Since the beginning, psychiatrists have had a role in movies and TV — playing roles across genres and far outside their professional remit. Not only do they explain complex behaviors to the lay viewer, they provide comedic relief, and sometimes titillate or mock. Horror films in particular often fear-monger based on misunderstandings about mental illness and violence, “reflect[ing] a sinister version of mental illness and psychiatry.”
The lay public are more likely to see a psychiatrist on the screen than to have seen one in real life — and on-screen psychiatrists can give real-world psychiatry a bad rap.
Hollywood’s Psychiatry Archetypes
Dating back over a century, psychiatrists are seen on screen in rather stereotypical ways, with their characters often falling into one of several archetypes: Dr. Dippy, Dr. Wonderful, Dr. Evil, or Dr. Detached.
Dr. Dippy: Dr. Dippy is scatter-brained, ineffective, wacky, and lacking in common sense, though apparently harmless.
The first Dr. Dippy was also the first cinematic psychiatrist, the titular character in “Dr. Dippy’s Sanitarium,” a 1906 silent film. Billy Crystal’s psychiatrist character in the comedy “Analyze This” was a Dr. Dippy caught up in the mafia. Professor Plum, in the mystery-comedy “Clue,” was a psychiatrist with a secret: he had sex with his patient. Tim Curry’s character Wadsworth’s comedic line is (unfortunately) telling: “Professor Plum, you were once a professor of psychiatry specializing in helping paranoid and homicidal lunatics suffering from delusions of grandeur.” (“Yes, but now I work for the United Nations.”http://www.medpagetoday.com/”So, your work has not changed.”)
Dr. Wonderful: Dr. Wonderful is warm, kind, and therapeutic, but crosses boundaries like having sex with patients, as Lena Olin’s character did with Richard Gere’s titular “Mr. Jones” character — suggesting that female psychiatrists are just looking for the right male patient.
Dr. Evil: Dr. Evil, as one would expect, is coercive, dangerous, malevolent, and exploitative, seeking to control his patients for his own gain.
Hannibal Lecter is perhaps the best-known fictional psychiatrist (and well-known villain), equally scaring and enthralling audiences. Originating in Thomas Harris’ novels, Lecter has seen various adaptations, most famously “Silence of the Lambs” featuring Sir Anthony Hopkins as a brilliant psychiatrist who uses his skills for his own gain, including cannibalism.
In horror, psychiatrists are often Dr. Evils. “The Cabinet of Dr. Caligari” (1920) and “Testament of Dr. Mabuse” (1933) were both early horror films in which the psychiatrist was the criminal, long before Lecter appeared. In “Child’s Play” and “The House on Haunted Hill,” electro-convulsive treatment (ECT) is used as a weapon — exploiting audience fears — rather than as the highly effective treatment it is for depression.
Dr. Detached: Dr. Detached is devoid of emotion, and truly indifferent to her patients — not quite evil but not the psychiatrist you’d want to see if you needed help. Beverly Hofstadter (Leonard’s mother) on the widely acclaimed “Big Bang Theory” is a detached but highly renowned psychiatrist (and not a loving mother).
In forensic psychiatry, in addition to Dr. Evils, we also see the long-winded professor, the activist, the hired gun, and the jack-of-all-trades (who solves mysteries and saves the day by transcending the role of the forensic psychiatrist). For example, George Huang on the long-running “Law & Order: SVU” is a professor-type character, working as a forensic psychiatrist and profiler with the police. He is mostly portrayed as very competent.
Another rare positive example is Jennifer Melfi, from “The Sopranos.” Because of this much-lauded portrayal of psychiatry, the actor Lorraine Bracco received an award from the American Psychoanalytic Association. Melfi treats Tony Soprano, mafia boss, initially for his panic attacks and then for depression throughout the popular series. Melfi tells Tony in the first episode that if she is aware of any criminal activity, she “technically” needs to report it. The nature of confidentiality is more fully explored after Tony’s enemies worry that she might know their secrets too. She aptly avoids any romantic entanglement with the mafioso. Tony’s weekly trips to therapy helped normalize therapy and psychotropic medication — even for the ultimate tough-guy.
Several recent series also feature portrayals of psychiatrists and therapists: “Frasier,” “After Life,” “Unstable,” and “Shrinking.”
“Frasier” was a wildly popular comedy from 1993-2004, with a 2023 reboot. In the original “Frasier,” radio psychiatrist Frasier Crane and his brother Niles Crane, who practices clinical psychiatry, are Dr. Dippies. Both characters are warm toward others, but are preoccupied with being part of a club. Frasier dishes out radio advice to everyone, but the comedy exists in his own foibles, which are a counterpoint to his esteemed guidance. The reboot appears to focus more on Frasier joining a psychology teaching faculty rather than practicing as a psychiatrist.
“After Life,” Ricky Gervais’s wickedly dark comedic series, had three seasons during the pandemic. Gervais’s character grieves the loss of his wife, and sees the town psychiatrist, who reveals confidential doctor-patient information, and tweets and yawns in sessions. He makes vulgar self-disclosures and mocks his patients openly in the pub. While his behaviors are obviously satirical, they may represent fears the lay public has about what happens behind the closed doors of psychiatry.
In Rob Lowe’s (and his son John Owen Lowe’s) “Unstable,” Rob Lowe’s eccentric character holds his (also eccentric) therapist captive in the basement, with his therapist attempting extortion.
In the cleverly titled recent comedy “Shrinking,” Jason Segel’s character is also grieving his wife’s death, while continuing to perform cognitive-behavioral therapy. Harrison Ford’s character asks if he is going to “burn down” his career. Segel yawns, and doesn’t listen in sessions, makes inappropriate disclosures, and tells his patients everything he really thinks (e.g., telling one patient to leave her partner) — and thinks this makes them “thrive.”
What’s Real?
We must acknowledge some historical real-world basis of how psychiatrists are portrayed, with inhumane treatments and abuses noted in psychiatry’s past generations, and (an understandable) historical suspicion of psychiatrists, such as in “One Flew Over the Cuckoo’s Nest.”
But today’s negative portrayals of fictional psychiatrists — such as being judgmental or not taking confidentiality seriously — can deter real people from seeking the mental healthcare they need. Negative media portrayals of psychiatrists also contribute to perceptions by medical students, and can even decrease their desire to pursue careers in psychiatry. When I was a medical student, I had taken the elevator to the wrong floor in the psychiatry building and was absolutely freaked out to see the ECT suite — my only past experience being horror films.
But if portrayals are more reality-based (such as Melfi in “The Sopranos” and Huang in “Law & Order: SVU”), there is another wonderful possibility too — increased openness about seeing a psychiatrist or the potential for more medical students to consider becoming psychiatrists.
Susan Hatters Friedman, MD, is the Phillip Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland, where she is also professor of psychiatry, reproductive biology, pediatrics, and law (adj).