Movies stimulate more than just our visual acuity. Movies are able to produce thoughts, feelings and different states of mind in the viewer, guided by the director. To watch a movie is to be manipulated and seduced. When we allow ourselves to surrender to the cinematographic screen, it is possible to have experiences that might be similar to those of our patients, thereby achieving a supplementary psychopathological understanding.
Since the creation of motion picture – some 120 years ago – psychiatry has been used repeatedly as an element or the main theme in movies. Psychiatric themes are exquisite tools to tell a story: Psychiatric illness displays the individual’s estrangement from the surroundings. Changes in a psychiatric illness provide a storyline. Madness may be used in crime and horror movies to portray the dangerous and unexpected. Psychiatrists (or psychiatric nurses), who are supposed to be caretakers, have often been portrayed as evil authority figures. This dichotomy is much more threatening than a mean and aggressive crook.
Movies are intended to tell a story – not to tell the truth or expand the general knowledge of psychiatry. Therefore, the psychiatric reality, as we know it, is often bent and difficult to find. According to the cinematographic truth almost all psychiatric sufferings are caused by childhood-trauma. The cure is either love or the cathartic recovery of repressed memory, and until the end of the last century psychiatric medication is described as making you heavily sedated.
Nevertheless, movies may render information about psychiatric topics, which are otherwise difficult to understand. From the movies psychiatrists can get new and expanded understanding of their patients sufferings, and concepts may be taught more easily to trainees. In 1919 Karl Jaspers wrote: “…the entire field of psychopathology concerns itself with actual experiences…”. Films are particularly well suited to depict different states of mind. When the viewer surrenders himself to the screen, the director takes over - constructing the reality of the movie and for a while that of the viewer. Using not only the talents of the actor, but also the setting of light, the colors, the angles and distance of the camera, the music and the pace in the cutting, the director can make us perceive, think and feel, what he wants. What emotes from the screen makes us believe, that we are actually experiencing, what is happening up there. The viewer enters a trance, a state of absorption and attention with thoughts and feelings like those, which occur in the stream of consciousness. The emotions of the characters are not told to us, we experience them, and we begin to feel like the protagonist. Seeing a movie could make us experience the same as our patients.
Most of the symptoms in affective disorders are easily recognized, since they are extremes of normality, whereas schizophrenic symptoms are harder to comprehend, because they are anomalous experiences. In several of the films directed by David Cronenberg the emergence of the unreal, the supernatural and the hallucinations are depicted in such a sensual and material way, that it makes us feel, how disgusting and intruding a psychosis might be. When we see The Truman Show (Peter Weier) for the first time, we experience derealisation along with the main character.
The film media is exquisite in showing the change from normality to manifest psychosis with maybe an apocalyptic Weltuntergang-erlebnis. In movies like The Tenant (Roman Polansky), A Beautiful Mind (Ron Howard) and Black Swan (Darren Aronofsky) we follow the progression of the illness from the protagonist's view, and we experience how the reality-testing weakens. By watching these movies, it is easier to understand the gradual development from sanity to psychosis, and why our psychotic patients have such a poor insight.
In artistic movies the pace is slower, there is less action and maybe more speech. This is done deliberately to allow the viewer the time and space to reflect. The spectator’s involvement becomes less emotional and more intellectual, which may permit another enlightening. Finally, two contemporary Nordic films, where aspects of depression are in focus, may exemplify this. In Melancholia (Lars von Trier) a huge planet is going to destroy the earth. Depression is portrayed as a devastating power, that controls the person who has no future. In Oslo, 31. August (Joachim Trier) a young suicidal Norwegian is walking around the tortuous streets of Oslo. Depression is shown as causing an isolation, that keeps the protagonist separated from the rest of the society. The circular narrative structure highlights depression as an inner subjective prison.
Further reading
Richard Allen, Projecting Illusion, Film, spectatorship and the Impression of Reality, 1997, Cambridge University Press.
Davide Caputo, Polanski and Perception: The Psychology of Seeing and the Cinema of Roman Polanski, 2013, University of Chicago Press.
Glen O. Gabbard et al, Psychiatry and the Cinema, 1999, American Psychiatric Press.
Jeppe Mørch Jensen, Depression, Isolation og circularitet, skildringen af melankolisk depression i samtidige skandinaviske kunstfilm. Kandidatspeciale, University of Copenhagen 2017. Abstract in English.
David J. Robinson, Reel Psychiatry: Movie Portrayals of Psychiatric Conditions, 2003, Rapid Psychler Press.
Danny Wedding et al, Movies & Mental Illness, using films to understand psychopathology, 2014, Hogrefe Publishing. □