The Role of Movies and Mental Health

Abstract

This chapter primarily deals with the problem of mental illness as well as psychiatrists and psychologists and demonstrates how they have been exhibited in the motion pictures from 1919 to the present. This theme is important because it plays a fundamental role in helping us understand how Americans may form their impressions of mental illness and those who treat it. One of many reasons for the interest of Hollywood using themes of mental illness may be the unique ability of the camera to capture and represent fantasy dreams and unconscious processes of the past and present. The film provides us with an unusual opportunity to communicate to the world of imagination. A review of the current and past literature will be presented in order for us to understand how this process took place. The chapter concludes by summarizing the importance of the content of the most important films that reflect our argument.

This chapter was written by Charles Winick and is based on previous work.

Psychiatry and Movies

How have psychiatry and its related activities been presented in movies? Psychoanalysis (in Austria) and motion pictures (in France) each began in the 1890s and have continued to adapt to the changing world, with the United States becoming very hospitable to both fields.

One reason for the interest of Hollywood in psychiatry and psychoanalysis could be the unique ability of the camera to capture and represent fantasy, dreams, the unconscious, thought processes, ambiguity, juxtapositions of images, and of past, present, and future, and similar content germane to mental illness. Film provides an unusual opportunity to communicate the “primary process” or world of the nonrational (Winick 1977). The social context of moviegoing, in which a decision is made to see a film, a trip is made to a theater where other people are also sharing an experience in a large darkened room, and there is a return trip home, provides a “set” with special expectancies and readiness to discuss the experience. Films have always had the potential to transport us to an interesting communal experience.

Another reason for Hollywood’s interest in movies about mental illness and its treatment would be the role of psychoanalysis in the private lives of Hollywood film people. Los Angeles received a substantial number of eminent disciples of Sigmund Freud from Germany and Austria as the Nazi government implemented its program of eliminating Jews and democratic ideas during the 1930s and 1940s. Dr. Ernst Simmel, who became the first leader of the psychoanalytic society of Los Angeles in 1934, was a protégé of Freud who had been president of the Berlin Psychoanalytic Society (Farber and Green 1993).

Freud himself is known to have rejected very substantial offers to participate with Hollywood studios. Although the Freud family refused to cooperate with any film about its patriarch before or after his death, several films with Freud as a character were made. Directed by John Huston, who had previously made “Let There Be Light” (1946), a documentary dealing with a group of soldiers receiving treatment for mental illness during World War II and with a script from Jean Paul Sartre, “Freud” was released in 1962. Several of Freud’s case histories were combined in one young female patient. The film’s approach to its subject, which is played by Montgomery Clift, is deferential and sensitive. He is shown in discussions with Dr. Breuer (Larry Parks) and an unfriendly physician (Eric Portman). Freud is presented as a symbolic hero who has helped the world. “The Seven Per Cent Solution” (Herbert Ross 1976) involves Sherlock Holmes visiting Freud (Alan Arkin) to treat his addiction, a relatively mellow Freud cooperates with Holmes in solving a criminal conspiracy. The disintegrating relationship between Freud (Viggo Mortenson) and Carl Jung (Michael Fassbender) over Jung’s treatment of real-life patient Sabina Spielrein is set forth in “A Dangerous Method” (David Cronenberg 2012).

Psychoanalysis became a salient interest of some Hollywood people. Actress Marilyn Monroe left one fourth of her estate to her New York psychoanalyst, Dr. Marianne Kris. Upon the death of Dr. Kris, the income from the estate was bequeathed to Anna Freud’s Hampstead Clinic in London. For many years, the estate income represented a large part of the budget needed to support the Clinic. (Young-Bruehl 1988). Other actors are known to have had near-symbiotic relationships with their analysts (Farber and Green 1993).

Hollywood has been making psychiatry-related films, many of which are of high artistic quality, for a long time. It may not be a coincidence, that the only two films since “It Happened One Night (1934) to win the top five Academy Awards (film, director, script, male and female leads) are “One Flew Over the Cuckoo’s Nest” (1975) and “Silence of the Lambs” (1991), each centrally concerned with psychiatric themes. Films about therapists could be made for many reasons besides economic gain. They might represent an informed piety, a way for a patient who is a movie functionary tried to please his analyst. This could also be an indirect way of learning more about personal symptoms, as well as an approach to undermining the treatment process, or toward acting out feelings about the therapist. For example, the author of “Lover Come Back” (1961) and “That Touch of Mink” (1962) has said that although he had been for 6 years as an analysand, his treatment would continue until the psychoanalyst completed building a swimming pool (Crowther 1962). This attitude toward the psychoanalyst may be at least partially responsible for the negative representation of the profession in these two films. Some individuals may decide to become patients, influenced by the manner in which the helping professions are presented in movies, which have so long provided food for popular fantasy needs. How psychiatry has been shown in cinema may have other implications for the profession itself, in terms of young physicians’ interest in it. Many people may form their impressions of various kinds of mental illness from movies, which carry special emotional freight because they feature famous stars. Patients in real life may use movie material on mental illness as reinforcement for resistances. It is also possible that such content could have some positive effects on the doctor-patient relationship by providing a question, a topic of conversation, or some other content that may be turned to therapeutic advantage.

Movie executives and performers are traditionally more likely to be patients than are most other kinds of occupations. They can afford to pay for treatment and, by the nature of their work, are likely to be continually aware of their sensibilities. Psychoanalysts were so accepted in Hollywood at one point that one of their number, Dr. Aaron Stern, was director of the industry’s Rating Administration (1971–1973) and then became a movie studio producer. The movie Rating Administration, like the original Motion Picture Production Code of 1930, does not prescribe any protective handling of mental illness. Indeed, many movies have presented psychiatrists or related practitioners in a way that is not positive.

Until the 1950s, movies often ridiculed some psychiatric conditions. Thus, in Frank Capra’s “Arsenic and Old Lace” (1944), Cary Grant’s brother thinks that he is President Theodore Roosevelt, dresses like Roosevelt, and keeps charging up the stairs to imitate the attack at San Juan Hill. This behavior is humored by Grant and the other characters. But the idea of mental illness as a source of comedy seems less likely today. Some comedy situations have been barely credible. In “Harvey” (Henry Koster 1950), James Stewart is a friendly drunk who visits psychiatrist Cecil Kellaway to discuss the imaginary six-foot rabbit friend whom he can see. The movie, as well as the Pulitzer Prize winning play from which it was adapted, was very successful. In general, odd behavior which merely adds texture to a film, like the character actors of early films who represented “humors” or types, is not counted as mental illness (Winick 1965). Even major stars may play eccentric or odd people who are not technically mentally ill. W. C. Fields’ misogyny and dubious habits as Egbert Souse in “The Bank Dick” (1940), the softcore transvestism of Jack Benny in “Charley’s Aunt” (1941), the raffish gamblers in “Guys and Dolls” (1955), the extravagant characters in “You Can’t Take It With You” (1938) provide examples of the bizarre which are not classified as mental illness.

Black humor may distinguish some films with characters whose behavior is clearly abnormal and shudderingly funny. In Stanley Kubrick’s salute to the atomic age, “Dr. Strangelove” (1963), Sterling Hayden plays military post commander General Jack D. Ripper, who is committed to appropriate “purity of essence” of “bodily fluids.” Although the general’s madness is known at a high command level, there is little effort to deal with his condition right up until he single-handedly orders atomic bomb carrying airplanes to bomb Moscow. Many media dealing with mental illness have contributed for raising public awareness and could encourage interest in psychiatry (Winick 1982). More than a century ago, Clifford Beers’s (1907) autobiography A Mind That Found Itself helped to create the mental hygiene movement. A book by a prominent newspaperwoman about her psychoanalysis sold over one million copies (Freeman 1951). Novels about psychiatry, many of which have been the basis for movies, have long been a literary staple (Winick 1963). Some celebrities freely discuss their psychiatric treatment (Freeman 1967). A number of actors have been analytic patients and written frankly about the experience. Thus, Orson Bean plays a psychiatrist in Otto Preminger’s “Anatomy Of A Murder” (1959), working with the defense to prove that the accused murderer was not sane. Bean (2000) wrote a book on his own failure as a patient in traditional psychoanalysis and subsequent success in orgone therapy.

Many psychiatric and psychoanalytic concepts (e.g., projection, repression, acting out) have entered the larger language and are widely used in ordinary conversation. Some psychiatric tools have become so familiar that ordinary persons use them, in daily life and movies. In “Marnie” (Alfred Hitchcock 1960), Sean Connery is curious about the reasons for the frigidity, lying, and thievery of his new wife (Tippi Hedren). He interprets her dreams, helps her to interpret word associations (“you Freud, me Jane”), explains Marnie’s reactions to color, and arranges a confrontation with her mother. Connery relates Marnie’s frigidity to a long forgotten episode involving Marnie’s mother’s behavior with a male visitor during a storm. By the film’s end, as if it were the conclusion of a successful treatment situation, the couple seems to be able to live together constructively.

Study Design

This report is based on an examination of 330 psychiatry-related films released in the United States from the end of World War I to the present. Special attention is paid to the professional identification of the therapist, the problems of patients, careers of therapists, actors, experience as therapists and patients, and adaptations of psychiatric movies to television and other media. For each film, its director and the year of release in the United States are given. The films were viewed and coded in terms of content categories, which had been established on the basis of preliminary scrutiny of representative films. Psychiatrists and other therapists are generally clearly identifiable in terms of their function and role. They represent a considerable range of occupations and professions and the patients or clients also reflect heterogeneity. The films discussed represent great variations in approach, quality of performers and direction, style, technology, and similar factors. In addition, the psychiatry world has been changing, along with developments in the other healing professions, since World War I.

Less than one fifth of the films were made outside of the United States. There is no way of knowing the representativeness of foreign films shown in America, because of some legal and practical considerations. The American film industry regulates the number of films imported here, based on currency exchange rates, other countries’ willingness to admit our films, the presence or absence of dubbing or subtitles, and similar factors. It is also possible that other countries may not wish to expose any significant degrees of their mental illness problems to American audiences. It is noteworthy that several important film-making countries are poorly represented, notably Italy, India, Sweden, and France. Italy’s film industry is famous for the sophistication of writers and directors like De Sica, Rossellini, Antonioni, and Fellini. The comparative lack of psychiatry in the country’s films is perhaps partly a function of the central place of the confession as an institution. It may also be a result of the large number of characters playing onlookers, who interpret others’ actions. A director in Italian films also exercises many of the traditional functions of a novelist, making the psychiatrist less necessary. Scriptwriters may feel that it would be reductionist to introduce psychiatric concepts into the dramatic colors of Italian life. The country’s relative paucity of psychiatrists is at least probably responsible for the relative lack of psychiatric films from India, the world’s most active movie-making country. Sweden has also made few psychiatric films in spite of its artistic leadership. The Swedes’ relative lack of interest in such films may reflect their feeling that psychological matters are adequately handled in the religious and mystical themes that characterize much Scandinavian screen output.

France, with what is probably Europe’s leading psychoanalytic profession, has produced few films involving mental illness or its treatment. One of the few French films about mental illness is Sacha Guitry’s “Lovers and Thieves” (1962). A psychiatrist who is the director of a mental hospital speaks at a machine-gun rate, in a burbling manic manner. An example of the tone is a remark he makes about why he likes to save women from drowning: “It is the only way that I can ask a woman to put her arms around my neck and spread her legs.”

Some clues to Hollywood’s sense of what attracts audiences to themes of mental illness emerge from noting films which have been remade. “The Cabinet of Dr. Caligari” (1919 and 1962) deals with a psychopathic psychiatrist. “M” (1932 and 1951) is about a murderer who is pedophilic. “Blind Alley” (1939 and 1949) concerns a murderer who is neutralized by a psychiatrist. “Psycho” (1960 and 1998) involves a female office worker who flees with stolen money. These films feature violence, mental illness, and an effective psychiatrist and were artistically and commercially successful in their original versions.

Approaches to Treatment

In recent years, the boundaries among the various professions involved in treating mental illness have become somewhat blurred, reflecting the proliferation of a range of such professionals in real life. Relevant helping professions in addition to the traditional psychiatrist, psychoanalyst, psychologist, and social worker, include life coaches, sex therapists, motivation guides, holistic counselors, hypnotherapists, family therapists, nondirective therapists, biofeedback, network therapists, psychodramatists, and many others.

The career ladder concept emerging from anti-poverty programs of the 1960s and expansion of the human potential movement in the 1970s provided access to credentials as a therapist for persons with non-traditional backgrounds. Physicians, psychologists, and social workers are licensed by the states and professional societies have their own criteria for membership and specialized recognition. People with a range of backgrounds may call themselves psychoanalysts and analytic training institutes establish criteria for accreditation.

Some form of psychotherapy (the “talking cure”) was the major treatment approach from the 1920s through the 1950s when new psychotropic medications began emerging. These medications were especially useful for patients who had been receiving residential treatment at state hospitals or private facilities and could now be treated on an outpatient basis.

In the last half century, the use of medications by psychiatrists has soared. The continuing ascendancy of medications over the talking care can be seen in a National Medical Expenditure Panel Survey: Some 44.1 % of outpatients in 1998 received only psychotropic medication but 57.4 % did so by 2007. In 1998, the average patient receiving psychotherapy had 9.7 sessions but only 7.9 sessions in 2007 (Olfson and Marcus (2010)). A 2005 government survey reported that only 11 % of psychiatrists provided talk therapy to all patients, a share that has most likely fallen more since then (Harris 2011). In spite of this trend, some form of talk therapy still is dominant in movies, in which medication is less likely to be the focus. The various physical therapies also do not easily lend themselves to valid movie representation. Table 3.1, Types of Therapy in Movies In Percent, summarizes the proportion of therapy types in the films studied. “Psychodynamic” includes psychoanalytically related treatment; “Counseling” includes eclectic talk therapy, “Medical, Physical” involve medication and work with and on the body.

Table 3.1 Type of therapy in movies in percent

The high incidence of psychodynamic therapists in movies has been relatively consistent since World War I. The psychoanalytic approach has offered a view of the development and motivations of human behavior that has worked very well for the drama that films evoke. However, it should be noted that in the actual world of treatment in the United States, there have always been more psychiatrists than psychoanalysts. In 2000, there were 45,615 psychiatrists and 3,458 members of the leading psychoanalytic society (Scully and Wilk 2003; American Psychoanalytic Association 2012).

Experience in World War II and the need to provide mental health services for large numbers of veterans led to fresh approaches and the training of many new therapists. In the early 1960s, federal government support for the creation of community mental health centers for outpatient treatment further facilitated access to professional help. U.S. Supreme Court decisions in the 1960s recognized alcohol and drug problems as diseases that could be treated; the treatment was largely developed by psychiatrists.

The human potential movement in the 1960s gave rise to new approaches to group therapy, like the encounter group figuring in “Bob and Carol and Ted and Alice” (Paul Mazursky 1969). Since the 1970s, mental health problems have been increasingly accepted for treatment via employee assistance programs, many of which were established at little or no cost to employees. Group approaches attracted more support because they cost less and provided an additional dimension. These kinds of larger developments found their way into movies concerned with mental illness and its treatment.

Kinds of Therapists

Detailed trends in the kinds of film psychiatrists who have characterized various epochs have been identified and explicated. (Gabbard and Gabbard 1999). The authors relate movements in psychiatry and psychoanalysis to larger shifts in the society and in motion pictures. They identify a Golden Age of psychiatry in films from 1957 through 1963, during which psychiatrists were valid voices of reason, adjustment, and well being. An Australian survey of psychiatric-related films that were released between 1985 and 2000 reported greater diversity of views on psychiatry than in any earlier period. Some other trends include more films set in the past and increases in the number of critically and commercially acclaimed productions (Larme 2000).

The films discussed in this study were coded into one of seven categories, which had been established on the basis of each film’s predominant approach, the setting, and the person or persons providing the treatment and its nature. Table 3.2, Movie Therapist Classification In Percent, sets forth the central characteristics of the treatment provider and the proportion of films in each category. Some representative films in each category are briefly discussed.

Table 3.2 Movie therapist classification in percent

Serious

The serious therapist deals thoughtfully with patients and works on the basis of appropriate treatment.

One such psychiatrist is Dr. Andrew Collins (Lee J. Cobb) who appears in “The Dark Past” (Rudolph Mate 1948), a remake of “Blind Alley” (Charles Vidor 1939). Collins stresses that his job is curing people, uses psychoanalytic concepts comfortably and has an opportunity to do so when he and his weekend guests are invaded by escaped murderer Al Walker (William Holden). Collins, a thoughtful pipe smoker, gets the murderer to recount a recurrent dream, and to free associate to each aspect of it. Walker realizes that the thought of his father’s blood being on his hands has led him to kill every man who stood in his way, as an acting out of the Oedipus complex. Once he understands the dream, Dr. Collins assures Walker, he will not be able to kill anymore. When police surround the house and Walker raises his weapon to squeeze the trigger, he cannot do so, even to protect himself.

Probably, the first film to present a lay psychoanalyst and one which was also praised as the first “adult” British film after World War II, “Mine Own Executioner” (Anthony Kimmins 1947), deals with Felix Milne (Burgess Meredith) as a young London psychoanalyst. He is treating Adam Lucian (Kieron Moore) a former World War II prisoner of war with schizoid and homicidal tendencies who questions the therapist’s lack of an M.D. degree and is a reluctant therapy participant. Milne, who is having substantial problems of his own, is committed to help the patient. The treatment situation’s ups and downs and dynamics are conveyed realistically. The film gives a multidimensional and honest picture of a complicated and very challenging psychotherapeutic relationship, affected by Milne’s lay status. There is an unfolding of his difficult relationship with his wife and growing awareness of the reasons for which he became a psychoanalyst. The script was adapted from a novel of the same name by Balchin (1947).

In Anatole Litvak’s “The Snake Pit” (1949), adapted from Mary Jane Ward’s (1946) novel, Dr. Mark Kik (Leo Genn) is on the staff of a state mental hospital and uses shock, hydrotherapy, and psychotherapy with patient Virginia Cunningham (Olivia de Havilland). He has a picture of Freud in his office, as well as a leather couch. Dr. Kik interprets Cunningham’s problem as being at least partly a result of her fantasy of having killed her father. Dr. Kik is a healer whose commitment can be related to his European background. “The Snake Pit” was the fourth most successful film at the box office for 1949 and its title has entered the language, for a horrific place from which there may be no return.

In “The Three Face of Eve” (Nunnally Johnson 1957). Joanne Woodward consults psychiatrist Lee J. Cobb because she hears voices. She behaves in a provocative manner, telling the doctor “certainly not!” when asked if she is Eve White. Cobb sends her to a hospital when she identifies herself as Eve Black. He uses hypnosis and sensitive interviewing to deal with her problem. He suggests that the two Eves be introduced to each other and a third personality, able to recall her former elementary school teachers and addresses, emerges. A childhood molestation episode which she is able to remember facilitates Eve’s successful dealing with the problem. A 2 years later, she writes Cobb and is pleased that “we’re all together now.” The movie is based on a best selling book (Thigpen and Cleckley 1957).

A warm, informal, and very accessible psychiatrist (Judd Hirsch) helps a suicidal young man (Timothy Hutton) who believes himself to be responsible for the death of his brother in a boating accident in “Ordinary People” (Robert Redford 1980). The doctor helps the patient to understand what happened during the accident and how it has affected his subsequent difficulties.

Former delinquent Matt Damon (Will Hunting) avoids jail time by agreeing to have therapy with psychologist Robin Williams (Dr. Sean Maguire) in “Good Will Hunting” (Gus Van Sant 1997). Will expects to remain a blue collar worker and is a janitor at M.I.T. Dr. Maguire and Will have both been victims of child abuse. The doctor uses physicality and other non-mainstream methods, discussing his own emotional problems, acting out baseball games. As a result of the treatment, Will develops more productive relationships with his best friend and gradually realizes that he is a latent mathematician with skills that can lead to his making significant contributions to science. Dr. Maguire, on the basis of his interaction with Will, realizes that he himself is ready for a life change and decides to travel on a sabbatical. Will decides to drive to California to be with his girlfriend. Williams won an Academy Award for his performance.

“Antwone Fisher” (2002) is a Navy sailor who was born in prison and whose father was murdered. He receives very careful and sensitive treatment from a Navy psychiatrist, played by Denzel Washington, who also directed the film. Washington invites the young sailor to his home and facilitates the patient’s reestablishment of contacts with important figures from earlier years. The real Antwone Fisher wrote the screenplay, reinforcing the credibility of the situation that is described.

Exceptional Workers

There are some healers who can interpret behavior so impressively and others who are given such difficult professional tasks that they can be called exceptional.

The first movie to present a psychoanalyst was G. W. Pabst’s “Secrets of a Soul” (1926), in Germany, supervised by famous analysts Nicholas Kaufmann, Hanns Sachs, and Karl Abraham. A still photograph of Freud is shown at its beginning. A chemist loses his house keys in a coffee house, and is followed home by psychoanalyst Dr. Charles Orth, who tells the chemist that he has special reasons for not wishing to enter his home. The chemist free associates on a couch as Dr. Orth smokes. The analyst helps the patient, via a dream and repressed memories, to deal with fantasies of killing his young wife with a knife. The dream sequences are loaded with symbols: e.g., “That water is your dream of impending birth.” After a few sessions, the patient’s treatment is complete.

For over a half century, psychoanalysts have been attempting to enter into patient’s dreams, daydreams, and fantasies, via what has been called the consention approach (Holt and Winick 1960). Some movies present a therapist who is able to enter the unconscious of patients or subjects.

In “The Cell” (Tarem Singh 2000), researcher Jennifer Lopez develops a virtual reality psychotherapy technology that enables her to penetrate the thoughts of patients. At the request of the FBI, she uses her approach to enter the mind of a comatose serial killer in order to avoid the death of an abduction victim. Similar skill is required of psychiatrist Michael Douglas in “Don’t Say A Word” (Gary Fleder 2001), when thieves kidnap his young daughter in order to force the doctor to retrieve a six digit number from a psychotic patient’s brain. The number will enable the kidnapers to recover a valuable gem.

In “The Sixth Sense” (M. Night Shyamalan 1999), Dr. Malcome Crowe (Bruce Willis 1999), in a disintegrating marriage, has experienced an unpleasant confrontation with a former patient. Child psychologist Crowe wants to help troubled 8-year-old Cole Sear (Haley Joel Osment) who has a problem similar to his former patient’s. Cole has paranormal supernatural powers and can interact with the dead. Crowe’s nurturing approach to the child enables him to reach the frightened little boy and uncover the truth behind what appears to be a mysterious mystical situation. The film’s seamless mixture of drama, horror, action, and mysticism led to the film’s becoming a huge box office success.

Even more influential than “The Sixth Sense” is “The Exorcist” (William Friedkin 1974). It deals with Regan MacNeil (Linda Blair), a 12-year-old girl who is possessed by the devil. Father Damian Karras (Jason Miller), a priest who is also a psychiatrist, is asked to assess her psychologically and requests exorcism for the child. Karras, who is having a crisis of faith, conducts the exorcism with Father Merrin (Max von Sydow). Karras challenges the Devil to leave Regan and enter him. Regan’s vocal and physical behavior strains the faith and strength of the two priests; they subsequently die. The strange events in the film repelled and fascinated audiences and there were episodes of mass hysteria in some theaters. With its potent conflict of religion and psychiatry, “The Exorcist” was a singular success spawning many imitators.

A prison Death Row is the setting for “Dead Man Out” (Richard Pearce 1989). Ben (Ruben Blades) is a career criminal who has murdered four innocent people and is awaiting execution. After 8 years of trials and appeals, he has snapped and is now psychotic. Psychiatrist Dr. Alex Marsh (Danny Glover) is called into calm Ben down and “fix” him so that he can be certified to be sane and thus able to be executed. Ben and the doctor are pitting their wits against each other. Dr. Marsh handles his ambiguous role and its ethical dilemma and his own underlying feelings about Ben and the death penalty with care and sensitivity.

Robin Williams gives a subtle performance as a neurologist who begins working with a group of patients in “Awakenings” (Penny Marshall 1990), based on experience with chronic Parkinson’s Disease patients reported by Dr. Oliver Sacks (1973). Williams is troubled by these hospitalized “human vegetables” and starts with one patient (Robert De Niro). He experiments with giving the patients L-DOPA, which dramatically revives them, if only for a finite unpredictable period. The film ends with the doctor movingly telling a hospital group that although the awakening did not last, it led to a different kind of appreciation for life and reconnection with humanity.

Marlon Brando, in the twilight of his career, appears as a psychiatrist in “Don Juan De Marco” (Jeremy Leven 1995). About 10 days before his retirement as a state hospital staff member, Dr. Jack Mickler (Marlon Brando) takes a cherry picker bucket to the top of a billboard, where a young man in a cape and mask, Don Juan De Marco (Johnny Depp) is about to commit suicide. Mickler returns Don Juan to earth. Via flashback, Don Juan relates his career as a lover throughout history to his therapist Dr. Mickler, who decides to enter De Marco’s world as Don Ottavio de Flores. Each man learns about the other’s world. Don Juan enlightens Dr. Mickler about love, to the latter’s benefit and the rebirth of his relationship with his wife Marilyn (Faye Dunaway).

Don Juan appears to recover without the benefit of medication, as the result of his very brief treatment by Dr. Mickler. At the sanity hearing conducted by a judge, Don Juan comes across as an insightful, intelligent, articulate man; the judge finds him to be sane and competent and orders that he be released from the hospital. Mickler is a sensitive and imaginative therapist, defending his patient against bureaucracy and uncovering reality within the romantic imagination.

Comic

Comedy may characterize the therapist, the situation, or aspects of the treatment. The ludicrous comic doctor is often presented in caricature. One memorable psychiatrist is the police alienist played by Gustav Von Seyffertitz in Lewis Milestone’s “The Front Page” (1931). A hobo who has shot and killed a policeman is taken for diagnosis to a cadaverous doctor who speaks with a heavy accent and tells the prisoner to reenact the crime. The prisoner says, “I got frightened and shot him.’ The doctor says, “We need more realism here—Sheriff, lend him your gun.” When the prisoner reluctantly takes the gun, the doctor says, “Well…?” The prisoner points it at the doctor and pulls the trigger. The blood spurts out of the doctor, who falls to the floor crying, “Dementia Praecox!”

Two generations later, a similar scene occurs in Blake Edwards’ “Return of the Pink Panther” (1975). The chief inspector who supervises bumbling Inspector Clouseau (Peter Sellers) has dreams of killing Clouseau. When the chief inspector’s analyst tries to get him to illustrate the dreams, he strangles the analyst.

Howard Hawk’s “Bringing Up Baby” (1938) has a monocled European psychiatrist as a foil for the “screwball comedy” antics of Cary Grant and Katherine Hepburn. The doctor is vain, naïve, and enchanted with his jargon and cliché interpretations. In the final scene of the film, the doctor (“you have probably heard me lecture on love”) is fooled by Katherine Hepburn’s rather transparent attempt to claim that she is a gun moll.

The ease with which even juvenile delinquents can poke fun at psychiatrists and their methods is shown in Robert Wise and Jerome Robbins’ “West Side Story” (1961). Several delinquents are singing about the difficulties of their lives. One lies on the step of a slum building and another puts on glasses, to represent an analyst. When the “patient” reports his difficult family situation, the “analyst” says that he cannot help the “patient” because he has a “social disease.” The “analyst” refers him to a social worker. The scene shows the delinquents laughing at the adult society’s efforts to understand and control young people.

In “What A Way To Go!” (J. Lee Thompson 1964), Louisa Benson (Shirley MacLaine) is referred to psychiatrist Victor Stephenson (Robert Cummings) by the Internal Revenue Service because she has given the Service a $200,000,000 gift, although she owes no taxes. In flashbacks at the doctor’s office, she explains that each of her four husbands worked hard, died young, and left her a fortune. Each husband’s story is presented in a different movie style. Dr. Stephenson begs her to marry him, but a janitor who has come to repair the doctor’s hydraulic chair inadvertently knocks him unconscious. The doctor recovers but passes out again when he sees Louisa kissing the janitor, possibly someone she has known previously. The film’s title conveys the farcical tone of this black comedy.

Janet Leigh is Dr. Elizabeth Acord in “Three On A Couch” (Jerry Lewis 1966). She is especially dedicated to three young women patients who dislike men, so that she fears to leave them in order to go to Paris with her fiance, artist Chris Pride (Jerry Lewis). Wearing disguises, Pride romances each of the three women so that the doctor will be free to go to Paris. Dr. Acord accepts Pride’s comically bizarre impersonations, and decides to leave her practice and travel with him to France.

A comic doctor figures in Mel Brook’s “High Anxiety” (1977), in which a Nobel prizewinning psychiatrist directs Los Angles’ Psycho-Neurotic Institute for the Very, Very Nervous. The doctor is involved in a murder investigation which debunks psychiatry and spoofs Alfred Hitchcock films. “High Anxiety” could only be released because it is intended as a spoof, which relies on the audience’s knowledge of Hitchcock films for much of its humorous appeal.

Radio’s serious advice givers of the 1930s have been adapted for television by comic actors who use movies to laugh at the qualifications of radio advisers. Dan Aykroyd, in “The Couch Trip” (Michael Ritchie 1987) is a career criminal feigning insanity who transforms his identity to that of his psychiatrist’s supervisor and steals his contract to provide counseling over the radio in California. He uses highly profane language to interpret dreams on radio. One woman wants him to interpret her dream of driving her car to a Pakistan parking lot which has a large number of lizards wearing dark glasses. He is dodging a disheveled Russian priest (Walter Matthau), who knows Aykroyd to be an imposter and is blackmailing him. The psychiatrist who is impersonating is seen in a straightjacket, behind bars.

In “Straight Talk” (Barnett Kelman 1992), singer-comedienne Dolly Parton is a country bumpkin who accidentally gives radio advice which is so well received that she gets her own program, for which she has no background. She modifies folk wisdom (“Get off the cross, they need the wood”) and rejects a suitor with a quip (“I know the saying ‘take your work to bed’ but I didn’t know it was quite so literal”). Her wit carries “Dr. Shirley” to success in Chicago, a long way from the small town cabaret from where she came.

A psychiatrist whose treatment of the same patient extends over two movies is Dr. Ben Sobel (Billy Crystal), with patient Robert De Niro in “Analyze This” (Harold Ramis 1999). De Niro plays Paul Vitti, the head of a gangster family who experiences panic attacks and anxiety. The doctor’s wedding is canceled by an assassin being thrown from a hotel roof. In sequel “Analyze That” (2002), the FBI assigns Vitti to the doctor for further treatment and the gangster produces a television series based on his own career. The doctor, who had previously been uncomfortable in the company of gangsters, takes Vitti’s place at a meeting of the Mafia leaders and is accepted by them. De Niro mocks his familiar gangster characteristics while seeming to take them seriously. The doctor is farcical even when confronted with grave events.

Troubled

Interpersonal difficulties at the workplace or within their families often characterize movie psychiatrists.

A psychiatric staff that is almost as troubled as the patients is the subject of Gregory La Cava’s “Private Worlds” (1934). Dr. Charles Monet is played by Charles Boyer, who has become the hospital’s director. Another staff member is Dr. Jane Everest (Claudette Colbert), who has problems with him. Personal relations are complicated because Monet is resented by Dr. Alex MacGregor (Joel McCrae), a staff psychiatrist. The romantic and power intramural relationships and conflicts in this film prefigure dynamics in a number of later films.

“The Flame Within” (1934) is waiting to be fanned to life in Dr. Mary White (Ann Harding), a calm and clear-eyed psychiatrist in Edmund Goulding’s film. She falls in love with an alcoholic patient who is 15 years her junior and married to a dipsomaniac heiress. Dr. White entertains the idea of marrying the patient but decides against it because his wife, who is also her patient, will commit suicide if her husband leaves.

A fashionable psychoanalyst (David Niven) in Nunnally Johnson’s “Oh Men, Oh Women” (1957), is treating a patient who used to be in love with the analyst’s fiancée. The analyst is so bedeviled that he returns to his own analyst, who reminds him how difficult it is to translate knowledge into behavior.

The psychiatrist as parent is often a failure. A woman psychiatrist married to a Harley Street physician is the focus of John P. Carstairs’ “Tony Draws a Horse” (1951). Their son likes to draw lewd pictures on walls, but the doctor believes that her son should be encouraged to express himself freely: “I will not have my son put into a psychological straightjacket.” The psychiatrist is pompous and unable to use her professional knowledge in her role as a mother.

Victor Hansbury’s “Sleeping Tiger” (1954) is seething within the wife of psychiatrist Clive Esmond (Alexander Knox). Dr. Esmond permits a young criminal to live with him as a houseguest as a method of treatment. Esmond neglects his beautiful wife (Alexis Smith). She stubs out cigarettes after a few puffs, drives cars at high speed, and bites her lips so sharply that blood comes. The criminal spends his nights seducing Mrs. Esmond, whom he describes as a “tight wire” who is “empty inside.” When the criminal decides to leave, Mrs. Esmond follows him. The doctor’s treatment method and marriage both collapse at the same time.

Richard Gere, who played the title role in his breakout movie “American Gigolo” (Paul Schrader 1979), is again involved in an unconventional love situation, as a San Francisco psychiatrist who falls in love with the sister (Kim Basinger) of a patient in “Final Analysis” (Phil Joanou 1992). The doctor believes that there is no ethical barrier to his affair with the sister and helps her legal defense when she is charged with murdering her husband, citing a questionable legal doctrine.

Dudley Moore, as a middle-aged married New York psychoanalyst, is experiencing a condition that is summarized in the title of the film: “Lovesick” (Marshall Brickman 1983). He falls in love with a beautiful young patient and turns aside the advice of his professional colleagues, a supervisor, and the ghost of Sigmund Freud, played by Alec Guinness.

Prison psychiatrist Halle Berry has an accident while driving and wakes up after several days to find herself a patient in the prison’s hospital, a prime suspect in the murder of her husband, in “Gothika” (Mathieu Kassovitz 2003). Her multiple problems include a ghost.

Dr. Henry Carter (Kevin Spacey) is a prominent Los Angeles psychiatrist whose patients all work in some aspect of the movie industry, in “Shrink” (Jonas Pate 2009). Recovering from his wife’s suicide, he uses marijuana continually. A best selling author of self-help books, he is often bleary eyed and regards his profession as useless and himself as unable to “fix” people. Many of his patients are not satisfied with him and medicate themselves. Carter’s disintegration disturbs his therapist father, who organizes an intervention to confront Henry, who walks out in disgust. Henry is further annoyed when his marijuana turns out to be laced with embalming fluid. During a television interview with Gore Vidal, the doctor has a meltdown and storms out. He conveys a feeling of bitterness and of becoming unhinged. Carter’s situation is communicated indirectly when a teenage student whom he has tried to help, visits the famous hillside sign of “Hollywood,” photographed from the rear, perhaps intimating the dark side of the doctor’s life and the city’s subculture.

Eccentric

Some therapists appear to deal with clients or patients in a bizarre or eccentric manner.

In “Carefree” (Mark Sandrich 1938), attorney Stephen Arden (Ralph Bellamy) asks his friend Dr. Tony Flagg (Fred Astaire) to treat Amanda Cooper (Ginger Rogers) and convince her to become Mrs. Arden. Flagg is a dancing psychoanalyst who prescribes dream inducing foods for Amanda. In one dream, she falls in love with the doctor, who tells her that patients always fall in love with their analysts. He hypnotizes Amada, convincing her that she loves Stephen and that Tony should be shot for misleading her. She does try to shoot Tony, unsuccessfully. Tony talks to his unconscious, looking at himself in a mirror, and realizes that he loves her. In spite of Astaire’s bizarre moves as a singing and dancing therapist in “Carefree,” one critic has noted that “…he’s strangely convincing as a psychoanalyst…the whole improbable idea becomes lyrical” (Croce 1972). Although Tony’s behavior is unethical and eccentric, it alludes, however glancingly, to some psychoanalytic canons.

A 6 years after Rogers was an unconventional patient of Astaire in “Carefree,” she was again in an atypical music and dancing setting for analysis, as a patient of Barry Sullivan, in “Lady in the Dark” (Mitchell Leisen 1944). This film was made from the 1941 musical comedy of the same name with lyrics by Ira Gershwin and Kurt Weill’s score. The analyst is more conventional than Astaire was in “Carefree” but the musical pieces add a more eccentric bounce to the treatment. The dreams, with their musical background and the analyst’s help in interpretation, enable Rogers to understand her desire for a wedding.

Dr. Ludwig Brubaker (Oscar Homolka) has an eccentric demeanor in “The Seven Year Itch” (Billy Wilder 1955). He advises middle-aged married patient Tom Ewell about how to handle his “itch,” with symptoms that include a twitching thumb and sexual fantasies about his neighbor Marilyn Monroe: “If you itch, the tendency is to scratch.” When asked how interesting his patients are, he replies that “…at $50 an hour, all my cases interest me.”

In “Penelope” (Arthur Hiller 1966), Natalie Wood (Penelope) is the wife of a banker who pays little attention to her. She decides to get attention by robbing his bank, disguised as an old lady. When she tells her psychiatrist Dick Shawn (Dr. Gregory Mannix) that she has robbed $60,000, he volunteers to return the cash to the bank’s night depository. He tries to do so but is frightened by the sound of an approaching police car and leaves the money on the sidewalk. Even after she tells Dr. Mannix of her previous record of thievery, he says that he loves her and wants her to run away with him. She refuses and is reunited with her husband.

In “End of the Road” (Aram Avakian 1970) based on John Barth’s first novel, Stacy Keach (Jacob Horner), is catatonically watching the trains go by from a railroad platform. His rescuer is psychiatrist James Earl Jones (Doctor D), who takes Jacob to his Remobilization Farm, a mixture of mental hospital and commune, for treatment. An introductory collage of contemporary events—the 1968 assassinations, Vietnam, riots—presumably suggests that Jacob’s university education has not helped him to cope with life and made him catatonic. Dr. D can be described as a very eccentric existential psychiatrist who is especially concerned with alienation and despair. His treatment includes sensory overload, sex involving poultry, rolling in mud with pigs, mythotherapy, acting out exotic fantasies. Jacob’s treatment advances and he gets a job teaching grammar at a small college, where he becomes friendly with a faculty couple. When the wife becomes pregnant with Jacob’s child, she decides to have an abortion, which is conducted by Doctor D and ends badly.

Robin Williams (Dr. Cozy Carlisle) is a supermarket meat-cutter employee who lost his credentials as a psychiatrist for having had sex with patients, in “Dead Again” (Kenneth Branagh 1991). Cozy’s unhappiness at his situation is expressed in cryptic advice and comments, e.g., “That’s the karma credit plan, buy now, pay forever.” He wears eccentric clothes and believes that life has been unfair to him.

Eccentricity characterizes the treatment approach in “Anger Management” (Peter Segal 2003). Jack Nicholson (Dr. Buddy Rydell) is an anger management therapist helping soft spoken Adam Sandler (Dave Buznik) who is forced into treatment after a misunderstanding about headphones on an airplane. Dr. Rydell believes that Dave is too gentle and places him into increasingly pseudo-challenging events at Yankee Stadium. While in a car together, Rydell has Buznik pull over and sing “I Feel Pretty.” He has Buznik in the backseat of another car, for a date with a transvestite prostitute. The doctor, nude, invites himself into the bed in which Buznik is asleep. Buznik is encouraged to steal a blind man’s cane.

Evil

Evil and crime may be found among psychiatrists as an avocational or salient activity. It is sometimes presented as an extreme behavior.

A number of practitioners do great harm and destruction. In Robert Wiene’s famous German film, “The Cabinet of Dr. Caligari” (1919), the doctor uses witchcraft to exercise power over a somnambulist, whom he commands to commit murders. Caligari, who is the personification of evil, is the head of a mental hospital. Caligari is myopic, even with spectacles. His face is pasty white with ghoulishly framed eyes and white hair askew. The sets convey a visual sensation of disorientation and unbalance. Caligari’s appearance is that of a madman, and few films have captured the world of madness so effectively. The film’s use of expressionist photography techniques made it a landmark, and helped to give wide currency to its picture of psychiatry. A film historian notes that “no other film has been shown so often every single year since its production” (Card 1994).

Anatole Litvak’s “The Amazing Dr. Clitterhouse” (1938) deals with a psychiatrist who becomes the leader of a criminal gang in order to obtain material for a book. Played by Edward G. Robinson, Dr. Clitterhouse kills a gangster blackmailer and goes on trial for the crime. In a bizarre final courtroom scene, Clitterhouse insists he is sane. The jury finds him not guilty of murder on the ground that he must be insane to claim that he is sane.

A ruthless and depraved psychiatrist appears in Fritz Lang’s “The Testament of Dr. Mabuse” (1941). This German film deals with the criminal gang that Dr. Mabuse is directing from the hospital for the criminally insane to which he has been sent and where he has hypnotized another doctor who becomes his medium. The doctor parrots Nazi slogans; Lang himself subsequently indicated that he deliberately put such slogans into the mouth of a psychotic. Another Lang film, “The Ministry of Fear” (1945), features Dr. Forester, who runs a clinic with a robotized staff, and who kills patients.

Tyrone Power is the only film romantic leading man who actively sought a role as a psychological healer, in “Nightmare Alley” (Edmund Goulding 1947). He is Stanton Carlisle, an unscrupulous psychologist or “mentalist” who learns how to read minds from a roustabout whom he inadvertently kills. He becomes a patient of successful psychologist Dr. Lilith Ritter (Helen Walker), who uses the knowledge she gets from Carlisle to blackmail people. She convinces the mentalist that he is mentally ill after stealing $150,000 from him. Ritter returns to her luxury practice as a psychologist while Carlisle becomes an itinerant drunk. Although Power and many critics regarded this as his finest performance, it is the only one of his many films that was not profitable (Basinger 2009). He had wanted the part to prove that the public would enjoy him in a non-costume drama dueling role.

Another evil doctor was presented by director Brian De Palma in “Dressed to Kill” (1980). The title refers to psychoanalyst Michael Caine, who puts on women’s clothing when he leaves his elegant office to kill a patient. When psychiatrist Maximilian Schell murders his wealthy patients in “St. Ives” (J. Lee Thompson 1975) he offers a psychoanalytic explanation of his deed to the patient before killing him.

In David Mamet’s “House of Games” (1987), Lindsay Crouse is a psychiatrist who enters the world of confidence men and crime in order to track down and revenge one of her patients who was cheated. She becomes a very successful deadly participant in the criminal culture.

Anthony Hopkins in 2003 was named by the American Film Institute as the Number One Movie Villain for his role of Dr. Hannibal Lecter in “Silence of the Lambs” (Jonathan Demme 1991). The doctor is a brilliant psychiatrist who kills and eats his victims (“Hannibal the Cannibal”). Trainee FBI agent Clarice Starling (Jodie Foster) is assigned to interview him in prison to get urgent help on a kidnaping case. He mocks and ridicules her background. Of a census taker who tried to test him, Lecter says that “I ate his liver with some fava beans and a nice Chianti,” reliving the taste with a sucking sound through his teeth. He is kept behind cannibal-proof glass and a special mask has been made for his face so that he can talk but not bite. He is resourceful enough to escape and telephone Starling at her FBI graduation party.

Fools

Psychiatrists may lack common sense, fail to see connections, or make absurd choices or recommendations.

Marlene Dietrich hoodwinks a gullible psychiatrist (Alan Mowbray) in Frank Borzage’s “Desire” (1936). She asks a jeweler to deliver a brooch to her “husband,” Dr. Edouard Pauquet, the famous psychiatrist. She explains that he doesn’t like to pay bills. She then visits the doctor as a patient, telling him that her “husband,” the jeweler, has a delusion that everybody owes him money. Leaving the consulting room, she meets the jeweler, takes the delivery of the brooch and drives rapidly away. The jeweler is ushered into Dr. Pauquet’s office. When he asks the doctor for money for the brooch, the doctor says, “Of course, of course.” Both he and the jeweler are fooled by Dietrich.

Sometimes a psychiatrist is foolish but confident in his rationality. The British film, “Dead of Night” (1946), directed by Alberto Cavalcanti, Charles Crichton, Basil Dearden, and Robert Hamer involving strange experiences which blend psychiatry with mysticism. At the beginning of the film, a man is shown walking to a house. He tells a group in the house that he has a recurring dream that he will murder someone who wishes him no ill. He strangles a psychiatrist who speaks with an accent and continually ridicules the discussion of ghosts and the supernatural. The psychiatrist is obviously the man of good will. The implication is that the stereotyped psychiatrist was so sure of the power of reason that he lost his life as the result of underestimating the power of the nonrational.

A Navy psychiatrist who has written a book about the strains of the executive life does not seem to apply his knowledge and is the butt of cross-examination by defense counsel in the court-martial scene of Edward Dymtryk’s “The Caine Mutiny” (1954). The doctor denies that Captain Queeg is paranoid, but admits that Queeg’s symptoms are those of paranoia.

Psychoanalyst Dr. Gruber provides the plot continuity as well as its climax in Delbert Mann’s “That Touch of Mink” (1962). Dr. Gruber (Alan Hewitt), treating an economic advisor (Gig Young) to a millionaire businessman (Cary Grant), invests his money on the basis of the economic adviser’s tips. The doctor displays an uncanny ability to misinterpret what his patient says and to be unable to help him in coping with his problems.

In “Sex and the Single Girl” (Richard Quine 1964), Natalie Wood is a Ph.D. psychologist (Dr. Helen Brown). Tony Curtis (Bob Weston) is an unmarried adventurer seeking to humiliate her and seeks Brown’s professional help for problems with his “wife.” When he phones after the first meeting, she rushes to a pier to block his suicide; they both fall in the water. Returning to Brown’s home, he serves her a glassful of liquor, seemingly convincing her that the large glass “bypasses metabolism.” Confused by her unexpected love for Curtis, she telephones her mother for guidance. Later, she races to the airport with a handsome psychiatrist colleague. All of Dr. Brown’s activities seem to lack judgment or fitness.

The therapy situation can lend itself to foolish behavior, as in Chantal Akerman’s (1995) “A Couch in New York” in which a Parisian dancer temporarily rents the New York office-apartment of therapist William Hurt. Because his patients believe that she has taken over his practice, she dispenses guidance to them. He returns to New York unexpectedly and she believes him to be a new patient, with strained consequences.

Foolishness characterizes a pact that psychotherapist Sarah Jessica Parker has made, 10 years ago, with an old friend and former roommate that if they had not each found a mate by age 30, they would jump into the East River, from the Brooklyn Bridge, in “If Lucy Fell” (Eric Schaefer 1995). Such behavior would hardly be suggested by any reasonable therapist.

Burke Ryan (Aaron Eckhart) is a prominent psychologist specializing in how to handle grief, in “Love Happens” (Brandon Camp 2009). A glad handing guru, he greets the members of his seminars with “I’m feeling OK, how are you?” They reply “A-OK!” He is noted for a book on handling grief (A-OK!). He has minimal insight about himself and his personal problems include closet drinking and elevator phobia. He bullies the seminar members into walking barefoot over hot coals. Burke attempts to date florist Eloise (Jennifer Aniston), who pretends to be mute and rejects him via sign language. His ultimate foolhardiness is a secret he is keeping that could topple him and destroy his future.

The Patients Take Over

A recurrent subgenre of psychiatric films suggests that some simple or mentally ill or disturbed people may be superior to “normal” folks. An emphasis on patients’ rights and “revolt of the patients” is anticipated in Mark Robson’s “Bedlam” (1946), in which an actress is sent to an 18-century hospital, suggested by the Hogarth painting which is the film’s opening shot, on trumped-up charges of lunacy. By the film’s end, the residents have captured the hospital head and put him on trial for insanity.

“The King of Hearts” (Philippe de Broca 1966) is a French film dealing with World War I. German soldiers setting explosives to blow up an asylum before they leave a town. The occupying British troops send a Scottish soldier (Alan Bates) to disarm the explosives; he is elected king. The Germans return to the town and resume their slaughter. The asylum becomes a symbol of sanity in the middle of war.

A film that earned very wide attention for its theme of patients being wiser than the staff of a psychiatric institution is Milos Forman’s “One Flew Over the Cuckoo’s Nest” (1975), which not only won an Academy Award as best picture, but enjoyed the biggest box office success of any film with a mental illness theme. It grossed more than twice as much as the year’s next most popular film. Its success is probably attributable to a combination of the message, brilliant direction, powerful supporting roles, and Jack Nicholson’s bravura performance.

Randle Patrick McMurphy (Jack Nicholson) is serving time for statutory rape but feigns insanity in order to transfer to a mental hospital. The movie, made from Ken Kesey’s (1962) nightmare novel which was one of the key books of the 1960s, centers around the conflict between iconoclastic, magnetic McMurphy and Nurse Ratched (Louise Fletcher), a shrewd official who controls the ward. We see the group therapy, with the psychotic participants very real. Shock treatments are used as punishment and the nurse is able to authorize lobotomy. Psychiatry appears to be a vehicle of cruelty. McMurphy encourages the other patients to revolt but their doing so has tragic consequences.

Along with Ken Kesey, author Peter Shaffer, in Sidney Lumet’s (1977) movie version of the successful play “Equus,” thinks that madness could be a greater virtue than sanity in a sterile modern world. Madness, conceived as the true root of vitality, is represented by a handsome blond youth whose sexual interest in horses leads him to blind them. The youth consults a psychiatrist (Richard Burton) who is sterile, bland and repressed. Envious of the boy and feeling fraudulent, the doctor says that “passion can be destroyed by an analyst.”

A spate of earlier movies, such as “Marat/Sade” (1967), and “Going Places” (1974), argues that it is more reasonable to be mad than sane in today’s world. Such films, reflecting popular philosophers of the 1960s like R.D. Laing, hold that authority is repressive and hostile to the spirit of self-expression.

Richard Benner’s “Outrageous” (1977) also presents the sanity versus insanity argument, but is unusual in permitting its “crazies” to cope successfully with their problems. A male homosexual hairdresser shares an apartment with a schizophrenic young woman who has escaped from a mental hospital. The hairdresser, who asks, “Who’s insane anyhow?” becomes a successful female impersonator and the woman resumes treatment with a psychiatrist, but on an outpatient basis. Toward the film’s end, the hairdresser tells the woman, “You’ll never be normal…you have a healthy case of craziness, just make it work for you.”

Although this approach blossomed in the 1960s, as part of the antiwar, “greening of America” revolutionary movement, it found its fullest expression in the 1970s. It is probably relevant that the movie audience, then as now, primarily consists of teenagers and young adults. The Occupy Wall Street movement of 2012 could be related to the anti-institutional movement of earlier decades.

In “Crazy People” (Tony Bill 1990), Dudley Moore is an advertising copywriter who is fired and sent to a mental hospital because his copy is bizarre, presenting products too truthfully. By an inadvertent error, his advertisements appear on television and in magazines and prove very effective (“Visit New York, it’s not as filthy as you think”). (“If you look like this, you’re a fat slob.”) At the hospital, psychiatrist Dr. Elizabeth Baylor (Mercedes Ruehl) encourages Moore to train the other patients in his techniques and facilitates their leaving the hospital in order to start a new advertising agency that incorporates his approach. Cheering, they depart in a helicopter, with the doctor’s blessing.

“The Butcher’s Wife” (Terry Hughes 1991) is concerned with the disagreement between a psychiatrist and a layperson with paranormal insight. The psychiatrist, with a neighborhood practice in New York City, is Dr. Alex Tremor (Jeff Daniels). The layperson, Marina (Demi Moore), lives on a North Carolina island. Marina understands her destiny to be that a vacationing New York butcher Leo Lemke (George Dzundza), will be her husband.

They marry immediately and Leo and Marina settle in New York’s Greenwich Village, where she works in his butcher shop, near Dr. Tremor’s office. Marina specializes in short term futurology and gives accurate clairvoyant counseling to her neighbors, including some of the doctor’s patients. She and he also share neighborhood friends. She is a psychic elf while the doctor quotes Plato and uses psychiatric jargon. The doctor is puzzled by the validity of her guidance and predictions and by his increasing attraction to her. He tells her that her work is “hoodoo voodoo, dangerous, a nightmare.” However, husband Leo becomes interested in another woman and we realize that destiny will lead to a romantic resolution of the psychic-psychiatrist relationship.

Actors and Their Roles

Movie actors obtain their parts in many different ways. Through the 1940s, most actors were under long term contract to one or another of the major studios, which would assign roles to their actors. With the end of the studio system in the 1950s, and the competition for audiences from television, it became more necessary for actors to find their own roles.

Actors could enjoy their increased ability to influence casting, following the lead of stars like James Stewart and Cary Grant who pioneered in choosing their roles. More recently, actors’ careers could be more precarious, without the predictability provided by the contracts with the studios. Earlier audiences were more involved with actors, who typically appeared in more films and led more airbrushed lives than is the case today. The arc of an actor’s career is shorter than it used to be.

An actor’s experience with mental illness and/or treatment may add texture and dimensions to a part. It is possible, for example, that Robert Walker’s brilliant performance as a murderer in Alfred Hitchcock’s “Strangers On A Train (1951) and his last role as an undercover Communist agent in “My Son John” (Leo McCarey 1952) were related to his extended psychoanalytic treatment. Vivian Leigh was probably cast in some roles requiring the expression of depression because of her real life experience with it, which had become a matter of public knowledge. Dissonances may occur, however, between the actor’s real life condition and a film role. Some distinguished actors who have played the role of a psychiatrist have turned in extraordinarily bad performances, perhaps because they were too involved in real life roles as patients. The same considerations may apply to directors or producers whose decision to make a film may be affected by latent factors of which they are not conscious. Psychiatrists and the mentally ill may, of course, be presented in films by artists who are quite aware of the effects they are creating. Fritz Lang, who directed the Dr. Mabuse films, said that “My profession makes me like a psychoanalyst.” Lang’s “Ministry of Fear” (1944) and “Fury” (1936) are impressive examples of his claim.

Many factors contribute to the choice of the gender of therapists in psychiatry-related films. The decision may be made because of contractual commitments, script requirements, a star’s preference, and similar considerations. Jane Fonda, for example, is said to have insisted that the therapist in “Klute” (1971) be female.

In this study, 23 % of the film therapists are women; the proportion of women therapists has increased over the years in the subject films. Movies tend to reflect larger trends in society. In the United States, women psychiatrists increased from 19 % in 1998–1999 to more than 30 % in 2002 (Scully and Wilk 2003). Women psychologists increased from 39 % in 1990 to 49 % in 2000 to 56.6 % in 2010 (American Psychological Association 2012). These gender changes could have impact on kinds of therapy available (Carey 2011).

Black actors playing psychiatrists and psychotherapists have had a range of roles in the last half century; some examples follow. Sidney Poitier is the dedicated chief psychiatrist at a state hospital, treating a young neo-fascist in “Pressure Point” (1962). Joe Adams is a government psychiatrist in “The Manchurian Candidate” (1962). James Earl Jones is the director of a bizarre treatment center in “End of the Road” (1970). S. Epatha Merkerson is a psychotherapist in Spike Lee’s debut movie “She’s Gotta Have It” (1986). Morgan Freeman is an effective counselor at a rehabilitation center in “Clean and Sober” (1988). Psychiatrist Danny Glover deals with a Death Row convict in “Dead Man Out” (1989). Psychiatrist C.C.H. Pounder deals with the possible hazards of the romance of Mary Stuart Masterson and Johnny Depp, each highly disturbed, in “Benny and Joon” (Jeramiah Chechik 1993).

Angela Hall treats severely disturbed young adults in “Mad Love” (1995). Cuba Gooding, Jr., a psychiatrist, assesses Anthony Hopkins, a specialist in gorillas who has killed poachers who attacked his primate friends, in “Instinct” (1999).

Phylicia Rashad is a prison psychiatrist in “The Visit” (2000). At a psychiatric hospital, counselor Don Cheadle works with delinquent youths in “Manic” (2001). Navy psychiatrist Denzel Washington treats eponymous “Antwone Fisher” (2002). Halle Berry, following her Best Actress Academy Award in “The Monster’s Ball” (2001), faces problems in “Gothika” (2003) as a psychiatrist at a hospital for the criminally insane.

Actors Who Appeared Twice as Therapists

Some actors have had a role as a therapist in more than one relevant film. A second appearance in a related role may suggest that the first appearance was noteworthy or successful and/or that the treatment setting was particularly valid for the actor. In the films studied, there are eight men and two women who played the role twice. The number of years between each assignment ranged from one to 21, with an average of 8 years. Each film is cited briefly.

Alan Arkin is Sigmund Freud in “The Seven Per Cent Solution” (Herbert Ross 1976). Freud withdraws Sherlock Holmes from his cocaine habit and helps the great detective to understand a traumatic memory. In “Grosse Point Blank” (George Armitage 1997), Arkin is Dr. Oatman, treating a hit man called Blank, whom he advises “not to kill anyone, to see how it feels.”

Lauren Bacall, a therapist at the Castle House Clinic for Nervous Disorders, is grappling with recent widowhood and a relationship with another staff member, in “The Cobweb” (Vincente Minelli 1955). In “Shock Treatmnt” (Denis Sanders 1964), she is a psychiatrist at a state hospital who is engaging in criminal activity.

Charles Boyer, a former French film star, plays a mental hospital director in “Private Worlds” (Gregory La Cava 1935). He is a staff member at another hospital in “The Cobweb” (Vincente Minelli 1955).

In “Suddenly, Last Summer” (Joseph L. Mankiewicz 1959), Montgomery Clift as Dr. Cukrowiz, saves patient Elizabeth Taylor from lobotomy and deals with her emotional problems. In “Freud” (John Huston 1962), Clift, as the founder of psychoanalysis, is shown developing his craft and some key ideas.

In “The Dark Past” (Rudolf Maté 1948), psychiatrist Lee J. Cobb helps escapee William Holden to reject violence. In “The Three Face of Eve” (Nunnally Johnson 1957), as psychiatrist Dr. Luther, he helps a housewife experiencing blackouts and headaches to understand that she has three coexisting personalities.

Billy Crystal is Dr. Ben Sobel, a psychoanalyst who treats mob boss Robert De Niro for anxiety-related problems in “Analyze This” (Harold Ramis 1999). De Niro consults the doctor again in “Analyze That” (Harold Ramis 2002), for more intensive treatment for work-related difficulties.

Janet Leigh is an Army psychologist in “The Perfect Furlough” (Blake Edwards 1959), charged with monitoring the conduct of soldier Tony Curtis in Paris. In “Three On A Couch” (Jerry Lewis 1966), she is a psychologist coping with an elaborate scheme concocted by her fiancé Jerry Lewis.

Alan Mowbray is Dr. Pauquet, a Paris psychiatrist duped by Marlene Dietrich, who is stealing some jewelry in “Desire” (Frank Borzage 1936). In “That Uncertain Feeling” (Ernst Lubitsch 1941), as a psychiatrist, he is consulted by patient Merle Oberon for treatment of hiccups, which he relates to her relationship with her husband.

Claude Rains is a thoughtful chief psychiatrist treating Bette Davis at a hospital in “Now, Voyager” (Irving Rapper 1942). In “Kings Row” (Sam Wood 1941), Rains is a sensitive psychiatrist with few patients who is pedantic in conversation.

Robin Williams is a neurologist in “Awakenings” (Penny Marshall 1990). He helps patients who are temporarily released from being catatonic. In “Good Will Hunting” (Gus Van Sant 1997) he is a Cambridge, Massachusetts psychologist who treats a young janitor. He plays a former psychiatrist in “Dead Again” (Kenneth Branagh 1991).

Actors Who Appear as Therapist and Patient

Another way of understanding actors who have played psychotherapists is to note those who also had a role as a patient, in another film. There may be a connection between the two roles and appearing as a provider could enhance a role as a receiver of service. Of the 13 actors, eight are male and five are female. Each film is identified briefly. If an actor has appeared more than once in either of the two film categories, the second and third titles are included. The number of years between the two assignments range from one to 14, with an average of eight.

There is no way of knowing whether an actor playing one of these parts is related to his or her having been previously seen as the other half of the therapist dyad. An actor who had played a patient first might have been more confident about later appearing as a therapist, or vice versa. Of the 13 such pairs, eight had first had a role as a patient.

Michael Caine won an Academy Award for his role as a patient in Woody Allen’s “Hannah and Her Sisters” (1986); he is a homicidal cross-dressing psychiatrist in Brian De Palma’s “Dressed to Kill” (1980).

Maximum upward mobility is seen in James Coburn’s going from parole patient in Bernard Girard’s “Dead Heat on a Merry-Go-Round” (1966) to an eponymous role as “The President’s Analyst” (Theodore Flicker 1967), whose patient is President of the United States.

Richard Dreyfuss is a patient fighting for the right to control his own life in John Badham’s (1981) “Whose Life Is It, Anyway?” He is fighting, as a therapist, for his right to vacation privacy in Frank Oz’s (1991) “What About Bob?” from a patient. In “Silent Fall” (Bruce Beresford 1994), he is treating autism and is a rehabilitation counselor in “Postcards from the Edge” (Mike Nichols 1990).

A call girl patient in Alan J. Pakula’s “Klute” (1971), Jane Fonda is a forensic therapist dealing with a complex theological situation in Norman Jewison’s “Agnes of God” (1985).

In “Final Analysis” (Phil Joanou 1992), psychiatrist Richard Gere has an intimate relationship with the sister of his patient. Gere plays a manic depressive patient, whose psychiatrist (Lena Olin) confesses to her supervisor that she loves Gere, in “Mr. Jones (Mike Figgis 1983).

Patient Dudley Moore is a 40-year-old songwriter patient who has met his dream woman in Blake Edward’s “10” (1980) and a psychoanalyst desperately in love with a beautiful young patient in “Lovesick” (1983), directed by Marshall Brickman.

Debonair David Niven plays a famous movie star seeking psychoanalytic help for his “power fixation” in Charles Crichton’s “The Love Lottery” (1954). Niven becomes a suburban psychiatrist, barely able to cope with life, in Michael Gordon’s “The Impossible Years” (1968).

Gregory Peck is a psychiatrist who becomes an amnesia patient of Ingrid Bergman in Alfred Hitchcock’s (1945) “Spellbound.” In David Miller’s Captain Newman, M.D. (1963) he is a devoted military psychiatrist but again has amnesia as a patient in Edward Dmytryk’s “Mirage” (1965).

Meryl Streep receives family guidance in “Marvin’s Room” (Jerry Zaks 1996) and is a rehabilitation patient in “Postcards from the Edge” (Mike Nichols 1990), an unhappy group therapy member in “Heartburn” (Nora Ephron 1986), a suburban divorcee patient in “It’s Complicated” (Nancy Meyer 2009), a participant in couple therapy in “Hope Springs” (David Frankel 2012), and a New York City psychoanalyst in “Prime” (Ben Younger 2005).

Martin Ritt’s “Nuts” (1987) finds Barbra Streisand as a patient staving off therapist and parents who want to institutionalize her. In “On A Clear Day You Can See Forever” (Vincente Minnelli 1970), she is a patient in two different centuries. She is a sex therapist in “Meet the Fockers” (Jay Roach 2004) and “Little Fockers” (2010). In “Prince of Tides” which she also directed (1991), she is a psychiatrist in love with a relative of her patient.

Previously known for his performance as an action hero, Bruce Willis is a time traveling patient who is sent back to the wrong year, in “12 Monkeys” (Terry Gilliam 1995). In “Color of Night” (Richard Rush 1994), he is a therapist taking over a friend’s therapy group. In “The Sixth Sense” (M. Night Shyamalan 1999, his patient is a child.

Natalie Wood is a teenage patient in “Splendor in the Grass” (Elia Kazan 1961), and a young woman patient in “Bob and Carole and Ted and Alice” (Paul Mazursky 1969), “Penelope” (Arthur Hiller 1966), and “Inside Daisy Clover (Robert Mulligan 1966). She is a psychologist in “Sex and the Single Girl” (Richard Quine 1964) and “Brainstorm” (Douglas Trumbull 1983).

Joanne Woodward is the patient in “The Three Faces of Eve” (Nunnally Johnson 1957) and a therapist in “They Might Be Giants” (Anthony Harvey 1971).

Actors Appearing Most Frequently in Therapy Situation

Which actor or actress appeared in the most psychiatry-related movies as either a therapist and/or a patient? Our analysis suggests that four such roles represent a reasonable upper limit category of the distribution of film psychiatry appearances. We tabulated the number of such roles played up to the present by each actor. Five performers met or exceeded the minimum upper limit of four roles. Natalie Wood and Meryl Streep were in the first place with six roles each. Barbra Streisand had five roles. Two other performers each had been in four relevant pictures: Ginger Rogers and Richard Dreyfuss. We can call these five performers the “frequent psychiatry actors.”

Natalie Wood is the rare child star who did well as a teen and ingénue performer and matured into an important leading lady. A patient four times, she is a psychologist in two roles. A teenager seeking help for problems of sexual awakening in “Splendor in the Grass” (Elia Kazan 1961), she is a patient of an eccentric therapist in “Penelope” (Arthur Hiller 1966), an actress treated badly by the psychiatrist provided by her studio in “Inside Daisy Clover” (Robert Mulligan 1966), and a participant in an alternate therapy group experience in “Bob and Carole and Ted and Alice” (Paul Mazursky 1969). In addition, she is a psychologist treating Tony Curtis in “Sex and the Single Girl” (Richard Quine 1964) and a psychologist co-inventor of a machine that records unconscious material that can be played back to a subject or patient in “Brainstorm” (Douglas Trumbull 1983).

Meryl Streep, with three Academy Awards and 17 Academy nominations, is the most honored American actress. She appears as a patient five times and once as an analyst. She is an unhappily married member of a therapy group in “Heartburn” (Mike Nichols 1986), a rehabilitation patient struggling with career, family, and drug problems in “Postcards from the Edge” (Mike Nichols 1990), a mother receiving guidance from a psychologist on her relationship with a son, sick sister, and dying father in “Marvin’s Room” (Jerry Zaks 1996), a suburban divorcée dating her former husband in “It’s Complicated” (Nancy Meyer 2009), and a participant in couple therapy in “Hope Springs” (David Frankel 2012). In “Prime” (Ben Younger 2005), she is an urban psychotherapist deciding how to handle the discovery that her patient is her son’s girlfriend.

Barbra Streisand is the magnetic star of a variety of settings and roles. She has been a patient twice and a therapist three times. She first appears undergoing hypnosis in order to stop smoking in “On A Clear Day You Can See Forever” (Vincente Minnelli 1970). Treated by psychiatrist Yves Montand, flashbacks alternate her contemporary Brooklyn self as Daisy Gamble with her eighteenth century self as Melinda Wainwhistle. Her second psychiatry-related appearance is in “Nuts” (Martin Ritt 1987), as a patient under siege. She directed “Prince of Tides” (1991), in which she is a psychiatrist emotionally involved with her patient’s family. As a sex therapist, she learns to “Meet the Fockers” (Jay Roach 2004) and deal with the “Little Fockers” (2010).

Richard Dreyfuss is a versatile actor who has been a patient once and a therapist three times. He is a paralyzed sculptor patient in “Whose Life Is It Anyway?” (John Badham 1991). A dedicated staff member at a clinic in “Postcards from the Edge” (Mike Nichols 1990), he is a psychiatrist attempting to cope with a stalker in “What About Bob?” (Frank Oz 1991). A retired child psychiatrist in “Silent Fall” (Bruce Beresford 1994), he patiently works with a 9-year-old autistic child whom he helps and helps to solve a murder.

Long time versatile star Ginger Rogers is a patient in four movies. She plays an actress with agoraphobia in “In Person” (William Seiter 1935) a radio personality receiving diagnosis from dancing psychiatrist Fred Astaire in “Carefree” (Mark Sandrich 1938) and an executive seeking psychiatric guidance in “Lady in the Dark” (Mitchell Leisen 1944). In “Oh, Men! Oh, Women!” (Nunnally Johnson 1957), she is a neglected wife being treated by analyst David Niven.

Rogers’ record differs from the other four actors in several ways. Perhaps reflecting the lesser clout of female stars in the 1930s and 1940s, she never played a therapist. Her first three relevant roles listed involve significant musical content, and she made a total of 73 films. The other four “frequent psychiatry actors” average a total of 34 films each.

We can make some generalizations about the careers of the five frequent psychiatry actors, who are defined by their appearing in four or more psychiatry-related films. Their films were released during the period 1935 through 2012 and represent at least three generations of actors.

The five actors are all very successful over a substantial period of time and have also spaced their psychiatric roles over a range of years. Table 3.3, Years of Acting in Movies and Psychiatry Movies In Years, indicates an average of 36.4 years for total years of acting and 22.6 years for psychiatry-related roles. It is surprising that the two time measures of professional acting are fairly similar for these five performers, who are so different in other ways. We can speculate that there may be something about psychiatric film roles that contributes to these actors’ career arcs in a cognate way.

Table 3.3 Years of acting in movies and psychiatry movies in years

There are other dimensions of similarity. Each actor’s first relevant role was as a patient. All are versatile, have also appeared in non-psychiatric films involving music, and have received major recognition by their colleagues and the public.

It is noteworthy that Richard Dreyfuss is the only male in this group of five frequent psychiatry actors. Dreyfuss is a character star, as distinct from the early leading men, like Clark Gable, James Stewart, and Gary Cooper, who did not appear in psychiatry-related roles. In contrast, early leading ladies like Joan Crawford (“Possessed,” 1931 and 1947), Bette Davis (“Now, Voyager,” (1942) and Olivia de Havilland (“The Snake Pit,” 1948) earned recognition for such parts.

Although not a member of our frequent actor group, Gregory Peck is the only leading man who has played three relevant roles: a therapist experiencing amnesia (“Spellbound,” 1945), a military psychiatrist (“Captain Newman, M.D.,” 1963), and an executive who loses his memory and whose psychiatrist does not believe him (“Mirage,” 1965). Peck’s reputation for integrity and his aura of decency and heroism from other roles could contribute positively to the perception of psychiatry in film.

Directors

The directors of movies dealing with the psychiatric milieu are, of course, key figures in any attempt to explore the genre. The current study is concerned with other dimensions of therapy-related films, with special reference to actors. However, a few comments on directors may be relevant.

Some directors of supernatural, melodrama, and horror movies have used a psychiatric or mental illness theme because it lends itself to mystery and dramatic climates. Many noted directors have made a psychiatrist or mental illness film, because the theme permits much latitude. One additional reason for the subject’s attractions is that it is one of the few medical themes in which the integrity and effectiveness of doctors may be criticized.

Some directors tend to make films that present characters who are disturbed or atypical or quirky but are not involved in psychiatric settings or treatment. Andy Warhol began his international artistic and commercial success in 1970, when a major distributor took over his film “Trash,” which deals with an impotent heroin addict being romanced by Holly Woodlawn, a female impersonator. In his films, the characters tend to be ambulatory schizophrenics or psychopaths who are open to all behavior, and for whom dimensions like “normal” or “right” are meaningless.

Other successful directors, like Roman Polanski, have specialized in oddity verging on psychopathy (e.g., “Cul de Sac,” 1966). Other films of Polanski present extreme behavior or highly disturbed people: the beautiful manicurist in “Repulsion” (1965) lives in a private world of reverie, with a progressive condition which involves hallucinations, delusions, and catatonia. This withdrawn woman commits two murders.

In Martin Scorsese’s “Taxi Driver” (1976), Robert De Niro is a Vietnam veteran who cannot relate to others and hates everybody. This “commando for God” is a kind of charming lunatic who kills a pimp and decides to achieve recognition by assassinating a presidential candidate. In Scorsese’s “The King of Comedy” (1983), De Niro plays a comedian who seeks recognition by kidnaping a prominent television comedian.

Some of the other directors with interest in the bizarre include David Cronenberg (“Videodrome,” 1983; “The Fly,” 1986; “Dead Ringers,” 1988); David Lynch (“Eraserhead,” 1977; “Blue Velvet,” 1986); and Brian De Palma (“The Fury,” 1981).

Psychoanalysis as a profession, an approach to life, and a concept has been notably important to directors Woody Allan and Paul Mazursky (Gabbard and Gabbard 1999). Allen often introduces analytic concepts, sometimes humorous but often serious or ambivalent. Psychoanalysis is one part of the urban life that is often his theme, as in the multiple Academy Award winning “Annie Hall” (1977).

Psychoanalysis can also be a central theme of the stories of Paul Mazursky’s characters (e.g., “Bob and Carol and Ted and Alice,” 1969; “An Unmarried Woman,” 1978). Mazursky himself plays a psychotherapist in his film “Faithful” (1996). In his other films, the therapist is often played by an actual therapist.

Psychiatry-Related Films in Learning

The use of Hollywood movies for educational and therapeutic purposes has emerged on a number of levels and under many different auspices in recent decades. Such use follows years in which movies were denounced for their effects in contributing to immorality, crime, diversion from healthier activities, violence, lower academic standards, and a wide ranger of other personal and social problems.

Even before the introduction of sound to motion pictures, a number of groups became interested in how audiences were affected and influenced by exposure to the new medium. Educators were especially concerned about many aspects of film effects on young people, as in the Payne Fund Studies (Jowett et al. 1996). The Rockefeller Foundation supported a 1935–1954 program to explore the use of motion pictures for educational and public purposes. One such study involved a group of Hollywood films, each of which included a significant human relations problem, which was shown in order to explore how audiences perceive and use such material in their daily lives (Singer 1951).

Hollywood movies have long been used by some audience members for self-therapeutic purposes. More recently such possible therapeutic dimensions have been generating considerable attention. The use of movies for therapeutic purposes has been parallel to a similar expansion of other art forms. (Winick and Holt 1960; Kadis and Winick 1973). Undoubtedly, some persons who have gone to a theater to enjoy a movie that had a psychiatric dimension were significantly and perhaps unexpectedly affected by it. Such a person is writer Dominick Dunne. Asked if there were any movie that had changed his life, he replied that “I must have been twelve, thirteen when I saw Bette Davis in ‘Now, Voyager’… I was so unhappy because of the abuse I took from my father. That film showed me that it was possible to totally change your life, as Bette Davis did in that movie.” (Hofler 2009). Dunne was referring to the Davis character’s ability to stand up to her dominant mother and transform herself as a result of treatment by psychiatrist Claude Rains in the 1942 film.

This kind of anecdotal material could be strengthened by systematic studies of audiences in realistic movie going situations. Such studies, that include the social context of seeing movies, might help us to better understand the effects of psychiatry-related movies. (Winick 1963).

A fresh approach to the use of entertainment movies to build character strengths and emotional learning has been provided by the positive psychology movement, which is seen merging scientific research with self-help in order to build virtues and character strength. Martin E. P. Seligman, who was president of the American Psychological Association for 1998, has been the leading proponent of positive psychology (Peterson and Seligman 2004). Positive psychologists believe that films may have a greater influence than any other art form. They explain how such influencing can occur. Films can convey a wide range of knowledge about mental illness and such material can also be organized into various instruction modalities, for college and other settings. (Wedding et al. 2005; Niemiec and Wedding 2008).

Some medical educators use Hollywood films to teach residents and psychiatrists about disorders of the mind, especially subjects like paranoia, psychopathy, and obsessive compulsive problems, where actual patients may be unavailable for educational purposes. The New York University School of Medicine has a popular course called “Teaching Psychiatry? Let Hollywood Help!” (Great plot 2007).

Psychiatric Content on Television

Television represents another modality for the presentation of movies related to psychiatry, psychoanalysis, and related therapies. Television can show an American or foreign movie after it has appeared in theaters. Hollywood studios may decide to bypass theaters and release movies directly to television stations and/or in DVD format to consumers or retail chains. Stations or networks may make their own movies to appear in theaters, television, or home use. In recent years, many new outlets (e.g., tablets, computers) have been emerging, so that movies can be viewed outside theaters relatively easily. The newer digital devices enable their users to obtain a movie and replay specific scenes, whenever they wish to do so.

The increase in psychiatrists in movies during the 1956–1965 decade reflected and reinforced their visibility in network television during the same period. “Road to Reality” was a daily soap opera dealing with a psychotherapy group. “The Eleventh Hour” and “The Breaking Point” were weekly hour-long dramas, with psychiatrists played by Ralph Bellamy and Wendell Corey, two seasoned Hollywood actors. The psychiatric drama has remained a staple.

The widespread growth of cable television over the last several decades has increased the audiences for new kinds of adult content in more flexible formats. One reason for the enormous artistic and commercial success of cable series “The Sopranos” (1999–2007) was that its dominant character, mob chief Tony Soprano (James Gandolfini) was being treated by psychiatrist Jennifer Melfi (Lorraine Bracco). Their many sessions together were shown, as were her sessions with supervisor Dr. Elliot Kupferberg (Peter Bogdanovich, who played a group therapist in the film “Mr. Jealousy” 1998).

Dr. Melfi, who was a continuing and central character, used a psychodynamic approach, that often characterizes other cable therapists. Considerable attention is paid to sexual behavior in the cable series “Tell Me You Love Me,” (2007), with psychotherapist Dr. May Foster (Jane Alexander) treating three couples, who are in their 20s, 30s, and 40s, respectively. The doctor and her husband, in their 60s, have a solid relationship and appear to be able to deal easily with their own family issues.

The 106 cable episodes of “In Treatment” (2008–2010) feature Gabriel Byrne as psychologist Dr. Paul Weston, who had previously worked at the Washington-Baltimore Psychoanalytic Institute. The series, based on an Israeli program, mimics actual scheduling practice, with each patient regularly seen on the same day of every week so that viewers could know in advance when each of their favorite patients would have his or her sessions. Dr. Weston had a number of counter-transference problems, which he was shown discussing with a supervisor. He had to relocate his practice because of one such problem.

In recent years, many entertainment luminaries have had problems of mental illness, sometimes involving alcohol and drugs, for which they publicly sought treatment, at hospitals or specialized centers like the Betty Ford Clinic, started by the former First Lady. During the last several years a number of cable channels have presented series that present actual celebrities who are patients in residential treatment settings, on a “reality television” basis, e.g., “Celebrity Rehab.” These series do not present treatment realistically and may influence audience impressions on what is involved in genuine treatment activities. Because the celebrities are paid for their appearance, and the rigid time requirements for scheduling programs must be observed, theatrical rather than therapeutic considerations tend to prevail in these series.

Television has also been used to promote the use of traditional entertainment movies for personal emotional education, via the Cinematherapy series, beginning in 2001 on cable stations and geared to women. The two hosts introduce and show a Hollywood movie, followed by a discussion of it that is led by the hosts and deals with relevant relationships and coping with problems. A series of related books lists other movies that can similarly be used for personal growth (Penske and West 2004).

Some psychotherapists may recommend a specific film to a client, so that it can be a basis for follow-up discussion. One counselor published a “prescription” book, summarizing 200 movies “to help you heal life’s problems,” with a listing of relevant titles for each problem (Solomon 1995).

Some Trends

Applications of psychiatry to the creation, study and understanding of theatrical films are very likely to continue in the future. More specifically, the psychoanalytic approach has proven to be productive in offering significant insights and findings (Gabbard and Gabbard 1999). Television and the newer digital modalities have aggressively made and presented psychiatry-related films. There is every reason to believe that these media vehicles will continue to meet the needs and gratifications of audiences in the future.

In addition, the expansion of interest in self-improvement and newer educational functions of psychiatrically relevant films can draw on the hundreds of titles that have been made over more than a century. The content and themes of this body of material have continually been related to trends and developments in psychiatry and its cognate fields. As the number of persons working in the healing professions expands, they can be expected to provide continuing inspiration for moviemakers, some of whom have already made films that are not generally associated with psychiatry-related treatment. Among their subjects are space aliens (Dan Curtis, “Intruders,” 1992), vampires (Francis Ford Coppola, “Bram Stoker’s Dracula,” 1992), new superheroes (Joel Schumacher, “Batman Forever,” 1995), cults (Jane Campion, “Holy Smoke,” 1999), and ghosts (William Malone, “The House on Haunted Hill,” 1999).

Emerging research areas like neuroscience, and computer applications are creating new film subjects. Dream research, for example, has provided subjects and plots for a few decades. Motion picture technology has kept up with the requirements of such newer subjects. “Inception” (Christopher Nolan 2010) is not psychiatry related but is a science fiction film which can be described as a dream within a dream, or people sharing a dream space. It won Academy Awards for visual effects, cinematography, sound mixing and sound editing. The public’s enthusiasm for the dream material in “Inception” is reflected in the film’s ranking thirtieth in worldwide gross income (Worldwide grosses 2012).

Whether we are considering films that are more or less traditional in subject or technology, there surely will be actors eager to act in them. Actors today are far more willing to accept the challenges of therapy on the screen and in their private lives than their predecessors. A half-century ago, attitudes were less positive. At that time, leading man Cary Grant told interviewers how greatly he had profited from 18 months of LSD-enhanced psychotherapy. He later denied having had the therapy, presumably because of concern about revealing his private life (Eliot 2004; Wansell 1984). Although he played a physician in three different films, he never appeared as a psychiatrist.

Another consideration that would encourage actors to appear in these films is society’s steadily growing recognition of psychiatry and the increasing quality of its film applications. Such trends can be expected to attract a wide range of future performers to this significant subject matter. Whoever the future actors in psychiatry-related films will be, the impact of their work will be perceived in the context of the changing American problem of mental illness. Fortunately, the twenty-first century has seen significant government, professional, and community initiatives toward dealing with this problem.