The Cinematic Psychiatrist

Whenever a Stanley Kubrick film opens, it is an event. Kubrick, who is considered by many the cinematic genius of the 20th century, made 15 feature films. The eager anticipation surrounding his last film "Eyes Wide Shut," scheduled to be released this summer, has intensified even further because of Kubrick's unexpected death last March at the age of 70. Although the film is shrouded in standard Kubrickian secrecy, leaks suggest that Tom Cruise and Nicole Kidman play psychotherapists who are sexually involved with their patients.

While many in our field will shake their heads in exasperation at more negative publicity for psychiatry at a time when the specialty is particularly beleaguered, we may take solace in the fact that filmmakers continue to be fascinated with what we do. In the first edition of Psychiatry and the Cinema (University of Chicago Press, 1987), my co-author Krin Gabbard, Ph.D., and I catalogued 250 theatrically released American films that featured some type of psychiatrist or psychiatrist-like figure at work. In the second edition, recently released by American Psychiatric Press (1999), we have identified nearly 450. This rather staggering figure excludes television movies, foreign films and assorted pornographic films in which psychiatrists and other mental health care professionals appear for "redeeming social value."

It all began with the 1906 silent film "Dr. Dippy's Sanitarium." Images of psychiatrists have continued and have included "Analyze This," the biggest box office hit in March of this year, and now "Eyes Wide Shut." Why is Hollywood so enamored with us?

Psychiatrist and film scholar Irving Schneider once quipped, "If psychiatry had not existed, the movies would have had to invent it. And in a sense they did." Film critic Parker Tyler referred to the movie house as the "psychoanalytic clinic of the average worker." Indeed, psychiatry and the cinema have always been inextricably intertwined. They both grew up in the early years of the 20th century and came of age together.

The psychotherapist has always been a marvelous plot device for filmmakers. While an omniscient narrator can describe the inner life of the protagonist in a novel, the cinematic medium must resort to a hokey voice-over or elaborate exposition that takes away from the action. A simpler solution is to have the protagonist visit a therapist so the audience can see a side of the character that isn't revealed in the action of the narrative.

In the 1971 film "Klute," Jane Fonda plays an apparently self-confident prostitute who visits a therapist and pours out her heart, revealing a vulnerability and complexity that surprises the audience. The same year George C. Scott appeared in "The Hospital," where he visits a psychiatrist early in the film to establish that he is depressed and contemplating suicide.

When psychiatrists are used in this way by the screenwriter, they are often faceless characters who have no personality and simply sit quietly and listen. In early Woody Allen films, such as "Bananas" in 1971, the analyst sitting behind him is nothing more than a silent audience for stand-up comedy routines delivered from the couch.

Throughout cinematic history, however, many psychiatrists and psychotherapists, who are actively involved in the action and take on importance as central characters have appeared. They may appear as romantic leads, such as in the 1938 classic "Carefree," in which Fred Astaire "psychoanalyzes" Ginger Rogers while wearing a tuxedo and dancing with his patient. They may play sinister figures such as Hannibal Lecter in the 1991 film "The Silence of the Lambs." Here, the psychiatrist is the embodiment of evil but also an extraordinarily astute clinician who can diagnose Clarice Starling's psychological conflicts by identifying her perfume and assessing her shoes and clothing with the clinical acumen of Sherlock Holmes.

Like the Tom Cruise and Nicole Kidman characters in "Eyes Wide Shut," psychiatrists and psychologists have often slept with their patients in the movies. In "What's New Pussycat?" (1965), Peter O'Toole is a libidinous seducer and Viennese quack pursuing his female patients with great fervor. In almost every film in which a female psychotherapist treats a male patient, from Ingrid Bergman in "Spellbound" (1945) through Lena Olin in "Mr. Jones" (1993), the therapeutic relationship is almost always transformed into a sexual relationship. In fact, we were able to identify 29 films in which a female therapist becomes sexually involved with her male patient. By contrast, we only identified 17 films in which a male therapist sleeps with a female patient. As any member of a psychiatric ethics committee knows, this situation is exactly the reverse in the real world, where male cases of sexual misconduct outnumber female cases by a ratio of at least 3:1.

Hollywood has never been able to accept the notion that a woman could be a competent professional and at the same time have a satisfying personal life. This view is not confined to women psychiatrists. In Jeanine Basinger's scholarly review of the women's films of the 1930s, '40s and '50s, she noted that women are frequently depicted as functioning outside rules and conventions, dodging bullets, settling the frontier, and performing brain surgery, but they are ultimately tripped up when they fall in love with a handsome male character in the film. Sexual stereotypes must be undermined and then restored by the end of the film so that the audience can go home with everything in psychological order. One finds occasional exceptions when a female psychotherapist does not fall in love with her male patient, but out of nearly 450 films, we could only find two theatrically released American movies, "Private Worlds" (1935) and "Last Embrace" (1979) in which a woman therapist effectively treats a male patient.

While the depictions of psychiatrists and psychotherapists in film over the years are predominantly negative, there was a brief golden age between the years 1957 and 1963 when we found over 20 consistently idealized portrayals of psychiatrists and psychotherapists in mainstream American film. These include "Psycho" (1960), "Splendor in the Grass" (1961), "Freud" (1962), "Captain Newman, M.D." (1963) and "Fear Strikes Out" (1957) among others.

Beginning in 1964, however, psychiatrists began a steady decline in movies as they became viewed as part of the establishment in the wake of the counterculture and anti-Vietnam war movement. This view of psychiatry was well established by 1975 in "One Flew Over the Cuckoo's Nest," in which psychiatrists have clearly become repressive agents of a society that attempts to stifle the creativity of free spirits.

The shift in the cinematic view of psychiatric expertise is particularly striking when contrasting the 1960 version of "Psycho" to the 1998 version. Before Simon Oakland appears in the 1960 version, a detective can be heard saying, "If anyone can explain this, it will be the psychiatrist." Oakland then unleashes a magnificent psychodynamic formulation that explains the psychopathology of Norman Bates while also solving the crime and locating the missing money. His authority and competence are awesome to behold. In Gus Van Sant's 1998 remake, Robert Forster plays the same character with a befuddled look on his face and approximately 10% of the conviction that Simon Oakland displayed in the original. His monologue is reduced in length, and his credibility is undermined.

Psychiatric treatment in American movies also follows standard conventions and genres. The psychopharmacological revolution that happened in psychiatry is hardly in evidence in cinematic depictions. Psychotherapy or psychoanalysis are almost always the modes of treatment on the great silver screen because of their usefulness in illuminating the depths of character. In fact, until the 1997 hit "As Good As It Gets," we could not find one example of the effective prescribing of psychotropic medication in any American film. In that movie, Jack Nicholson's character (Melvin) is tortured by obsessive-compulsive disorder until he finds himself falling in love with a waitress played by Helen Hunt (Carol). At one point he tells her that meeting her and getting to know her has made him want to be a better man, so he decides to take the medication that has been prescribed for his disorder. As the film progresses, Melvin finds himself much less concerned about stepping on cracks in the sidewalk and contracting germs. However, the film is a bit ambiguous regarding whether it is Carol's love for him or the psychotropic medication (or perhaps both) that serves as the therapeutic agent in his obvious improvement.

Much more commonly, the cinematic cure involves the recovery of a repressed traumatic memory with a cathartic abreaction the likes of which one rarely sees in actual psychiatric practice. In "The Three Faces of Eve," the 1957 vehicle for Joanne Woodward that won her a best actress Oscar, Eve recalls under hypnosis that she had to kiss her dead grandmother when she was a little girl. Miraculously, her multiple personality disorder is cured, and she lives happily ever after. However, catharsis does not always involve the retrieval of a repressed traumatic memory.

For example, in a more contemporary film, like 1997's "Good Will Hunting," Robin Williams plays a therapist (Sean McGuire) who takes a highly unorthodox psychotherapeutic approach with Will Hunting, portrayed by Matt Damon. In the climax of the film, the cathartic scene occurs when McGuire repeatedly states, "It's not your fault," moving one step closer to Will with each utterance. Will has apparently been harboring extraordinary self-blame and guilt, though nothing in the screenplay has suggested such feelings, and eventually breaks down and sobs as he recognizes that his abusive childhood experiences as an orphan were not of his own doing.

Sometimes the cures are even simpler, as in the 1989 film "Skin Deep." John Ritter (Zach Hutton) portrays a narcissistic womanizer seeking psychoanalytic treatment from an analyst, Dr. Westford, played by Michael Kidd. The pivotal intervention comes when the analyst compares womanizing to alcoholism. Westford tells his patient that when he treats an alcoholic, he delivers a simple message: "First, stop drinking." Zach then stops womanizing and, after several months of celibacy, appears ready to live happily ever after with his former wife.

This mode of therapeutic action departs from the usual cathartic cure we expect to see from Hollywood. However, the technique depicted is equally simplistic and similarly nave about therapeutic change. The method of cure is straightforward: Whatever it is you are doing, stop it. This approach would undoubtedly be endorsed by managed care companies, who might argue that such advice could be offered in one session.

While we can commiserate with one another about the impact such depictions have on our public image and on potential patients, we can also learn something about the image we project to those outside our field. Indeed, as Michael Crichton said at a recent meeting of the American Association for Advancement of Science, where he was criticized for his portrayal of scientists in "Jurassic Park" and other movies, no profession likes the way they're depicted in movies. We may actually take heart from the old Hollywood axiom that there's no such thing as negative publicity.