‘Cine-diagnostics’: Mental illness on the Big Screen

Silver Linings Playbook,” one of nine pictures nominated for the 2012 Oscars, featured a bipolar hero. (The last nominee with an Axis I protagonist was “A Beautiful Mind,” a lamentably inaccurate portrayal of paranoid schizophrenia, which nevertheless became a beautiful gold mine for Universal Studios.)

My research shows that “Playbook” is one of a half handful of films about bipolar disorder. This set me wondering about the prevalence of various psychiatric disorders in a small group of so-called “mental health” movies focused on the specific syndrome of the hero/heroine, as well many more movies from other genres that provide sufficient material to infer a character’s diagnosis.

Why has cinema favored some disorders while others go neglected? Obviously, there are no statistics on this score. The following remarks about what I’ll call “cine-diagnostics” are based my own impressions rather than established fact.

Whether a feature film (I’m excluding documentaries) focuses on a specific psychiatric disorder or contains characters so well drawn that a diagnosis can be sussed out, filmmakers have always been especially attracted to syndromes that they perceive as hallmarked by especially melodramatic symptoms and behavior. (Of course, the disorder’s presentation might not be as electrifying in real-world psychiatry.)

I suspect that producers and filmmakers conceive that characters with “spectacular” symptomatology offer more entertaining narrative possibilities than less sensational maladies, thereby generating bigger box office revenues. When it comes down to the wire, a disorder’s prevalence or clinical accuracy usually will not count as much to the industry as the picture’s profit potential.

That’s not always a bad thing. See my article on “In Treatment,” the HBO series, on internationalpsychoanalysis.net for more on this point.

The largest group of “mental health” movies was produced from about 1957 to 1963, a period in which increasing public knowledge about psychiatric illness coincided with greater acceptance of its treatment. Krin and Glen O. Gabbard have explored this golden age of “pro-therapy” pictures in their estimable “Psychiatry and the Cinema” (Washington: American Psychiatric Association Publishing, 1999).

The Gabbards note that former World War II military physicians, who became conversant with promising new therapies during service, were instrumental in demystifying psychiatry upon returning to America. (These methods were often taught by émigré psychoanalysts who had fled Nazi persecution.) Not unsurprisingly, some of the most popular pro-therapy movies were about wartime and post-war post-traumatic stress disorder. Films like “Home of the Brave” (1949) often portrayed PTSD’s more melodramatic features.

Courtesy Showtime
Showtime’s “Homeland” has provided a reasonably accurate portrayal about character Carrie’s (pictured) bipolarity, says Dr. Harvey Roy Greenberg.

After the Golden Age, other “spectacular” syndromes depicted in mental health pictures and popular genres included: conversion disorder (“Freud,” 1962); multiple personality disorder (“The Three Faces of Eve,” 1957); dissociative disorder (“The Swimmer, 1968″); erotomania/de Clerambaults syndrome (“Fatal Attraction,” 1987; “The Story of Adele H,” 1975); alcoholic hallucinosis and delirium tremens (“The Lost Weekend,” 1945); acute schizophrenia (“The Snake Pit,” 1948); and compulsive gambling (“The Lady Gambles,” 1949; “California Split,” 1974).

Antisocial personality disorder was, and still remains, the most prevalent – often immensely popular – Axis II category, particularly in mainstream fare featuring sociopathic characters who relish mayhem and murder (“The Talented Mr. Ripley,” 1999). Movies about antisocial serial killers have done so well in recent years that they’ve become an industry staple (“Silence of the Lambs,” 1991; “Manhunter,”1986).

Major depression doesn’t usually present the florid symptomatology of multiple personality disorder or acute paranoid schizophrenia. Arguably, that’s why major depressive disorder (MDD) seems to appear far more often in thoughtful indie or foreign cinema than in action-oriented mainstream movies.

MDD has evoked some of the greatest acting by accomplished actors in cinema – for example, Victor Sjöström’s despairing aged physician in “Wild Strawberries,” (1957); Jeremy Irons’s despondent Antonio in “The Merchant of Venice,” (2004); and Steve Cochran’s inarticulate, ultimately suicidal despair in “Il Grido,” 1957). (“Il Grido” – “The Cry” in English – is a neglected small masterpiece by Michelangelo Antonioni.)

Other psychiatric disorders/conditions less often addressed at the multiplex include Alzheimer’s disease (“Away From Her,” 2006); autism/savant syndrome, (“Rain Man,” 1988); and mental deficiency (“I Am Sam,” 2001); “Light in the Piazza,” 1962). One wonders if filmmakers imagine that a film about Alzheimer’s disease would be too close to the bone for older viewers and might not interest young viewers, who don’t imagine they’ll ever grow old. (The Dustin Hoffman character in “Rain Man” was a misdiagnosed savant, possibly for narrative purposes, but I would rate him in an autistic category.)

I can’t easily account for the dearth of movies about autism and the mentally challenged. Perhaps there’s a mistaken assumption that audiences would be turned off by such pictures because of the uncomfortable, if unacknowledged sense of “otherness” these syndromes evoke in some people, filmmakers included. (The “praecox feeling” of schizophrenia comes to mind.)

I return to the peculiar shortfall of bipolar disorder at the Bijou. “Lust for Life” (1956) isn’t on my short list, because I don’t think Van Gogh was bipolar.

The Madness of King George” (1994) is another vexed case: It remains unclear whether George III’s mania was attributable to porphyria or some other organic disorder. (The porphyria theory has been much disputed.) The monarch’s medical records offer no evidence of a major depressive swing – but then, I wasn’t there. In “Bigger Than Life” (1956), James Mason’s flagrant mania obviously stemmed from heavy doses of steroids given for a collagen vascular disease.

Pressured speech and giddy behavior pervade screwball comedies of the 1930s and ’40s (“The Awful Truth,” 1937; and “Bringing Up Baby, 1938″). However, their rat-a-tat zaniness is a function of the genre, evidenced by virtually everyone in a screwball movie.

Mr. Jones” (1993) presents an incontestably bipolar patient: Richard Gere’s eponymous hero seems embued with a romantic aura from the start. The picture intimates that his illness endows him with a “specialness” placing him far above the mortal crowd (R.D. Laing was of the same opinion about schizophrenia, and that notion caused much woe.)

Jones and his psychiatrist (Lena Olin) fall in love. Typical of Lalaland’s female practitioner, life outside the job is lackluster until she’s smitten with her patient. I don’t recall if she quits her work to marry Jones/Gere, another standard outcome for female cinetherapists.

She would do well to stop practicing, and not only because of her flagrant boundary violations. A real-life psychiatrist would fend off Gere’s advances and instead seek to determine whether his mania is influenced by a comorbid narcissistic personality disorder or is solely a symptom of his mood disorder – a vital therapeutic issue.

The paucity of bipolarity in past movies, when the disorder was still known as manic depression, might be a function of its unfamiliarity to the average screenwriter back in the day.

It’s not unlikely that the manic side of bipolarity could be confused with acute paranoid schizophrenia with grandiose delusions – a common clinical error that still crops up. Bipolarity also was once deemed relatively rare and didn’t enter as much into public, let alone psychiatric discourse, compared with schizophrenia and “neurotic” diagnoses.

Bipolar disorder had finally come into its own before “Silver Linings Playbook.” One reason is the revelation of their bipolarity by celebrities. I also wonder whether the name change might have played a role in making bipolarity better known and more accepted.

The very word “bipolar” has a kinder, friendlier nimbus than “manic depressive.” Arguably, “manic depression” also held obscure connotations of aggression and irresponsibility for some folks. In my practice, I’ve found that “bipolar disorder” is frequently thought to be somehow more treatable than “manic depression.” I free associate to a patient’s belief that “Wellbutrin” would do him more good than “bupropion.”

Today, bipolar disorder has become the flavor of the month, notably among the glitterati, where it’s as fashionable as Botox. Bipolarity is jabbered about at Hollywood watering holes, on TMZ and reality TV shows.

The word is so detoxified that it’s comfortably entered the vernacular. When an adolescent patient told me that her best girlfriend had become bipolar, she meant the kid was scatterbrained, moody, and, worst of all, messing around with her (the patient’s) boyfriend.

With the ups and downs of bipolarity getting so much play, I expect that screenwriters will create more bipolar characters, because the inherent dramatic value of those affective swings has been recognized in Hollywood. The success of “Silver Linings Playbook” is sure to generate clones.

So far, Showtime’s “Homeland” series has been reasonably accurate about Carrie’s bipolarity; it’s also proved a useful plot device. One can only hope that filmmakers can come up with more fare like “Homeland,” rather than grinding out flyweights like “Silver Linings Playbook.”

A closing thought: Dorothy Gale in “The Wizard of Oz” could by a stretch be construed in her dream of Oz as afflicted with Charles Bonnet syndrome, except the tiny and very busy little people of Munchkin Land are extremely interested in her, indeed honor her for slaying the Wicked Witch of the East. In the real deal, the Bonnet’s munchkins go about their business utterly uninterested in the hallucinator. That’s show business.


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