Side effects is a movie directed by Steven Soderbergh and starring Jude Law as a fashionable Manhattan psychiatrist, Dr Banks. The story centres on a patient whose depression and self-harming draw the apparently reasonable Dr Banks into a strange, unfamiliar world. As the movie progresses the atmosphere darkens, culminating in a dystopian nightmare of corruption and deceit.

There are many interesting aspects to the movie, not least of which is the sympathetic portrayal of Dr Banks in the opening scenes, as he sees patients with mental health problems. Abruptly, however, the plot changes direction and presents a curious reversal of the usual Hollywood battle between good and evil: for as long as Dr Banks continues to behave in a compassionate, ethical fashion, things go from bad to worse for him. But as soon as Dr Banks loses his ethical moorings, things start to work out for him and his family. The movie disappoints on many levels. While Jude Law is very convincing as the sympathetic psychiatrist at the start, he is substantially less convincing as a villain. The movie also misunderstands the key dynamics of psychiatric care, and lapses into ever more hackneyed clichés. The fundamental problem stems from a failure to grasp the complexity of psychiatric care, when detention can co-exist with treatment, and engagement with care is infinitely more nuanced and complicated than presented here.

The history of psychiatry in film

Psychiatry and cinema have always enjoyed a complicated, fascinating relationship. Indeed, psychiatry and cinema are historically, thematically and structurally linked to such an extent that each discipline now actively complements the other. 

At heart, both cinema and psychiatry are driven by narrative – the creation, realisation and sharing of stories. Both disciplines involve a series of translations. In cinema, the idea for a movie is translated into a script, which is translated onto screen, and finally interpreted by the audience. In psychiatry, a series of signs and symptoms is translated by the patient into a complaint, which is translated by a psychiatrist into diagnostic terminology, which is duly translated into treatment recommendations. All of these processes represent transformations of language and ideas between doctor and patient, making the search for a shared language a key feature of both psychiatry and cinema. 

Against this backdrop, it is unsurprising that psychiatrists featured heavily in movies from the earliest days of cinema. Especially memorable early portrayals include those in The Escaped Lunatic (1904), Dr Dippy’s Sanatorium (1906) and, perhaps most vividly, Robert Wiene’s chilling Cabinet of Dr Caligari/Das Cabinet des Dr Caligari (1920).

Throughout the 20th century, psychiatrist characters played a range of roles in a wide array of movies, often serving to advance their plots in interesting and unusual fashions. In Lady In The Dark (1944), for example, visits to the psychiatrist pave the way for musical dream sequences that would otherwise have been difficult to incorporate into the plot. The resulting film is an especially unusual one, combining musical comedy with psychoanalysis in an unlikely but oddly satisfying combination. Other memorable screen portrayals of psychiatrists include the extraordinary Ordinary People (1980) and, of course, One Flew Over The Cuckoo’s Nest (1975). 

Against this backdrop, the portrayal of the psychiatrist in Side Effects is especially interesting. The fictional Dr Jonathan Banks is, as Peter Bradshaw noted in The Guardian (March 8, 2013), “compassionate”, “self-possessed, credibly human and flawed, but also greedy and vain.” This portrayal of the psychiatrist as compassionate but flawed is, to a certain extent, similar to that in John Carney’s excellent On The Edge (2001). 

One of the few Irish films to portray a psychiatrist in any depth, On The Edge was filmed, in part, at St Brendan’s Hospital in Dublin. It tells the story of Jonathan Breech (played by Cillian Murphy) who is treated by Dr Figure (Stephen Rea) at a psychiatric hospital. Dr Figure is portrayed as determined to understand and treat his troubled patient, but also insightful about his patient’s predicament and, for the most part, compassionate. He is never cruel or vain, like Dr Banks in Side Effects and, although Dr Figure is clearly flawed in certain ways, On The Edge includes strong indications of redemption for both psychiatrist and patient.

MedFest 2013

The broader theme of psychiatry and film was explored earlier this year at MedFest 2013, an international medical film festival co-hosted at UCD by PSYCHED (UCD Psychiatry Special Interest Group), UCD MedSoc and the Trainee Committee of the College of Psychiatry of Ireland. The theme for the festival was ‘The Power of Medicine’ and the evening focused on three dimensions of this theme: the ‘power of medicine for the patient’, the ‘power of medicine for the doctor’ and the ‘power of medicine for society’. The evening was chaired by Dr Eric Kelleher. For each of the three thematic sections of the evening, film clips were shown and followed by a panel discussion, with plenty of questions from the audience. The panel comprised Dr Michael Doran (consultant psychiatrist in addictions), Dr Des Crowley (general practitioner), Dr Rhona Mahony (master of National Maternity Hospital, Holles Street), Dr Ceppie Merry (senior lecturer in global health at TCD) and me.  

Prior to its Irish debut, MedFest had already toured some 20 UK universities, having been pioneered by the Trainee Committee of the Royal College of Psychiatrists in the UK in 2011. In Dublin, as in the UK, the event was very well attended, with plenty of audience participation and no shortage of questions and opinions for the panel. The evening served as yet another reminder of the power of film in medicine, and the usefulness of cinema as a tool for communicating, teaching and learning.