Hollywood has had a long-standing love affair with psychiatry (Gabbard and Gabbard, 1999; Schneider, 1987, 1977). Dating from the first psychiatric film, Dr. Dippy's Sanitarium (1906), almost 500 movies dealing with the specialty have been made. While the film industry has demonstrated a particular fascination for depicting psychotherapy, physical treatments including electroconvulsive therapy have also been featured (McDonald and Walter, 2001; Walter, 1998). Indeed, some of the major psychiatric films--The Snake Pit (1948), One Flew Over the Cuckoo's Nest (1975), Frances (1982) and Shine (1996)--have prominent convulsive therapy scenes. (See the Table for a selected chronology of films depicting ECT.)
Portrayals of ECT reflect and influence public attitudes toward the treatment. For example, in a survey of lay attitudes toward convulsive therapy, the majority of respondents who had seen One Flew Over the Cuckoo's Nest were "put off ECT" by the film (O'Shea and McGennis, 1983). In another study, one-third of medical students decreased their support for the treatment after being shown ECT scenes from movies, and the proportion of students who would dissuade a family member or friend from having ECT rose from less than 10% prior to viewing to almost 25% afterward (Walter et al., 2002). So what is the legacy of portrayals that have been so abhorrent, and are there any exceptions to the rule?
Electroconvulsive therapy made its film debut in 1948 in Anatole Litvak's Academy Award-winning The Snake Pit, a movie set at Juniper Hill State Hospital. The film follows the path to recovery of Virginia Cunningham (Olivia de Havilland), a young writer who develops a psychosis shortly after marriage. Taken to the ECT room for treatment, a perplexed Virginia sees the previous patient being wheeled out, mouth guard still protruding. Fully conscious, Virginia asks before receiving the treatment, "Why are you electrocuting me?" Trumpets and flutes loudly announce the delivery of the electrical current. After three further treatments, mild improvement is noted and Virginia's psychiatrist terminates the course, much to the annoyance of the officious head nurse. Psychotherapy could then begin.
The second celluloid appearance is in Fear Strikes Out (1957), a recounting of the true story of Jim Piersall, a baseball player who suffered a catatonic breakdown shortly after joining the Boston Red Sox. Soon after his admission to hospital, the psychiatrist seeks consent for "electroshock" from Jim's wife. "I can't promise anything, and I won't minimize the risk," he declares, without elaborating upon the latter. After several treatments, Jim emerges from catatonia and can engage in psychotherapy. Electroconvulsive therapy was again a helpful adjunct to the psychotherapist's treatment.
After such a promising start, ECT is progressively depicted more negatively. In Shock Corridor (1963), a reporter becomes psychotic and receives convulsive therapy. The portrayed treatment is barbaric. The reporter is strapped to a table with leather bands on his arms and legs, as a rolled-up bandage wad is shoved into his mouth. His recovery is short-lived and, by the movie's end, he is frozen and mute.
Subsequent films during the heyday of the antipsychiatry movement portrayed ECT as an agent of social control, a protector of the status quo, a weapon against individual freedom. In A Woman Under the Influence (1974), Mabel, the overburdened matriarch of a wild young family, cannot cope with her unruly children and her frenzied husband; she has a "nervous breakdown" and is taken to a psychiatric hospital. The underlying theme is that the real problem is the family (society), and her reaction is entirely appropriate. When she returns home, Mabel announces that she received shock treatment every day in hospital. Nothing has changed and, shortly afterward, she attempts to cut her wrists.
The quintessential antipsychiatry movie is One Flew Over the Cuckoo's Nest (1975), in which the misguided and malevolent role of psychiatry is explicitly made. The movie follows the fate of Randle Patrick McMurphy (Jack Nicholson) as the renegade individualist clashing with society. McMurphy, a small-time criminal feigning psychiatric illness to dodge jail, is sent for an inpatient assessment. He becomes locked in a battle of wills with the staff, who soon call on ever stronger weapons: first medicines, then ECT seizures and finally bilateral frontal lobotomy. Near the beginning of the film, McMurphy stimulates a patient revolt on the ward. After a scuffle with the staff, he and two others are led to the ECT suite. We see the first patient being dragged into the room kicking and screaming, soon emerging unconscious on a trolley. McMurphy is led into the suite in restraints. He is met by three wardsmen, a nurse and a doctor, who smilingly declares, "This won't hurt a bit and it will be over in just a minute." His forehead is swabbed, a mouth guard inserted, a pincer set of electrodes is placed on his temples and, as he lies fully conscious, a switch is flicked on the ECT machine. McMurphy immediately begins a clonic seizure as the camera zooms in on his face, full of tension and pain. Unlike the frenzied musical accompaniment of previous ECT scenes, the only sounds are his laboured grunts and heavy breathing. When the seizure ends, the scene cuts to a group therapy session in the old ward, presided over by the manipulative Nurse Ratched (Louise Fletcher). McMurphy stumbles in like a zombie, much to the distress of the other patients, but he winks at one of them and we are soon aware that he is faking it. He suddenly bursts into life and teases his gullible mates, memorably declaring, "Perfect. They was giving me 10,000 watts a day, you know, and I'm hot to trot. Next woman takes me on's gonna light up like a pinball machine and pay off in silver dollars." Electroconvulsive therapy is presented as a barbaric and unjustified tool for social control, but also as impotent and ineffective.
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Walter G, McDonald A, Rey JM, Rosen A (2002), Medical student knowledge and attitudes regarding ECT prior to and after viewing ECT scenes from movies. J ECT 18(1):43-46 [see comment].