The Film

We meet Bree, formerly known as Stanley, at the start of the film practising the voice exercises that help her to sound more like a woman.  She then takes a phone call and states that “Stanley doesn’t live here anymore”, but learns from that call that Stanley has a son, called Toby, who is in trouble in New York.  Bree, unaware that she had ever fathered a child, mentions Toby to her therapist when she is about to hand over the paperwork allowing Bree to proceed with surgery.  Her therapist consequently suggests that she must find out more about her son before the surgery can proceed. Bree’s male biological identity, and her ability to have fathered a child, must be acknowledged and explored before it can be relinquished.

This sets the scene for the journey that follows as Bree, posing as a church worker, bails her son from jail and travels back across America to Los Angeles with him, only revealing various truths about herself to him at different stages along the way.  Toby’s search for a stable and positive relationship with his unknown father adds dramatic tension for viewers, who are in the privileged position of understanding just who Bree is to Toby before he discovers the truth. It is through Toby’s eyes that we are able to scrutinise Bree’s performance as a woman, such as when they befriend a man who gives them a ride part of the way, and who appears to fall for Bree, unaware of her history.  We watch as Toby struggles to see his father as a woman, to whom another man is attracted as a woman.

A reluctant visit to her family home provides some very painful scenes, as her mother states that she cannot respect Bree’s new identity and both parents express grief for the loss of their son Stanley.  However, even crueler is their delight in the discovery that they have a grandson, who somehow replaces their lost son. It is in this setting that Bree is forced into revealing her circumstances fully to Toby and to outline her plans for surgery.

Bree and Toby do finally end up in Los Angeles but the film resists a completely ‘Happy ever after’ ending. While Transamerica tells its story with humour, it does not trivialise any of the big issues at the core of the film.

Relevance to the field of Mental Health

The challenge for anyone working in the mental health field is always to elicit and understand what a person is thinking and feeling whilst recognising that this may be in contrast to their appearance and behaviour.  This is especially so in matters of gender identity (the gender that you feel you should be) and gender dysphoria (a condition that describes the feeling of being trapped in a body of the wrong sex). Transamerica offers the viewer the experience of just such an assessment, through the eyes of Toby, from his first encounter with Bree to the final scenes. The film raises an awareness of the psychological conflict an individual may experience if they decide to be open about their transsexuality and illustrates the courage that is required to make such a life choice. Bree, like many others had not chosen the path of openness, but is unexpectedly forced into revealing her history to Toby, giving us an empathic understanding of what it may be like to be ‘outed’ against one’s will.

Transamerica is a film about performance and the search for authenticity.  We watch, in some detail, the struggle of Bree as she tries to pass as a woman. At the same time, we are drawn to the work of the actress, Felicity Huffman, who must offer us a credible performance as a biological male before she can perform as a transitioning transsexual woman. The film encourages us to reflect upon the performance of gender stereotypical roles that we all learn at an early age and to consider how hard it might be to change those performances.

Transsexualism is an extreme and long-term type of gender dysphoria. It is defined in ICD-10 as a mental disorder of adult personality and behaviour (F64.0). For diagnosis, the individual must have a very strong desire to live as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, their anatomic sex and a wish to make his or her body as congruent as possible with the preferred sex (usually involving hormone treatment and surgery). It is also important that none of these feelings exist as a symptom of another mental disorder like schizophrenia or as a result of a genetic or chromosomal abnormality.

The NHS has good information available on its website on the subject of Gender Dysphoria, which has an estimated prevalence in the UK of 1 in 4,000 people who are receiving medical help, although there may be many more people with the condition who have yet to seek help. On average, men are diagnosed with gender dysphoria five times more often than women.

The subject of transsexualism is gaining wider general public awareness in the UK, through various openly transsexual individuals, such as supermodel Lea T who is the new face of Givenchy, and Juliet Jacques, who has been describing her personal transgender journey in a regular column in the Guardian newspaper as well as TV soap Hollyoaks, which is tackling the subject in a storyline about a teenager with gender dysphoria.

For anyone wanting to gain a greater empathic understanding of the enormously complex issues facing people who seek to realign their biological sex to match their gender identity, Transamerica is a perfect starting point.

More information about Transamerica can be found at IMDB as can a short trailer.

The DVD may be purchased at amazon.co.uk.

Minds on Film blog is written by Dr J Almeida, Consultant Psychiatrist.                          

The Film

Ordinary People is set in upper-middle class suburban America (Illinois), where the Jarrett family have lived a seemingly ‘perfect’ life until the sudden death of their eldest son,  Buck, in a boating accident which also involved their younger son Conrad, who survives.

The film begins with scenes that show the family trying to get on with their lives but revealing that just below the surface lies a profound lack of communication. Mother, Beth, is desperate to keep up appearances in public and show that all is now well. It becomes apparent, however, that Conrad is struggling with insomnia, flashbacks, isolation at college and an inability to ‘play happy families’. His father, Calvin, seems more attuned to his son’s difficulties and encourages him to seek help from a psychiatrist, Dr Berger. At this point it becomes clear that Conrad has been in hospital for four months following a suicide attempt.

The ‘back story’ is told through Conrad’s twice weekly therapy sessions with Dr Berger and reveals that Buck, a successful athlete, was always his mother’s favourite while Conrad struggled to feel love from her.  This feeling of rejection by his mother seems to have worsened since the death of Buck and the film shows us evidence to support this belief.

Conrad is gradually enabled to express many unspoken feelings about the relationship with his mother as well as his survivor guilt and rage about the boating accident and his brother’s death.  The complex transformation that begins to take hold in Conrad is well illustrated and leads to changes in his father Calvin too.

We see Conrad begin to recover optimism as he starts dating a sensitive, nonjudgmental girl from school but an unexpected event threatens his improving mental state.  He turns in crisis to Dr Berger at this point and is helped to recognise the damaging effect of his unspoken resentment and anger toward his mother. In the confrontation that follows between Conrad and Beth we find out that she never visited him in the psychiatric hospital.  This exchange is witnessed by Calvin, who begins to question his relationship with his wife as he observes her coldness toward Conrad.

The final scenes are not ‘Happy ever after’ but are grounded in Calvin and Conrad experiencing the beginnings of an honest and truthful relationship between parent and teenage child.

Relevance to the field of Mental Health

This film, in the broadest sense, explores the varied responses of different personality types struggling to work through their grief. It is also about a family trying to deal with the aftermath of their surviving son’s suicide attempt and ongoing depression.  It highlights the importance of good communication within families as the film gradually uncovers the significant difficulties that were present between the members of the Jarrett family before the accident. Under stress these difficulties become magnified.

Ordinary People provides a wonderful starting point for a discussion about the indications for individual psychotherapy and family therapy and accurately illustrates the psychological resistance of a family member to any form of outside intervention that can so seriously interfere with the healing of the whole family.

By using the scenes of the therapy to tell the ‘back story’, the film cleverly mirrors the way in which information is often revealed over a period of time during psychodynamic psychotherapy, with neither the therapist nor the patient knowing the complete story at the start.  It also demonstrates the importance, to the therapist, of observing when and how a patient chooses to disclose particular information and offers a very good understanding of the processes involved in discovering hidden emotions and allowing them to find expression.

Finally, Ordinary People highlights the stigma that still surrounds psychiatric treatment for many people and perhaps helps us to understand why there is an urgent need to encourage awareness amongst young people about depression, suicidal feelings and the help that is available.  For an excellent review of the topic of self-harm in adolescents, I can recommend the article by Alison Wood in Advances in Psychiatric Treatment last November.

There is plenty of information for young people about all aspects of mental health on the Royal College of Psychiatrists website and a booklet is available to download on Child and Adolescent Mental Health Services (CAMHS), specifically for young people in the UK.

Any member of the Royal College of Psychiatrists interested in recording their view about the portrayal of the psychiatrist in this film or any other film can cast a vote in the survey set up by psychiatrist, Dr Peter Byrne, at http://www.surveymonkey.com/s/50films, in preparation for a Top 50 Psychiatry Film series beginning in the BJPsych in 2011.

(Thanks to my colleague D.G. for suggesting this film to me).

Further information about Ordinary People can be found at IMDB, and a short trailer can be viewed here.

The DVD is available to purchase at amazon.co.uk.

Minds on Film blog is written by Dr Joyce Almeida.