Harvey Roy Greenberg, MD

"Silver Linings Playbook," one of nine pictures nominated for the 2012 Oscars, featured a bipolar hero. (The last nominee with an Axis I protagonist was "A Beautiful Mind," a lamentably inaccurate portrayal of paranoid schizophrenia, which nevertheless became a beautiful gold mine for Universal Studios.)

My research shows that "Playbook" is one of a half handful of films about bipolar disorder. This set me wondering about the prevalence of various psychiatric disorders in a small group of so-called "mental health" movies focused on the specific syndrome of the hero/heroine, as well many more movies from other genres that provide sufficient material to infer a character’s diagnosis.

Why has cinema favored some disorders while others go neglected? Obviously, there are no statistics on this score. The following remarks about what I’ll call "cine-diagnostics" are based my own impressions rather than established fact.

Whether a feature film (I’m excluding documentaries) focuses on a specific psychiatric disorder or contains characters so well drawn that a diagnosis can be sussed out, filmmakers have always been especially attracted to syndromes that they perceive as hallmarked by especially melodramatic symptoms and behavior. (Of course, the disorder’s presentation might not be as electrifying in real-world psychiatry.)

I suspect that producers and filmmakers conceive that characters with "spectacular" symptomatology offer more entertaining narrative possibilities than less sensational maladies, thereby generating bigger box office revenues. When it comes down to the wire, a disorder’s prevalence or clinical accuracy usually will not count as much to the industry as the picture’s profit potential.

That’s not always a bad thing. See my article on "In Treatment," the HBO series, on internationalpsychoanalysis.net for more on this point.

The largest group of "mental health" movies was produced from about 1957 to 1963, a period in which increasing public knowledge about psychiatric illness coincided with greater acceptance of its treatment. Krin and Glen O. Gabbard have explored this golden age of "pro-therapy" pictures in their estimable "Psychiatry and the Cinema" (Washington: American Psychiatric Association Publishing, 1999).

The Gabbards note that former World War II military physicians, who became conversant with promising new therapies during service, were instrumental in demystifying psychiatry upon returning to America. (These methods were often taught by émigré psychoanalysts who had fled Nazi persecution.) Not unsurprisingly, some of the most popular pro-therapy movies were about wartime and post-war post-traumatic stress disorder. Films like "Home of the Brave" (1949) often portrayed PTSD’s more melodramatic features.

Courtesy Showtime

After the Golden Age, other "spectacular" syndromes depicted in mental health pictures and popular genres included: conversion disorder ("Freud," 1962); multiple personality disorder ("The Three Faces of Eve," 1957); dissociative disorder ("The Swimmer, 1968"); erotomania/de Clerambaults syndrome ("Fatal Attraction," 1987; "The Story of Adele H," 1975); alcoholic hallucinosis and delirium tremens ("The Lost Weekend," 1945); acute schizophrenia ("The Snake Pit," 1948); and compulsive gambling ("The Lady Gambles," 1949; "California Split," 1974).

Antisocial personality disorder was, and still remains, the most prevalent – often immensely popular – Axis II category, particularly in mainstream fare featuring sociopathic characters who relish mayhem and murder ("The Talented Mr. Ripley," 1999). Movies about antisocial serial killers have done so well in recent years that they’ve become an industry staple ("Silence of the Lambs," 1991; "Manhunter,"1986).

Major depression doesn’t usually present the florid symptomatology of multiple personality disorder or acute paranoid schizophrenia. Arguably, that’s why major depressive disorder (MDD) seems to appear far more often in thoughtful indie or foreign cinema than in action-oriented mainstream movies.

MDD has evoked some of the greatest acting by accomplished actors in cinema – for example, Victor Sjöström’s despairing aged physician in "Wild Strawberries," (1957); Jeremy Irons’s despondent Antonio in "The Merchant of Venice," (2004); and Steve Cochran’s inarticulate, ultimately suicidal despair in "Il Grido," 1957). ("Il Grido" – "The Cry" in English – is a neglected small masterpiece by Michelangelo Antonioni.)

Other psychiatric disorders/conditions less often addressed at the multiplex include Alzheimer’s disease ("Away From Her," 2006); autism/savant syndrome, ("Rain Man," 1988); and mental deficiency ("I Am Sam," 2001); "Light in the Piazza," 1962). One wonders if filmmakers imagine that a film about Alzheimer’s disease would be too close to the bone for older viewers and might not interest young viewers, who don’t imagine they’ll ever grow old. (The Dustin Hoffman character in "Rain Man" was a misdiagnosed savant, possibly for narrative purposes, but I would rate him in an autistic category.)

I can’t easily account for the dearth of movies about autism and the mentally challenged. Perhaps there’s a mistaken assumption that audiences would be turned off by such pictures because of the uncomfortable, if unacknowledged sense of "otherness" these syndromes evoke in some people, filmmakers included. (The "praecox feeling" of schizophrenia comes to mind.)

I return to the peculiar shortfall of bipolar disorder at the Bijou. "Lust for Life" (1956) isn’t on my short list, because I don’t think Van Gogh was bipolar.

"The Madness of King George" (1994) is another vexed case: It remains unclear whether George III’s mania was attributable to porphyria or some other organic disorder. (The porphyria theory has been much disputed.) The monarch’s medical records offer no evidence of a major depressive swing – but then, I wasn’t there. In "Bigger Than Life" (1956), James Mason’s flagrant mania obviously stemmed from heavy doses of steroids given for a collagen vascular disease.

Pressured speech and giddy behavior pervade screwball comedies of the 1930s and ’40s ("The Awful Truth," 1937; and "Bringing Up Baby, 1938"). However, their rat-a-tat zaniness is a function of the genre, evidenced by virtually everyone in a screwball movie.

"Mr. Jones" (1993) presents an incontestably bipolar patient: Richard Gere’s eponymous hero seems embued with a romantic aura from the start. The picture intimates that his illness endows him with a "specialness" placing him far above the mortal crowd (R.D. Laing was of the same opinion about schizophrenia, and that notion caused much woe.)

Jones and his psychiatrist (Lena Olin) fall in love. Typical of Lalaland’s female practitioner, life outside the job is lackluster until she’s smitten with her patient. I don’t recall if she quits her work to marry Jones/Gere, another standard outcome for female cinetherapists.

She would do well to stop practicing, and not only because of her flagrant boundary violations. A real-life psychiatrist would fend off Gere’s advances and instead seek to determine whether his mania is influenced by a comorbid narcissistic personality disorder or is solely a symptom of his mood disorder – a vital therapeutic issue.

The paucity of bipolarity in past movies, when the disorder was still known as manic depression, might be a function of its unfamiliarity to the average screenwriter back in the day.

It’s not unlikely that the manic side of bipolarity could be confused with acute paranoid schizophrenia with grandiose delusions – a common clinical error that still crops up. Bipolarity also was once deemed relatively rare and didn’t enter as much into public, let alone psychiatric discourse, compared with schizophrenia and "neurotic" diagnoses.

Bipolar disorder had finally come into its own before "Silver Linings Playbook." One reason is the revelation of their bipolarity by celebrities. I also wonder whether the name change might have played a role in making bipolarity better known and more accepted.

The very word "bipolar" has a kinder, friendlier nimbus than "manic depressive." Arguably, "manic depression" also held obscure connotations of aggression and irresponsibility for some folks. In my practice, I’ve found that "bipolar disorder" is frequently thought to be somehow more treatable than "manic depression." I free associate to a patient’s belief that "Wellbutrin" would do him more good than "bupropion."

Today, bipolar disorder has become the flavor of the month, notably among the glitterati, where it’s as fashionable as Botox. Bipolarity is jabbered about at Hollywood watering holes, on TMZ and reality TV shows.

The word is so detoxified that it’s comfortably entered the vernacular. When an adolescent patient told me that her best girlfriend had become bipolar, she meant the kid was scatterbrained, moody, and, worst of all, messing around with her (the patient’s) boyfriend.

With the ups and downs of bipolarity getting so much play, I expect that screenwriters will create more bipolar characters, because the inherent dramatic value of those affective swings has been recognized in Hollywood. The success of "Silver Linings Playbook" is sure to generate clones.

So far, Showtime’s "Homeland" series has been reasonably accurate about Carrie’s bipolarity; it’s also proved a useful plot device. One can only hope that filmmakers can come up with more fare like "Homeland," rather than grinding out flyweights like "Silver Linings Playbook."

A closing thought: Dorothy Gale in "The Wizard of Oz" could by a stretch be construed in her dream of Oz as afflicted with Charles Bonnet syndrome, except the tiny and very busy little people of Munchkin Land are extremely interested in her, indeed honor her for slaying the Wicked Witch of the East. In the real deal, the Bonnet’s munchkins go about their business utterly uninterested in the hallucinator. That’s show business.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. E-mail him at HRGMES@aol.com and find more at doctorgreenberg.net.

This column, "The Media on My Mind: Adventures in Pop Culture," appears regularly in Clinical Psychiatry News.

"Silver Linings Playbook," one of nine pictures nominated for the 2012 Oscars, featured a bipolar hero. (The last nominee with an Axis I protagonist was "A Beautiful Mind," a lamentably inaccurate portrayal of paranoid schizophrenia, which nevertheless became a beautiful gold mine for Universal Studios.)

My research shows that "Playbook" is one of a half handful of films about bipolar disorder. This set me wondering about the prevalence of various psychiatric disorders in a small group of so-called "mental health" movies focused on the specific syndrome of the hero/heroine, as well many more movies from other genres that provide sufficient material to infer a character’s diagnosis.

Why has cinema favored some disorders while others go neglected? Obviously, there are no statistics on this score. The following remarks about what I’ll call "cine-diagnostics" are based my own impressions rather than established fact.

Whether a feature film (I’m excluding documentaries) focuses on a specific psychiatric disorder or contains characters so well drawn that a diagnosis can be sussed out, filmmakers have always been especially attracted to syndromes that they perceive as hallmarked by especially melodramatic symptoms and behavior. (Of course, the disorder’s presentation might not be as electrifying in real-world psychiatry.)

I suspect that producers and filmmakers conceive that characters with "spectacular" symptomatology offer more entertaining narrative possibilities than less sensational maladies, thereby generating bigger box office revenues. When it comes down to the wire, a disorder’s prevalence or clinical accuracy usually will not count as much to the industry as the picture’s profit potential.

That’s not always a bad thing. See my article on "In Treatment," the HBO series, on internationalpsychoanalysis.net for more on this point.

The largest group of "mental health" movies was produced from about 1957 to 1963, a period in which increasing public knowledge about psychiatric illness coincided with greater acceptance of its treatment. Krin and Glen O. Gabbard have explored this golden age of "pro-therapy" pictures in their estimable "Psychiatry and the Cinema" (Washington: American Psychiatric Association Publishing, 1999).

The Gabbards note that former World War II military physicians, who became conversant with promising new therapies during service, were instrumental in demystifying psychiatry upon returning to America. (These methods were often taught by émigré psychoanalysts who had fled Nazi persecution.) Not unsurprisingly, some of the most popular pro-therapy movies were about wartime and post-war post-traumatic stress disorder. Films like "Home of the Brave" (1949) often portrayed PTSD’s more melodramatic features.

Courtesy Showtime

After the Golden Age, other "spectacular" syndromes depicted in mental health pictures and popular genres included: conversion disorder ("Freud," 1962); multiple personality disorder ("The Three Faces of Eve," 1957); dissociative disorder ("The Swimmer, 1968"); erotomania/de Clerambaults syndrome ("Fatal Attraction," 1987; "The Story of Adele H," 1975); alcoholic hallucinosis and delirium tremens ("The Lost Weekend," 1945); acute schizophrenia ("The Snake Pit," 1948); and compulsive gambling ("The Lady Gambles," 1949; "California Split," 1974).

Antisocial personality disorder was, and still remains, the most prevalent – often immensely popular – Axis II category, particularly in mainstream fare featuring sociopathic characters who relish mayhem and murder ("The Talented Mr. Ripley," 1999). Movies about antisocial serial killers have done so well in recent years that they’ve become an industry staple ("Silence of the Lambs," 1991; "Manhunter,"1986).

Major depression doesn’t usually present the florid symptomatology of multiple personality disorder or acute paranoid schizophrenia. Arguably, that’s why major depressive disorder (MDD) seems to appear far more often in thoughtful indie or foreign cinema than in action-oriented mainstream movies.

MDD has evoked some of the greatest acting by accomplished actors in cinema – for example, Victor Sjöström’s despairing aged physician in "Wild Strawberries," (1957); Jeremy Irons’s despondent Antonio in "The Merchant of Venice," (2004); and Steve Cochran’s inarticulate, ultimately suicidal despair in "Il Grido," 1957). ("Il Grido" – "The Cry" in English – is a neglected small masterpiece by Michelangelo Antonioni.)

Other psychiatric disorders/conditions less often addressed at the multiplex include Alzheimer’s disease ("Away From Her," 2006); autism/savant syndrome, ("Rain Man," 1988); and mental deficiency ("I Am Sam," 2001); "Light in the Piazza," 1962). One wonders if filmmakers imagine that a film about Alzheimer’s disease would be too close to the bone for older viewers and might not interest young viewers, who don’t imagine they’ll ever grow old. (The Dustin Hoffman character in "Rain Man" was a misdiagnosed savant, possibly for narrative purposes, but I would rate him in an autistic category.)

I can’t easily account for the dearth of movies about autism and the mentally challenged. Perhaps there’s a mistaken assumption that audiences would be turned off by such pictures because of the uncomfortable, if unacknowledged sense of "otherness" these syndromes evoke in some people, filmmakers included. (The "praecox feeling" of schizophrenia comes to mind.)

I return to the peculiar shortfall of bipolar disorder at the Bijou. "Lust for Life" (1956) isn’t on my short list, because I don’t think Van Gogh was bipolar.

"The Madness of King George" (1994) is another vexed case: It remains unclear whether George III’s mania was attributable to porphyria or some other organic disorder. (The porphyria theory has been much disputed.) The monarch’s medical records offer no evidence of a major depressive swing – but then, I wasn’t there. In "Bigger Than Life" (1956), James Mason’s flagrant mania obviously stemmed from heavy doses of steroids given for a collagen vascular disease.

Pressured speech and giddy behavior pervade screwball comedies of the 1930s and ’40s ("The Awful Truth," 1937; and "Bringing Up Baby, 1938"). However, their rat-a-tat zaniness is a function of the genre, evidenced by virtually everyone in a screwball movie.

"Mr. Jones" (1993) presents an incontestably bipolar patient: Richard Gere’s eponymous hero seems embued with a romantic aura from the start. The picture intimates that his illness endows him with a "specialness" placing him far above the mortal crowd (R.D. Laing was of the same opinion about schizophrenia, and that notion caused much woe.)

Jones and his psychiatrist (Lena Olin) fall in love. Typical of Lalaland’s female practitioner, life outside the job is lackluster until she’s smitten with her patient. I don’t recall if she quits her work to marry Jones/Gere, another standard outcome for female cinetherapists.

She would do well to stop practicing, and not only because of her flagrant boundary violations. A real-life psychiatrist would fend off Gere’s advances and instead seek to determine whether his mania is influenced by a comorbid narcissistic personality disorder or is solely a symptom of his mood disorder – a vital therapeutic issue.

The paucity of bipolarity in past movies, when the disorder was still known as manic depression, might be a function of its unfamiliarity to the average screenwriter back in the day.

It’s not unlikely that the manic side of bipolarity could be confused with acute paranoid schizophrenia with grandiose delusions – a common clinical error that still crops up. Bipolarity also was once deemed relatively rare and didn’t enter as much into public, let alone psychiatric discourse, compared with schizophrenia and "neurotic" diagnoses.

Bipolar disorder had finally come into its own before "Silver Linings Playbook." One reason is the revelation of their bipolarity by celebrities. I also wonder whether the name change might have played a role in making bipolarity better known and more accepted.

The very word "bipolar" has a kinder, friendlier nimbus than "manic depressive." Arguably, "manic depression" also held obscure connotations of aggression and irresponsibility for some folks. In my practice, I’ve found that "bipolar disorder" is frequently thought to be somehow more treatable than "manic depression." I free associate to a patient’s belief that "Wellbutrin" would do him more good than "bupropion."

Today, bipolar disorder has become the flavor of the month, notably among the glitterati, where it’s as fashionable as Botox. Bipolarity is jabbered about at Hollywood watering holes, on TMZ and reality TV shows.

The word is so detoxified that it’s comfortably entered the vernacular. When an adolescent patient told me that her best girlfriend had become bipolar, she meant the kid was scatterbrained, moody, and, worst of all, messing around with her (the patient’s) boyfriend.

With the ups and downs of bipolarity getting so much play, I expect that screenwriters will create more bipolar characters, because the inherent dramatic value of those affective swings has been recognized in Hollywood. The success of "Silver Linings Playbook" is sure to generate clones.

So far, Showtime’s "Homeland" series has been reasonably accurate about Carrie’s bipolarity; it’s also proved a useful plot device. One can only hope that filmmakers can come up with more fare like "Homeland," rather than grinding out flyweights like "Silver Linings Playbook."

A closing thought: Dorothy Gale in "The Wizard of Oz" could by a stretch be construed in her dream of Oz as afflicted with Charles Bonnet syndrome, except the tiny and very busy little people of Munchkin Land are extremely interested in her, indeed honor her for slaying the Wicked Witch of the East. In the real deal, the Bonnet’s munchkins go about their business utterly uninterested in the hallucinator. That’s show business.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. E-mail him at HRGMES@aol.com and find more at doctorgreenberg.net.

This column, "The Media on My Mind: Adventures in Pop Culture," appears regularly in Clinical Psychiatry News.

"Silver Linings Playbook," one of nine pictures nominated for the 2012 Oscars, featured a bipolar hero. (The last nominee with an Axis I protagonist was "A Beautiful Mind," a lamentably inaccurate portrayal of paranoid schizophrenia, which nevertheless became a beautiful gold mine for Universal Studios.)

My research shows that "Playbook" is one of a half handful of films about bipolar disorder. This set me wondering about the prevalence of various psychiatric disorders in a small group of so-called "mental health" movies focused on the specific syndrome of the hero/heroine, as well many more movies from other genres that provide sufficient material to infer a character’s diagnosis.

Why has cinema favored some disorders while others go neglected? Obviously, there are no statistics on this score. The following remarks about what I’ll call "cine-diagnostics" are based my own impressions rather than established fact.

Whether a feature film (I’m excluding documentaries) focuses on a specific psychiatric disorder or contains characters so well drawn that a diagnosis can be sussed out, filmmakers have always been especially attracted to syndromes that they perceive as hallmarked by especially melodramatic symptoms and behavior. (Of course, the disorder’s presentation might not be as electrifying in real-world psychiatry.)

I suspect that producers and filmmakers conceive that characters with "spectacular" symptomatology offer more entertaining narrative possibilities than less sensational maladies, thereby generating bigger box office revenues. When it comes down to the wire, a disorder’s prevalence or clinical accuracy usually will not count as much to the industry as the picture’s profit potential.

That’s not always a bad thing. See my article on "In Treatment," the HBO series, on internationalpsychoanalysis.net for more on this point.

The largest group of "mental health" movies was produced from about 1957 to 1963, a period in which increasing public knowledge about psychiatric illness coincided with greater acceptance of its treatment. Krin and Glen O. Gabbard have explored this golden age of "pro-therapy" pictures in their estimable "Psychiatry and the Cinema" (Washington: American Psychiatric Association Publishing, 1999).

The Gabbards note that former World War II military physicians, who became conversant with promising new therapies during service, were instrumental in demystifying psychiatry upon returning to America. (These methods were often taught by émigré psychoanalysts who had fled Nazi persecution.) Not unsurprisingly, some of the most popular pro-therapy movies were about wartime and post-war post-traumatic stress disorder. Films like "Home of the Brave" (1949) often portrayed PTSD’s more melodramatic features.

Courtesy Showtime

After the Golden Age, other "spectacular" syndromes depicted in mental health pictures and popular genres included: conversion disorder ("Freud," 1962); multiple personality disorder ("The Three Faces of Eve," 1957); dissociative disorder ("The Swimmer, 1968"); erotomania/de Clerambaults syndrome ("Fatal Attraction," 1987; "The Story of Adele H," 1975); alcoholic hallucinosis and delirium tremens ("The Lost Weekend," 1945); acute schizophrenia ("The Snake Pit," 1948); and compulsive gambling ("The Lady Gambles," 1949; "California Split," 1974).

Antisocial personality disorder was, and still remains, the most prevalent – often immensely popular – Axis II category, particularly in mainstream fare featuring sociopathic characters who relish mayhem and murder ("The Talented Mr. Ripley," 1999). Movies about antisocial serial killers have done so well in recent years that they’ve become an industry staple ("Silence of the Lambs," 1991; "Manhunter,"1986).

Major depression doesn’t usually present the florid symptomatology of multiple personality disorder or acute paranoid schizophrenia. Arguably, that’s why major depressive disorder (MDD) seems to appear far more often in thoughtful indie or foreign cinema than in action-oriented mainstream movies.

MDD has evoked some of the greatest acting by accomplished actors in cinema – for example, Victor Sjöström’s despairing aged physician in "Wild Strawberries," (1957); Jeremy Irons’s despondent Antonio in "The Merchant of Venice," (2004); and Steve Cochran’s inarticulate, ultimately suicidal despair in "Il Grido," 1957). ("Il Grido" – "The Cry" in English – is a neglected small masterpiece by Michelangelo Antonioni.)

Other psychiatric disorders/conditions less often addressed at the multiplex include Alzheimer’s disease ("Away From Her," 2006); autism/savant syndrome, ("Rain Man," 1988); and mental deficiency ("I Am Sam," 2001); "Light in the Piazza," 1962). One wonders if filmmakers imagine that a film about Alzheimer’s disease would be too close to the bone for older viewers and might not interest young viewers, who don’t imagine they’ll ever grow old. (The Dustin Hoffman character in "Rain Man" was a misdiagnosed savant, possibly for narrative purposes, but I would rate him in an autistic category.)

I can’t easily account for the dearth of movies about autism and the mentally challenged. Perhaps there’s a mistaken assumption that audiences would be turned off by such pictures because of the uncomfortable, if unacknowledged sense of "otherness" these syndromes evoke in some people, filmmakers included. (The "praecox feeling" of schizophrenia comes to mind.)

I return to the peculiar shortfall of bipolar disorder at the Bijou. "Lust for Life" (1956) isn’t on my short list, because I don’t think Van Gogh was bipolar.

"The Madness of King George" (1994) is another vexed case: It remains unclear whether George III’s mania was attributable to porphyria or some other organic disorder. (The porphyria theory has been much disputed.) The monarch’s medical records offer no evidence of a major depressive swing – but then, I wasn’t there. In "Bigger Than Life" (1956), James Mason’s flagrant mania obviously stemmed from heavy doses of steroids given for a collagen vascular disease.

Pressured speech and giddy behavior pervade screwball comedies of the 1930s and ’40s ("The Awful Truth," 1937; and "Bringing Up Baby, 1938"). However, their rat-a-tat zaniness is a function of the genre, evidenced by virtually everyone in a screwball movie.

"Mr. Jones" (1993) presents an incontestably bipolar patient: Richard Gere’s eponymous hero seems embued with a romantic aura from the start. The picture intimates that his illness endows him with a "specialness" placing him far above the mortal crowd (R.D. Laing was of the same opinion about schizophrenia, and that notion caused much woe.)

Jones and his psychiatrist (Lena Olin) fall in love. Typical of Lalaland’s female practitioner, life outside the job is lackluster until she’s smitten with her patient. I don’t recall if she quits her work to marry Jones/Gere, another standard outcome for female cinetherapists.

She would do well to stop practicing, and not only because of her flagrant boundary violations. A real-life psychiatrist would fend off Gere’s advances and instead seek to determine whether his mania is influenced by a comorbid narcissistic personality disorder or is solely a symptom of his mood disorder – a vital therapeutic issue.

The paucity of bipolarity in past movies, when the disorder was still known as manic depression, might be a function of its unfamiliarity to the average screenwriter back in the day.

It’s not unlikely that the manic side of bipolarity could be confused with acute paranoid schizophrenia with grandiose delusions – a common clinical error that still crops up. Bipolarity also was once deemed relatively rare and didn’t enter as much into public, let alone psychiatric discourse, compared with schizophrenia and "neurotic" diagnoses.

Bipolar disorder had finally come into its own before "Silver Linings Playbook." One reason is the revelation of their bipolarity by celebrities. I also wonder whether the name change might have played a role in making bipolarity better known and more accepted.

The very word "bipolar" has a kinder, friendlier nimbus than "manic depressive." Arguably, "manic depression" also held obscure connotations of aggression and irresponsibility for some folks. In my practice, I’ve found that "bipolar disorder" is frequently thought to be somehow more treatable than "manic depression." I free associate to a patient’s belief that "Wellbutrin" would do him more good than "bupropion."

Today, bipolar disorder has become the flavor of the month, notably among the glitterati, where it’s as fashionable as Botox. Bipolarity is jabbered about at Hollywood watering holes, on TMZ and reality TV shows.

The word is so detoxified that it’s comfortably entered the vernacular. When an adolescent patient told me that her best girlfriend had become bipolar, she meant the kid was scatterbrained, moody, and, worst of all, messing around with her (the patient’s) boyfriend.

With the ups and downs of bipolarity getting so much play, I expect that screenwriters will create more bipolar characters, because the inherent dramatic value of those affective swings has been recognized in Hollywood. The success of "Silver Linings Playbook" is sure to generate clones.

So far, Showtime’s "Homeland" series has been reasonably accurate about Carrie’s bipolarity; it’s also proved a useful plot device. One can only hope that filmmakers can come up with more fare like "Homeland," rather than grinding out flyweights like "Silver Linings Playbook."

A closing thought: Dorothy Gale in "The Wizard of Oz" could by a stretch be construed in her dream of Oz as afflicted with Charles Bonnet syndrome, except the tiny and very busy little people of Munchkin Land are extremely interested in her, indeed honor her for slaying the Wicked Witch of the East. In the real deal, the Bonnet’s munchkins go about their business utterly uninterested in the hallucinator. That’s show business.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. E-mail him at HRGMES@aol.com and find more at doctorgreenberg.net.

This column, "The Media on My Mind: Adventures in Pop Culture," appears regularly in Clinical Psychiatry News.

The Academy of Motion Picture Arts and Sciences annual award ceremony debuted at a modest dinner in the Blossom Room of Los Angeles’s Hollywood Roosevelt hotel in 1929. Two hundred and seventy people attended at $5 a head. Who could have predicted that by 2013, the Oscars would have evolved – or devolved, depending upon one’s viewpoint – into a Tinseltown behemoth, staged before a glittering celebrity horde, broadcast to millions of viewers across America and around the world?

(Worshipping at Oscar’s Golden Calf also yields millions of shekels to the host TV network from commercials, as well as to winners – especially big name stars –- their retinues and sundry studio machers.)

Today’s Oscar ceremony (it’s officially no longer called the Academy Awards) is a gross spectacle of self-congratulation, wherein Lalaland egos are stroked to an even higher gloss. Standing ovations, once rare, are now obligatory, regardless of the talent on display, or lack of same.

The dilemma posed year after year to the producers of this anthem to the culture of narcissism is how to articulate the actual presentations with a semblance of entertainment. One doubts this can ever be satisfyingly brought off, due to the nature of the beast.

Each year brings an ever-glitzier high-tech mise-en-scene, but the Oscars inevitably – and endlessly – pivot around the unwrapping of the Holy Envelope, the strut to glory, then an acceptance speech cataloguing the recipient’s benefactors, which frequently stretches from parents, to high school drama teacher, to King Abimelech.

This year, the Oscar sachems chose Seth MacFarlane, creator of Fox’s "Family Guy" and the hit movie "Ted" (2012) to host the show. One supposes they thought that the series’ irreverent humor, which has notably drawn young adult viewers, would likewise seduce them to watch the awards: MacFarlane could surely be trusted to send up Hollywood’s foibles in the spirit of "Family Guy’s" satirical edginess.

Instead, his wise-ass dishing was so witless as to make one yearn for Bob Hope’s harmless, but quite funny ba-da-BUMP-BUMP one-liners back in the day. In the introductory monologue, "Star Trek’s" Captain Kirk (William Shatner) addressed MacFarlane from the future. Kirk/Shatner prophesized that MacFarlane would receive a negative critical and industry response the next day – which is precisely what happened in many quarters.

The debacle following MacFarlane’s began with "We Saw Your Boobs," a blatantly misogynistic number about famous actresses who had appeared topless. One of the spoofed was Jodie Foster, whose nakedness sharpened the horror of her rape in "The Accused."

Then followed a reasonably repellant bashing of – inter alia – gays and Jews. (A sketch about how you couldn’t make it in Tinseltown without a yarmulke was particularly reprehensible.) His humor even descended into the territories of domestic violence and slavery with a joke about Rihanna and Chris Brown.

How to account for this orgy of bad taste? My guess is that the writing team assumed their odious gags would be received as so "in" to veterans of the industry that no offense would be taken. Many of the "in" crowd thought otherwise, women notably.

As for the "outs," it didn’t seem to occur to MacFarlane and company that a worldwide TV audience would include parents who might deem their kids unready for X-rated trash talk. Or that the merely ignorant, or truly down-and-dirty nazified would find the argument that Jews really do run Hollywood quite persuasive.

Andrew O’Hehir, who writes for salon.com, did a good job of explaining why what MacFarlane tried to do just didn’t work: " ... If anything, I think MacFarlane’s Oscar night performance was too clever by half and resulted in a profound failure of messaging and symbolism. As one female friend of mine succinctly put it, ‘Somebody else might’ve been able to pull that off, but that guy just looked like a frat boy in a tux.’ " He went on to say that many people experienced MacFarlane’s humor as "the humor of mockery and abuse."

It was entirely fitting to the mediocre tenor of the 2013 Oscars that "Argo," an entertaining but hardly memorable escape caper, would win best picture over Steven Spielberg’s magisterial "Lincoln."

But let’s give MacFarlane credit for analyzing the 16th president’s enigmatic character with a subtlety that eluded Spielberg and Daniel Day-Lewis. The only person who ever really was able to get into Lincoln’s head, our host asserted, was John Wilkes Booth. That’s entertainment!

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. He has written several hundred reviews and essays; two books on cinema, media, and popular culture; and numerous articles on adolescent and general psychiatry.

The Academy of Motion Picture Arts and Sciences annual award ceremony debuted at a modest dinner in the Blossom Room of Los Angeles’s Hollywood Roosevelt hotel in 1929. Two hundred and seventy people attended at $5 a head. Who could have predicted that by 2013, the Oscars would have evolved – or devolved, depending upon one’s viewpoint – into a Tinseltown behemoth, staged before a glittering celebrity horde, broadcast to millions of viewers across America and around the world?

(Worshipping at Oscar’s Golden Calf also yields millions of shekels to the host TV network from commercials, as well as to winners – especially big name stars –- their retinues and sundry studio machers.)

Today’s Oscar ceremony (it’s officially no longer called the Academy Awards) is a gross spectacle of self-congratulation, wherein Lalaland egos are stroked to an even higher gloss. Standing ovations, once rare, are now obligatory, regardless of the talent on display, or lack of same.

The dilemma posed year after year to the producers of this anthem to the culture of narcissism is how to articulate the actual presentations with a semblance of entertainment. One doubts this can ever be satisfyingly brought off, due to the nature of the beast.

Each year brings an ever-glitzier high-tech mise-en-scene, but the Oscars inevitably – and endlessly – pivot around the unwrapping of the Holy Envelope, the strut to glory, then an acceptance speech cataloguing the recipient’s benefactors, which frequently stretches from parents, to high school drama teacher, to King Abimelech.

This year, the Oscar sachems chose Seth MacFarlane, creator of Fox’s "Family Guy" and the hit movie "Ted" (2012) to host the show. One supposes they thought that the series’ irreverent humor, which has notably drawn young adult viewers, would likewise seduce them to watch the awards: MacFarlane could surely be trusted to send up Hollywood’s foibles in the spirit of "Family Guy’s" satirical edginess.

Instead, his wise-ass dishing was so witless as to make one yearn for Bob Hope’s harmless, but quite funny ba-da-BUMP-BUMP one-liners back in the day. In the introductory monologue, "Star Trek’s" Captain Kirk (William Shatner) addressed MacFarlane from the future. Kirk/Shatner prophesized that MacFarlane would receive a negative critical and industry response the next day – which is precisely what happened in many quarters.

The debacle following MacFarlane’s began with "We Saw Your Boobs," a blatantly misogynistic number about famous actresses who had appeared topless. One of the spoofed was Jodie Foster, whose nakedness sharpened the horror of her rape in "The Accused."

Then followed a reasonably repellant bashing of – inter alia – gays and Jews. (A sketch about how you couldn’t make it in Tinseltown without a yarmulke was particularly reprehensible.) His humor even descended into the territories of domestic violence and slavery with a joke about Rihanna and Chris Brown.

How to account for this orgy of bad taste? My guess is that the writing team assumed their odious gags would be received as so "in" to veterans of the industry that no offense would be taken. Many of the "in" crowd thought otherwise, women notably.

As for the "outs," it didn’t seem to occur to MacFarlane and company that a worldwide TV audience would include parents who might deem their kids unready for X-rated trash talk. Or that the merely ignorant, or truly down-and-dirty nazified would find the argument that Jews really do run Hollywood quite persuasive.

Andrew O’Hehir, who writes for salon.com, did a good job of explaining why what MacFarlane tried to do just didn’t work: " ... If anything, I think MacFarlane’s Oscar night performance was too clever by half and resulted in a profound failure of messaging and symbolism. As one female friend of mine succinctly put it, ‘Somebody else might’ve been able to pull that off, but that guy just looked like a frat boy in a tux.’ " He went on to say that many people experienced MacFarlane’s humor as "the humor of mockery and abuse."

It was entirely fitting to the mediocre tenor of the 2013 Oscars that "Argo," an entertaining but hardly memorable escape caper, would win best picture over Steven Spielberg’s magisterial "Lincoln."

But let’s give MacFarlane credit for analyzing the 16th president’s enigmatic character with a subtlety that eluded Spielberg and Daniel Day-Lewis. The only person who ever really was able to get into Lincoln’s head, our host asserted, was John Wilkes Booth. That’s entertainment!

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. He has written several hundred reviews and essays; two books on cinema, media, and popular culture; and numerous articles on adolescent and general psychiatry.

The Academy of Motion Picture Arts and Sciences annual award ceremony debuted at a modest dinner in the Blossom Room of Los Angeles’s Hollywood Roosevelt hotel in 1929. Two hundred and seventy people attended at $5 a head. Who could have predicted that by 2013, the Oscars would have evolved – or devolved, depending upon one’s viewpoint – into a Tinseltown behemoth, staged before a glittering celebrity horde, broadcast to millions of viewers across America and around the world?

(Worshipping at Oscar’s Golden Calf also yields millions of shekels to the host TV network from commercials, as well as to winners – especially big name stars –- their retinues and sundry studio machers.)

Today’s Oscar ceremony (it’s officially no longer called the Academy Awards) is a gross spectacle of self-congratulation, wherein Lalaland egos are stroked to an even higher gloss. Standing ovations, once rare, are now obligatory, regardless of the talent on display, or lack of same.

The dilemma posed year after year to the producers of this anthem to the culture of narcissism is how to articulate the actual presentations with a semblance of entertainment. One doubts this can ever be satisfyingly brought off, due to the nature of the beast.

Each year brings an ever-glitzier high-tech mise-en-scene, but the Oscars inevitably – and endlessly – pivot around the unwrapping of the Holy Envelope, the strut to glory, then an acceptance speech cataloguing the recipient’s benefactors, which frequently stretches from parents, to high school drama teacher, to King Abimelech.

This year, the Oscar sachems chose Seth MacFarlane, creator of Fox’s "Family Guy" and the hit movie "Ted" (2012) to host the show. One supposes they thought that the series’ irreverent humor, which has notably drawn young adult viewers, would likewise seduce them to watch the awards: MacFarlane could surely be trusted to send up Hollywood’s foibles in the spirit of "Family Guy’s" satirical edginess.

Instead, his wise-ass dishing was so witless as to make one yearn for Bob Hope’s harmless, but quite funny ba-da-BUMP-BUMP one-liners back in the day. In the introductory monologue, "Star Trek’s" Captain Kirk (William Shatner) addressed MacFarlane from the future. Kirk/Shatner prophesized that MacFarlane would receive a negative critical and industry response the next day – which is precisely what happened in many quarters.

The debacle following MacFarlane’s began with "We Saw Your Boobs," a blatantly misogynistic number about famous actresses who had appeared topless. One of the spoofed was Jodie Foster, whose nakedness sharpened the horror of her rape in "The Accused."

Then followed a reasonably repellant bashing of – inter alia – gays and Jews. (A sketch about how you couldn’t make it in Tinseltown without a yarmulke was particularly reprehensible.) His humor even descended into the territories of domestic violence and slavery with a joke about Rihanna and Chris Brown.

How to account for this orgy of bad taste? My guess is that the writing team assumed their odious gags would be received as so "in" to veterans of the industry that no offense would be taken. Many of the "in" crowd thought otherwise, women notably.

As for the "outs," it didn’t seem to occur to MacFarlane and company that a worldwide TV audience would include parents who might deem their kids unready for X-rated trash talk. Or that the merely ignorant, or truly down-and-dirty nazified would find the argument that Jews really do run Hollywood quite persuasive.

Andrew O’Hehir, who writes for salon.com, did a good job of explaining why what MacFarlane tried to do just didn’t work: " ... If anything, I think MacFarlane’s Oscar night performance was too clever by half and resulted in a profound failure of messaging and symbolism. As one female friend of mine succinctly put it, ‘Somebody else might’ve been able to pull that off, but that guy just looked like a frat boy in a tux.’ " He went on to say that many people experienced MacFarlane’s humor as "the humor of mockery and abuse."

It was entirely fitting to the mediocre tenor of the 2013 Oscars that "Argo," an entertaining but hardly memorable escape caper, would win best picture over Steven Spielberg’s magisterial "Lincoln."

But let’s give MacFarlane credit for analyzing the 16th president’s enigmatic character with a subtlety that eluded Spielberg and Daniel Day-Lewis. The only person who ever really was able to get into Lincoln’s head, our host asserted, was John Wilkes Booth. That’s entertainment!

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. He has written several hundred reviews and essays; two books on cinema, media, and popular culture; and numerous articles on adolescent and general psychiatry.

Glen and Krin Gabbard’s "Psychiatry and the Cinema" describes our discipline’s considerable value for screenwriters. The Gabbards cite the term "ficelle," first used by Henry James in discussing narrative devices. A ficelle is the system of strings used to control a marionette.

According to the Gabbards, the celluloid practitioner often serves as an admirable ficelle – enabling exposition via flashbacks to recent or remote events ("Tell me more about your bar mitzvah ..."); eliciting sensational revelations about emotional trauma; illuminating motivation, and so on. In return, Hollywood’s contribution to the understanding of mental illness and its treatment has been meager. More often than not, movies serve up distortions and trivializations about our work.

Steven Soderbergh’s “Side Effects” is the 26^th picture in an artistically accomplished and lucrative career. His works range across nearly every genre from science fiction (“Solaris,” 2002) to the caper film ("Ocean’s Eleven,” 2001). He’s directed exemplary “indie” movies like “sex, lies, and videotape,” (1989) as well as box office hits like “Erin Brockovich”(2000). Bafflingly, "Side Effects" is a toss-away turkey. It owns the dubious distinction of cramming the greatest number of misrepresentations about our work and ourselves into a single movie. Some of these are merely risible, others potentially hurtful – of which more presently.

A thin screenplay is cribbed from thrillers with gonzo therapists – for example, "Dressed to Kill" (1980), "Basic Instinct" (1992), and "Final Analysis" (1992) – as well as the "black widow" crime subgenre. [Spoiler Alert!] Dedicated, compassionate Dr. Jonathan Banks (Jude Law) undertakes outpatient treatment of Emily Taylor (Rooney Mara), after a suicide attempt that brought her to the hospital ER, where he’s a consultation/liaison psychiatrist. Several years ago, her husband, Martin (Channing Tatum), was convicted of Wall Street insider trading. Martin’s recent return from prison apparently has exacerbated the devastating depression brought on by the loss of her husband, unborn child, and affluent suburban lifestyle. Crippling side effects from a first round of the usual suspect drugs leads Banks to prescribe a new antidepressant, Ablixa. It’s been recommended by Emily’s former Connecticut psychiatrist, Dr. Victoria Siebert (Catherine Zeta-Jones). The drug provokes a mild episode of somnambulism, but Banks continues it because Emily is improving.

A few days later, she slashes her husband to death during another bout of sleepwalking, awakening with no memory for the murder. Dr. Banks, a perennial multitasker, turns out to be a respected forensic psychiatrist. His testimony in that capacity gets Emily declared incapable of participating in her defense "by reason of insanity," and committed to an inpatient facility until deemed competent to stand trial.

As a result of the hailstorm of publicity surrounding the case, Dr. Banks’s life begins to unravel. He’s blamed for prescribing Ablixa, fired by his patients, shunned by his colleagues, threatened with losing his license. His marriage lies in ruins. Broke but not broken, Banks begins to smell more than one rat. He winkles out a conspiracy between Emily and Dr. Siebert – it’s as full of holes as John Dillinger’s corpse. Emily seduced Dr. Siebert. It’s unclear whether she came to Dr. Siebert for help, and intuited the latter’s latent lesbian yearnings and criminality, or planned to corrupt her from the start (my read). The smitten Dr. Siebert taught her to how to mime depression, while giving a short course in psychopathic psychopharmacology. Thus, Emily never took Ablixa, or anything else; faked her suicide; chivvied Dr. Banks into treating her; and slew her husband.

Figuring the value of the Big Pharma company manufacturing Ablixa would plunge in the wake of Martin’s death, Emily and Dr. Siebert scored immense profit by shorting Ablixa. (Emily arguably took a tip from her husband’s criminal market tampering to engineer her own insider fraud). Dr. Banks was cold-bloodedly selected because of his impeccable credentials and forensic clout, under the assumption he would find her incompetent, then push for her acquittal once she was "cured" of her phony major depressive disorder. Emily is now Dr. Banks’s only patient. At first, one cannot ascertain whether he’s only a visitor to the hospital where she’s confined or is consulting with ward therapists. By the end, he’s totally in charge of her care and fate.

One wonders if his job description mutated according to script changes dictated by the director and/or whichever writer was on board the project at whatever time. (Using multiple script writers is common in the industry, particularly in mainstream filmmaking: One of my patients was hired and fired from a production six times.) Dr. Banks compels Emily to confess to the murder by a devious combination of guile and threats. He cons her into thinking Dr. Siebert has secretly paid off his cooperation, because he’s ferreted out the deadly duo’s con. While she’s reasonably certain that that Dr. Banks has been bribed into enabling her release, admitting her guilt to him wouldn’t be a problem in any case: Once acquitted, she cannot be tried again. A murderer invoking double jeopardy is a bromide of crime film and fiction. Dr. Banks entices Emily into entrapping Dr. Siebert into making whoopie at her office. The latter is promptly arrested for professional misconduct, financial fraud, and as an accessory to Martin’s death. In a move typical of film noir, Dr. Banks abruptly turns the tables on Emily (think Sam Spade "sending over" spider lady Brigid O’Shaughnessy to prison and possible execution in "The Maltese Falcon"). Dr. Banks declares Emily is far sicker than he first imagined, summarily orders her communication with the outside world severed, and prescribes a massive cocktail of psychotropics that will keep her indefinitely hospitalized and zombified. His professional and personal happiness is restored in an eye blink.

In these pages and elsewhere, I’ve stated that mainstream moviemakers will always sacrifice clinical accuracy for narrative sizzle when push comes to shove. But I’ll always forgive a film that is only mildly inaccurate and owns redeeming artistic or sheer entertainment value. In recent years, "Homeland" and much of the "In Treatment" series fit that bill. I can’t forgive Soderbergh, whose hits like "Ocean’s Eleven" draw large audiences, for encouraging a multitude of misperceptions in order to make a dismal dud that could easily discourage an emotionally distressed viewer from seeking psychiatric care. I’ve always avoided the periodic wrangling over this issue. However, "Side Effects" is the only film that I believe does pose a substantive risk of putting off prospective clients. What follows is an anatomy of its mistakes and downright falsifications:

• In a case like Emily’s, it would be conceivable but uncommon for a psychiatrist treating a noncriminal patient to also be a qualified forensic expert, tasked to render the pivotal opinion about the client’s competence to stand trial. It would be decidedly rare for that psychiatrist to undertake inpatient treatment of the patient he’s been instrumental in committing. (Let me know if I’m wrong on this score.)

• No lawsuit is ever brought against the manufacturer of a drug with such lethal potential, nor against Dr. Banks for prescribing Ablixa, as would most certainly happen in the litigation-loving real world. (The validity of such legal action is beside the point.) Dr. Banks would seem to have a fourth-rate insurance carrier without a risk-management service. He’s not represented by a skilled malpractice attorney who might advise him not to testify at all if possible or would sharply limit his testimony. In either case, he would be cautioned to cease all contact with Emily.

• These and other omissions could proceed from the creative team’s blind ignorance or willful disregard of the facts in order to facilitate a tighter, more-compelling narrative, as noted above. While annoying to the practitioner, the elisions would not have significant impact on our notional prospective patient. The film’s negative presentation of various psychiatric therapies, and particularly its toxic characterization of practitioners themselves, is vastly more off-putting.

• Soderbergh seems bent on having it both ways vis-a-vis psychopharmacology. He discharges psychotropics from blame by revealing that Emily’s somnambulism and other side effects were malingered, then subliminally criticizes their use. The plentiful mention of unpleasant reactions to well-known psychotropics outweighs citing their very real benefits, particularly to seriously ill patients. (Be it noted in all fairness that Soderbergh also intimates, if distantly, that Big Pharma’s rampant hucksterism may be turning us into pill pushers and folks with ordinary woes into enthusiastic pill poppers.)

• The inpatient service where Emily is confined is at best a drab, cheerless place, where no one seems to care or do very much for the clientele beyond drugs and restraints. But via plot developments, the mise-en-scene’s design, and declarations of camera, the milieu is eventually transformed into a snake-pit cum penitentiary. Patients are totally at the mercy of their minders. Tyrannical psychiatrists can, on a whim, reduce them to vegetative compliance by overmedication and electroconvulsive therapy (ECT).

• To wangle Emily’s confession, Dr. Banks shows her an ECT treatment like an inquisitor exhibiting the instruments of torture to a recalcitrant heretic. He also infers that ECT memory loss is permanent. Soderbergh resurrects the standard "shake-rattle-and-roll" depiction of earlier mental health movies in which ECT – which in many cases rivals drugs in effectiveness for major affective disorders with fewer side effects – is painted as a barbaric assault upon brain and body.

• Most disheartening is the unsympathetic, even repellant portrayal of virtually every psychiatrist in the film. Underneath her empathic facade, Dr. Siebert is a debauched ice queen, a sleek pantheress capable of loving someone only as perverse and corrupt as she is. Dr. Banks’s colleagues quickly desert him when he most needs collegial support. They’re a timorous, distasteful lot – one recommends Effexor passim but offers not a jot of compassion. "Side Effects" quickly establishes that Dr. Banks is a smart, compassionate humanitarian when, at his ER consultation/liaison job, he identifies a Haitian patient’s supposed hallucinations as a cultural manifestation of grief. But he escapes Emily’s web of deceit by easily identifying with the aggressor, first introjecting, then outdoing her wickedness. Emily happily slaughtered Martin. Now Dr. Banks takes equal pleasure in murdering her spirit. In the closing sequence, he’s seen dropping off his son at a ritzy private school, with his contented wife at his side. All would seem as before, but the taint of Dr. Banks’s spectacular wrongdoing hover around him, rendering his reversion to benevolent healer profoundly suspect. One is reminded of the conclusion of "Suspicion," which suddenly revealed that Cary Grant/Johnnie never plotted his wife’s murder for her money; he’s always loved her and saw her as his redeemer. The studio allegedly suppressed Hitchcock’s original ending, which unmasked Johnnie’s remorseless psychopathy and had him strangle the wife. The taint of Johnnie’s evil hangs ominously over the bogus happy ending, utterly undoing it. Even auteurs like Hitchcock, Truffaut, and Welles had their flops. Several of Soderbergh’s previous pictures were unsuccessful but always honorable failures.

I would not be so disparaging about "Side Effects" were it not for the possibility that its deep stupidity or flagrant indifference vis-a-vis the psychiatrist’s methods and person might prejudice viewers needing help. Granted their numbers might be few, given greater public awareness of mental disorders. But even one would be too many. TV commercials routinely caution that such-and-such nostrum might not be "right for everyone," then unreel a list of black box warnings and other disagreeable reactions (the sinister roll call frequently concludes with the very ailment for which the drug is prescribed in the first place, but farewell that). I believe "Side Effects" isn’t right for anyone. Take this review as a warning against Soderbergh’s deplorable black box.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York.

Glen and Krin Gabbard’s "Psychiatry and the Cinema" describes our discipline’s considerable value for screenwriters. The Gabbards cite the term "ficelle," first used by Henry James in discussing narrative devices. A ficelle is the system of strings used to control a marionette.

According to the Gabbards, the celluloid practitioner often serves as an admirable ficelle – enabling exposition via flashbacks to recent or remote events ("Tell me more about your bar mitzvah ..."); eliciting sensational revelations about emotional trauma; illuminating motivation, and so on. In return, Hollywood’s contribution to the understanding of mental illness and its treatment has been meager. More often than not, movies serve up distortions and trivializations about our work.

Steven Soderbergh’s “Side Effects” is the 26^th picture in an artistically accomplished and lucrative career. His works range across nearly every genre from science fiction (“Solaris,” 2002) to the caper film ("Ocean’s Eleven,” 2001). He’s directed exemplary “indie” movies like “sex, lies, and videotape,” (1989) as well as box office hits like “Erin Brockovich”(2000). Bafflingly, "Side Effects" is a toss-away turkey. It owns the dubious distinction of cramming the greatest number of misrepresentations about our work and ourselves into a single movie. Some of these are merely risible, others potentially hurtful – of which more presently.

A thin screenplay is cribbed from thrillers with gonzo therapists – for example, "Dressed to Kill" (1980), "Basic Instinct" (1992), and "Final Analysis" (1992) – as well as the "black widow" crime subgenre. [Spoiler Alert!] Dedicated, compassionate Dr. Jonathan Banks (Jude Law) undertakes outpatient treatment of Emily Taylor (Rooney Mara), after a suicide attempt that brought her to the hospital ER, where he’s a consultation/liaison psychiatrist. Several years ago, her husband, Martin (Channing Tatum), was convicted of Wall Street insider trading. Martin’s recent return from prison apparently has exacerbated the devastating depression brought on by the loss of her husband, unborn child, and affluent suburban lifestyle. Crippling side effects from a first round of the usual suspect drugs leads Banks to prescribe a new antidepressant, Ablixa. It’s been recommended by Emily’s former Connecticut psychiatrist, Dr. Victoria Siebert (Catherine Zeta-Jones). The drug provokes a mild episode of somnambulism, but Banks continues it because Emily is improving.

A few days later, she slashes her husband to death during another bout of sleepwalking, awakening with no memory for the murder. Dr. Banks, a perennial multitasker, turns out to be a respected forensic psychiatrist. His testimony in that capacity gets Emily declared incapable of participating in her defense "by reason of insanity," and committed to an inpatient facility until deemed competent to stand trial.

As a result of the hailstorm of publicity surrounding the case, Dr. Banks’s life begins to unravel. He’s blamed for prescribing Ablixa, fired by his patients, shunned by his colleagues, threatened with losing his license. His marriage lies in ruins. Broke but not broken, Banks begins to smell more than one rat. He winkles out a conspiracy between Emily and Dr. Siebert – it’s as full of holes as John Dillinger’s corpse. Emily seduced Dr. Siebert. It’s unclear whether she came to Dr. Siebert for help, and intuited the latter’s latent lesbian yearnings and criminality, or planned to corrupt her from the start (my read). The smitten Dr. Siebert taught her to how to mime depression, while giving a short course in psychopathic psychopharmacology. Thus, Emily never took Ablixa, or anything else; faked her suicide; chivvied Dr. Banks into treating her; and slew her husband.

Figuring the value of the Big Pharma company manufacturing Ablixa would plunge in the wake of Martin’s death, Emily and Dr. Siebert scored immense profit by shorting Ablixa. (Emily arguably took a tip from her husband’s criminal market tampering to engineer her own insider fraud). Dr. Banks was cold-bloodedly selected because of his impeccable credentials and forensic clout, under the assumption he would find her incompetent, then push for her acquittal once she was "cured" of her phony major depressive disorder. Emily is now Dr. Banks’s only patient. At first, one cannot ascertain whether he’s only a visitor to the hospital where she’s confined or is consulting with ward therapists. By the end, he’s totally in charge of her care and fate.

One wonders if his job description mutated according to script changes dictated by the director and/or whichever writer was on board the project at whatever time. (Using multiple script writers is common in the industry, particularly in mainstream filmmaking: One of my patients was hired and fired from a production six times.) Dr. Banks compels Emily to confess to the murder by a devious combination of guile and threats. He cons her into thinking Dr. Siebert has secretly paid off his cooperation, because he’s ferreted out the deadly duo’s con. While she’s reasonably certain that that Dr. Banks has been bribed into enabling her release, admitting her guilt to him wouldn’t be a problem in any case: Once acquitted, she cannot be tried again. A murderer invoking double jeopardy is a bromide of crime film and fiction. Dr. Banks entices Emily into entrapping Dr. Siebert into making whoopie at her office. The latter is promptly arrested for professional misconduct, financial fraud, and as an accessory to Martin’s death. In a move typical of film noir, Dr. Banks abruptly turns the tables on Emily (think Sam Spade "sending over" spider lady Brigid O’Shaughnessy to prison and possible execution in "The Maltese Falcon"). Dr. Banks declares Emily is far sicker than he first imagined, summarily orders her communication with the outside world severed, and prescribes a massive cocktail of psychotropics that will keep her indefinitely hospitalized and zombified. His professional and personal happiness is restored in an eye blink.

In these pages and elsewhere, I’ve stated that mainstream moviemakers will always sacrifice clinical accuracy for narrative sizzle when push comes to shove. But I’ll always forgive a film that is only mildly inaccurate and owns redeeming artistic or sheer entertainment value. In recent years, "Homeland" and much of the "In Treatment" series fit that bill. I can’t forgive Soderbergh, whose hits like "Ocean’s Eleven" draw large audiences, for encouraging a multitude of misperceptions in order to make a dismal dud that could easily discourage an emotionally distressed viewer from seeking psychiatric care. I’ve always avoided the periodic wrangling over this issue. However, "Side Effects" is the only film that I believe does pose a substantive risk of putting off prospective clients. What follows is an anatomy of its mistakes and downright falsifications:

• In a case like Emily’s, it would be conceivable but uncommon for a psychiatrist treating a noncriminal patient to also be a qualified forensic expert, tasked to render the pivotal opinion about the client’s competence to stand trial. It would be decidedly rare for that psychiatrist to undertake inpatient treatment of the patient he’s been instrumental in committing. (Let me know if I’m wrong on this score.)

• No lawsuit is ever brought against the manufacturer of a drug with such lethal potential, nor against Dr. Banks for prescribing Ablixa, as would most certainly happen in the litigation-loving real world. (The validity of such legal action is beside the point.) Dr. Banks would seem to have a fourth-rate insurance carrier without a risk-management service. He’s not represented by a skilled malpractice attorney who might advise him not to testify at all if possible or would sharply limit his testimony. In either case, he would be cautioned to cease all contact with Emily.

• These and other omissions could proceed from the creative team’s blind ignorance or willful disregard of the facts in order to facilitate a tighter, more-compelling narrative, as noted above. While annoying to the practitioner, the elisions would not have significant impact on our notional prospective patient. The film’s negative presentation of various psychiatric therapies, and particularly its toxic characterization of practitioners themselves, is vastly more off-putting.

• Soderbergh seems bent on having it both ways vis-a-vis psychopharmacology. He discharges psychotropics from blame by revealing that Emily’s somnambulism and other side effects were malingered, then subliminally criticizes their use. The plentiful mention of unpleasant reactions to well-known psychotropics outweighs citing their very real benefits, particularly to seriously ill patients. (Be it noted in all fairness that Soderbergh also intimates, if distantly, that Big Pharma’s rampant hucksterism may be turning us into pill pushers and folks with ordinary woes into enthusiastic pill poppers.)

• The inpatient service where Emily is confined is at best a drab, cheerless place, where no one seems to care or do very much for the clientele beyond drugs and restraints. But via plot developments, the mise-en-scene’s design, and declarations of camera, the milieu is eventually transformed into a snake-pit cum penitentiary. Patients are totally at the mercy of their minders. Tyrannical psychiatrists can, on a whim, reduce them to vegetative compliance by overmedication and electroconvulsive therapy (ECT).

• To wangle Emily’s confession, Dr. Banks shows her an ECT treatment like an inquisitor exhibiting the instruments of torture to a recalcitrant heretic. He also infers that ECT memory loss is permanent. Soderbergh resurrects the standard "shake-rattle-and-roll" depiction of earlier mental health movies in which ECT – which in many cases rivals drugs in effectiveness for major affective disorders with fewer side effects – is painted as a barbaric assault upon brain and body.

• Most disheartening is the unsympathetic, even repellant portrayal of virtually every psychiatrist in the film. Underneath her empathic facade, Dr. Siebert is a debauched ice queen, a sleek pantheress capable of loving someone only as perverse and corrupt as she is. Dr. Banks’s colleagues quickly desert him when he most needs collegial support. They’re a timorous, distasteful lot – one recommends Effexor passim but offers not a jot of compassion. "Side Effects" quickly establishes that Dr. Banks is a smart, compassionate humanitarian when, at his ER consultation/liaison job, he identifies a Haitian patient’s supposed hallucinations as a cultural manifestation of grief. But he escapes Emily’s web of deceit by easily identifying with the aggressor, first introjecting, then outdoing her wickedness. Emily happily slaughtered Martin. Now Dr. Banks takes equal pleasure in murdering her spirit. In the closing sequence, he’s seen dropping off his son at a ritzy private school, with his contented wife at his side. All would seem as before, but the taint of Dr. Banks’s spectacular wrongdoing hover around him, rendering his reversion to benevolent healer profoundly suspect. One is reminded of the conclusion of "Suspicion," which suddenly revealed that Cary Grant/Johnnie never plotted his wife’s murder for her money; he’s always loved her and saw her as his redeemer. The studio allegedly suppressed Hitchcock’s original ending, which unmasked Johnnie’s remorseless psychopathy and had him strangle the wife. The taint of Johnnie’s evil hangs ominously over the bogus happy ending, utterly undoing it. Even auteurs like Hitchcock, Truffaut, and Welles had their flops. Several of Soderbergh’s previous pictures were unsuccessful but always honorable failures.

I would not be so disparaging about "Side Effects" were it not for the possibility that its deep stupidity or flagrant indifference vis-a-vis the psychiatrist’s methods and person might prejudice viewers needing help. Granted their numbers might be few, given greater public awareness of mental disorders. But even one would be too many. TV commercials routinely caution that such-and-such nostrum might not be "right for everyone," then unreel a list of black box warnings and other disagreeable reactions (the sinister roll call frequently concludes with the very ailment for which the drug is prescribed in the first place, but farewell that). I believe "Side Effects" isn’t right for anyone. Take this review as a warning against Soderbergh’s deplorable black box.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York.

Glen and Krin Gabbard’s "Psychiatry and the Cinema" describes our discipline’s considerable value for screenwriters. The Gabbards cite the term "ficelle," first used by Henry James in discussing narrative devices. A ficelle is the system of strings used to control a marionette.

According to the Gabbards, the celluloid practitioner often serves as an admirable ficelle – enabling exposition via flashbacks to recent or remote events ("Tell me more about your bar mitzvah ..."); eliciting sensational revelations about emotional trauma; illuminating motivation, and so on. In return, Hollywood’s contribution to the understanding of mental illness and its treatment has been meager. More often than not, movies serve up distortions and trivializations about our work.

Steven Soderbergh’s “Side Effects” is the 26^th picture in an artistically accomplished and lucrative career. His works range across nearly every genre from science fiction (“Solaris,” 2002) to the caper film ("Ocean’s Eleven,” 2001). He’s directed exemplary “indie” movies like “sex, lies, and videotape,” (1989) as well as box office hits like “Erin Brockovich”(2000). Bafflingly, "Side Effects" is a toss-away turkey. It owns the dubious distinction of cramming the greatest number of misrepresentations about our work and ourselves into a single movie. Some of these are merely risible, others potentially hurtful – of which more presently.

A thin screenplay is cribbed from thrillers with gonzo therapists – for example, "Dressed to Kill" (1980), "Basic Instinct" (1992), and "Final Analysis" (1992) – as well as the "black widow" crime subgenre. [Spoiler Alert!] Dedicated, compassionate Dr. Jonathan Banks (Jude Law) undertakes outpatient treatment of Emily Taylor (Rooney Mara), after a suicide attempt that brought her to the hospital ER, where he’s a consultation/liaison psychiatrist. Several years ago, her husband, Martin (Channing Tatum), was convicted of Wall Street insider trading. Martin’s recent return from prison apparently has exacerbated the devastating depression brought on by the loss of her husband, unborn child, and affluent suburban lifestyle. Crippling side effects from a first round of the usual suspect drugs leads Banks to prescribe a new antidepressant, Ablixa. It’s been recommended by Emily’s former Connecticut psychiatrist, Dr. Victoria Siebert (Catherine Zeta-Jones). The drug provokes a mild episode of somnambulism, but Banks continues it because Emily is improving.

A few days later, she slashes her husband to death during another bout of sleepwalking, awakening with no memory for the murder. Dr. Banks, a perennial multitasker, turns out to be a respected forensic psychiatrist. His testimony in that capacity gets Emily declared incapable of participating in her defense "by reason of insanity," and committed to an inpatient facility until deemed competent to stand trial.

As a result of the hailstorm of publicity surrounding the case, Dr. Banks’s life begins to unravel. He’s blamed for prescribing Ablixa, fired by his patients, shunned by his colleagues, threatened with losing his license. His marriage lies in ruins. Broke but not broken, Banks begins to smell more than one rat. He winkles out a conspiracy between Emily and Dr. Siebert – it’s as full of holes as John Dillinger’s corpse. Emily seduced Dr. Siebert. It’s unclear whether she came to Dr. Siebert for help, and intuited the latter’s latent lesbian yearnings and criminality, or planned to corrupt her from the start (my read). The smitten Dr. Siebert taught her to how to mime depression, while giving a short course in psychopathic psychopharmacology. Thus, Emily never took Ablixa, or anything else; faked her suicide; chivvied Dr. Banks into treating her; and slew her husband.

Figuring the value of the Big Pharma company manufacturing Ablixa would plunge in the wake of Martin’s death, Emily and Dr. Siebert scored immense profit by shorting Ablixa. (Emily arguably took a tip from her husband’s criminal market tampering to engineer her own insider fraud). Dr. Banks was cold-bloodedly selected because of his impeccable credentials and forensic clout, under the assumption he would find her incompetent, then push for her acquittal once she was "cured" of her phony major depressive disorder. Emily is now Dr. Banks’s only patient. At first, one cannot ascertain whether he’s only a visitor to the hospital where she’s confined or is consulting with ward therapists. By the end, he’s totally in charge of her care and fate.

One wonders if his job description mutated according to script changes dictated by the director and/or whichever writer was on board the project at whatever time. (Using multiple script writers is common in the industry, particularly in mainstream filmmaking: One of my patients was hired and fired from a production six times.) Dr. Banks compels Emily to confess to the murder by a devious combination of guile and threats. He cons her into thinking Dr. Siebert has secretly paid off his cooperation, because he’s ferreted out the deadly duo’s con. While she’s reasonably certain that that Dr. Banks has been bribed into enabling her release, admitting her guilt to him wouldn’t be a problem in any case: Once acquitted, she cannot be tried again. A murderer invoking double jeopardy is a bromide of crime film and fiction. Dr. Banks entices Emily into entrapping Dr. Siebert into making whoopie at her office. The latter is promptly arrested for professional misconduct, financial fraud, and as an accessory to Martin’s death. In a move typical of film noir, Dr. Banks abruptly turns the tables on Emily (think Sam Spade "sending over" spider lady Brigid O’Shaughnessy to prison and possible execution in "The Maltese Falcon"). Dr. Banks declares Emily is far sicker than he first imagined, summarily orders her communication with the outside world severed, and prescribes a massive cocktail of psychotropics that will keep her indefinitely hospitalized and zombified. His professional and personal happiness is restored in an eye blink.

In these pages and elsewhere, I’ve stated that mainstream moviemakers will always sacrifice clinical accuracy for narrative sizzle when push comes to shove. But I’ll always forgive a film that is only mildly inaccurate and owns redeeming artistic or sheer entertainment value. In recent years, "Homeland" and much of the "In Treatment" series fit that bill. I can’t forgive Soderbergh, whose hits like "Ocean’s Eleven" draw large audiences, for encouraging a multitude of misperceptions in order to make a dismal dud that could easily discourage an emotionally distressed viewer from seeking psychiatric care. I’ve always avoided the periodic wrangling over this issue. However, "Side Effects" is the only film that I believe does pose a substantive risk of putting off prospective clients. What follows is an anatomy of its mistakes and downright falsifications:

• In a case like Emily’s, it would be conceivable but uncommon for a psychiatrist treating a noncriminal patient to also be a qualified forensic expert, tasked to render the pivotal opinion about the client’s competence to stand trial. It would be decidedly rare for that psychiatrist to undertake inpatient treatment of the patient he’s been instrumental in committing. (Let me know if I’m wrong on this score.)

• No lawsuit is ever brought against the manufacturer of a drug with such lethal potential, nor against Dr. Banks for prescribing Ablixa, as would most certainly happen in the litigation-loving real world. (The validity of such legal action is beside the point.) Dr. Banks would seem to have a fourth-rate insurance carrier without a risk-management service. He’s not represented by a skilled malpractice attorney who might advise him not to testify at all if possible or would sharply limit his testimony. In either case, he would be cautioned to cease all contact with Emily.

• These and other omissions could proceed from the creative team’s blind ignorance or willful disregard of the facts in order to facilitate a tighter, more-compelling narrative, as noted above. While annoying to the practitioner, the elisions would not have significant impact on our notional prospective patient. The film’s negative presentation of various psychiatric therapies, and particularly its toxic characterization of practitioners themselves, is vastly more off-putting.

• Soderbergh seems bent on having it both ways vis-a-vis psychopharmacology. He discharges psychotropics from blame by revealing that Emily’s somnambulism and other side effects were malingered, then subliminally criticizes their use. The plentiful mention of unpleasant reactions to well-known psychotropics outweighs citing their very real benefits, particularly to seriously ill patients. (Be it noted in all fairness that Soderbergh also intimates, if distantly, that Big Pharma’s rampant hucksterism may be turning us into pill pushers and folks with ordinary woes into enthusiastic pill poppers.)

• The inpatient service where Emily is confined is at best a drab, cheerless place, where no one seems to care or do very much for the clientele beyond drugs and restraints. But via plot developments, the mise-en-scene’s design, and declarations of camera, the milieu is eventually transformed into a snake-pit cum penitentiary. Patients are totally at the mercy of their minders. Tyrannical psychiatrists can, on a whim, reduce them to vegetative compliance by overmedication and electroconvulsive therapy (ECT).

• To wangle Emily’s confession, Dr. Banks shows her an ECT treatment like an inquisitor exhibiting the instruments of torture to a recalcitrant heretic. He also infers that ECT memory loss is permanent. Soderbergh resurrects the standard "shake-rattle-and-roll" depiction of earlier mental health movies in which ECT – which in many cases rivals drugs in effectiveness for major affective disorders with fewer side effects – is painted as a barbaric assault upon brain and body.

• Most disheartening is the unsympathetic, even repellant portrayal of virtually every psychiatrist in the film. Underneath her empathic facade, Dr. Siebert is a debauched ice queen, a sleek pantheress capable of loving someone only as perverse and corrupt as she is. Dr. Banks’s colleagues quickly desert him when he most needs collegial support. They’re a timorous, distasteful lot – one recommends Effexor passim but offers not a jot of compassion. "Side Effects" quickly establishes that Dr. Banks is a smart, compassionate humanitarian when, at his ER consultation/liaison job, he identifies a Haitian patient’s supposed hallucinations as a cultural manifestation of grief. But he escapes Emily’s web of deceit by easily identifying with the aggressor, first introjecting, then outdoing her wickedness. Emily happily slaughtered Martin. Now Dr. Banks takes equal pleasure in murdering her spirit. In the closing sequence, he’s seen dropping off his son at a ritzy private school, with his contented wife at his side. All would seem as before, but the taint of Dr. Banks’s spectacular wrongdoing hover around him, rendering his reversion to benevolent healer profoundly suspect. One is reminded of the conclusion of "Suspicion," which suddenly revealed that Cary Grant/Johnnie never plotted his wife’s murder for her money; he’s always loved her and saw her as his redeemer. The studio allegedly suppressed Hitchcock’s original ending, which unmasked Johnnie’s remorseless psychopathy and had him strangle the wife. The taint of Johnnie’s evil hangs ominously over the bogus happy ending, utterly undoing it. Even auteurs like Hitchcock, Truffaut, and Welles had their flops. Several of Soderbergh’s previous pictures were unsuccessful but always honorable failures.

I would not be so disparaging about "Side Effects" were it not for the possibility that its deep stupidity or flagrant indifference vis-a-vis the psychiatrist’s methods and person might prejudice viewers needing help. Granted their numbers might be few, given greater public awareness of mental disorders. But even one would be too many. TV commercials routinely caution that such-and-such nostrum might not be "right for everyone," then unreel a list of black box warnings and other disagreeable reactions (the sinister roll call frequently concludes with the very ailment for which the drug is prescribed in the first place, but farewell that). I believe "Side Effects" isn’t right for anyone. Take this review as a warning against Soderbergh’s deplorable black box.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York.