COMMENTARY

A Psychiatrist on Hollywood

Jeffrey A. Lieberman, MD

Disclosures

April 02, 2013

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Hi. This is Dr. Jeffrey Lieberman of Columbia University, talking to you today for Medscape. The recent broadcast of the Academy Awards reminded me of the issue of psychiatry in the movies. Historically, the entertainment industry and filmmakers have not been kind to mental illness or psychiatry. To be perfectly frank, they have exploited the issues for sensationalized entertainment -- for example, depicting the terrible conditions in The Snake Pit or the horrific murders in Dressed to Kill; or making some kind of political statement as in One Flew Over the Cuckoo's Nest; or showing, perhaps more realistically, the problems with our mental health care system and the devastation of mental illness in The Soloist.

Occasionally they get it right and do something that is more accurate and socially constructive. I am thinking of Ordinary People and A Beautiful Mind. But more often than not, in the interest of being entertaining and telling its story, the movie industry really takes artistic license and does not represent mental illness and the field of psychiatry accurately.

Two recent movies illustrate these extremes. Silver Linings Playbook was a very entertaining and poignant story of a family and a young man who is affected by bipolar disorder. He has problems controlling his behavior in the context of his mood swings and is involuntarily remanded to the hospital and later is released. The movie is about how he and his family come to terms with this. His father, played by Robert De Niro, has obsessive compulsive disorder. The main character, played by Bradley Cooper, has bipolar disorder and meets the romantic interest in this story, played by Jennifer Lawrence, who won an Academy Award for this role. She is dealing with the aftermath of having lost her husband and is going through some real adjustment reactions. Together, they find a way to meet their problems, overcome them, and redirect their lives in a positive way.

The movie presents the man with bipolar disorder in a very normal, humane way, as a regular guy as opposed to some type of weirdo or deviant personality. This movie was entertaining, affecting, and also did right by how mental illness can occur naturally in our society to people with ordinary families. It presents the field of psychiatry as being caring and attempting to really help people in need.

Contrast this with the movie Side Effects, which was directed by a very talented director, Steven Soderbergh, and is a very engaging "whodunit" starring Jude Law, Catherine Zeta-Jones, and Rooney Mara. This movie told a good story at the expense of psychiatry and mental illness. How did it do that? Well, I don't want to spoil the plot, but it presented the psychiatrists as being willing to act as shills or mercenaries for the pharmaceutical industry and enroll patients in clinical trials with new drugs that were potentially unsafe. It also reflected, in a way, questions about the validity of mental illness, which people genuinely suffer from. It also represented the psychiatrists as not knowing professional boundaries with patients.

I thought this movie could be quite damaging to the public's perception of mental illness and psychiatry. The excuse may be that it did so in the interest of telling you a story and providing some kind of entertainment, but at the same time, I think it conveyed a wrong impression. People who don't know any better will come away from this movie thinking, "My goodness, is mental illness real?" and "If I did have some problems mentally or emotionally, would I really want to see a psychiatrist for treatment?"

I can't tell Hollywood that they should mend their ways so much as I can say to think of the consequences of the entertainments you produce in terms of what people are going to take away from this and how it could affect their understanding of their health and their potential need for care. Both movies are good movies. I would recommend them to people in the mental health care profession and to psychiatrists because the stories are about the field that we work in. But in terms of their constructive messages and their social value, clearly Silver Linings Playbook came out on top.

This is Dr. Jeffrey Lieberman of Columbia University speaking to you today for Medscape.

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