The Ultimate Antipsychiatry Movie?

Side Effects may qualify as a new level of antipsychiatry film.  I went to see this film last night with a vague notion that it was a thriller with some surprise plot twists and that it may have something to do with psychiatry. I walked out one hour and 46 minutes later with the impression that I had seen an antipsychiatry movie on a grander scale than previously observed. My previous standard was the psychiatrist who happened to be a serial killer and cannibal. The psychiatrists portrayed in this film were not as aggressive but certainly had their fair share of criminal activity, unethical behavior, and boundary violations.  The sheer scope of that behavior was striking.

The plot unfolds as we get to know Emily Taylor (Rooney Mara).  She appears to be depressed and even suicidal at times. This depression occurs in the context of significant life stressors including the incarceration and subsequent release of her husband Martin (Channing Tatum) for securities fraud. There is an overall impression that the couple lost quite a bit of status and financial resources as a result of that problem. We see her struggling at work and eventually intentionally injuring herself. That leads to her initial encounter with Dr. Jonathan Banks (Jude Law).  Dr. Banks initiates treatment with antidepressant medication and Emily seems to be experiencing intolerable side effects from the initial SSRIs.  In the meantime, Dr. Banks is in touch with Emily's previous psychiatrist Dr. Victoria Siebert (Catherine Zeta-Jones) who suggests a new recently approved antidepressant.  Emily takes this new medication and appears to be experiencing even more side effects right up to the point that she kills Martin while she is apparently “sleepwalking” as a medication related side effect.

From the initial perspective, it seemed like a heavy-handed “psychiatrists corrupted by Big Pharma” film until that point. After all Emily seems to be clearly made ill by the drugs and that point is emphasized cinematically by slowing down the entire scene in what seems to be her drug addled perspective.  Her psychiatrist seems indifferent to the problem and the fact that her spouse is getting more angry about the situation.  At one point the representative of a pharmaceutical company offers to pay Dr. Banks a considerable sum of money for doing research on the new antidepressant. There is a suggestion that Dr. Banks is already spread too thin. In that same scene, the representative emphasizes that she can buy psychiatrists meals and they banter about consulting fees.  Dr. Siebert hands Dr. Banks a pharmaceutical company branded pen with the name of the new drug printed on the side.  The sum of the cinematic effect at that point is to suggest that antidepressants are very toxic drugs, psychiatrists inflict more problems on people with these drugs, and that psychiatrists essentially prescribe these drugs because they are pawns for Big Pharma.  Admittedly nothing more than you might read in the Washington Post.

The plot lurched forward at that point to the issue of a not guilty by reason of insanity defense and the interactions of Dr. Banks with his patient even after she was sent away to a forensics facility. There was also considerable emphasis on the interaction between Dr. Banks and Dr. Siebert.  I will try to point out problems that occur along the way without giving away the rest of the plot. The first problem at that point in the movie was both the defense attorney and the prosecuting attorney suggesting that Dr. Banks should consult for their side. The fact that Dr. Banks has a treatment relationship with Emily makes his consulting with either side a clear conflict of interest, even in a non-criminal matter. He continues to see Emily at the state forensics facility.  At that time he is seeing her only to advance his interests and they no longer have a therapeutic relationship.  He threatens her, essentially blackmails her, and administers a questionable treatment in an unethical manner.  We later learn that Dr. Siebert also has an inappropriate relationship with Emily and has been involved in criminal activity with her.

At one point, Dr. Siebert attempts to ruin Dr. Banks’ professional reputation and relationship with his wife by releasing a letter from a former patient and manipulated photographs of Dr. Banks and Emily. His partners react strongly and fire him from their practice. An investigator from the state medical board seems suspicious of Dr. Banks.  Part of this side plot seems to be the only plausible aspect of this film and only insofar as complaints against physicians and psychiatrists are common and greatly outnumber the incidence of inappropriate physician behavior. The reaction of Dr. Banks’ partners to this material as well as an adverse outcome is overdone.  Any psychiatrist treating people with severe mental illnesses has adverse outcomes.  Most reasonable people agree that an adverse outcome in medicine and psychiatry does not imply either negligence or criminal intent.

I am generally focused on the purely cinematic aspects of any film that portrays psychiatrists. I explained my rationale for this approach in a previous review.  My approach is based on the low likelihood of seeing an accurate cinematic portrayal of a psychiatrist.  I imagine that other professionals have the same experience. The problem with this film is that the actions of psychiatrists are the major part of the plot and it is difficult to focus on the motivations and personalities of the other characters.  The character of Emily is not developed very well and her actions are difficult to understand.  Dr. Banks and Dr. Siebert are certainly much more active but their de novo sociopathy and unethical behavior have no context.  This lack of character development, dominant scenes by psychiatrists, and the implausibility of those scenes makes this a difficult film to watch.

Regarding the entire issue of why I referred to this as an anti-psychiatry movie that is based on the classification from the Oxford Textbook of Philosophy and Psychiatry. It can be found in the footnote to this post (reference 2).  This film is a good illustration of the biomedical psychiatry as political control cliché.  The psychiatrists in this film are unhindered by any legal, ethical, or professional barrier in promoting their own self interests.  Their obnoxious behavior seems on par or worse than the actual crimes that were the focus of the story line and seems to be more than the typical antipsychiatry bias that is expected in the media. 

The psychiatrist as bogeyman is alive and well at the cinema.

George Dawson, MD, DFAPA