Psychiatry and Cinema: What Can We Learn from the Magical Screen?

Soumitra DAS, Nimisha DOVAL, Shabna MOHAMMED, Neha DUA , Seshadri Sekhar CHATTERJEE

•FORUM•

Psychiatry and Cinema: What Can We Learn from the Magical Screen?

Soumitra DAS1*, Nimisha DOVAL2, Shabna MOHAMMED3, Neha DUA4, Seshadri Sekhar CHATTERJEE5

cinema, mental illness, psychiatric disorder

1. Introduction

Psychiatry has transformed rapidly from the dark era of asylums and torture to the light of human rights and neurobiological interpretation. The path it traversed has been far from easy. Even now, in the twenty first century, we find ourselves fighting against stigma and the brutal behaviour of an ignorant society. It has been rightly said that "The eyes cannot see what the mind does not know." Likewise, we never understand the pain of the unseen battle that a mentally ill individual fights within himself as well as with the outside world.Cinema is a powerful medium and an instrument of social change. But, the art is not totally unbiased. In the current era, cinema about the medical field is like a coin with two sides. While on one hand cinema can help improve awareness of disorders and thus improve helpseeking behaviour by a sensitive depiction of certain psychiatric disorders in cinema, on the other hand, we have stereotypical portrayal of mental disorder, violent portrayal of psychotic patients, ultimately demonising them as psycho-killers, sensationalism in the presentation of a mental break down like suicide, and unnecessary criminalisation of psychiatric treatment have made a difficult situation worse.[1]Also, the portrayal of psychiatrist and treatment approaches in Indian as well as Western cinema has been equally stereotyped,ridiculous and stigmatizing.[2,3]At times, the only aim of some filmmakers seems to be to make money at the box office by showing the public what it wants - violence.[4]To popularise psychiatric themes among viewers, who are mostly laymen, the medium largely focuses on unipolar conflicts rather than taking an overall view. This article attempts to overview the overall impact of the magical world of cinema on psychiatry.

2. Violence

Violence has been the core theme of movies since the early 90's. The seminal work of Alfred Hitchcock,The Psycho (1960), shows violence as a prototype of psychiatric symptoms. Here, a quiet person whowould not even kill a fly turns into a heinous serial killer. It was one of the first of the "Psycho-killer"genres. Similarly, the film adaptation of the novel,"The American Psycho" by Bret Easton Ellis, exploited public perception of mental illness by depicting bloody violence and sex. A myriad of movies has since emerged with the same ideas. A few famous titles which are worth mentioning are M(1931), Butterfly Kiss(1995),Seven(1996), Fight Club(1999), Ichi the Killer(2001),Spider(2002), Asylum(2005) and Mr. Brooks(2007).

Filmmakers have almost forgotten that there is another part of psychosis- the negative symptoms. A few movies, like The Machinist (2004) however have portrayed it wonderfully. Cinematic representation has distorted the real picture so much, that even doctors get confused about the difference between psychopathic killing and Psychosis.

3. Boundary Violation

In the real world, psychiatrists arerarely involved in a romantic relationship with their patients. This extremely rare and unethical phenomenon has been depicted in many films. The Hindi movie "Kyon Ki" depicted the romantic relationship between a lady doctor and her patient which lead to the death of the patient. Also,in movies of a similar kind, like "Spell Bound(1945)", "Prince of Tide(1991)", "12 Monkeys(1995)" and "The Jacket(2005)" female therapists violated the boundaries of the doctor-patient relationship. Even though these stories were fascinating, it gave the wrong message about the integrity of doctors.

4. Sensational Melodrama

Suicide is always a sensational theme to attract people to the screen. The media has publicised it so much that it has lost its painful side. Movies like "The Bridge(2006)" exaggerated suicidal techniques. A few movies seem to suggest that suicide is the only solution to mental illness or addiction. An example is the Indian movie, "Ashiqui 2" where a singer suffering from alcohol dependence felt the only solution was killing himself rather than going to a psychiatrist. In "Love and Suicide (2006)", an ex-lover on finding that she had made a mistake in breaking up with her late lesbian girlfriend, presented her eternal respect by committing suicide. Also, grief is shown inaccurately in movies like"Windstruck (2004)", "Wristcutter: A Love Story(2006)"and "Under The Skin(1997)".

5. Drugs and Drama

Filmmakers have done some good in this aspect. A wonderful Malayalam movie, "Spirit" by Mohan Lal genuinely illustrated this grave problem of the society and the need for treatment. "Crazy Heart (2009)"showed the effectiveness of Alcoholic Anonymous (AA)and won thousands of hearts. "The Fighter (2010)"depicted the true story of brotherhood and redemption from cocaine addiction. These movies proved that commercial films can be made with good messages.There are innumerable movies showing the negative consequences of alcoholism like, There Will Be Blood(2008), Nixon (1995), Nil by Mouth (1998) which could be used to motivate patients.

6. Mood disorders in Movies

The journey started with "Prozac Nation" which beautifully described the stages of Depression.The author of the novel referred to the USA as the "United State of Depression". It showed the epidemic of depression during the pre-medicine era and the revolutionary effects of antidepressants like fluoxetine. On the other hand, "The Silver Linings Playbook" gave an inspiring account of a person who fought against mood disorder. These are only a few examples. However, many movies value love above treatment, as if love could cure all illnesses whether it was schizophrenia or depression. In fact in movies like "North 24 Kaatha", love could even cure severe OCD. ECT, a magical treatment for mood disorders and schizophrenia is always being criticised and dramatized by film makers.[5]This made ECT a taboo leading to its avoidance in most cases. In the film Akira, ECT was stigmatised by wrongly depicting it as a tool to control people and make them insane. Psychiatrists need to spend a lot of time proving that the bizarre nature of the treatment shown in movies during shock therapy is baseless and unscientific.

7. Wrong depictions in Bollywood

Girish Banwari studied the portrayal of psychiatrists in Hindi movies and found that 42.4 % of psychiatrists depicted in Bollywood were clinically incompetent,only 30.3 % could make an accurate diagnosis, 39.4 per cent of them breached professional ethics, 24.2% transgressed non-sexual boundaries, 15.2 per cent violated both sexual and non-sexual boundaries and lastly treatment outcome was depicted as positive in only 23.1 per cent of the movies analysed.[2]

Imagine how encouraged a person suffering from a mental illness would be to visit a psychiatrist after such depictions, especially in an already stigmatized society!

8. The positive side

Even this cloud has its silver lining! Movies have some positives aspects too. "A Beautiful Mind" was an outstanding movie which portrayed the psychopathology of schizophrenia so beautifully in a legendary mathematician, John Nash. It showed the usefulness of insulin coma therapy. Probably there is not a single movie which expounded the stages of Alzheimer's disease better than "A Moment to Remember". The catchy dialogues, "If you forget everything, I'll pop up out of nowhere. Like now. And I'll hit on you. You won't be able to turn me down. We'll start a new every day", sticks in our mind for a long time. Some Indian films have also shown dementia well like "Asthu (Marathi language)","Thanmathra(Malayalam language)" and "U Me Aur Hum". Zhang Yuan's Sons (1996) and Zhou Xiaowen's The Common People (1998) beautifully portrayed psychic and physical anguish combining biology and culture, which contributes to a cross-cultural perspective invaluable to the task of responding to illness and suffering.[6]

Movies like "The Shawshank Redemption", "Never Back Down" taught us the importance of resilience and coping even in the face of insurmountable distress."The Boy Who Could Fly", "Dear John", "My Name Is Khan" are a few titles which highlighted the emotional issues in autism. Fighting and overcoming mental distress with the help of therapies is not a highly appreciated theme in Hollywood or Bollywood but it is noteworthy to watch the few titles which do show it like, "Fear Strikes Out(1957)", "Ordinary People(1980),"Girl, Interrupted(1997)" and "Antoine Fisher (2001)".Most of these were directly supervised by psychiatrists or psychologists and show a good depth of knowledge.Narrowing the audience to psychiatric trainees, there have also been movies that depict the doctor patient relationship, examination of psychiatric patients,diagnosis, thus helping in the teaching of these trainees,making learning more interesting and lively.[7]In a more advanced era, virtual reality technologies (VRTs) will not just be for gaming , they can also be helpful in case of mental illness. Virtual reality exposure therapy is found to be useful in PTSD. Perhaps the medium of film can be used to prevent PTSD in the future.[8]

9. Conclusion

To conclude, the depiction of psychiatry in movies is like a coin with two sides. It is always wise to do some research before jumping to a conclusion about a particular illness and presenting it according to one's own whims and fancies. It is unlikely that filmmakers will deviate much from the existing path without strict control policies. As viewers, it is one's responsibility to find out what is wrong and what is right. But unless the entire psychiatric fraternity all over the world expresses their displeasure with the current media trends, they will continue the horrific and comic portrayal of mental illness, devaluing them as well as the work of psychiatric professionals all over, thus continuing the ongoing stigma of mental illnesses.

Funding statement

No funding support was obtained for preparing this forum.

Conflict of interest statement

The authors declare that they have no conflict of interest related to this manuscript.

Authors' contributions

SD drafted the initial manuscript which was modified and critically reviewed by NiD, SM, SSC AND ND. All the authors read and approved the final draft.

Table 1. Different categories of movies in regards to psychiatry

1. Damjanovic´ A, Vukovic´ O, Jovanovic´ AA, Jasovic´-Gasic´M. Psychiatry and movies. Psychiatr Danub. 2009; 21(2):230–235

2. Banwari GH. The portrayal of psychiatrists in Hindi movies released in the first decade of the 21st century.Asian J. Psychiatry. 2011; 4(3): 210–213. doi: http://dx.doi.org/10.1016/j.ajp.2011.07.001

3. Gharaibeh NM. The psychiatrist's image in commercially available American movies. Acta Psychiatr Scand. 2005;111(4): 316–319. doi: http://dx.doi.org/10.1111/j.1600-0447.2004.00489.x

4. Byrne P. Why psychiatrists should watch films (or What has cinema ever done for psychiatry)? Adv Psychiatr Treat.2009; 15(4): 286-296. doi: http://dx.doi.org/10.1192/apt.bp.107.005306

5. Andrade C, Shah N, Venkatesh BK. The depiction of electroconvulsive therapy in Hindi cinema.J ECT. 2010; 26(1): 16-22. doi: http://dx.doi.org/10.1097/YCT.0b013e3181d017ba

6. Knight DS. Madness and Disability in Contemporary Chinese Film. J Med Humanit. 2006; 27(2): 93–103. doi: http://dx.doi.org/10.1007/s10912-006-9008-7

7. Bhugra D. Teaching psychiatry through cinema. Psychiatr Bull. 2003; 27: 429–430. doi: http://dx.doi.org/10.1192/pb.27.11.429

8. Zinzow HM, Britt TW, McFadden AC, Burnette CM,Gillispie S. Connecting active duty and returning veterans to mental health treatment: Interventions and treatment adaptations that may reduce barriers to care. Clin Psychol Rev. 2012; 32(8): 741–753. doi: http://dx.doi.org/10.1016/j.cpr.2012.09.002

精神病学与电影:从神奇的画面中我们可以学到什么?

Das S, Doval N, Mohammed S, Dua N, Chatterjee SS

电影,精神疾病,精神障碍

Summary:Cinema, a vehicle of social transformation sheds light on different aspects of mental illness. Due to its dramatic and stigmatising depictions, it often spreads a negative aspect of psychiatric disorders and the patients who are suffering from them. Though it brings out a few positive and inspiring stories, they are sparse in comparison to its negative views. Here, we are going to describe the dual impact of cinema on psychiatry.

[Shanghai Arch Psychiatry. 2017;29(5): 310-313.

http://dx.doi.org/10.11919/j.issn.1002-0829.217014]

1Dept. of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, India

2Dept. of Psychiatry, UCMS and GTB Hospital, New Delhi, India

3Dept. of Psychiatry, Dr. SMCSI Medical College, Kerala, India

4Consultant Psychiatrist, Mind Plus, Punjab, India

5PDF Geriatric Psychiatry , NIMHANS, Bangalore.

*correspondence: Dr. Soumitra Das; Mailing address: Dept. of Psychiatry, National Institute of Mental Health and Neuroscience , Bengaluru, India.Postcode: Pin 560029; E-Mail: soumitra_nimhans@yahoo.com

概述:电影是一种社会形态的载体,它可展示精神疾病的各个不同方面.由于电影的戏剧性和污蔑性的描述,它有时会传播有关精神疾病的消极影响,给病人带来痛苦.与消极影响相比,虽然它也会有一些正面和鼓舞人心的故事,但却是少之又少.在此,我们将描述电影对精神病学的双重影响.

Dr. Soumitra Das graduated and obtained a bachelor's degree from the Agartala Govt. Medical College,Tripura, India in 2010, and a doctoral degree in psychiatry from the Govt. T D Medical College, Alappuzha,Kerala, India in 2015. Now he is working as a senior resident at the department of Psychiatry at the National Institute of Mental Health and Neuroscience, Bangalore, India. He is also a member of the Indian Psychiatric Society and IPS, Keraia. His research interests include ECT in clozapine resistant schizophrenia.