A topic I have been interested in for a while now has been how and when did clinical classifications and their concepts of mental disorder become common parlance in cinema to the extent that they could be deployed as tropes? At what point did writers feel comfortable dropping a reference to clinical psychology in a script without qualification?’ When did the hypothetical ‘typical audience member’ become viewed as informed enough about psychological knowledge to understand a reference to the DSM and its contents with little or no qualification?
I thought about this after the DSM was mentioned in passing halfway through the latest Charlie Kaufman film I’m Thinking of Ending Things (2020). A character casually mentions how the document’s first editions included homosexuality, functioning as a kind of shorthand on the links between psychiatric treatment and conformity, a particularly charged topic in the US. Aside from films like One Flew Over the Cuckoo’s Nest, (1975), certain organisations criticise psychological diagnosis very publicly, and accuse of it of being a disguised means of repressing liberty. The notoriety of figures like Walter Freeman have fuelled these flames, with his lobotomies, that irretrievably altered the brain, plugging into a set of anxieties that help to define cultural attitudes: in particular the fear that an external agent can warp our thoughts to the extent that it is no longer possible to grasp what it means to be free. Similarly, the fear of psychopathologising choices like our our romantic partners fits with the anxieties that medical science could strip away our humanity and reduce our abilities to act autonomously. These themes tend to be invoked by scriptwriters whenever the early DSM’s inclusion of homosexuality in its list of psychopathologies is mentioned, and it references how psychiatric judgements are influenced by the culture and society that surround medical practice.
There are other ways in which the The DSM functions as a trope in popular fiction. In Mindhunter (2017), a series set in the late seventies and early eighties which charts changes to the ways the FBI conducted criminal profiling, especially of serial killers, mention of the DSM functions as a metaphor for the accumulated knowledge of US psychology. It too plays upon the inclusion of homosexuality in the first two editions of the DSM when Dr. Wendy Carr (Anna Torv), herself being forced to conceal her sexuality from colleagues, announces its removal in the latest version of the document. The trope functions differently here and operates to show progression in psychological knowledge – whereas the DSM is a trope of conformity and other anxieties for Kaufman, in Mindhunter it serves as a sign of the advancement of the discipline, a theme that is pursued through much of the two seasons (it was discontinued by Netflix this year). Mindhunter preaches how diagnostic judgments based on vague psychoanalytic principles evolved to become empirically vigorous investigations that could make behavioural predictions that rest upon firm Neo-Kraepelinian definitions. Although in Mindhunter there are ethical and methodological problems with the unit and the ways that it conducts its research, the series is very much invested in the idea that advancements in clinical psychology took place around this time, and that the application of its methods to criminal behaviour have ultimately led to positive outcomes.
My blog posts can’t really work without a Sopranos (1998) reference, but this one is timely as the series too uses the DSM as a trope for the body of medical knowledge (EDIT: with my mind on Kaufman, I think perhaps synecdoche might be the right term). The first scenes of the pilot occur in Dr Melfi’s (Lorraine Bracco) office, and behind Tony’s (James Gandolfini) head is a small book case filled with psychology textbooks. When it cuts to Melfi sitting opposite, there is an another larger array of books, which symbolise the collected body of knowledge that structures this session, and is invoked in subsequent ones. Later on in the first series, the DSM IV gets an explicit mention in a session shortly after Tony’s mother (Nancy Marchand) plays a role in attempts to get him killed. Throughout the series it becomes clear that something is very wrong with Tony’s relationship to his mother, but up until this point her behaviour is framed as that of a difficult and sour parent. Melfi, concerned about Tony’s welfare, tries to helps him avoid harm, but in doing so crosses a dangerous boundary by revealing her diagnosis of his mother: Melfi thinks she may fit the definition of borderline personality disorder. She then reaches for the DSM IV (clip below), to read out its description: “a pattern of unstable relationships, affective instability”’ and then goes on to explain: ‘it means intense anxiety, a joylessness, these people’s internal phobias are the only things that exist for them, the real world and real people are peripheral, these people have no love or compassion’.
The appearance of the DSM as a trope for the body of psychological knowledge leads to a violent collision between subjective experience and diagnostic definitions that strive for objectivity. It is in this moment that Tony’s mother’s difficult behaviours becomes reframed within the parameters of clinical psychology, and it shifts from that of annoying character to being a psychopathology. Although resonating with its function in Mindhunter as a synecdoche for all psychological knowledge, the diagnostic concept serves to frame behaviours that Tony would not have thought were a mental disorder and leads to a terrifying outcome – he interrupts her by flipping over and smashing a glass table, shouts abuse, and threatens her not to talk about his mother ‘like that’. The cultural sanctity held towards the mother brushes against the cold steel of medical diagnosis, and the result is not pretty.
This is a very short blog post, and there could be a lot more research into the use of the DSM and clinical concepts as tropes in film. I am interested in how the iconography and the ideas of the clinic function as metaphors and tropes. I am less interested in the well trodden path of how film and television portray mental disorders, especially because I am not sure that they really can, and the problem with the assumption that they can is that it treats portrayals too literally. I can’t help but see representations of mental disorder as the creative output of people who themselves are restricted by their own experience, the society they inhabit and the cultural values surrounding mental disorder. In the last example, I don’t think the writer of the Sopranos, David Chase, is that interested in whether the DSM accurately portrays ASPD or of providing a faith rendition of it in Tony’s mother – rather he is invoking the document and the diagnostic concept to explore the tough question about subjective experience and how this fits to concepts designed for objectivity. I have a lot more to write on the ways that films represent mental disorder, but for now I’ll finish with this: I don’t regard films as windows to the world, but instead think they express through their medium and message prevailing social attitudes towards mental disorder. Whilst they provide a wealth of material to cultural historians of psychiatry, real caution should be exercised if they are read as providing representations of clinical concepts of psychopathology.
Kevin Matthew Jones 