The medium of film allows for concise audiovisual depictions of a rich variety of subject matter pertinent to psychiatrists (+1). Psychiatrists have long utilized commercial films in psychiatry seminars as teaching aids (+1—+3). Films have been used to help teach psychopathology (+4—+6), psychodynamic formulation (+7, +8), psychotherapy (+9—+12), child and adolescent development (+13—+18), and the dramatization of children’s stories (+1, +10, +17). Horror films create an imaginary world in which anxieties are confronted in a literal sense by the protagonists. They can then serve as a forum in which an audience can vicariously experience the confrontation and vanquishing of their own fears (+18, +19, +20). Science fiction as a genre of art lends itself to the presentation of psychological issues through situations and story lines that are unlikely to occur, but not impossible. In contrast, fantasy writing, as Bick points out, depicts impossible scenarios (+21) which permit the reader a transitory escape from the reality of the external world. The "science" part of science fiction reins in the fantasy element so the story line remains plausible to the reader’s psyche, yet creates an imaginary world with a loosening of logic. Thus, the science fiction film can serve the audience in a similar way as the horror film as both create superficially realistic worlds with which the audience can identify, but are infused with fantastic elements that stimulate anxiety. In certain films, such as Alien, the genres are actually combined into one as the setting is a futuristic world but the plot is one of suspense and anxiety. Gabbard and Gabbard have speculated that the success of Alien lies in the audiences’ reexperiencing and conquering of the infantile anxieties of the Kleinian paranoid-schizoid position the film recreates. They describe Invaders from Mars (Twentieth Century Fox, 1953) as another example of Kleinian infantile anxiety as this film depicts a child’s horror at the transformation of his parents into persecutory alter egos (+16). Such rich material in such a concise, time-constrained format as the commercial film may effectively serve as the basis for a tremendous amount of teaching material for child psychiatry residents. In the film seminar at my institution, Invaders From Mars is used to teach normal developmental theory, separation anxiety, school-age childhood nightmares, child protective issues, child psychotherapy, and crisis management.

Object relations theory provides a framework for an understanding of this film. Object relations holds that infants relate to others at a very early age. "Object" refers to an internal mental image of self and others obtained through experiences with others through the process of introjection, with the mother often being the first internal object formed by the infant, followed by those of other important persons. Object relationships are initially fragmented aspects of the self and others in the child’s world, and these fragmented internal images are termed part objects. As the child develops, part object relationships are integrated into more coherent images of self and others. In this early developmental stage termed the paranoid-schizoid position, when self-object differentiation is incomplete, intolerable feelings such as rage or longing are split off and repressed, and then projected onto the parent. The infant is then free of the intolerable feeling, which is then placed inside the parent. The child cannot tolerate the object of aggression and the object of libido being the same, and to tolerate the potential destruction of the good object, the object is split into good and bad, in order to protect the integrity of the good object. When the child experiences good enough parenting and is not rejected or retaliated against by the parent, the child begins to take responsibility for his own aggression and progressively sees himself and others as whole objects. At this stage of development known as the depressive position the child begins to take back negative feelings from the parent, owning his own aggression, and increasingly experiences the parent as a separate object. The world is experienced as a less threatening place when bad part objects are integrated with good objects, and the resulting whole objects are less threatening due to internal checks on aggression. The process by which this occurs is known as working through the depressive position (+22).

Another concept useful to understanding this film is separation anxiety. When a child is separated from his protective adults, worries may arise that they may never return or be harmed and should the protective figures in the child’s life disappear, the child will be exposed to harm. The central fear is that harm may come to either the attachment figure or the child, leading to permanent separation (+23). Should separation occur or harm come to attachment figures, the anxious child may also worry whether he or she possesses the competence to recruit substitute attachment figures or the possession of the skills necessary for survival. Treatment of separation anxiety disorder focuses on dealing with issues of autonomy, self-esteem, achieving age-appropriate independent behaviors, and helping parents understand the child’s need for security and mastering independent behavior (+23). +Table 1 includes examples of DSM—IV criteria for separation anxiety disorder seen in the film.

The film begins with the image of an ideal family at night: David, who is a 12-year-old in the script but seems closer to 8 years of age in the film, and his exaggeratedly benign parents, an affable scientist father and well-groomed mother. Relating to father in a cerebral manner, David gives his father a brief astronomy lesson leading his mother to hint at the oedipal issue of competition with father, stating, "It is not enough that I’m married to a scientist but my son has to turn into one, too." David is put to bed by his parents and his father closes the bedroom door and the lights are turned off. As in DSM—IV, a child suffering separation anxiety can experience great difficulty in this situation. The connection with the parents is broken and the child is encouraged to enter the realm of sleep without their protection. David drifts off to sleep and a nightmare begins, which consumes nearly the remainder of the film, as follows. A humming spaceship lands in the backyard. David’s father investigates and is captured by Martians who, via a device implanted in the back of his neck, transform him into a malevolent automaton who beats David and bullies his mother. Gabbard describes this as a depiction of Capgras syndrome, in which someone believes that a familiar person is replaced by an evil imposter (+8). The child experiences fear as a protective adult figure is replaced by a threatening one. This theme may be particularly frightening for an audience due to its dramatic portrayal of the Kleinian theme of an infant’s experience of the parent as alternately good and bad, albeit physically appearing identical, a normal developmental experience. The evil object can be understood as a "projection of the split-off bad self" (+8) as David’s aggressive feelings toward his father are projected onto him.

A similar fate befalls David’s mother as she and other protective authority figures such as police officers, the police chief, and a general are replaced by evil imposters, automatons controlled by the unseen evil Martians hiding underground. The terrified boy seeks protection from supportive adult figures only to discover, to his horror, that these figures are being transformed into evil twins. Overwhelmed by fear, David is detained by police in a jail cell. A policeman, worried about David’s mental health, requests a consultant and a kindly female physician, Dr. Blake, comes to David’s jail cell to interview him. He requests to see the back of her neck to confirm that she has not been transformed into an evil automaton and once reassured, he tells her what he has experienced. Dr. Blake calls a friend, the dramatic astronomer Dr. Kelston, who supports David and his story as being credible. She then takes emergency custody of David, seeing his parents as a threat. At the height of the boy’s fear, Drs. Blake and Kelston take the boy under their care for protection, effectively assuming the roles of surrogate parents. David’s attachment to Drs. Blake and Kelston is positive, yet he continually urges them to save his parents so he may return to them. Although David has lost his kindly parents due to their transformation into evil automatons controlled by Martians, he has replaced them with positive attachment figures. An analogy can be made to child protective services, which may similarly intervene when a determination has been made that a child’s parents present a threat. Despite his parents’ becoming abusive, David nevertheless says "they’re wonderful" suggestive of the denial and idealization abused children may demonstrate, as they yearn for reunification with their abusive parents.

Police and military authorities still free of Martian influence then gather to fight the Martian invasion, generating images of phallic symbols such as tanks, cannons, and guns, and from this point oedipal aggressive themes become more apparent. The Martians are hiding unseen, buried under a sandpit where they conduct their operations. Word arrives that David’s parents have been captured and taken to a hospital to have the Martian implants removed and they will be safe, and Dr. Blake informs David of this in a straightforward professional manner. David and Dr. Blake are then sucked underground into the Martians’ lair. This point of transition from aboveground to underground may be interpreted as a transition from the conscious to the unconscious, where David will confront his fears, which can be seen as taking the form of repressed aggression. In the literal story line the threat is posed by the Martians to David’s world. The true threat to a child with separation anxiety disorder may be internal, in the child’s inner world. At the climax of the film the main characters, David and his surrogate mother/therapist Dr. Blake, delve into his internal psychic world where his enemies truly reside. Soldiers blast their way underground and confront pudgy ogre-like Martians called "mutants," created to serve the Martian leader, a bizarre oversized head with phallus-like appendages inside a transparent egg-like globe, described by Gabbard as a "disembodied part-object" (+8). Dr. Blake is told by an automaton that the Martian leader is "Mankind, developed to his ultimate intelligence." Given David’s mother’s comment about David being a young scientist like his father, David’s competition with his father may assume an intellectual manner. Therefore his intellectual aggression toward his father may be symbolized by this combination of phallus and brain that is the Martian leader, a visual depiction of the split-off part object of David’s aggressive feelings toward father which is repressed to the unconscious. In the film, this repression takes the literal form of burial beneath the ground. David runs up and bangs on the globe, confronting the Martian leader and commanding it to leave his parents alone. What David may really fear are his own aggressive impulses toward his parents.

A party of soldiers enters the underground Martian lair and frees David and Dr. Blake from the Martians, who then use huge guns to destroy the exit and trap all of them underground. David arrives with his "own" phallic symbol—a captured Martian gun. "Can you work it, David?" David is asked by an officer before he uses the weapon to open an escape path to the surface, freeing himself and the soldiers. At this point in the story, David has finally used his aggressive feelings for constructive use, rather than simply repressing them, demonstrating an improved level of comfort with them. Also, school-aged children’s dreams can reflect efforts to master fears of catastrophic events via becoming heroes who save families or entire communities from enemies or natural disasters. When a school-aged child feels incompetent, he or she may be overwhelmed by fear and have nightmares in which they are helpless (+24). David confronted his fears and captured and used a symbol of his enemy’s power to demonstrate his ability to take care of himself and his competence in the face of threatening situations.

David, Dr. Blake, and the soldiers all climb above ground, leaving the Martians beneath the surface to be destroyed by high explosives. At the moment of detonation, David awakens from his dream and rushes to his parents’ bedroom. They awaken and comfort him, demonstrating that they have not been taken over by Martians and are his unchanged parents. The story can be seen as David’s working through the depressive position, as his aggressive feelings toward his parents, his father in particular, are split off and repressed to the underground lair of the Martians. The Martians’ transformations of David’s father and others into evil automatons can be seen as a dramatic portrayal of the projection of David’s repressed aggressive feelings, and the alternation of his parents between good-object and bad-object as a depiction of splitting. With the assistance of kind and consistent parental figures, Drs. Blake and Kelston, David is able to own up to his aggressive feelings toward his parents, as Blake and Kelston neither abandon nor retaliate against him, but reassure him that he is still worthy of care and protection. David’s use of the Martian gun to save himself and his comrades demonstrates that he is more comfortable with his own aggressive impulses, which are put to good use. After the defeat of the Martians, David is reunited with his parents, who appear once again as whole objects. We may also see the film as David working through his anxiety about a terrible fate befalling his parents and himself during a separation, as in his nightmare, his parents are rescued and he demonstrates the ability to recruit assistance and to overcome the challenges posed by the evil Martians. When David awakens, he finds himself and his parents safe and reunited.

Invaders From Mars depicts a child in crisis, whose world has fallen apart in a nightmare scenario. Locked in a jail cell despite having committed no crime, David is approached by Dr. Blake. David asks to see the back of her neck to determine whether she too has been transformed into a Martian automaton. She obliges, in a necessary loosening of boundaries which reassures David that he can confide his story to her. In contrast with the example of adult psychodynamic psychotherapy, in which such a request would likely be interpreted rather than granted, the child crisis psychological evaluation which Dr. Blake is conducting calls for different rules, and her grant of his request helps to foster trust and a doctor-patient alliance. Appropriately, she does not tell him whether she believes or disbelieves his story but instead she listens, investigates, and is honest with David. Dr. Blake leaves the cell and when David mentions that she does not have to lock the gate, she replies that she has to lock it because she "must obey the rules." This may be reassuring to David as in his nightmare world in which parents are turned into evil automatons and Martians invade the earth, rules are no longer being followed, emphasizing the necessity of stabilizing figures such as Dr. Blake to demonstrate to David that she, at least, will follow a normal code of conduct. Patients in similar clinical situations may be reassured by the clinician following standard practices. Obtaining collateral information that supports David’s story from her call to Dr. Kelston, she makes the decision to believe his story and adopts a protective stance toward him. The decision to take custody of David should be emphasized as child clinicians must always be vigilant in deciding whether to involve child protective services which have the legal authority to assume legal and physical custody of a child.

Dr. Blake honestly informs David in a calm and reassuring manner about the condition of his parents, that they are en route to the hospital to remove the controlling devices. Her exercising professional boundaries and avoidance of the mother role is effective and appropriate. No matter what temptation there might be for her to assume a maternal role, she remains a mental health professional, which is what David needs, as he has already endured sufficient confusion about who his mother really is. Remaining something of a therapist for David, at the climax of the film she and David enter the underground realm of the Martians, where he confronts his repressed aggressive feelings. Perhaps this reflects the therapeutic alliance in which the patient does not confront the source of anxiety alone, but does so with the accompaniment of the therapist.

The Capgras scenario, in which one experiences familiar persons to be replaced by evil twins, as is depicted in the film, has similarities to common clinical situations. First, normal child development involves a very similar experience as the child perceives the parent as alternating between good-object and bad-object, termed normative splitting. Gabbard and Gabbard suggest that films’ entertainment value may in part hinge on their dramatic recreations of such universal developmental experiences (+16). Second, Capgras scenarios can be seen as depictions of children’s experiences of the psychopathology of the adults in their worlds. Psychotic, intoxicated, neurologically ill, borderline, or angry parents may all vacillate between being "good" and "bad" objects in the child’s view. The borderline parent’s oscillations between tenderness and abusiveness can be particularly confusing to children and some parents with mood instability, personality disorders, or substance abuse may truly provide unstable and conflicting responses to children. When the parent’s condition improves, the child may be reassured that the parent who was feared "lost" forever has "returned." In child custody disputes, a similar situation arises, as in severe cases, each parent may alternately devalue the other parent, interfering with the child’s efforts to integrate and internalize consistent and reality-based parental figures. The child’s worst fears about one parent may be reinforced at each visit with the other parent. In Invaders From Mars, David experiences a similar situation, as he is the victim of parental betrayal when his "good" parents are transformed into "bad" parents.

The science fiction film Invaders From Mars, a 1950s-era film about an invasion of the earth by Martians, contains a rich display of material pertinent to a child psychiatry film seminar. The major teaching points covered in the seminar for Invaders From Mars include normative developmental issues and tasks; psychopathology in children and their parents, crisis intervention, child protection, and child psychotherapy. Normal developmental issues such as normative splitting, the paranoid-schizoid and depressive positions, repression, projection, and part objects can be discussed with the audiovisual aid of this film. Essential elements of separation anxiety in children can be demonstrated with the aid of the basic storyline of the nightmare of harm befalling parents after separation from the child. Key points in child crisis intervention are demonstrated by Dr. Blake’s professional style in rapidly forming a helpful treatment alliance with David and helping to calm and reassure him. Dr. Blake assumes temporary custody of David, which can be used to discuss child protective issues. As Dr. Blake helps David confront his own aggressive impulses toward his parents, embodied here in the dramatic device of the Martians, David’s distress is relieved, leading to reunification with his whole-object parents, as he is assisted in working through the depressive position, and the benefit of this psychotherapeutic intervention can be discussed. The response from the child psychiatry residents has been very positive for each year of the course as they have expressed benefit in learning child development and psychodynamics, with sample comments such as "learned much about development" and that the discussion of the film provoked "a great deal of thought [about] the psychodynamic piece." Child psychiatry residents described the use of film in the seminar as "extremely memorable," "interesting," and a "great medium to teach." The overall rating for the course has consistently scored in the "excellent" range. In summary, the child psychiatry residents have found the use of Invaders From Mars and other films to teach these aspects of child psychiatry to be useful and memorable.