Psychiatrists on the casting couch

Therapists in the movies tend to be mad, bad or brilliant. For proof, see this week's Don't Say a Word. Let's analyse this, says Ryan Gilbey

Cinema has never been shy of ushering an audience into the therapist's office, but what the camera finds there often has less to do with the psychiatric profession than with plugging holes in a leaky script. In the new thriller Don't Say a Word, a psychiatrist (Michael Douglas) is forced to interrogate an unstable patient in order to retrieve from her memory a sought-after code number. This is cliché number one: the use of the psychiatrist as detective, to uncover information crucial to the resolution of the plot. For all the relation that his character bears to the reality of psychiatry, Douglas might just as well be playing Nancy Drew.

Then there is the forthcoming K-PAX, which features cliché number two: the psychiatrist as a warm and fuzzy individualist whose humanity is brought into focus by an unorthodox individual. In this case it is Kevin Spacey, claiming to be an alien, who brings illumination to Jeff Bridges' life.

Both these pictures remind you just how radical the representation of psychiatry is in Nanni Moretti's The Son's Room (currently on release). Moretti plays a psychoanalyst who reassesses his life after a family tragedy. Whatever the picture's merits, it must deserve brownie points for approaching its central character's vocation with sobriety. "We always see caricatures," complained Moretti recently, "both in comic films where psychoanalysts have more problems than their patients, and in serious films where they resemble some kind of oracle delivering bookish sentences." Not only does The Son's Room avoid those traps, it also features that genuine rarity in cinema, the shrink with more than one patient.

Since the earliest example of a movie psychiatrist at the start of the last century, the therapist has become one of cinema's most reliable characters, and one of its most misunderstood. Good-natured curiosity marked the first appearance of a psychiatrist in a movie, when the kindly shrink in Dr Dippy's Sanitarium (1906) calmed his agitated charges with the offer of pies; an approach not much in evidence these days. In early cinema, the psychiatrist was largely consigned to the role of faceless authority figure. Occasionally he might be rescued from anonymity to receive the ire of a big-shot star who had no truck with airy-fairy mind games: Douglas Fairbanks harboured a well-known distrust of psychiatry, and hoped to stem its increasing popularity with his swashbuckler When the Clouds Roll By (1919), in which the villainous shrink is finally unmasked as an escaped inmate from the New York Insane Asylum.

This sneaking suspicion that the lunatics have not only taken over the asylum but are billing us handsomely into the bargain persists in dark comedies such as Dressed to Kill (1980), where a psychiatrist is capable of not only messing up your mind, but carving up your body too, or The Couch Trip (1988) and Beyond Therapy (1987), both of which feature shrinks who are in a more advanced state of mental collapse than the poor saps they're trying to help. Recently, movies have begun to question whether psychiatrists are even up to the task of paying attention: the therapist in There's Something About Mary (1998) wants to tutor his client in the etiquette of gay cruising, while the one in Happiness (1999) is struggling just to stay awake. In Cruel Intentions (1999) and What About Bob? (1991), the client is presented with a book authored by his analyst, only for the cost of this supposed gift to be added to his bill. In those films, and in those details, you can feel petty scores being settled by screenwriters whose advances have been siphoned off by their shrinks.

Not that all films treat therapists as two-bit hucksters, from the same gene pool as lawyers and insurance salesmen. Distinctly more reverence is displayed in Blind Alley (1939), which stars Ralph Bellamy as a psychology professor who gradually dismantles and overpowers his tough-talking captor through psychoanalysis. It may belong to that group of films that turn the shrink into a proxy detective, but this transformation could not occur without real faith in the profession. While the picture provides a disquieting example of confessions being used against the confessor, it also places psychoanalysis firmly on the side of good. The friendly neighbourhood psychiatrist was presented as everything you could want in a best friend in The Snake Pit (1948), a film that became "an important stimulus for public acceptance of the health movement", according to Leslie Rabkin, author of The Celluloid Couch. And therapy could be also be synonymous with tenderness and sensitivity: long before Lena Olin swapped couch for bed with her not-bonkers-just-free-spirited client Richard Gere in Mr Jones (1994), Ingrid Bergman took the time to unpick Gregory Peck's mental knots in Spellbound (1945), leading The New York Times's Bosley Crowther to breathlessly conclude: "If all psychiatrists are as fruitful as [Bergman]... then psychiatry deserves such popularity as this picture most certainly will enjoy."

Robin Williams, in Good Will Hunting (1997), is a modern version of the saintly head-doctor. Indeed, Good Will embodies so many of the most abhorrent clichés in cinema's portrayal of psychoanalysis that it can only be viewed as a deliberate act of provocation against the mental-health profession. Take the field trips designed to suggest that Williams is eccentric but not threatening, and to give the audience something to look at other than bookshelves. Or the simple, one-step cure, which consists of Williams embracing Matt Damon and repeating the words "It's not your fault," after which the patient is sufficiently well-adjusted to hit the open road in search of happiness.

Such conceits, though well intentioned, perpetuate the misapprehension that psychiatry is an exact science, with rewards and benefits which can be readily quantified, whether it's a code number, the restoration of inner peace, or in the case of the virtuous Ordinary People (1980), the redemption of an emotionally paralysed family. One of the few films to aggressively deride this habit of using psychoanalysis as an all-purpose cure is Mel Brooks' Hitchcock parody High Anxiety (1977). Brooks is the psychiatrist taking up residence at the Institute For The Very, Very Nervous, and discovering in the film's climax that his vertigo can be traced back to infancy, when an argument between his mother and father sent him toppling from his high chair. "It's not heights I'm afraid of," he announces triumphantly at the news of this breakthrough. "It's parents!"

When High Anxiety was released, viewers were familiar enough with the babble and buzzwords of psychoanalysis to respond instinctively to the film's wittiest sequence, when Brooks's speech at a psychiatric conference has to be spontaneously modified so as not to impinge upon the innocence of two young children who have joined the audience ("penis envy" becomes "pee-pee envy", while the womb is temporarily rechristened "the woo-woo").

Woody Allen had by then played his part in making therapy fashionable, most notably in Annie Hall (1977), but only on television would therapy really receive the scrutiny that it deserves. Complex or insightful characterisation abounds, from the unseen psychiatrist in This Life, whose disembodied voice is every bit as sinisterly placatory as HAL in 2001: A Space Odyssey, to Frasier himself, whose protective veneer of arrogance has over the course of many years been carefully exposed as all chinks and no armour.

Perhaps time is the key. Just as the convention of the "50-minute hour" seems designed to provoke frustration, so the brevity of films like Grosse Pointe Blank (1997) and Analyze This (1999) will naturally put them at a disadvantage compared with the three long, rigorous seasons that The Sopranos has so far taken to investigate a similar client/therapist dynamic. Those hours of television provide space for the riveting essence of psychoanalysis: the fumbling misunderstandings; the drawn-out silences; the sheer, staring-at-the-wall nothingness. What cinema's prevailing view of therapy, as displayed in Don't Say a Word and K-PAX, cannot countenance is that mysteries aren't always wrapped up in time for the closing credits. They take a long time to crack, or they get taken to the grave.

'Don't Say a Word' opens today. 'K-PAX' opens on 12 April