The image of psychiatrist in Academy Award winning films from 1991 to 2001

Abstracts

OBJETIVOS: Os objetivos do estudo são descrever os personagens de psiquiatras existentes em filmes vencedores de um ou mais Prêmios da Academia, entre 1991 e 2001, bem como, verificar se esses filmes transmitem mensagens negativas sobre a psiquiatria ou se apresentam retratos idealizados de profissionais, como algumas produções cinematográficas anteriores ao período estudado. MÉTODO: Foi realizada a análise de caracterização dramática dos personagens. Foram identificados os temas e as mensagens relacionados à psiquiatria presentes nas tramas para comparação com produções anteriores a 1991. RESULTADOS: Nove filmes foram selecionados e analisados 17 personagens. "O Silêncio dos Inocentes" associa psiquiatria e loucura, genialidade e doença mental, análise e canibalismo. De acordo com "As Loucuras do Rei George", "Gênio Indomável" e "Garota, Interrompida", o psiquiatra ideal tem idéias modernas, histórico semelhante ao do paciente, postura informal e demonstra emoção. "Shakespeare Apaixonado" associa a psiquiatria à magia. "Melhor é Impossível" apresenta uma representação positiva da medicação psiquiátrica. "Shine - Brilhante" e "Mente Brilhante" destacam a importância da família para a recuperação do paciente. Em "Céu Azul", a psiquiatria é usada para a interdição de uma pessoa por motivos políticos. CONCLUSÕES: Os filmes estudados não contestam a validade da psiquiatria, mas apresentam uma batalha entre a abordagem tradicional e uma não tradicional, advogando que um psiquiatra deve ser alguém fora dos padrões e excepcionalmente talentoso para ser capaz de entender e tratar uma pessoa. As críticas e as imagens negativas apresentadas nessas tramas podem ser um reflexo do profundo estigma existente na sociedade em relação aos profissionais de saúde mental e pacientes.

Psiquiatria; meios de comunicação de massa; cinema; comunicação em saúde

THEORETICAL–CLINICAL COMMUNICATION

The image of psychiatrist in Academy Award winning films from 1991 to 2001

Maria Thereza Bonilha Dubugras^I; Jair de Jesus Mari^II; José Francisco Fernandes Quirino dos Santos^III

^IMSc, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

^IIMD, PhD, Professor, Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil

^IIIPhD, Professor, Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil

^{Endereço para correspondência}

ABSTRACT

OBJECTIVES: This study aims at describing characters portraying psychiatrists in Academy Award winning films from 1991 to 2001, and determining whether these plots disseminate negative messages or idealized portrayal of practitioners, like some previous movie productions.

METHOD: Dramatic characterization analysis was performed. Movies produced before 1991 with similar characters and dramatic situations were identified to compare themes and messages concerning psychiatry.

RESULTS: Nine films were selected, 17 characters were analyzed. "The Silence of the Lambs" associates psychiatry and madness, brightness and madness, analysis and cannibalism. According to "The Madness of King George," "Good Will Hunting" and "Girl, Interrupted," the ideal professional has modern ideas, background similar to his/her patient, informal posture and demonstrates emotion. "Shakespeare in Love" suggests the association between psychiatry and magic. "As Good as it Gets" presents a positive

representation of psychiatric medication. "Shine" and "Beautiful Mind" stress the importance of family in patient's recovery. "Blue Sky" has a negative portrayal of psychiatry.

CONCLUSIONS: These plots recognize the value of psychiatry, but present a battle between traditional and unorthodox approach, formal and informal professionals. They propose that a psychiatrist should be someone "out of the box" and exceptionally talented to be able to understand and treat another human being. The criticisms and negative images about psychiatry presented in the plots may be a consequence of a deep rooted stigma against professionals and patients dealing with mental disorders.

Keywords: Psychiatry, mass media, motion pictures, health communication.

Introduction

"If psychiatry had not existed, the movies would have had to invent it. And in a sense they did."¹ Cinema created its "own nosology, treatment methods, theories and practitioners."² Frequently, films do not present accurate portraits of psychiatrists, disseminating idealized or negative images.

Schneider² delineated three types of psychiatrists from movies: Dr. Dippy – who is crazier or more foolish than his patients, uses bizarre treatment methods that seldom do any harm; Dr. Evil – Dr. Frankenstein of the mind, mad or insecure, abuses his profession to perform evil deeds and Dr. Wonderful – idealized portrayal. Gabbard³ divided the image of psychiatry in American movies into three periods. In the first, from 1906 through 1956, psychiatrists were portrayed as "alienists, quacks" or "oracles." The second period, from 1957 through 1963, is the "Golden Age," in which psychiatry was presented in a mythical way. The third period, 1964 through 1998, is the "fall from grace," with a majority of negative depictions.

According to Philo,⁴ popular attitudes are more influenced by media information than by contact with patients. Metz⁵ suggests that the audience learn how to read a film according to cinema conventions. Therefore character analysis, based on plot elements, cinema language and conventions can identify messages about psychiatry disseminated to the public.

This study aims to describe the portrayal of psychiatrists in Academy of Motion Pictures Arts and Science Award (Oscar) Winners, fictional films, between 1991 and 2001, and to determine if these plots disseminate negative messages or idealized portrayal of practitioners, like some previous movie productions.

Method

The films included in the study had to meet the following criteria: fictional gender, had won at least one Academy Award, between 1991 and 2001, produced in English language, with one or more characters of psychiatrists.

Characters were classified according to their function in the plot, in one of the following types:

a) Protagonist – character at the center of the plot, who pursues a specific goal or goals related to central conflict.

b) Antagonist – character who seeks to prevent the protagonist from achieving his goal(s).

c) Protagonist's helper– character relatively well developed, that supports the protagonist in pursuing for his goal(s).

d) Antagonist's helpers – character relatively well developed, that supports the antagonist in preventing protagonist from achieving his goal(s).

e) Decorative character – character that remains largely undeveloped, but collaborates to establish the context of the conflict.

f) Functional character – character that remains largely undeveloped, but plays a crucial role, at some point, performing a key action that propels the plot in a particular direction.

Dramatic characterization analysis was performed as described by Bradley⁶ and Pallotini⁷: inference of character traits, based on the character's background; physical appearance; social position and public image; setting; dramatic actions; dialogues, objectives, super–objective; motivation, camera narrative; symbolic meanings of elements from the mise–en–scene, lighting, music and dialogues. These elements also were used to define the representation of professional competence.

Movies, produced before 1991, with characters of psychiatrists presenting similar traits or analogous dramatic situations were identified in order to compare themes and messages about psychiatrists and psychiatry.

Results

Nine films were selected and 17 characters were analyzed, described in Table 1. The main elements of the character's analysis are presented in Table 2.

"Silence of the Lambs"

In the past, Dr. Hannibal Lecter was a well renowned psychiatrist, and had received awards "for the excellence in research in the field of Psychiatry." He presents attributes that are superlatives (brilliant, wise, demoniacal, savage) and contradictory (polite and courteous with the heroine, but is a violent man, similar to a wild animal, attacks when he got the chance to). He has a divine (magical, omniscient) and a criminal nature (violent, revengeful, an assassin). The scenarios and objects relating to him denote danger, an animalesque figure, a man who is difficult to be controlled. The camera narrative distorts his figure. Photography alternates within the character between light and shadow. He is the protagonist's helper, leading Clarice in her path towards transformation. Dr. Lecter also provides the plot viewpoint about mental illness.

Dr. Chilton is characterized as an incompetent professional, unable to communicate with Hannibal. FBI does not look him up to aid Clarice in Lecter's interviews, nor to help in the hunting for the serial killer. He describes Lecter as being an animal, "he's a monster. Pure psychopath. It's so rare to capture one alive." He deems the patient is his "most prized asset," protesting on behalf of his "rights" when he does not take part in the conversations between Clarice and Lecter. He spies upon their meetings, steals an idea from Clarice and tries to take credit upon himself for solving the crime. He causes Clarice's removal from the investigation, and involuntarily become the antagonist's helper because of that. He is a foil–character to Dr. Lecter: his unsuccessful in seducing Clarice, his professional incompetence and unethical position provide a contrast to highlight Dr. Lecter's alliance with the heroine, professional talent and antihero traits.

"The Madness of King George"

The Court's doctors use the psychiatric diagnosis as a weapon in a dispute for the throne of England. Dr. Baker is characterized comically; he is a fool and a coward. Arrogant, he criticizes Dr. Willis for not being a member of the Royal School of Physicians. A traditionalist, he follows the protocol of the Court, considering the patient physical exam as "an intolerable intrusion into a gentleman's privacy." His objective is to maintain the rules of society; his motivation is the belief in them, and the fear he feels before the presence of the king. When he services the king, his aim is to help the patient, albeit through an inefficient approach. Dr. Warren is austere, has a rigid and controlled expression and stance. His obstacle towards his super–objective is having George III remain in the throne. Because of that, he collaborates in a plan to take over power. Dr. Pepys has hyperbolic facial expressions, with comical mask aspect. His gait is bouncy. He is characterized as a comical character; this contrasts with the seriousness with which he looks upon his trade, disqualifying his competence. He agrees to the conspiracy against Willis, but differently from Warren, is interested in having patient improve, but is not capable to do it. Participating in Prince of Wales´ plan for usurpation of the throne of England, these three doctors are antagonist's helpers.

Dr. Willis is a stranger in the Court and a physician that thinks "out of the box." His colleagues criticize him for his modern ideas. Willis' physical characterization is that of a serious man, without the extravagancies of the monarchy. He is the owner of a sanatorium in Lincolnshire, in which patients "cultivate the soil," to acquire a "better consideration" about themselves. He does not take part in the plan for the king's interdiction, and is merely interested in the patient's cure. At the end, the film does not affirm that the psychiatrist cured the king's illness, but the journey of transformation he proposes benefited George III.

"Blue Sky"

Dr. Vankay's role in the plot, as a decorative character, is to help define the oppressive and corrupt environment within the army. He uses the psychiatry to interdict a person who has no health problem, in favor of military confidentiality.

"Shine"

The psychiatrist in "Shine" is an off character. He prevents the main character, David, from going back to playing music, as he believes he could have a new crisis. However, it is when David leaves the hospital and contradicts the physician that his life enhances its' quality. He is a decorative character, being one of the elements that reveals David's trajectory.

"As Good as it Gets"

Dr. Green is presented as a competent professional. This functional character introduces information into the plot regarding Melvin's disease and about the importance of being treated with medication. The efficacy of his approach is suggested through Melvin's improvement.

"Good Will Hunting"

Henry presents a formal stance and presentation. Arrogant, he loses control when faced with the provocations made by the protagonist, Will, and calls his patient a "lunatic." Ricky is impatient. He is fooled by the patient and interrupts the session by stating that he has better things to do with his time. The role of these characters is to expose Will's traits, a rebel and an intelligent man. Therefore, they are decorative characters.

The portrayal presented of Sean is that of a competent, affective physician who is informal. His physical characterization suggests that Sean does not care much for his appearance, differently from Henry and Ricky. Although he does not have professional projection, is the best professional in the plot. His prior history is similar to that of the main character, and the plot suggests that is the reason behind the success of treatment he proposes to Will, as the protagonist's helper. He is a dynamic character, modifies his patient but also is changed by him.

"Shakespeare in Love"

Dr. Moth has a comical characterization. He proposes that the protagonist, Shakespeare, resolve his internal conflicts through a magical charm. He supplies information about the Bard of Avon's internal conflicts, as a decorative character.

"Girl, Interrupted"

The first psychiatrist who sees Susanna proves to be impatient and ironical when faced with the patient's complaints. The character cooperates in exposing the main character's internal conflict. Contrary to the first physician, Dr. Melvin is characterized as being affective and patient. He supplies information on the Susanna's medical condition, information which is not questioned in the plot. Dr. Wicks arises in the plot after a scene that could be a quote from the crisis sequence of "One Flew Over the Cuckoo's Nest" (1975). In this scene, protagonist MacMurph organizes a party in the hospital with the patients, and all of them are punished by the inflexible nurse Ratched. "Girl, Interrupted" presents a similar situation, but patients are not penalized. Dr. Wick uses the incident to communicate with Susanna. The doctor stimulates Susanna to seek recovery, as her helper.

"A Beautiful Mind"

Dr. Rosen reveals that the main character, Nash, has hallucinations and obsessions, in a plot turning point. The psychiatrist has the role of clarifying Nash's mental disease for the audience, being a functional character. The protagonist's helper is Nash's wife; who helps him to deal with his condition. The plot suggests that Dr. Rosen's diagnose for Nash's illness is correct, but, isolatedly, the treatment he prescribes does not permit Nash to have a life with quality.

Discussion

Academy Awards winners were studied because these films had broadly disseminated in mass media, and thus they may has attained a large audience. The conclusions refer exclusively to the films analyzed, and certainly have no intention of representing the entire period surveyed.

None of the psychiatrists of studied films is the plot protagonist. They are secondary characters: help or make opposition to the protagonist, or bring story elements. The action sphere and their traits suggest in what position they are in the hero–versus–villain dualism.

According to Schneider's typology,² Dr. Lecter in "The Silence of the Lambs" is an example of Dr. Evil. In Pies'⁸ classification, he is the archetype of "The Vampire," "cult and intelligent on the outside, pure meanness on the inside." Gabbard³ classifies Hannibal as an example of the stereotype of the evil and criminal psychiatrist. Dr. Lecter is an assassin, goes back to killing during the plot; however, with respect to the central conflict, he is the protagonist's helper. It is thanks to him that Clarice finds Buffalo Bill, and, under his guidance, she undertakes the path to becoming a heroine.

Being protagonist's helper does not imply redemption for Lecter's criminality. He commits new murders, without showing repentance. Besides that, he cooperates in solving the crime through a system of exchange, not out of compassion for the victim. His motivation is to demonstrate his brightness and to uncover Clarice's internal conflicts. The psychiatrist "Hannibal, the Cannibal" may need to have her memories because, in his glass cell, he no longer has access to human flesh.

Gabbard³ identified psychiatrists that kill or attempt to kill their patients in films such as "When the Clouds Roll By" (1919), "Spellbound" (1945), "Coming Apart" (1969), "St. Ives" (1976), "Dressed to Kill" (1980). In these films, the psychiatrist is "more perturbed than his/her patients, or he or she is simply psychotic."⁵ The action sphere for these characters is that of the antagonist or the antagonist's helper, different from Lecter's role.

Despite having been expelled from the American Medical Association and having been a prisoner, Lecter is still called doctor by other characters, and this is how he is identified in the final credits in the film. His information and explanation about mental illness are not denied in the plot becoming the movie viewpoint.

Dr. Lecter manages to manipulate people with cruelty. More than that, he can dominate another human being. He causes the death of the character Miggs simply by whispering to him. Crawford warns Clarice: "Believe me, you don't want Hannibal Lecter inside your head." A psychiatrist with the capacity to control and force a person to do something against his will can also be found in German films "The Cabinet of Dr. Caligari" ("Das Kabinett des Doktor Caligari", 1919) and "The Testament of Dr. Mabuse" ("Das Testament des Dr. Mabuse", 1933).

Dr. Lecter has supernatural, magical powers. The association between the psychiatrist and magic may be suggested in "The Silence of the Lambs" when Dr. Lecter, hidden in the shadow, hands Clarice a towel through a food carrier that seems to opens on its own, as if with a stroke of magic. Omniscient, he always knows who approaches him, even without seeing the person; perceives that Clarice has a wound that is not visible. It is through magic that Dr. Moth in "Shakespeare in Love" attempts to help his patient. In "The Cabinet of Dr. Caligari" and "The Testament of Dr. Mabuse," psychiatrists present magical numbers using hypnosis. The association between psychiatry and super–human powers can either represent the fascination cinema has for psychiatry, as well as the disbelief that common human beings are able to understand their fellowmen. According to Bentley⁹, "traditionally, only God is credited with the gift of knowing humankind, of penetrating their innermost thoughts, their most intimate feelings, anyone who can do that has to be a god."

Hannibal's mental illness is presented as being unknown, which might suggest an exceptional condition, without possibility of treatment. The leading character Clarice states: "I have no name for what he is." Like the psychiatrist present in a patient's hallucinations, of "The Cabinet of Dr. Caligari" and the psychiatrist, Dr. Elliot, in "Dressed to kill," Dr. Lecter does not have his mental disease been recognized by his professional colleagues. Because of that, they can have a double life: respected doctors and violent madmen. It is their criminal acts that reveal their insanity, and provoke their expulsion from the practice of medicine. These dramatic situation may be a criticism to the capacity psychiatry has of identify mental disease. Cinema explains that these characters can have a double life because they have "double or multiple personalities."

The first object lit up by Clarice in a warehouse rented by Lecter is a stuffed owl (symbol of knowledge), similar to the one presented in "Psycho" (1960). The owl is the first object that Marion Craine sees in "Psycho" upon entering the room where Bates exhibits his stuffed animals. He takes Marion to this room, which he considers to be the most intimate one, and where the contact between the two will end up in Marion been murdered. The garage leased by Lecter is a warehouse for the "rest of" himself. Dr. Lecter leads Clarice to the warehouse, but Clarice shall not be a victim, but instead, the witness of a murder. In this sequence, "Silence of the Lambs" may be quoting "Psycho". Does this quotation denote similarities between Norman and Hannibal? Film publicity announced that the serial killer Ed Gein was the source for the creation of Hannibal Lecter, who also was the inspiration for the character of Norman Bates.

In "Psycho," Norman Bates is presented as having a "split personality" and a double life. Does "The Silence of the Lambs" suggest that Hannibal has two personalities, according to cinematographic convention, like Dr. Caligari, Dr. Elliot and Bates? The contradictory traits, the distortions in Lecter's figure, caused by the position of the camera, the contrast of light and shadow; and the cut with a reduction in time, with transition from the music in the story space (diegetic) into outside the story space (non–diegetic), during the murder of the two policemen, may insinuate two characterizations for the doctor.

After the revelation of their crimes, Dr. Caligari, Dr. Elliot and Norman Bates are characterized as being "possessed" by madness, by their mad personality, having no memory about their crimes. They are forever handicapped, like Dr. Jekyll, in the end of the Robert Louis Stevenson's romance Dr Jekyll and Mr. Hyde. Nevertheless, after the divulgation of his murders, Dr. Lecter continues to be able to present himself in a polite and courteous fashion, able to exercise his ability to analyze, as well as kill anew, suggesting that a violent mad mind can always hid itself in society, waiting the moment to attack.

Dr. Lecter is an exceptionally talented professional and a bright man, but "Hannibal, the Cannibal" has a mental illness. Is his capacity to analyze human conflicts due to his psychiatric training or to his condition as a madman? Is the cruel psychiatrist Dr. Lecter or the sickly Hannibal who is capable of controlling the mind and the will of other persons? Is his intelligence associated to his insanity? The contradictory and superlative traits may lead audience to associate his professional skills to his sick mind. "Silence of the Lambs" associates psychiatry and madness, psychiatry and manipulation, brightness and madness, the capability of understanding the human mind and a supernatural power, analysis and cannibalism, mental illness and violence.

The mad criminal Dr. Hannibal Lecter helps to resolve the central conflict in the plot and the heroine's internal conflicts, whilst the acting psychiatrist, Dr. Chilton, is incompetent and dishonest.

Some of Dr. Lecter's characteristics may be pleasing for the audience, such as his well–humored and intelligent remarks, his alliance with the heroine. A charming criminal is a dramatic resource. According to Hitchcock, the villain "needs to be charming and attractive. If he were not, he would never get close to his victims." Furthermore, there is the stringent, dishonest and mediocre figure of Dr. Chilton, which enhances the qualities of Dr. Lecter. The choice to characterize Dr. Lecter with some attractive traits may be a way of valuing whoever does not comply with the standards, the anti–hero, similar to McMurph in "One Flew Over the Cuckoo's Nest." Dr. Lecter contests society by his condition as a criminal, his disdain and scorn for everyone, and through the scenarios he sets up to expose his criticism. With his help, Clarice also grows distant from her group, seeking to find Bill on her own, taking a different path than of the FBI team.

"Blue Sky" does not contest the existence of mental illness, as films with antipsychiatric messages do, but brings up an element common in these films: the "non patient." In "Blue Sky," as in "The Madness of King George," psychiatry is used for political issues. Gabbard³ identified this characterization in plots such as "Lady in the Dark" (1944), "Since You Went Away" (1944), "One Flew Over the Cuckoo's Nest," where the psychiatrist is an "agent of society." However, contrary to these examples, in "The Madness of King George" there does exist a psychiatrist, Dr. Willis, who, as he defines himself, is "the King's doctor". His aim is to help his patient.

Dr. Willis is a priest who has abandoned the church to become a psychiatrist. Father Karras from "The Exorcist" (1973) is a religious man sent by the church to study psychiatry. At the beginning of the plot, he suffers due a lack of religious faith. He believes that demoniacal possessions in truth are psychiatric disorders; therefore, he observes Regan's case as a psychiatrist. Nevertheless, it is when he takes on his role as a priest, under the tutelage of an experienced father exorcist that he is able to save the girl and redeem himself. Dr. Willis does not believe he is dealing with a supernatural problem, nor does he resort to his religious training during treatment. Quite the contrary, he contests the belief in the monarch's divine character, pointing to the fact he needs to be confronted like an ordinary man.

According to Hyler (1988), in "A Clockwork Orange" (1971), the young rebel, Alex, fond of "ultra–violence," is submitted to behavior therapy, "portrayed as punitive or unfeelingly scientific, virtually as crimes against humanity." In "The Madness of King George," Dr. Willis sets up coercive measures for the King's treatment, but the treatment is justified. Dr. Willis explains that the state of monarchy shares a frontier with the state of lunacy. No one "can prosper" with such compliance as a king has. George III has to be confronted, contradicted in order to exercises his character and makes his spirit more flexible. Dr. Willis is the only doctor in the plot that can help the king, due his non–orthodox and modern ideas.

The protagonist Will easily fools the psychiatrists caring for him, in "Good Will Hunting." Similar situations are present in "Frances" (1982), a film in which the patient is more articulate than her psychiatrist, and in an ironic humorous dialog of "Awakenings" (1990): when the psychiatrist asks the patient if he does not perceive the unconscious hostility he has towards doctors, the former asks how he could perceive it, if it is unconscious. Will however is not able to fool or disqualify the informal psychiatrist Sean. At same time, Sean is capable to treat Will because they have similar backgrounds.

A competent psychiatrist, with a characterization similar to that of Sean is present in the Academy Award Winner "Ordinary People" (1980), a film that, according to Gabbard³, "was against the tradition of antipsychiatry". Will is submitted to what Schneider² calls the "discovery of a traumatic event" that fosters an "instant cure," a frequent movie representations of psychiatric treatment.

"Girl Interrupted" takes place in the same historic period as "One Flew Over the Cuckoo's Nest," and makes reference to the Milos Forman's film. The character Lisa is portrayed as a rebel who contests the existence of mental illness, like McMurphy. For her, psychoanalysis is a cursed industry and the treatment is similar to a rape, an invasion. But with the unfolding of the plot, Susanna agrees with the need to be hospitalized and Lisa is made devoid of her leadership with the revelation of her disease and violence.

The first psychiatrist that sees Susanna is more concerned in helping the girl's father. The psychiatrists that can help Susanna are who show emotion, and who never criticizes Susanna's esoteric ideas.

Susanna in "Girl, Interrupted" and Will from "Good Will Hunting" are sent for psychiatric treatment due to their rebellious behavior. The rebel, the one who contests society, is present in "One Flew over the Cuckoo's Nest" and "Frances." The psychiatrists in these films are the antagonists' helpers. In these examples, the antagonists are, respectively, society and the film industry. These plots debate the definitions of normalcy and insanity, and show psychiatric treatments as being inhumane and useless; the hospital is an institution that aims to annul patients' individuality. However, Will and Susanna benefit from their treatments, and their psychiatrists represent aides. The antagonists in the two films are the character's internal conflicts. The difference in the role of the psychiatry in these movies can also be observed when classifying the plots. According to Friedman's typology¹⁰, "One Flew Over the Cuckoo's Nest" and "Frances" can be considered tragic plots, "that describe the fall of an attractive hero," while "Good Will Hunting" and "Girl, Interrupted" can be considered revelation plots, where the "hero becomes aware of his/her condition."

The psychiatric hospital can be a character in many "psychiatric films," in the sense defined by Tesniere¹¹ of actant, "beings or objects that participate in the process, in whichever way, even in a passive manner." In the hospital portrayal of "One Flew Over the Cuckoo's Nest," fences with barbed wire and a limited space are stands out. The professionals are portrayed wearing impeccable white uniforms, suggesting austerity. Only the employee who permits that McMurphy breaks the hospital rules appears in a scene without his full uniform. In "The Madness of King George," "Girl, Interrupted" and "Shine," there is nothing to suggest a restricted, oppressive space. Oppression is present in the psychiatric institution portrayed in "Blue Sky."

Frances ("Frances") and McMurph ("One Flew Over the Cuckoo's Nest") are not heard nor understood by their psychiatrist. They no longer have control over their own lives after being hospitalized in a psychiatric institution. They claim against this situation and are punished by an oppressive system. These plot elements can be considered antipsychiatric ideas. John Nash, in "A Beautiful Mind," protests that he is not mad and denounces a conspiracy against him. However, with the appearance of Dr. Rosen, the audience understands that Nash is ill; and his psychiatrist is concerned with his recovery.

"Girl, Interrupted," "Shine," "As Good as it Gets," "A Beautiful Mind" do not portray a search for a cure to mental illnesses, they highlight the patient recovery and the possibility of living with a condition that is different from what is considered normalcy, having a life "as good as it gets."

The psychiatrist in "Shine" is an off character; the audience receives information about him only by protagonist's speech. The lack of character development enhances the fact that David's recovery occurs without his doctor help. The protagonist manages to have a quality life when leaves the psychiatric hospital and returns to the world of music. David's happiness is fulfilled through the support and love of his wife. Nash, in "A Beautiful Mind," stands out his wife's love as the most important element of his recovery. Nash and Alicia plan a strategy for him to be able to live with his hallucinations and obsessions. At the end, Nash explains that he takes new medication, but still sees things that not exist. Hyler¹² observed a similar theme in "David and Lisa" (1963) and in "An Unmarried Woman" (1977) where the cure takes place far from psychiatric offices, and is due to the support of friends. Different to these films, in "As Good as it Gets" the protagonist Melvin manages his recovery because of the love of a woman and not thought this love.

Melvin decides to take medication to become a better man. "As Good as it Gets" is the only studied film that presents a positive representation of psychotropic medication. The film shows no details of the treatment, but credits Melvin's improvement to the medication prescribed by the psychiatrist, showing the gradual change in his behavior. Melvin refers to the difficulty of treatment, but acknowledges how much he has gained compared to the problems set forth by the medication. The option of not portraying the treatment in detail could suggest the possibility of the patients' recovery, without having to undergo a dramatic trajectory; he continues on with his life, differently from "One Flew over the Cuckoo's Nest" in which the psychiatric treatment is shown as controlling, and interrupting the life of patients.

Conclusions

Four of the studied films have comparisons between peculiar characterizations suggesting that it is not the psychiatrists that can treat patients, only some types of psychiatrists are capable of doing it. The superlative and unnatural traits of the exceptional bright Dr. Lecter may imply that an ordinary man can not understand another human being. According to "The Madness of King George," "Good Will Hunting," "Girl, Interrupted," the ideal professional has modern ideas, similar background of his patient, an informal posture, demonstrates emotion and does not confront patients' beliefs. Additionally, "Shine" and "Beautiful Mind" present medical treatments that can not provide a life with quality for patients.

The studied films do not deny the existence of mental illness; neither oppose to psychiatry in general and its practice like antipsychiatric films of the 1970s and 1980s, but present a battle between traditional and unorthodox approach, formal and informal professional posture. They propose that a psychiatrist should be someone "out of the box" and exceptionally talented in order to be able to understand and help another human being. The criticisms and negative images about psychiatry presented in the plots may be consequence of a deep rooted stigma against professionals and patients dealing with mental disorders.

References

Received February 13, 2007.

Accepted March 21, 2007.

Dra. Maria Thereza Bonilha Dubugras received a grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). This study was conducted as part of her Master of Science training in the Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. The dissertation was entitled "A caracterização dos personagens de psiquiatras nos filmes 'O silêncio dos inocentes', 'As loucuras do Rei George', 'Céu azul', 'Shine – Brilhante', 'Melhor é impossível', 'Gênio indomável', 'Garota interrompida', 'Uma mente brilhante'".

Prof. Jair Mari is an I–A Researcher from CNPq.

The conclusions of the study were presented in the International Mental Health Conference at the IoP – "Mental Health and the Millennium Development Goals", held at the Institute of Psychiatry, London, UK, 2005, and also at II Encontro Paulista de Psiquiatria – "Psiquiatria e Psicologia na Prática Médica", held at Universidade Federal de São Paulo, São Paulo, SP, June 10–12, 2004.

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Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007

History

• Accepted
  21 Mar 2007
• Received
  13 Feb 2007