心理（Psychiatrist Breaks Down Mental Health Scenes From Movies & TV

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- You're serious, aren't you?
You're telling us you killed those three young men
on the subway?
- Mm-hm.
- And why should we believe you?
- I got nothing left to lose.
- Not everybody does this,
it's extremely rare.
And, in fact, the Joker, unfortunately,
overplays the idea that mental illness
and violence are linked.
Hey GQ, I'm Dr. Eric Bender.
I'm a child, adolescent, adult and forensic psychiatrist,
and this is The Breakdown.
[upbeat music]
- [Eric] First up, "BoJack Horseman."
- Okay.
Trey and I will be in the coat room doing hand stuff.
Otherwise, you don't know anybody here.
- Hollyhock has walked into this party
and her friend is teasing her right away,
"You don't know anyone."
That is the worst thing you could say
to somebody who has what's called social anxiety disorder.
In social anxiety disorder,
people are terrified that when they go into a setting
where they don't know people,
or even when they do know people,
that they're gonna embarrass themselves,
that people are gonna see that they're anxious.
They might get so upset
they might even have some bodily pains,
like nausea or stomach pain,
and they wanna avoid the situation.
[club music] [Hollyhock breathing heavily]
As she looks around,
she starts to get more and more anxious.
You see her starting to hyperventilate.
She's starting to get short of breath.
There are all kinds of anxieties
and they differ in very significant ways.
Sometimes anxiety is really serious,
and we call things disorders if, in fact,
the anxiety impairs people's functionings during the day,
or in these cases,
say if she does have social anxiety disorder,
she avoids socializing.
That's pretty important for development.
That's impairing part of her life and a part of her day.
If it's a certain situation people avoid,
that can be called a phobia.
A fear of snakes, fear of flying.
So, there are specific situations that arise
that cause people anxiety too.
[Hollyhock breathing heavily]
- What do you see? - What?
- You are having an anxiety attack,
so look around the room and tell me what you see.
- I see people partying and passing out.
- This guy has done a really good job here
of using a therapy technique called grounding.
I have used this with patients.
When they get super anxious,
you can tell them to look around themselves
and to tell themselves where they are.
I'm standing here, I'm in a room, it is Tuesday.
- What else do you see?
- Books.
Pizza boxes.
I see light fixtures.
I see an odd amount of floor poufs.
- That's a terrific technique.
He also called it an anxiety attack.
That is another word people use to describe a panic attack.
She's clearly having a panic attack here.
He helps her with this grounding technique.
- You feel any calmer?
- Yeah, actually.
- It's a trick my psychiatrist taught me.
I'm Peter by the way.
So, this part is kinda of crowded.
You wanna go get some air?
- Yeah.
- If there are a lot of people around you
blocking where you are and where you're breathing,
yeah, absolutely, get out of the room
and get some fresh air.
You hear fresh air
because a lot of people have trouble, they're,
[Eric breathing quickly]
they're trying to breath,
so you want to get them out to a place
where they feel like they have more access to air,
so that can be more psychologically helpful too.
But I think sometimes it's even more,
"All right, let me get out of this crowded environment
"that's making me feel like I can't breathe."
Now, a panic attack usually comes on sudden onset
and they can tell they're having one.
They might say, "Yeah, I suspect if I go into that situation
"I'm going to have a panic attack."
But when it happens, it's just a super sudden onset
for most people.
Sometimes people with anxiety tend to drink more,
use substances more.
They want to feel relaxed.
Alcohol can relax you to some degree.
However, it can also on the rebound
make people's moods feel worse
or make anxiety worse.
So, then you can run into bad cycles of people feeling good,
and then it wears off, and they take more,
and they take more.
So there's this feeling like it can help,
but in the long run it might be hurting more.
I can't believe that one of the best portrayals
of anxiety and getting help
comes from a cartoon about anthropomorphize animals,
but this is really great.
First off, this guy is saying,
"Hey, I go to a psychiatrist."
That's going to make Hollyhock feel better.
He's saying, "Try this, it's helped me."
That's going to make her feel better.
So, this is a really good portrayal.
Next up, "Joker."
- You're serious, aren't you?
You're telling us you killed those three young men
on the subway?
- Mm-hm.
- And why should we believe you?
- I got nothing left to lose.
- So , I think about a couple of things.
The first thing is psychopathy.
And psychopathy is not a mental illness,
it's not a diagnosis.
Psychopathy is a collection of personality traits
that includes feeling no remorse,
it includes being callous, uncaring.
The Joker here is letting us know he's exactly that,
he has no remorse for killing these three people.
He also says he has nothing left to lose.
In a violence risk assessment in forensic psychiatry,
you look for things that are warning signs,
such as people who have been isolated and lonely,
people who have felt traumatized and persecuted,
and those who don't have any resilience factors,
factors inside that help them recover from traumatic events,
or external support, and that's exactly Arthur Fleck,
that's the Joker.
That can be what's called a pathway to violence.
Not everybody does this.
It's extremely rare.
And, in fact, the Joker unfortunately overplays the idea
that mental illness and violence are linked.
It's important to know that we don't know why
people get pushed over the edge,
and there are very, very few,
so that's really important.
At the same time,
there are people who are repeatedly traumatized,
neglected, abused,
and there's a rage that can develop inside them,
and I see that sometimes in psychotherapy
when I'm talking to people
who have been chronically abused or traumatized.
But again, those people do not, for the most part,
go out and commit any violent acts.
- My life is nothing but a comedy.
- Let me get this straight,
you think that killing those guys is funny?
- I do,
and I'm tired of pretending it's not.
- There's a difference between psychopathy and psychosis.
Psychosis is a break from reality.
People are hearing things, seeing things.
It's called hallucinations.
Those are psychotic issues.
The Joker doesn't seem to any of that.
In cases of psychopathy,
people use others in their lives to get what they want.
Other people are pawns.
- Ugh, why is everybody so upset about these guys?
If it was me dying on the sidewalk,
you'd walk right over me.
- We see his mood go back and forth from irritable,
to seemingly crying, to almost laughing a little bit.
That can be called a couple different things,
One word is lability, where you have such shifts,
but what explains it even more is probably a diagnosis
of what's called pseudobulbar affect.
And what that means is there's a disconnection
between the front of the brain, the cortex,
and the back of the brain, the cerebellum.
That connection actually helps us express our emotions.
When that's broken, either because of trauma,
and we know Arthur flack has a history of trauma
to his head even,
that connection can get disrupted.
And what happens is there can be a sudden onset of crying,
or laughing, even though the person might not even feel
as if something's humorous or that they're sad,
it just starts.
- What do you get-- - I don't think so.
- When you cross--
- [Murray] I think we're done with this show.
- A mentally ill loner with a society
that abandons him and treats him like trash?
- Call the police, Gene. - I'll tell you what you get.
- [Murray] Call the police.
- You get what you [beep] deserve.
- Something that also shows that this is more of
what's called psychopathy and not a psychosis,
a break from reality,
is that he's telling Murray exactly what's going to happen.
This is what you get.
He knows clearly what he's doing.
That show's he's of a sound mind.
He does not have any psychotic issue at this time.
He's not hearing voices.
He's not seeing things.
He doesn't have delusions.
In fact, his complaint about feeling discarded,
that is a common feeling
among people who do try to seek help
in the system for the traumas they've experienced.
Psychopath, you hear that word
and you do think of a serial killer
because a lot of the serial killers show psychopathy.
They don't care.
People are just pawns in their lives.
They're there for entertainment.
And I think in the Joker's case,
you might look at him and say,
"Here's this dude dressed all in clown makeup.
"There's gotta be something wrong with him."
Well, he's actually trying to be noticed in some ways.
This guy's lacked attention for his entire life
and he's been neglected.
He ends up getting pushed over the edge,
and again, we don't know why that happens,
and he turns to violence.
There is a genetic component to mental illness,
and his mother did have severe depression.
It's also much more common than people realize.
One in five Americans will have
a mental health challenge within a year.
And in fact, half of Americans will have
some mental health issue during their lifetime.
While the Joker ends up portraying this link
between violence and mental health issues
that doesn't exist, or perpetuates that stereotype,
it does do a very good job of showing
that resources can get pulled at any time.
At the end of the movie,
the social worker is explaining
that nobody cares about people like him,
that, in fact, money goes away,
and that does happen a lot.
So, clinics might be there,
and then they're relying on funding
that suddenly gets pulled,
and that translates into less help
for people who really do need it.
Next up, "Rain Man."
- Sally Dibbs.
Dibbs, Sally.
461-0192.
- How did you know my phone number?
- How'd you know that?
- You said read the telephone book last night.
Dibbs, Sally.
- Okay, so this is something...
It's pretty rare.
It's called savant syndrome, first off.
The idea of someone being able to read a phone book
and memorize it and know phone numbers,
that is a pretty extraordinary ability.
Right now, there's supposedly maybe one in a million people
living with savant syndrome.
That means there's a certain gift,
and it's usually in a few areas.
It could be an art, in arithmetic or math,
it could be in music.
So, here we see Raymond is able to memorize phone numbers.
He has this savant syndrome.
He also has autism.
Autism is a developmental disorder,
which means that as someone is developing,
they don't develop in the way most people
in society would develop.
And in autism, you look at two main areas.
You look at how somebody is developing
and how they're communicating,
and that includes do they make eye contact
and communicate with language?
Do they actually seek out reciprocity
or do they offer reciprocity?
Meaning, can they participate with someone
in a conversation in a normal way?
Or do they not point things out,
not try to draw attention to things in their world,
and not respond to people?
And you look and see how they respond to
nonverbal cues, nonverbal language.
People with autism can have some deficits
in some of those areas.
Another area you look at
is the interests of people with autism,
where someone maybe just hones in on one thing
and sticks with that,
and has an unusual attachment to that one thing,
or do they have a broad range of interests?
Also, you look to see if somebody has what's called
stereotyped behaviors.
It's an attempt to really soothe oneself,
but it doesn't really fit.
We see a little bit of self-soothing here in "Rain Man"
where Raymond, at first,
is rocking back and forth like this.
He's trying to calm himself down.
So, these are things that I look for
in autistic spectrum disorders.
It's also important to note autistic spectrum disorder,
or autism, it's a wide spectrum.
It just like if you say you're sick,
you might have a cold
or you might be in the ICU and need surgery.
If someone has autism, they could be impaired severely,
and Raymond is more towards that end,
or someone can be highly functioning
and have what used to be called Asperger's disorder,
where they don't really have the problem
of never developing language,
which can happen in severe cases of autism.
They might develop language,
but there are these other quirks about them.
- Of course, I don't have my toothpicks.
- No, you don't need toothpicks.
- I don't have my toothpicks.
- You don't need toothpicks, Ray,
if the pancakes keeps sliding off,
you're gonna eat with a fork.
- I don't have my maple syrup either.
I'm gonna be without my maple syrup and my toothpicks.
- Here we see what's called an adherence to a routine
that doesn't make sense to most people,
but to someone with autism, like Raymond,
that routine really is important.
And you could see his brother just wants to get breakfast.
He just wants to eat.
But when there's a shift from that routine,
it can be very hard for someone with autism
to deal with that.
In terms of why, a lot of people believe
that it is a comfort, it's a soothing thing.
And when he's pulled away from that, he has some trouble.
- Definitely not gonna have my pancakes without--
Ow!
- Don't make a scene.
- Ow!
- So, Tom Cruise, while he seems to be
a jerky guy in the movie,
in some ways he's responding to Raymond,
at least in this scene,
the same way most people would feel: frustrated.
I see this with family sometimes
with children with autism for instance, or even adults.
They just want to eat breakfast.
They don't want to go through this routine
of putting things out in a certain way.
So, a lot of times families will say to me, "Do we do this?
"Do we just go with these routines or what?"
There is a method of teaching people with autism
to discover and to work on behaviors
that are not adherent to their routine.
Applied behavioral analysis is the technique,
and you are really positively reinforcing behaviors
that help someone deal with shifts in their routine.
You reward that, and that teaches them
that they can actually do something
outside of their routine they want.
There are times when you do feel forced to
go along with this adherence to routine,
but there are ways to change that.
[toothpicks clattering]
- 82, 82, 82.
- That's a lot more than 82 toothpicks, Ray.
- 246 total. - The change.
- What also is seen here is more of the savant syndrome.
About half the people with savant syndrome have autism,
the other half have other abnormalities
in their brain development.
In fact, the person, Kim Peek,
whom supposedly Raymond Babbitt was based on,
he actually had a different type of issue with his brain
not related to autism.
But again, savant syndrome is very rare.
"Rain Man" does a wonderful job
of bringing to the screen a topic
that was not talked about at all.
This was great.
It started a conversation.
The challenge here is that "Rain Man" ends up making people
think that if you have autism you have some superpower,
and that's not the case.
Next up, "The Undoing."
- The defendant's mother told you
that Jonathan suffered neither guilt nor grief
in reaction to his four year old sister's death.
- They were certain once the shock wore off
the suffering would begin, but it didn't.
It never came.
- There's a difference in my mind
between suffering and remorse.
Not being able to suffer to me
doesn't suggest that someone doesn't care.
Some people really push away those feelings.
They don't let themselves feel sad about it.
Just because somebody doesn't grieve
the way we would expect doesn't make them a psychopath.
But, the lack of remorse seen again,
and again, and again, and again,
that could make somebody a psychopath.
If I'm looking at a lack of remorse,
I'm looking for other qualities about somebody too.
A collection of personality traits
to say they're psychopathic.
So, that might mean somebody lies consistently
about their background and who they are,
where they are, what they're doing.
Somebody is very glib,
able to feign interest in things.
I don't look for just no grief and no remorse.
I'm looking for this collection of things together.
- You told your friend, Sylvia Steinetz,
that you believed your husband
suffered from narcissistic personality disorder.
- It wasn't a professional diagnosis.
- [Catherine] But your opinion--
- Narcissistic personality disorder
is another type of personality disorder.
A narcissist, they do have a sense of grandiosity.
A sense of self-importance.
There might be fantasies about unlimited power,
beauty, money, things like that.
There are a number of other ways
someone can be a narcissist,
but there's a term called malignant narcissism,
which is used to describe people who do have
the narcissistic personality disorder
that include this lack of empathy,
that include using people in an exploitative ways.
In fact, when we look at serial killers,
sometimes we say that
serial killers have malignant narcissism,
that there's this lack of empathy.
And again, these are psychopathic traits as well.
Psychopathy is really interesting.
Even in populations that are very genetically isolated,
you might get a psychopath popping up,
just they're born that way.
That's the idea,
that innately there's just this callous,
uncaring nature to them.
The old way of looking at psychopathy,
they had what were called factor one traits,
there were traits about your personality,
and they had factor two traits.
That was the criminal behavior.
So, there's different layers of criminal behavior,
and it doesn't have to be murder.
Some people think that there's
white collar psychopaths so to speak,
where in companies people are doing things
that are kind of dodgy, not exactly following the rules,
and maybe those are psychopaths too.
There was a book a couple of years ago
exploring how many CEOs might have psychopathic traits.
Perhaps there's something about power,
perhaps in order to get to that level
you have to not care about other people.
You have to demand a certain level of treatment and respect,
and that's what narcissists do.
So there are all these different factors of narcissism,
but like I said, it doesn't mean they all lack empathy.
However, perhaps there's some degree of that
in certain people that do make it into those positions.
- Doctor, in your practice,
do you not tell patients that sometimes
they so want to believe in their partners
that they choose to unknown things, unsee things?
- There are cases of serial killers
where their partners had no idea
that they were out there killing hundreds of people.
That's pretty common that people don't know
about that side of their partner.
I think, as a psychologist or a psychiatrist,
you might actually try to hone in more
on people's personalities,
but you have to separate business and pleasure,
so maybe there was a lack of ability for her to see that.
It wouldn't surprise me.
Next up, "As Good As It Gets."
[locks clicking]
- One, two, three.
- I think what this character is certainly trying to depict
is something called obsessive compulsive disorder, or OCD.
Now, obsessive compulsive disorder
means that an individual has obsessions
or intrusive thoughts that don't feel right to them.
They feel what's called egodystonic.
It doesn't mesh with how they actually think,
or believe, or feel,
but something so powerful about them
that they obsess over them.
And then what we saw here
is what's called compulsive behavior.
The compulsions are the behaviors you do
to get rid of that anxiety over the obsessions.
It's a pretty extreme example.
Jack Nicholson's character has the obsessions
over being dirty, and the obsessions over numbers,
and the obsessions over this.
I mean, that's a pretty extreme example,
but that's what Hollywood does
to try to depict these things.
What's not seen is just how powerful
the obsession itself can be.
You kind of glean that
from the fact that he's doing all these things,
that obsession about being dirty is so upsetting to him,
but that parts left out.
It can be an extremely uncomfortable feeling
not to participate in the compulsive behavior.
His anxiety level might be sky high,
and that's why he's doing this, to avoid that feeling.
So, he's driven to do it to get rid of that
severe, severe anxiety.
There are ways to treat this.
There's cognitive behavioral therapy.
It's a way of challenging your thoughts,
the cognitive part.
Even more specifically is something called
exposure response prevention.
You expose yourself to the thing that makes you so anxious.
So, if it's that he's going to be dirty,
you might have him touch something that's dirty
and then wait, not wash his hands immediately.
And the idea is with repeated exposures
he could actually have his anxiety level go down over time.
We don't know why it happens.
It does just come in and start,
and you really do need to treat it
with exposure and response prevention
and also some medications.
People can actually have rituals or routines that they do
that seem very obsessive
but never really get diagnosed.
So, for instance, if you're always worried
about the door being locked,
and say you live with somebody
who doesn't always keep it locked,
and you go back and check,
that serves a functional purpose.
It means there's a reason you do that,
making sure you're safe.
But at the same time,
for some people there might be an element
of an obsession about that.
A fear that somebody's going to break in,
a fear that the door's not locked.
So, you can have OCD symptoms and not get diagnosed.
- Hi.
Help!
- If you want to see me, you will not do this.
You will make an appointment.
- So, here we do start to see just how upset
Jack Nicholson's character is with these anxieties,
and these obsessions, these compulsions that he has.
If someone has OCD,
they're not necessarily going to be a jerk and act this way.
The psychiatrist responds well
by putting limits on things and boundaries.
"We're not going to do this now.
"If you want an appointment, make an appointment."
I think that's also really important
in treatment with anybody to have good boundaries,
but you do start to see how hard this is for this character.
Typically, this doesn't happen with OCD.
There are other mental health issues where maybe
somebody has really bad boundaries.
And I think that's what they're hinting at too,
that he has other personality traits that make it hard
for him to interact with people in his world,
but at the same time, you see how much pain he's in.
- If you take responsibility to keep regular appointment--
- You changed the room.
- Two years ago.
I also regrew my beard,
but you're not interested in changes in me.
- That's not typical for someone with OCD
that they don't have any interest in other people.
I think what they're getting at here is that
there's something about this character that's beyond OCD.
That could be a personality disorder.
There's a difference between obsessive compulsive disorder
and obsessive compulsive personality disorder.
OCD, the phrase is you're uncomfortable.
You're really uncomfortable with what's going on.
OCPD, obsessive compulsive disorder,
the phrase is you make other people uncomfortable
because you want things in a certain way
and you believe it should be in a certain way.
Not because of OCD,
just because of the way you're wired here.
Here they're mixing a little bit of both.
Next up, "Girl, Interrupted."
- Am I in trouble for kissing an orderly
or giving my boyfriend a [beep]job?
- Susanna is supposed to have a diagnosis
of borderline personality disorder.
What that means is somebody is interacting
with the world vastly different than the cultural norm
and it causes problems for them.
Borderline was originally used to describe someone
who is on the border between neurotic,
meaning managing a lot of anxiety,
and psychotic, having a break from reality.
- You have some very interesting theories
about your illness.
You believe there is a mystical undertow in life.
Quicksands of shadows.
- We see a couple of things that suggests
she does have borderline personality disorder.
You have references to reckless behavior, which can occur,
and they're hinting that it's the sexual episode she's had.
There is this description of quicksands of time,
which might be more philosophical,
but the idea of shadows, is she seeing things at times?
Does she feel like there's something else there?
There can be chronic feelings of emptiness.
There can be an unstable sense of oneself.
That's what's being identified here by the psychiatrist.
- Your progress has plateaued.
Does that disappoint you?
- I'm ambivalent.
In fact, that's my new favorite word.
- This is actually really good therapy.
The psychiatrist identifies a plateau,
and she feels this patient can handle it
and pushes her a bit to say, you know,
"What do you think about your treatment?"
- It means I don't care.
That's what it means.
- On the contrary, Susanna, ambivalence suggests
strong feelings in opposition.
- She says she's ambivalent,
and she's really identifying something
I see in a lot of patients.
There are two types of feeling,
there's both a desire to get better
and there's this desire to give up.
A lot of times those are the opposing feelings,
so you really do see ambivalence in patients
and identifying it is very important for the therapy.
- The prefix, as an ambidextrous, means "both."
The rest of it, in Latin, means "figure."
The word suggests that you are torn.
- The doctor does a great job
in pointing out that it's not about not caring,
it's about the conflict between really wanting to get better
and feeling, "This is so hard, I'm never going to better,
"and I can't do this."
Ambivalence isn't a diagnosis, but it's commented on.
It certainly can be commented on
and it is fodder for the therapy.
I mean, that's certainly something to talk about,
and she picks up on it well.
- I signed myself in, I should be able to sign myself out.
- You signed yourself into our care.
We decide when you leave.
- You can sign yourself in voluntarily,
and you can argue that it's time to leave the hospital.
They can't keep you like this
unless you're a danger to self, danger to others,
or you're gravely disabled.
- How much will you indulge in your flaws?
What are your flaws?
Are they flaws?
If you embrace them,
will you commit yourself to hospital for life?
- You typically don't have this kind of
intensive psychotherapy when someone is in the hospital
for a short time.
This was a different time, the '60s,
and the psychiatrist does a really good job.
She's actually bringing forth all the questions
that someone with a borderline personality disorder
might be facing but not know how to articulate.
They're wondering are they really a bad person?
That unstable sense of self.
Or are they not?
Are there different ways to see things?
If I go down this path of thinking about myself,
how will my life look?
If I go down this path, how will life be?
So she does a really good job articulating for the patient
what might be inside her, what she might be thinking,
what she might be feeling,
and that can be a really effective therapeutic method.
There are a lot more pressures on kids
and adolescents these days.
What used to happen is
if you were getting bullied at school,
you were having a disagreement with somebody,
you could go home and have a respite
at least for, you know, 10 hours, 12 hours.
Now you can't, it's nonstop.
There is social media, there are text messages,
it's just nonstop.
Not only in a negative way,
because maybe people are cyber bullying,
but also kids today feel like their social life
revolves around who's commenting on this
and who's done what,
so there's this drive to be social that way to keep up,
and that can cause a lot of anxiety.
Another good thing that "Girl, Interrupted" does
is it shows someone who can participate in their treatment,
and who's not quote, unquote, "Crazy."
A lot of depictions of mental illness
show people who are so affected by their illness
that they can't function in society.
Susanna here does not have psychotic illnesses.
She might have some beliefs about herself that aren't true,
but that could come from trauma.
It could come from other things.
"Girl, Interrupted" does a good job of showing
that you can have somebody who is quite functional.
For many people,
mental illness is a part of who they are,
it doesn't define them.
Next up, "Inside Out."
- Won't it be great to be back out on the ice?
- Oh yeah, that sounds fantastic.
- So, pretty good depiction of depression in a teenager.
People often expect kids and teenagers
to appear sad when they're depressed,
but more commonly you see teenagers as irritable.
There is literally the absence of joy in her mind,
and she's not necessarily sad, she's irritable.
She doesn't know what to do or what to say.
That might be polite,
because she's not focused on that.
- Did you guys pick up on that?
- Uh-huh. - Mm-hm.
- Sure did. - Something's wrong.
- Should we ask her?
- Let's probe, but keep it subtle so she doesn't notice.
So, how was the first day of school?
- She's probing us.
- The other part of this that's really good
is the depiction of the parents, while humorous,
the mom's wondering, "What do I do?
"What do I do for my daughter?
"Something's not quite right."
They have a sense that something's not okay.
I think it's pretty clear as you see her more
throughout the movie that she's suffering
from some depression.
In depression, you look for a depressed mood,
or that irritability in an adolescent.
You look at loss of appetite, difficulty with sleep.
Are the things that interested her still joyful to her?
So hockey used to be, it doesn't seem to be anymore.
How she's concentrating.
She's not even focused on the questions.
It's kind of, "Huh?
"What?"
What you look at all of these things,
and together they describe a picture of depression.
Kids feel a lot of different things,
and especially in the teenage years
what they're interested in is new to them,
and they don't know how to explore that sometimes.
So all these feelings do intermix
and do exist in the head of a teenager.
I'm somebody who doesn't believe that teenage years
need to be all kinds of crazy.
I think actually they can be enjoyable years,
but it's important for parents to let kids explore life
and to take chances.
- School was great, all right?
- Riley, is everything okay?
- Ugh.
- Sir, she just rolled her eyes at us.
- What is her deal?
- Riley also just moved from Minnesota to San Francisco,
which is like moving to the moon,
so it's totally understandable
that she would feel out of place.
Even little things are hard for her to get used to.
When I see kids, one of the things I ask,
"Are there any major life changes?"
Because it can really be jarring to somebody.
- Riley, I do not like this new attitude.
- Oh, I'll show you attitude, old man.
- No, no, no, no, stay happy!
- What is your problem?
Just leave me alone!
- It is common for kids and teenagers, though,
to have mood issues, to have depression, to have anxiety.
And in some areas, the Bay area for instance,
New York, there's a high pressure,
so you often see kids with a lot of anxiety.
- That's it.
Go to your room.
Now.
- Ugh!
[emotions cheering]
- Good job, gentlemen.
That could have been a disaster.
- Well, that was a disaster.
- With adolescents there are certain approaches
that I recommend parents take.
You learn a lot more from an adolescent
when you are sitting side by side with them
or walking side by side with them
as opposed to direct eye contact.
That's more threatening for a teenager.
So if you go to a baseball game,
or if you're driving, or walking,
you're going to get a lot more out of that teenager
than you would if you're sitting there
talking to them eye to eye.
Also, probing is a good word.
You don't have to probe the teenager.
You can make observations.
You can make quick observations that can be really helpful
for fostering conversation.
This movie is actually really supposed to be
about mental health.
They had consultants working on the film,
psychologists and people really did explore emotions.
They really wanted to get it to be an accurate depiction
of mental health issues.
So, I really liked movie
and I think they did a good job depicting that.
And also, the parents feel so helpless
and they just want their kid to feel good,
and that's a message I see all the time from parents.
Next up, "Lars and the Real Girl."
- Minimalist Living or Country Home?
That's what I would have said.
- First thought you have about this guy
is that he's psychotic.
He has some delusional thinking here,
meaning he believes this doll is real
despite evidence to show she's not real.
In real life, you'd never see a psychotic issue like this,
because this last through the whole movie
and psychosis is generally not that persistent.
When someone has a psychotic disorder
you would have episodes of that.
Lars in the movie is being depicted as somebody
who really has no interest in relationships.
He's wearing gloves at times too,
doesn't want to touch people.
So it's never really explained in the movie what Lars has,
but when I look at him, I think he has some form of autism,
probably what would have been called Asperger's.
We don't use the term Asperger's disorder any longer.
What used to be those criteria are now fit under
autistic spectrum disorder.
He can communicate with people,
but he has trouble with relationships.
He doesn't know how to have them.
And that can be part of the problem
in terms of how they socialize
and communicate with other people.
The fact that he does want to have it
makes me think he falls more in line with
an autistic spectrum disorder
as opposed to other psychiatric illnesses
that you might see where someone stays away
from other people and fails to have relationships with them.
One of those things is schizoid personality disorder,
where a person doesn't want to have
any contact with anybody,
they see no meaning whatsoever in relationships.
He seems to see something,
because he wants to have this relationship with Bianca.
He brings her to the doctor
and is concerned about her blood pressure.
And I really think the best way to think about Lars
is what's the poetic meaning behind it,
but if we're looking for a mental health diagnosis
it probably falls more in line with
autistic spectrum disorder.
- I want you to bring her in every week
for special treatment.
Can you do that?
- Yeah.
Are you sure that that's necessary?
- I like to look at the whole emotional picture of Lars.
That's certainly what the doctor here does.
What Lars does have trouble with
is interacting with other people.
At times he's seen wearing black gloves even.
He doesn't want to touch people, said it hurts.
If you look at the psychological way to interpret that,
the emotional part of it,
he had a mother who died early
to the point that his father wasn't available to him.
That's some significant psychological trauma for a kid
not to have parents who are emotionally available.
So, wearing those gloves might signify it's painful for him
to even imagine being able to touch somebody,
because he feels so removed and so isolated from people.
So, there's a real emotional meaning behind this movie,
and the doctor picks up on it.
- I look forward to getting to know you, Bianca.
- So, this doctor is also a psychologist in the movie.
In this case, she's that this doll means something to Lars.
It's not just a psychotic disorder,
which means it's not just some delusion.
There's something here more emotional for him
and she picks up on that.
She asks him to come back.
And she's starting to some might say play into the delusion,
but I think what she's doing,
she's creating what's called a holding space.
What that is in psychology is a place for someone
to make a transition from something
very difficult emotionally to another place
that can be also difficult emotionally.
I think for Lars, he's transitioning from not really knowing
how to have relationships with people to even trying.
And this doll is kind of the object
that he starts to use to make that transition.
It's a good thing this is in Wisconsin,
because good luck getting somebody
to buy into this in New York City.
But in this town, this doctor can foster the whole town
to inquire about Bianca and make it seem like she is real
because she sees it is something important to Lars.
I think, again, this is more of a magical movie,
in that sense.
There is that emotional component to it.
If you are a functioning person
in therapy coming every week,
there could be some therapeutic component
to talking about the doll.
He's not hurting anybody with the doll.
He's not causing any violence.
He's not doing anything that would make it seem like
he's not functioning or needs to go to the hospital.
So, this is certainly a path to try to understand him more.
Next up, "Silver Linings Playbook."
- Mom, mom, mom!
I can't find my wedding video.
Mom, wake up.
- What is it?
- [Pat] Where's my wedding video?
- It's after three o'clock, what are you doing?
- I looked in here but this is all your [beep] up here
for your sewing and everything.
- This is a good depiction of a manic episode.
A manic episode means that for about a week
someone has had increased energy
with no need for a full night's sleep,
maybe just a couple hours.
They can be really elevated with their mood
and they can be irritable.
There's also a grandiosity,
a sense of self-importance,
possibly even doing things
that are somewhat dangerous or reckless.
And we're seeing him start to spiral
into this manic episode here.
We know the character has a bipolar disorder.
Bipolar disorder means that there's this change in mood
from baseline to this expansive elevated state.
There can be the other side, a depressive episode,
but there doesn't have to be
for somebody to be diagnosed with bipolar disorder.
Some people with bipolar disorder have only a manic state
every now and then, they don't have the depressive low.
You can get something in a manic episode
called increased goal directed behavior.
You can be really focused on one thing.
Some people, it's like,
"I'm going to write the next great novel.
"I'm going to change the course of humanity.
"I'm going to rebuild this wing of my home."
This is a much smaller task,
but he does get very focused on finding his wedding video.
It's not unheard of to have a task
that doesn't seem to mean a lot
suddenly take up all of someone's time
when they're in the middle of a manic episode.
- [Pat] I want to watch it!
- Stop it! - Hey!
- It's my wedding!
It's my wedding video!
- What's also important to note is that their family
are woken up in the middle of the night.
The family involvement is quite often seen.
A family can get really disrupted
because of an untreated episode
or because of these episodes.
- Let go of me! - Let him go!
- I'm sorry, I'm sorry!
- You have to make some hard choices.
If this were going on and he's manic like this
and he were actually violent with the family
and not able to stop,
you might have to call the police and have him brought in
to a mental health hospital so that he can be
at least evaluated for some time and calm down.
- You have to talk to her.
- Hey, sit down.
Listen, you're the one with a problem here, nobody else.
- You got to stop with these crazy theories.
He's a cop.
What are you doing?
- It's a medication problem and he's fine.
- Yeah, he's fine now?
You want to send it back to Baltimore?
- The mother says it's a medication issue.
That can be really demeaning to a patient
to feel like everything's dismissed
and it's just about medication.
It's true that that often is said,
and it's really painful to the person
who has the bipolar disorder
or any mental health issue.
It's common with mental illness
that people do have strong feelings about their medication.
There can be side effects.
In a bipolar disorder, if it's a manic episode,
you would try to put the brakes on
with an anti-psychotic medication,
and those medications do have side effects.
They can make people very sleepy.
There can be weight gain.
But, it's a bigger danger to have somebody who's manic
and who can do dangerous things.
You can use some medications, including anti-psychotics,
as mood stabilizers for long-term treatment.
Family members can really support people
with bipolar disorder
or even other mental health issues in many ways.
You can ask them, "What's it like to have this?"
They might not want to talk about it,
but just saying something like,
"If you ever want to talk about this,
"I'm certainly willing to talk about it with you.
"I want to be here to help you."
So just knowing that somebody's there for you to talk about
can be super helpful.
Support and love are very important
when it comes to helping somebody with mental illness.
It can't cure it.
That's the knock on the movie is that
everything turns out fine.
And there's some hint that Pat starts
taking his medication again,
but it's a hint,
it's not something that's shown very clearly.
So you do need to have love,
you do need to have support,
but it's not going to clear everything.
Next up, "A Beautiful Mind."
- Saw my name on the lecture slate.
You lying son of a bitch!
- who you're talking to?
Tell me who you see.
- Here we see a depiction of schizophrenia,
and schizophrenia is often misunderstood.
Schizophrenia is a psychotic illness.
It's an illness, meaning there's a break from reality.
Schizophrenia is a diagnosis you give after seeing someone
have a consistent psychotic episode
or episodes over a certain amount of time.
So at first it would be a psychotic episode
or a psychotic break,
but you wait to diagnose schizophrenia
until time has passed and it's still there.
A month long of hallucinations, or delusions,
or a thought disorder.
In schizophrenia, visual hallucinations
are not as consistent as this guy, Charles,
his so-called roommate.
I think they're trying to obviously get you to see that
he's seeing something that's not really there,
but you don't usually see something as consistent.
It's more of a blur.
It's more temporary.
The doctor really does try to ask John, "What's going on?
"What are you seeing?"
And that's a good technique.
What I often like to do is to say something like,
"Do you feel like your mind is playing tricks on you?
"Do you feel like you're seeing things
"other people aren't seeing
"or hearing things other people aren't hearing?"
Sometimes that can be a little bit more gentle than,
"What are you seeing?"
But I think it is a good idea to figure out
what is this person seeing.
- There's no one there, John.
There's no one there.
- He's right there.
He's right there.
- Some of these medications do have side effects
that can include drooling,
but it shouldn't be a deterrent from taking medication
because the medications can help with delusions
and hallucinations that really impair
someone's ability to function.
One thing that "A Beautiful Mind" did
was it kind of correlated having schizophrenia
and having a psychotic illness with having genius,
or that he's a genius because of his schizophrenia.
That's not the case.
You're not going to become a genius
because you have a psychotic illness like schizophrenia.
He might have a high intellect and also have schizophrenia,
but it's not the cause of it.
In fact, there's what's called a downward drift.
If someone has a psychotic illness
and doesn't get treated,
over time, it becomes harder and harder for them
to function in society,
not that they get smarter and smarter,
and they actually have a really hard time
functioning in their daily life.
- My name is John Nash.
I'm being held against my will.
Somebody call the Department of Defense.
- You do sometimes see patients yelling out like that
who are delusional, who are paranoid
that they're being held against their will,
and sometimes they are being held against their will
because they're believed to be a danger
to themselves or others,
or because they actually can't provide themselves
with food, clothing, and shelter, they're gravely disabled,
which is more of what he is.
But you do see people sometimes yell like this.
This is an old psych ward.
It's pretty big and there are a lot of people around.
I think in this shot here there's maybe six
mental health providers.
I feel like in some States there might not even be
six mental health providers,
there's such a shortage of mental health providers.
But a psychiatric ward can look like this
where there are rooms
and those rooms are private rooms for people.
This is dramatized to some degree.
They usually don't look like jails,
so that part's a little bit off,
but I can see that they're trying to show
that the patients are housed here
and their individual rooms and doors on the left.
I think it's really important for media to get depictions
of mental health right,
because people get a lot of their information
from these movies,
even though it's not necessarily accurate.
It's important to be accurate.
I was at a convention once.
This girl stood up, started crying, and said,
"When am I going to see a depiction of someone
"with mental illness who's not going to make me feel like
"I'm going to turn into a serial killer?"
So that's reason enough to have accurate depictions,
so people don't feel ashamed about themselves,
so people don't feel ashamed of going to treatment,
so people can have conversations,
and people can really pursue the help that they need.
Thanks so much for watching these clips with me.
I enjoyed breaking them down
and I hope you did too.
Hope to do it again with you in the future.
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心理（Psychiatrist Breaks Down Mental Health Scenes From Movies & TV | GQ）