Many in the medical profession seem to be innately attracted to George Lucas’s famous "Star Wars" saga, which has been the catalyst for scholarly work by medical professionals, including academic psychiatrists (¹, ²). Medical students, residents, and physicians in practice are often found making references to Star Wars characters in various collegial discussions—perhaps as testament to Mr. Lucas’s success in introducing Star Wars to a generation of us during the formative years of our childhood and adolescence (in the late 1970s and early 1980s) and again during our young-to-mid adulthood.

The first author has often captured the interest of medical students by showing a brief clip of the movie and referring to the various characters and themes in the saga during discussions on the role of child and adolescent psychiatry in preventing future violence and other causes of suffering. Similarly, in learning about leadership and administration from various mentors in the course of faculty development, both authors have benefited from analogies to systems and governments depicted in the Star Wars saga.

We believe that there are important lessons in Star Wars that can potentially inspire and illuminate the work that psychiatrists do: in caring for psychiatric patients, in addressing concerns on systems levels, and in teaching students and junior colleagues. In this article, we present an analysis of the rise, fall, and redemption of Anakin Skywalker, the "main character" in the Star Wars saga, and the rise, fall, and redemption of the Galactic Republic, where the events of the saga take place. We then discuss potential applications to education and practice.

The story of Anakin Skywalker may be of interest to future physicians who will care for children and adolescents or any patients succumbing to darkness in the modern clinical sense (e.g., delinquency, crime, violence, addiction, non-adherence).

In the saga, Anakin Skywalker is introduced in Star Wars Episode I: The Phantom Menace, as an unassuming 9-year old child who has special "Force" abilities. The Force (as explained by Obi-Wan Kenobi in Star Wars Episode IV: A New Hope, which is the first movie seen by Star Wars fans), is "an energy field generated by living things… The Force surrounds each and every one of us. Some men believe it directs our actions, and not the other way around. Knowledge of the Force and how to manipulate it was what gave the Jedi his special power" (³). Proper training allowed one to harness the Force for either good or evil. The Jedi order emphasized use of the "light side" of the Force for knowledge, peace, healing and self-defense and strove for harmonious relations, trust, respect and the formation of mutual alliances, ultimately putting "self-interests" behind, in order to capture its power. The Sith order, on the other hand, harnessed the "dark side" of the Force, which was made stronger by fear and anger, hatred, aggression and evil intent, ultimately intending its use for selfish purposes and corruption (⁴).

Anakin Skywalker leaves his home planet of Tatooine and subsequently becomes Jedi apprentice to Obi-Wan Kenobi. In Star Wars Episode II: Attack of the Clones, Anakin demonstrates considerable powers as a Jedi but experiences various transitions, including the death of his mother and a secret marriage to Senator Padmé Naberrie, whom he had known since his childhood. In Star Wars Episode III: Revenge of the Sith, Anakin is seduced by the dark power of Chancellor Palpatine (a.k.a. Darth Sidious) and becomes the evil Darth Vader of the original "Star Wars Trilogy," which includes Episode IV: A New Hope, Episode V: The Empire Strikes Back, and Episode VI: Return of the Jedi.

Episode IV: A New Hope introduces young Luke Skywalker as an apprentice to Obi-Wan Kenobi. Luke joins the fledgling Rebel Alliance that fights for freedom against the Empire ruled by the evil Emperor Palpatine and Darth Vader. Episode V: The Empire Strikes Back chronicles how the Empire regains strength after its Death Star was destroyed by the Rebel Alliance. Luke undergoes further Jedi training under Yoda’s tutelage and ultimately discovers that he is the son of Darth Vader (a.k.a. Anakin Skywalker). Episode VI: Return of the Jedi outlines the overthrow of the Empire by the Rebel Alliance. Darth Vader saves Luke from death by the Emperor’s hand and gains ultimate redemption through Luke’s saving love and hope.

Although some have criticized, from a storytelling point of view, what appears to be an unexplainable transformation from the youngster portrayed as the 9-year old Anakin to the evil Darth Vader (⁵), and although this degree of transformation (galactic fiction aside) would unlikely be seen in the real clinical world, it may be productive for educators to ask students (perhaps after showing video clips of the Episode I scene in which the predatory Senator Palpatine tells Anakin Skywalker, recognized as a brave young hero, that the latter’s career will be watched with great interest) to reflect upon what developmental factors enable innocent infants and young children to become "bad" teenagers and adults, because clearly such transformations do occur, and almost certainly while the children are under the longitudinal care of a physician.

Woolfenden et al. described Conduct Disorder as a "repetitive and persistent pattern of antisocial behavior in children and adolescents," and delinquency as a "socio-legal category that refers to children and adolescent who break the law" (⁶). These authors noted that a history of conduct problem in childhood is an important predictor of future delinquency. Risk factors for these two conditions are multiple and include genetic and biological factors; family factors such as ineffective parental discipline and family dysfunction; and other social factors such as poverty, school failure, and unemployment. The authors found that parental and familial interventions appear to significantly reduce criminal behavior and time spent by delinquent youth in institutions. Farrington also noted that important childhood predictors of delinquency appear to include impulsivity and low intelligence (⁷, ⁸).

Given that both Anakin and his son, Luke Skywalker, appeared to share common genetic and biological traits (including high intelligence and capability, strength in the Force, and a restless—perhaps impulsive—sense of adventure), it is interesting for students to speculate on the other factors that led to such differences in character and behavior. Educators may introduce the principle of "resilience" in comparing these two characters, who, at multiple points in the original Trilogy, found themselves polarized in good-versus-evil combat.

In the Star Wars saga, both heroes are encountered during their adolescence, a time of great psychological and personality changes. From the perspective of family and other adult attachments, Luke’s protective factors (which his father lacked) included consistent parent figures (Uncle Owen and Aunt Beru) and the absence of any separations or serious disruptions in these relationships during most of his childhood (he was already a young adult when the Sand People killed them); the ability to respect Obi-Wan Kenobi and Yoda (who were also his father’s mentors) both as parent figures and Jedi mentors; and an even-keel environment during biologically vulnerable stages of development (e.g., no known romantic attachments during adolescence to interfere with other commitments; no malevolent Chancellor Palpatine to prey upon the adolescent drives for independence).

Clearly, in looking beyond the tragedy of Anakin Skywalker, one can see the "new hope" in his son, Luke. However, the real beauty of Star Wars may lie in the fact that, as much as evil can be hidden (in the form of Darth Sidious), goodness can likewise be hidden and brought to fruition (in the form of Anakin Skywalker). In spite of Anakin’s transformation to Darth Vader, he nonetheless reemerges in Episode 6 as the real hero who brings balance to the Force. In his choice to save Luke from the Emperor’s deadly "Sith lightning," he destroys the Sith line by renouncing his own identity as a Sith and destroying the most evil Sith of all, Emperor Palpatine, or Darth Sidious. He ultimately redeems himself through love for his son, which presumably had never been part of the usual Sith experience.

Anakin’s salvation was possible because, even though he lacked the protective factors that allowed his son to have a more positive fate, he nonetheless had basic inner strengths (e.g., love for his family) as well as a champion (e.g., his son) who believed that this goodness existed. The risk and protective factors we have identified for Anakin and Luke Skywalker are summarized in Table 1.

By highlighting the above analysis and the salvation that Luke was able to achieve for his father, educators may be able to impress upon students that, when working with children, adolescents, and adults who have succumbed to "darkness," there is value in hoping for "salvation" and in consistently maintaining an unconditionally positive regard toward the patient. Object relations theorists, D.W. Winnicott in particular, had noted that aggression was often related to deprivation in earlier relationships and, therefore, could represent a "new hope" in an attempt to reengage the environment (⁹).

Furthermore, educators may also be able to impress upon students that treatment should always be based on a thorough inventory of the strengths and vulnerabilities in the patient, family, and system of care that surrounds the patient. Indeed, this is the approach inherent in Multisystemic Therapy, which is the treatment best supported by evidence to be effective for Conduct Disorder (¹⁰). In retrospect, one may ask why powerful Jedi such as Yoda and Obi-Wan Kenobi, who were deeply compassionate toward Anakin, were helpless in preventing his fall, and the answer may be that they were not able to effectively address the problems in the system that surrounded him: namely, a malevolent influence (Chancellor Palpatine) and a misled, war-torn Galactic Republic.

In addition to telling a story about the fall and redemption of a person, the Star Wars saga tells a story about the fall and redemption of a system (the Galactic Republic). The ultimate outcomes in the saga reflect a complex interplay of individual and systems-level dynamics that may be of interest to administrative and liaison psychiatrists working on a "systems level."

In the field of medicine, we strive for the highest standards of excellence and perfection in caring for the sick; yet, statistics indicate that we have alarming death rates from medical error, now recognized to be a major cause of death in the United States, with 98,000 lives lost per year (¹¹). In medicine, we often strive for the same safety statistics that exist in the airline industry, which achieves success in this regard not only by creating multiple redundancies that prevent inevitable human errors from resulting in passenger deaths, but also by creating systems of teamwork that prevent the drama of human conflict from ultimately harming passengers. Indeed, the Institute of Medicine recommends cooperation among clinicians as one of the 10 simple rules (the others are continuous healing relationships, customization, patient control, shared information, evidence-based decision-making, safety as system property, transparency, anticipation of needs, and continuous decrease in waste) to achieve its six goals for health care (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability) (¹²).

Unfortunately, it is not uncommon for psychiatrists—in both liaison and administrative roles—to work within systems that are not particularly safe, efficient, or free of human drama or conflict. Yet it is likely that psychiatrists, by virtue of their training, may be the best able to address dysfunctional health care teams where more time is spent creating and resolving conflict rather than caring for patients, or where interpersonal drama—perhaps precipitated by an ill patient or other person with negative influence, but often a reflection of the personal issues of the team leaders—results in lapses of care and communication and ultimately harm to patients.

In Episode I of the Star Wars saga, the Republic is introduced as the organization that had peacefully governed the entire galaxy for tens of thousands of years. This episode begins with an unusual crisis: the blockade of the planet Naboo by the Trade Federation. This event is the beginning of a series of steps carefully orchestrated by the man who will eventually be revealed as the evil Sith Lord, Darth Sidious. In Episode I, as a hooded holographic figure, he manipulates the Trade Federation into blockading Naboo, so as to highlight the uselessness of Valorum, the incumbent Supreme Chancellor of the Republic, and to engender support among the other Republic Senators for the planet Naboo, from where he serves as Senator (without his Sith hood). As the Naboo Senator, he also manipulates the Naboo Queen, Amidala, into calling for a vote of "no confidence" in Supreme Chancellor Valorum. Through these manipulations, he then becomes elected the new Supreme Chancellor of the Republic.

In Episode II, again as a hooded holographic figure, he manipulates the "Separatists" into waging war against the Republic. As the non-hooded Supreme Chancellor, he convinces the Senate to authorize the creation of a large clone army, ostensibly to defend the Republic. This army subsequently wages war against the Separatists, and the entire Galaxy is left in a state of chaos, which gives him ample reason to maintain the dictatorial powers granted him by the Senate.

Finally, in Episode III, Supreme Chancellor Palpatine, who has revealed himself as a Sith Lord and who has already seduced Anakin Skywalker to the Dark Side of the Force, proclaims that the Jedi are traitors for attempting to murder him, and calls upon the clone army to execute all remaining Jedi. Through his manipulations, the apparently benevolent dictator convinces the Senate that he has won the war and brought peace to the Galaxy, and hence gains their overwhelming support for all of his actions and for his creation of the new Galactic Empire.

Although it is not immediately clear, in reviewing the whole sequence of the tragedy, that anything could have been done differently to thwart the powerful evil of the dark side of the Force, there may be interesting lessons for psychiatric administrators and liaison psychiatrists in-training to learn, through individual and group mentorship with other Star Wars-literate colleagues.

The first lesson is that a poorly functioning system, where selfish (Sith-like) desires for power supersede principle and chaos and interpersonal drama abound, is fertile ground for bad things to happen and for the worst characteristics in people, including pathological narcissism, to emerge. The Star Wars literature describes the Galactic Republic as an organization where Senators sought to live out their most grandiose of political ambitions and to amass extreme wealth, power, and other excesses (¹³, ¹⁴). It describes issues as urgently life-threatening as the blockade of a planet being lost in the politics and drama of the Senate. It is in this environment where the negative influence of a single person was brought to fruition. Furthermore, in the state of conflict orchestrated by this person, well-meaning people and aliens developed strong opinions and alliances that were based on severely flawed assumptions but that seemed to give them a "moral compass" where no other such frame of reference existed.

The second lesson is that there is no room for complacency when lives and other vital things are at stake, because, as the story illustrates, evil and destruction can be insidious and difficult to see. According to Master Yoda (in Star Wars Episode I: A Phantom Menace): "hard to see, the dark side [of the Force] is" (¹⁵). Psychiatrists, particularly in leadership roles, can help health care teams to realize that, unlike the self-serving Senators of the pre-Empire Republic, everyone is responsible for not allowing a system to turn dysfunctional. Even without the benefit of Jedi insight, they can lead others in being mindful of the system dynamics that may adversely influence group functioning and ultimately the well being of the most important stakeholders, namely the patients or common citizens (as was the case in the Star Wars saga).

The third lesson is that the ultimate outcome of a system is dependent on the abilities and character of the leader(s) who emerge. (Table 2)

In Episodes 4, 5, and 6 of the Star Wars saga, one can see how the powerful and evil Empire is destroyed by the young, inexperienced, and probably under-funded Rebel Alliance, apparently, 26 or so years after the creation of the Empire. It appears that, in the end, it was a simple matter of triumph of the light side of the Force over the dark side of the Force. However, it also seems that the "system" that existed in the Rebel Alliance and that allowed Princess Leia and Luke Skywalker (as the only surviving Force-endowed individuals) to victoriously emerge, was clearly different from the system of the old Republic that the previous Jedi (who were far greater in number) existed in. Different from the old Republic, the Rebel Alliance had a strongly united cause that attracted the support of unlikely heroes, ranging from the smuggler Han Solo, to the previously traitorous Lando Calrissian, to the very primitive Ewoks of Endor; that apparently mitigated any interpersonal drama or conflict from creating internal factions or detracting from their military effectiveness; and that allowed the best values (such as selflessness, altruism, and compassion) in people and aliens—even the non-Jedi—to emerge.

Administrative and liaison psychiatrists in-training can therefore learn from the success of the Rebel Alliance by paying attention to an organization’s mission and assessing the degree to which the team functions as a cohesive group unified around this mission—as opposed to a group where chaos is the accepted norm and where self-service supersedes the needs of the team and the patients served. It is this sort of team, in which the whole is greater than the sum of its parts, that is the agent of healing. Obviously, the ability of psychiatrists to lead a team or positively impact upon team functioning is contingent upon strong liaison relationships and the medical team’s acceptance of the psychiatrist’s role in the process. Psychiatrists in leadership roles may consider learning from the perseverance, patience, and consensus-building skills of the high-ability Star Wars leaders listed in Table 2 (minus the malevolence of Emperor Palpatine). In this regard, it is quite evident that the Jedi Luke Skywalker, with his compassion, team orientation, and dedication to the light side of the Force, ultimately emerged as the redeemer of both Anakin Skywalker and the Galactic Republic.

In this article, we have discussed how the fictional stories of Anakin Skywalker and the Galactic Republic can be integrated into the education of medical students and residents in psychiatry and administrative and liaison psychiatrists who may be favorably disposed to learning through analogies from the Star Wars saga. At this point, our integration of the Star Wars saga into curricular methodology has included only brief video clips to stimulate discussions with medical students, and references to the saga in mentorship discussions among Star Wars-literate colleagues. We believe that there is a role to further expand the use of Star Wars in medical education curricula. Specifically, we recommend that video clips of the Anakin/Palpatine and Anakin/Luke relationship can be used to capture students’ and residents’ interest in learning about the etiology and treatment of Conduct Disorder and other child and adolescent psychiatric disorders. We also recommend that video clips of the dysfunctional Republic (that was about to defer action on the life-threatening situation in Naboo to a separate committee) can be used to introduce topics such as health care quality, medical error, and clinician teamwork. Finally, we recommend that the Star Wars saga be available for viewing by anyone who may wish to further their knowledge of the saga and participate more deeply in discussions aimed at improving their skills in leadership, administration, and liaison. Overall, we contend that if we, as educators, are able to successfully inspire learners to 1) find "new hope" in patients and other health care team members who have succumbed to "darkness," 2) formulate treatment based on a careful inventory of risk and resilience factors, 3) identify and address difficulties in "the system" that may limit the quality of care received by patients, and 4) function as principled, unifying (and Jedi-like) leaders of health care systems, then we will have helped these learners to fulfill their Hippocratic Oath and their efforts to implement more modern recommendations for improving the quality of medical care.