What’s up with all the shrinks and movies?

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An Italian psychiatrist asks, “What’s up with all the shrinks and movies?” and dives into a discussion about the role of film in psychiatry.

Apart from the narratives, the visual pleasure, the innovations in form and content, the recognition, the stereotypes and the challenges, what has cinema ever done for psychiatry?

Please allow me to suggest/summarize a few potential answers.

Cinema is at once a powerful medium, art, entertainment, an industry and an instrument of social change; psychiatrists should neither ignore nor censor it.

Representations of psychiatrists are mixed but psychiatric treatments are rarely portrayed positively. This may be used for teaching purposes.

Commercial and artistic pressures reduce verisimilitude in fictional and factual films, although many are useful to advance understanding of phenomenology, shared history and social contexts in psychiatry.

Acknowledging some negative representations, the three areas where cinema gets it mostly right are: addictions, bereavement and personality disorder. Although there are excellent representations of psychosis on film, film-makers have more often portrayed it violently – ultimately demonising people (again, this may be very useful anyway for teaching or divulgative purposes).

When people with mental illness are stigmatised through stereotypes, examining unwelcome depictions can uncover important truths (anti-stigma).

Given the iron triangle of public anxiety and distrust of people with mental illness, an alienated tabloid press and government policies focused on populist measures, any media coverage that helps to engage that public is better than none. Would we and our patients really be better off if films with a theme of mental illness were censored or banned?

I have seen more young people with psychosis who reference The Truman Show (1998) and The Matrix (1999) than higher powers. Many films perpetuate public perceptions that violence is a symptom of mental illness, but films depicting mental illness are not universally negative.

Let’s not forget the opportunities to watch and/or discuss films in group work (psychiatry film club, often successful in my experience).

Many films can be used to teach psychopathology and the wider effects of the mental illness label. Some films are: ‘encouraging, as are the messages of hope, resilience, rebellion, and self-determination’ (Rosen).

Films in which a mental health theme is a minor component stretch audiences beyond the confines of clinic-based psychiatry. We can’t catch everything but as psychiatrists we should be familiar with what our patients and their families watch (cultural training): astute clinicians explore people’s preconceptions about psychiatric labels before imparting a new diagnosis.

For a more articulated discussion you may read this brilliant, inspiring paper on APT.

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