Film’s side effects not worth the risks

Glen and Krin Gabbard’s “Psychiatry and the Cinema” describes our discipline’s considerable value for screenwriters. The Gabbards cite the term “ficelle,” first used by Henry James in discussing narrative devices. A ficelle is the system of strings used to control a marionette.

According to the Gabbards, the celluloid practitioner often serves as an admirable ficelle – enabling exposition via flashbacks to recent or remote events (“Tell me more about your bar mitzvah …”); eliciting sensational revelations about emotional trauma; illuminating motivation, and so on. In return, Hollywood’s contribution to the understanding of mental illness and its treatment has been meager. More often than not, movies serve up distortions and trivializations about our work.

Steven Soderbergh’s “Side Effects” is the 26th picture in an artistically accomplished and lucrative career. His works range across nearly every genre from science fiction (“Solaris,” 2002) to the caper film (“Ocean’s Eleven,” 2001). He’s directed exemplary “indie” movies like “sex, lies, and videotape,” (1989) as well as box office hits like “Erin Brockovich”(2000). Bafflingly, “Side Effects” is a toss-away turkey. It owns the dubious distinction of cramming the greatest number of misrepresentations about our work and ourselves into a single movie. Some of these are merely risible, others potentially hurtful – of which more presently.

A thin screenplay is cribbed from thrillers with gonzo therapists – for example, “Dressed to Kill” (1980), “Basic Instinct” (1992), and “Final Analysis” (1992) – as well as the “black widow” crime subgenre. [Spoiler Alert!] Dedicated, compassionate Dr. Jonathan Banks (Jude Law) undertakes outpatient treatment of Emily Taylor (Rooney Mara), after a suicide attempt that brought her to the hospital ER, where he’s a consultation/liaison psychiatrist. Several years ago, her husband, Martin (Channing Tatum), was convicted of Wall Street insider trading. Martin’s recent return from prison apparently has exacerbated the devastating depression brought on by the loss of her husband, unborn child, and affluent suburban lifestyle. Crippling side effects from a first round of the usual suspect drugs leads Banks to prescribe a new antidepressant, Ablixa. It’s been recommended by Emily’s former Connecticut psychiatrist, Dr. Victoria Siebert (Catherine Zeta-Jones). The drug provokes a mild episode of somnambulism, but Banks continues it because Emily is improving.

A few days later, she slashes her husband to death during another bout of sleepwalking, awakening with no memory for the murder. Dr. Banks, a perennial multitasker, turns out to be a respected forensic psychiatrist. His testimony in that capacity gets Emily declared incapable of participating in her defense “by reason of insanity,” and committed to an inpatient facility until deemed competent to stand trial.

As a result of the hailstorm of publicity surrounding the case, Dr. Banks’s life begins to unravel. He’s blamed for prescribing Ablixa, fired by his patients, shunned by his colleagues, threatened with losing his license. His marriage lies in ruins. Broke but not broken, Banks begins to smell more than one rat. He winkles out a conspiracy between Emily and Dr. Siebert – it’s as full of holes as John Dillinger’s corpse. Emily seduced Dr. Siebert. It’s unclear whether she came to Dr. Siebert for help, and intuited the latter’s latent lesbian yearnings and criminality, or planned to corrupt her from the start (my read). The smitten Dr. Siebert taught her to how to mime depression, while giving a short course in psychopathic psychopharmacology. Thus, Emily never took Ablixa, or anything else; faked her suicide; chivvied Dr. Banks into treating her; and slew her husband.

Figuring the value of the Big Pharma company manufacturing Ablixa would plunge in the wake of Martin’s death, Emily and Dr. Siebert scored immense profit by shorting Ablixa. (Emily arguably took a tip from her husband’s criminal market tampering to engineer her own insider fraud). Dr. Banks was cold-bloodedly selected because of his impeccable credentials and forensic clout, under the assumption he would find her incompetent, then push for her acquittal once she was “cured” of her phony major depressive disorder. Emily is now Dr. Banks’s only patient. At first, one cannot ascertain whether he’s only a visitor to the hospital where she’s confined or is consulting with ward therapists. By the end, he’s totally in charge of her care and fate.

One wonders if his job description mutated according to script changes dictated by the director and/or whichever writer was on board the project at whatever time. (Using multiple script writers is common in the industry, particularly in mainstream filmmaking: One of my patients was hired and fired from a production six times.) Dr. Banks compels Emily to confess to the murder by a devious combination of guile and threats. He cons her into thinking Dr. Siebert has secretly paid off his cooperation, because he’s ferreted out the deadly duo’s con. While she’s reasonably certain that that Dr. Banks has been bribed into enabling her release, admitting her guilt to him wouldn’t be a problem in any case: Once acquitted, she cannot be tried again. A murderer invoking double jeopardy is a bromide of crime film and fiction. Dr. Banks entices Emily into entrapping Dr. Siebert into making whoopie at her office. The latter is promptly arrested for professional misconduct, financial fraud, and as an accessory to Martin’s death. In a move typical of film noir, Dr. Banks abruptly turns the tables on Emily (think Sam Spade “sending over” spider lady Brigid O’Shaughnessy to prison and possible execution in “The Maltese Falcon”). Dr. Banks declares Emily is far sicker than he first imagined, summarily orders her communication with the outside world severed, and prescribes a massive cocktail of psychotropics that will keep her indefinitely hospitalized and zombified. His professional and personal happiness is restored in an eye blink.

In these pages and elsewhere, I’ve stated that mainstream moviemakers will always sacrifice clinical accuracy for narrative sizzle when push comes to shove. But I’ll always forgive a film that is only mildly inaccurate and owns redeeming artistic or sheer entertainment value. In recent years, “Homeland” and much of the “In Treatment” series fit that bill. I can’t forgive Soderbergh, whose hits like “Ocean’s Eleven” draw large audiences, for encouraging a multitude of misperceptions in order to make a dismal dud that could easily discourage an emotionally distressed viewer from seeking psychiatric care. I’ve always avoided the periodic wrangling over this issue. However, “Side Effects” is the only film that I believe does pose a substantive risk of putting off prospective clients. What follows is an anatomy of its mistakes and downright falsifications:

• In a case like Emily’s, it would be conceivable but uncommon for a psychiatrist treating a noncriminal patient to also be a qualified forensic expert, tasked to render the pivotal opinion about the client’s competence to stand trial. It would be decidedly rare for that psychiatrist to undertake inpatient treatment of the patient he’s been instrumental in committing. (Let me know if I’m wrong on this score.)

• No lawsuit is ever brought against the manufacturer of a drug with such lethal potential, nor against Dr. Banks for prescribing Ablixa, as would most certainly happen in the litigation-loving real world. (The validity of such legal action is beside the point.) Dr. Banks would seem to have a fourth-rate insurance carrier without a risk-management service. He’s not represented by a skilled malpractice attorney who might advise him not to testify at all if possible or would sharply limit his testimony. In either case, he would be cautioned to cease all contact with Emily.

• These and other omissions could proceed from the creative team’s blind ignorance or willful disregard of the facts in order to facilitate a tighter, more-compelling narrative, as noted above. While annoying to the practitioner, the elisions would not have significant impact on our notional prospective patient. The film’s negative presentation of various psychiatric therapies, and particularly its toxic characterization of practitioners themselves, is vastly more off-putting.

• Soderbergh seems bent on having it both ways vis-a-vis psychopharmacology. He discharges psychotropics from blame by revealing that Emily’s somnambulism and other side effects were malingered, then subliminally criticizes their use. The plentiful mention of unpleasant reactions to well-known psychotropics outweighs citing their very real benefits, particularly to seriously ill patients. (Be it noted in all fairness that Soderbergh also intimates, if distantly, that Big Pharma’s rampant hucksterism may be turning us into pill pushers and folks with ordinary woes into enthusiastic pill poppers.)

• The inpatient service where Emily is confined is at best a drab, cheerless place, where no one seems to care or do very much for the clientele beyond drugs and restraints. But via plot developments, the mise-en-scene’s design, and declarations of camera, the milieu is eventually transformed into a snake-pit cum penitentiary. Patients are totally at the mercy of their minders. Tyrannical psychiatrists can, on a whim, reduce them to vegetative compliance by overmedication and electroconvulsive therapy (ECT).

• To wangle Emily’s confession, Dr. Banks shows her an ECT treatment like an inquisitor exhibiting the instruments of torture to a recalcitrant heretic. He also infers that ECT memory loss is permanent. Soderbergh resurrects the standard “shake-rattle-and-roll” depiction of earlier mental health movies in which ECT – which in many cases rivals drugs in effectiveness for major affective disorders with fewer side effects – is painted as a barbaric assault upon brain and body.

• Most disheartening is the unsympathetic, even repellant portrayal of virtually every psychiatrist in the film. Underneath her empathic facade, Dr. Siebert is a debauched ice queen, a sleek pantheress capable of loving someone only as perverse and corrupt as she is. Dr. Banks’s colleagues quickly desert him when he most needs collegial support. They’re a timorous, distasteful lot – one recommends Effexor passim but offers not a jot of compassion. “Side Effects” quickly establishes that Dr. Banks is a smart, compassionate humanitarian when, at his ER consultation/liaison job, he identifies a Haitian patient’s supposed hallucinations as a cultural manifestation of grief. But he escapes Emily’s web of deceit by easily identifying with the aggressor, first introjecting, then outdoing her wickedness. Emily happily slaughtered Martin. Now Dr. Banks takes equal pleasure in murdering her spirit. In the closing sequence, he’s seen dropping off his son at a ritzy private school, with his contented wife at his side. All would seem as before, but the taint of Dr. Banks’s spectacular wrongdoing hover around him, rendering his reversion to benevolent healer profoundly suspect. One is reminded of the conclusion of “Suspicion,” which suddenly revealed that Cary Grant/Johnnie never plotted his wife’s murder for her money; he’s always loved her and saw her as his redeemer. The studio allegedly suppressed Hitchcock’s original ending, which unmasked Johnnie’s remorseless psychopathy and had him strangle the wife. The taint of Johnnie’s evil hangs ominously over the bogus happy ending, utterly undoing it. Even auteurs like Hitchcock, Truffaut, and Welles had their flops. Several of Soderbergh’s previous pictures were unsuccessful but always honorable failures.

I would not be so disparaging about “Side Effects” were it not for the possibility that its deep stupidity or flagrant indifference vis-a-vis the psychiatrist’s methods and person might prejudice viewers needing help. Granted their numbers might be few, given greater public awareness of mental disorders. But even one would be too many. TV commercials routinely caution that such-and-such nostrum might not be “right for everyone,” then unreel a list of black box warnings and other disagreeable reactions (the sinister roll call frequently concludes with the very ailment for which the drug is prescribed in the first place, but farewell that). I believe “Side Effects” isn’t right for anyone. Take this review as a warning against Soderbergh’s deplorable black box.


  1. Margaret

    Side Effects review: In the real world, what patient permission would be required for one psychiatrist to share treatment details with another?

    Are psychiatrists really able to share samples with one another as Dr S tried to do? Don’t they have to at least record to whom they dispensed samples after they are trained by the reps from the company?

  2. Snusan

    You forgot about:
    1. The TERRIBLE suicide risk assessment Dr. Banks does after Emily is brought into the CPEP/ER post-car crash. “Hurt yourself” does not equal “risk for death”. He also did not complete an assessment regarding additional lethal means in the home.
    2. In the state of NY she would have been kept in for a 72 hour hold and not have been sent home with an appointment in a few days.
    3. The Police never say to a patient “We are bringing you in on a 330.20” nor is the language “NGRI” used-that died in 1982 with the Hinkley case.

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