Film and television continue to depict psychiatrists as heartless swindlers [PODCAST]

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“Have you ever watched a movie, television show, or read a book where the villain is a medical doctor? If you are a psychiatrist, you will be alarmed by how many times the villain in these stories turns out to be a psychiatrist. In all fairness, psychiatry has had its share of blunders. However, in recent years psychiatry has made a significant effort to enhance the use of evidence-based medicine and procedures. The diagnostic criteria for mental disorders continue to be revised and updated regularly. New medications and procedures are developing at an increasingly rapid rate. With all of the advances in the field, why does popular media continue to represent psychiatry as a barbaric field with poor patient outcomes and medications/treatments that do not work?”

Garrett Rossi is a psychiatry resident who blogs at Shrinks in Sneakers.

He shares his story and discusses his KevinMD article, “Film and television continue to depict psychiatrists as heartless swindlers.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Garrett Rossi. He is a psychiatry resident, and he wrote the KevinMD article “Film and television continue to depict psychiatrists as heartless swindlers.” Garrett, welcome to the show.

Garrett Rossi: Thank you, Kevin. And like I was saying, you’re a hard guy to get an appointment with, so I’m happy I was able to make it to the show finally.

Kevin Pho: Well, thank you so much for joining us today, and thank you for contributing to KevinMD. Now, before we get to the article, could you just share your story and your journey to where you are today?

Garrett Rossi: Yeah, absolutely. So like we said in the introduction, my name is Dr. Garrett Rossi. I’m a current PGY-4 psychiatric resident here in New Jersey, and I’m a completely nontraditional student. I was going to be a police officer prior to medical school, and I happened to just kind of work my way into medicine.

I think what sets me apart from other psychiatrists and other physicians is just my personal experience. I grew up in a very blue-collar, working-class family, and from that I saw pretty much a lot of the same things my patients come to me with now. I saw opioid addiction, I saw mental health issues, financial insecurities. So I was very familiar with, I think, a lot of the issues, psychosocial issues as well as psychiatric and addiction issues, that most patients are facing. So this offers me a unique perspective, and I always say I’m uniquely qualified to empathize with my patients because I’ve either personally experienced it or seen it within my own life.

Kevin Pho: How will that specifically affect how you’re going to practice medicine? How are you going to practice psychiatry as you finish residency and become an attending?

Garrett Rossi: Yeah, so my interest is really in community psychiatry. I think that is where I can contribute a lot of value. So when I finish residency, I’m going to take a position in a community psychiatry facility, and I’m looking forward to offering, again, that empathetic value, either in my psychotherapy or even in my psychopharmacology, just kind of understanding that there are ethical ways of prescribing these medications and that, like we’re going to talk about in the article, not every psychiatrist is selling snake oil.

Kevin Pho: All right, so let’s talk about that KevinMD article, and it’s provocatively titled “Film and television continue to depict psychiatrists as heartless swindlers.” So for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Garrett Rossi: So I enjoy film and TV like everybody else, and I often see in the films and television shows where a psychiatrist is present that that person is usually depicted sort of negatively. They’re usually doing something wrong. They’re either the person who’s like the evil genius behind everything. And it’s interesting, I have an attending who says that people think of psychiatrists as, “We know everything, do nothing, and still get paid in full,” right? So there’s this perception that we kind of know everything that’s going on in all situations and that we don’t do very much.

A great example of this might be the way One Flew Over the Cuckoo’s Nest depicts the ECT scene, right? Arguably, and I wrote this in the article, it was a scene that really set psychiatry back, and specifically electroconvulsive therapy, right? It’s very hard to convince patients, even if they would really benefit from this treatment, to get it now, and a lot of it goes back to that scene. And it’s quite archaic and barbaric. I mean, you’re sort of watching this gentleman being walked into this procedure against his will in shackles, right? And it just really represents psychiatry, and that treatment, in a very negative light.

So my goal with this article was to kind of shed some light on these points, right? That psychiatrists are practicing in a very ethical manner, that most of us are very compassionate human beings who are genuinely interested in helping our patients get better, and I would like to sort of see more of that being depicted in Hollywood, in popular media.

Kevin Pho: Now, why do you think psychiatrists are depicted in such a negative light?

Garrett Rossi: I think it goes back to the fact that, unlike other medical specialties, we often don’t have all of the pathophysiology of these diseases understood. Actually, I would say at this point we really don’t understand very much about what causes most of these psychiatric disorders. And if you go to things like the DSM-5, so the Diagnostic and Statistical Manual for psychiatry, which we basically use to make our diagnoses, you will see that it’s really a collection of symptoms, right? A diagnosis is made on a collection of symptoms. And that’s similar in medicine, but often you’re able to back it up with laboratory results or imaging studies that can give some definitive, objective evidence, and in psychiatry we really still lack that, although I think there is a push to start seeing more of that.

Kevin Pho: And to your knowledge, when these television shows and movies write about psychiatrists, do they just simply rely on their writers? Do they have any input from real psychiatrists on how psychiatry is depicted on the screen?

Garrett Rossi: So I do think some of them, I don’t think all of them, hire some type of mental health professional to offer advice on how the movie is going to be written, or how the psychiatrist is going to be depicted, or even how mental health in general is depicted.

I’ll give another good example, I think, because I recently made a video about the 2019 Joker film starring Phoenix, right? This was a very popular film, and there was a lot of criticism in the mental health field about it, because it really showed violence, and it showed this link between mental illness and violence that we actually, when you review the literature, don’t see. It’s not as clear-cut as, I think, the average person and legislators want it to be. So this movie then depicts this link between violence and mental illness. It says, “Well, yes, it all must be mental illness, right? The only reason people would do something like this is if they were mentally ill.” But often it’s not the case.

Kevin Pho: So what are the effects of the negative portrayal of psychiatry and mental health on the unsuspecting public who won’t know better?

Garrett Rossi: Yeah, I think it’s stigma, right? One of the biggest things that I face as a psychiatrist is that there’s still stigma surrounding coming to see me as a practitioner, right? My patients feel like this is very different than, say, going to see your primary care physician or going to see an orthopedic surgeon for a hip replacement or knee replacement, right? A very different kind of feeling.

So these things, I think, perpetuate stigma in the field. And so I feel like it’s my job, and it’s other psychiatrists’ job, honestly, to come out and sort of say, “Hey, maybe you guys should take a look at what we actually are doing as a psychiatrist and the value that we are providing to our patients.” Because this comes up very, very often. I get a lot of criticism from people, assuming, again, we’re just kind of pushing meds, we’re pushing treatments that are unethical, treatments that don’t really work. And while I agree with people, yes, the medications maybe are not the best, overall they are still effective. They are still better than placebo in most cases, and we work with the tools we currently have to help our patients.

Kevin Pho: Now, is there an example, whether it’s a television show, book, or movie, where psychiatry or mental health is portrayed in a more positive light, or in a light that you would want that field portrayed in?

Garrett Rossi: Sure, yeah. I mean, I think that’s a great question. I just saw it the other day, and you’re probably going to think this is an interesting choice, but the film Girl, Interrupted, with Angelina Jolie. I thought that the scenes with the psychiatrist, the therapy she was providing, and mind you, that was period-specific, the 1960s, but what I saw there was actually really good therapy. I mean, a very, very good depiction of how a psychiatrist would interact with a patient with what, in that case, was borderline personality disorder. So that would be a good example where I think the psychiatrist was adding a lot of value to that patient’s life, although maybe the story as a whole doesn’t play out as nicely as we’d like it to.

Kevin Pho: We’re talking to Garrett Rossi. He’s a psychiatry resident, and he wrote the KevinMD article “Film and television continue to depict psychiatrists as heartless swindlers.” Garrett, if you were to be a consultant to those filmmakers and TV and movie producers writing about mental health, what kind of tips, what kind of advice can you share with them?

Garrett Rossi: I think what would really help those people who are writing or producing these films is to maybe spend some time with a psychiatrist in their day-to-day interactions and just kind of get a real picture of what the job entails and the type of work that we do. And I think that would be one of the ways that they would get a firm understanding of what we’re doing and how we’re doing it, and again, see it for what it really is. I guess it wouldn’t make for as interesting of TV, though, unfortunately. I think that’s where the difficult part comes into play here when we discuss this topic.

Kevin Pho: And if you were to name the single biggest misconception about psychiatry that you want to convey clearly to the entertainment industry, what would that one thing be?

Garrett Rossi: I would say the biggest misconception is that psychiatrists are largely out to harm patients, and, again, that the treatments that we offer are not treatments, they’re actually harmful and detrimental to the patients, which, again, I as a psychiatrist don’t believe, and I think a lot of people in the medical community don’t believe that. But the average person can sometimes be confused by this idea that the treatments we’re offering are meant to harm people.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Garrett Rossi: I think it comes down to advocacy for our field, right? I think we need more people to come out and say, “Hey, psychiatry is as valuable as any other medical specialty, and the treatments and things that we have to offer do help patients and do improve their lives.” I think if we all are willing to speak out when we do see things that are incorrect or inaccurately represented, that’s also going to really help us in the long run.

Kevin Pho: And let me ask one follow-up question to that. What are some ways a psychiatrist can advocate for the profession that you recommend?

Garrett Rossi: Well, I think one of the great options is working on your site. If you have something that you want to write about, or you have something that you want to say, that’s a great way to get your message out there to the population. But I think the other way now is that we all have this opportunity. We can work with our local organizations. I’m very active with the New Jersey Psychiatric Association, so they’re a huge help in advocating for not only patients but also the field of psychiatry. And the other way is to do it as an individual. Everybody has access to these social media outlets these days, and you can start providing your thoughts and your opinions on these platforms right away, and likely develop some type of a following to help dispel some of these rumors and myths.

Kevin Pho: Garrett, thank you so much for sharing your time and insight. Thanks again for being on the show.

Garrett Rossi: Thank you.

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