Artistic madness

How the seventh art depicts mental disorders

Published in February 2011

Dali’s madness in "Spellbound"

More than any other form of art, cinema lends itself to the representation of mental disorders.  Paranoids, psychotics, and other mentally unsettled people fascinate or disturb spectators because mental madness shatters the inherent order of the world and one’s usual perceptions of it.  Cinema e loucura – Conhecendo os transtornos mentais através dos filmes [Cinema and madness – Learning about mental disorders through movies] (Artmed), by J. Landeira-Fernandez and Elie Cheniaux, is the first published work that systematically classifies the mental disorders of movie characters. Each chapter describes the clinical aspects of a given mental disorder, followed by the presentation and discussion of cinematic examples of the said disorder. The authors discuss a total of 184 movies, many of which are well known. “The book is an academic tool for the teaching of psychopathology and psychiatry, providing concrete examples that are treated in a more abstract manner in lectures,” states J. Landeira-Fernandez, a professor at the Psychology Department of PUC-Rio. “Using movies motivates the student and is especially interesting in the case of students that have no access to actual patients,” notes Elie Cheniaux, a professor at the UFRJ Psychiatry Institute.

The relationship between cinema and the human psyche is highly evident, as the seventh art represents humans in all their forms, from the most cheerful to the gloomiest. On the other hand, the very situational environment in which movies are shown (i.e., the cinema, a dark room in which images are projected for a relatively passive and immobile spectator) fosters an artificially regressive, dreamlike state, implying that the individual draws away from reality and becomes involved with the images of the films. In cinema, a similar phenomenon takes place. The experience of a dream, with its free associations, is comparable to cinematographic construction, which enables apparently heterogeneous worlds to coexist.

Beside these analogies, one should keep in mind that cinema and psychoanalysis, which was born out of psychiatry, came about at almost the same time—the end of the nineteenth century and the start of the twentieth century—and revolutionized how reality is addressed. For example, Hanns Sachs, one of Freud’s disciples, was among the first psychoanalysts to show an interest in cinema. In his seminar, Jacques Lacan, another psychoanalysis pioneer, analyzed the main character in Luiz Buñuel’s This strange passion, a notorious case of paranoia.

Nicholson’s lunatic in "The shining"

“The script is based on conflict. A film, according to the classic model, has three acts: an introduction to the characters, the development of conflicts amongst them and the resolution of these conflicts, many of which are of a mental nature. A movie with ‘normal’ characters, who are at one with themselves and conflict-free, would not arouse the interest of the audience. However, a movie with disturbed characters, outside normality, depicts conflicts that drive the plot forward. A ‘crazy’ character is more cinematographic. Deviation seduces; normality does not,” argues Flávio Ramos Tambellini, professor and coordinator of the Darcy Ribeiro School of Cinema in Rio de Janeiro.

In Cinema e loucura [Cinema and madness], movie characters are regarded as clinical cases. Lost Weekend (1945), by Billy Wilder, vividly depicts the wealth of symptoms of abstinence from alcohol. Annie Hall (1977), by Woody Allen, presents dysthymia, characterized by depressive symptoms that are weaker than those of typical depression, and a generalized anxiety disorder.

However, mental disorders are often misrepresented because movies are not educational, but instead follow artistic and commercial dictates. “Screenwriters and movie makers are not obliged to be true to reality. Cinema is not required to be educational. It’s an art, not a science,” Cheniaux notes. However, these distortions do not mean that the author’s form of addressing such issues as proposed should be disregarded.  In Ron Howard’s A Beautiful Mind (2001), a biography of John Nash, a mathematician and Nobel Prize laureate in Economics, John Nash’s schizophrenia is poorly described. “He has visual, kinesthetic and hearing hallucinations. This is wrong, because schizophrenics have single-mode hallucinations, of which the hearing type is the most common one. Actually, this was the only form of hallucination that Nash suffered from. Although wrong, the representation of the symptom works as a negative example,” says Landeira-Fernandez.

In other cases, the character’s behavior does not fit any diagnostic category. Frequently, this “madness” reflects common sense and is very different from the symptoms of a real mental patient. The book also includes movies with such distortions. In Roman Polanski’s Repulsion (1965), Carol, the character played by Catherine Deneuve, has a horror of penetration and behaves in a very strange way. What mental disorder might these characteristics show? Carol’s disturbances do not fit the categories described by the DSMIV-TR (the Diagnostic and Statistical Manual of Mental Disorders), which guided the authors.

The problem of mental illness diagnosis, however, is far from being specific to movies. “In medicine, diseases are defined based on their causes. However, in psychiatry the categories are described only by their symptoms, a fact open to criticism. Often a given patient meets the diagnostic criteria for more than one category of disorder at the same time. It is difficult to believe that he has three or four psychiatric illnesses at the same time. So things are arbitrary, to some extent,” states Cheniaux.

In the first decades of the last century, those who were “mad” were generally limited to the fantastic and weregenerally considered criminals.   With Robert Wiene’s German expressionism classic, Das Kabinett des Doktor Caligari, mental madness is first cinematographically represented. As in other expressionistic movies, the sets were strongly stylized, and the abrupt gestures of the actors symbolically translated the mentality of the characters and the state of their souls. The character Caligari is a mad doctor who hypnotizes Cesar, his assistant, and directs to him to commit crimes, which reflects a paranoid need for power.  Another perverse and intelligent figure of that time was the central character of Fritz Lang’s Dr. Mabuse (1922), a psychiatrist who also resorts to hypnotism to manipulate people to commit crimes. Mabuse is driven by the desire to govern by money, whereas Caligari’s thirst for power is abstract. Mabuse’s madness and the morbid passivity of his victims point to the decadence of German society at that time and to the chaos that was overtaking the country.

Scene from "Repulsion"

Another Fritz Lang movie, M (1931), focuses more realistically on the psychology of its characters. The central figure is a murderer of girls who is depicted with humanity in the horror he commits. Nevertheless, society is no better: in the face of the police’s inability to arrest him, he is “judged” by other delinquents, pointing to what was to become true in Germany a few months later when the Nazis rose to power.

In the 1940s, the media gave more room to psychoanalysis. During this era, psychoanalytic thrillers appeared, and the filmmakers resorted to the psychoanalysis arsenal clumsily and naively. The prototype of such movies is Alfred Hitchcock’s Spellbound. Constance (played by Ingrid Bergman) is a young psychiatrist in an asylum who falls in love with the new director. However, she soon realizes that the man she loves (played by Gregory Peck) is mentally ill and is pretending to be Dr. Edwards. Based on the sick man’s dreams and a session of analysis, Constance discovers that he has lost his memory, and she understands why he had shouldered the burden of guilt for a crime he had not committed: he had witnessed the death of the real Dr. Edwards, who was murdered by the asylum’s former director, just as the patient himself, during a game as a child, had pushed his younger brother to his death. Beside anguish in the face of madness, the movie depicts the anguish of madness by showing the character’s fear through dreams (as drawn by Salvador Dalí) that reveal a world full of hallucinations and symbols supposedly produced by the unconscious. In this and in other movies of this period, psychoanalysis is reduced to a method that can resolve obscure conflicts by deciphering a set of generally clear signs.

Starting in the 1950s, under the impact of the horrors of World War II, movies began questioning the confinement of mental patients. Concurrently, new psychiatric drugs appeared that caused severe side effects, which led many patients to refuse treatment. In reaction to psychiatry at that time, anti-psychiatry arose and grew during the 1960s, when this counterculture peaked. Some movies show this movement very well, such as Family Life (1971), by Ken Loach, A Woman Under the Influence (1974), by John Cassavetes, and One Flew Over the Cuckoo’s Nest (1975), by Milos Forman. These works criticize the society that chose to confine its mentally ill people and offer them only straitjackets, electric shocks and drugs, rather than help them mitigate their suffering. These movies reflect a new view of cinema that regarded madness with more concern regarding the burden society put upon its individuals. Some questioned the “madness” of this society and of the family, which raised the issue of defining normalcy.

The great precursor of this line of movies is the cinematographer Ingmar Bergman, one of whose obsessive themes was mental madness. Despite the transformations of the representation of madness in cinema occurring during that time, most movies continued to portray madness as banal, with old clichés that turned the mentally ill into criminals in thrillers or fools in comedies.