'Cine-diagnostics': Mental illness on the Big Screen

I return to the peculiar shortfall of bipolar disorder at the Bijou. "Lust for Life" (1956) isn’t on my short list, because I don’t think Van Gogh was bipolar.

"The Madness of King George" (1994) is another vexed case: It remains unclear whether George III’s mania was attributable to porphyria or some other organic disorder. (The porphyria theory has been much disputed.) The monarch’s medical records offer no evidence of a major depressive swing – but then, I wasn’t there. In "Bigger Than Life" (1956), James Mason’s flagrant mania obviously stemmed from heavy doses of steroids given for a collagen vascular disease.

Pressured speech and giddy behavior pervade screwball comedies of the 1930s and ’40s ("The Awful Truth," 1937; and "Bringing Up Baby, 1938"). However, their rat-a-tat zaniness is a function of the genre, evidenced by virtually everyone in a screwball movie.

"Mr. Jones" (1993) presents an incontestably bipolar patient: Richard Gere’s eponymous hero seems embued with a romantic aura from the start. The picture intimates that his illness endows him with a "specialness" placing him far above the mortal crowd (R.D. Laing was of the same opinion about schizophrenia, and that notion caused much woe.)

Jones and his psychiatrist (Lena Olin) fall in love. Typical of Lalaland’s female practitioner, life outside the job is lackluster until she’s smitten with her patient. I don’t recall if she quits her work to marry Jones/Gere, another standard outcome for female cinetherapists.

She would do well to stop practicing, and not only because of her flagrant boundary violations. A real-life psychiatrist would fend off Gere’s advances and instead seek to determine whether his mania is influenced by a comorbid narcissistic personality disorder or is solely a symptom of his mood disorder – a vital therapeutic issue.

The paucity of bipolarity in past movies, when the disorder was still known as manic depression, might be a function of its unfamiliarity to the average screenwriter back in the day.

It’s not unlikely that the manic side of bipolarity could be confused with acute paranoid schizophrenia with grandiose delusions – a common clinical error that still crops up. Bipolarity also was once deemed relatively rare and didn’t enter as much into public, let alone psychiatric discourse, compared with schizophrenia and "neurotic" diagnoses.

Bipolar disorder had finally come into its own before "Silver Linings Playbook." One reason is the revelation of their bipolarity by celebrities. I also wonder whether the name change might have played a role in making bipolarity better known and more accepted.

The very word "bipolar" has a kinder, friendlier nimbus than "manic depressive." Arguably, "manic depression" also held obscure connotations of aggression and irresponsibility for some folks. In my practice, I’ve found that "bipolar disorder" is frequently thought to be somehow more treatable than "manic depression." I free associate to a patient’s belief that "Wellbutrin" would do him more good than "bupropion."

Today, bipolar disorder has become the flavor of the month, notably among the glitterati, where it’s as fashionable as Botox. Bipolarity is jabbered about at Hollywood watering holes, on TMZ and reality TV shows.

The word is so detoxified that it’s comfortably entered the vernacular. When an adolescent patient told me that her best girlfriend had become bipolar, she meant the kid was scatterbrained, moody, and, worst of all, messing around with her (the patient’s) boyfriend.

With the ups and downs of bipolarity getting so much play, I expect that screenwriters will create more bipolar characters, because the inherent dramatic value of those affective swings has been recognized in Hollywood. The success of "Silver Linings Playbook" is sure to generate clones.

So far, Showtime’s "Homeland" series has been reasonably accurate about Carrie’s bipolarity; it’s also proved a useful plot device. One can only hope that filmmakers can come up with more fare like "Homeland," rather than grinding out flyweights like "Silver Linings Playbook."

A closing thought: Dorothy Gale in "The Wizard of Oz" could by a stretch be construed in her dream of Oz as afflicted with Charles Bonnet syndrome, except the tiny and very busy little people of Munchkin Land are extremely interested in her, indeed honor her for slaying the Wicked Witch of the East. In the real deal, the Bonnet’s munchkins go about their business utterly uninterested in the hallucinator. That’s show business.

Dr. Greenberg is a clinical professor of psychiatry at the Albert Einstein College of Medicine, New York. E-mail him at HRGMES@aol.com and find more at doctorgreenberg.net.

This column, "The Media on My Mind: Adventures in Pop Culture," appears regularly in Clinical Psychiatry News.