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Insanity and Cinema: Keys to understand a complicated affair

Beatriz Vera Poseck

Psicología Clínica. Universidad Complutense de Madrid (Spain).

Correspondence: Beatriz Vera Poseck. Psicología Clínica. Universidad complutense de Madrid (Spain).

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Received 16 July 2006; accepted 24 July 2006


Summary

Psychopathology and mental disturbances have always been prevalent in cinema because they add an element of drama and mystery. Films portraying mentally disturbed characters like Dr. Dippy´s Sanitarium (1906) or Das Kabinett des Dr. Caligari (1919) by Robert Wiener were released only a short time after the Lumière brothers had invented the cinematographer. Since then, there are a large number of films whose plot and intrigue are based on insanity and its manifestations. The list grows steadily every year.

This article is a review of some of the mental disturbances that have been portrayed in films. Its main purpose is to establish sensible choices and mistakes that have been committed while attempting to address the bottomless world of madness.

Keywords: Mental Disturbances, Prejudice, Dissociative Identity Disorder, Amnesia, Psychopathy, Obsessive-Compulsive Disorder, Mental Retardation, Autism.


Of all the disturbances being listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)1 only a few of them have not yet been portrayed in films. Cinema has certainly been fascinated by insanity and its manifestations, and psychiatric disorders have provided film directors and scriptwriters with a stream of material for their scripts, action, and themes.

Taking that interest into account, it is necessary to reflect on the vision of mental disturbances that has been transmitted by cinema to the public in general. For most average citizens the only contact they may have with the psychiatric reality is through cinema; hence, films are their one - yet strong - reference.

The extensive reviews of hundreds of films of all times raises anew the question of how erroneously the cinema has portrayed insanity thus leading to a stigmatized vision, full of false myths and prejudice. However, this is not the whole truth since cinema has also supplied plenty of ideas to tackle this problem. There are many positive aspects about the Seventh Art that can be used as introductory elements into Psychiatry. If movie-goers are aware of the details and key elements, they may be able to discover and learn about the disturbances that are being dealt with in films.

From a general perspective, when depicting mental disturbances, two trends have been followed by cinema2. Some films seem to portray a diluted and mellifluous view of mental disturbances. Some even consider it as a trait worth achieving. Other films, however, have presented some of these disturbances as being related to crime, delinquency, and terror, an extreme that has contributed to perpetuate myths that tend to link violence to mental diseases. The first trend can clearly be observed in films dealing with mental retardation or autism where characters are depicted as having an extremely sweet and affectionate personality. The second trend is usually related to psychotic disturbances, mainly schizophrenia and dissociative identity disorders, depicting evil and frightening characters who commit murders and crimes.

Cinema exhibits a prevailing trend towards mistaking disturbances and mixing up symptoms thus making it difficult to analyze films from a psychopathological point of view. Among these disturbances, schizophrenia and the dissociative identity disorder are two of the diseases most commonly confused and mixed in films. If we consider, for instance, the mythical film Psychosis (1960) by Alfred Hitchcock, the main character Norman Bates (Anthony Perkins) is being depicted as suffering from a dissociative identity disorder with dissociative parts of his personality being progressively dominated by the figure of his mother. Alternatively, from the psychiatric point of view it is considered to be a case of paranoid schizophrenia that manifests mainly through perceptual disorders such as hallucinations and delirium that are mainly referred to his mother. The comedy Me, myself and Irene (2000) by Bobby Farrelly and Peter Farrelly, in contrast, portrays the case of Charlie Baileygates (Jim Carrey) as being diagnosed with schizophrenia - in his case, “an advanced delirant schizophrenia with uncontrolled narcissistic attacks”- while he actually was suffering from a dissociative identity disorder.

In any case, when considering the visible symptoms being presented by the role being played, it is hard to establish a clear-cut diagnosis, and in most of the cases these ideas do not arise from clinical observations but instead were lifted from mere speculations. This situation gives rise to opinions that are hardly scientifically sound.


Mental disturbances on screen

Dissociative identity disorder

As already mentioned, the vast majority of mental disturbances have already been addressed by cinema. However, film directors and script-writers seem to prefer certain types of mental disturbances that are more appealing to the general public.

Dissociative identity disorder (DID), a disorder rarely mentioned and then only under one’s breath, was formerly known until 1994 as Multiple personality disorder. In modern times it is one of the disturbances that has captured the attention of many filmmakers. This disturbance involves a dissociative division of the personality that can be fragmented into two or more distinct personalities or ego-states. In most of the cases one ego-state takes over and will not allow any other to come out and one ego-state may not be aware of the existence of the others.

Much has been debated over the nature of this disturbance and many specialists have informed in contrary to the possibility that patients that are receptive and readily influenced might appear to develop this multiple-personality disorder. Take for instance the case of Sybil, a patient who appears to develop a multiple-personality disorder, the strange and, until recently, rare condition brought to wide public attention by the book Sybil published in 1977. The author, Flora Rheta Schreiber, describes in this book the condition of a woman who develops up to 16 strikingly different but interchangeable personas in the course of her treatment with a psychologist. This book soon became a best-seller and was the basis to the TV-film Sybil (1976) by Daniel Petrie. Sally Field plays the role of Sybil and Joanne Woodward is the psychologist in charge of her treatment. DID was initially considered to be a rare condition; around the world no more than 50 cases had been documented. However, after the book was published and the TV-film debuted, the number of diagnosed cases experienced a sharp rise to more than 40.000 identified cases, the vast majority being diagnosed in the USA. This unusual phenomenon has become a matter of debate since some people tend to consider this disorder as “an artificially created disturbance with clear mediatic and cultural components.” Once these patients have been diagnosed with DID, they are convinced that they have it, tend to exhibit what they think are the symptoms and often reinterpret their entire life accordingly. It should also be mentioned that some films seem to take advantage of this situation as they use DID as a “deus ex machina” device that allows films to take unexpected turns or surprise endings that resolve things at a stroke that otherwise would remain unexplained. There are films such as Identity (2003) by James Mangold; Session 9 (2001) by Brad Anderson or Hide and Seek (2005) by John Polson, whose plot initially evolves around two or more characters that finally end up corresponding to the different ego-states in which the personality of the main character is split.


Amnesia

Since its very beginnings, cinema has been addressing amnesia in all its expressions depicting characters that have lost not only their memory but also their own identity. Silent films from the first decades of the twentieth century were especially captivated by the loss of memory and there have been dozen of films using this disturbance as a device aimed at structuring the plot. However, by that time, it was already commonplace to mistake disturbances and mix up symptoms. The fact is that even nowadays many of these same mistakes created by silent films have been inherited modern cinema. Among these clichés are the loss of memory resulting from a head trauma may be recovered by a successive head trauma, brain surgery that allows recovery of the lost memory, and concussions resulting from head trauma may lead to the loss of one’s own identity.

According to psychopathology, the causes for amnesia can be divided into two groups: the organic cause when there is a physical cause: head trauma, thrombosis, tumors, anoxia, embolism, and infarction) and the dissociative cause, when no physical cause can be found but instead is due to an emotional shock or to the experience of a traumatic event. However, although they share some similarities, each of these disturbances has its specific sintomatology. In the first case there is always a certain degree of anterograde loss of memory (impaired ability to acquire new information or “anterograde amnesia”) that may or may not be accompanied by retrograde loss of memory (impaired ability to recall events from the past or “retrograde amnesia”). In the second case there is only a retrograde loss of memory and never an anterograde loss.

Although there are clear-cut differences, cinema has mistaken and blended both types of amnesia and organic causes have been mistakenly associated to dissociative manifestations. Thus, it is not uncommon to see how concussions, injuries or even diseases have been exclusively associated to retrograde loss of memory.

It is infrequent for retrograde amnesia due to head trauma to be massive, and absolutely no derangement of memory takes place that can be associated neither with the loss of ancient memories nor with the loss of one’s own identity. However, the loss of retrograde memory depicted by the different films results in an absolute inability to recall events from the past together with the loss of the identity of the self, thus determining the inability to recall who one is and where one is from. Actually, there are only a few cases of dissociative amnesia that may affect a massive amnesia, but no full-blown amnesia can ever be attributed to a head trauma.

In comparison to anterograde amnesia, the film industry has profited by the abuse of retrograde amnesia as the main issue to be addressed in films. Strange as it may seem, there are scarcely two films about anterograde amnesia. The Spanish film Sé quién eres/ I Know Who You Are (1999) by Patricia Ferrer, dealing with a case of Korsakov´s syndrome, was the first film to address the issue of anterograde amnesia. Other films like Memento (2000), by Christian Nolan, use anterograde amnesia not only as the story-line but also as the foundation of the narrative and the aesthetical structure of the film. The film director endows the film with this kind of structure so as to force spectators to do an mnemonic effort to understand the scheme – he places the audience in the same state of confusion and lack of connection with the past and future that the disturbed patient experiences.

In recent years two films about nonexistent cases of amnesic disturbances have been released, namely Eternal Sunshine of the Spotless Mind (2004) by Michael Gondry and 50 First Dates (2004) by Peter Segal. The first is one of many films like Total Recall (1990) by Paul Verhoeven; Abre los ojos (1997) by Alejandro Amenábar , Dark City ((1998) by Alex Proyas and others, who deal with the control of the mind and the artificial erasure of memory. The other movie is a romantic comedy that deals with a woman who experiences memory loss every single night thus waking up each morning with an absence of memories of what she had previously experienced. The film portrays a distorted vision of what anterograde amnesia actually is and the film Clean State (1994) by Mick Jackson can be considered an antecedent to the aforementioned film.


Psychopathies and psychosis

Psychopathies have undoubtedly been the supportive column of many thrillers and terror films throughout history. The antisocial personality disorder, which is the technical term for psychopathy, has always been present in the history of Seventh Art. This disturbance, however, does not necessarily imply murder and cinema has therefore mistakenly identified psychopaths with serial killers. This is true not only for the classical terror films but also for hit films such as Henry, Portrait of a Serial Killer (1990) by John Mc Naughton; /The Silence of the Lambs (1991) by Jonathan Demme; Seven (1995) by David Finch Or American Psycho (2000) by Mary Harron. Psychopathy has been mistaken for psychosis in a number of occasions.  One of the clichés that have been portrayed by cinema is that sociopathic behaviour is linked to violence; however it is wrong to assume that this is a correct argument. One must bear in mind that the distinction between psychopathy and psychosis is often not easy to make and the relation between psychotic disturbances and cinema has been invariably upset by a common and non-innocuous mistake.  This mistake occurs when one believes that schizophrenias are always accompanied by violence or that psychosis and psychopathy are synonyms. The frenzied mind of Norman Bates (Anthony Perkins) portrayed in Psychosis is a good example of this situation. However, contrary to the popular idea that Bates is the prototypical psychopathic murderer, conclusions that may have been reached by the scientific community should be viewed as provisional as no clear-cut diagnosis is currently available.


Obsessive-compulsive personality disorder

The film As Good as it Gets (1997) by James Brooks, starring Jack Nicholson, is a landmark in the history of cinema. The lay public knew little about this disturbance and it was hard for them to remain unaffected by this awkward and spectacular disturbance deftly displayed by Melvin´s character. Actually, it is believed that many people who were unaware of their illness suddenly recognize their own symptoms after viewing this film - an effect that became apparent only when they were re-exposed to symptoms reminiscent of their own disturbances, thus leading them to seek psychiatric advice. However, the main shortcoming of this film is that it seems to blend obsessive-compulsive personality disorder with certain facets of the personality of the main character such as misogamy, homophobia, elusiveness and asociality, a circumstance that caused the general public to believe that these elements were invariably linked to each other.

At present, the American TV series Monk (2002-???), created by Andy Breckman portraying a detective suffering from an anthological obsessive-compulsive personality disorder that is vastly displayed in all chapters of the series, is a hit series all over the world. As a perfectionist detective preoccupied with details, Monk displays his wide variety of obsessions and compulsion neurosis that leads him to put at risk the investigations he is undertaking; however, as he is stubbornly insistent on accuracy and carefulness, he ends up being the only one to discover the identity of the criminal. Up to now, the best portrait of the obsessive-compulsive personality disorder has been provided by the British TV-film Dirty Filthy Love (2004) by Adrian Shergold. The script, written together with Ian Puleston, who himself suffers from this disturbance, is a self-reflexive vision to his own experience with an almost auto-biographical character that furnishes the film with the necessary truthfulness. The film is a portrait of the life of Mark Furness (Michael Sheen), a prominent architect whose life is being destroyed little by little due to the obsessive-compulsive disorder conjoined with a Tourette´s syndrome from which he is suffering. These disturbances are responsible for the awkward and uncomfortable situations he experiences. Fortunately, he happens to meet Charlotte (Shirley Henderson), a friend who also suffers from the same disturbance. She finally manages to convince him about joining her in her psychotherapy group, a treatment that will help him overcome his hang-ups and learn to live with his disturbance.


Mental retardation and autism

Mental retardation affects a person’s understanding; however, films such as Forrest Gump (1994) by Robert Zemekis or I am Sam (2001) by Jesse Nelson, give a distorted and mellifluous vision of what mental retardation actually is. People proven to be retarded are presented as having a superior emotional intelligence. This is clearly not true, at least not in general. There is a current trend aimed at presenting defective mentality as being free of all negative elements, connecting the character and his disorder to purity, naiveté and simple-mindedness. The following scheme is quite prototypical: an apparently unintelligent person ends up being wiser than his partenaire considered to be brighter and more successful, thus giving a “lesson about life”- that is commonplace of the “idiot savant”.

It is important to acknowledge the fact that young children suffering from autism are usually presented as being “normal children” who seem to hide under a cuirass; however, the general belief that, when treated with care and love, this cuirass may easily be removed is a myth that still prevails among certain people. John Duigan´s film Molly (1991), featuring Elisabeth Shue recounts the life of a young autistic girl who, after undergoing brain surgery, manages to regain control of herself and return to normal behaviour. In reality, she was fully aware that in her case, autism was like a wall that kept her away from contact with the outside world.

Films about autistic persons often include the phenomenon known as “idiot savant” where mentally and emotionally retarded persons may exhibit skills far beyond that expected of a mentally retarded person. They may exhibit exceptional talents such as in memory, mathematics, music or art. Films have almost constantly associated the phenomenon of “idiot savant” to autism, a mistake that may induce one to think of it as one of the many symptoms this disturbance has. However, not all “idiot savants” are autistic persons (only 50% are autistic, the rest of them suffers from other disturbances) and not more than 1 in 10 autistic persons are “idiot savants”3.

The film Rain Man (1988) by Barry Levinson starring Dustin Hoffman is the prototypical case of a film about an autistic person exhibiting the exceptional talents of an idiot savant.

The outcome of the disturbances has also been seriously distorted by films and in many of them we can see a “miracle” cure. This is particularly true for films about autistic persons who seem to “wake up” from their isolation. Such is the case of Silent Fall (1994) by Bruce Beresford, a film about an autistic boy who ends up being an affectionate person full of love towards his new parents.


The importance of physicians as technical advisers

Technical advisers who document and control the psychiatric aspects are sometimes key elements to the final unfolding of the plot. Such is the case of Rain Man (1988) and Primal Fear (1996) by Gregory Hoblit.

The two psychiatrists who were working as technical advisers in the film by Barry Levinson introduced several modifications in the script that were critical to the ending of this film4. In the first place, the original mental retardation was substituted by autism. Secondly, certain aspects about the “idiot savant” phenomenon were discarded as excessive. The most important modification was, however, the way the film ends. Although Raymond (Dustin Hoffman) suffers from severe autism there are strong attachment bonds that are maintained between him and his brother. The original version considered the possibility of Raymond living together with his brother. The psychiatric advisers, however, were against this idea as this would prompt the idea of a miracle cure of Raymond’s case. In spite of his desire, it was advisable for a severely disturbed person to go back to a psychiatric ward. This solution is probably closer to reality than the originally intended Hollywood-like “happy ending”

Technical advisers also considered it wise to modify the ending of the film Primal Fear. In its original version it was considered to exonerate Aaron (Edward Norton) from the charges of murder as no allegations of conscious involvement could be presented against somebody who was suffering from dissociative identity disorder. It was not him but instead his other personality, Roy, who committed the crime. The final version, however, considered a new element. Based on criminal law, the technical advisers devised a solution to this problem consisting of the introduction of the rhetorical figure of the faked-disturbance, a make-believe disturbance displayed deftly by the main character. It is precisely due to this ending that the film achieved such great success. There have been many serial killers who have allegedly intended to fake having different personalities, among these was Ted Bundy. The only successful attempt occurred in the case of Billy Milligan. At the present time, the film The Crowded Room (2008) by Joel Schumacher, is based on this case and currently being produced5.

There are many films addressing mental disturbances whose main shortcomings are the lack of due documentation and the absence of technical advisers. The cases being portrayed in these films can hardly approach reality if they are not sustained by facts and research. Actors, however, do seem to try to be educated and prepared to play the role of mentally disturbed persons they have been assigned to. For a better performance they resort to the direct contact with persons suffering this kind of disturbance, to the views of videos about this kind of patients, or to interviews with specialized psychiatrists or psychologists.


Conclusions

Mental disturbances and their patients are fraught with myths that have been created and perpetuated by cinema. However, films can also be an important tool in helping people become acquainted with the fascinating world of mental disturbances.

Films addressing mental disturbances allow the masses to get access to a world that would otherwise be out of their reach. It is just like an incognito visit to a psychiatric hospital where films allow people to satiate their morbid, although natural curiosity. This, however, may lead to mistakes in judgement. For most people, films are their only source of information about mental illnesses and the facts being presented by films may be blindly accepted as absolute truths, and skewed and prejudiced visions about mental disturbances may pollute in their minds. But, in spite of it all, the love story between cinema and insanity seems to be a never ending tale, and new and exciting films about these themes will continue to be released year after year.


References

  1. American Psychiatric Association APA. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR 4th ed.. Washington, DC.: American Psychiatric Pub, Inc. 2000.
  2. Vera Posek B. Imágenes de la locura. La psicopatología en el cine. Madrid: Calamar Ediciones; 2006.
  3. Treffert DA. Extraordinary People: Understanding Savant Syndrome Omaha: Backinprint.com/iUniverse.com; 2000.
  4. 4.-Treffert, D. A.  Rain Man, the Movie / Rain Man, Real Life. Wisconsin Medical Society [cited  2005 may 10]. [about 6 p.]  Available from: link
  5. The internet movie database  [database on the Internet]. The Crowded Room (2006) [cited  2005 may 10]. Available from: link