Academic Psychiatry 24:214-224, December 2000
© 2000 Academic Psychiatry
The Life Stories of Children and Adolescents
Using Commercial Films as Teaching Aids
Adrian Sondheimer, M.D.
Dr. Sondheimer is Associate Professor of Psychiatry and Training Director of Child and Adolescent Psychiatry at the Division of Child and Adolescent Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ)–New Jersey Medical School, Newark, NJ. Address reprint requests to Dr. Sondheimer, Division of Child and Adolescent Psychiatry, UMDNJ–New Jersey Medical School, 215 South Orange Avenue, Newark, NJ 07103. e-mail: sondhean{at}umdnj.edu
|
ABSTRACT
|
Commercial films have been used by educators as helpful components in the psychiatry training process. Professional literature describing cinema focusing on children, adolescents, and their families, however, has been conspicuous by its absence. A solicitation from child and adolescent psychiatry members of the Association for Academic Psychiatry resulted in a compilation of 97 substantial and relevant commercial films, with each accompanied by a single-sentence annotated description. The author proposes a teaching approach and suggests questions to assist educators in the utilization of these films during the training of residents about child and adolescent themes and issues. A description of this approach is illustrated using two representative films.
Key Words: Films for Training • Childhood Disorders
|
INTRODUCTION
|
Stone (1) asserts: "life is a moral [read psychological, behavioral, and ethical] adventure." That is, human beings live, and tell, their stories. These stories becomes texts. Often these texts are the print or film descriptions of an individual's moral adventures, and it is via these media that readers, viewers, and professionals can more closely examine situations, contents, and themes.
Both print and video media have the power to harness the attention and emotions of students and trainees in a manner that unadorned, reductionistic professional case descriptions often do not. As with the use of fiction literature by psychiatric educators (2–5), commercial film is similarly used for teaching purposes. Engaging films, viewed with a suspension of disbelief, usually evoke an unfolding, enveloping, and uninterrupted atmosphere for the duration of the story. The experience of this medium contrasts with that of print literature, during the reading of which the reader is more likely to experience interruptions and discontinuities. It is no accident, therefore, that films have been used in the education of sundry health professionals (6–8), and specifically that of medical students, general house staff, and, more to the point, psychiatry residents (9,10).
|
CINEMA AND PSYCHIATRY
|
Cinema has long captured the attention and interest of psychiatric professionals, who have devoted considerable effort to movie analysis (11–13). Commercial films have been used to illustrate numerous psychiatric concerns, including diagnostic considerations (14), psychopathologic manifestations (15–18), and differing treatment approaches (19). For example, As Good as it Gets, The Man with the Golden Arm, Play Misty for Me, and Klute represent films that, respectively, do good jobs of depicting manifestations of obsessive– compulsive disorder, substance abuse, borderline personality disorder, and therapeutic technique. Somewhat less tangible, but nonetheless important, concepts, such as countertransference (20) and stigma (21) have similarly been portrayed. Representations of charged attractions between archetypal characters, as commonly occurs in the genre of film noir, have promoted insights into the interpersonal dynamics of ordinary individuals (22). Commercial film portrayals of physicians (23), psychiatrists, and psychiatric practice have received extensive description as well (24–26). The bulk of the psychiatric professional literature concerning films, however, as it relates to mental health concepts, practice, and education, has dealt largely with adult behaviors and manifestations. By contrast, the cinematic worlds inhabited by children and adolescents await larger exposure and more professional attention.
Film Selection Process
In March 1998, to address that need, the child and adolescent psychiatry members of the Association for Academic Psychiatry received a letter soliciting the titles, and one-sentence descriptors, of engaging and thought-provoking popular films depicting "important facets of child and adolescent development, pathology, and/or responses to the environment." It was intended that the proposed compilation be used by psychiatric educators to portray, for teaching purposes in general and/or child and adolescent psychiatry residency training settings, the developmental stages of childhood and adolescence and associated psychological phenomena.
Over a 2-year period, 112 titles were submitted, and 97 were included. Fictional screenplays, several documentaries, and the occasional animated film comprise those selected. Excluded from the compilation were films focusing primarily on adults as subjects, as well as those produced specifically as teaching vehicles with explicit didactic foci, for example, treatment approaches for designated psychopathologies; school-based discussions of non-majority sexual lifestyles, or drug use, etc. Clearly, such educational tools have great value, and relevant lists can be obtained from a variety of educational video producers and distributors. The focus of this effort, however, is on the world of evocative, visually-based, cinematic imagination.
Child and Adolescent Themes
The cinema compilation (see Appendix) has been parsed into a variety of categories, and the films are listed in alphabetical order by title. Individual films focus primarily on child and/or adolescent and/or familial functioning. Consequently, the portrayal of cognitive functions, interpersonal dynamics, developmental tasks, interests, and responses to stressors will vary with the protagonists' developmental stages. For example, Ponette deals with the life of a 4- year-old child, whereas Clueless focuses on adolescent shenanigans. The films also approach their subject matter in differing ways—with humor (comedy: e.g., Caddyshack, Hairspray), seriousness (drama: e.g., Dead Poets Society, Los Olvidados), a combination of the two (tragicomedy: e.g., Matilda, Say Anything), affection (e.g., Peppermint Soda, The White Balloon) and/or austerity (e.g., Sleepers, The Sweet Hereafter). Some films focus largely on single themes, for example, children's responses to abuse (Radio Flyer, This Boy's Life), loss (Careful, He Might Hear You, House of Cards), or war (Europa Europa, Forbidden Games); others focus on the varied manifestations of a developmental stage, for example, sexual interests, conflicts with parents, and inter-peer dynamics among adolescents (The Breakfast Club, Dazed and Confused, Sixteen Candles). Rarely, a film will depict children and/or adolescents with clear-cut psychiatric disorders (e.g., David and Lisa). More commonly, the delineation between normative and pathologic, when that issue arises at all, is hazy.
|
FILM DESCRIPTIONS/EDITORIAL DECISIONS
|
The descriptions of the selected films include the country in which the film was produced (for example, France) and, by implication, the language spoken (French); the nature of the approach (i.e., comedy, tragedy, drama, fable, fantasy, thriller), and year of release. The brief descriptions are written in the words of the contributing psychiatrist, identified in parentheses, with editing of the submission in order to improve clarity. The number of contributors and the wide variety of film subjects and approaches is confirmation of the range of tastes and interests among child and adolescent psychiatrists.
The request to avoid popular productions in favor of substantive ones was the single limitation posed for the contributors. A rating of 0–4 stars, derived from an industry-respected work that rates the perceived qualities of thousands of individual films (27), may possibly help guide instructor choices. It is certain, however, that determinations of quality most accurately reflect the tastes that exist in the eyes of the beholder. For example, whereas the majority of the selected films are rated 3 stars or better, representing "fine (* * *), memorable (* * *  ), or masterful (* * * *) cinematic expression," both Brooks (Blue Lagoon; no rating) and Sondheimer (Milk Money, * ) staunchly defend their recommendations. Not to include parental guidance (MPAA) ratings for this project was another editorial decision. Apart from sincere differences between professionals about their value and their potential for misuse via the exercise of censorship, it is assumed that all medical and psychiatry trainees are of sufficient maturity to be exposed to each of the films included in the attached list.
|
TEACHING APPROACHES
|
The films can largely be used in one of two ways: either by using excerpts, or "clips," to illustrate a particular psychiatric facet, or by showing a film in its entirety. Clearly, clips are convenient for instruction, given time and scheduling considerations. Also, they are a good means for rapidly portraying simple, unelaborated topics, for example, diagnostic entities, disordered communications, and/or pathological behaviors (15). By contrast, in a manner similar to discussions that follow the reading of a complete short story or novel, (28) it is proposed that the viewing of a film in its entirety by residents as a group provides them with the opportunity to respond affectively, cognitively, comprehensively, and collectively to the portrayals of the life stories viewed on the screen. In this setting, trainees commonly exchange comments and insights that reflect an expanded breadth and depth of understanding, while they frequently introduce ideas and notions not previously considered by the instructor. The attached compilation is intended to provide a listing of films that lend themselves to complete viewings by residents to produce this outcome.
All of the selected films lend themselves to instructional questions inclusive of: who is/are the protagonist(s); what are the central themes; how (in)accurately and/or (un)realistically are they conveyed; what is normative vs. pathological behavior; are the developmental features age-(in)congruent; what is the quality of the parenting; to what extent is child/adolescent initiative encouraged/discouraged; to what extent is adult limit-setting excessive/inadequate; what vulnerabilities and assets do the children possess; and to what extent do the sociocultural influences of gender, ethnicity, class, religion, and/or other environmental contexts shape or determine the protagonists' behaviors? Later in the discussion, speculation commonly develops concerning how the possession of psychiatric knowledge and/or the provision of psychiatric input might have affected the course of the portrayed behaviors and their outcomes.
Two Illustrative Films
To briefly illustrate the use of films as potential teaching tools, described below are the contents of two representative movies, some of their salient psychological features, and a sampling of resident responses to their viewing.
The novel Carrie, a gothic horror story written by Stephen King in 1974, with a screenplay directed by Brian DePalma in 1976, focuses on the sexually innocent mid-adolescent Carrie, the only child of a single-parent, fanatically religious, delusional mother. Setting the events of the film in motion, the girl, without preparation for the event, experiences with terror the onset of menarche while showering in her school's locker room. Consequently, immediately thereafter, she suffers vicious teasing at the hands of her female peers. Carrie is comforted and befriended by a concerned teacher/coach and, during later developments in the story, responds positively to the friendly overtures of a well-meaning teen couple. Subsequently, Carrie chooses to attend the school's graduation prom despite her mother's strongly antagonistic stance. After election as the prom queen, however, she experiences profound humiliation at the coronation, when her jealous peers drop a bucket of blood on her. In a murderous rage, and through the exercise of supernatural powers, Carrie creates a fiery inferno that destroys her school and all of the faculty and students attending the dance.
The film is an "over-the-top," taken-to-extremes, exaggeration of common adolescent experiences and events, pervaded by the pressured driving force of omnipresent sexual urges. Somewhat more subtly, the film dramatizes the negative impact of grossly disturbed parenting on a child, portrays the attempts of the vulnerable child to adjust to the demands of a severely disordered parent, and hints at the possibility of wholesome psychological change in injured children if aided by benevolent influences. However, the film also indicates the inherent fragility of the newly developed internal psychological structures when the vulnerable child or adolescent faces unexpected stress. The depiction of Carrie's relationship with her mother also portrays the need of the abused child for approval from his or her parents, irrespective of their coldness and lack of emotional support. Demonstrating yet another perspective on the adolescent–parent divide, the film ends with a dream episode experienced by the one survivor of the school's holocaust. This benevolent teen, clearly suffering from (undoubtedly chronic) posttraumatic stress disorder after the decimation of her world, is overwhelmed by her mother's attempts to comfort her with the endless repetition of the refrain: "it's all right." Hardly!!
Some trainees respond to the film as the horror story it literally is; others see beyond the literal view to the film's metaphoric representation of norms and pathologies in adolescent (and adult) development. Discussions with the residents range through diverse features and varied perceptions of the film, but tend to include the following comments: Carrie is a coming- of-age film—distorted, to be sure—but descriptive of the tendencies of individuals to engage periodically in extreme behaviors, whether they be cruel, impulsive, risk-taking, or generous. The enormous power and danger of the unbridled exercise of extreme will and/ or word, particularly in the service of doing harm or causing destruction to others as well as to self, is expressed in the mother's delusional rants, students' cruel teasing, and Carrie's devastating rage. Omnipresent, barely restrained sexual feelings and fantasies serve as constant refrains, underpinnings, and motivations for the behaviors in evidence throughout the story. When Carrie plaintively cries to her mother: "it's not Satan; it's me!", she personifies the movie's embodiment of the projected fears and fantasies commonly harbored by adults regarding adolescents, that is, that their rapidly developing physical and sexual powers represent significant threats of potential rebellion and overthrow to the adults' desires for order and constraint (29), thus obscuring the realistic view of the adolescent as the genuine person that he or she in fact is.
In addition to the themes described above, residents bring unique and personal perspectives to the discussion of the film. Their contributions have included comments by one trainee who, living in the context of an insular religious community, declares the film's portrayal of religious extremism to be realistic and not exaggerated; another focuses on Carrie as the prototype of an emotionally abused child and likens her generally repressed rage to what he has seen in abused patients under his care. Yet another trainee startles those assembled by pointing out the imitation of art by life, as she adjoins the reality of the recent Columbine High School massacre with features it shares with the film—namely, the school setting, the adolescents' rage, the possession of powerful instruments of destruction, the desire to use them for retaliation, and the absence of both internal and external structures to prevent their pernicious implementation.
The opening scene of Salaam Bombay, released in 1988 as a first directorial effort by Mira Nair, features the move of a touring circus from a rural area that results in the unanticipated abandonment and sudden unemployment of an illiterate 10-year-old boy, Krishna. Penniless and alone, he arrives by train in Bombay, is immediately engulfed by the overflowing multitudes and sounds of that large city, and is pursued by a deranged street person in his first human encounter there. Krishna quickly becomes one of many homeless boys living together on the streets, as the story describes his exposure to life in Bombay's teeming slums. Krishna's experiences include child labor at meager pay, mothering by a prostitute, friendship with a low-level drug runner, attraction to a girl kidnapped in the country for purposes of prostitution, petty thievery, and an introduction to alcohol and soft drug use. Later, he is incarcerated in, and escapes from, a boy's detention home. Throughout these experiences, Krishna is portrayed as a quiet, resourceful, observant, and resilient child, capable of emotional attachment and caring. On the other hand, in the course of his short life, he has set two fires, and at the close of the film he stabs to death a male assailant of the prostitute who initially befriended him. The film ends with the pair fleeing the murder scene together, but subsequently becoming separated by the jostling of an enormous crowd participating in a cacophonous outdoor festival. Krishna is last seen sitting by himself on a side-street window sill, crying briefly, and then staring numbly into what must be a bleak future with no obvious options.
At a recent showing of this film, five of the six attending residents were international medical graduates, representing three different "underdeveloped" nations. All five immediately stated that the movie's depictions of conditions in Bombay were factual and illustrative of the harsh realities extant in the huge metropolises of many third-world countries. The sixth resident reminded her peers that these conditions were no different from those existing in North America's inner-cities. Other comments included speculations about the effects of disadvantaged settings on child development; the variable degrees of resilience, and the posited contributors to these internal strengths, shown by young individuals living in situations of deprivation; the degree to which hopes for a better future (on the part of child or caretaker) are well-founded or poorly constructed; and the perplexing quests for solutions to, and useful interventions directed at, the problems of both the individual child and the environmental contexts in which he or she lives. The residents viewed themselves as privileged individuals, who take food, shelter, and clothing for granted, in contrast to the film's disadvantaged children. The imperative need to survive in the present, with the past essentially erased and with little concrete thought devoted to the future, made the most salient impression on the viewers.
Several additional major considerations emerged. First, despite the antisocial behavior in which many of the inhabitants engaged, none of the individuals were thoroughly malevolent. Rather, all were multifaceted persons possessing a mix of qualities and impediments and, despite off-putting surface behaviors, they all sought dignity. The residents felt, therefore, that the protagonists deserved to be treated with respect, although the story clearly made the point that such individuals are rarely approached with courtesy or regard. Second, the residents remarked on the numbing process, necessary for survival, experienced by individuals living in disadvantaged settings. They spoke of a related numbing process affecting themselves that followed their frequent exposure to similar life stories during their treatments of patients. One resident remarked that it often requires a new experience, "such as a new patient or film," to "make me start thinking again—to remind myself to be sensitive, and not to condemn or ignore [the patient]."
Finally, after numerous comments focusing on socioenvironmental matters, the discussion centered on possible outcomes for individual children. Krishna, an appealing and sensitive boy, responsive to warmth, has, by age 10, committed two arsons and a murder, albeit in the pursuit of his approach to righting wrongs. What is his likely prognosis? Would the expenditure of "much love" and "many dollars" make a difference? If so, what kind, in what quantity, and how would it and they be administered? Would individual treatment, foster care, and/or a group home lead to an improved outcome for a boy like Krishna? This discussion led to an analysis of the friction existing between the significance of statistics supporting the predictive probability of "past as prologue" vs. the hope inherent to the treatment of each child as a unique person with no predetermined outcome, and to the acknowledgement of advocacy for such an impaired child as an essential component of the armamentarium of the child and adolescent psychiatrist.
|
CONCLUSIONS
|
The attached compilation should serve well as a current source of accessible films "certified," primarily by child and adolescent psychiatry educators in a collaborative effort, as cinema that can be and has been (30,31) readily and easily used to educate trainees concerning a host of psychological matters relevant to children and adolescents. Expertise in the world of cinema was not required of the contributors, although such knowledge can be readily obtained (32). Rather, the compilation is a reflection of the thought that educators can give to media not ordinarily used for teaching purposes. Undoubtedly, the selections do not include many films whose titles will occur to readers, and numerous films created in the future will similarly deserve consideration for inclusion. Furthermore, many questions in addition to those mentioned above would be expected to be raised in discussions after the viewing of these films, and highly specific teaching goals could be attempted as well (33). Whatever the inadequacies of this compilation, however, the list should serve as both a useful teaching tool for psychiatry educators and as a reminder of the value of using teaching aids and approaches that are "outside the box."
|
ACKNOWLEDGMENTS
|
The author acknowledges and gratefully thanks the physicians who contributed titles to this film compilation, including child and adolescent psychiatrists M. Abene, B. Brooks, D. Cline, M. Drell, E. Frosch, L. Hartmann, J. Harris, H. Leonard, J. Lock, J. Penn, A. Rostain, J. Sargent, S. Satterfield, K. Shaw, A. Sood, H. Wright, and J. Zrull; general psychiatrists M. Alpert, J. Guerrero, S. Hyler, J. McCartney, and E. Silberman; pediatrician and public health physician B. Guyer; and my teenage (film) critics Ilan and Tavor.
|
REFERENCES
|
- Stone A: Law, psychology, and morality: an exploration through film. American Psychiatric Association Annual Meeting Media Session 13, Chicago, IL, May 2000
- Silberger J Jr: Using literary materials to teach psychiatry. Seminars in Psychiatry 1973; 5:275-285[Medline]
- Robert JL, Steinfink DE: "Story-hour psychiatry:" a fiction seminar for residents. Journal of Psychiatric Education 1980; 4:43-46
- Sondheimer A: The literature and medicine seminar for medical students. Academic Psychiatry 1994; 18:38-44[Abstract]
- Tucker WM: Teaching psychiatry through literature: the short story as case history. Academic Psychiatry 1994; 18:211-219[Abstract]
- Nissam-Sabbat D: The teaching of abnormal psychology through cinema. Teaching Psychology 1979; 17:185-187
- Fleming MZ, Manvell R: Images of Madness: the Portrayal of Insanity in the Feature Film. Rutherford, NJ, Associated University Presses, 1985
- Wilt DL, Evans GW, Muenchen R, et al: Teaching with entertainment films: an empathic focus. J Psychosoc Nurs Ment Health Serv 1995; 6:5-14
- Fritz GF, Poe RO: The role of a cinema seminar in psychiatric education. Am J Psychiatry 1979; 136:207-210[Abstract/Free Full Text]
- Rodenhauser P, Leetz KL: Complementing the education of psychiatry residents: a study of novels, plays, and films. Journal of Psychiatric Education 1987; 11:243-248
- Wolfenstein M, Leites N: The Movies. New York, Atheneum, 1970
- Greenberg HR: The Movies on Your Mind. New York, EP Dutton, 1975
- Gabbard GO: The psychoanalyst at the movies. Int J Psychoanal 1997; 78:429-434
- Hyler SE: DSM-III at the cinema: madness in the movies. Compr Psychiatry 1988; 29:195-206[CrossRef][Medline]
- Hyler SE, Moore J: Teaching psychiatry? let Hollywood help! suicide in the cinema. Academic Psychiatry 1996; 20:212-219[Abstract]
- Hyler SE, Schanzer B: Using commercially available films to teach about borderline personality disorder. Bull Menninger Clin 1997; 61:458-468[Medline]
- Hyler SE, Remien R: Using commercial films to teach about AIDS. Journal of Practical Psychiatry and Behavioral Health 1998; 4:230-235
- Wedding D, Boyd MA: Movies and Mental Illness: Using Films to Understand Psychopathology. New York, McGraw- Hill College, 1999
- Samuels L: Female psychotherapists as portrayed in film, fiction, and nonfiction. J Am Acad Psychoanal 1985; 13:367-378[Medline]
- Gabbard GO, Gabbard K: Countertransference at the movies. Psychoanal Rev 1985; 72:171-184[Medline]
- Hyler SE, Gabbard GO, Schneider I: Homicidal maniacs to narcissistic parasites: the stigmatization of the mentally ill in the movies. Hosp Community Psychiatry 1991; 42:1044-1048
- Swift WJ, Cody G: Gilda: fear and loathing of the exquisite object of relentless desire. Gender and Psychoanalysis 1998; 3:301-330
- Daws PE: Doctors in the Movies. Bloomington, IL, Medi-Ed Press, 2000
- Schneider I: The theory and practice of movie psychiatry. Am J Psychiatry 1987; 144:996-1002
- Schneider I: Images of the mind: psychiatry in the commercial film. Am J Psychiatry 1977; 134:613-620[Abstract/Free Full Text]
- Gabbard GO, Gabbard K: Psychiatry and the Cinema, 2nd Edition. Washington, DC, American Psychiatric Press, 1999
- Connors M, Craddock J: VideoHound's Golden Movie Retriever. Detroit, Visible Ink, 2000
- Coles R: The Call of Stories. Boston, MA, Houghton-Mifflin, 1989
- Anthony EJ: The reactions of adults to adolescents and their behavior, in: The Psychology of Adolescence. Edited by Esman AH. New York, International Universities Press, 1975, pp 467-493
- Miller F: Using the movie "Ordinary People" to teach psychodynamic psychotherapy with adolescents. Academic Psychiatry 1999; 23:174-179[Abstract/Free Full Text]
- Kaye DL, Ets-Hokin E: The Breakfast Club: utilizing popular film to teach adolescent development. Academic Psychiatry 2000; 24:110-116[Abstract/Free Full Text]
- Mast G, Kawin B: A Short History of the Movies, 4th Edition. New York, Bobbs-Merrill, 1996
- Misch DA: Psychosocial formulation training using commercial films. Academic Psychiatry 2000; 24:99-104[Abstract/Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
S. A. Zerby
Using the Science Fiction Film Invaders From Mars in a Child Psychiatry Seminar
Acad Psychiatry,
August 1, 2005;
29(3):
316 - 321.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Rosenstock
Beyond A Beautiful Mind: Film Choices for Teaching Schizophrenia
Acad Psychiatry,
June 1, 2003;
27(2):
117 - 122.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kaliebe and A. Sondheimer
The Media: Relationships to Psychiatry and Children: A Seminar
Acad Psychiatry,
September 1, 2002;
26(3):
205 - 215.
[Abstract]
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2000
Academic Psychiatry.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
TOP
ABSTRACT
INTRODUCTION
