by Mark S. Komrad M.D.
[February 1995; Vol. 22 No. 1]
There has been considerable discussion in MPS concerning the distortions of psychiatrists portrayed in feature Hollywood movies, especially in the 1990's. Movies such as What About Bob, Silence of the Lambs, and The Prince of Tides have portrayed foolish or frightening stereotypes or shown blatant ethical violations. In fact, the scenario of psychiatrists being sexual with their patients or patients’ siblings (e.g. The Prince of Tides, Mr. Jones, Final Analysis) has been so widespread in films lately that it seems to be virtually the “standard” expectation of movie-goers who leave crestfallen if a psychiatrist keeps to any realistic sexual boundaries.
I have lectured around the country to professional and lay audiences about these distortions, while trying to correct them and to present an accurate picture of who psychiatrists are and what they do. Last fall, I had the opportunity to stop complaining and try to help get things right. I was asked to be technical advisor to a major Hollywood production, the filming of Silent Fall starring Richard Dreyfus, John Lithgow, Linda Hamilton, J.T. Walsh, and Liv Tyler; and directed by Academy Award winning director, Bruce Beresford. This film was produced and filmed here in Maryland by Morgan Creek Productions, and was released in October 1994.
I helped to extensively revise the screenplay, met at length with the director, and then worked quite closely with Richard Dreyfus and John Lithgow in their portrayals of psychiatrists. My aim was to help develop a more accurate portrayal of what psychiatrists do. Most importantly, I tried to round off the sharp edges of contrast in the original screenplay between the “biological” psychiatrist (Lithgow) and the “psychotherapist” psychiatrist (Dreyfus). I also helped specifically in the direction of a few key scenes that involved psychiatric techniques and the alleged toxic side effect of a psychotropic medication. Finally, I was insistent that the psychiatrist maintain appropriate sexual boundaries when his patient’s sister becomes seductive.
Though I did not accomplish everything I hoped for, the experience was enormously illuminating. I learned by immersion about some of the common neuroses of Hollywood actors, particularly some impressive issues of narcissism. I also had to grapple with some feelings of my own, including the seductiveness of being needed by these very “needy” stars behind the scenes, and the dance of projective identification in their overvaluation of the psychiatrist on the set. Boundary issues were particularly tricky. I also learned about the real and important tension between the need for box office success in a movie and the need for artistic integrity. Finally, I came to understand that documentary accuracy in the portrayal of anything in a movie (psychiatrists and the mentally ill included) was secondary to drama, plot devices, and narrative forms that make the story “work.” Overall, it was a humbling experience for one who heretofore has stood on the outside of this process and complained about the effects it has had on our professional image and the stigma of our patients. As we learn with our patients, things are much more complex than they appear when we start to penetrate inside, behind the scenes.
However, these challenges notwithstanding, I am happy to report that overall the film is an excellent one and very entertaining. Sadly, despite my best efforts, it still has some typical distortions at out psychiatrists, though far more minor than usual. Many of my rewrites of the script were used and certain edges of the characters softened, though the Lithgow character of the “biological” psychiatrist still comes off as slightly evil [a major motif in Hollywood and the topic of a future article]. The character of the “psychotherapist” psychiatrist played by Richard Dreyfus, on the other hand, is one of the most positive and ethical depictions of a psychiatrist since Judd Hirsch in Ordinary People. Above all, I am pleased to say that this is the first major Hollywood film of the ‘90s in which the psychiatrist says “No!” to a patient’s sister who attempts to seduce him. A turning point in Hollywood of the 90s, I hope!
It is just such direct involvement with Hollywood that holds some hope for educating the public more properly about psychiatry. Now that movies, TV and radio are the great public educators, it is not enough for us to complaint to one another and write exasperating letters to the editor. It is incumbent upon us to try to penetrate the studios where scenes are being produced, and the rooms where scripts are being written. Indeed, as I have discussed previously in this publication, I think it is important that some of us become regular participants in the media and movies: talkshow hosts, columnists, script writers and technical directors. It is this kind of participatory posture in interfacing with these various contemporary forms of public education, that is the approach of the MPS Public Affairs Committee. Hopefully, after you have seen Silent Fall, you might consider joining the committee. In these challenging times, psychiatry needs you to help the image makers get it right!
Mark S.