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Mental Illness on the Screen: No More Snake Pit

Mental Illness on the Screen: No More Snake Pit

Just 2 minutes before an episode of the television show Boston Legal aired, Roger Pitman, MD, professor of psychiatry at Harvard Medical School, received a telephone call from his sister-in-law informing him that the show would include a segment on propranolol, a drug he was researching for the prevention and treatment of posttraumatic stress disorder (PTSD).

After watching the "Selling Sickness" episode,1 Pitman was amazed at how quickly his research, albeit substantially embellished, had made it to a popular television show viewed by more than 10 million people.

The episode included a fictional story about a 16-year-old girl, Michelle, who had recently been molested by a rabbi, and about the ensuing conflict between her divorced parents over whether Michelle should take the "forgetting pill." Michelle's psychiatrist father sought a court order to permit her to take the pill, while her mother opposed it. The pill was propranolol (Inderal), a ß-blocker, which is FDA-approved for the treatment of hypertension and angina pectoris, among other disorders.

In the courtroom drama, the father's attorney described the drug as essentially blocking "adrenaline from entering the nerve cell, and adrenaline attaches emotion to memories. If you take the drug quickly enough, it can prevent you from remembering and being scarred by the trauma." He then added that it had been used "with soldiers suffering from PTSD with good results."

Opposing the drug's use, Michelle's mother argued: "You just can't erase the bad parts of life," and "our best artists are informed by their pain. . . . Certainly, if the trauma affects your life, treat it, either behaviorally or with medication. But some miracle amnesia pill, so you have no memory of bad things—what kind of brave new world are we entering into?"

The episode segment ends with the judge ruling against Michelle being given the drug.

Boston Legal's writers "used artistic license to make more out of this than there currently is," Pitman said. "I thought the [drug's] effects that were portrayed in the show were beyond what we know the effects to be, but . . . the discussion of the ethical issues was fairly good."

Pitman believes the Boston Legal script was based on a CBS 60 Minutes segment aired November 26, 2006, in which correspondent Lesley Stahl interviewed him, other researchers, and study participants with PTSD who had received propranolol.2

"The 60 Minutes show indicated that this research was experimental and that there were not any firm results yet," Pitman said. "Now, in . . . Boston Legal, the plaintiffs were portraying it like it was this miracle drug. On the other hand, the defendant's lawyer did say that it hadn't even been shown to be effective yet."

Summarizing his reaction to the episode, Pitman said, "It was an interesting show, but what we need is more data rather than more interest. . . . At this point, the most important thing for us to do is to continue our research and see what there really is to this drug."

Writers draw on life experience As with the Boston Legal episode, many story lines of television series and films are increasingly imitating life. But is the information accurate? The importance of this question is highlighted by a 2001 Healthstyles Survey that found more than half (57%) of regular viewers reported learning something about a disease or how to prevent it from a daytime/ prime time drama.3

Certainly, when mobster Tony Soprano sought treatment for panic attacks in The Sopranos, the process and purpose of psychotherapy received wide exposure. The television series provided one of the best depictions of psychotherapy "to ever appear on film or television," according to Glenn Gabbard, MD, Brown Foundation Professor of Psychoanalysis at Baylor College of Medicine and author of a book about The Sopranos.4

Increasingly, writers, directors, and producers of prime time shows or feature- length films, along with actors, are shifting away from mental illness stereotypes and seeking the input of psychiatrists, psychologists, other mental health experts, family members of the mentally ill, and those suffering from the disorders.

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