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Screening psychiatrists: the good, the bad, and the dippy

2015; Elsevier BV; Volume: 2; Issue: 1 Linguagem: Inglês

10.1016/s2215-0366(14)00140-0

2215-0374

Stephen Ginn,

Primary Care and Health Outcomes

Hector (Simon Pegg), a London-based psychiatrist, is increasingly dissatisfied with his humdrum, predictable existence. His professional and personal lives are suffering. The trouble is that he's unable to make anyone happy. So Hector resolves he must travel to distant lands to find out what happiness is. Calling this venture “research”, he leaves behind his bewildered girlfriend Clara (Rosmund Pike), and boards a plane to China. In the narrative that follows, Hector learns to dance and meets a wise mountain monk. He gets kidnapped and almost gets murdered. He talks to animals. He guides a drug dealer towards enlightenment. Yet, despite all this effort, Hector's research yields no dramatic insights. This doesn't matter though; on his return his abilities as a clinician are refreshed and he finds renewed satisfaction with Clara. Critics found Pegg unconvincing and Hector and the Search for Happiness (2014) schmaltzy and culturally insensitive. Despite being based on a novel by a psychiatrist, the film is another contribution to the canon of undistinguished and unrealistic films about psychiatrists. Right from their beginnings, motion pictures have featured psychiatrists and mental disorders in their storylines. Cinematic art and psychodynamic practice evolved in parallel at the turn of the 20th century and a slew of silent films unselfconsciously depicted talking therapy. Despite this, the sliver screen's focus on psychiatrists has produced very few masterpieces. A Beautiful Mind (2001) was sympathetic towards Nobel Laureate John Nash's (Russell Crowe) experience of paranoid schizophrenia and it took Best Picture at the Oscars. However, it competes for attention alongside the likes of the much less subtle Me, Myself and Irene (2000). This vehicle for comedian Jim Carrey is remembered for a grossly insensitive portrayal of schizophrenia, equating the disorder with violence and split personality. Artistic pretentions notwithstanding, motion pictures exist solely to entertain audiences, and generate profits. Verisimilitude is routinely ignored, and movies rarely present anything even half accurately. Heroes are impervious to bullets and middle-aged men consistently attract much younger women. As a result, students of onscreen psychiatrists should proceed with caution. The only thing about psychiatry that is routinely realistically depicted onscreen is confusion about what psychiatrists actually do. In The Dark Mirror (1946), for instance, the door to the protagonist's (Lew Ayres) office bears the muddled inscription “Dr Scott Elliott MD PhD MS Psychologist”. The average cinema psychiatrist is actually a conflation of fact and fantasy, moulded to serve the conventions of the genre. He or she may be a plot device, earning a place in a movie simply by listening. Theatrical soliloquies once served a similar function. Both are ways in which the thoughts and distress of a central character are shared, sometimes for laughs. In Groundhog Day (1994), television weatherman Phil Connors (Bill Murray) is inexplicably living the same day over and over. He soon becomes despondent and consults a psychiatrist, who unhelpfully requests that Connors return again “tomorrow”. This propensity to harness psychiatrists as an excuse to purge characters of their inner secrets is mercilessly lampooned in Austin Powers International Man of Mystery (1997). Master-criminal Dr Evil (Mike Myers) memorably divulges details of his upbringing to a therapy group: Therapist: Please tell us about your childhood. Dr Evil: Very well, where do I begin? My father was a relentlessly self-improving boulangerie owner from Belgium with low-grade narcolepsy and a penchant for buggery. My mother was a 15-year-old French prostitute named Chloe with webbed feet. My father would womanize, he would drink, he would make outrageous claims—like he invented the question mark. Sometimes he would accuse chestnuts of being lazy. The sort of general malaise that only the genius possess and the insane lament. My childhood was typical: summers in Rangoon, luge lessons. In the spring we'd make meat helmets. If I was insolent, I was placed in a burlap bag and beaten with reeds. Pretty standard, really. At the age of 12 I received my first scribe. At the age of 14, a Zoroastrian named Vilma ritualistically shaved my testicles. There really is nothing like a shorn scrotum. It's breathtaking—I suggest you try it. Psychiatrists do break out of supporting roles. Analyze This (1999) features comedian Billy Crystal as Dr Ben Sobel. Sobel has a line in pedestrian interpretations but he also really rolls up his sleeves, eventually taking a bullet for his mafia boss patient Paul Vitti (Robert De Niro). Steven Soderbergh's Side Effects (2012) is replete with psychiatrists. Dr Jonathan Banks (Jude Law) is duped into a plot to manipulate the share price of a pharmaceutical company. This film is a rare example of an onscreen psychiatrist actually prescribing medication, albeit one that places patients into a murderous fugue state. At 408 pages long, Gabbard and Gabbard's Psychiatry and the Cinema (1999) is a thorough investigation of onscreen psychiatrists. The Gabbards view celluloid psychiatrists as adhering to stereotypes of either “good” or “bad”. Whereas the “good” psychiatrist cures with his or her very presence, the “bad” is ineffectual. The good psychiatrist is caring, the bad manipulative and vindictive. Psychiatrist Irving Schneider prefers to consider three varieties. Onscreen psychiatrists are “Dr Evil” (no relation to Austin Power's foe), “Dr Wonderful”, or “Dr Dippy”. Named after the early silent film Dr Dippy's Sanatorium (1906), “Dr Dippy”' is the sort of psychiatrist who lacks common sense, but is harmless. In the eponymous film, Dr Dippy brings disorderly patients under control with a tasty picnic lunch. The Dream Team (1989) is a more contemporary example. Dr Jeff Weitzman (Dennis Boutsikaris) takes his in-patients on a daytrip to New York City. Weitzman stumbles across a murder in progress, is knocked unconscious, and his patients must fend for themselves. One “bad” psychiatrist has made this category all his own. The barbaric Hannibal Lecter—forensic psychiatrist and cannibalistic serial killer—was chosen in 2010 by the American Film Institute as the number one movie villain ever. Introduced in Thomas Harris's 1981 novel Red Dragon, Lecter is cultured, intellectually brilliant and irretrievably psychopathic. To date he has eviscerated (and dismembered) his way through five films, and two television series. Should Lecter ever be retired, there is no shortage of other evil psychiatrists. Dr Jonathan Crane (Cillian Murphy) in Batman Begins (2005) is also known as “The Scarecrow”. Crane, the head psychiatrist at Arkham Asylum, develops a fear toxin, which is released into the Gotham City water supply, endangering millions. Almost as reprehensibly, Dr Peter Silberman (Earl Boen) repeatedly tries to stop Sarah Connor (Linda Hamilton) saving the world in The Terminator (1984) and its sequels. Not homicidal, but still worth avoiding, is Dr Gideon Largeman (Ian Holm) in Garden State (2004). After a tragic accident, Largeman heavily medicates his nine year-old son Andrew to control his emotions. The film takes place after Andrew (Zach Braff), now adult, decides to stop the medication. So-called good psychiatrists also show varying levels of ability and ambition. In the final reel of Psycho (1960). Dr Fred Richmond (Simon Oakland) offers an explanation for Norman Bates' (Anthony Perkins) behaviour. This scene is so brilliant and insightful that one wonders where he was earlier on in the action, when such intellect was in short supply. Dr Sonia Wick (Vanessa Redgrave) is wise and kind when she appears briefly in Girl, Interrupted (1999) as head psychiatrist at the Claymoore Hospital. Meanwhile, Dr John Cawley (Ben Kingsley) is a doctor of great therapeutic aspiration. Crawley is also a lead psychiatrist, this time at the Ashecliffe Hospital for the criminally insane as seen in Martin Scorsese's Shutter Island (2010). Crawley oversees an epic bid to cure his patient Edward Daniels (Leonardo DiCaprio), by contriving that his entire facility assume roles drawn from Daniels' psychotic delusions. A similar idea to Crawley's was dramatized on the small screen 20 years earlier, in the David-Lynch-conceived TV series Twin Peaks (1990–91). The series relates the bizarre events that follow the murder of Twin Peaks resident Laura Palmer. Dr Jacoby (Russ Tamblyn) was Palmer's psychiatrist at the time of her death. Jacoby cures psychotic depression of a fellow Twin Peaks resident by way of an American Civil War re-enactment. Beyond Lynch's aegis, the small screen is the home of the most detailed characterization of fictional psychiatrists. Frasier Crane was pompous and snobbish through six series of Cheers (1982–93) and 11 series of Frasier (1993–2004). Jennifer Melfi (Lorraine Bracco) is mobster boss Tony Soprano's (James Gandolfini) therapist and confidant during six series of The Sopranos (1999–2007). This is not always to her advantage: at one point she is forced to go into hiding, when Soprano's associates fear that she could testify against them in court. As a female psychiatrist in a significant role, Dr Melfi is a relative rarity and only a few of the above productions feature female psychiatrists. This issue is symptomatic of a wider and ongoing concern about the film industry, in which cinematic representation of women is, generally, inadequate. The so-called Bechdel test is sometimes deployed to illustrate how frequently onscreen women have little to do and feature in films only in relation to men. Only five out of nine of the 2014 best picture Oscar nominees passed. It is female onscreen psychiatrists who have particular trouble maintaining professional boundaries with their patients. In Hitchcock's Spellbound (1945), Ingrid Bergman falls in love with Gregory Peck, even though he may (or may not) be a murderer. 12 Monkeys (1995) takes place in a world where a deadly virus has forced humanity into subterranean existence. James Cole (Bruce Willis) is sent back in time to the present day to collect information to allow the virus to be combated. However, he is detained in hospital. He kidnaps his psychiatrist Dr Kathryn Railly (Madeleine Stowe), who comes to believe his fantastical story. Ultimately, movies and psychiatrists share a focus in kind: human emotions, behaviours, and motivations. It's not hard to see why psychiatrists receive so much more attention than many other professions. This isn't to say that things couldn't be done a little better. For every film that makes it to cinemas there are legion that are abandoned along the way. The missing masterpieces about psychiatrists might exist only as dusty scripts in forgotten basements. I have one idea I wish to share. Films based on Marvel Comics characters have been extremely popular in recent years. Dr Leonard “Leo” Samson, a Marvel character, is a psychiatrist who gains superhuman strength following exposure to gamma radiation. Samson appeared (without superpowers) in The Hulk (2008), but a definitive screen treatment is thus far lacking. A film starring Benedict Cumberbatch is planned about another Marvel superhero Dr Strange—a former neurosurgeon with magical abilities. Is it possible that Doc Samson might also get his moment of cinema glory?