Psychiatry movie club: A novel way to teach psychiatry.

For decades, films across the world have entertained people and affected their attitudes regarding certain issues and conditions. Documentary films have been used by governments in different parts of the world to educate the general public and promote health and prevent the spread of disease as part of public health programs. Psychiatry as a branch of medicine like the rest of medicine continues to develop. With an increasing awareness among the general population and popularity of films showing various aspects of mental illnesses on the rise, educators and teachers are turning their attention to using films for education of medical students and psychiatric trainees. Although films may be stereotypical and prejudiced, they can be used successfully in teaching psychiatry trainees. In this paper, development of a movie club and its use are described and suggestions made to improve the use of films in this process.

INTRODUCTION

Cinema is a powerful medium providing us with entertainment. Across the globe, films have portrayed a multitude of issues about society, science, mythology, and mankind. Over the decades, films have depicted various psychiatric conditions ranging from suicide and substance use disorders to multiple personality disorders and schizophrenia. Although such portrayals may not always be perfect, they may nevertheless be good enough for us to understand and analyze some aspect of the disorder. It is inevitable that films are made for entertainment, unlike documentaries which are meant for education. Times have changed from the films being criticized for the negative portrayal of psychiatrists and psychiatric conditions to the current times when they can be used to teach in classrooms. This paper describes how films can be successfully used as a tool for training the psychiatry residents along with potential pitfalls in using these methods.

WHY USE FILMS?

Story-telling has been a favorite mode of teaching right from childhood and kindergarten to high-school. In childhood, stories and telling of stories lay the foundations of human communication and understanding. A number of issues including moral and taboo can be taught using stories. One can draw parallels to short stories and view them being similar to case presentations in medical schools which ultimately lead one to the diagnosis and management of a patient's disorder. Case presentation has been a classical mode of teaching in medicine and in psychiatry too.

When one looks at films, one can see stories being told in a more presentable and audio-visually appealing form. Films make the audience laugh, cry, sing to their tunes, and question some of the very vital decisions of life. Films are often viewed as an art form, a source of entertainment, an industry, and an instrument of social change,[1-3] powerful enough to shape the attitudes of audience. A number of academicians and researchers have examined and studied the portrayal of various psychiatric and related issues[45] and therapies like electroconvulsive therapy in films and the impact that they have on the viewers.[6-12] It is only recently that their use in teaching psychiatry has been realized.[13-16] A few related articles have appeared every now and then in renowned journals like Academic Psychiatry, while a whole issue of International Review of Psychiatry (2009, Volume 21, number 3) has been dedicated solely to the portrayal of psychiatric conditions in films across the world.

Not relying solely on their entertainment value, one can combine entertainment and education and get a better understanding of the issues portrayed in the film. Films can be successfully used to point out various aspects of psychiatric conditions and patients. Through films, students can learn some delicate intricacies of the personal and social aspects of psychiatric patients, and understand patient perspectives in a better way. The advantage of using films to teach as opposed to that of case conference is that one gets to see rather than simply hear about psychopathology and that important information is presented in condensed form in films.[17] A major advantage of films is the issue of confidentiality. Although in India most patients will come to the clinic accompanied by their relatives and families, the notion of confidentiality is strikingly different; it is possible to see the reactions of others generated by the patient in films. It is also useful to see that ethical issues can be debated. Another benefit of using films is that all trainees have the same data about the character (patient in the film), rather than just one trainee having full information as in case presentation; everyone sees the same character and same story from their own perspective and hence can contribute differently to the discussion of the topic. Misch (2000)[17] pointed out how stories in films reflect the situations in a psychiatrist's office: certain aspects of the story in a film are highlighted by the director, while others are not told at all, similar to case histories in psychiatry which may be based on incomplete data.

THE PROGRAM

The idea of using films as teaching tools is not a new one. Interest in this area started with film reviews by Gabbard and Gabbard[4] and Hyler et al.[8] among others. Thus, when this idea was suggested to the Head of Department of Psychiatry at L.T.M. Medical College, he was very interested and enthusiastically supported this initiative. When the same idea was suggested to the trainees, they were equally thrilled about it. At the psychiatry department of L.T.M. Medical College, a psychiatry movie club was thus started that consisted of screening a film based on a psychiatric condition regularly.

Since different residents may be on calls on different days, no list of residents was made who would be attending the films. The trainees were thus free to attend the training sessions at their own will with no intended or unintended pressure. A list of possible films that could be used to teach various aspects of psychiatry to the trainees was prepared after reading relevant articles from different journals. Film DVDs were then procured and screenings done on a projecting system. The films were usually screened in afternoons after the outpatient department is closed. It usually started with a short introduction to the film and how it is important to understand the condition that is portrayed in it. The trainees are instructed to watch the film closely, and if required, ask for certain scenes to be replayed for a better understanding. This is then followed by screening of the film and then, an in depth discussion on the positive points and criticisms on the negative points in relation to the psychiatric illness, the patient and the mental health professional in the film. Usually, one to two issues that have been portrayed in the film and have already been preselected and prepared by the author are then subsequently taught to the students. If needed, the films are also paused at appropriate scenes that depict different aspects of the psychiatric condition or the patient, or the patient-therapist relationship for discussion of those scenes. The trainees are expected to comment on whatever aspect of the film they feel like. Some of the films that can be used to teach various psychiatric conditions in movie clubs are enumerated in Table 1. These films are personal choices of the author and one may use them as a guide and come up with one's own library of films. Trainees are encouraged to think of their own favorites and bring those films. Those who may wish to start similar ventures or use films for teaching will have their own ideas and selected films.

Table 1

Films that can be used in teaching

Usually, the film names are not revealed until the final time of screening so as to maintain a level of curiosity in trainees. However, this is not mandatory and the film names can be revealed beforehand; trainees may then choose to watch these films themselves before the club and re-watch it during the club screening in a group, and actively partake in the discussions giving insights into different aspects of the film.

Other method of using films to teach residents is by using clips instead of whole films. The use of clips is time efficient and provides emotionally engaging experiences for both the faculty and residents. One can incorporate a collection of such suitable clips into 1-hour long teaching conferences along with discussions.[18]

PITFALLS IN USING FILMS

By using films for teaching, one can get an interesting combination of entertainment and education. However, this method is not without its drawbacks. One has to be aware that commercial films are primarily made for entertainment and not education. They may not be made based on sufficient research and hence may reflect how an individual understands a mental illness rather than presenting a scientific understanding of the same. There may be distortion of data in order to make the stories more compelling and get better reviews and public attention. Similarly, diagnoses may not be always clear, in which case one has to always consider differential diagnosis and not ICD-10 or DSM IV categories.[15] There is also a disadvantage of distortion and increased stigmatization of mental illness and the mentally ill in their portrayals in films that may lead to stronger stereotypes in the viewer's minds.

THE LESSONS LEARNT

From an initial experience with this entertainment-filled educational initiative, it was learnt that films do teach us. We, as viewers, may go to watch films for different reasons, because the film is a box-office hit, or because it is our favorite starrer, or just to kill time, but little do we realize that in the process, we may get newer insights and perspectives on our own life issues and learn newer ways to deal with problems. This departmental film training venture has been welcomed by the trainees as a teaching tool and still takes place regularly, with the head of the psychiatry department fully endorsing the concept of using films to teach. Learning from this venture, one can use films in various vernacular languages and some from Bollywood too in teaching psychiatry to residents.

CONCLUSIONS

Films are a social phenomenon that have always had a keen interest in portraying different aspects of the mind, be it emotions or the emotional upheavals resulting from various reasons in the lead characters. The general public and psychiatry residents as well are likely to build opinions on some psychiatry topics after having watched them being portrayed in films. These opinions are likely to become stereotypically strong with every new film that portrays the same condition similarly. Thus, in case one thinks of using films to teach any aspect of psychiatry, one has to do so sensibly. In educating psychiatry trainees, all the available methods should be used to ensure that they gain sufficient knowledge and skills in order to achieve competence in their fields. And in doing so, the tools of entertainment, films can be successfully used thus educating through entertainment.