June 15, 2023

Psychiatrists in Fiction: The Good, the Bad, and the Ugly

Dr. Monica Starkman's article was published in Psychology Today

Read the original article on Psychology Today's website.

Psychiatrists have often appeared as characters in a wide range of novels, from crime thrillers to literary fiction. While some portrayals are positive, others show psychiatrists to be incompetent or evil. Too many perpetuate harmful stereotypes about mental illness and those who treat it.

Why It Matters

How psychiatrists are portrayed in fiction matters. It matters because, for many people, the decision to consult a psychiatrist is often made with difficulty. It matters because negative, ugly portrayals of psychiatrists in fiction only add to that difficulty by reinforcing stereotypes that psychiatrists may be incompetent or untrustworthy. Realistic and positive portrayals, however, can be reassuring to people as they consider seeing a psychiatrist for diagnosis and treatment.

Here are examples of the negative and positive ways psychiatrists are portrayed in fiction.

The Ugly Psychiatrist

  • The Silence of the Lambs, by Thomas Harris

This novel presents the story of Clarice Starling, a young woman still in training at the FBI's behavioral sciences unit who is sent to a high-security mental asylum to interview Dr. Hannibal Lecter, a brilliant forensic psychiatrist. Dr. Lecter forms a strange partnership with Ms. Starling: On the basis of the facts she tells him, he provides clues about the psychological profile of a disturbed serial killer now on the loose that are helpful to the FBI’s urgent search for that murderer. But, in exchange for his providing Clarice with more and more cryptic clues and psychological insights about the killer, she must provide him details of her unhappy childhood.

Dr. Lecter is courteous and knowledgeable. However, he is also an incarcerated, cannibalistic serial killer, and one can scarcely get uglier than that. In addition, he can perceive hidden motivations and vulnerabilities, which gives him a unique understanding of both the killer and Clarice’s psyche.

This book is written so persuasively that its power as literature may reinforce stereotypes of psychiatrists as disturbed individuals or as people with the scary ability to intuit a person’s deepest secrets from just a few words they speak or by observing just a sliver of their behavior.

The Bad Psychiatrist

  • The Lathe of Heaven, by Ursula Le Guin

Psychiatrist Dr. William Haber, who is also a sleep researcher, has a patient whose dreams can become reality. While maintaining that he is administering treatment, the doctor hypnotizes and gives suggestions for the patient to dream things that will transform reality into what the psychiatrist views as a perfect world. While Dr. Haber has some ideals, he is also power-hungry and clearly believes that the means, however terrible, justify the ends. For example, he cares not that in order to address overpopulation, the patient's dream will create a plague that kills billions of people. By the novel’s end, the psychiatrist is institutionalized, having become catatonic after his own dream produced a temporary collapse of reality.

This novel reinforces the stereotype of the psychiatrist as psychologically unstable, as having great powers over people, and as using patients for his own benefit.

  • The Girl Who…., a series by Stieg Larsson

This series of novels revolves around the character of Lisbeth Salander, a highly skilled hacker with a troubled past. As Lisbeth becomes entangled in dark conspiracies, investigates crimes, and seeks justice for herself and others, often collaborating with journalist Mikael Blomkvist, the novels tackle issues of social injustice, corruption, misogyny, and the abuse of power within Swedish society.

The psychiatrist in the series is Dr. Peter Teleborian. When Lisbeth was a young child sent for evaluation to a psychiatric hospital for children, he “treated” her by placing her in isolation and keeping her in restraints. When she is an adult, Dr. Teleborian gives her a false diagnosis to comply with the wishes of a corrupt subgroup in Swedish Security. In addition, the doctor is involved in child pornography.

 So, here, again, is an evil psychiatrist who commits professional misconduct, mistreating his patient and using his power over her to hurt rather than heal.   

The Good Psychiatrist

  • One Flew Over the Cuckoo's Nest, by Ken Kesey

This novel is about a criminal who fakes insanity to avoid prison time and is sent to a mental institution. The book is a critique of the conditions decades ago at some state hospitals, personified by the evil Nurse Ratched. In contrast, the psychiatrist is portrayed as a caring and empathic doctor who tries to help his patients.

This novel was also made into a fine movie, and it is interesting that the psychiatrist in the film was played by the real-life psychiatrist who was the head of the state hospital where the movie was filmed.

  • The Bell Jar, by Sylvia Plath

This novel follows the story of brilliant and talented Esther Greenwood as she struggles with mental illness and suicidal thoughts. The first psychiatrist she sees doesn't listen to her as she would wish and, without enough explanation, prescribes a course of electroconvulsive therapy (ECT), which was frightening and not helpful. After a serious suicide attempt, Esther is admitted to several psychiatric hospitals and eventually comes under the care of psychiatrist Dr. Nolan. Dr. Nolan is a caring, compassionate physician. She explains and supervises another course of ECT, which, this time, is helpful, and she provides psychotherapy as well.

With these treatments by a compassionate and competent psychiatrist, Esther greatly improves.

  • Ordinary People, by Judith Guest

Ordinary People is about a seemingly well-functioning family shattered by grief following the boating-accident death of their older son. Conrad, their younger son, has survived the accident. He is burdened by self-blame for the death and attempts suicide. After a psychiatric hospitalization, Conrad is released, but he still suffers from guilt and depression. He begins outpatient treatment with psychiatrist Dr. Berger, a blunt but empathetic and effective doctor who helps Conrad abandon his unrealistic guilt. He also helps Conrad recognize the limitations of his mother, who is unable to provide him with warmth and support.

During his successful treatment of the suffering adolescent, Dr. Berger is portrayed as a psychiatrist who works with both caring and skill. He is an example of how psychiatrists are knowledgeable and effective with their patients.

  • The End of Miracles, by Monica Starkman

The End of Miracles, written by a psychiatrist, is a psychological suspense about the drastic consequences of a frustrated obsession. Margo, a woman with a complex past and a promising career, desperately wants to become a mother, but she struggles with infertility and a tragic miscarriage. She is temporarily comforted by a wish-fulfilling false pregnancy, but when reality inevitably dashes that fantasy, she falls into a depression so deep she must be hospitalized. The sometimes-turbulent environment of the psychiatry unit rattles her and makes her fear for her sanity, and she flees. Outside, under the influence of another fantasy, she impulsively commits a startling act with harrowing consequences for herself and others. Afterward, Dr. Taynor, her psychiatrist, works with knowledge and skill to treat her with medication and with psychotherapy that helps Margo understand the deeper motivations behind her powerful need to be pregnant and, so, begin to heal.

The End of Miracles accurately shows how feelings, psychological defenses, and breaks in reality testing are explored and understood by competent psychiatrists. The thoughts and feelings of the psychiatrist, too, are part of the story. Details of the medical conferences held about the patient on the psychiatric unit, as well as of the outpatient therapy sessions, are realistic and describe accurately the process of diagnosis and how decisions about treatment are made. This demystifies the work of psychiatrists.

How to Help

These examples show how psychiatrists in fiction are portrayed in very different ways, ranging from negative and evil to competent and compassionate. Those novels that perpetuate harmful stereotypes contribute to uncertainty about psychiatry. Since it is difficult for many people to tell others that they have seen a psychiatrist, many potentially positive views about the benefits of seeing a psychiatrist remain private and cannot counteract negative stereotypes.

However, there are other ways to help advance a more realistic view of psychiatrists in popular culture. For example, sharing opinions about the portrayals of fictional psychiatrists during book club meetings or in conversations can help shape perceptions of mental illness and of the psychiatrists who work diligently and with skill to treat it.