HUMAN ENCOUNTERS IN THE MOVIES
A Psychiatrist Film Junkie’s Guide to Relationships on Screen
(A selective filmography follows)

Roland Atkinson © 1999

(Modified version of an article that appeared in "Open Spaces," Vol.2, #2, 1999)

Harry Stack Sullivan, the pioneer American psychiatrist, said that a psychotherapist could not really hope to understand the inner psychic world of another person, was in fact barred from doing so, because of the ultimate privacy of each individual’s thought and feeling.  The best thing a therapist could do, Sullivan believed, was to understand human relationships, to witness, to describe, and to attempt to influence the transactions that occur between people.  This distinction between what psychotherapy can and cannot do might also be applied to film.  No film has time to give us an adequate account of the interior thoughts of people, arguably the most distinctive measure of our humanness: the rich and ever operative world of mental reflections, the "inner dialogue" of our experience, thoughts that - whether fleeting and momentary, or deeply patterned and reoccurring - define our sense of being. 

However, just as therapy can effectively focus on relationships, so movies can also give us, in the most bold and intimate manner possible, the immediacy, the poignancy, of human encounters.  Fine examples abound.  Among American films think of Bogart and Hepburn in The African Queen - proud, fierce, contentious characters whose more appealing depths are revealed in the course of their joint struggle for survival on a jungle river; or Taylor and Burton, who revel in their acrimony in Who's Afraid of Virginia Wolfe?; Jane Fonda, Jon Voight and Bruce Dern, whose painful entanglements epitomize the tragic domestic aftermath of Vietnam in Coming Home;  Sidney Poitier and Rod Steiger, personifying the incendiary quality of southern race relations during the civil rights era in In the Heat of the Night,  William Hurt and his deaf pupil, Marlee Matlin, finding intimacy as they struggle to communicate in Children of a Lesser God.  Or consider such wonderful imports from international cinema as Anthony Quinn and Giulietta Masina, desperate survivors in war ravaged Italy, in Fellini’s La Strada, Bibi Andersson and Liv Ullman, whose separate identities merge in Ingmar Bergman’s Persona; Jeanne Moreau, Henri Serre and Oskar Werner as a classic menage a trois in Truffaut’s Jules et Jim;  or these two gems from Japan: Woman in the Dunes,  Hiroshi Teshigahara's surreal meditation on human existence and domestic relations, and Shomei Imamura's The Ballad of Narayama, a riveting story of family life and social customs in a 19th century northern Japanese mountain village.

I.  Emotion

One reason film succeeds so well in portraying human encounters is that film can convey emotion perhaps more powerfully than any other creative medium.  Not the inner feelings of people, but emotion.  E-motion, literally meaning movement outward, the outward, behavioral manifestations of inner feeling states, the social, and therefore photographable, dimension of human feeling.  Some emotional expressions and gestures are candid, inadvertent, automatic even, outer signs of inner physiological processes, like Hans Selye's "fight or flight" responses to stress.  Other expressions may be falsified, with or without intent, to mask or veil inner feelings and thoughts.  Most are earnest yet imperfect communications that at best give us only an approximation or simplified version of the more complex inner feeling state of another person.  Feeling is partly a visceral experience not easily translated into words or gestures.  And human feeling is inescapably cognitive as well.  Neither the psychotherapist nor the filmmaker can fully plumb the private depths of feeling.  Film can, however, vividly capture emotion, and the better the actor, the more likely his or her performance will suggest the nature and complexity of inner feelings through emotional expression.  (The famed Stanislavski school of "method acting" required an actor to try to become the character, so that the actor's inner feelings can inform and infect emotional gesture and kinesics.)  Among others, recent demonstrations of this skill have been offered by Robert Duvall, who portrays a deeply flawed yet somehow spiritually honest charismatic preacher in his film, The Apostle; Pruitt Taylor Vince, the dependent, immature and sensitive protagonist of Heavy; Emma Thompson, a bereaved young widow in The Winter Guest; Albert Finney, an aging, lonely homosexual who finds some measure of intimacy while directing amateur plays in A Man of No Importance; Jack Lemmon as a desperate and demoralized worthless land huckster in Glengarry Glen Ross.

II.  Mood

Film can also, most wondrously, set an overall mood, a tone to the world on screen, that can induce an inner feeling state in the viewer that may be similar to what the screenwriter or director imagines as the inner feeling state of the major characters.  Photography, setting, lighting, costume, music and editing all can be employed to aid this purpose.  Recently watching again Michelangelo Antonioni's 1960 masterpiece, L'avventura, I was astonished by the atmosphere of numbing depression and estrangement conveyed in that film, and by the way in which all the elements were built up to achieve this effect: the use of many shades of black and white (all grays, really) rather than sharp contrasts or color, the interminably slow pace (and it's a long film at 145 minutes), the power of a half deserted hotel or an uninhabited island setting to diminish and isolate the characters, the suppressed emotion of the players.  One inexorably feels impinged upon by the bleakness of these bored, well off people.  In the recent film, Pi, Darren Aronofsky employs strongly contrasting black and white images, jerky handheld photography, bold editing and touches of magical realism to impart the sense of paranoid fear and feverish preoccupation that increasingly engulf the protagonist, a mathematician with migrainous fits who is obsessed with discovering formulas that explain how everything in the world works.  The viewer exposed to these marvelously employed effects is hard pressed after awhile not to feel as desperate as the hero appears to be.

III.  Character 
           
Emotional expression is one aspect of character - which consists of a person's habitual and abiding values, expectations, perspectives, the capacities for intimacy, for work and for change, whims, quirks, perversions, ambitions, vulnerabilities, habits of feeling, thinking, conduct, mannerisms, expression.  As the Reichian psychotherapist, Alexander Lowen, demonstrated, character shows through in surprising ways in physical posture, movement and gesture, as well as in modes of speech.  Movies thus can give us not only emotion but many other ingredients of character as well.  But then only if (big if) the screenwriter and the director, as well as the actor, all understand the character and get it right.  Sometimes, even though the acting is satisfactory, a character doesn't ring true.  Isn't written true.  Take the popular 1997 movie, As Good as it Gets.  The character played by Jack Nicholson not only has symptoms of obsessive-compulsive disorder (OCD), but has an obsessive - compulsive character to match: rigid, insensitive, callous even, passively hostile.  Certainly not all sufferers of OCD also have OC personalities.  But such a combination is not uncommon.  So far so good.  But while OCD symptoms - such as repetitive, unnecessary hand washing, counting, checking the door locks, or not walking on cracks in the sidewalk like Nicholson does - are treatable and changeable, the character traits of OC personality are notoriously intractable.  When Nicholson's character metamorphosed into a curmudgeonly sweetie pie, my interest in this film faded fast.  (My partner very much liked As Good As it Gets...the changes in Nicholson's character didn't bother her one bit.  My partner was a fine violinist.  It makes her cringe to see badly simulated violin playing in films.  She literally averts her gaze.  I don't know enough about the violin to notice that, but when character is false, it makes me cringe.)

Film is rich in wonderful and startling character portrayals that do ring true.  Some movies focus primarily on provocative characters and subordinate relationships.  Examples include Lili Taylor's portrayal of a paranoid personality bordering on psychosis in I Shot Andy Warhol;  Laurence Olivier as Archie Rice, the egocentric, failing vaudevillian in The Entertainer; Catherine Denueve as an emotionally suppressed but elegant bourgeois woman who finds sexual release working in a brothel in Belle de Jour; Dustin Hoffman as an autistic savant in Rain Man; Meryl Streep as a guilt ridden holocaust survivor in Sophie's Choice.  Nor are character oriented films limited to pathological and antisocial types.  Others tell of more virtuous people whose integrity or social responsibility stand out.  Like Gregory Peck as the southern small town lawyer, Atticus Finch, modeling tolerance for his young daughter in To Kill a Mockingbird.   (Robert Duvall's film debut occurred in this one: his small role as a shy man suffering from chronic schizophrenia was acted to perfection.)  Or Edward James Olmos as the real life barrio teacher, Jaime Escalante, in Stand and Deliver; Seema Biswas as the resourceful Bandit Queen of northern India; Gerard Depardieu as a military officer presumed dead who returns to reclaim his place in life in Le Colonel Chabert; Gong Li as the resolute peasant who presses her cause to the top levels of the Maoist bureaucracy in The Story of Qiu Ju.

IV.  Relationship
                                                                                                      A shortcoming of many of these films is that with the focus on provocative and intriguing characters, we don't learn very much about their relationships, except by inference.  Sometimes relationships are better evoked in film when the individual characters are not so outsized.  My favorite recent examples come from Alan Rickman's The Winter Guest, in which Emma Thompson and her real mother, the actress, Phyllida Law, star as a recently widowed woman and her aging mother.  Their largely failed efforts to comfort and aid one another - when it is painfully obvious that each wants so much to be loving but at the same time feels invaded and ill understood by the other's reciprocal efforts - underscore a compelling relationship that remains central throughout the film, while around these two women, three other pairs of town characters dance in and out: 11 year old boys trying to inhabit their budding sexuality, an adolescent couple who are mutually attracted, two old women whose main pastime is attending funerals.  Here the naturalness and simplicity of dialogue, the containment of feeling, the balanced attention to each character and especially to the encounters between them, an emphasis on the ways in which these people support one another, however imperfectly, all these features yield a story rich in relationship.  The setting helps: a winter storm encases the world in ice and silences it, and against this pale, silent, icy background the characters, all ordinary people really, burdened by the ordinary dilemmas life places before them, stand out in bold relief.

When the players are related in real life, as in Winter Guest, this can enhance the realism, the naturalness, of their on screen relationship.  Several other wonderful examples come to mind.  Henry and Jane Fonda offered a poignant encounter between an aging father and his daughter in On Golden Pond, and afterward Miss Fonda said that the experience of working with her father in this film had helped to improve their long conflicted relationship.  Ryan O'Neal and his young daughter Tatum were captivating as a 1930s con man and his kid in Peter Bogdanovich's Paper Moon.  Brothers Jeff and Beau Bridges created a delightful fraternal relationship as a fading cocktail lounge duo in The Fabulous Baker Boys.  Movies that focus on extended families typically subordinate individual character to relationships.  Among the best are Woody Allen's Hannah and Her Sisters, Ingmar Bergman's Fanny and Alexander, and Ang Lee's Eat Drink Man Woman, each a celebration of family relationships.

Besides Winter Guest, other recent films that succeed in portraying relationships while understating individual character include Jonathan Nossiter's Sunday  (fine and complex, enigmatic roles by Lisa Harrow and David Suchet); the popular Czech film, Kolya  (a rare instance of an adult- child relationship on film that is totally charming but never syrupy); John Sayles' Lone Star, a splendid story of enduring and intertwining connections among the inhabitants of a Texas border town; Gillian Armstrong's Last Days of Chez Nous, in which Lisa Harrow plays a writer burdened by vexing relationships with her quirky French spouse (Bruno Ganz), troubled sister and irritable father; and British director Mike Leigh's Secrets and Lies,  in which a working class woman is doubly surprised when a young woman - a child she adopted out at birth and never saw - comes seeking her roots.

The most memorable movies about relationships, though, are those in which all the elements come together: an underlying mood consistent with the human drama at hand; strong and provocative characters, who express emotion with suppleness and authenticity; and engagement of the characters in love, combat or the surmounting of adversity in such a manner that their interactions are enhanced by their individual foibles, not in competition with them for the viewer's attention.  I mentioned The African Queen and Who's Afraid of Virginia Wolfe? at the beginning because these films bring all the elements together so well, establishing a sort of balance or reciprocity, a synergy between individual characters and their relationships.  For better and for worse, respectively, these two films show us an important truth about human nature: that it is often the encounter between human beings that reveals their character, exposes their true colors as opposed to their social personas. (The human confrontation with stressful life events also evokes character, but that is a subject in itself.)

Five recent films offer good examples of outsize, emotionally compelling characters who are also able to establish strong and interesting relationships: Silence of the Lambs, The Piano, Farewell My Concubine, A Pure Formality  and Shine.  In Silence, Anthony Hopkins as the sophisticated criminal psychopath, Hannibal Lecter, would have stolen the show were it not for an equally fine performance by Jodie Foster as his police cadet interrogator.  His veiled violence is all the more chilling because of the fear it evokes in Foster (and in us as we identify with Foster's character).  Her fortitude despite her anxiety in joining the relationship intrigues Lecter and brings forth his murderous lust.  Jane Campion's The Piano features three divergent characters in an isolated New Zealand setting: a voluntarily mute woman of volcanic passions (Holly Hunter), her patient and kindly husband (Sam Neill), and their strongly sensuous Maori neighbor (Harvey Keitel).  Movements among these three open wide their characters and their actions tumble out of control toward inevitable tragedy.  Leslie Cheung and Zhang Fengyi create an astonishing 50 year long relationship as male stars of the Peking Opera against the tumultuous background of events in a radically changing China, in Farewell My Concubine.  Gong Li completes a love triangle that proves ruinous for everyone.

A Pure Formality is a triple treat.  Two strong performances by Gerard Depardieu and Roman Polanski.  The engrossing story of a well off man (Depardieu) whose character foibles lead to his destruction.  And most importantly a riveting encounter between this man and the police inspector (Polanski) who detains him, in a setting that is...what?  A dream?  A place that is dark and damp where the clocks don't work.  The Jungian psychotherapist, Thomas Moore, would say it is a setting for the soul.  It is through the extraordinary battle of wits between these two men that the protagonist comes to understand the riddle of his misdirected life. In Scott Hicks' Shine, Geoffrey Rush so perfectly portrays the pianist David Helfgott's unusual mental illness (schizoaffective disorder, manic type) that I was able to make this difficult diagnosis watching the movie (later confirmed in an article on the film in the New York Times).  Rush's highly energized, eccentric performance might have eclipsed other features of the film, but a powerful if destructive relationship between Rush's Helfgott and his uncompromising father, played with equivalent intensity by Armin Mueller-Stahl, also graces this film, and we can see how their conflict sets in motion the circumstances conducive to Helfgott's first psychotic episode in London.

V.  Psychotherapy Relationships on Screen

I wish that I could as easily illustrate the film portrayal of psychotherapy influencing human affairs.  There is an irony here.  One might think that a legitimate therapist-patient relationship - one that is ethical and that reflects authentic standards and methods of practice, while at the same time employing dramatically interesting characters - should make for more than a few intriguing stories.  This seems especially likely because, as Ted Mahar, who reviews films for the Oregonian, used to tell film criticism classes at the Northwest Film Study Center, much of North American and Western European film is permeated by the psychoanalytic perspective.  Many of the actors, directors, screenwriters and even the money people have been or are being psychoanalyzed.  But when I search for substantive therapist roles in the movies, I find only a handful.  Many movies show therapists in brief roles that suggest they are ineffectual, irresponsible or merely an extravagance of the neurotically well off, as in the films of Woody Allen.  Some films cast a character as a therapist, or employ a therapy relationship, simply as an ironic dramatic device to highlight the therapist’s personal problems (for example, Agnes of God, Happiness, Man Facing Southeast).  Even so, bad therapy by a troubled therapist can on occasion yield good drama (Equus) or comedy (Don Juan DeMarco).

Alfred Hitchcock's Spellbound offers an especially corny psychoanalytic tale but is noteworthy for being among the first films to build a story around a psychotherapy relationship and for its early deviation from conventional gender arrangements. This film overly dramatizes the powers of a psychotherapist (Ingrid Bergman) to heal a man (Gregory Peck) who suffers from a post-traumatic dissociative disorder, but no real effort is made to depict therapy realistically, and the couple cross the line into romance.  Called by Hitchcock, himself, "just another manhunt story wrapped up in pseudo-psychoanalysis," Spellbound arrived at a time (1945) when psychoanalysis was in the first flushes of its 40 year run as the dominant force in American psychiatry.

Twelve years later, in The Three Faces of Eve, Lee J. Cobb turned in a much more credible performance as the psychiatrist treating multiple personalitied Joanne Woodward, in the screen enactment of an actual case.  Cobb's therapist conducts himself in a manner that stands up well as a model today, 40 years later.  He is a strong and interesting character, while at the same time he is emotionally supportive, attentive, reliable, caring, even tempered, ethical (his only transgression, by today's standards, is to chain smoke cigars during sessions).  Partly the integrity of this portrayal can be credited to writer-director Nunnally Johnson, who faithfully followed the account given in a book length report of the case by Georgia psychiatrists Hervey Cleckley and Corbett Thigpen, who treated the actual patient.  But Cobb deserves much of the credit as well.

In 1977 two prominent films portrayed therapist-patient relationships.  Richard Burton (the psychiatrist) and Peter Firth (the patient, a stableboy with a bizarre attachment to horses) provide a dramatically remarkable encounter in Sidney Lumet's film of Peter Shaffer's play, Equus, but Burton's psychiatrist is technically atrocious.  Supposedly an expert with young patients, he makes every sort of blunder imaginable: he is asleep in his office when Firth arrives for his first appointment (having impressed upon Firth at their brief initial meeting the importance of punctuality), is emotionally volatile and unpredictable (once in anger he skips a scheduled session with the patient), lets himself be manipulated, and uses hypnosis and placebo drugs without informed consent.  His conduct, in short, is almost entirely self centered.  He offers an excuse of sorts for his behavior in several powerful soliloquies.  Like the maverick British psychoanalyst, Ronald Laing, whose writings were fashionable at the time Shaffer wrote the play, Burton’s psychiatrist despairs that his patients’ symptoms are desperate signs of sanity in an insane world, and that by curing them he is, like some ancient high priest, sacrificing their individuality on the alter of social conformity. I Never Promised You a Rose Garden, adapted from an autobiographical account by Hannah Green of her triumph over psychosis with the help of the eminent psychotherapist, Frieda Fromm-Reichmann, was also dramatically compelling.  The adolescent Green was ably played by Kathleen Quinlan, and a highly accomplished portrayal of the therapist was given by the Swedish actress, Bibi Andersson, who showed gentleness, compassion, patience and humility.

Three more recent films demonstrate rather well some of the contemporary techniques of psychotherapy and counseling.  Not a psychodynamic approach.  But one that is far more commonly practiced these days, less expensive, and perhaps more useful to more people: direct, active engagement of the client by the therapist, at both emotional and cognitive levels, from the getgo.  In Robert Redford’s 1980 directorial debut film, Ordinary People, Timothy Hutton delivers an astonishingly realistic portrayal of a bereaved, depressed adolescent, whose psychiatrist is played by Judd Hirsch.  Though Hirsch’s therapist often hectors Hutton with bulletlike questions (“Why do you think that? Why? Why?”) he is at the same time engaging, caring, unafraid to offer sound advice.  In Clean and Sober Michael Keaton is convincing as a man with serious substance abuse problems, and Morgan Freeman, as his counselor, very accurately portrays the confrontative, “tough love” style of therapy used in many addictions treatment programs today.  In Gus Van Sant's 1997 film, Good Will Hunting,  Robin Williams is believable as the therapist, as is Matt Damon, his misguided genius client.  Williams’s therapist is more self-revealing, shares more of his own emotional experience with his young patient, than Hirsch’s therapist did in Ordinary People.  Williams received an Academy Award for Best Supporting Actor for his performance, the first film therapist role to earn an Oscar, I believe.  

VI.  "Sigi" Awards

If I were to give awards for acting a therapist role based on the integrity of the therapy as well as dramatic integrity - let’s call them the “Sigmund” awards after Freud, or “Sigis” for short (Sigi was Freud’s mother’s childhood nickname for him) - my all time Sigi for best actor would go to Lee J. Cobb (for Three Faces of Eve) and for best actress to Bibi Andersson (for Rose Garden).

I could go on.  There are so many other fine depictions of relationships in film that it is both difficult and, in a sense, unfair to offer so few.  Viewing a film that convincingly portrays human encounters gives us pause for thought, for reflection, about our social condition.  In that pause we are given an opportunity to enrich our understanding of ourselves and how we relate to the important people in our lives.

VII. Selected Filmography

Films are listed by title, director, country of origin and year of release. All are available on VHS as of March, 1999, except as noted.

Films illustrating vivid character and emotional portrayals
(actor or actress in featured role in parentheses)

As Good as it Gets, James L. Brooks, U.S., 1997 (Jack Nicholson)
Apostle, The, Robert Duvall, U.S., 1997 (Robert Duvall)
Bandit Queen, Shakhar Kapur, India, 1994 (Seema Biswas)
Belle de Jour, Luis Bunuel, France, 1967 (Catherine Deneuve)
Bridge on the River Kwai, David Lean, U.S., 1957 (Alec Guinness)
City Hall, Harold Becker, U.S., 1996 (Al Pacino)
Cobb, Ron Shelton, U.S., 1994 (Tommy Lee Jones)
Entertainer, The, Tony Richardson, U.K., 1960 (Laurence Olivier)
Fireworks (Hana-Bi), Takeshi Kitano, Japan, 1998 (Beat Takeshi)
Glengarry Glen Ross, James Foley, U.S., 1992 (Jack Lemmon)
Heavy, James Mangold, U.S., 1995 (Pruitt Taylor Vince)
Hustler, The, Robert Rossen, U.S., 1961 (Paul Newman)
I Shot Andy Warhol, Mary Harron, U.S., 1995 (Lili Taylor)
I Stand Alone , Gaspar Noe, France, 1998 (Philippe Hahon)
Le Colonel Chabert, Yves Angelo, France, 1994 (Gerard Depardieu)
Lete Meurtrier (One Deadly Summer), Jean Becker, France, 1983 (Isabelle Adjani)
Man of No Importance, A, Suri Krishnamma, U.K., 1994 (Albert Finney)
Mrs. Dalloway, Marleen Gorris, U.K., 1997 (Vanessa Redgrave)
Of Mice and Men, Gary Sinise, U.S., 1992 (John Malkovich)
Patton, Franklin J. Schaffner, U.S., 1970 (George C. Scott)
Pi, Darren Aronofsky, U.S., 1997 (Sean Gullette)
Rain Man, Barry Levinson, U.S., 1988 (Dustin Hoffman)
Slingblade, Billy Bob Thornton, U.S., 1996 (Billy Bob Thornton)
Sophie's Choice, Alan J. Pakula, U.S., 1982 (Meryl Streep)
Stand and Deliver, Ramon Menendez, U.S., 1988 (Edward James Olmos)
Story of Qiu Ju, The, Zhang Yimou, China, 1993 (Gong Li)
Taxi Driver, Martin Scorsese, U.S., 1976 (Robert DeNiro)
To Kill a Mockingbird, Robert Mulligan, U.S., 1962 (Gregory Peck)
Trip to Bountiful, The, Peter Masterson, U.S., 1986 (Geraldine Page)
Woman Under the Influence, A, John Cassavetes, U.S., 1974 (Gena Rowlands)

Films illustrating relationships

African Queen, The, John Huston, U.S., 1951
Annie Hall, Woody Allen, U.S., 1977
Antonia's Line, Marleen Gorris, The Netherlands, 1995
Ballad of Narayama, The, Shomei Imamura, Japan, 1983
Basileus Quartet, Fabio Carpi, Italy, 1982
Breaking the Waves, Lars von Trier, Denmark, 1996
Burnt by the Sun, Nikita Mikhailkov, Russia, 1994
Children of a Lesser God, Randa Haines, U.S., 1986
Coming Home, Hal Ashby, U.S., 1978
Crimes and Misdemeanors, Woody Allen, U.S., 1989
Dresser, The, Peter Yates, U.K., 1983
Eat Drink Man Woman, Ang Lee, Taiwan, 1994
Fabulous Baker Boys, The, Steve Kloves, U.S., 1989
Fanny and Alexander, Ingmar Bergman, Sweden, 1983
Farewell My Concubine, Chen Kaige, China, 1993
Godfather, The, Francis Ford Coppola, U.S., 1972
Hannah and Her Sisters, Woody Allen, U.S., 1986
In the Heat of the Night, Norman Jewison, U.S., 1967
Jules et Jim, Francois Truffaut, France, 1961
Kolya, Jan Sverak, Czechoslovakia, 1996
La Ceremonie, Claude Chabrol, France, 1995
Last Days of Chez Nous, Gillian Armstrong, Australia, 1993
La Strada, Frederico Fellini, Italy, 1954
L'avventura, Michelangelo Antonioni, Italy, 1960
Lone Star, John Sayles, U.S., 1996
On Golden Pond, Mark Rydell, U.S., 1981
Oscar and Lucinda, Gillian Armstrong, Australia, 1997
Paper Moon, Peter Bogdanovich, U.S., 1973
Persona, Ingmar Bergman, Sweden, 1966
Piano, The, Jane Campion, Australia, 1993
Pure Formality, A, Giuseppe Tornatore, France, 1995
Scenes from a Marriage, Ingmar Bergman, Sweden, 1973
Secrets and Lies, Mike Leigh, U.K., 1996
Shine, Scott Hicks, Australia, 1996
Silence of the Lambs, Jonathan Demme, U.S., 1991
Strangers in Good Company, Cynthia Scott, Canada, 1990
Strawberry and Chocolate, Tomas Gutierrez Alea, Cuba, 1994
Sunday, Jonathan Nossiter, U.S., 1997
Sundays and Cybele, Serge Bourguignon, France, 1962
Who's Afraid of Virginia Wolfe? Mike Nichols, U.S., 1966
Winter Guest, The, Alan Rickman, U.K., 1997
Woman in the Dunes, Hiroshi Teshigahara, Japan, 1964

Films illustrating psychotherapy relationships
(actor or actress portraying the therapist in parentheses)

Agnes of God, Norman Jewison, U.S., 1985 (Jane Fonda)
Clean and Sober, Glenn Gordon Caron, U.S., 1988 (Morgan Freeman)
Don Juan DeMarco, Jeremy Leven, U.S., 1995 (Marlon Brando)
Equus, Sidney Lumet, U.K., 1977 (Richard Burton)
Good Will Hunting, Gus Van Sant, U.S., 1997 (Robin Williams)
Happiness, Todd Solondz, U.S., 1998 (Dylan Baker)
I Never Promised You a Rose Garden, Anthony Page, U.S., 1977 (Bibi Andersson)
Man Facing Southeast, Eliseo Subiela, Argentina, 1987 (Lorenzo Quinteros)
Ordinary People , Robert Redford, U.S., 1980 (Judd Hirsch)
Spellbound, Alfred Hitchcock, U.S., 1945 (Ingrid Bergman)
Three Faces of Eve, The, Nunnally Johnson, U.S., 1957 (Lee J. Cobb)

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"EMOTION PICTURES":
THE OHSU SOUNDING BOARD REVIEWS

All articles copyright 1999, 2000, 2001, 2002, 2003, 2004 or 2005 by Roland Atkinson. Any may be quoted with appropriate credit to the author.  (Some articles mentioned in reviews on other pages may not yet have been added below)

BEYOND OUTRAGE, OR HOW I LEARNED TO ENJOY FILMS THAT MAKE FOOLS OF PSYCHIATRISTS           Roland Atkinson © 1999

It used to make my blood boil when psychiatrists were portrayed as fools in the movies.  Like Rodney Dangerfield, I thought that we don't get enough respect, not from the creators of pop culture at least.  But two recent comedies have changed my point of view:  Don Juan DeMarco and Analyze This. The psychiatrists in these films certainly make errors and lapse into outrageous boundary violations, so there is much to chafe about if one is so inclined.  But these therapists are also sympathetic characters with foibles and limitations.  And the dilemmas they create for themselves resonate with clinical experience.  In Don Juan DeMarco,  the title character (played by Johnny Depp) is a presumably psychotic but bright young New York tenement dweller who has adopted the costume and lifestyle of his Spanish namesake, and Marlon Brando is the psychiatrist placed in charge of Depp's care in a mental hospital where Depp is admitted on a hold after publicly threatening suicide.  In Analyze This, Robert DeNiro is a mafia boss who demands that a psychiatrist (Billy Crystal) treat him for panic and depression. 

These films in fact raise very good counter-transference issues.  A major theme in both movies is that the psychiatrist is captivated by the prospect of treating a patient with exceptional qualities the psychiatrist himself seems to lack.  Treating such a patient appeals to the vanity of the therapist, provides a narcissistic quick fix that inflates the psychiatrist's self esteem, which in turn leads to errors in judgment that result in ethical dilemmas.  Sound familiar?   In Don Juan, Brando's psychiatrist is close to retirement, and both his career and his marriage are in the doldrums.  He envies Depp's character's youthful sexual exuberance and identifies with it.  Depp's character, like a smart manic patient, soon surmises this situation and plays to the psychiatrist's vulnerabilities.  Most of us have experienced something similar - when patients accurately enough perceive that we are passing through difficult times.

In Analyze This, the mafioso oozes raw power and authority, traits that appear to be distinctly lacking in the Crystal's insipidly mild mannered therapist.  DeNiro's character uses intimidation and threats to force Crystal to continue treatment against his better judgment.  But by this time his fascination with this difficult patient has made any other course of action impossible.  Besides, the threats appear to be real.  What would you do if a seriously (not to mention effectively) violent man idealized you and your ability to treat him, and threatened you and your family unless you did?   Far fetched, you say?  I think not.  I can think of situations with several patients suffering from paranoid schizophrenia, or borderline personality disorder, where such themes emerged. 

These films, for all their farcical hyperbole, in fact tread on sensitive ground for psychiatrists.  And how pleasant it is to be reminded of such matters, not during a dour case conference or, worse yet, in the throes of a tense clinical encounter, but while chuckling, relaxed and anonymous, through a funny movie.

FREUD'S FAR REACH ON FILM                         Roland Atkinson © 1999

American films have for decades been influenced by psychoanalysis.  While analysts themselves might think this only natural on the merits of their views about human nature, Ted Mahar, longtime film critic for the Oregonian, once offered a more immediate reason.  He thought it was because most of the directors, actors, screenwriters, studio executives and investors had been or were being analyzed.  It's true that in the 30s and 40s, many European analysts resettled in Los Angeles or New York City, where most films are made.  The first Hollywood film to feature an explicit psychoanalytic theme was Alfred Hitchcock’s 1945 release, Spellbound.  The producer, David O. Selznick, fresh from a brief period of personal analysis with May Romm, insisted that a reluctant Hitchcock play up the psychoanalytic theme and retained Romm as a consultant for the film.  During training at UCLA in the 60s, I often passed people like Lee Marvin or Burt Lancaster heading for their appointments with my professors.  We residents discussed the fate of the late Marilyn Monroe in seminars with her analyst, Rommie Greenson.  So Mahar had a point.  Psychotinseltown.  At any rate, the psychoanalytic influence has remained evident to the present day, most recently in the late Stanley Kubrick's final film, Eyes Wide Shut.

In Eyes, a young Manhattan society physician (Tom Cruise) is stunned when his wife (Nicole Kidman) tells him that while on vacation the prior summer she had felt highly sexually attracted to a stranger staying at their hotel (nothing came of it).  This small revelation comes just after he had been summoned to examine a nude, drugged prostitute at the home of a friend (Sydney Pollack), and was later that evening propositioned by the daughter of a patient of his who had just died.  This concatenation of events seems to seize the young doctor, propelling him into a vortex of sexual and jealous obsession that pulls him off into the night, away from his wife and toward some inchoate erotic awakening.  Suddenly the world is alive with sexual intrigue.  A street prostitute befriends him.  Through a chance meeting with a medical school classmate, he attends a gothic masked orgy for the rich and powerful.  Between these and other encounters the doctor is tortured by fantasies of his wife making love with the stranger, spurring him on to his next misadventure.  Or is all of this simply a bad dream?  We can’t be sure.  Even the film’s title is tantalizingly ambiguous: does it refer to the doctor’s dreaming or to his naivete?

This work has the feel of most Kubrick films: a chilling, pristine, almost clinical sterility to each set and scene, the camera weaving along its quiet, probing path like an endoscope, actors used more as set pieces than real people.  But for this discussion, the important thing is the story.  It is based on a short novel, "Traumnovelle" ("Dream Story," or "Rhapsody: A Dream Novel" in various English translations), written in 1925 by Arthur Schnitzler, a Viennese physician, playright, novelist and sexual athlete who apparently was an acquaintance of Freud's.  Schnitzler's story bears the clear stamp of early psychoanalytic thinking. Sexuality is the prime source of human motivation.  Dreams and fantasies develop the vividness and press of reality itself.  A person whose own sexual awareness has been limited by repression may, if traumatic circumstances weaken his defenses, be flooded by impulses that both frighten and fascinate him, and, in any case, leave him helpless in the face of their dark libidinal power.  The artifices of the ego are no match for the volcanic forces of the id. 

All of this is quite fitting for a Viennese novella written in the 1920s and set in the 1910s.  Indeed, Schnitzler was a modern psychological writer for his time.  But Kubrick and his cowriter, Frederic Raphael, made a pivotal and, I think, bad decision to update the story from 10s Vienna to 90s New York City. The notion that a slick young society physician in 1999 could be the sexual naif portrayed here, is plain silly.  That this doctor could become so undone when his glamorous wife confides that she had felt turned on by some guy she once saw, is not believable.  A flair of jealous feelings and fantasies - yes.  Some talk about how the marriage is going - clearly in order.  A few visits, at least, with a therapist - perhaps. 

Not only do people differ in other times and places, but, as we know, psychoanalysis itself has come a long way since the 20s.  The resources of the ego are now regarded as far more extensive and sophisticated than the early Freudians believed.  Interpersonal (not just sexual) relations and self regard are considered to be central to motivation and behavior.  Like the book, Eyes Wide Shut should have been set early in the century.  That would have been consistent with its psychological premises.  And it surely would have resulted in a more believable film, if not a better one.

PSYCHIATRY SIXTIES STYLE, INTERRUPTED    
Roland Atkinson © 2000

Watching James Mangold's new film, Girl, Interrupted, I was overwhelmed with a sense of familiarity.  In nearly every way, this film about young women treated at the McLean Hospital in Massachusetts in the late 1960s reminded me of the way things were on the wards at UCLA when I was a resident in 1963.  The place is clean and generally well run, and the staff-to-patient ratio appears to be favorable.  The nursing staff are all believable characters: the naive young man who lets himself be seduced by a patient, the primly rigid older nurse, the timid young one, and Valerie, the head nurse, played with wonderfully proportioned warmth and authority by Whoopi Goldberg.  Power struggles of a subtle sort occur between patients and staff, but there is none of the sadism in the name of treatment that marks films like Oregon's own One Flew Over the Cuckoo's Nest or the fine Australian film, An Angel at My Table.  As Goldberg's character comments at one point, "I've worked in state hospitals, and compared to them, this is a five-star hotel."  She's right.

The film follows the encounters and antics of a half dozen teenagers who try to cobble together some sort of normal adolescent experience within the bizzare confines of the hospital milieu.  They pull pranks just like our young patients did at UCLA.  Although these particular young women are not psychotic, most have remained on the ward for months or even years (our voluntary patients often stayed for 3 to 9 months, sometimes longer).  One is reminded by these long stays of how our profession squandered precious treatment resources in that era.  On the other hand, without big bucks or a benevolent relation to take you in, where can anyone go these days who genuinely needs asylum, a timeout that lasts longer than 5.3 days, an "interruption" when life has become an unbearable routine?  I suppose that’s what prisons are for nowadays.

The realism of this film is undoubtedly influenced by the source material, an autobiographical account of the same title by Susanna Kaysen, who is the film's central character (played by Winona Ryder).  Susanna (Ryder) is depressed, painfully thin and pasty looking, pops pills and booze, fails in school although bright, is impulsively promiscuous, makes a suicidal gesture, and lands on the ward. She carries the diagnosis of borderline personality disorder, although as played here she seems more to suffer from a straightforward depression, never displaying the faulty capacity for relationships that is a trademark of borderlines.  She meets Lisa (Angelina Jolie), who steals a number of scenes as a sexy, hypomanic troublemaker.  Labeled an antisocial personality, her anger and capacity for splitting (polarizing people's feelings toward her, stirring up controversy) is much more the stuff of which borderlines are made.  Their buddies include a pathological liar, another with an eating disorder, and a third who has burned her face and body (Lisa calls her "Torchy").  All these folks pretty much ring true, even if the diagnostic labels applied to them are a bit mixed up.  I knew kids just like them on our wards.

As for the psychiatrists, they vary from the clueless Dr. Crumble, who arranges Susanna's admission, to the bumbling but sincere doctor everyone calls "Melvin," to the arresting Dr. Wick (Vanessa Redgrave), who heads the hospital.  Redgrave's psychiatrist is wise, restrained and empathic, and had the role been created as more than a cameo, her performance might rank right up there close to Bibi Andersson's, when she played Frieda Fromm-Reichmann in the 1977 film, I Never Promised You a Rose Garden.  I consider Andersson's performance the best ever portrayal of a psychiatrist by an actress.

Mangold, who cowrote the screenplay and directed, shows here once again his gift for evoking well nuanced, believable portrayals of troubled personalities.  He demonstrated this first in Heavy, in which Taylor Pruitt Vince is heartbreaking as an overweight, introverted, dependent personality, and then, in Copland, where Mangold somehow drew from Sylvester Stallone a performance as unexpected as it was poignant, playing a sad, propped-up small town sheriff who had failed to fulfill any of his life's dreams. Now Mangold proves he can work just as effectively with actresses.

All of this said, Girl, Interrupted is not a great film.  Clinically realistic?  Yes.  So much so that after the wonder of deja vu had worn off, I found it all a bit boring, too much a busman's holiday (although my partner, who is not in the mental health trade, found it absorbing throughout).  Certainly there are films set in mental hospitals that work better as dramatic entertainment, Cuckoo's Nest, Angel, and the incomparable King of Hearts, among them.  All take ironic advantage of the grimmer setting of public mental institutions to add tension and poignancy to their stories of the human condition.  But give Mangold and his cast an "A" for authenticity.

ME, MYSELF AND LAURIE: NAMI TAKES ON HOLLYWOOD

Roland Atkinson © 2000

Back in June, the National Alliance for the Mentally Ill (NAMI) made quite a fuss about Bobby and Peter Farrelly's new comedy, Me, Myself and Irene, starring rubberfaced Jim Carrey as Charlie, a mild mannered state trooper who develops a nasty alternative personality, "Hank," and gets labelled schizophrenic. NAMI's Executive Director, Laurie Flynn, launched a national protest, claiming among other things that the film shows "gross ignorance and insensitivity" to the mentally ill, perpetuates a myth that schizophrenia and split personality are synonymous, and misinforms teens about the true early signs of schizophrenia. She deplored an ad campaign for the movie that includes "stigmatizing" posters (they say 'from gentle to mental'), T-shirts, and bottles of psychotherapeutic "pills" (white jelly beans).

It may be no coincidence that the same week Ms. Flynn went on the attack, Tipper Gore launched a Mental Health Awareness Campaign from the White House, targeting in particular the problem of the stigma of mental illness among youth, the major consumers of films like this one. Even in the Op-Ed pages of "The Oregonian," Robert Landauer took up the cause, indicting the film, not because it "...exploits mental illness for laughs [which he defends]. The issue is that the film misrepresents mental illness in ways that will cause or increase harm." His specific charges: the film confuses schizophrenia with multiple personality disorder, equates mental illness with danger to others, and portrays schizophrenia as a joke (he fails to explain how this differs from exploiting mental illness for laughs).

The Farrellys (Dumb and Dumber, There's Something About Mary) routinely revel in gross ignorance and insensitivity and pander to cultural stereotypes and myths. Everyone under the age of 25 who attends a film made by these people knows that they will see lots of stupid coarse dumb stuff. This movie is like their others. And the mentally ill fare no worse here than African Americans or dwarfs, and a good deal better than law enforcement officers, none of whom are protesting to my knowledge. (In one of the film's less ennobling sight gags, Charlie's three black teenage sons - whose birth father was a dwarf who had an affair with Charlie's wife and later ran off with her - handcuff a sheriff's deputy, pull his pants down, and leave him with a live chicken's head stuck up his rear end.)

Now for the specific charges: does the film confuse schizophrenia with multiple personality? Yes, but who cares. People have been doing that for eons without a shred of evidence that such a misconception ever harmed anybody. Does the film equate mental illness with danger to others? No, certainly not in any sweeping sense. Granted, "Hank" can become sexually intrusive, although Charlie and the woman he pursues are in fact falling in love. He does retaliate a bit against some neighbors and townsfolk who had been pushing Charlie around for years. And at various points Hank briefly frightens a child, insults an albino server (whom he calls 'Q-Tip'), and sucks milk from the breast of a nursing mother.

But his aggression is for the most part just bluster...Hank routinely loses every actual fight he picks. Nor is there any dialogue by anybody about the dangerousness of the mentally ill. Does the film portray schizophrenia as a joke? No. In the first place, there is nothing in Carrey’s actions that remotely suggests any sign or symptom of schizophrenia. The word itself is mentioned only twice, rapidly, as part of a long diagnostic litany. Beyond that, the first 40 minutes of the film are taken up showing us why we should feel sympathetic about Charlie's repressed rage that eventually becomes manifest in “Hank's” nastiness. The real point here, though, is that what nearly everybody thinks about while watching this film is not schizophrenia or mental illness at all. What we are thinking about is the amazing capacity of Jim Carrey to rapidly alter his physical expression of character between wildly divergent extremes, and wondering what antic he will spring on us next.

TEEN SUICIDE                                                          Roland Atkinson © 2000

In The Virgin Suicides, first time writer-director Sofia Coppola has created an absorbing film, the story of a family in which five teenage sisters kill themselves.  The screenplay is based on a fictional account by Jeffrey Eugenides, set in a 1970s Michigan suburb.  Cecille, at 13 the youngest of the sisters, cuts her wrists.  An attempt at therapy appears to fail.  She seems low, withdrawn.  Her parents understandably are nervous.  A few weeks after the event they throw a teen party in her honor.  She excuses herself and jumps to her death off an upstairs balcony.  The mother (a hulking Kathleen Turner) becomes painfully depressed.  The father (James Woods), a mild mannered math teacher at the high school, just zones out.  The four surviving sisters - ages 14 to 17 - seem after a while to carry on rather well, although the pall in the household remains, a pall conveyed almost palpably by the use of subdued lighting, unkempt belongings and unwashed dishes strewn here and there, diseased trees being condemned by the city. 

Months go by, and then, after one of the middle sisters, the sexually provocative Lux (Kirsten Dunst), stays out all night on a date, mother cracks down - fanatically, viciously.  She pulls all the girls out of school, and the entire family goes into an acute regressive, shadowy, isolated tailspin of bare existence, cut off from everyone.  After two weeks of imprisonment, during which the girls seem mainly bored, except when amusing themselves by playing telephone games with neighbor boys, the sisters successfully carry out a mutual suicide pact.  The parents put the house on the market and drive away, never to be seen again.  End of film.

There is much that is good, even outstanding, in this film.  Like American Graffiti, it tells of the longing of adolescent boys for girls instead be for other boys) and for their own emergence as men.  It is also the compelling story of a family, the Lisbons, a deeply repressive, conventional, Roman Catholic family, ruled by a powerful, brooding woman, who through the force of her indomitable will is attempting to insulate her daughters from the perils of 70s youth culture.  This family is the polar opposite of the 70s family depicted by Ang Lee in Ice Storm, whose members are spinning out of control as the adults try to outdo the kids in seeking sexual and other thrills. 

Beyond these convincing aspects, this film is clinically puzzling. It doesn’t ring true.  For one thing, while the shrouds of tragedy that envelop the Lisbon family seem to suffocate the parents and the viewer alike, the surviving daughters seem strangely immune to this pall.  The film implies that teen suicide occurs unpredictably, for mysterious reasons, even in youngsters who appear resilient and full of good cheer.  (One can almost hear the familiar refrain: 'Ah. Kids. Who can understand 'em?')  In fact, as we know, typically there are warning signs before teen suicide: depressed mood, change in personal habits, decline in school performance, social withdrawal, substance abuse, and so on. The film further suggests that repressive, controlling parents drive their children to suicide.  But rates are known to be lower in close knit religious families, higher when parents are absent or indifferent.  Cecille's psychotherapist is portrayed as worse than useless: a cameo by Danny DeVito wearing a fake beard and administering a Rorschach test on the first visit.  The truth is that even brief psychotherapy can favorably influence many demoralized teens. So these are all false depictions.  This film even hints that suicide might somehow be associated with the mysteries of adolescent female sexuality, with clever secret pacts or hi jinks.  Sorry, but this is bogus.

Teen suicide is not an uncommon theme in the movies.  Think of the black comedic suicide gestures of Bud Cort in Harold and Maude;  the doomed young lovers in Elvira Madigan; the realistic suicide of a young psychiatric patient in the recent Girl, Interrupted.  The cinematic "gold standard" here is Robert Redford's 1980 film Ordinary People, in which Timothy Hutton so ably portrays a depressed, guilt-ridden teenager who eventually attempts suicide.  There is no ambiguity here.  Hutton's nihilism emerges from obvious and terrible pain.  Nor can the problem be easily fixed in his case, even with the aid of a good psychotherapist (Judd Hirsch).  But there is no mystery, no cheapening of suffering by suggesting its absence, no message that seeking help is a waste.  Compared to the silly stuff in a film like Me, Myself and Irene, the serious misrepresentations in Virgin Suicides should cause misgivings for Tipper Gore, NAMI and anyone else interested in preventing adolescent suicide.

GOOD TO THE LAST DROP:
THE SOPHISTICATED CINEMA OF ALCOHOLISM
Roland Atkinson © 2000

Foremost among the major psychiatric syndromes, alcoholism has been very well depicted on screen in several memorable films over the years.  For starters, who can forget City Lights (1931), offering the first film demonstration of state dependent memory, when Chaplin's little tramp is only recognizable to his wealthy drinking partner and benefactor while he is soused?  Then there are such classic alcoholic roles as Ray Milland’s in The Lost Weekend (1945) or Jack Lemmon’s and Lee Remick’s in Days of Wine and Roses (1962). These films not only dramatized the lurid details of compulsive drinking and D.T.s, but also ably demonstrated codependent relationships, years before that term permeated popular culture.

That the nuances of alcoholism should apparently be so accessible to filmmakers is, on the one hand, no great surprise, for notorious examples certainly abound in Hollywood.  Recalling some famous drunks of filmdom is easy enough, whether screenwriters, actors or directors: think of William Faulkner, Richard Burton or John Huston.  But then most people - in and out of film - also know depressives and schizophrenics.  Yet these "types" are not so often well portrayed on screen, compared with alcoholics.  Why the difference?  Intimacy with the subject may be one factor, granted, but another may simply be that alcoholism is more photographable.  Schizophrenia, after all, is largely a disorder of internal experience (thinking, feeling, perceiving), while people suffering from an episode of depression by definition tend to constrict their emotional expression and behavior.  Alcoholics often behave extravagantly while intoxicated, manipulate other people in provocative ways, and frequently cause major social and physical damage.  There can be a lot for the camera to see while following an alcoholic around. 

Here are five more recent films that view alcoholism from different perspectives: Clean and Sober,  Once Were Warriors from New Zealand, Georgia,  the British film My Name is Joe, and the recently released 28 Days *   In Clean and Sober, Michael Keaton plays an ace real estate salesman who becomes hooked on cocaine and alcohol.  His arrogance and in-and-out flirtations with treatment ring true.  Morgan Freeman offers an equally convincing portrayal as his counselor, dispensing confrontive "tough love" as needed. Clean and Sober arrived at a time when 12-step recovery programs were becoming all the rage in Hollywood, and talk show hosts quipped that the place to catch a show biz bigwig hanging out was no longer at some fancy watering hole but at a meeting of Alcoholics Anonymous.

Once Were Warriors is a powerful story about rural Maori uprooted to the city, and it depicts how drunkenness becomes intertwined with socioeconomic and family problems of a disenfranchised group.  It could as easily be a story of Native Americans or any other marginalized minority.  For her work in Georgia, Jennifer Jason Leigh won the New York Film Critics best actress award.  Her jarring portrayal of a strident, hyperactive Seattle grunge singer strung out on alcohol and drugs is agonizing to watch but vividly real.  My Name is Joe offers finely nuanced performances and an intriguing examination of problems that can face a recovering alcoholic.  Peter Mullan, in a role that won him best actor honors at Cannes, is struggling to put his life together, living on the dole in a disadvantaged Glasgow neighborhood.  Mullan's Joe captivates as a wild, vulnerable and sometimes violent man who is at the same time principled and decent.  As if being a big brother to a group of marginal younger men were not burden enough, he falls in love with his caseworker, who predictably finds that she has gotten into something way over her head.  Her brittle morality overcomes her attachment to Joe, with disastrous consequences.  Everyone in this film talks in indecipherable working class Scot-speak, but, mercifully, English subtitles are provided!  In the comedy 28 Days, Sandra Bullock stars as Gwen, an alcoholic, pill popping writer who is court ordered into a chemical dependency program after a drunk driving accident.  This send up of residential treatment is by turns improbably corny, genuinely funny, and also, yes, sobering.  Gwen's rapid progress is perhaps too good to be true, but beneath the hyperbole the basic lessons of early recovery are all covered.              

       Any of these films could well complement an introductory course on alcoholism.  ___________
Credits: Clean and Sober was directed by Glenn Gordon Caron, 1988;Once Were Warriors (Lee Tamahori, 1994); Georgia (Ulu Grosbard, 1995);My Name is Joe (Ken Loach, 1998), and 28 Days (Betty Thomas, 2000)

OUR WAR AGAINST THE WESTERN HEMISPHERE   
Roland Atkinson © 2001

Among recent examples of national lunacy, perhaps none outranks our “War on Drugs.” The first shot fired over the bow was the Harrison Act of 1917, but the battle began in earnest during the Nixon administration, in response to widespread illicit drug use in the 1960s and early 70s.  Since then hundreds of billions have been spent in exponentially increasing amounts, more than two dollars for law enforcement to every dollar for treatment (and, in comparison, about 12 cents for research).  By most measures, this effort has been a collosal failure.  The street prices of heroin and cocaine have been declining steadily for years, drug purity has increased, and the number of drug-related emergency room visits has risen. These are clear indicators that drug supplies have become more plentiful despite massive U.S. sponsored interdiction efforts in Colombia, Mexico, Peru and elsewhere.  One cartel is toppled, one jungle-based factory destroyed, and others spring up overnight.  The drug trade is so profitable, and the economic plight of most Latin Americans is so desperate, that traffickers can always recruit help despite the hazards and reckon on up to 90% loss of product and still prosper.  Domestic interdiction efforts fare no better, for similar reasons.

Meanwhile effective treatment options exist that can reduce drug demand.  Arizona's recent effort to treat, not imprison, nonviolent drug offenders has saved millions and reduced recidivism.  But treatment nationally is seriously underfunded, even according to outgoing drug czar Barry McCaffrey (the most aggressive Army general in the Gulf War, McCaffrey has been the perfect embodiment of a drug warrior).  Waiting lists for drug treatment number in the 100s to 1000s in most cities. As Mexico's new reform-minded president, Vicente Fox, rightly points out, America's drug problem cannot be solved without efforts to reduce demand, and that means more support of treatment and prevention programs.

The public's appetite for a tough approach to drugs became so voracious and unquestioning in the 1980s that most politicians were and still are terrified to confront the war’s failures and destructiveness.  Small wonder, then, that moviemakers have preferred to offer films that portray the lurid horrors of drug addiction (from The Man with the Golden Arm to Requiem for a Dream) while avoiding the incredibly convoluted, often ironic story of our contemporary drug problem.  Now, at last, many of these issues are confronted in Steven Soderbergh's new film Traffic, a brilliantly conceived and compelling examination of our drug problem in much of its awful complexity.

The film weaves among three color-coded stories. First there is the Mexican story (with segments in sepia-tone), full of treachery and double dealing, in which everyone appears corrupted in some way, up to the top echelons of Mexico City officialdom. Then there is the Cincinnati-Washington DC story (with segments tinted blue), in which a respected federal judge is tapped to become the nation's new drug czar, while back home his 16 year old daughter is secretly spiraling downward into hard drug addiction. Finally there is the San Diego story (in bright, full color) of a socialite whose husband turns out to be a major drug distributor, and the DEA agents who try to get the goods on him.  By the end several people have died and no real progress has been made, although the final scene is not one of cynicism but of hope as the drug czar’s daughter speaks tentatively but positively to her fellow addicts at a self-help group meeting.

Traffic fails to address important aspects of the war here at home, against U.S. citizens.  Prosecutorial rights have flourished at the expense of individual liberties, especially privacy rights.  Here's one example to show how far things have gotten out of hand: in a case currently under review by the U.S. Supreme Court, a university teaching hospital in the south routinely gave information on illicit drug use by (mainly black) pregnant women to local authorities while these patients were hospitalized for delivery and without their knowledge or consent.  This arrangement enabled the efficient arrest of the women as they were being discharged from the maternity ward.  Our "zero tolerance" mindset precludes public health measures to reduce drug-related illnesses (e.g., needle exchanges), and frequently negates important distinctions between relatively safe versus harmful drugs, and between possession of small amounts versus distribution of large amounts.  Severe mandatory sentencing for drug offenses prompts drug kingpins to plea bargain by naming less dangerous underlings, who in turn end up with more severe sentences.  Mainly thanks to the war, the U.S. now has the highest rate of incarceration in the world, including untold numbers of ordinary people who have been criminalized for minor drug violations and an estimated 400,000 (22% of all inmates) with drug addictions. 

Despite these omissions, Traffic is a profound and honest film, one that raises questions but never preaches.  Example: the new drug czar is flying with Washington drug war higher ups to inspect border interdiction efforts.  He asks if anyone representing treatment is on board.  There is only silence.  Then he asks for new ideas on reducing the drug problem.  More silence.  Although complex, the interposed and partially overlapping stories are easy enough to follow.  The large acting ensemble is uniformly excellent.  Soderbergh is an amazingly spare and efficient filmmaker: he never wastes time or footage.  There is a tightness, a well-fitting integrity, to his pictures that reflects craftsmanship of the highest order (also apparent in his films Out of Sight and The Limey).  Soderbergh himself photographed this film with a Steadicam, and his excellent shooting creates an intimate verite quality to many scenes.  This film succeeds brilliantly as drama and as social commentary.

Popular sentiment about the war seems to be shifting.  Emergence of a high budget mainstream film like Traffic itself suggests this.  Some physicians are beginning to speak out against the war, like the national group co-led by OHSU trauma surgeon Donald Trunkey.  It was a ballot initiative, not the political will of its leaders, that launched Arizona’s program of treatment instead of prison for nonviolent drug offenders, and California just passed a similar initiative last November.  The public could very well be out in front of our leaders now in pressing for a more rational approach to the drug problem.

DANCE OF DISSOCIATION                                  Roland Atkinson © 2001

George Vaillant, in the introduction to his book, The Wisdom of the Ego, reminds us that all mental mechanisms result in some degree of self deception, because we all need to turn a blind eye to reality at times to help us persevere through life's ordeals.  This is a major subtext of what is undoubtedly the quirkiest musical film ever made, Lars von Trier's Dancer in the Dark,* which won awards at the 2000 Cannes film festival for best picture and best actress (the Icelandic pop singer, Bjork).*           

'Dark' in this film’s title conveys two meanings.  Selma (Bjork) is fast losing her eyesight from a hereditary condition.  She is also an emotionally intense person who often hides behind a facade of childlike insouciance.  And when the going gets really rough, as it does for her in a rapidly downhill spiral of events, she dissociates.  She fantasizes herself and the other people around her suddenly breaking into zippy song and dance routines reminiscent of Broadway shows, or, in her case, performances back home by a man named Novy, who was famous when she was a little girl.  In this manner she is able for the moment to shut out the awful circumstances in which she finds herself.

Selma is a Czech immigrant who has come to the US to find medical help for her 12 year old son, who will otherwise lose his eyesight from the same disorder.  It is 1964 and Selma is working in a factory in a rural town in Washington state, running a sheet metal press, scrimping to save for her son's operation.  Her best friends are factory coworker Kathy (Catherine Deneuve), humble would-be suitor Jeff (Peter Stormare, last seen in a decidedly different role stuffing a body into a wood chipper in Fargo), and Bill, her landlord, a local sheriff's deputy (David Morse).

Bad things soon begin to happen, with varying degrees of implausibility.  Bill - desperate and despondent because he has squandered a large inheritance and is in debt - discovers where Selma stashes the money she is saving and steals it.  Selma boldly confronts him and takes back her money, but he attempts to frame her, claiming to his wife that Selma has made sexual advances and tried to steal his money.  He pulls his gun to arrest her and in the struggle he is wounded.  He then implores Selma to kill him (he had been considering suicide) and - lo and behold - she complies!  At trial she lies that she sent the missing money to her "father" in the Czech Republic, the dancer Novy whom she had idolized as a child, because she fears that otherwise authorities will confiscate the funds and her son's sight will not be saved (if this sounds like a hundred year old melodrama plot we're on the same page). Unfortunately for Selma, the prosecution produces Novy (a dapper, tanned Joel Grey), now retired in Hollywood, and he of course testifies he's never heard of her.  She is convicted and later hanged, after refusing a chance to have her sentence commuted because the legal costs would require the money needed for her son's operation.  We get to see the hanging: fall, neck jerk and all.                              

Throughout this improbable yet sad story of Selma's figurative and literal fall from grace, the proceedings are periodically interrupted by reveries of hers in which suddenly she's free, happy, singing, twirling, usually accompanied by an ensemble of six to a dozen dancers.  This happens often: in the factory (where the distractions lead to a major machine foulup by Selma that results in her being fired), right after she kills Bill (when he magically comes to life and they dance and sing together), during her trial (where the rapacious prosecuting attorney and the jury all join her and Joel Grey in a courtroom dance routine), and just before she is executed. 

There is nothing wrong with these routines in themselves.  Bjork wrote and delivers the songs very ably, and the dancing is good.  For that matter, the acting is, with one exception, superb.  The exception is Deneuve, and the problem is really not her acting, but the fact that she is so stupendously miscast.   La Deneuve, as a down-at-the-heels working class rural American factory worker?  I'm sure.  But Morse, Grey and several others - especially Stormare and a corrections officer (Siobhan Fallon) who befriends Selma in prison - are all good.  Best of all, Bjork herself is captivating as a Victorian sort of woman-child, an interesting amalgam of boldness and resolve, sweet innocence and vulnerability, pluck and self-defeating stubbornness.  Just the sort to rely on dissociation, you might say.  We can't know, here, how much of her transfixing screen presence and manner are essential parts of her true personality versus evidence of her acting ability.  But she does seem to possess range, and she clearly deserved her Cannes best actress award.  

As for the film itself, it is a huge daring mess of contrivances.  Von Trier, who also wrote the screenplay and lyrics for several of the songs, dwells overly much on closeups of Bjork, and the editing is way too frenetic, almost febrile.  More important is his decision to juxtapose the tragic with the frivolous.  Excellent musicals often have tragic themes, of course, from the sentimental Carousel to the leather tough Cabaret, to what is arguably the best musical ever made: West Side Story.   But these favorites are distinguished by the integration, the harmony, of the songs and dancing with the story line.  In these works, the key musical material is itself tragic in tone, and the individual numbers either move the story along or reflect on what has been occurring.  Not so in Dancer.  The musical numbers here are escapist fantasies of a desperate protagonist.  In theory this could work, perhaps.  But it doesn't here.  The tragedy of Selma's story is too appalling, the song and dance routines too starkly interruptive and incongruous.  It may ring true as psychopathology but is it effective as drama? 

In Roberto Begnini's Life is Beautiful, incredible scenes of slapstick gaity made a gratuitous mockery of massive human suffering in the Holocaust.  Von Trier's conceit is another matter.  Selma's tragedy is not trivialized here.  One can imagine a person like her who copes with anguish through fantasy.  But it is one thing to be prone to dissociative fantasy in one's own mental experience.  It's quite another to attempt to depict such a process occurring in someone else.  Almost invariably such film portrayals, whether of hallucinations or complex fantasies, tend to fail.  Still, this is an outrageous and compelling film.
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* Dancer in the Dark was directed by Lars von Trier, Denmark, 2000; although many of the players are European, everyone speaks English in this film.

TREATING TONY SOPRANO      Roland Atkinson © 2001, 2002, 2003, 2005

I don’t watch television.  But thanks to a tip from a colleague, I learned belatedly that the HBO hit series, The Sopranos, prominently features psychiatric treatment.  All 39 episodes from the first three seasons (1999-2001) are now available on VHS and DVD.  This review will focus only on the first season - the initial 13 episodes.This is a “family” show in a doubly ironic sense.  Tony Soprano (James Gandolfini) owns a waste management company and lives with his wife Carmela (Edie Falco) and their two children in a suburban New Jersey mansion.  Meadow (Jamie-Lynn Sigler), Tony’s 17 year old daughter, is engaged in typical teen warfare with her parents.  Anthony Jr. (Robert Iler) at 13 is close to his dad but veering towards trouble at school.  Carmela is justifiably impatient with Tony’s philandering and otherwise shadowy life.  His aging mother, Livia (Nancy Marchand) is also critical of him – to her he’s a bum next to his sainted deceased father; never mind the fact that she thought the father was a bum too.  And Livia is also beginning to fail.

Then there is the other family: Tony is a Capo – a “captain” – in the Jersey Mafia.  Profits are down.  Loyalty is on the wane.  His pushy old uncle Junior (Dominic Chianese) is competing to run the mob.  Life isn’t easy.  Tony has become depressed and developed panic attacks, and he seeks professional help.  The very first scene in the first episode finds Tony bemusedly awaiting his initial visit with a psychiatrist, Dr. Jennifer Melfi (Lorraine Bracco).  She is a prominent character not only in this episode but throughout the series.  Tony is not an easy patient.  He often denies his symptoms and is deeply involved in illegal, and sometimes violent, activities.  He is used to being in charge; the patient role does not suit him (much like Robert DeNiro’s gangland character in the film, Analyze This).  Tony storms out of Dr. Melfi’s office before the end of their first hour together and will do so again.  He develops an intense maternal transference, then sexualizes the relationship in erotic dreams and actual attempts to seduce the doctor.  It doesn’t stop there.  Tony directs a corrupt detective on his payroll to follow Dr. Melfi and report details of her personal life to him.  As a gift, he arranges for her car to be stolen in the night for needed repairs and then returned. Gandolfini infuses his character with the same bristling bulldog intensity that Carroll O’Connor brought to “All in the Family.”  But Tony Soprano is full of more contradictions than Archie Bunker: in some respects Tony is more modern and caring, in others far more primitive and ruthless.  His attachment to his family – his wife, his children, his difficult mother and murderous uncle – is steadfast.  He can be as genuinely affectionate as a puppy; guily feelings can cause him to cringe with contriteness.  He can also kill people or rough them up with devastating violence and not an ounce of remorse.

Dr. Melfi is no less complex.  She’s tough and confident in her personal life, even something of a foulmouth.  But in the office with Tony she seems hesitant, overly restrained, softspoken to a fault, often lacking in authority.  She knows from the referring physician that Tony is a Mafioso.  In the first session she is especially inconsistent, shifting among three different personas.  She’s the clichéd pop therapist, overselling SSRIs (“…nowadays no one has to suffer from depression,” she says) and delivering with wide eyed insouciance, almost farcically, lines like “you seem to have strong feelings about this” or “there certainly is a formidable maternal presence in your life.”  Fortunately this aspect fades away in later episodes.  She can also be seductive.  There is a lifesize metal statue of a nude woman in her waiting room in the first epidose (interestingly it is nowhere to be seen in subsequent episodes).  She wears very short skirts at times, and her soft, hesitant manner could be mistaken for coming on.However, in most respects she delivers as a competent psychiatrist.  She cares; she nicely balances questions with empathic statements; she shows an appropriate sense of humor.  She clearly explains confidentiality rules and limits.  She properly pursues such matters as Tony’s neurotic distortions of his mother and forthrightly if quietly confronts behavior like his bringing her coffee, having her car worked on, and trying to make a pass at her. 

Her competence seems to grow with time, and her reticent, gentle manner might well be viewed as deliberate, possibly the only approach Tony has the capacity to tolerate.  Dr. Melfi tells him as much in the 6th episode when she says that her gentleness is a strategy she needs to use “…to do my work here.” She does commit a gaffe or two along the way.  In episode 10 she volunteers that she had recently attended a dinner party at Tony’s next door neighbor’s house.  This gratuitous overture of familiarity, with its hint of boundary transgression, serves no dramatic purpose and occurs when Tony’s admission of sexual attraction to her is still fresh.  In the 12th episode she assertively reads to Tony the unflattering criteria for borderline personality disorder listed in DSM-IV to help make her point that his mother may merit this diagnosis.  This provokes a physically menacing response from Tony that is clinically right on the mark.So, is Tony making any progress?  His depressive and anxiety symptoms wax and wane.  An SSRI (Prozac) was no panacea, and Dr. Melfi has had to try augmentation strategies using other medications.  In later episodes there are signs that psychotherapy may be helping.  Tony is taking a more realistic tack with his mother.  He is able for the first time to feel compassion for a kid whom he and his friends used to torment back in school, after he himself is treated contemptuously by members of a private country club.  Most important is Tony’s change of heart after discovering that the soccer coach of the girls team on which Meadow plays had sex with one of her teammates.  Tony hints to Dr. Melfi that he has organized a “hit” on this man.  She persistently challenges his impulse to take justice into his own hands, and later he calls off the hit in favor of letting civil authorities intervene.The nature and rules of psychotherapy are explored through the encounters between these two.  Tony accuses Dr. Melfi of being a whore when she insists that he pay for a missed session, raising the old debate about whether therapy is anything more than “rent a friend.”  Whether it is morally acceptable for a psychiatrist to treat a patient as corrupt as Tony becomes a subject for discussion in her family. 

In a larger sense Bracco’s character can be viewed as an important dramatic device: if a psychiatrist – and a woman at that – can find grounds for empathy with this violent, contradictory man, then, through her, viewers are challenged to consider a similar perspective. Good film depictions of psychiatrists – portrayals that meet high standards for ethical conduct, a caring attitude and technical proficiency, as well as dramatic sensibility – are surprisingly few and far between.  My all-time favorites are Lee J. Cobb in The Three Faces of Eve (1957) and Bibi Andersson in I Never Promised You a Rose Garden (1977).  Both roles were based on real, well known psychiatrists.  On television in the 1970s, the comedian Bob Newhart managed to create a character – Dr. Robert Hartley, a clinical psychologist – who maintained a principled and caring attitude toward his patients for six years in a weekly sitcom, no small task.  Based on her work in the first season of The Sopranos, add Lorraine Bracco’s Dr. Jennifer Melfi to the “A” list of generally positive, authentic fictional film portrayals of mental health professionals at work.   

Sad note on the sequel (the second season):  In its second season, The Sopranos continues to present episodes with generally high dramatic values.  However, I regret to report that the writers virtually destroyed Bracco’s character, Dr. Melfi, a role so carefully built up in the first season.  Her ambivalence about treating Tony reemerges and results in on-again-off-again contacts with him.  While this is in part understandable, since her life may be endangered by Mafia figures who think Tony may have told her too much, things run to improbable and unnecessary extremes.  She begins to belt down shots of whiskey between sessions.  She’s a nervous wreck and seeks treatment from her own therapist (Dr. Kupferman, played very ably by Peter Bogdanovich).  In later episodes she seems to regain some composure but not the steady hand she showed in the earlier series.  Oh, well.  Sequels often disappoint.  And the excellent portrayal of a psychiatrist at work in the first season still stands on its own merits. 

Dr. Melfi (and psychiatry) redeemed (the third season): Overall, the dramatic luster of the series is starting to wear a bit thin.  At times new variations on old themes and characters come across as merely recycling of prior material.  Example:  the character Ralphie (well played by a menacing, near lunatic Joe Pantoliano) is too much like the character Richie Aprile in the second season.  Annabella Sciorra is outstanding as Gloria, a predatory, mercurial woman with a severe borderline personality disorder whom Tony meets in Dr. Melfi’s waiting room.  Melfi herself is resurrected this season.  She and her estranged therapist spouse, Richard, reconcile.  She is restored as competent, insightful, at times quite justifiably assertive in her psychotherapeutic work with Tony, who continues to have panic attacks.  She suggests referral to a cognitive-behavioral therapist (in part because of Tony’s refractory symptoms but also because she has come to think that she doesn’t want to continue working with him).  This prompts Tony to try a little harder.  Carmela joins them for several sessions.  In episode 3, a decidedly psychodynamic spin is placed on Tony’s panic attacks, when he recalls the initial attack, at age 11, after witnessing his father hack the little finger off a butcher who hasn’t paid his protection money.  This psychodynamic explanation of Tony’s disorder is overly pat and dated.  Tony’s son, A.J., also begins to have panic attacks (we know it runs in families).  In episode 4 Dr. Melfi is raped in her office building parking garage, and the rapist, whom Melfi can identify, is not prosecuted on a technicality.