapped.


The writer is a freelance journalist and author of the novel Arsenal. She can be reached at