Mental Illness

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DANNY WEDDING· • RYAN M. NIEMIEC TH

MOVIES & Mental 4Edition Illness PSYCHOPATHOLOGY TO UNDERSTAND USING FILMS Movies and Mental Illness

For Lester R. Bryant, MD, ScD, who continues to be a great mentor, model, scholar, and friend. DW

For my newborn, Ryland Zander, who inspired the revamping of Chapter 2, and elicits the goodness in me each day. RMN

About the Authors

Danny Wedding, PhD, MPH, is associate dean for management and international programs at the Cali- fornia School of Professional Psychology, Alliant International University. He is the editor of PsycCRI- TIQUES: Contemporary Psychology – APA Review of Books, the senior editor for Hogrefe’s book series on Advances in Psychotherapy: Evidence-Based Practice, and the coauthor of Positive Psychology at the Movies: Using Films to Build Virtues and Character Strengths. Wedding lectures widely on international psychology and the portrayal of mental illness in contemporary cinema.

Ryan M. Niemiec, PsyD, is education director of the VIA Institute on Character, a global nonprofit organization that advances the science and practice of character strengths. He is a licensed psychologist, ad- junct professor at Xavier University, and an international speaker. He is author of Mindfulness and Char- acter Strengths: A Practical Guide to Flourishing and coauthor of Positive Psychology at the Movies: Using Films to Build Character Strengths and Well-Being, and a number of articles and book chapters on films. He is film editor of PsycCRITIQUES and received a specialization in film studies from Michigan State University. His website is www.ryanniemiec.com

4th edition

Danny Wedding California School of Professional Psychology Alliant International University San Francisco, CA

Ryan M. Niemiec VIA Institute on Character Cincinnati, OH

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Library of Congress Cataloging information for the print version of this book is available via the Library of Congress Marc Database National Library of Canada Cataloguing in Publication Wedding, Danny, author Movies and mental illness : using films to understand psychopathology / Danny Wedding, California School of Profes- sional Psychology, Alliant International University, San Francisco, CA, Ryan M. Niemiec, VIA Institute on Character, Cin- cinnati, OH. -- 4th edition. Includes bibliographical references and index. Issued in print and electronic formats. ISBN 978-0-88937-461-4 (pbk.).--ISBN 978-1-61676-461-6 (pdf).-- ISBN 978-1-61334-461-3 (epub) 1. Psychology, Pathological--Study and teaching--Audio-visual aids. 2. Mental illness in motion pictures. I. Niemiec, Ryan M., author II. Title. RC459.W43 2014 616.89 C2014-902339-1 C2014-902340-5

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I have been a fan of the Movies and Mental Illness dience can be enjoyable, educational, active and from the first edition, so I am delighted to write this creative” (Pritzker, 2007). Foreword with Ruth Richards. Prior to becoming a An example of the emotional power of film to psychologist, I worked for over 20 years in Holly- influence the viewer was described to me by a Say- wood as a television writer and producer. I saw first- brook University Creativity Studies doctoral stu- hand how powerful TV and of course, movies, can dent. He said that he was watching a scene in the be in impacting viewers. movie Good Will Hunting in which Will Hunting I was lucky enough to work as a writer on The (Matt Damon) is talking to his psychologist (Robin Mary Tyler Moore show, which was seen by many Williams) about Will’s foster father coming up the women as a breakthrough depiction of a woman stairs to beat him. His psychologist repeatedly tells who “could make it on … [her] own.” I also worked him: “It’s not your fault, it’s not your fault, it’s not on Room 222, an Emmy-winning show, where some your fault …” until Will finally breaks down and episodes I wrote were used in schools of education cries. The student who told me this story found for teaching. An episode of Silver Spoons I wrote himself crying as he connected the scene to his about a child who was being physically abused by mother coming up the stairs to beat him with a belt, his father triggered thousands of calls to a hotline and he realized for the first time it really was not by abused children. his fault. Based on my experience both professionally and What is interesting about the hundreds of films personally, I suggested the concept of audience flow in Movies and Mental Illness is the pervasive fasci- could apply to watching television and movies. Au- nation with psychopathology. It is a testament to dience flow is defined as watching “in an active and how deeply mental illness touches almost every- mentally engaged state that may allow insights and body’s life in one form or another. Screenwriters new perspectives to develop. … A ‘conversation’ and psychologists have a great deal in common in develops between the viewer and the work that is trying to understand the dynamics of mental illness, so engaging that all sense of time is lost. This cog- which is a positive development because under- nitive engagement means that being part of an au- standing can lead to compassion. Steven R. Pritzker, PhD Professor and Director, Creativity Studies Specialization Saybrook University President, Division of Aesthetics, Creativity, & the Arts American Psychological Association Co-Editor-in-Chief, Encyclopedia of Creativity

Steve and I teach together at Saybrook University in “flow” with the movies, as an active and aware and started one of the first graduate programs in observer, can also fit our criteria for creativity, in- psychology with a specialization in creativity, of- cluding originality and usefulness. Creativity can fering certificates and MA and PhD degrees. We do be good for us – and for society as well. not offer these just for fun (although it often is fun), I am a psychiatrist as well as educational psy- but because we truly believe that the process of cre- chologist and professor, and have studied issues of ating can change lives. It can bring us more fully creativity and mental health for quite a few years – into the present moment, aware, open, flexible, and in schools, clinics, and in our spiritual lives. I am adaptive – more in tune with life, its richness, cheered by how much people can learn about psy- beauty, and potential, and with our many life op- chopathology at the movies – and how the best tions. Creative process, all else being equal, tends movies can even change how culture views certain to be healthy and good for us. As Steve notes, being disorders and treatments. Take, for instance, Silver

Linings Playbook, with Jennifer Lawrence winning sons falling on the bipolar spectrum than among Best Actress for 2013 for both the Oscars (7 other control participants. nominations) and Golden Globes (3 other nomina- Yet this is in connection with higher function (not tions). The film received 5 out of 5 stars in Movies with greater illness). The chance of creativity is en- and Mental Health. Most people would never curl hanced with milder compared with the more severe up on Saturday night with a diagnostic and treat- bipolar spectrum disorders (e.g., the milder cyclo- ment manual, yet they might well say, “let’s go to thymic disorder compared with full manic-depres- the movies – what was that new Oscar winner …?” sive syndrome, again on average), or for a particular Every person and every experience is different, person during better functioning states, compared yet in Silver Linings, I was immediately struck by with very ill states (e.g., mild hypomania versus the authenticity of the characters. A well-done film mania). We see this last difference in Silver Linings. can give a real three-dimensional flavor of the lived It is important that treatment may not only re- experience of a psychiatric disorder, along with the duce terrible suffering, but also potentially free a distinguishing central features. Meanwhile it can hindered potential, toward a richer life and more show real people, their lives, and their individual productive contributions to society. Yet how many patterns and challenges – along with hopes and people at risk for bipolar disorder think it is a mat- ways of coping. This one touched a great many of ter of “the sicker, the better” with regard to creativ- those bases – as do selected others receiving high ity – a serious misunderstanding. Some even refuse ratings in Movies and Mental Illness. treatment. This can be dangerous. Please note these In Silver Linings, Bradley Cooper played a young findings potentially generalize to millions of peo- man with bipolar disorder, type I (manic-depressive ple. illness), and Ms. Lawrence's character suffered from Before leaving this example, let us be careful to her own challenges. We see disruption of lives, why note that there are many routes to creativity, and not medications can make a huge difference (and what just ones linked to personal or familial psychiatric happens without them), the magic of a good thera- disorder. It is human to be creative. pist (meds don’t do everything!), major influences Meanwhile what an important chance the mov- of (and effects on) family and friends, and on the ies have to lower the stigma of mental disorders, in larger community, and even the value of – and be- general, to raise self-esteem, and to share accurate havioral benefits, resilient coping, and triumph pos- information, including information about treatment, sible from – creative work. Talk about overcoming and renew hope in life. Movies and Mental Illness adversity; how marvelous when this young and cre- helps us find just those films of the greatest value. ative couple … well you need to see it for yourself. I was privileged to speak on the topic of the arts As Steve suggests, we can learn not only by liv- and self-expression in mental health at the Carter ing our own challenges, but by living them through Presidential Center in Atlanta, for the Mental Health the lives of others, by entering the magic of film and Program chaired by Former First Lady Rosalynn imagination, and enlarging our experience, con- Carter. This Carter Center program has related ob- sciously as well as vicariously. Our “empathetic” jectives for improving how mental illness is under- mirror neurons jump right in to know that mood stood, viewed by, and treated in society, goals that swing, that awkwardness or desperate fear of loss; resonate with the objectives of Movies and Mental suddenly the pain becomes our own. Illness. Film can meanwhile impart vital information – Finally, while we moviegoers can learn bitter and perhaps even save lives. For instance, it turns truths about mental illness, and see how people out that enhanced everyday creativity (originality learn to cope with their painful symptoms, do we of everyday life) can be found associated with cer- not also want to see how people triumph and over- tain forms of psychopathology – yet the message is come, how they build on their strengths, passions, relatively more about health than illness – as I, with and positive qualities? Do we not wonder how suf- Dennis Kinney and other colleagues at McLean fering individuals try to find meaning in life, per- Hospital and Harvard Medical School, among oth- haps a greater good, or even transcendence? Un- ers, have shown (see Kinney & Richards, 2011). fortunately, individuals’ strengths sometimes get The results of these studies do support a higher rate overlooked by well-meaning mental health profes- of everyday creativity, on the average, among per- sionals who are more focused on what has “gone

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Foreword to the Fourth Edition vii wrong” than what could “go right.” It seems enough often found in the movies. We in the audience can to some clinicians to reverse the depression, psy- again live the drama, this time ascending to a higher chosis, loss and heartbreak, substance abuse, stress, human promise. We can imagine, experience, and or crippling anxiety. Yet who needs the hope more sometimes soar. For the person in pain, and for than the struggling patient? friends and family – which is to say, for pretty much As can be seen in the companion book Positive all of us – here is the chance not only to regain one’s Psychology at the Movies 2 by the same authors, life vicariously, but also to discover what one is liv- themes of resilience, resurrection, and renewal are ing for. Ruth Richards, MD, PhD Professor, Saybrook University Lecturer, Dept. of Psychiatry, Harvard Medical School Member-At-Large, Division of Aesthetics, Creativity, and the Arts American Psychological Association Editor, Everyday Creativity and New Views of Human Nature

You know a book is valuable when it enters multi- films. Whether it’s called cinematherapy, movie ple editions in tumultuous economic times. Such is treatment, or reel therapy, the goal is to enhance certainly the case for Movies and Mental Illness, health and happiness. now entering its third edition as a classic resource Many of the movies featured in these pages por- and an authoritative guide. tray healing stories. The best of them typically in- Movies play a powerful and pervasive role in crease awareness about a disorder or treatment; As our culture and, increasingly, in our classrooms. Good as It Gets springs to mind for its accurate and Psychologist Ken Gergen (The Saturated Self, 1991, humorous depiction of obsessive-compulsive dis- pp. 56–57) opined that movies have become one of order. The best movies also show flawed, yet effec- the most influential rhetorical devices in the world: tive role models struggling realistically with prob- “Films can catapult us rapidly and effectively into lems and ultimately triumphing; a case in point is states of fear, anger, sadness, romance, lust, and aes- the inspiring film The Soloist about living well with thetic ecstasy – often within the same two-hour pe- psychosis. Such films stir the soul as they generate riod. It is undoubtedly true that for many people hope and offer a fresh perspective on ourselves and film relationships provide the most emotionally our relationships. wrenching experiences of the average week.” Like the very movies it recommends, Movies If a picture is worth a thousand words, then a and Mental Illness is a powerful medium for teach- movie is worth tens of thousands of words in even ing students, engaging patients, and educating the the most engaging of textbooks. My students – all public. Wedding, Boyd, and Niemiec have produced students – clamor for immediate, personal, and riv- an invaluable guide for all those committed to un- eting examples of mental disorders and their treat- derstanding the human experience. ment. Movies can easily be integrated into education John C. Norcross, PhD to illustrate psychopathology, but can also be used University of Scranton for clinical purposes. The use of films for treatment Editor, Journal of Clinical Psychology can be traced back to the 1930s, but more profes- 2009 President of the Society of Clinical sionals are recommending or prescribing specific Psychology

John Milton, in Paradise Lost, tells us that we must As a didactic tool, the work by Wedding, Boyd, “strike the visual nerve, for we have much to see.” and Niemiec should have a salutary effect in engag- So, too, in this present work, do Wedding, Boyd, ing the attention of the student, as well as in engag- and Niemiec admonish us that there is much to ing the affective response of the student through a learn by seeing with the mind’s eye what these vicarious identification with the film characters por- well-chosen films, by turns sad and silly, offer us trayed, and hopefully, enhancing the learning pro- in illuminating the psychopathologies set forth in cess of what otherwise tends to be a rather tedious the Diagnostic and Statistical Manual of the Amer- pedagogical process for most students. ican Psychiatric Association. The authors provide a lively expository style, Ranging from such classics as the depiction of and the use of epigraphs for each chapter is a par- alcoholism in The Lost Weekend, to relatively ob- ticularly happy device for setting a tone for each scure films perhaps known only to the aficionado chapter and for capturing a pithy bit of dialogue that of foreign films, Wedding, Boyd, and Niemiec have may cause the reader to engage in some cognitive achieved a work which may itself become a classic restructuring, as when one of the characters says, “I in this genre, particularly with respect to its intended recall every fall, every hook, every jab” in the chap- purpose of teaching how the various psychopathol- ter on the dementias, a quote which instantly evokes ogies might play themselves out in an approxima- an image of the prizefighter with organic brain dam- tion of real-life, real-world situations of which these age. Other such examples abound and contribute films are a simulacrum. significantly to the teaching potential of the work. Wedding, Boyd, and Niemiec provide a brief On balance, this is a work that is likely to be- synopsis of each film in relation to the major cate- come a classic of its type and a particularly useful gory of psychopathology being covered in a chap- teaching tool for the diagnosis and understanding ter, and they relate the manifest and latent content of the various psychopathologies for students of the of the film to the various diagnostic symptoms helping professions. I commend it to the reader, be within a category, such as childhood disorders, and the reader a student or professor. further provide an illustrative case study to assist in the process of generalizing from the film to actual Allan Barclay, PhD diagnostic work. St. Louis, Missouri

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Table of Contents

About the Authors ...... ii Foreword to the Fourth Edition ...... v Foreword to the Third Edition ...... viii Foreword to the Second Edition ...... ix Preface ...... xiii Acknowledgments ...... xvi

1 Films and Psychopathology ...... 1 2 Neurodevelopmental Disorders ...... 15 3 Schizophrenia Spectrum and Other Psychotic Disorders ...... 39 4 Bipolar and Depressive Disorders ...... 63 5 Anxiety and Obsessive-Compulsive Disorders ...... 89 6 Trauma- and Stressor-Related Disorders ...... 105 7 Dissociative Disorders ...... 117 8 Sleep-Wake, Eating, and Somatic Symptom Disorders ...... 135 9 Gender Dysphoria and Sexual Dysfunctions ...... 153 10 Disruptive, Impulse-Control, and Conduct Disorders ...... 165 11 Substance-Related and Addictive Disorders ...... 181 12 Neurocognitive Disorders ...... 209 13 Personality Disorders ...... 229 14 Paraphilic Disorders ...... 261 15 Violence and Physical and Sexual Abuse ...... 281 16 Treatment ...... 299

Appendix A : The American Film Institute’s Top 50 Heroes and Villains ...... 321 Appendix B: Syllabus for Sample Course that Integrates Films ...... 323 Appendix C: Recommended Websites ...... 325 Appendix D: 12 Misconceptions About Mental Illness and Mental Health Professionals Perpetuated by Movies ...... 327 Appendix E: Portrayals of Psychotherapists in Movies ...... 328 Appendix F : PRISM Awards for Feature Films ...... 329 Appendix G: SAMHSA Voice Awards ...... 330 Appendix H: Films Illustrating Psychopathology ...... 339

References ...... 432 Film Index ...... 437

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Preface

The whole of life is just like watching a film. Only it’s as though you always get in ten minutes after the big picture has started, and no-one will tell you the plot, so you have to work it out all yourself from the clues. Terry Pratchett, Moving Pictures

We wrote Movies and Mental Illness because of our ogy and neurofibrillary tangles. One way to ap- conviction that films are a powerful medium for proach Movies and Mental Illness is to simply start teaching students (in psychology, social work, med- with Appendix H and a highlighter, identifying in- icine, nursing, and counseling), engaging patients, teresting films, and then seeing what we have to say and educating the public about the fascinating world about them in the book. of psychopathology. In addition, we wrote the book We have also updated our list of our favorite films because we genuinely love watching and talking in each category (“Authors’ Picks”). We did not al- about movies. While this book’s title is Movies and ways agree about which films were most important Mental Illness, we also discuss serious problems for readers to see, but we negotiated and debated each that do not reflect mental illness per se, including list and eventually selected around 10 films for each neurodevelopmental disorders, physical or sexual chapter that balanced artistic merit and clinical rele- abuse, and violence. vance. This addition is in response to the frequent re- We have made numerous changes in this edition. quest for our recommendations for movies that can A new edition was necessary because dozens of ex- be used to help train mental health professionals and cellent films have been released in the past 5 years students from various health professionals. that need to be included in any book that purports to We have continued the practice of recommend- be both contemporary and comprehensive. We have ing a single book and a single article in the “Future added over a hundred recent films to Appendix H that Exploration” section at the end of each chapter. We illustrate psychopathology. Although it is impossible envision that these additional readings will be used to list every film depicting every disorder, we feel in honors courses or perhaps as supplemental read- we have seen and critiqued the majority of important ings to compensate for a missed class, exam, or as- films that illustrate psychopathology. The reader will signment. All students will benefit from taking time find a significant number of these new films dis- to read the recommended books and the key articles cussed in the relevant chapters. we identify. The release of the fifth edition of the Diagnos- Finally, we have continued to expand the sec- tic and Statistical Manual of Mental Disorders tions on international films in each chapter. Often (DSM-5) required that we rework our Table of Con- these films are more powerful and accurate than tents to line it up with the new nosology that was anything filmmakers in the United States have pro- developed by the American Psychiatric Association. duced. We hope this will entice readers to watch In our clinical examples, we include the appropri- more foreign language films; we have found this an ate codes from the International Classification of especially interesting and rewarding way to learn Diseases (ICD-11) after each diagnosis. We hope about other cultures. students will debate the merits of the various diag- In discussing psychopathology, we occasionally noses we assign, discussing differential diagnosis reveal endings or surprise twists to films, and we and alternate possibilities. realize this may spoil these films for some readers. We have updated the sample course syllabus, We apologize in advance if this occurs. and we have selected numerous new headliner films The book was originally designed to supplement to teach students the look and feel of the various dis- core texts in abnormal psychology; if the book is orders they are likely to encounter in clinical prac- being used in this way, the relevant core chapters in tice. For example, we believe watching Michael the primary text should be read before reviewing Haneke’s Amour captures the pathos of Alzheimer’s the corresponding chapter in Movies and Mental Ill- disease with raw emotion and a vivid power that can ness. (However, it is almost always helpful to re- never be had by simply reading about neuropathol- view the “Questions to Consider” section that intro-

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. xiv Movies and Mental Illness duces each chapter on psychopathology before liner films are movies we have watched repeatedly. seeing the recommended film.) We will occasion- In many cases, they are popular movies that students ally present detailed and specific information about are likely to have already seen (e.g., A Beautiful mental illness, but these facts are almost incidental Mind); in other cases, they are simply films that we to the discussion of the films themselves, and we believe every student learning to be a mental health have tried to avoid redundancy with the many fine professional should see (e.g., Temple Grandin). textbooks that already explain psychopathology in Usually the connection between the films being considerable detail. We assume the reader will look discussed and the chapter is immediate and direct, up unfamiliar terms or discuss them in class, and we but we occasionally include obscure films when a have not always defined each new term. small section relates in a meaningful way to the Each chapter is introduced with a fabricated case points made in the chapter. There are also some history and Mini-Mental State Examination. We classic films such as Psycho, A Clockwork Orange, have developed composite presentations linked as and One Flew Over the Cuckoo’s Nest that have tre- closely as possible to the character being portrayed mendous pedagogical value, and we take great plea- in the film being discussed. In every case, the diag- sure in introducing a new generation of students to noses we present reflect hypotheses, not facts; the these movies. In addition, films such as Pelle the case studies are designed to generate ideas, enliven Conqueror or Antonio’s Line are occasionally in- discussion, and stimulate learning. Our diagnoses cluded, even when there is no direct connection to and character descriptions are always derived from psychopathology, because the films are provocative our own judgment and clinical experience, and our and moving and are good illustrations of various fabricated evaluations are anchored in the events psychological phenomena. For detailed examples of portrayed on screen, even when films are based on these and other films depicting character strengths, actual figures (e.g., the characters of John Nash in resilience, and various positive psychological phe- A Beautiful Mind, Ray Charles in Ray, and Teena nomena, we recommend our book, Positive Psy- Brandon in Boys Don’t Cry). chology at the Movies: Using Films to Build Char- We are clinical psychologists and educators, and acter Strengths and Well-Being, which discusses we have both learned that the judicious use of films 1,500 films. dramatically increases students’ and clients’ under- Films can be integrated into courses in abnor- standing of abnormal behavior. For example, when mal psychology and psychopathology in a variety lecturing about alcoholism, we might supplement of ways. The particular approach selected will vary our lectures with a “demonstration” of delirium tre- from course to course, depending on the needs of mens using The Lost Weekend or illustrate with- the instructor and the interests of students. drawal and tolerance using Denzel Washington’s First, students can be asked to take responsibil- character in Flight. Before a lecture on bipolar dis- ity for seeing many of these films on their own. Be- order, we will ask our students to watch Michael cause we have selected popular films as the exem- Clayton or Silver Linings Playbook. All four films plars for each clinical chapter, students can easily provide a rich intensity that simply cannot be cap- attain them from any number of commercial sources. tured by a classroom lecture or the printed page. Costs are minimized if students choose to see the Likewise, when working with a client going through films in small groups. This promotes the intellec- a divorce who becomes incensed over the behavior tual camaraderie, discussion, and debate that char- of his or her spouse, we might recommend watch- acterize effective learning. We recommend that ing Kramer vs. Kramer or The Squid and the Whale. whenever possible students see the films before A counselor working with parents attempting to un- coming to class to discuss the corresponding topic. derstand and cope with their adolescent child’s sui- Second, we have used films in classes that meet cidality might consider reviewing Boy Interrupted. twice weekly. The first class meeting is devoted to We have found that the discussion of relevant films seeing the film; the second is spent discussing the offers a wonderful way to open clinically relevant content of the related textbook chapter and deter- areas that have not previously been explored. mining whether or not the film accurately represents We discuss a variety of films throughout the the disorder being discussed. It is ideal when such book; however, we usually use one or two films as courses can be team taught by a mental health pro- primary illustrations of each disorder. These head- fessional and a literature/drama professor. Danny

Wedding used this approach in the abnormal psy- fessor teaching the class) to pay a fee for public chology course he taught at Yonsei University in usage. Most colleges and universities have audio- Seoul, Korea, where he spent a year as the Ful- visual departments well equipped to handle such ad- bright-Yonsei Distinguished Scholar. ministrative details. Finally, most professors choose to use class time Many readers will disagree about the ratings we to show selected vignettes from pedagogically pow- have assigned films included in Appendix H. How- erful films, and they encourage students to view the ever, it is important to remember that our ratings are entire film and other related films on their own time. based primarily on the utility of the film as a teach- The goal with this approach is to augment lectures ing tool and only secondarily on the film’s artistic with relevant in-class discussion while minimizing merit. the total amount of class time spent watching films. We are including our e-mail addresses below Using a film vignette that vividly depicts a psychi- so we can get feedback about the book. We hope atric disorder circumvents the ethical issues (confi- those readers who share our enthusiasm about dentiality, securing releases and permission, etc.) movies as a teaching tool will recommend addi- associated with using real cases and clients as illus- tional films that we can include in the next edition trations in the classroom. We have found it useful of Movies and Mental Illness. for our students to present selected film clips along with diagnostic criteria from the DSM-5, arguing Danny Wedding, PhD, MPH the merits and limitations of potential diagnoses for [email protected] particular film characters. When films are used in the classroom, it may be Ryan M. Niemiec, PsyD necessary for the educational institution (or the pro- [email protected]

We are constantly writing about and discussing several films partway through, helping Danny know movies, and there are numerous friends and col- when films were too confusing, provocative, or dis- leagues to acknowledge. Many of our ideas and the turbing for the typical viewer (e.g., Cloud Atlas and selections of films to be included in each new edi- We Need to Talk About Kevin). tion of Movies and Mental Illness grew out of dis- Danny Wedding is the editor of PsycCRITIQUES: cussions with these individuals, especially those Contemporary Psychology – APA Review of Books, who are mental health professionals interested in and Ryan Niemiec is the associate editor for films the fascinating ways in which psychopathology is for this American Psychological Association publi- portrayed in film. cation. When Wedding became editor, he reinstated Rob Dimbleby at Hogrefe Publishing is an ex- the practice of reviewing psychologically relevant traordinary publisher, a true visionary, and a valued films in the journal, a practice first introduced by friend. We appreciate his enthusiasm for publishing the journal’s founding editor, E. G. Boring. Read- an expanded and enhanced edition of this book. ing weekly film reviews written by psychologists We are also grateful to Mary Ann Boyd, our col- has both sharpened and deepened our appreciation league and friend, who served as coauthor on the for the psychological relevance of films. Although first three editions of Movies and Mental Illness. the journal itself requires a subscription, interested Christoph Zepeda and Chris Pearce are two col- readers can read and comment on selected film re- leagues who help with each week’s release of a new views at no cost by visiting the website (http://psyc- issue of PsycCRITIQUES; both helped immeasur- critiquesblog.apa.org). ably with this new edition. This book has opened up some incredible speak- Many people gave us specific feedback or sug- ing opportunities for Danny Wedding. For example, gestions relating to the psychopathology or movie Drs. Moira Nakousi, Daniel Soto, John Norcross, portions of the book. We believe these have helped and Roberto Opazo Castro arranged for him to pres- us make solid improvements throughout this partic- ent talks on Movies and Mental Illness in Santiago, ular edition. Thanks go to our colleagues in two di- Chile; Dr. Catherine Sun invited Danny to keynote visions of the American Psychological Association: a conference in counseling psychology in Hong The Society for Media Psychology and Technology, Kong, presenting a talk on films and mental illness; and the Society for the Psychology of Aesthetics, Dr. Saths Cooper invited him to present on the topic Creativity, and the Arts. The members of these two at the 2012 International Congress of Psychology divisions made multiple recommendations for films in Cape Town, South Africa; Professor Paul Craw- we include in this new edition. ford arranged for Danny to present at an Interna- Danny Wedding benefited from hundreds of dis- tional Health Humanities conference sponsored by cussions about films with his two sons, Joshua Wed- the University of Nottingham; and Danny was able ding and Jeremiah Wedding (whose decision to to present on the topic of bipolar disorders and cin- major in film studies was no doubt influenced by his ema at the 12th International Review of Bipolar father’s habit of watching two or three movies each Disorders in May, 2012, in Nice, France. The Nice week). Kayley Harrington, Kristine Harrington, and talk coincided with the by-invitation-only Cannes Thomas Harrington also made numerous useful sug- Film Festival (Festival de Cannes), and Danny was gestions, along with their respective partners, Aaron able to use a flyer for Movies and Mental Illness to Bach, Steve Rutkowski, and Krystle Bartholomew. establish his credentials as a serious scholar and a Danny Wedding’s work on this edition was de- journalist with a genuine interest in films. layed by his October 2013 marriage to Karen Har- Special thanks goes to Ryan Niemiec’s wife, rington; however, she has proven herself to be a Rachelle Plummer, who continues to support his stalwart partner who shares his passion for both lan- compulsive need to watch movies; this often entails guage and films (if not his passions for films deal- light-up pens in movie theaters, tolerating the ubiq- ing with depression, pathology, and suicide). Karen’s uitous laptop he keeps by his side while watching mother, Dorothea (Dody) Schwaiger, also helped movies at home, and frequent interruptions from with this edition – in part by walking away from new alerts on recent movies on his iPhone. His

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Acknowledgments xvii young sons, Rhys and Ryland, have slept through tions in Japanese, German (Psyche Im Kino) and many hours of films in their father’s arms as he Polish (Kino I Choroby Psychiczne). studied the characters on the screen. We appreciate the feedback from our colleagues, Finally, we want to thank two world class friends, family, and the many readers who have scholars: Dr. Antonio Díez Herranz, who translated taken the time to share suggestions, opinions, and Movies and Mental Illness into Spanish, and Pro- support for our work. We hope you will contribute fessor Seung-hwa Beack, from Myong-Ji Univer- to our blog (http://moviesandmentalillness.blogspot. sity, who translated our book into Korean. We were com) and let us know when you come across a great also gratified to receive copies of recent transla- film that should be discussed in the next edition.

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Chapter 1 Films and Psychopathology

For better or worse, movies and television contribute significantly to shaping the public’s perception of the mentally ill and those who treat them.

Steven E. Hyler

For contemporary audiences, attending movies is an experience that provides catharsis and unites the audience with their culture in much the same way that the tragedies of Sophocles and Aeschylus performed these functions for 5th-century BC Greek audiences.

Glen Gabbard and Krin Gabbard

Introduction The Pervasive Influence of Films

In all of human perceptual experience, nothing con- Film has become such an integral part of our cul- veys information or evokes emotion quite as clearly ture that it seems to be the mirror in which we see as our visual sense. Filmmakers capture the rich- ourselves reflected every day. Indeed, the social im- ness of this visual sense, combine it with auditory pact of film extends around the globe. The wide- stimuli, and create the ultimate waking dream ex- spread popularity of online movies, DVDs by mail perience: the movie. The viewer enters a trance, a (e.g., through Netflix), nominally priced Redbox state of absorption, concentration, and attention, en- rentals at the street corner, the use of unlimited rent- grossed by the story and the plight of the characters. als for a monthly fee, and in-home, cable features When someone is watching a movie, an immediate like On-Demand make hundreds of thousands of bond is set up between the viewer and the film, and movies available and accessible to virtually anyone all of the technical apparatus involved with the pro- in the world (and certainly anyone who has Internet jection of the film becomes invisible as the images access). No longer are individuals limited solely to from the film pass into the viewer’s consciousness. the film selection and discretion of the corner video The viewer experiences a sort of dissociative state store. People now have wide access to films beyond in which ordinary existence is temporarily sus- Hollywood, including access to films from indepen- pended, serving as a psychological clutch (Butler & dent filmmakers, even those from developing coun- Palesh, 2004) in which the individual escapes from tries. Moreover, with the affordability of digital the stressors, conflicts, and worries of the day. This video, neophyte and/or low-budget filmmakers can trance state is further enhanced in movie theaters now tell their stories within the constraints of a where the viewer is fully enveloped in sight and much more reasonable budget without sacrificing sound, and in some instances experiences the sense quality (Taylor & Hsu, 2003); this increases the of touch through vibration effects. No other art form range of topics and themes that can be covered. Re- pervades the consciousness of the individual to the cent award-winning films such as Gravity (2013), same extent and with such power as cinema. Many Rust and Bone (2012), and Life of Pi (2012) were consider movies to be the most influential form of all shot using digital video. mass communication (Cape, 2003). We believe films have a greater influence than Hollywood took the original invention of the any other art form. This influence is felt across age, cinematic camera and invented a new art form in gender, nationality, and culture – and even across which the viewer becomes enveloped in the work time. Films have become a pervasive and omnipres- of art. The camera carries the viewer into each ent part of our society, and yet people often have lit- scene, and the viewer perceives events from the in- tle conscious awareness of the profound influence side as if surrounded by the characters in the film. the medium exerts. The actors do not have to describe their feelings, as Films are especially important in influencing in a play, because the viewer directly experiences the public perception of mental illness because what they see and feel. many people are relatively uninformed about the To produce an emotional response to a film, the problems of people with mental disorders, and the director carefully develops both plot and character media tend to be especially effective in shaping through precise camera work. Editing creates a vi- opinion in those situations in which strong opinions sual and acoustic gestalt, to which the viewer re- are not already held. Although some films present sponds. The more effective the technique, the more sympathetic portrayals of people with mental ill- involved the viewer. In effect, the director constructs ness and those professionals who work in the field the film’s (and the viewer’s) reality. The selection of mental health (e.g., The Three Faces of Eve, of locations, sets, actors, costumes, and lighting David and Lisa, Ordinary People, and A Beautiful contributes to the film’s organization and shot-by- Mind), many more do not. Individuals with mental shot mise-en-scene (the physical arrangement of illness are often portrayed as aggressive, danger- the visual image). ous, and unpredictable; psychiatrists, psycholo-

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Chapter 1: Films and Psychopathology 3 gists, nurses, and other health professionals who 2. Film begets film: every new film draws on previous work with these patients are often portrayed as “ar- films within the genre; rogant and ineffectual,” “cold-hearted and author- 3. Skewed distribution hides more films than censor- ship ever did; itarian,” “passive and apathetic,” or “shrewd and 4. There are no mental health films, just mental illness manipulative” (Niemiec & Wedding, 2006; Wed- ones; ding & Niemiec, 2003). Psychiatrists in particular 5. If it bleeds it leads: violence, injury and death often have been negatively portrayed in the cinema (Gab- ensure prominence of a story in both news and film. bard & Gabbard, 1992). (Byrne, 2009, pp. 287–288). Films such as Psycho (1960) perpetuate the Byrne’s points are well-taken, although we would continuing confusion about the relationship be- challenge Number 4 because we have written a tween schizophrenia and dissociative identity dis- book titled Positive Psychology at the Movies (Ni- order (formerly multiple personality disorder); Fri- emiec & Wedding, 2014) in which we document day the 13th (1980) and Nightmare on Elm Street nearly 1,500 movies that display character strengths (1984) both perpetuate the misconception that peo- and other healthy aspects of human psychology, in- ple who leave psychiatric hospitals are violent and cluding positive mental health. This edition of Mov- dangerous; movies such as The Exorcist (1973) sug- ies and Mental Illness also describes many films gest to the public that mental illness is the equiva- that offer positive depictions of mental health. lent of possession by the devil; and movies such as One Flew Over the Cuckoo’s Nest (1975) make the case that psychiatric hospitals are simply prisons in which there is little or no regard for patient rights Cinematic Elements or welfare. These films in part account for the continuing stigma of mental illness. Stigma is one of the reasons that so few people A film director must consider countless technical with mental problems actually receive help (Corri- elements in the making of a film, often orchestrat- gan, Roe, & Tsang, 2011). The National Institute of ing hundreds of people, many of whom monitor and Mental Health (NIMH) estimates that only 20% of pass down orders to hundreds or thousands of other those with mental disorders actually reach out for collaborators. There are three general phases in- help with their problems, despite the fact that many volved in making a film. current treatments for these disorders are inexpen- The time spent prior to filming in the prepro- sive and effective. In addition, there is still a strong duction phase is often seen as the most important. tendency to see patients with mental disorders as Many directors storyboard (draw out) every shot the cause of their own disorders – for example, the and choreograph every movement for each scene to National Alliance for the Mentally Ill (NAMI) has be filmed. Countless meetings with each technical polling data that indicate that about one in three US supervisor (e.g., cinematographer, costume designer, citizens still conceptualizes mental illness in terms set designer, electrician) are held to facilitate prep- of evil and punishment for misbehavior. aration, coordination, and integration. The director Psychiatrist Peter Byrne has pointed out that will also scout out locations, work with casting ap- films rarely portray mental illness or mental health propriate actors and actresses for the various roles, practitioners accurately, but he also makes the com- and may rework the screenplay. pelling point that the job of a director is to create a In the production phase, the director attempts film that will generate revenue for producers and to film his or her vision, working closely with the investors, and it is not necessarily their job to edu- actors and actresses to encourage, stimulate, guide, cate the public. In a recent article, he described five or alter their work, while carefully monitoring cam- rules of movie psychiatry (Byrne, 2009): era angles, lighting, sound, and other technical areas. 1. Follow the money: film-making is a commercial enterprise and producers may include inaccurate re- In the postproduction phase, editing and laying presentations in their films to ‘give the public what out the musical score and background sounds are they want’; major areas of focus. The director integrates each of

Table 1. Film elements with movie examples

Film element Explanation Classic example Recent example Themes Overall meaning, messa- It’s a Wonderful Life (1946) 12 Years a Slave (2013) ges, motifs Cinematography Visual appeal, framing, Lawrence of Arabia (1962) Gravity (2013) camera work, lighting Pacing Movement, fluidity M*A*S*H (1970) Life of Pi (2012) Sound Music, score, sound effects Ben-Hur (1959) Django Unchained (2012) Mood Tone, atmosphere M (1931) Beasts of the Southern Wild (2012) Art Set design, costumes Star Wars (1977) The Great Gatsby (2013) Dialogue Conversation, modes of Annie Hall (1977) Blue Jasmine (2013) communication Acting Character portrayal, depth The Philadelphia Story Dallas Buyers Club (2013) and quality, casting (1940) Editing Continuity, transitions Citizen Kane (1941) Captain Phillips (2013) Screenplay Storyline, plot; original or One Flew Over the Cuckoo’s Silver Linings Playbook adapted to the screen Nest (1975) (2012) Direction All elements together, A Clockwork Orange (1971) Cloud Atlas (2012) quality of film overall

flects the atmosphere of the film itself. Movements are film’s characters so strongly that it appears clear heavy, thoughts are hard to grasp, time is slow and ten- that the defense mechanism of projection is pres- sion is hiding – hiding but present. When it finally ex- ent. This process is facilitated when the viewer can plodes, it is like fireworks – sudden, loud, and quick. Panoramic shots of landscape become unexpectedly anticipate the storyline, the plot, or the outcome. mixed with nervous details of action. It all lasts for a The avid moviegoer quickly realizes familiar themes, moment or two, and then tension hides again, waiting similar settings, and “formulas” for plots and end- for the next opportunity to surprise. Time slows down ings across a variety of films. again.” Danis Tanovic, quoted in the DVD insert for No Man’s Land The Close-Up

Changes in color and sound have a significant im- When we see an isolated face on the screen, our pact on the viewer’s experience of a film. Butler and consciousness of space is suspended, and we be- Palesh (2004) offer the example of Steven Spiel- come vividly aware of all the nuances of emotion berg’s manipulation of these cinematic elements in that can be expressed by a grimace or a glance. We Saving Private Ryan (1998). In addition to screams form beliefs about a character’s emotions, moods, turned slowly into sobs or mumbles, colors are sub- intentions, and thoughts as we look directly into his dued to an almost black-and-white appearance so or her face. Indeed, many of the most profound that when the color red is introduced in the battle emotional experiences (such as grief) are expressed scenes amid the muted background, the depiction much more powerfully through the human face than of the reality of war becomes even more vivid for through words. Consider the dynamic film, Amélie the viewer. (2001), in which director Jean-Pierre Jeunet pur- For the most skilled directors, virtually every- posefully chooses characters (as he does for all of thing that the camera “sees” and records is mean- his films) who have very expressive faces. There ingful. The sense of subjective experience produced are numerous close-ups on several of the characters’ by a sequence of point-of-view shots facilitates the faces throughout the film. He explains that he wants viewer’s identification with the film’s characters, to have characters who are interesting for the viewer their perceptions, and their circumstances. Extreme to look at. In turn, this enhances viewer interest and close-up shots and a variety of panning techniques character development. facilitate the importance of an emotional expression Director Woody Allen uses close-up shots or inner conflict, or develop pacing for the film. smoothly and effectively, and they are a hallmark High-angle and low-angle shots give emphasis to of many of his films. Some of the close-up images character control, power, strength, weakness, and a of Cate Blanchett playing the role of Jasmine in variety of other dynamics. For example, in Ameri- Blue Jasmine (2013) are unforgettable, and they lin- can Beauty (1999), high-angle shots are used at the ger with the viewer long after he or she leaves the beginning of the film focused on Lester Burnham theater (see Figure 24 on page 250). (Kevin Spacey) to indicate a passiveness and sub- This ability to share and comprehend subjec- mission to authority prior to his transformation to a tive experiences through empathic interpretation strong-willed, commanding character. of the language of the face is clearly evident in Each viewer possesses unique perceptual pref- early silent films, and these films still have the erences, prior knowledge about the film’s content, power to evoke strong emotions. In fact, many and preconceptions about the images the film con- early directors of silent films, confronted with the tains that mediate his or her perceptions and expe- development of “talkies,” feared that the addition rience. Rarely, if ever, do any two viewers have an of sound would place a barrier between the spec- identical experience when viewing the same film. tator and the film and restore the external and in- Each viewer subjectively selects, attends to, and ternal distance and dualism present in other works translates the visual and acoustic images projected of art. The principles of observing emotional nu- in a theater into his or her own version of the story. ances can be extended from the human face to the Often viewers are affected by, or identify with, the background and surroundings in which the charac-

As a film is being projected onto a theater screen, we project ourselves into the action and identify with its protagonists. At one time it was thought The Representation of Psycholog- that to maintain the attention of viewers, a film had to have a central character and theme. At times this ical Phenomena in Film central figure has been an antihero. However, directors such as Robert Altman and Quentin Taran- Film is particularly well suited to depicting psycho- tino have experimented with techniques in which logical states of mind and altered mental states. The they rapidly shift among short vignettes that may combination of images, dialogue, sound effects, and be only loosely linked with a storyline or central music in a movie mimics and parallels the thoughts character. Altman’s Short Cuts (1994) and Taranti- and feelings that occur in our stream of conscious- no’s Pulp Fiction (1994) are two examples of this ness. Lights, colors, and sounds emanate from the approach. Crash (2005), directed by Paul Haggis, screen in such a way that we readily find ourselves was so masterful at interweaving stories to enhance believing that we are actually experiencing what is meaning and viewer engagement that it won an happening on the screen. Academy Award for Best Picture, among many In Secrets of a Soul (1926), German director other awards. The most recent example of this ap- Georg Wilhelm Pabst dramatized psychoanalytic proach is Cloud Atlas (2012), a film in which mul- theory with the help of two of Freud’s assistants, tiple actors play multiple roles in vignettes that are Karl Abraham and Hanns Sachs, and depicted loosely but meaningfully connected. The film ad- dream sequences with multilayered superimposition dresses the obscure links between past, present, and (achieved through rewinding and multiple expo-

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Chapter 1: Films and Psychopathology 7 sures). Freud himself did not want his name con- The inclusion of images with symbolic meaning, nected with the project and had misgivings about such as a hearse passing by or the well-known chess the film’s ability to convey the nuances of psycho- game with Death in The Seventh Seal (1957), can analytic process. In a letter to Abraham, Freud evoke certain moods or prepare the viewer for wrote, “My chief objection is still that I do not be- events that are about to occur. Symbolic sounds, lieve satisfactory plastic representation of our ab- such as a baby crying, can have a similar effect. stractions is at all possible” (Freud, cited in Green- Another symbol often used in film is the mirror. berg, 1993, p. 19). Freud remained skeptical about When a character is filmed looking in the mirror, it the cinema all his life. This perspective is in direct often represents self-reflection, insight, a new iden- contrast to that of the late, renowned filmmaker tity emerging or changing, or even a narcissistic pre- Stanley Kubrick, who noted, “If it can be written, occupation with oneself. Monster’s Ball (2001) uses or thought, it can be filmed.” mirrors and other reflective objects to symbolize Film is frequently used to objectively portray self-distortion and negative self-perception in the subjective states such as dreams. Perhaps the best ex- two lead characters who are numb to their own lives. ample of this is Hitchcock’s collaboration with Sal- Mirrored images depict Marlon Brando’s broken and vador Dali on the dream sequence in Spellbound distorted character in Last Tango in Paris (1972), (1945). Hitchcock wanted to “turn out the first pic- self-deprecation in American Splendor (2003), self- ture on psychoanalysis.” He was determined to break criticism in Soldier’s Girl (2003), deterioration in the traditional way of handling dream sequences Ben X (2007), Black Swan (2010), and Focus (2001), through a blurred and hazy screen. Hitchcock wanted self-reflection and distortion in Chloe (2010), and dreams with great visual sharpness and clarity, and externalization of blame in a dramatic, comical scene images sharper than those in the film itself. He chose in 25th Hour (2002). Salvador Dali as a collaborator because of the archi- tectural precision of the artist’s work. Hitchcock originally wanted to shoot Spellbound in the open air “Beyond all physical and palpable reality another and in natural light, but he wound up shooting the dimension defined only in painting, a mirror which film in the studio to cut costs. Spellbound depicts the deforms life … an instant reflected … a magical cathartic recovery of repressed memories, and an reality where all is possible.” emotional experience intense enough to eliminate the hero’s amnesia. This is a psychological process that Goya in Bordeaux (1999) has been depicted in film since its early days. Films can also be used to interweave fantasy and reality, and a director may intentionally set up situ- Films offer numerous examples of unconscious mo- ations in which the viewer cannot tell if the film por- tivation and defense mechanisms, involuntary pat- trays reality or the unconscious fantasies of a char- terns of thinking, feeling, or acting that arise in re- acter. Examples of this technique include Ingmar sponse to the subjective experience of anxiety. Bergman’s Persona (1966), Federico Fellini’s Ju- Acting out in reaction to stress or inner conflict is liet of the Spirits (1965), Luis Buñuel’s Belle de present in The Hammer (2010), Intimacy (2000), Jour (1966), Robert Altman’s Images (1972), and You Can Count On Me (2000), and Lantana (2001), Derek Cianfrance’s Beasts of the Southern Wild and in Michael Douglas’ response to the stress in (2012). Director David Lynch has made this ap- his life in Falling Down (1993). Altruism can be proach his trademark with such films as Mulholland seen in Patch Adams (1998), and the character of Drive (2001), Lost Highway (1997), Blue Velvet the doctor who devotes himself to the indigent peo- (1986), and Eraserhead (1977). ple of India in Streets of Joy (1994). Denial is dra- Processes such as thinking, recalling, imagin- matically illustrated in Katharine Hepburn’s and ing, and feeling are not visible, but the language of Ellen Burstyn’s gripping roles as drug addicts in the montage and camera techniques such as slow Long Day’s Journey into Night (1962) and Requiem fades can suggest these invisible processes. Also, for a Dream (2000), respectively, as well as the Os- the film can be edited in such a way that the viewer car-winning film The White Ribbon (2009), and is forced to think about psychological phenomena. most of the townspeople in both The Village (2004)

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. 8 Movies and Mental Illness and Dogville (2003). Intellectualization is present An early film that served as a prototype for hor- Table 2. DSM-5 categories and movies that portray them in Lorenzo’s Oil (1992), and suppression is appar- ror films, Wiene’s The Cabinet of Dr. Caligari ent in A Dangerous Method (2011), Rabbit Hole (1920), is highly expressionistic, and it established Category Classic film examples More recent film examples (2010), The United States of Leland (2003), Cara- a precedent for setting macabre murders in mental mel (2007), and Kill Bill: Vol. 2 (2004), and is com- institutions. Like dozens of films that followed, it Neurodevelopmental disor- Sling Blade (1996); My Left Foot Me, Too (2009); Monica and David (2009); monplace in Gone with the Wind (1939). linked insanity and the personal lives of psychia- ders: Intellectual disability (1989) Rory O’Shea Was Here (2004) trists and implied that mental health professionals Neurodevelopmental disor- David and Lisa (1962); Adam (2009); The Horse Boy (2009); The are all “a little odd.” Evidence of the enduring ef- ders: Autism spectrum Rain Man (1988) Black Balloon (2008) “I’ll think about it tomorrow. Tara! Home. I’ll go fects of these themes is found in the successful and Neurocognitive disorders On Golden Pond (1981) Away From Her (2006); Amour (2012) home, and I’ll think of some way to get him back! highly acclaimed film The Silence of the Lambs After all, tomorrow is another day!” (1991), in which Anthony Hopkins plays a mentally Substance-related and The Lost Weekend (1945) Half Nelson (2006); Walk the Line (2005); The deranged and cannibalistic psychiatrist. The various addictive disorders Fighter (2010); Bob and the Monster (2013); Gone with the Wind (1939) Saw (2004; 2005; 2006; 2007; 2008; 2009) movies Owning Mahowny (2002); Smashed (2012) and House of 1000 Corpses (2003) portray psycho- pathic villains who are clearly out of touch with re- Schizophrenia spectrum and Clean, Shaven (1994) Take Shelter (2011); Shutter Island (2010); A ality, as does the dreadful trilogy of films that tell other psychotic disorders Beautiful Mind (2001) the story of The Human Centipede (2009; 2011; Depressive disorders Ordinary People (1980) A Single Man (2009); Melancholia (2011) The Depiction of Psychological 2014). Disorders in Films The seminal films of Alfred Hitchcock provide Bipolar disorders Mr. Jones (1993) Silver Linings Playbook (2012); Crooked Beau- the best examples of the suspense genre. They are ty: Navigating the Space Between Beauty and unique in the way they engage the viewer and pan- Madness (2010); Michael Clayton (2007) This book organizes the categories of mental disorder to his or her anxieties in subtle, unrelenting, and Anxiety disorders Vertigo (1958) The Perks of Being a Wallflower (2012) ders in the fifth edition of the Diagnostic and Sta- convincing ways. The majority of Hitchcock’s tistical Manual of Mental Disorders (DSM-5) with films, noted for their stylized realism, invariably Obsessive-compulsive As Good As It Gets (1997) Phoebe in Wonderland (2008); Matchstick appropriate film examples. Table 2 presents an over- evoke a sensation of vicariously pulling the viewer disorders Men (2003) view of well-recognized and accepted disorders and “in” to the plight of the characters as a not-so-inno- some of the best representations of them in cinema. cent bystander, through a carefully edited montage Trauma- and stressor-related The Deer Hunter (1978) The Hurt Locker (2008); The Dry Land (2010) Watching any of these films will provide the viewer of a variety of objective and subjective camera disorders with insights into the presentation of the particular shots. Hitchcock’s filmography reflects not only a Somatic symptom disorders Persona (1966) Therese (2004); Hollywood Ending (2002) disorder portrayed. fascination with pronounced and extreme psychopathology (e.g., Psycho, 1960), but more importantly, Dissociative disorders Psycho (1960) Peacock (2010); Unknown White Male (2005) an appreciation of more subtle psychological phe- Paraphilic disorders Lolita (1962) The Woodsman (2004); Secretary (2002); Psychopathology in Different Film Genres nomena such as acting out, reaction formation, ide- alization, repression, and undoing. These defense Gender dysphoria Boys Don’t Cry (1999) Transamerica (2005); Normal (2003) The depiction of mental illness in films most com- mechanisms are depicted in Hitchcock’s films Feeding and eating disorders The Best Little Girl in the World Primo Amore (2004); Center Stage (2000); monly appears in three popular genres: the drama, Shadow of a Doubt (1943), Spellbound (1945), and (1982) Black Swan (2010) the horror film, and the suspense film. Often the Marnie (1964). Hitchcock’s style is immensely pop- most effective portrayals of mental illness are those ular and has been imitated frequently by other di- Sleep-wake disorders My Own Private Idaho (1991) Inception (2010); The Machinist (2004); that infuse surreal and expressionistic images into rectors such as Brian De Palma and Roman Polan- Insomnia (2002) a montage that is realistic and plausible, powerfully ski. conveying the “interior” of a character’s psyche. More recent examples of suspense films include Disruptive, impulse-control, Marnie (1964) 2 Days in Paris (2007); Klepto (2003) The popular genre of drama is perhaps the most Robert Redford’s All Is Lost (2013), Sean Durkin’s and conduct disorders fertile ground for psychopathology to be portrayed Martha Marcy May Marlene (2011), and Ben Af- Adjustment disorders The Wrong Man (1957) The Upside of Anger (2005); Best in Show in movies in a very realistic, engaging way. Every fleck’s Argo (2012). Argo won the Academy Award (2000) chapter in this book has numerous examples of dra- for Best Picture. matic films depicting psychological disorders. The Mental illness is also depicted, although less Sexual dysfunctions Bliss (1997) The Sessions (2012) range is vast, and it extends from the slow-moving often, in the genre of documentary films. Freder- Personality disorders Compulsion (1959); Fatal Attraction Side Effects (2013); Jobs (2013); Blue Jasmine drama of The Human Stain (2003) and the disjointed, ick Wiseman’s Titicut Follies (1967) and Capturing (1987) (2013); We Need to Talk About Kevin (2011); complex drama of 21 Grams (2003), to the affec- the Friedmans (2003) illustrate clear cases of psy- The Iceman (2012) tively engaging dramas of 12 Years a Slave (2013) chopathology. It is interesting to contrast the former and Captain Phillips (2013). movie with the horror film Bedlam (1945) or “docu- Note. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

An early film that served as a prototype for hor- Table 2. DSM-5 categories and movies that portray them ror films, Wiene’s The Cabinet of Dr. Caligari (1920), is highly expressionistic, and it established Category Classic film examples More recent film examples a precedent for setting macabre murders in mental institutions. Like dozens of films that followed, it Neurodevelopmental disor- Sling Blade (1996); My Left Foot Me, Too (2009); Monica and David (2009); linked insanity and the personal lives of psychia- ders: Intellectual disability (1989) Rory O’Shea Was Here (2004) trists and implied that mental health professionals Neurodevelopmental disor- David and Lisa (1962); Adam (2009); The Horse Boy (2009); The are all “a little odd.” Evidence of the enduring ef- ders: Autism spectrum Rain Man (1988) Black Balloon (2008) fects of these themes is found in the successful and highly acclaimed film The Silence of the Lambs Neurocognitive disorders On Golden Pond (1981) Away From Her (2006); Amour (2012) (1991), in which Anthony Hopkins plays a mentally Substance-related and The Lost Weekend (1945) Half Nelson (2006); Walk the Line (2005); The deranged and cannibalistic psychiatrist. The various addictive disorders Fighter (2010); Bob and the Monster (2013); Saw (2004; 2005; 2006; 2007; 2008; 2009) movies Owning Mahowny (2002); Smashed (2012) and House of 1000 Corpses (2003) portray psycho- pathic villains who are clearly out of touch with re- Schizophrenia spectrum and Clean, Shaven (1994) Take Shelter (2011); Shutter Island (2010); A ality, as does the dreadful trilogy of films that tell other psychotic disorders Beautiful Mind (2001) the story of The Human Centipede (2009; 2011; Depressive disorders Ordinary People (1980) A Single Man (2009); Melancholia (2011) 2014). The seminal films of Alfred Hitchcock provide Bipolar disorders Mr. Jones (1993) Silver Linings Playbook (2012); Crooked Beau- the best examples of the suspense genre. They are ty: Navigating the Space Between Beauty and unique in the way they engage the viewer and pan- Madness (2010); Michael Clayton (2007) der to his or her anxieties in subtle, unrelenting, and Anxiety disorders Vertigo (1958) The Perks of Being a Wallflower (2012) convincing ways. The majority of Hitchcock’s films, noted for their stylized realism, invariably Obsessive-compulsive As Good As It Gets (1997) Phoebe in Wonderland (2008); Matchstick evoke a sensation of vicariously pulling the viewer disorders Men (2003) “in” to the plight of the characters as a not-so-innocent bystander, through a carefully edited montage Trauma- and stressor-related The Deer Hunter (1978) The Hurt Locker (2008); The Dry Land (2010) of a variety of objective and subjective camera disorders shots. Hitchcock’s filmography reflects not only a Somatic symptom disorders Persona (1966) Therese (2004); Hollywood Ending (2002) fascination with pronounced and extreme psychopathology (e.g., Psycho, 1960), but more importantly, Dissociative disorders Psycho (1960) Peacock (2010); Unknown White Male (2005) an appreciation of more subtle psychological phe- Paraphilic disorders Lolita (1962) The Woodsman (2004); Secretary (2002); nomena such as acting out, reaction formation, ide- alization, repression, and undoing. These defense Gender dysphoria Boys Don’t Cry (1999) Transamerica (2005); Normal (2003) mechanisms are depicted in Hitchcock’s films Feeding and eating disorders The Best Little Girl in the World Primo Amore (2004); Center Stage (2000); Shadow of a Doubt (1943), Spellbound (1945), and (1982) Black Swan (2010) Marnie (1964). Hitchcock’s style is immensely popular and has been imitated frequently by other di- Sleep-wake disorders My Own Private Idaho (1991) Inception (2010); The Machinist (2004); rectors such as Brian De Palma and Roman Polan- Insomnia (2002) ski. More recent examples of suspense films include Disruptive, impulse-control, Marnie (1964) 2 Days in Paris (2007); Klepto (2003) Robert Redford’s All Is Lost (2013), Sean Durkin’s and conduct disorders Martha Marcy May Marlene (2011), and Ben Af- Adjustment disorders The Wrong Man (1957) The Upside of Anger (2005); Best in Show fleck’s Argo (2012). Argo won the Academy Award (2000) for Best Picture. Mental illness is also depicted, although less Sexual dysfunctions Bliss (1997) The Sessions (2012) often, in the genre of documentary films. Freder- Personality disorders Compulsion (1959); Fatal Attraction Side Effects (2013); Jobs (2013); Blue Jasmine ick Wiseman’s Titicut Follies (1967) and Capturing (1987) (2013); We Need to Talk About Kevin (2011); the Friedmans (2003) illustrate clear cases of psy- The Iceman (2012) chopathology. It is interesting to contrast the former movie with the horror film Bedlam (1945) or “docu- Note. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. 10 Movies and Mental Illness dramatic” films such as The Snake Pit (1948), Pres- Steven Hyler (Hyler, Gabbard, & Schneider, sure Point (1962), and One Flew Over the Cuckoo’s 1991) has provided a compelling analysis of the Nest (1975), all dealing with mental institutions and portrayal of mental illness in films. Hyler and his the treatment of people with mental illness. At least colleagues describe six common stereotypes that two heralded films, The Three Faces of Eve (1957) perpetuate stigma. The first of these is that of the and Sybil (1976), provide viewers with full-scale mental patient as rebellious free spirit. Examples case histories and the struggles between patient and of this portrayal can be found in films such as Fran- psychiatrist. ces (1982), Nuts (1987), The Dream Team (1989), The comedy genre has its share of films portray- The Couch Trip (1989), An Angel At My Table ing psychopathology. Drop Dead Fred (1991), What (1990), Shine (1996), K-Pax (2001), Asylum (2005), About Bob? (1991), High Anxiety (1977), and Scot- and perhaps most clearly in One Flew Over the land, PA (2001) portray psychological aberrations Cuckoo’s Nest (1975). The stereotype of the homi- with quirky humor that is used to defuse the sense cidal maniac is present in many of the slasher/hor- of anxiety that is produced by the behavior of the ror films described earlier. However, the authors lead characters in each of the films. Director Woody point out that this stereotype can also be traced back Allen has made a career out of portraying anxiety, as far as D. W. Griffith’s 1909 film The Maniac neuroticism, and somatization in various films such Cook, in which a psychotic employee attempts to as Hannah and Her Sisters (1988) and Hollywood kill an infant by cooking the child in an oven. Ending (2002), but more recently has turned to sub- The patient as seductress is seen in films such tle, dark, and complex psychopathology as seen in as The Caretakers (1963) and Dressed to Kill (1980), the portrayal of personality disorders in Match Point and most clearly in the 1964 film Lilith, which stars (2005), Vicky Cristina Barcelona (2008), and Blue Warren Beatty as a hospital therapist who is seduced Jasmine (2013). by a psychiatric patient played by Jean Seberg. The stereotype of the enlightened member of society is linked to the work of writers such as R. D. Laing and Misconceptions and Stereotypic Themes Thomas Szasz and is illustrated in films such as King in Films of Hearts (1966) and A Fine Madness (1966). The narcissistic parasite stereotype presents people Otto Wahl, an authority on media psychology, sum- with mental disorders as self-centered, attention- marizes the media’s portrayal of mental illness in his seeking, and demanding. It is reflected in films such book Media Madness: Public Images of Mental Ill- as What About Bob? (1991), Annie Hall (1977), ness (1995): “Overall, the mass media do a poor job High Anxiety (1977), and Lovesick (1983). Finally, of depicting mental illness, with misinformation fre- the stereotype of zoo specimen is perpetuated by quently communicated, unfavorable stereotypes of films that degrade people with mental illness by people with mental illness predominating, and psy- treating them as objects of derision or a source of chiatric terms used in inaccurate and offensive ways” amusement or entertainment for those who are “nor- (pp. 12–13). This is largely due to media framing, mal.” Films that exemplify this stereotype include a concept that refers to the way a form of media pres- Bedlam (1948) and Marat/Sade (1966). A variation ents and organizes information that leads to interpre- on this theme occurs in Brian De Palma’s Dressed tations by the public. In the case of mental illness in to Kill (1980), in which a psychotic and homicidal films, media framing is overwhelmingly negative psychiatrist murders a nurse in a surrealistic amphi- and usually inaccurate (Goffman, 1986; Sieff, 2003). theater-like setting, with dozens of other patients sit- The media frames for mental illness are typically nar- ting in the gallery and watching in silent approval. row and distorted, frequently presenting those with Hyler (1988) describes three dominant themes mental illness as violent, dangerous, simplistic, dis- in film that contribute to stereotypes about the eti- illusioned, and/or innocent. This is troubling for at ology manifestation of mental disorders. The first least two reasons: (1) Mental health literacy levels is the presumption of traumatic etiology. This for the general public are low (Orchowski, Spickard, theme reinforces the belief that a single traumatic & McNamara, 2006); (2) Research has shown that event is the cause of mental illness. Examples in- people’s primary source of information about men- clude the amnesia experienced by Gregory Peck that tal illness are the mass media (Wahl, 1995). was eventually shown to be related to his role in the

This document is for personal use only. Reproduction or distribution is not permitted. From D. Wedding & R. M. Niemiec: Movies and Mental Illness: Using Films to Understand Psychopathology (ISBN 9781616764616) © 2014 Hogrefe Publishing. Chapter 1: Films and Psychopathology 11 childhood death of his brother (revealed by Hitch- a full list of misconceptions perpetrated in movies cock in a dramatic and unforgettable flashback accompanied by film examples see Appendix D. scene) in Spellbound (1945), and the dissociative Appendix E looks specifically at the mental health identity disorder that resulted when a child was re- profession and delineates a list of both “balanced” quired to kiss the corpse of her dead grandmother and “unbalanced” portrayals of psychotherapists. in The Three Faces of Eve (1957). Other examples Another myth, although one not specifically ad- of this theme are found in films such as Suddenly, dressed by Hyler, is the belief that love will always Last Summer (1959), Home of the Brave (1949), conquer mental illness. This myth is promulgated Nuts (1987), and Robin Williams’ character in The by films like Shine (1996) and Benny & Joon Fisher King (1991). (1993). Although the benefits and buffering effects Hyler’s second theme is that of the schizo- of love are important for anyone coping with men- phrenogenic parent. This is a widely held miscon- tal illness or addiction, the reality is that some peo- ception that holds parents (most often, the mother) ple with these disorders do not improve no matter accountable for serious mental illness in their chil- how much they are loved. The pernicious corollary dren. NAMI has worked hard to dispel this un- to this myth is that if people who are mentally ill do founded but pervasive belief, but it is deeply rooted not improve, it must be because they simply were in popular culture and commonplace in films. Ex- not loved enough. amples include Agnes of God (1985), Face to Face Psychopathology and its representation in films (1976), Sybil (1980), Carrie (1976), Frances (1982), will be discussed in some detail in the chapters that Fear Strikes Out (1957), and Shine (1995). follow. In general, we will follow the nosology of the American Psychiatric Association’s DSM-5, while also including diagnostic codes from the In- “Insanity runs in my family. It practically gallops.” ternational Classification of Diseases, whenever appropriate. Appendix H includes a filmography Mortimer Brewster (Cary Grant) in broken down by diagnostic category. Readers who Arsenic and Old Lace (1944) take time to review even a few of the films included in Appendix H will find that the experience will supplement and enhance their understanding of psycho- The third misconception discussed by Hyler is that pathology. harmless eccentricity is frequently labeled as mental illness and inappropriately treated. We see this theme most vividly presented in the film One Flew Over the Cuckoo’s Nest (1975). Jack Mental Illness, Mental Health, Nicholson’s character, Randle P. McMurphy, is charismatic, flamboyant, and colorful. The only di- and the Human Condition agnosis that seems at all appropriate is that of anti- social personality disorder, although it is not even Mental illness is one of the most fascinating phe- clear that this is justified. However, once in the sys- nomena a filmmaker can depict on screen. There is, tem he cannot get out, and he is eventually treated of course, much more to the human condition than with electroconvulsive therapy and lobotomy, pre- psychopathology and what is going wrong with in- sumably as a way of punishing his misbehavior in dividuals. The positive aspects of human beings – the name of treatment. The same theme is found in happiness, achievement, talents, character strengths, two films released in 1966, King of Hearts and A interests, etc. – should not be viewed as mutually ex- Fine Madness, and in the film Chattahoochee clusive from mental struggles and disorders. Indeed, (1990). A related theme, that treatment in mental both can co-occur, and certainly one (i.e., positive health facilities is actually a form of social control, psychology) can frequently benefit the other (i.e., is reflected in the work of Thomas Szasz (e.g., in mental disorders). In fact, while mental disorders are books such as The Myth of Mental Illness and Psy- associated with lower levels of happiness, most peo- chiatric Slavery). It is also reflected in films depict- ple with mental disorders are happy (Bergsma, ten ing excesses in treatment, such as the aversion ther- Have, Veenhoven, & Graaf, 2011). High levels of apies portrayed in A Clockwork Orange (1971). For distress do not preclude happy moods, and happi-

Table 3. Films portraying psychopathology as well as character strengths and virtues

Film Psychopathology Virtue Character strength(s) Elling (2001) Anxiety disorder Courage Bravery and perseverance Away from Her (2006) Dementia Humanity Love Mishima: A Life in Four Suicide Temperance Self-regulation Chapters (1985) Canvas (2006) Schizophrenia Wisdom and transcen- Creativity and Hope dence The Soloist (2009) Schizophrenia Wisdom Creativity Insomnia (2002) Sleep disorder Courage Bravery and perseverance American Beauty (1999) Mood disorder Transcendence Appreciation of beauty It’s a Wonderful Life (1946) Adjustment disorder Transcendence Gratitude and hope A Clockwork Orange (1971) Personality disorder Wisdom and transcen- Curiosity and appreciation dence of excellence