Schizophrenia in the Silver Screen: Beyond the Love-Hate Relationship

Department of Psychiatry, Senior Resident, Medical College and Hospital, Kolkata

Corresponding Author:

Arghya Pal
Department of Psychiatry, Senior Resident
Medical College and Hospital, Kolkata
E-mail: drarghyamb@gmail.com

Visit for more related articles at International Journal of Emergency Mental Health and Human Resilience

Abstract

A film is a series of still images which, when shown on a screen, creates the illusion of moving images. Since its advent, other than being a mode of entertainment and a popular industry, it has been an important weapon of dispersal of information and spreading propaganda. It is well known that the representation of the psychiatric disorders in films has a profound effect on the perception of mental disorders to the public (Orchowski, Spickard & McNamara, 2006). Schizophrenia is a chronic mental disorder that is associated with significant stigma and negative perception among the lay public (VidoviÃ?Â?, BreciÃ?Â?, VilibiÃ?Â? & JukiÃ?Â?, 2016). Considering this, the way schizophrenia has been portrayed in films will be interesting to look at and has been a focus of research.

Introduction

A film is a series of still images which, when shown on a screen, creates the illusion of moving images. Since its advent, other than being a mode of entertainment and a popular industry, it has been an important weapon of dispersal of information and spreading propaganda. It is well known that the representation of the psychiatric disorders in films has a profound effect on the perception of mental disorders to the public (Orchowski, Spickard & McNamara, 2006). Schizophrenia is a chronic mental disorder that is associated with significant stigma and negative perception among the lay public (VidoviÄ?, BreciÄ?, VilibiÄ? & JukiÄ?, 2016). Considering this, the way schizophrenia has been portrayed in films will be interesting to look at and has been a focus of research.

The portrayal of the illness in films can be broadly classified as follows based on the character with schizophrenia. The most common attempts to depict the struggle with the illness have been shown in institutionalized patients like in The Snake Pit (1948), Shabd (India- 2005), or Spider Forest (2004). Many films like Santa Sangre (1989), Fisher King (1991), and Spider Forest (2004) depicted the character with the illness to be violent. Films like Caveman’s Valentine (2001), A Beautiful Mind (2001) and The Soloist (2009) showed the characters to possess exceptional capabilities in spite of struggling with the illness. A few other films like Nightbreed (1990) or Keane (2004) had their lead characters struggling with issues of substance use along with symptoms of schizophrenia. Some films like Spider (2002) and Karthik calling Karthik (India- 2010) showed that the characters developed symptoms following traumatic events in the developmental age. However, many of these films had inaccurately portrayed various aspects of the illness which had often raised eyebrows from various quarters.

But, besides this, not much emphasis had been given to the fact that cinema can have a far reaching effect, other than just what it depicts. It has been proven to be useful mode of psycho education in various other disorders and also has been helpful in management (Shankar et al., 2016). As a result, an effort was made to review the available literature on the use of cinema in managing the various aspects of schizophrenia.

Method

The intention was to conduct a narrative review based on the available literature on the determined topic. The search was conducted on PubMed with the help of the following search terms: ‘films’, ‘schizophrenia’, ‘social media’, psychosis’, movies’, ‘motion pictures’, ‘documentaries and factual films’, ‘schizophrenia spectrum and other psychotic disorders’. No limitations were placed regarding the methodological designs of the studies. The abstracts of the studies were initially screened and full texts of the selected studies were accessed. Only articles whose full text could be accessed were included in this review.

Results

Portrayal of Schizophrenia in Films

A study (Owen, 2012) reviewed all the English language movies that were released in theatres between 1990 and 2010 where at least one character was depicted to be suffering from schizophrenia. 42 characters from 41 films were analyzed independently by separate researchers on a predetermined checklist that aimed to assess the socio-demographic parameters, symptoms and stereotypes associated with the disorder, depiction of causation of the illness and treatment measures. The findings showed that majority of the characters that were depicted were male (79%) and of Caucasian background (95%). Most of the characters were shown to display the positive symptoms, in which delusions followed by auditory and visual hallucinations were most common. A vast majority of the characters were shown to display violent behavior. About one-third of the violent characters were shown to have homicidal behavior and another one-fourth had committed suicide. Most of the movies did not depict the onset of the illness and amongst those who did, most showed it to be following a traumatic event. The most commonly depicted treatment modality was the use of psychotropic drugs (55%), but, other modes of treated were not shown. A few movies (24%) also inaccurately showed that love can cure the illness.

Use of Movies in the Management of Schizophrenia

A study (Walker & Lewine, 1990) looked into the possibility of using home made movies in helping to detect schizophrenia in adults. The study which the authors refer to as a preliminary study evaluated the home-made movies of adult onset patients with schizophrenia and their siblings filmed during the first to fifth year of their life. The films were evaluated by judges with expertise in mental health. The authors found that the judges could reliably make out differences in between the patients and their siblings, though none of them had any symptoms at the time of filming. Probably being a preliminary study the authors did not provide the further details of the basis on which the differentiation was possible. Our efforts to find out a follow up study of the group also did not yield any results. This finding could be evaluated in the light of other studies (Ebisch et al., 2014; Ebisch et al., 2013) where the authors concluded that schizophrenia is actually a disorder of self-experience which leads to dysfunction in the selfother relationship. Attempts to trace neuro-anatomical correlates were localized to the dysfunction in ventral premotor cortex and the posterior insula.

Films has also been found to be useful in delineating closely resembling states like psychotropic induced extra-pyramidal symptoms and negative symptoms. A study (Juckel et al., 2008) tried to use the differences in the kinetics of the facial muscles in response to the stimulus presented by humorous film (Mr. Bean) in differentiating the two states. The sample consisted of 21 indoor patients with schizophrenia and 30 healthy controls. It was found that unmedicated patients showed abnormally high initial velocity of laughing (IV), whereas patients on typical neuroleptics had a low IV. On the other hand, a significant positive correlation was found between the negative symptoms and IV. A similar approach was adopted in another study (Park & Kim, 2011) who tried to find out the differences in physiological reactivity and ability to respond to emotion-inducing films in patients with schizophrenia. The physiological parameters that were measured were skin conductance response, skin conductance level, heart rate, respiration, corrugator muscle, and orbicularis muscle. It was found that patients with schizophrenia had lower intensity of experienced anger and disgust. Films have also been used as a part of the neuropsychological assessment of the patients with schizophrenia where it was shown that the patients had more difficulty in recalling the event details of the films shown as opposed to the normal controls and also performed poor in delineating action boundaries than the controls (Zalla et al., 2004).

Other than the diagnostic efficacy, films have also been used in treating the patients. Using a pre-post design to test the feasibility, the authors (Von Maffei et al., 2015) had shown six films on symptoms, diagnosis, causes, warning signs, treatment of schizophrenia and about the influence of family members and friends in a groups setting under the supervision of the nursing personnel. The data was collected after the screening and after six months from 102 patients. It was found that majority of the group found the measure to acceptable and the knowledge, compliance and insight about the illness improved after the screening and stayed put for over the six months. In another study (Gelkopf et al., 2006) done on 29 inpatients on schizophrenia in open wards, the authors tried to assess the impact of humorous movies on the psychopathology, anxiety, depression, anger, social functioning, insight, and therapeutic alliance in schizophrenia inpatients. The intervention comprised of dividing the patients into two groups where one group was shown humorous movies whereas the other group were shown neutral movies daily over 3 months. It was found that exposure to the humorous movies resulted in reduced levels of psychopathology, anger, anxiety and depressive symptoms with improvement in their social functioning. But, the measures failed to show any improvement in treatment insight or working alliance.

Use of Movies in General Population

In order to examine the impact of the movie “The White Noise”, the authors (Baumann, Zaeske & Gaebel, 2003) used a pre-post questionnaire to evaluate the audience’s belief and attitude about schizophrenia. In the study they found that the film actually managed to increase the social distance and the negative stereotypes were increased. Another study also tried to examine the role of cinema in the way how viewers perceive the disorder. In this study (Penn, Chamberlin & Mueser, 2003) 163 individuals were randomly assigned into one of either no documentary film, documentary about polar bears, documentary about fears of being overweight, documentary about schizophrenia. It was found that persons who were shown the documentary on schizophrenia had more favorable outlook about the disorder, but that did not increase the viewers’ intention to interact with patients with schizophrenia.

Conclusion

It can be safely said that in spite of the love-hate relationship between cinema and schizophrenia, some efforts from the researchers has gone into evaluating the various roles that can be played by cinema in managing the various aspect of this complex disorder with modest success. This has resulted in researchers trying to use cinemas as a mode of educating the young medical students due to its ability to attract attention and popular demand. In one such effort to compile a list of movies for schizophrenia (Wilson et al., 2014), The Devil and Daniel Johnston (2006), and An Angel at My Table (1990) were chosen on the basis of their high entertainment value and rich content. It should thus be stressed that further concerted effort is the need of the hour in evaluating this and thus further studies should be carried out in this field.

References

1. Orchowski, L.M, Spickard, B.A,& McNamara, J.R. (2006). Cinema and the valuing of psychotherapy: Implications for clinical practice. Prof Psychol Res Pract, 37(5), 506â514
2. Vidovic, D., Brecic, P., Vilibic, M.,&Jukic, V. (2016).Insight and self-stigma in patients with schizophrenia.ActaClin Croat, 55(1), 23â28
3. Shankar, P.R., Rose, C., Balasubramanium, R., Nandy, A., &Friedmann, A. (2016).Using movies to strengthen learning of the humanistic aspects of medicine.J ClinDiagn Res JCDR, 10(1), JC05-07
4. Owen, P.R. (2012). Portrayals of schizophrenia by entertainment media: a content analysis of contemporary movies. PsychiatrServ,63(7), 655â659
5. Walker, E.,&Lewine, R.J. (1990). Prediction of adult-onset schizophrenia from childhood home movies of the patients. AmJ Psychiatry,147(8),1052â1056
6. Ebisch, S.J.H., Mantini, D., Northoff, G., Salone, A., De Berardis, D., Ferri, F., et al. (2014).Altered brain long-range functional interactions underlying the link between aberrant self-experience and self-other relationship in first-episode schizophrenia.Schizophr Bull,40(5),1072â1082
7. Ebisch, S.J.H., Salone, A., Ferri, F., De Berardis, D., Romani, G.L., Ferro, F.M., et al. (2013).Out of touch with reality? Social perception in first-episode schizophrenia.SocCogn Affect Neurosci,8(4), 394â403. Juckel, G., Mergl, R., Prässl, A., Mavrogiorgou, P., Witthaus, H., Möller, H.J., et al. (2008). Kinematic analysis of facial behaviour in patients with schizophrenia under emotional stimulation by films with â?Mr. Bean.â Eur Arch Psychiatry ClinNeurosci,258(3),186â191
8. Park, S., &Kim, K. (2011).Physiological reactivity and facial expression to emotion-inducing films in patients with schizophrenia.Arch PsychiatrNurs,25(6),e37-47
9. Zalla, T., Verlut, I., Franck, N., Puzenat, D., &Sirigu, A. (2004).Perception of dynamic action in patients with schizophrenia.Psychiatry Res,128(1), 39â51
10. Von Maffei, C., Görges, F., Kissling, W., Schreiber, W., &Rummel-Kluge, C. (2015).Using films as a psychoeducation tool for patients with schizophrenia: a pilot study using a quasi-experimental pre-post design.BMC Psychiatry,15, 93
11. Gelkopf, M., Gonen, B., Kurs, R., Melamed, Y.,&Bleich, A. (2006).The effect of humorous movies on inpatients with chronic schizophrenia.J NervMent Dis,194(11),880â883
12. Baumann, A., Zaeske, H., &Gaebel, W. (2003).The image of people with mental illness in movies: effects on beliefs, attitudes and social distance, considering as example the movie â?The white noiseâ. PsychiatrPrax,(7),372â378
13. Penn, D.L., Chamberlin, C., &Mueser, K.T. (2003).The effects of a documentary film about schizophrenia on psychiatric stigma. Schizophr Bull, 29(2), 383â391
14. Wilson, N., Heath, D., Heath, T., Gallagher, P., &Huthwaite, M. (2014). Madness at the movies: prioritised movies for self-directed learning by medical students. Australas Psychiatry Bull R Aust N Z CollPsychiatr,22(5), 450â453