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.
1. Moss L, Dr Dippy, Dr Wonderful and Dr Evil will see you now – the casual sexism
of film shrinks. The Scotsman July 17th 2007.
2. Lawson A, Fouts G, (2004) Mental illness in Disney animated films. The Canadian
Journal of Psychiatry 49(5) pp310-314.
3. McDonald A, Walter G, (2001) The Portrayal of ECT in American Movies, The
Journal Of ECT 17(4) pp264-274.
4. 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