Psychiatry at the movies
The silver screen seems to have a
certain fascination with psychiatry: its illnesses, treatments,
institutions and doctors. Indeed psychiatrists appear in only
slightly fewer films than cowboys (404 vs. 491 films), according to
one recent survey.1 Even in animated Disney films 85%
contained some references to mental illness with characters being
described as “crazy” or “nuts.”2 But what is the role of
Hollywood in helping to highlight mental illness in today’s
society? Is it a help or a hindrance? And can it count as proper
revision for your exams?
Over the years the image
of psychiatry in films has struggled and, from an early start, the
role of psychiatry was unfortunately often used for shock value.
The incorrect portrayal of patients as either incurable or violent
has been a recurrent theme, and psychiatrists have been depicted as
incompetent, controlling or downright nasty. No wonder psychiatry
is still affected by stigma! Even in the silent film era,
depictions of mental illness exist. Two early German films Das
Cabinet Des Dr Caligari (The Cabinet of Dr Caligari 1919), which
shows a chaotic “psychiatric asylum” and murderous doctor, and M
(1923) which deals with psychopathy and serial killing, are notable
examples.
Perhaps the film best
encapsulating the public’s fears about psychiatry came in the
1970’s with Jack Nicholson’s role as Randle Patrick (Mac) McMurphy
in the 1975 film One Flew Over the Cuckoo’s Nest. After signing
himself into a mental institution to avoid prison, he finds the
ward full of institutionalised patients under the rule of the
imposing Nurse Ratched. The film questions the ability of
psychiatrists to diagnose, and the environment and treatments used.
The scene that everybody remembers though shows Mac receiving
Electroconvulsive Therapy (ECT). The book that the film is based on
is set in the early 1950s, and hence ECT is given without
anaesthetic, however many assume that this is still an accurate
portrayal of ECT today. Indeed a survey of 22 films containing ECT
showed that this treatment is almost always shown as being harmful
and distressing, without showing the positive impact it has on
people’s lives.3
Fortunately today’s films
about psychiatric topics have increasingly begun to adopt a more
balanced approach. There are examples of films showing the whole
range of psychiatric illnesses and which touch on important issues
that affect our patients’ lives. How much psychiatry you want to
read into the movie industry is up to you, but even films like the
Indiana Jones series could be said to show how phobias affect the
lives of even the most heroic of people. “Snakes, why did it have
to be snakes? I hate snakes!”
Changes in the portrayal
of psychiatry have also been seen in Bollywood as summarised by
Dinesh Bhugra in a 2005 paper, moving from early portrayals
highlighting the use of psychotherapy as a treatment (Khamoshi
(1969) and Raat Aur Din), to showing more antisocial problems, and
loss of faith in the system through the 70’s and 80’s. Through the
1990s the themes of psychosis and morbid jealousy have risen with
films like Kaun (1999), Gupt (1997) and Dilwale (1994) showing
psychosis and psychiatric treatment. Tere Naam (2003) also shows a
supposed Ayurvedic approach to psychiatric care, albeit within a
rather fearsome asylum, which eventually leads the protagonist to a
full recovery.4
Western films that
specifically deal with psychiatric topics have some notable
examples that are well worth watching – who says that revision has
to be boring?
For organic illness,
Memento (2000) shows Guy Pearce suffering from a form of memory
impairment resulting from head injury, whilst Iris (2001) starring
Dame Judi Dench, shows the troubles of coming to terms with a
diagnosis of Alzheimer’s disease. Substance misuse disorders crop
up in numerous films, with a young Ewan McGregor starring as Mark
Renton in the 1996 classic Trainspotting. Heroin addiction, the
complications of blood borne viruses and the social problems that
can affect drug dependent patients are all tackled in this gritty
portrayal of the Edinburgh drug scene. In their own ways too the
films Fear and Loathing in Las Vegas (1998) and A Scanner Darkly
(2006) deal with different aspects of drug use from the bizarre
psychedelic experiences of the former to the relentlessly
encroaching paranoia of the second.
And speaking of paranoia,
The Number 23 (2007), a surprisingly serious role for Jim Carey,
charts the increasing obsessionality and eventual descent into
paranoid delusions of the main character over the significance of
the number in his life. It is almost enough to make you start
wondering about it too… Schizophrenia is dealt with obliquely in
several films; both Twelve Monkeys (1995) and Donnie Darko (2001)
can be interpreted as the main characters suffering from delusions
and hallucinations. More directly Russell Crowe’s role in A
Beautiful Mind (2001) charting the life of the Nobel prize winning
economist John Forbes Nash who suffers from paranoid schizophrenia
won 4 Academy Awards and is well worth a look. The most unique view
of schizophrenia and its impact on the lives of those close to
sufferers is shown in Tarnation (2003). It is unique for being put
together by the director Jonathan Caouette on his home computer
from a collection of snapshots, recordings and camcorder clips of
his own life, one which was overshadowed by his mother’s
schizophrenia.
Mood disorder is
surprisingly under-represented but two films from 2002: The Hours
(dealing with the effects of suicide) and About Schmidt (showing
grief reaction and abnormal bereavement) cover some of the related
areas.
Other notable films
attempt to convey something of the complexities of personality
disorder. Girl, Interrupted (1999), Clockwork Orange (1971),
American Psycho (2000) and The Virgin Suicides (1999) deal with
Borderline, Antisocial, Psychopathic and Dependent (possibly in the
mother) personality disorders respectively. Fight Club (1999)
touches on dissociation, multiple personality and antisocial
personality disorder (just who is Tyler Durden?) whilst Kevin
Spacey as Prot in K-PAX (2002) also shows dissociation in the face
of severe emotional stress. Incidentally Jeff Bridges’ role as the
psychiatrist Dr Powell is my favourite of any on-screen
psychiatrists to date! Finally the topics of autistic spectrum
disorder and learning disability are covered in movies such as
Rainman (1988), Cube (1997) and Forrest Gump (1994).
So, how do we sum up the
attempts of the film industry to show the impact of psychiatric
disorders on people’s lives? Perhaps we can see that perceptions
and portrayals are becoming more balanced, more realistic and less
sensationalistic. This development mirrors the changes in other
media, such as newspaper reporting, television news, soap operas
and the like. My hope is that this will help dispel many of the
myths that people still believe about psychiatric illness and its
treatment, and allow patients to feel more confident and less
stigmatised when discussing their problems. Overall though, the
best way to decide is to watch these films for yourself, and ask:
“What is this film really trying to say about psychiatry?” You may
be surprised by the answers you find.
- Moss L, Dr Dippy,
Dr Wonderful and Dr Evil will see you now – the casual sexism of
film shrinks. The Scotsman July 17th 2007.
- Lawson A, Fouts G,
(2004) Mental illness in Disney animated films. The Canadian
Journal of Psychiatry 49(5) pp310-314.
- McDonald A, Walter G,
(2001) The Portrayal of ECT in American Movies, The Journal
Of ECT 17(4) pp264-274.
- Bhugra D. (2005) Mad
tales from Bollywood: the impact of social, political and economic
climate on the portrayal of madness in Hindi films.
Dr Chris Pell
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Page last updated on 26th January
2009 by E Baker-Glenn