Abstract
The motion picture psychiatrist has had a chequered career since his first cinematic depiction in Dr Dippy's Sanitorium (1906). Irving Schneider has catalogued three broad psychiatric typologies: Dr Dippy, the buffoonish and ineffectual therapist; Dr Evil, his manipulative and psychopathic cousin; and Dr Wonderful, the idealized screen psychiatrist who can do no wrong. 1 Gabbard and Gabbard identified the additional use of the psychiatrist, largely within the horror and science fiction genres, as a rationalist foil who might present scientific counterarguments to the presence of supernatural or alien forces, only to have these dramatically disproved as events unfold. 2 Further subtypes including ‘Dr Rigid’, a stifler of fun and creativity, and ‘Dr Line-Crosser’ (usually a female psychiatrist who becomes seduced by her male patient), have also been identified. 3 Quadrio has proposed the additional stereotype of ‘Dr Sexy’, a female therapist portrayed in such a blatantly sexual way that any semblance of professionalism and competence is annihilated. 4
Surveys of first-year medical students consistently reveal that psychiatry is held in considerably lower regard than other medical specialties. 5 ,6 Given that most students at this level would have had no first-hand exposure to psychiatry, it is reasonable to conclude that their assumptions about psychiatry arise in part through observations of the practice of ‘movie psychiatry’. The same is likely to be true of the broader public. The profession itself does not seem to be immune from certain assumptions regarding, for example, female psychoanalysts and their male patients. Mayer and de Marneffe examined the referral patterns of 1510 patients to 170 psychoanalysts, and demonstrated that female analysts receive relatively few male referrals from both analysts and non-analysts alike, concluding that the extent to which gender influences the referral process is not adequately explained by explicit clinical theory alone. 7
Antwone Fisher marked the directorial debut of actor Denzel Washington. It was released to critical acclaim in 2002, but was only moderately successful at the box office in Australia. Derek Luke plays the title role of a naval seaman with an anger management problem, who is referred to a naval psychiatrist – Dr Davenport, played by Washington – for assessment. We learn, through a series of flashbacks, about Antwone's troubled past. His father died violently while Antwone was still in the womb, and Antwone was born in a women's prison, to be fostered out in infancy to a home where he was physically and sexually abused.
Fisher is referred to Dr Davenport after assaulting a fellow sailor. It is clear that his future in the navy depends on the outcome of this assessment, but Fisher refuses to talk. Having only been given an arbitrary three sessions in which to make a diagnosis, Davenport responds to his patient's stonewalling by decreeing that the three sessions don't begin until Fisher begins to talk. Weeks pass, until boredom drives Fisher to open up about his past.
Washington is portrayed as a ‘Dr Wonderful.’ He is warm, empathic, intelligent, likeable and attractive (although he does manage to wear a cardigan over his naval uniform in several scenes). He is not beyond yelling at his patient on occasion, however, and although this is justified in the script as a matter of relative rank, there are overtones of the necessity for ‘tough love’ and of the expectation that Fisher should somehow just ‘pull himself together’ during this scene.
The initial three sessions pass, and Dr Davenport has made a diagnostic formulation that allows him to advise that Fisher not be discharged from the navy. Having sensed that he has somehow failed the young man, however, he commences a series of boundary violations. He agrees to see Fisher out of hours, circumventing the navy's ‘three-session rule’, and commences regular therapy sessions within his own home. It is around this point that we learn that Dr Davenport is having marital difficulties that revolve around the couple's inability to conceive. Fisher meets Davenport's wife, who invites him over for Thanksgiving with Davenport's approval. The dinner scene makes it clear that this has great therapeutic benefit for Antwone, in terms of providing him with an idealized surrogate family upon which normal family interactions can be modelled. It is clear also, however, that the symbolism of the act equally meets the needs of Davenport and his wife by providing them with a substitute child for this most family orientated of American holidays.
Therapy progresses, and Davenport rightly links Antwone's difficulties in current functioning to his experiences of past trauma. His main therapeutic intervention in this regard, however, is to encourage Antwone to seek out his long-lost mother and confront her with his anguish and torment such that he can find relief. This leads to a lengthy search that culminates in a standard Hollywood ‘cathartic cure’. 8 Fisher confronts his mother in an emotional scene, and then returns to the (literal) embrace of a new found extended family who have been summoned to welcome him at an uncle's house. In this scene, he gains the sense of belonging and connectedness, the lack of which, it is implied, explained all his problems. He returns to Dr Davenport to express his thanks in the final scene of the film, at which point Davenport inappropriately discloses the fact that his treatment of Antwone has enabled him to examine and successfully resolve issues within his own marriage that were deeply troubling to him and his wife.
DISCUSSION
Antwone Fisher has a number of things to say about modern psychiatry. Dr Davenport realizes that an arbitrarily mandated three sessions will be completely inadequate to address Antwone's needs. His consequent provision of extended psychotherapy may be seen as an appropriate rejection of a managed-care style of psychiatry that might otherwise offer selective serotonin re-uptake inhibitors, mood stabilizers, beta-blockers or, at best, a few sessions of cognitive behavioural therapy for the management of inappropriate anger.
This film paints a picture of psychiatrists and the process of psychiatry that is extremely attractive on a superficial level. I do not doubt that most people who see the film would regard Washington's portrayal as unambiguously positive. In this way, it stands alongside other positive cinematic depictions of psychiatrists/psychotherapists, such as those found in Ordinary People (1980) and Good Will Hunting (1997), whose plot closely parallels that of Antwone Fisher.
How can such an ostensibly positive portrayal be a bad thing for the profession? Mainly, I think, because it sets us up to fail. The rapid cathartic cure is largely an invention of Hollywood that has come about as a necessity in order to add dramatic elements to a process that would otherwise appear extremely dull and uninteresting. 8 Its repeated depiction, however, creates a sense of expectation in patients, not only of what might underlie their problems, but how these issues can be resolved. The portrayal of ‘wonderful’ psychiatrists as always being available (‘You can phone me, day or night’), willing to bend the rules, and open to (if not encouraging of) social contact out of hours is also potentially harmful, setting up an expectation of these boundary violations as a necessary part of the therapy. One is reminded of Marilyn Monroe's analyst, Dr Ralph Greenson, in this regard. He was able to justify therapy sessions that took place at her apartment, then later at his own home, where she typically had the last appointment of the day and stayed for supper. She befriended his two children and attended his daughter's birthday party. Greenson defended such unorthodoxy on the grounds of therapeutic need. 9 Although there may be some form of short-term therapeutic benefit in this unorthodox form of ‘family therapy’, it is clearly neither practical nor appropriate. A colleague of Greenson's, Leo Rangell, commented that ‘We all have needy, traumatized patients. Very few of them end up in our families the way she did. She did because she was Marilyn Monroe’. 9
Not everyone can be treated as a ‘special patient’ and it is unfair and potentially damaging to create the expectation that they can. Portrayals of female therapists, specifically, as being capable of therapeutic good only when this is married to sexualization of the doctor-patient relationship is of particular concern. 4 The idealization of psychiatry in films such as Antwone Fisher, although it may encourage patients (who would otherwise go unaided) to seek help, may perversely do the profession more harm than good by creating false hopes of a rapid cure that is obtained, not through time-consuming and painful work on the part of the patient, but by the therapist bending the rules, crossing boundaries and becoming over-involved. ‘I love you’, says Dr Davenport to Antwone Fisher, ‘Because of you, Antwone, I'm a better doctor … and I'm learning to be a better husband … so don't thank me, son, I thank you’. The irony inherent in seeing these ‘positive’ portrayals of psychiatry is that the inevitable shattering of the false expectations that they raise may result in the ultimate devaluation of the profession, rather than its promotion.