A Dangerous Method

 We are taking a break from our normal forensic programming to bring you this guest post from Jesse, a review of the film "A Dangerous Method."  ---Clink

Another psychiatrist and I went with our spouses. We all hated it. There were at least three levels on which I considered the film, the first being whether it in fact is a good film, the second relating to what it shows about Freud, Jung, and the birth of psychoanalysis, and the third what it shows about a psychiatrist getting involved with his patient.

A Dangerous Method purports to show Jung, the protagonist, treating a young (and of course beautiful, played by Keira Knightly) Russian Jewish woman named Sabina Spielrein, who was brought to his clinic for treatment of her hysteria. It is quite obvious from the outset that he will fall in love with her, and we are not disappointed, but the predictability and lack of drama in the film are striking. Spielrein gets better and wants to become a physician and analyst herself, which she does (historically, her most famous analysand was Jean Piaget).

We see a little of Freud, stiff and priggish, but quite adamant on maintaining the scientific stature of psychoanalysis and opposed to Jung’s efforts to bring in parapsychology. It is hard to imagine a less sympathetic picture of Jung, and as one who knows relatively little about him I can just say that I hope this film’s portrayal is a strong dramatization: unfeeling, narcissistic, and breaking every rule that has been standard in our field since its inception.

Sabina has been abused by her father by being beaten, which she acknowledges led to sexual arousal. Her symptoms remit as she became able to talk about it. Of course the very worst thing for this woman would be to reproduce that trauma with her psychiatrist, but that is exactly what Jung repeatedly does. The director switches (again quite predictably) between scenes of Sabina being beaten by Jung prior to sex to scenes of Jung’s beautiful and virginally white-clad wife, loyal and forgiving, who tells Jung haltingly that she disappointed him by having given birth to a girl, but will do better next time.

Of course Sabina falls in love with him. You do understand that it is transference. But he soaks it up and wallows in it. For a patient who has been sexually abused and beaten by her father everything Jung does is the worst it could be.

No viewer has any sympathy for him. He is without feeling except for himself. No guilt. No regrets.

Now, if the film really taught us something about psychoanalysis! But it doesn’t. It uses the language but throws off profoundly important concepts with the ease of a ten year old telling you that E = mc2, and with equivalent understanding. Spielrein herself made some important contributions, and Jung was one of the most famous psychologists in the world, but how he got that distinction (rather than ostracism and shame) is anyone’s guess.

So the more you know about psychoanalysis and good drama the more you will hate this film. The more you understand that a patient having a sexual relationship (and even more a perverted one) with a psychiatrist causes profound and lasting damage, the more you will feel that a film that makes the relationship appear harmless is itself causing serious harm.

Guest Blogger Dr. Jesse Hellman on Mrs. Brown

Recently there have been a number of posts on Shrink Rap that touched on issues of what is normal, and do we today treat as illness the vicissitudes of normal human life. And occasionally there are films which also address these themes, if inadvertently.

In Mourning and Melancholia Freud discussed the question of the natural state of mourning and how it resembles, and differs from, melancholia, as depression was called then. I doubt that Freud’s work was on the minds of the producers of Mrs Brown, starring the great Judi Dench, but perhaps it was, as Queen Victoria was still deep in mourning three years after her husband Prince Albert’s death. She kept herself secluded from the public, allowed no happy sounds or colors around her, took no pleasure in anything, had an increasingly irritable nature, and was sad and morose.

Trying to cheer her, her chief-of-staff Sir Henry Ponsonby brought to Balmoral Castle one John Brown, an eccentric Scot who had served the Prince, and whose good report in that regard made her acceptable to the queen. He was to take her riding. John Brown, disregarding all protocol and tyrannizing the staff, gradually became very close to Victoria, so much so that it was virtually a scandal. The queen was called by her detractors, in derision, Mrs Brown. All Parliament was looking to how events in the queen’s life would affect them, and Benjamin Disraeli, the prime minister, visited her in Scotland. Eventually Victoria managed to regain her interests in life and returned to London to both vanquish the opposition that had emerged and retake her role in the center of the Empire.

Curiously, one week before seeing this film I had stumbled onto an estate sale in Georgetown. The house itself had just been sold and most of the furnishings were gone. Among books remaining in the library was a complete edition of the novels of Benjamin Disraeli. I had not realized that the great prime minister wrote novels. Anyway, I passed on it and now after seeing the film sorely regret it. If I had seen the film first...

Black and White on Romance ...and Other Things in Life

I'm stealing a post from Jay at Two Women Blogging----which is interesting because it's written by three women blogging and you'd think that three bright women could count (maybe even up to five), but okay.... Here is their stolen post and I'll discuss it below. I think they'll be okay with my stealing, and here's a shout out to Tigermom.

Was Harry Right?
~by Jay

Bluemilk got me started thinking about this. I first heard Harry's thesis advanced by the resident I worked with on my med school psych rotation. She assured me that while I might think I had platonic friendships with men, the men didn't see it that way. I was pretty sure they did see it that way. I wasn't naive - I was engaged to be married and had done my share of dating and flirting; I knew what it felt like when a man was interested in me sexually and I knew the difference. I still know the difference, and I still have men friends. For most of my life, my closest friends have been men.

I had a best girlfriend growing up, but we weren't together very much - she lived in a different neighborhood and had a lot of afterschool activities and we weren't usually in the same class at school. We didn't trade sleepovers and call each other to check our outfits and have long closed-door talks like Eve does with her friends. My day-to-day best friend, the person I hung out after school with and rode bikes with and watched TV with and waded in the creek with, was the boy across the street. We were inseparable until he moved away when we were ten.

During that same psych rotation, we had a lecture on child development in which I learned that "all children" had a same-sex best friend during latency. I asked the lecturer afterwards what would happen if a child had an opposite-sex best friend during that period, and she said "gender development would become abnormal". Perhaps that explains it.

I started to seek out and cultivate female friendships when I was in med school, but I find I still gravitate toward friendships with men. I am blessed, now, with wonderful women friends, and I'm deeply grateful for them, but I still think my psych resident - and Harry - were wrong.
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I picked this post to blog about because 1) I liked having the When Harry Met Sally clip in it and 2) because these kinds of black-and-white statements about How Life Works come up all the time in therapy. In the case above, the teacher tells the student that during latency one must have a same sex best friend. Must. If not, the person grows up to be "abnormal" in their gender development. Show me the science. Oh, first define for me "normal" in terms of gender development? And who out there has "normal" gender development? What's the goal? Martha Stewart? Barbie? Elana Kagan? J Lo?

What comes up more often in therapy is the question of can you be friends with an ex-girl/boy friend? An ex-husband or wife? I tend to think that it's usually hard, but there are people who do it, so counseling: "you can't be friends with an ex" or "you can't be friends with a member of the opposite sex" or pretty much any absolute, seems, well, not evidence-based. My personal favorite piece of advice-- to give-- along the 'absolute,' non-evidence based line is to tell people to stay away from the person they are so painfully breaking up with for a good long time, at least until all parties are no longer in love and have moved on with their lives. Now all I need is a movie scene.

Movie Review: Oasis

I saw this film over the weekend after a recommendation from a friend. It's a Korean film about ostracized misfits who find one another in the midst of a harsh society. The main character, Jong-du Hong, is released from prison after serving time for killing someone in a drunk driving accident. His family are not happy to see him again. They are hard-pressed for money and have had to squeeze into a small apartment with his many siblings. His family does not hesitate to tell him that he is a burden and that they were better off when he was locked up.

He visits the family of the person he killed to make amends, only to find them in the process of moving out of their apartment. They are leaving behind the child of the accident victim, Gong-ju Han, a severely disabled woman with cerebral palsy. Jong-du confronts her brother as they are leaving and demands to know who will take care of her. He is kicked out of the apartment and she is left alone, with physical contortions that horribly distort her limbs. It was painful to watch.

Jong-du returns repeatedly to try to visit Gong-ju, to bring her flowers and to check on her. Finally, one day he is let into the apartment. He tries to rape her then flees when she passes out.

This is the point where the movie becomes inexplicable to me. Following the attempted rape Gong-ju fantasizes about Jong-du and imagines having a lover, and struggles against her cerebral palsy to put on makeup. Jong-du returns and the two become lovers. Their train-wrecked lives come together in a predictable way. One physically damaged, one psychologically damaged, both without psychological or social support. The result is inevitable and predictable.

The Rotten Tomatoes web site gave this film an 89% favorable rating, although I'm not sure why. One of the difficulties of this movie, besides the implication that rape can trigger love, is the fact that Jong-du's facial contortions made it impossible to read her emotions, and I was left wondering if she was in pain, afraid or ecstatic. When it was crucial to directly tell the audience what she was feeling the director cut to a fantasy mode, and the physically-whole actress acted out Gong-ju's feelings. We learn she is entranced by this man, that she fancies herself teasing him and playfully flirting with him, that her days are filled with wonder and fulfillment when he is around.

The most potent part of the film was the portrayal of how this disabled woman was treated by Korean society----she was refused service at a restaurant and rejected at a family gathering---overt discrimination highlighted by Jong-du's naivety. He brings her to his mother's birthday party only to be confronted by his siblings about his inappropriateness. Gong-ju's family can't even imagine that anyone could love her, and they take it for granted that he is abusing her when they finally do make love.

Jong-du ultimately goest to prison after a false rape allegation, but personally I think he should have been there quicker after the first, real, attempt.

Dinah's Away, Clink Will Play

So Dinah has gone off on vacation and left Roy and I in charge of the blog. Doesn't she know what a really really bad idea that is??

The day started off with her calling me to help with a computer problem. Dinah wanted to download a movie to watch on her iPod on the plane. No problem, except that she needed to upgrade iTunes to do this. She downloaded iTunes but for some reason it didn't install (she later asked me which password she was supposed to enter during the install process, that may have been part of the problem). So I talked her through the upgrade and told her how to open system preferences and get to the software upgrade control panel:

"Go down to the bottom of the screen until the little launch bar pops up. Then click on the little picture that looks like a gear."

"Deer??" Dinah said. "I don't have any deer!"

"No no, click on the gear," I said. "Gear with a 'g'." I'm hollering this into the dashboard of my car as I'm trying to drive on the beltway in the rain. I wonder if my other tech savvy friends (meaning Roy) end up in situations like this, trying to solve computer problems from memory while multitasking other things. I also wonder how I'm going to teach Dinah how to use GarageBand so she can edit our podcasts when she gets lost looking for deer on her laptop. O gods of computer tech support, have mercy!

Well, she got the upgrade done, went to iTunes and bought her movie then found out it was going to take two hours to download. At that point my tech support was done. I don't know if she ever got her movie or not, but I do know I'm going to schedule an entire afternoon for the GarageBand training.

A Movie For ClinkShrink

Perhaps the most disturbing movie I've ever seen.

So we start with the ferry ride to Shutter Island where two federal agents are headed to a a particularly creepy hospital for the criminally insane to search for an escapee--- a mother who drowned her three children and who has now "evaporated" from her locked cell. The story revolves around the haunted character of Teddy Daniels (Leonardo DiCaprio) whose flashbacks and dreams pave the story: his role in the liberation of a Nazi death camp & the horrifying death of his young wife in a fire. The movie is dark, it is set on an island during a hurricane, in a hospital built during the Civil War, with Ben Kingsley in a bow tie playing the polite but devious head psychiatrist. In every scene, things are falling: rain, snow, papers swirling, ashes, unknown particles. It's compelling and confusing, all at the same time. The plot twists and weaves, and by the end the reality was a bit of a jumble. What really happened? We didn't agree, and when we caught dinner after, the couples at the next table were having the same discussion.

Not exactly a positive view of psychiatry, but this one was so much about the twists of the plot, that it hardly seems worth worrying about the portrayal of our profession. And "disturbing" : the storyline itself was not terribly disturbing, but the images of dead children left me very unsettled. I'll leave the full analysis to ClinkShrink....and no plot spoilers here.

Academy for Film and Psychiatry

There's nothing quite like blogging in a blizzard. My house, by the way, is the one with the gutters torn off one side and draped across the front with the disconnected downspouts. You will notice that our flat roofs have been shoveled off-- makes for a fine family project in the snow-- after having the insight that another 20 inches could well cause their collapse.

So I thought I'd give a plug to Dr. Fred Miller and his Academy for Film and Psychiatry. His 'filmosophy' reads:

FILM IS NOTHING SHORT OF OUR STRUGGLE TO UNDERSTAND PEOPLE, CULTURE AND OURSELVES. FILM ENGAGES ALL OF OUR SENSES AND IN THAT WAY IS LIKE NO OTHER MEDIUM. THE PARALLELS BETWEEN THE FILMMAKER AND THE PSYCHOTHERAPIST ARE MANY. EACH IS ACUTELY AWARE (OR SHOULD BE) THAT HE OR SHE IS PRESENTING AN UNDERSTANDING OF THE HUMAN CONDITION AND ALSO THAT THE PROCESS OF UNDERSTANDING IN AND OF ITSELF IS HEALING AND FULFILLING. BOTH ARE SUBJECTS OF INTENSIVE STUDY AND ENDLESS DEBATE. ENJOY!

Film seems like as a good a thing as any to do today, so long as the power holds. Brrrr from Maryland, hon!

Glenn Close on the Stigma of Mental Illness

Thanks to Laszlo for sharing this piece from The Huffington Post.

Actress Glenn Close writes about "Mental Illness: The Stigma of Silence:"

It is an odd paradox that a society, which can now speak openly and unabashedly about topics that were once unspeakable, still remains largely silent when it comes to mental illness. This month, for example, NFL players are rumbling onto the field in pink cleats and sweatbands to raise awareness about breast cancer. On December 1st, World AIDS Day will engage political and health care leaders from every part of the globe. Illnesses that were once discussed only in hushed tones are now part of healthy conversation and activism.

Yet when it comes to bipolar disorder, post-traumatic stress, schizophrenia or depression, an uncharacteristic coyness takes over. We often say nothing. The mentally ill frighten and embarrass us. And so we marginalize the people who most need our acceptance.

What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well. Our society ought to understand that many people with mental illness, given the right treatment, can be full participants in our society.

Read more at: http://www.huffingtonpost.com/glenn-close/mental-illness-the-stigma_b_328591.html

Seems like a good follow-up to our discussion of whether only perfect people should have children.

Julia & Julie: Dinah's Comments.

I went to see Julia & Julie tonight. I've decided it's my job to blog about it because there's no chance that either Roy or ClinkShrink will go to this movie.

The storyline is simple: A young New Yorker named Julie is looking for meaning in her life---she's an unpublished novelist who looks for meaning in being a blogger. I think she might be my soul mate. She becomes obsessed with her cooking blog, and a mission to cook every recipe in Julia Child's cookbook (that would be 541 recipes...Oops...542) in 365 days. We go back and forth with this plot to Julia Child in Paris in 1949 and her role as a bored housewife, also in search of meaning: hat making, bridge playing, and finally cooking. She takes a class, becomes obsessed, and meets two other French chef women and they become a trio, obsessed with writing a book. Well, two of them work on this book....40, 60, 80 hours a week...the third one is not so in to it (---oy...feels a little too familiar!). It takes them 8 years and well, everyone from Julia Child the chef/author/TV personality to Julie Powell the blogger/author and now the subject of a movie, all become famous.

If you take out the cooking and the food, I could totally relate to the obsession of a blog and a book...and to all the innuendo. Both women become fixed on their projects, their lives revolve around them. Julia Child's publisher isn't so happy with her book...again, oy!...and there is some focus on getting the correct title for the book (something we Shrink Rappers are still struggling with.

So, I'm calling Meryl Streep in the morning. I'd like her to play me in the Shrink Rapper movie. My nose is a little different, but we don't have to tell anyone. Suggestions for the roles of Roy & ClinkShrink, anyone?

Psychiatry on Broadway

The world is so weird. This morning, I looked out my back window and wondered if the neighbor behind me was pregnant. You can't really ask someone this-- it could just be 15 unwanted pounds, kind of concentrated in one place. I went to her Facebook page, and there was a comment on her wall, "Congratulations on the Pregnancy!" Okay, so it's official.

So today's New York Times mental health Shrink-Rappable article comes from the Arts & Leisure section. Patricia Cohen writes in "Mental Health, the Musical, Aims for Truth" about Broadway plays where mental illness is the focus of attention. She talks about a new Broadway play, Next to Normal, as well as about Proof and Equus. Cohen writes:

Mental illness on the stage and screen is often portrayed in extreme ways, and not just for dramatic effect. In Western culture psychic pain has tended to be seen as the territory of the artist, visionary, rebel and genius, from Emily Dickinson to Sylvia Plath and Friedrich Nietzsche to John Forbes Nash Jr. So it should be no surprise that madness is often used to signify creativity, sensitivity or spiritual and intellectual depth.

She goes on to write:

The musical now presents a much more subtle and complex view of psychotherapy. In “My Psychopharmacologist and I,” Diana catalogs the side effects of her drugs — nausea, drowsiness, sexual dysfunction, headaches, seizures — until she finally says, “I don’t feel anything.”

The doctor pronounces, “Patient stable.”

Will I see it? No...sounds too much like going to the office.

Grizzly Man

I watched the documentary Grizzly Man last night and it's still haunting me. It's the story of Timothy Treadwell, the failed actor and recovering alcoholic who dropped out of civilization and moved to the Alaskan wilderness to dedicate himself to the protection of grizzlies. The story became a documentary because, eventually, he and his girlfriend were killed by a grizzly. Their deaths were caught on audiotape, which mercifully was not played during the film.

There were so many things that fascinated and bothered me about this film.

On one level the documentatry represented a clash of cultures---the ecologically-minded friends who supported Treadwell's efforts to acclimate to the grizzlies versus the scientists and conserative traditionalists who felt this was dangerous for both the animals and humans. Given that the grizzly was killed by park rangers as they retrieved Treadwell's remains, fate eventually made the traditionalists' case.

The main character of the film was Treadwell himself---flamboyant and effeminate as he professes his love to every creature he encounters, yet adamantly straight when talking to his camera. Knowing that he aspired to be an actor made me constantly question whether or not I was seeing the real person during any given scene. Treadwell himself didn't seem to know his own reality. At one point he told friends he was an orphan from Australia and adopted an Australian accent as an affectation. Even his friend in California wasn't aware of this deception until after Treadwell's death. While living in the wilderness he recreated his persona again, this time as the center of his own story as he filmed over one hundred hours of himself and the bears. He became the lone martyr sacrificing himself for a higher cause, a form of rehabilitation through conversion to an ideal.

And then there is is ill-fated girlfriend, Amie Huguenard. LIttle is known about her because her family did not want to participate in the film. We are left to speculate about her reasons for following him into the wilderness and we could easily be wrong. She was afraid of the bears and considered leaving him, but stayed and died while trying to protect him from the bear attack. I'm left to wonder: was she a reluctant companion, a person naive to the wilderness who merely followed a charismatic eccentric? Was she a self-righteous rescuer who saw herself taming the wildman and, through love, bringing him back to civilization? We'll never know. We do know that in the end she was heroic.

What we do know about her and their deaths we find out through the creepy coroner who describes the attack, right down to the screams and moans. He describes their scanty remains and their wounds in vivid detail. It was awful to picture these unusual but vibrant people reduced to a small plastic bag inside a long metal box. I was struck by the questionable ethics of discussing this medical information, knowing that confidentiality (in theory) is supposed to extend beyond the death of the patient. If Amie Huguenard's family did not want to participate in the documentary it's questionable that they would have given permission for the pathologist to discuss her remains.

In the end Grizzly Man is not a story about bears. But it's still a story worth telling.

A Brief History of Shock Treatment

Dinah's post about the new movie, The Changeling, generated some discussion about ECT in the comments (Angelina Jolie's character got electroconvulsive therapy in 1928, nine years before the first published description), started by Romeo Vitelli who asked, "Did they have ECT in 1928? I was under the impression that it was first developed in Europe in the 1930s."

Anonymous wrote:

Electroconvulsive shock therapy was discovered by Ugo Cerletti and Lucio Bini in Rome, in 1937.

Source:  The History of Shock Therapy in Psychiatry

Apparently insulin-induced coma was all the rage in the late 20s.

And didn't Francis Farmer (and a whole bunch of other people) get an ice-pick lobotomy from a psychiatrist in the 1950s?

Psychiatrists of yore performed some pretty barbaric treatments on their patients.

It seems the movie took some liberties with "the truth," though. No surprise there.

Anon is right about 1937 being the first description, though it must have occurred earlier for them to write about it.  But other types of "shock" treatments were used before electricity (as in "a shock to the system").

Insulin shock treatment was first described in 1934 by Manfred Sakel, according to my 1948 third edition of Samuel Kraines' The Therapy of the Neuroses and Psychoses.  Insulin was used to induce a "therapeutic coma," usually daily for 15-30 days and lasting 30-60 minutes. Occasionally, the coma resulted in a convulsion, and it was found that these convulsions resulted in improvement, spawning many different "treatment" pathways to achieve these therapeutic convulsions.

Kraines (p487): "There may be convulsions present during the coma; but contrary to Sakel's fears, these convulsions are usually found to be beneficial to the patient. Indeed, some authors give metrazol or use electric shock for patients who are in insulin coma." (p493): "... [other] agents include ... picrotoxin, coriamytrin, azoman, ammonium chloride, camphor, methylguanidine and others."

Metrazol was first introduced by von Meduna in 1935 for schizophrenia, the same year that Moniz and Lima from Portugal described prefrontal lobotomies.

As for the therapeutic use of electricity, well, speculations started almost as soon as electricity was discovered to affect tissue in the late 1700's.  

From "Electricity and Life", a translation of three French articles by Fernand Papillon in the Journal of Insanity from 1873: "It is for this reason that the diseases which have their seat in the encephalon are particularly easy to treat by electricity. The latter, wisely applied, is a sovereign remedy for cerebral crises, delirious conceptions, headache, sleeplessness, etc. The first physicians who made use of the electric current understood perfectly the happy influence of the galvanic fluid on the disturbances of the brain; they even thought to use it for the treatment of insanity. Researches have not been continued in this direction, but the facts published by Hiffelsheim authorize the opinion that they would not be unprofitable. These facts show how much service the electric currents, but the constant currents only, will some day be able to render in cerebral affections. This is a point to which it is important to call the attention of alienist physicians." [alienist=psychiatrist]

I haven't seen the movie yet, but I guess they must have wanted it to be in 1928 (because of stock market crash?), so they took artistic license on when ECT began.

Psychiatry, Hollywood Style

Warning: early plot spoilers...I don't discuss the end at all.

I went to the movies last night and saw The Changeling. It was an intense, riveting movie. Based on a true story: the year is 1928, the town is Los Angeles, and 9-year-old boy is missing, his single mother is terribly distraught, and 5 months later the boy is returned to the mother except, oops, wrong child. There is a side plot about the corrupt police department, and they are using the mother-child reunion as an example of how things sometimes go right, so no one is happy when the child who claims to be the missing Walter Collins steps off the train and mom is not over-joyed. Pictures are taken, and the police chief convinces mom that the boy has changed with time. Take him home on a 'trial basis,' really, this shorter kid is yours. The dentist and teacher confirm that it's not the right kid, but the police have their own doctors in hand, and oh no, they all manage to paint mom as being paranoid when she wants the police to re-open the case and find her the right kid. In the meantime, she's got this other kid hanging around who calls her Mommy.

Mrs. Collins gets agitated while talking to the police chief who simply insists, we got you the right kid. He has her taken away to the psychopathic ward. The staff are emotionless, the place is bleak, the rooms are cells with bars and the room doors have windows with hatches. The patients are all unwashed (though Angelino Jolie's makeup never comes off) and they are dressed in hospital johnnies to make certain they look all the crazier. Medication is forced, and if you smack the shrink, you're hauled off for immediate and un-anaesthetised ECT where the button gets pushed by blank-faced nurses who have no thoughts of their own. And if you refuse to sign a paper saying the police were right, they did nothing wrong, and the kiddy they gave you is yours, same thing-- more ECT, especially if you say to the shrink who asks for the signature, "F** you and the horse you rode in on." To help matters, the psychiatric ward is full of women who've questioned the police (--this could be a setting in Communist Russia) where it's so much easier to call whistle-blowers psychotic and lock them away forever. My favorite was the prostitute, played by Amy Ryan, who was locked up for claiming one of her clients had brutalized her, and oops he was a policeman. She tells the protagonist, ""You gotta do everything you can to look normal. If you smile too much, you're delusional; if you don't smile, you're depressed." Oh, there was something brilliant about if you don't do either, but I can't remember or find the whole line. The message was a simple one of you can't win and no matter who you are, the psychiatrist finds a way of contorting into something being horribly wrong with you.

It's a pretty bleak view of psychiatry all done Hollywood style.

Hollywood, Schizophrenia

I'm watching the Academy Awards. I'm betting on Atonement. You heard it hear first. I also loved Juno. We were going to do a podcast today, but Clink went to the opera. Roy and I and our beloved non-shrink proles went to see Vantage Point. Not shrinky, I leave it to Roy to find a way to blog about it.

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You can read about a new Schizophrenia medication in development in the New York Times business section: "Daring to Think Differently About Schizophrenia." LY2140023 works on glutamate receptors, a new approach but the article mentions that preliminary testing shows it to be slightly less effective than Zyprexa.

CANVAS (The Movie): This is Mental Illness Awareness Week

(from NAMI): Help CANVAS Fight Stigma This Week
Movie about a boy whose mother has schizophrenia — Spread the word about the movie, no matter where you live.

View the Trailer

Just in time for Mental Illness Awareness Week (October 7-13), the movie CANVAS is being released in Chicago and New York on Friday, to be followed by three other cities next week. If Friday and Saturday ticket sales run high in these five cities, the release may expand to 200 cities nationwide.

Starring Emmy Award-winner Joe Pantoliano and Academy Award-winner Marcia Gay Harden, CANVAS is the story of a family's struggle with schizophrenia. It educates as well as entertains. It will build awareness about mental illness and strike a blow against stigma--but only if enough people see it. In order for the movie to reach a nationwide audience, please take action to help:

• Spread the word! Please spread the word now with a personal message to family and friends in the cities below—and friends elsewhere.
• Buy tickets on-line early each week. You don't even have to live in the opening cities. Tickets make great gifts or donations. Use the links below to purchase tickets online.
• If you live in one of the five cities, go see the movie on a Friday or Saturday. Take a friend. Go in a group. Hold a discussion afterwards.

Starting October 12...
• In Chicago, AMC Loews 600 North Michigan 9, 600 N. Michigan Ave. 60611
• In New York, Regal Union Square Stadium 14, 850 Broadway, 10003

Starting October 19...
• In Los Angeles, Laemmie Sunset 5, 8000 Sunset Boulevard, 90046
• In Phoenix, Harkins Shea 14, 7354 E. Shea Blvd, (Scottsdale) 85260
• In Fort Lauderdale, check local listings as the date approaches.

My Three Shrinks Podcast 35: Shrinks on Film

[34] . . . [35] . . . [36] . . . [All]

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Last week, we had our guest, Dr. Mark Komrad, join us and begin to discuss the portrayal of psychiatrists in the movies. Mark used to have a live, two-hour, coast-to-coast, nationally syndicated talk radio show, and is a regular guest on NPR. He is also the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger back in July, when he posted on Ethics and Continuing Education for the Psychiatrist.
This week Mark continues to discuss how Hollywood likes to portray psychiatrists in film. You can find him at www.komrad.yourmd.com. (Unfortunately, Monkey the parakeet gets sidelined in this podcast.)

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October 5, 2007: #35 Shrinks on Film


Topics include:

• Leona Helmsley's dog, Testamentary capacity, and Psychological Autopsies. ClinkShrink discusses how one starts to address the question of competency to being able to make the decsion to leave $12 million to one's dog. Bounty and one's natural heirs.
  
  
• Irv Schneider's 3 Psychiatric Archetypes: Doctors Dippy, Darling & Dangerous. These are the three categories of psychiatrists most frequently played in the movies and television.
  
  -Dr. Dippy: Bob Newhart Show; What About Bob? (Richard Dreyfuss); High Anxiety (Mel Brooks); Analyze This (Billy Crystal)
  
  -Dr. Darling: Equus (Richard Burton); The Sopranos (Dr. Melfi); Sixth Sense (Bruce Willis); Good Will Hunting (Robin Williams); Prince of Tides (Barbra Streisand); Ordinary People (Judd Hirsch); K-PAX (Jeff Bridges)
  
  -Dr. Dangerous: Silence of the Lambs (Anthony Hopkins); Terminator 2: Judgment Day (Dr. Silberman); Dressed to Kill (Michael Caine); Beauty and the Beast (Belle's father)
  
  See My Patient, Myself. How we must "neutralize" the negative images of psychiatrists in the media, "like your podcast." How the movie, Lovesick, affected the idea of psychiatrists falling in love with their patients.
  
  
  
• Psychiatric Services: Religion and Psychiatry. We have an interesting talk about the role that a physician's religious background may play in the likelihood of referring a patient with complicated grief to clergy versus a psychiatrist. See Roy's upcoming post on Religion and Psychiatry for more info. Briefly:
  
  -Psychiatric physicians were more likely to be Jewish or non-religious than nonpsychiatric physicians.
  
  -Protestant physicians were twice as likely as other physicians to refer the example patient to clergy rather than a psychiatrist.
  
  
  
• Washington Post on Virginia Tech: Roy briefly mentions his recent post on the final report on the Virginia Tech tragedy and the potential impacts on privacy of health care information, willingness of college students to get help, and liability. Dinah suggests readers go back to look at our prior posts about college mental health, Suicidal Students and Let's Talk About Suicide. This also led to a discussion about outpatient commitment.
  
  
  
• Correction: Dinah corrects her reference in Podcast 34 to Reign Over Me. The movie she was actually discussing was The Departed.
  

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

My Three Shrinks Podcast 34: Guest Mark Komrad, MD

[33] . . . [34] . . . [35] . . . [All]

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This week we have a special guest, Dr. Mark Komrad, who is an old hat at discussing psychiatric issues on broadcast media. Mark had a live, two-hour, coast-to-coast, nationally syndicated talk radio show for about 5 years. He also had a regular gig on Channel 2 with Rudy Miller, and continues to be a regular guest on NPR. Mark is the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger in July, when he posted on Ethics and Continuing Education for the Psychiatrist. (And Monkey the parakeet joins in.)

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September 26, 2007: #34 Guest Mark Komrad, MD


Topics include:

• Prison Tattoo Database. Clink informs us about Maryland's tattoo database.
  Dr. Komrad talks about Match.com's inclusion of tattoos in their matching database. We also talk a bit about the psychology of getting tattoos, in general.
  
  
  
  
• Q&A: I am a second-year medical student in Canada who is considering psychiatry. I have a few questions that hopefully you haven't already addressed elsewhere.
  
  Firstly, do you get many negative responses from other medical professionals and the general public for being psychiatrists. If so, how do you deal with it?
  
  Secondly, can you discuss some of the differences you know of in practicing psychiatry in Canada versus the US?
  
  
• Dr. Komrad discusses how he got into Psychiatry, and the images of Psychiatrists in the movies and in Hollywood. (Mentions Irving Goffman here.) Mark points out that only 3% of Americans have even been to a psychiatrist, and so most people learn about what Psychiatry is about from movies. Movies and shows discussed include The Sopranos, Dark Shadows, Beauty and the Beast, Prince of Tides... more on Podcast #35.
  
  
• Check out NAMI's Ask-the-Doctor column that Mark writes, also his website at komradmd.com.
  
  
• [Edit] Correction: Somewhere on the podcast, Dinah discusses a movie she incorrectly refers to as Reign Over Me. She meant to say The Departed.
  
  

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

I Saw Sicko

In the comment section to Roy's Mental iPhone post, Rach asked if we've seen Michael Moore's Sicko.

It wasn't on this weekend's agenda, but hey...Okay, so I couldn't resist (-- someone actually wants my opinion!!), and for Rach, I spent Sunday evening watching Sicko. My husband left the Red Sox with a tie score for this.

Okay, so Sicko. Michael Moore starts with the statement that he thought health insurance companies want to help people, and he's had this unnerving revelation that they want to make money. He has no trouble finding examples of people who've been denied coverage for the lamest of reasons (too fat, too thin, too too), or those who've been denied at the mercy of mis-managed care. He finds ex-industry employees riddled with guilt who pour tears. He villainizes everyone from John F. Kennedy, Jr. to Hillary Clinton (yup) to George Pataki. He finds people who've been dumped in the street by hospitals, delirious and still in hospital gowns, as well as Ground Zero heroes with no access to health care. It's one heart-wrenching sob story after another.

Where's it any better? What's the answer? Socialized medicine. It's better in Canada, England, Cuba, and even Guantanamo Bay, where the ratio of prisoners to health care workers is 1:4 and state-of-the-art-care is readily available. France doesn't just have great free health care where doctors make house calls in cute little vehicles, but workers get 100% disability pay, weeks and weeks of vacation, months and months of maternity leave, and the government sends out free nannies to do your laundry and cook dinner. Why would anyone live here if they could live there? And don't worry about physician reimbursements with national health insurance: the French doctor drives an Audi and lives in a million dollar home.

So what did I think? Gosh, it was nice of Rach to ask!

I guess I thought the story was one-sided. It sounded like no one in the US, even the well-insured, is happy and everyone is screwed by the health insurance companies who are digging into every last health record to deny the last surgical claim because the insured didn't reveal that once upon a time they'd had a yeast infection. It's not hard to find unbelievable health care stories, and Mr. Moore didn't seem to have any trouble trumping them up. I've heard them too (none involving dead children), but I've also heard people say their illnesses were completely covered without any battles, and that part of the story was not mentioned.

Sicko was engrossing, entertaining even, thought-provoking, rage-provoking, and there were several laugh-out-loud moments. Michael Moore is nothing if not clever. Is socialized medicine the answer? To read Dr. Crippen's NHS Blog or Shiny Happy Person's rendition of life working in the NHS, there's another story to be told. My opinion would be a random one. I've no experience in this arena, and I'd love to hear from our readers in Canada, Great Britain, France, Cuba, and Guantanamo Bay.

We all know the system's broken. I hope Michael Moore's sensationalized presentation will help to change things.
For the record, Psychiatry was totally ignored in Sicko. One Ground Zero hero had PTSD, but this was presented as a dental problem (he ground his teeth). Maybe in Mr. Moore's next movie?

Darth Vader had Borderline Personality Disorder?

WebMD reports that Anakin Skywalker (you know, from Star Wars), who, of course, became Darth Vader, showed "clearly" symptoms of Borderline Personality Disorder, as determined by psychiatrists at the French Toulouse Hospital. [5 commas!]

The French psychiatrists — who included Laurent Schmitt, M.D. — based their diagnosis on original Star Wars film scripts. Schmitt's team describes Skywalker's symptoms, including problems with controlling anger and impulsivity, temporary stress-related paranoia, "frantic efforts to avoid real or imagined abandonment (when trying to save his wife at all costs), and a pattern of unstable and intense personal relationships," including his relationships with his Jedi masters. Changing his name and turning into "Darth Vader" is a red flag of Skywalker's disturbed identity, note Schmitt and colleagues.

Huh? BPD is not the first diagnosis I would come up with. I would've thought Narcissistic PD before BPD. Needs at least 5 of these [from Wikipedia]:

1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and unique and can only be understood by other special people
4. requires excessive admiration
5. strong sense of entitlement
6. takes advantage of others to achieve his or her own ends
7. lacks empathy
8. is often envious or believes others are envious of him or her
9. arrogant affect.

I think he had them all.

You Order Salad Like A Shrink

Or: working towards the MNP (see posts below)
Warning-- Plot Spoiler



So I went to see Reign Over Me with the connected Judge and my connected now-13-year-old daughter. I think Carrie recommended it some time ago in a comment on an old post. It was my second attempt this weekend to see The Namesake, the first go around I ended up at The Hoax with my husband.

So Reign Over Me Was a shrink blogger's jackpot. Here's the drift:
Alan Johnson (Don Cheadle) is a dentist, he lives in Manhattan with the perfect wife, the perfect life and two lovely daughters. His job and family define him, he longs for friendship, maybe even adventure, his life is perfect but sterile. In a boundary-violating maneuver bordering on stalking, he lurks outside a psychiatrist's office to bombard her with questions about "a friend" as she leaves her office--he can't hear that he should schedule an appointment, and the poor beautiful Dr. Angela Oakhurst (Liv Tyler) gets question after question.

Enter scooter-riding, unkempt, can we pleeese give him a haircut, Dr. Charlie Fineman, Alan's long lost college roommate and dental school pal. Charlie is a walking talking post-traumatic mess from the aftermath of the 9/11 terrorist attacks in which his wife, 3 beautiful young daughters, and poodle (?) Spider, died in on one of the planes. By day, he compulsively and repetitively remodels the kitchen (--an apology, we later learn, to his wife who's final conversation with him was about the kitchen), by night he plays video games on a giant screen, goes to Mel Brooks flicks, collects vinyl from the 70's and 80's. He remembers nothing from before 9/11, has written off his in-laws, given up dentistry, doesn't recognize roommate Allan who reminds him how he used to sleep naked. Oh, good, another penis on the blog; hold on, there's more.

The two re-connect, their relationship becomes meaningful for both of them, their needs almost palpable. Charlie, however, has this little quirk that when someone mentions his past, he gets violent. Oops. Alan, however, is kind enough to overlook a few big outbursts, even one where Charlie grabs him by the neck, slams his diplomas to the wall. And Alan decides that Charlie needs help and he's going to be the one to get it for him.

So Alan has this other little sub-plot problem: a gorgeous patient, Donna Remar (Saffron Burrows) offers him a blow job (see, I told you, more penises), he tosses her from the office and she's sent off with orders to get a new dentist. Only jilted, she then sues him for sexual harassment, ridiculous, but how does one prove what goes on behind closed doors? Office partners just aren't happy. Eventually, he agrees to see her and she apologizes, explains she was mistreated by her ex, drops the lawsuit, turns out to be a patient of the lovely Angela, and will eventually be cast as the will-be girlfriend of the traumatized and violent Charlie the former Dentist.

Okay, so Alan wants to get help for Charlie, who wants no one and nothing that will touch on past memories. In a record store, they bump into the nerdy Nigel who invites them to join them for lunch-- Charlie quickly sniffs out the deception and yells over lunch "You're a shrink, you even order salad like a shrink." A man close to my heart, Nigel responds, "How does a shrink order salad."

Next, Alan introduces Charlie to Angela, who Charlie agrees to continue seeing, in part because she has great breasts, something he doesn't hesitate to tell her. He talks for a few minutes then ends each session abruptly. Finally, Angela confronts him with the fact that he needs to tell his story to someone or there's no point coming. He leaves, and tells his tragedy to Alan in the waiting room as Angela listens. It's one of those tear- jerking breakthrough moments that one hopes will lead to a cure, or even the end of the movie. But Charlie goes home, loads a gun, ends up pointing it at a police officer (this, my real-life judge friend tells me, is called Suicide By Cop), ends up tackled and spending 3 days in a psych unit, where Angela and Alan lobby for his release, and Angela insists what he needs is outpatient care which she can provide-- and ohmygosh nobody mentions that her last great intervention just days before nearly got the patient, or a cop, killed. Charlie goes free, there is another hearing a few days later in which the judge (Donald Sutherland) decides that his in-laws can dictate if he needs further inpatient commitment for up to a year, warning them harshly, "think about whether your little girl would want her husband to go to a place like this." Give me a break.

So Charlie moves out of the apartment with the now gorgeous kitchen, Angela the shrink and Donna the sexually harassing patient bring him root beer and pizza, everyone lives happily ever after.

So PTSD Adam Sandler style, with lots to think about, and while Dr. Angela is actually pretty good at times, there are all the boundary-blasting usual shrink things we've come to know and love in the movies.