To the Editor: Psychiatry has a very bad image in the media, and a lot of patients think psychiatric hospitals are similar to that portrayed in the movie One Flew Over the Cuckoo's Nest by Milos Forman (1976).1 Many still think that electroconvulsive therapy is given without anesthesia and that sane people are still lobotomized. Sometimes, patients with psychosis have good reason to feel persecuted before entering the hospital. Unfortunately, Martin Scorsese's recent movie Shutter Island (2010)2 proposes the same old-fashioned view of the psychiatric hospital. Furthermore, most medical students still define schizophrenia as “to have 2 independent personalities in 1 mind,” because this is the way the cinema has portrayed it for decades. Psychiatrists should be thankful to Michael Crichton for his television series ER,3 in which he tries to show a realistic view of the daily life of medical (and paramedical) staff. Psychiatry as a discipline appears only in the sixth and seventh seasons (2000–2001) with Dr Kim Legaspi (interpreted by Elizabeth Mitchell, later known for her role in the TV series Lost4), who has a sentimental relationship with Dr Weaver, the emergency department's chief (interpreted by Laura Innes). Dr Legaspi was called for specialist advice on psychiatric cases in the emergency department. She took care of a nurse's mother, who suffered from bipolar disorder. I was a medical student at the time those episodes aired, and it was the first time I heard about “bipolar disorders” (in France, bipolar disorders were still named manic-depressive psychosis in reference to Kraepelin's classification). Dr Legaspi was unfortunately fired because she told a young borderline patient that she was a lesbian, to help her understand that being homosexual was not hopeless. The patient filed a complaint against her for sexual harassment. Dr Weaver refused to defend her to hide her own homosexuality. It has to be underlined that the psychiatrist was a woman, which was a great advance in the representation of psychiatry given that psychiatrists are usually represented by an avatar of Freud, ie, an old man with a cigar and a tweed jacket. Many more women are psychiatrists now than in years past, yet fiction fails to represent this evolution. Another interesting point is the collaboration between psychiatry and the other medical specialties, which had never been treated before, even in David Shore's House, MD,5 in which top doctors see psychiatry as a discipline useful only when a differential diagnosis is needed. It has to be pointed out that Dr House was forced to be admitted to a psychiatric hospital during the sixth season for Vicodin (acetaminophen and hydrocodone) dependence. He had previously led a patient to commit suicide, understanding then that dealing with suicidal patients was extremely complex. Ironically, psychiatry appears as a limit for this genius. To our knowledge, the only American television drama series that provided a realistic view of psychiatric care is Six Feet Under (2001–2005)6 by Alan Ball, director of the movie American Beauty.7 This television series relates the life of a funeral director's family after his death. Two characters are mentally ill. Billy, the brother of Brenda (who is the girlfriend and later wife of the oldest of the children of the late funeral director), is bipolar and on lithium treatment. The question of medication observance is thus approached. George (the second husband of Ruth, the widow of the deceased funeral director), who suffers from psychotic depression, is treated by electroconvulsive therapy after drug failure and suffers then from amnesia. Six Feet Under has frequently been described by critics as one of the greatest television series of all time as well as having one of the greatest series finales of all time. The image of psychiatry is also in urgent need of change because the impact of its fictional portrayal, especially on-screen, remains infinitely stronger than that of any medical or research journal. Psychiatrists must feel concerned about this representation because the fictional depiction of their field has an impact on the global representation of mental illness in the general population and can affect therapeutic alliances with patients and their families. This depiction can also influence vocations of future doctors as well as potential funding bodies for research.
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Sep 1, 2014
Gary Scharnhorst 
Open Access