Wednesday, August 15, 2007

Continuing with that thought....

I started to write a reply to Jayme, who commented on my post Shrinks Aren't Perfect, then I realized the answer was its own post.

Jayme wrote:

I am having a hard time empathizing with psychiatrists being falsely portrayed in the media when psych patients are portrayed far worse, more often, and with incredibly damaging consequences. I don't see much discrimination against psychiatrists because of bad media portrayals. I'd really like to see you gripe about society's lack of empathy toward psych patients instead of your own. I hope this is taken with the spirit it was intended. Thank you.

Absolutely, I agree that the media portrayal of people with psychiatric disorders is awful and stigmatizing. I don't really care how the media portrays psychiatrists for my own sake--I make a living, I have a blog, what more could I want? I knew the profession carried stigma when I chose it, and I chose it. People don't choose to get mental illnesses. The media tends to portray the mentally ill in ways that obliterate any other aspect of their being. Often psychiatric patients are depicted as weird, creepy, or outright dangerous.

The psychiatric setting is used in media for 1) the entertainment value complete with distortions and 2) in terms of story development, the setting can often provide insights/information into a character that couldn't be gleaned in other ways--though this is more true in terms of written/literary plots where point of view limits access to information.

The issue of portraying the psychiatrist negatively is not one that means much to me-- face it, some psychiatrists are pretty weird. I may be pretty weird. The issue of portraying psychiatry in a negative light is that it creates a negative aura around mental health care delivery which spreads out to include the patient, it fosters the stigma, and it makes people with problems hesitant to seek care. You're going to go see a psychiatrist? Shrinks are so messed up themselves, how can they help you? You're doc might turn out to be Hannibal Lechter (pass the Chianti, please) or that transvestite serial killer from Dressed to Kill. Or maybe he'll just be twitchy and pompous like Niles Crane on Frasier.

In the movies, psychiatric patients aren't normal people living normal lives who either get overwhelmed with their problems or get afflicted with a mental illness, who then see a doc and get helpful treatment from a kind and caring person. There's nothing about what one sees on TV or in the movies that would make you want to see shrink.

An "Anonymous" commenter has been kind enough to provide the reference to the Letter I read in Psychiatric Times: The author is Harvey Roy Greenberg (not of Shrink Rap) and Anon writes:

Re: Dr Melfi. The guy who has the same middle name as your co-blogger did not write that she sometimes made mistakes or failed to be empathic all the time. He wrote that her treatment was riddled with EGREGIOUS mistakes and that at times she betrayed a STARTLING lack of empathy. Never watched the show, can't say what she did or didn't do,but there are mistakes and then there are mistakes. No shrink can be empathic all the time but when it comes to a STARTLING lack, then that shrink should refer or the patient should run. Shrinks everywhere: please try to remember that this is a TV character. It is wacko to get this connected with a TV character. As for Beautiful Mind, the ECT and other treatment depicted therein date back many years. If someone suggests that their patients watch it they might also add that disclaimer. This other Roy guy was not writing about you, but you sure took it personally and your reaction seems way out of whack with the provocation. I'm just not getting it.

The Sopranos is different from other media portrayals of psychiatry. Yes, I know it's a TV show, and yes, I've seen every episode (thanks to Blockbuster and HBO on DVDs). Tony Soprano is a nice normal Mafia boss, he "works," he loves, he functions as a Mafia boss will function, and he seeks psychiatric care because he starts having panic attacks. He may be evil, but he's not crazy, and his mental illness is a small part of who he is and what he does. He is a difficult patient-- he steals his doctor's car to have it repaired, he declares his love for her, he sends her flowers, he curses her out and leaves, he has affair with a woman he meets in her waiting room and that patient commits suicide after Tony ends the affair. The list goes on. We also get to see Dr. Melfi's therapy/supervision sessions so we have some insight into just how conflicted she is about treating Tony. Off hand, without reviewing every episode, I don't recall any Egregious errors. I guess the question might be asked, What would be an egregious error in psychotherapy? Dr. Greenberg is a psychoanalyst, perhaps his idea of an error is different than mine? A Startling lack of empathy? There are moments when it would be startlingly difficult to empathize with Tony--especially as a woman listening to his continued sexual indiscretions. Sympathy? Well maybe, but Empathy? He spares Dr. Melfi the details of his violent life--in the first season he talks about working out difficulties with an adversary where he cages running the guy down and breaking his legs as "We had coffee."
Finally-- Roy is back soon, and our regular podcast schedule will resume shortly.