Psychiatry and films
Great plot, shame about the characters
Mar 22nd 2007
From The Economist print edition
Using film to train shrinks works better in some places than in others
EVERY culture has its own ideas about health, privacy and medicine. But in most places people can agree there is nothing too mysterious or controversial about the science of broken bones—or the way aspiring doctors should be taught to mend them. As every medical professor knows, you just find a patient with some nice fractures and escort a gaggle of students to the bedside for a good long stare. As long as the sufferer is not prodded too hard, or denied a clear view of television, no ethical rules are violated.
But things are much more delicate when it comes to teaching pupils about psychiatric disorders—not least because the very definition of mental illness is controversial and varies from culture to culture. Then there are the ethical and legal questions: if patients' mental symptoms are severe, it might be harmful to subject them to student questioning. Even videotaped interviews with consenting patients have drawbacks. Show the tapes to enough students, and someone might recognise a neighbour or family friend.
In the United States, a growing number of psychiatry professors see an answer in Hollywood and its large output of films that deal with disorders of the mind. Carol Bernstein, a teacher of psychiatry at New York University School of Medicine, has found a good response to a course she co-presents called: “Teaching Psychiatry? Let Hollywood Help!”
Its popularity seems to disprove the charge that Hollywood “trivialises” mental disorders, Dr Bernstein says. The course attracts doctors from all over North America, and increasingly from Europe—although many European psychiatrists have their doubts about teaching by film.
Roelof ten Doesschate, head of a large psychiatric hospital in the Dutch city of Deventer, worries that films like “As Good As It Gets”—a portrayal of an obsessive, cantankerous writer—understate the wretchedness of real-life mental illness. Dutch hospitals already use actors for training purposes, hiring them to play disruptive patients—so the idea of using simulation to teach medical students is not too shocking. But the American practice of using film clips to teach already qualified doctors, training to be specialists, does alarm Dr ten Doesschate; at that level, he feels, only flesh-and-blood patients will do. “For registrars it's a poor solution, they need to be doing real work.”
But Dr Bernstein sees teaching by film as both valid and necessary, especially for instruction about personality disorders like paranoia, obsessive compulsive disorder or psychopathy. Sufferers from such disorders are hard to find. Psychopaths often shun psychiatrists, and, she notes: “A paranoid patient isn't going to consent to have a lot of people interviewing them.”
Her verdict on “As Good As It Gets”, which stars Jack Nicholson, is rather positive. Throughout the film, she argues, “you see how the disorder impairs his ability to function. Now, if you took a medical student into an interview with a patient, in 45 minutes you're not going to see that. Film gives them a sense of what life is like with that disorder.”
Dr Bernstein admits, though, that many film depictions of psychiatry and mental disorders are “terrible”. Among shrinks, there is keen resentment of the comedy “Me, Myself & Irene”, in which Jim Carrey plays a policeman variously described as “schizo”, “psycho” and suffering from multiple personality disorder. In contrast, the film “A Beautiful Mind”, about the mathematician John Nash, is praised as a fair depiction of schizophrenia.
Not that psychiatry on film is ever quite true to life. Much psychiatric medicine is undramatic stuff, involving the prescription of drugs to uncommunicative patients. Hollywood prefers to show sufferers talking about their problems. Glen Gabbard, director of the psychiatric clinic at Baylor College of Medicine in Texas, studied hundreds of fictional film psychiatrists to co-write the book “Psychiatry and the Cinema”. He found that “movie psychiatry bears almost no resemblance to real-life psychiatry. If we videotaped a typical day in my practice with patients, the audience would be bored out of their minds.”
Even in the old world, teaching by film has its advocates. Dinesh Bhugra, dean of the Royal College of Psychiatrists in Britain, has long supported the educational use not just of Hollywood films but also of Bollywood films from his native India. The professor, who began his training in India, is convinced that movies remain under-valued as teaching tools in both countries. “In Britain, cinema still has generally a low cultural value, and in India it is a snobbish thing to look down on Bollywood,” Dr Bhugra laments. Such arrogance is missing the point, he argues: whatever their artistic merits, Bollywood films are a useful way to teach medical and psychiatric students about “cultural issues to do with the family, or shame versus guilt”.
Indian films may not be as suitable as American ones for showing specific mental disorders. Having studied the way Hindi films treat mental illness, Dr Bhugra finds that too often psychoses are sketchily portrayed: they frequently involve people “hearing voices”. The mentally ill tend to be relegated to slapstick sub-plots, alongside a central love story.
Such stereotypes may be shocking to Western scientific sensibilities, but they can still—in Dr Bhugra's view—be a useful window on some aspects of Indian culture. It's the sort of insight a shrink might need in multicultural London.
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