Lessons From the Vast Wasteland

August 1, 2006

Could the content of television shows give you a common platform for discussing interests and experiences with your patients?

August 2006, Vol. XXIII, No. 9

The power of instantaneous sight and sound is without precedent in mankind's history. This is an awesome power. It has limitless capabilities for good-and for evil. And it carries with it awesome responsibilities- responsibilities which you and I cannot escape.

-Newton Minow, speech to the National Association of Broadcasters,
May 9, 1961

Mr Burby rubbed his temples vigorously. His wife covered her eyes and shook. I was puzzled by this couple's response to my parent guidance recommendation. I had suggested that they introduce a daily morning chat with their young children to preview the events of the day.

The Burbys, parents of 3- and 5-year-old healthy, active children, came to see me because they felt overwhelmed by the demands of parenthood. Each worked half-time so they could raise their children without a daily babysitter. By the end of the day, both parents were exhausted, and they were concerned that the children seemed grumpy and confused.

I explained that “previewing” often helps children deal with the feelings attached to that day's events. In addition, I thought that a day-activity chart might help the children hold on to the information shared in the morning talk.

Surely a day-activity chart could not be what evoked such a powerful response in both parents. I was quite sure that Mr Burby was holding back tears and that Mrs Burby was gently sobbing behind her covered face. Perhaps they were both reeling from their daily struggles.

Before I could offer comfort and ask about their intense feelings, Mr Burby chuckled. Mrs Burby uncovered her face but couldn't stop shaking: the shakes were from her laughter. “We watched that episode of Supernanny, too,” Mr Burby proclaimed. “Nanny Jo says to make daily activity charts.”

It turns out that the Burbys were right. We had both watched the same television show. Perhaps activity charts were at the forefront of my mind because of the show. But previewing events for children is a common suggestion in parent guidance and a helpful one. In this case, TV had served my patients and me well. The Burbys were more eager than usual to take my advice. That I had been validated by Nanny Jo seemed important to them.

A bad rap for television?

TV has gotten a bad rap. Yes, it's associated with childhood obesity, violent behavior, and a delay in learning to read. Perhaps it is even a cause for some children to shut down their use of imagination. Even Sesame Street has been criticized by educators for its frenzied pace. Could Sesame Street be a contributor to distractibility in the child viewer?

Trauma is also associated with TV viewing. News stations tend to replay visual images of real-life violent tragedies. I can still see President Kennedy's head being blown apart thanks to the continual rerun of the Zapruder tape. I was only 11 years old, but I will never forget the orange-red halo around JFK's head nor will I forget the searing sorrow caused by the assassination.

What visual images from TV will burn in the minds of our children? The images of the Twin Towers coming down? Terrorists holding knives and guns over shaking hostages? Or maybe everyday tragedies: bloodied bodies and wrecked cars shown repeatedly on the news at 5, 10, and 11 PM.

How television can help

Still, I do think that TV can be helpful to our patients and to us as we do the work of psychotherapy. First there are what I'll call “helping shows”: Dr Phil, Supernanny, Judge Judy, and The Apprentice, among others. I must also mention Oprah, who tries her best to help people through any number of serious issues from molestation to getting out of debt. I admit it: I love watching TV, and I do my best to learn from the shows that I watch.

Then there are “content shows”: comedies, dramas, and thrillers whose story lines hook my patients. The children often identify strongly with the tales and the characters.

My patient Deirdre is a 12-year-old tomboy. Her parents suffered greatly when they could not conceive a second child. They dealt with their grief by adopting a 6-year-old child with special needs. Despite many emotionally sensitive discussions between the parents and Deirdre to prepare her for the arrival of this new child, Deirdre was catapulted into a state of fear and despair.

Deirdre was already intensely involved with the TV show 7th Heaven, the ongoing saga of life with a kindly minister and his wife; their biologic children; and various other children who come to stay with them needing shelter, love, and support. Deirdre would often spend an entire psychotherapy session telling me about a specific episode in this series. I used the show's story, as recounted by my patient, to talk to her about her own unusual family structure. By talking about families in the context of the TV show, Deirdre was able to capture and articulate feelings that we both knew related to her real family situation. As with the Burbys, TV had come to the rescue.

One day, Deirdre arrived at our weekly session with DVDs containing 16 hours of 7th Heaven. “Watch it,” she demanded. “I need to know what you think.” Why was it so important to Deirdre that I watch the show rather than just hearing her accounts of it? Had she altered the facts of the story line? Was it possible that I might notice important details that Deirdre was aware of but couldn't quite put into words? Did she want to be sure that I spent time outside of our appointment thinking about her?

Without 16 hours to spare for Deirdre's “assignment,” I skimmed the season instead. Four episodes were sufficient to reveal that Deirdre had either missed or decided not to tell me details that I thought would have resonated with her. We had impassioned discussions about what I had noted and we were able to learn a great deal about the feelings that led to Deirdre's omissions. I did not position myself as a judge of whether Deirdre distorted information; rather, I had a genuine interest in the difference between what I saw by watching the show versus what I had heard from her. Having my own take on the characters and their lives did serve to deepen my work with Deirdre.

I had a similar experience with Suki, a 16-year-old patient with visual-spatial organizational issues. This cognitive challenge made it difficult for her to perform at an academic level commensurate with her intelligence. As a result, Suki often felt overwhelmed and anxious and had low self-regard. Her favorite TV show is Lost, the story of plane-crash survivors stranded on a mysterious island. Initially, Suki did not know that I am also an avid fan. Each episode of Lost begins with the startling close-up of an eye blinking open. The eye belongs to the character whose life will be featured in that episode. Lost has a broader focus than its predecessors in this genre, such as Lost in Space, Sliders, or Star Trek: Voyager. The background of each character is revealed through a series of nonlinear flashbacks. Over time, the viewer comes to understand how each character evolved into the person we see stranded on the island, and the characters' choices and behaviors make sense

Common experiences-or not?

So what happens when the therapist and the patient have interests or experiences in common, such as Suki's and my interest in Lost? The risk is that the therapist will assume that the patient views events the same way as the therapist. This happened when Suki and I had both watched a particular episode in which a child is abducted. I was caught up in the experience of a parent losing a child, but failed to realize that Suki had instead identified with the kidnapped child and was terrified. My failure to ask Suki about her take on this episode left me less able to understand her and made her feel alone with her fears. Luckily, Suki and I had already established a solid foundation and were able to get back on the track of understanding her inner world.

My patient Bill was a 16-year-old with severe attention-deficit/hyperactivity disorder, which always got him into trouble. Bill's impulses were hard for him to control even with the help of medication. He continually poked, pushed, and snapped at his classmates, leading to multiple detentions. Bill's favorite TV show, Law & Order, so tied into his emotional issues that he studiously viewed the show several times a day.

Crime, motivation for wrongdoing, and punishment were of intense interest to Bill. Bill's inner world was filled with questions about whether the TV criminal intended to commit the crime and whether the punishment was fair. I do think that watching Law & Order's trustworthy district attorney helped Bill a great deal.

Bill discussed one show incessantly. The content involved a decision by the DA to charge the criminal with manslaughter instead of “murder one.” Bill needed to know that the world could recognize that crimes might occur where there was no destructive goal.

Once Bill felt that he could be understood as a kid who did bad things without malicious intent, he became more interested in actually learning to control himself. Of course, we probably could have achieved this through direct discussions about his situation and through his interest in the game of chess and his love of cartooning. But Bill chose our venue-so Law & Order, and all that it meant to him, became the “playground” for our work.

It is a fact that in today's society, television has more influence on children than just about anything else. When my family and some family friends sat in a raft while a guide navigated us through the rapids of the Colorado River, the children connected by talking about The Simpsons. I was disappointed that they did not relate to each other around the thrill of traversing a class IV white-water rapid. But connect they did over intense discussions about a common interest: the exploits and antics of Bart Simpson.

I think that psychiatrists should welcome TV into their own lives-even “trashy” TV. We can be glad that through the content of helping shows and the narratives of thrillers, dramas, and comedies, we may find material that will facilitate the psychotherapy process. If we think of TV as useful, it may help catapult the people we treat into healthier emotional lives.

Dr Helper is a psychiatrist in private practice in Newton, Mass. She has written previously about managed care, the diagnostic assessment of children, the therapeutic space, and the developmental aspects of tree houses. All names used in this column are fictional.