This post was brought to you by my psych rotation. I won’t be telling you anything, really, about my experiences on the psych unit, because these are some of the most vulnerable patients in all of medicine and it doesn’t feel appropriate. Media representations of psychiatry, on the other hand, I will talk about all day. It’s been on my mind ever since the morning I got to sit in on some ECT sessions. ECT, if you’re not familiar, is Electroconvulsive Therapy, colloquially called shock treatments, and if you are familiar it’s probably because you’ve had some. Otherwise chances are you’ve been exposed to some wildly inaccurate conceptions of this medical procedure.
I haven’t experienced ECT as a patient, and wouldn’t presume to speak for those who have. As a rule, however, modern ECT is not represented in media from the patient’s perspective, and for good reason: that would be hard to film, and boring, because patients go through this procedure under anesthesia. In fact it’s kind of boring to watch IRL, in the best possible sense. ECT is performed with the patient 1) asleep and 2) medically prevented from having muscle spasms associated with some types of naturally occurring seizure. The patient points their foot, and makes a face (caused by involuntary muscle contractions, not pain, see above asleepness), and that’s the whole show. Well I guess the machine also makes an inoffensive beep to make sure everyone knows the shock is being administered. But there’s just…not much to see. Do these important details come through in the way ECT is represented in, say, Homeland?
Haha, not likely! No, Homeland wants you to know that mental health treatment not only ruins careers, it looks and sounds like a living nightmare. At least that’s how it seems by the end of Season 1; I stopped watching after that because of this scene. Also because of the more than slightly exploitative approach to its protagonist (as this blogger put it, “It says a lot that for the most part the obsequious wannabe terrorist was a more sympathetic character than the mentally ill woman he was conning”), because of its casual islamophobia, and because it is a major pet peeve of mine when supposedly hardened, CIA-employed characters say nonsarcastic lines like, “My god. You’re in love with him!”
Look ECT isn’t magic, though TBH it can feel that way when a really sick patient who isn’t responding to medications or therapies starts to get better after having this treatment. This isn’t going to be a summary of the evidence base surrounding its use, though please feel free to post one on your own blog. I raise this issue because I think it typifies the representations of psychiatry and mental health care in popular culture. In contrast to the way medical doctor characters are so often written as relatable heroes (Grey’s Anatomy, E.R.), or at worst as lovable scamps even when their behavior is sociopathic (Scrubs, House), our baseline cultural understanding of psychiatry is pretty different. I object to the double standard. There are deep historical reasons for the mistrust between the public and psychiatrists, but yo, there are deep historical reasons to distrust anyone remotely connected to medicine (paging Dr. J. Marion Sims). I don’t believe the double standard is fair or accurate. The stigma attached to mental illness is bad enough–do we have to stigmatize the treatment of those illnesses too?
And so, by way of counteracting the trope of the sadistic power-mad and also just vanilla-mad shrink, I have assembled a collection of representations that I believe give a more realistic picture of psychiatrists. They’re not hero-healers, they’re just folks, and sometimes they help their patients live with incurable and potentially life-ruining diseases. This is list is by no means comprehensive–hello, I’m in medical school, I don’t have time to watch good TV, much less shows I hate like The Sopranos–but let me know if you’d like to do an updated content analysis some day. Here is a link to an out-of-date scholarly analysis if that’s your bag.
Below the jump the entire post is spoilers.
1. Manic. This underrated indie film from 2001 stars Don Cheadle as Dr. David Monroe, a psychiatrist at an inpatient psychiatric facility for adolescents, along with a cast of young people including early-career Joseph Gordon-Leavitt and Zooey Deschanel. In some ways it sets itself up as an explicit rebuttal to One Flew Over the Cuckoo’s Nest. The patients in this movie are sick, and profoundly lonely, and they need to be where they are. Notably both films feature an indigenous character; Manic implicitly thumbs its nose at the noble savage trope with Kenny, one of the most vulnerable characters ever filmed. JGL’s character, Lyle, wants to rescue Kenny so much, but crucially Kenny’s suffering is about Kenny, and he won’t be saved to soothe Lyle’s pain.
Don Cheadle plays David as a capital G Good Doctor, who is one of the few positive forces in some of his patients’ lives, and one who is acutely feeling the strain and questioning whether what he does is worth it. He makes mistakes not because of a Tragic FlawTM but because being a psychiatrist is really, really hard. The scene where he loses his temper at Lyle resonates with me (I’m not embedding video due to the copious f-bombs, but here is a link), but so does the low-key scene where he makes amends for it. It realistically shows that some patients get better with treatment, some people won’t or can’t, and others cycle in and out of illness. It’s clear that as much as David is haunted by his limitations as a healer, he represents his patients’ best shot at beginning to have a life outside the hospital. Nobody in the world of this movie gets better by trying to make it on their own.
2. “The Killing.” In Season 2 of this AMC thriller, the show’s protagonist, Detective Sarah Linden, spends the episode “72 Hours” in an inpatient unit under an involuntary commitment. I am blown away by the way this episode is directed (by Nicole Kassell, apparently, whose work I don’t know). At first we experience Linden’s sensation of being trapped, and her mistrust of the hospital staff, especially her psychiatrist, Dr. Kerry. The atmosphere is so well constructed that only later do we wonder “Why does this doctor seem so creepy? She’s not actually doing anything creepy.” The answer is that Linden sees the world this way, including people who want to help her. Linden does not trust the medicines she is prescribed, either, and when her (generally falling apart) partner Detective Holder finds her sedated and incoherent a few hours later, her suspicions seem to be confirmed. He swings into action to get her out of the psych unit. He is busy mounting his rescue and is not around the next day, therefore, to see that Linden is tolerating the medications much better, and starting to feel like herself again–sleeping and eating, for example, for the first time in weeks.
The structure of her interview with Dr. Kerry is not super plausible and smacks of psychoanalytic techniques would be really weird to find in a contemporary hospital, but the quality of their relationship is convincing, and they slowly build rapport as Linden improves in her time on the unit. She and Dr. Kerry are on the verge of a breakthrough when they are interrupted–Holder has succeeded in getting the involuntary commitment lifted, and Linden leaves. This is when we learn that her sucky ex-fiance is also her sucky ex-psychiatrist, and he is the one who has sprung her from the hospital–just in time to save her from getting help. No wonder she had trouble trusting Dr. Kerry, she has been abused by almost everyone who has ever offered to help her. It’s Linden’s tragedy that she knows she is sick, but she can’t undo the patterns she learned as an abused and neglected child. The series continues for two more seasons, and she never gets help. She tries to make it on her own.
3. The Wackness. This move is in many ways annoying, and phallocentric as all get out, but it captures incredibly well the world of mid-90s in Manhattan in which I grew up. It’s a story of the relationship between a psychiatrist having a midlife crisis, played by Ben Kingsley, and one of his teenage patients, played by Josh Peck, who decides at the end of the movie to become a psychiatrist himself. I’m putting The Wackness on this list because of the way it approaches psychiatric medications. Kingsley’s Dr. Squires is blowing up his marriage and inappropriately blurring the lines between treatment and friendship with a patient who represents the youth he is missing in himself. Crucially, this kind of behavior that is so often romanticized in film turns out to be pretty strongly connected to the fact that Dr. Squires has gone off his psychiatric meds, and toward the end of the film he becomes suicidal (albeit in a darkly comic way). In contrast to movies like, say, Garden State, in which psychiatric medications are represented as a factor that stunts the protagonist’s emotional growth, Dr. Squires’ big revelation is when he realizes that maybe this childish behavior is hurting him, and it’s time to go back on his meds. They help. Feelings are hurt, but everyone turns out ok.
4. Silver Linings Playbook is another film that testifies to the fact that psychiatric meds, while they are often no picnic, can also help people who are in pain and struggling to function in a world full of people whose brain chemistry works differently from theirs. At the start of the movie Bradley Cooper’s character, Pat, is tonguing his meds on an inpatient unit. His character’s arc rests importantly on his acceptance of the need to take his medications–and they don’t make him symptom-free, but they do help him feel better. I know some have voiced objections to the behavior of the psychiatrist character Dr. Patel, played by Anupam Kher, and I can’t wholly disagree with that. I found the quality of his therapeutic relationship to Pat convincing, though, and it feels important to me that he’s a positive presence in Pat’s life. Eagles fans’ obsession with their team is a major theme of the film, implicitly compared to Pat’s obsession with his ex-wife, and I felt like it worked comedically that even Dr. Patel abandons his professional boundaries in the name of football. But “accurate” would probably not be a good description of that part of the movie.
5. Benny & Joon. I know what you’re thinking, but just hear me out. The movie is over 20 years old and deeply problematic–I would call it a problem if someone hired to care for a woman with a mental illness then has sex with her, and it is not a mitigating factor if that person looks like a young Johnny Depp. One part of the movie that I think holds up, however, is CCH Pounder’s performance as Dr. Garvey. She’s arguably the only person in the movie who actually looks out for Joon’s interests, and who kindly but completely correctly harps on about Benny’s caregiver fatigue and need to get his own life instead of micromanaging his sister’s. Unfortunately, because every character in this movie is dysfunctional, Dr. Garvey is the only one who doesn’t get to see Johnny Depp swinging back and forth across Joon’s window on the window washer’s cable. Presumably if she did she might go, “Hey guys, this person is an unstable abusive stalker who should not be in Joon’s life.” Rom coms are the worst.
6. “In Treatment”. Of course I’m going to include the mother of all mental health dramatizations. This is a show that follows Paul West, a therapist played by your sexy older boyfriend Gabriel Byrne. In the third season, Paul becomes the patient of a psychiatrist, Adele Brouse, played by Amy Ryan. She’s younger than him, she has an MD and a PhD (zing!) and she discloses very little of her own emotions–she is everything he isn’t, and her very existence rebukes him. Doctors, as always, make the worst patients, and Paul comes to her because he’s looking for a prescription. I love the way their arc shows Adele pushing Paul to engage with his own feelings, and the sophisticated defense mechanisms he has constructed.
This series’ main theme is the boundaries between Paul and his patients, and between him and his therapists, and about his urges to break across those boundaries–sometimes noble, generally destructive. It is an incredibly important contribution, in my opinion, that “In Treatment” shows how Paul fancies himself in love with Adele, and she…just deals with it, like a doctor is supposed to. She doesn’t take it personally. She doesn’t have sex with him. She doesn’t fire him from her practice. She just helps him try to figure out what it means, so he can get better. In fact she’s such a good doctor that Paul quits therapy because he basically can’t cope with the fact that he can’t read her, and doesn’t have access to her personal life outside their sessions.
That’s it! That’s the list! Go forth and try not to lie about mental health care.