Psychiatrists on TV/movies and New York / LA

On very many occasions there are references to people seeing their ‘shrink’ written into the script of USA TV shows and in the movies. This seems particularly common when set in New York or LA.

Is this some sort of running joke or is this actually common?

The only time I have ever heard of people seeing a psychiatrist is if they have a mental disorder.

What is going on?

I’ve known a few people who went to a shrink because their insurance paid for it, and hell, why not? I even considered it for a while.

It’s a general cliche. I believe New York and LA took to psychotheraphy more than most other areas. People went not because of serious problems, but in order to better deal with small yet nagging psychological issues.

It would take at least an upper-middle-class income to see a psychiatrist regularly if you didn’t have serious mental problems (in which case you could get your health insurance to pay for it). Seeing a psychiatrist regularly for ordinary things is thus restricted to a small subset of rich people. One more reason not to trust films or TV for an accurate view of anything.

Actually many insurance plans cover psyciatric care if your primary physician jumps through a few hoops for you.

antechinus - I’ve lived and worked in several major US cities. People see shrinks all the time and will talk about it for hours and hours and hours as though this is actually interesting.

I don’t recall seeing a TV show or movie set in the USA in which the person depicted as seeing a shrink was not otherwise presented as the kind of person who would see a shrink.

With the exception of thrillers in which a woman’s husband and her psychiatrist are in league against her!!! She’s not crazy, they just want the money!!!

When pschoanalysis was big- & Freudians ran most big psych residencies- yes Harvard, Yale, etc, analysis was considered psych treatment- 4-5 visits /week for years. The insurance companies finally caught on, began calling it “education” or “personal growth” & ( mostly) stopped paying. It was big in all cities-Boston,SF ,DC, but since TV shows are written by LA/NYC people ,hence the regional references.

I beg to differ, Wendell.

When my mother’s Alzheimer’s disease got really bad a few years ago, my then-girlfriend (who was a psychiatric nurse-practitioner) said I really seemed depressed and suggested grief counseling. (I never wanted to go out and do stuff, just go to work and deal with my mother’s care).

My HMO offered same, with a $20 copay per session. I went for about three months, after the shrink concluded that, yes, I was depressed, but not to the point where I needed meds or anything that drastic. The shrink suggested that I simply needed to get busy doing stuff, like going to grad school and playing music at night, all of which I had put on hold.

I was grateful for (and happy with) the service, and was left with absolutely no impression that shrinks try to get people hooked on their services. (At least, this one did not – maybe I was lucky).

And as you know, Wendell, I’m not rich.

I do agree with your sentiment though: never trust TV and movies for facts!

I just finished seeing a therapist. (I live in NYC) I saw him on a weekly basis for about 8 months and then every other week for about 4 months.

Insurance helped a bit. I paid $25 a session but sessions were only $55.

I was not ‘crazy’ but I do feel the sessions helped.

One thing though in NYC and I guess LA people don’t think ‘seeing therapist’ = ‘nut’ like people do in some other parts of the country. Since there is no social stigma from seeking help, people are more likely to get it.

An important pair of distinctions should probably be made here, between institutional psychiatry and private-session psychiatry, on the one hand, and between psychoanalysis and medical-model treatment of mental illness on the other.

a) Institutional psychiatry, the kind that gets imposed on people when they are determined to be a danger to themselves or other people, does not consist of psychoanalysis. I know some people have a sort of blurred-together idea, as if Philippe Pinel struck the chains off the poor suffering mental patients in the insane asylum and led them to Freudian couches to talk about their potty training, but it didn’t happen that way. Institutional psychiatry has always been about holding and controlling socially disruptive people. Before the medical model, it revolved around the belief that mad people were demon possessed or were under the influence of the moon (“lunacy”); the medical model replaced that with the belief that mad people had mental illnesses, problems in their brain that had no more to do with their personal experiences and psychological hangups than demon-possession did. In neither version of institutional psychiatry did/does prolonged conversations with the patient, geared towards helping the patient make breakthroughs, play a significant role, if any at all. (In some forms, including modern ones, the doctor never speaks directly with the patient at all).

b) Freudian psychoanalysis, and the competitive / offshoot schools such as Jungian and Adlerian and so forth, were never aimed at treating the population who get locked up in insane asylums / psychiatric wards etc. The target population from the start has been individual wealthy enough to pay for analysis, and in the era prior to medical insurance as we know it that pretty effectively limited the pool to people seeking treatment voluntarily plus wives and children and other dependents on whose behalf a head of household type person would pay. These modalities of therapy did not arise from a medical background, nor did they stem from institutional psychiatry, which predated it and existed concurrently with it.

c) The original administrative location of psychiatric services under the broad aegis of “medicine” occurred within institutional psychiatry, and did so decades and decades before the advent of Thorazine and other such psychiatric pharmaceuticals. Psychiatry was brought under medicine not because anything particularly “medical” was taking place within psychiatry but because of the social stature of medicine and physicians – much the same as getting the church to sponsor and be administrator to a small regional clinic might lend it more legitimacy than it would otherwise have in the community.

d) Between the initial deployment of Thorazine and other similar meds and the present, and the fade in reputation throughout academia and general social circles of orthodox psychotherapy, a wide and diverse mental health industry has come about and flourished, encompassing theories and practices that borrow bits and pieces from both the medical model and the underlying notion behind psychoanalysis of working one’s problems out psychologically. The primary practitioners may be nurses, social workers, psychologists, psychiatrists, psychotherapists, clergy, and/or self-defined “new school” licensees practicing in new traditions, some of which thrive and continue while others come and go.

e) Insurance companies may be prepared to pay for a limited number of sessions of non-institutional therapy based on some statistical information about average time and weighted in favor of short and finite. In addition, insurance companies will generally reimburse institutional psychiatric treatment up to a certain duration. Long term involuntary institutional psychiatry is reimbursable by Medicaid. In most locations, services that are not reimbursable are scarce, as the practitioners’ livelihood depends on an available supply of wealthy clients/patients. These are expensive and the tendency to put money into them appears to be affected in part by the perceived trendiness of doing so. New York and Los Angeles are two places where it has been a status symbol among certain segments of the relatively wealthy to engage in long-term therapy. In smaller venues lacking these specific trend-following social segments, therapy is more likely to consist of short-term narrowly-defined problem-fixing, such as that geared towards handling postpartum depression or helping you to lose weight and stop smoking. People who attend these may not hide the fact but probably don’t brag about it either. In yet smaller venues, where the psychiatry that people run across and hear of is proportionately more often institutional psychiatry, there’s more stigma and far less cachet.

MGM made it policy that all their star actors undergo psychoanalysis.
Just to name a few…

Judy Garland
Joan Crawford
Esther Williams
Gene Kelly

And of course Marilyn Monroe…but I think she signed to Fox.

So many not-crazy people, mainly from a wealthy ‘specific trend-following social segment’, do see pshychiatrists for counselling.

But movies/tv writers focus on this as a bit of a joke.

j.c. Do those people you have bumped into belong to this trend following social segment or are they just ordinary people? The TV/movie cliches I have noticed has fairly normal people ‘in the chair’.

I wonder how the lack-of-stigma and trendiness of seeing a shrink came to be.

Ralph Greenson, Monroe’s analyst, broke all the rules- had dinner at her house & vice versa. She had that way w/ men.

Actually, studies have been done showing celebrities, because of the therapist being a fan, in awe perhaps, don’t get as good care. THis is more common in-patient than out.

Hunter- after reading your post I’m applying for CME credit.

F. U. Shakespeare,

I was being vague when I used the term “serious mental problems.” I did not mean that someone had to be so badly off that they needed immediate confinement in a mental institution. I meant only that they had to have mental problems serious enough that a medical insurance company (which tends to be a bit on the cheap side) would think that your mental condition required regular visits with a psychiatrist. The sort of regular psychiatric visits you sometimes see in movies and TV, lasting for years and years, when the person really has no serious mental problems but merely wants to have someone to talk to about their general problems in life, is not covered by medical insurance and is thus confined to people of at least upper-middle-class income.

Hunter’s lengthy response left me frazzled, so I’ll just tell you what I remember - but it’s all basically WAG.

I think it has a lot to do with the Me generation & the load of self-help books that came out in the 1970s. EST and Wayne Dyer, Gail Sheehy, etc. People started looking for more answers right about the time of all that social change - the race riots, the women’s movement, the anti-war protests.

I also think there was a point where the number and availability of psychologists (as opposed to psychiatrists) increased, perhaps as a result of licensing decisions? Insurance company decisions? I may be wrong about this, but I believe that schools started turning out more psychologists & this changed the landscape. The availability and variety of psychological degrees is definitely different now from what it was 50 years ago.

I also think that, just as nowadays you see many homosexual characters on TV and in movies, at about the same point in the 1970s psychologists and people seeking psychological care began to appear in the media with greater frequency. Remember Sidney Friedman on MASH*? I think his character had a huge impact. What about Woody Allen’s analysis? I think Bea Arthur got some therapy on Maude. Again, I could be wrong, but I believe that going to a therapist to discuss problems (as opposed to being institutionalized or medicated) started being discussed in the public forum of sitcoms & movies. And Sybil was released at that time (altho she was truly batshit & not simply depressed).

Plus the key newspaper advice columns, Dear Abby and Ann Landers, started promoting therapy as an important tool & urged their readers to seek professional guidance. I won’t even go into the decline of the Church, although I’m sure that had something to do with it as well, along with the breakup of so many marriages.

Nowadays it’s my impression that a huge percentage of the educated populace voluntarily seeks psychological care from a professional at some point or another. Look at it this way - drinking’s out, smoking’s out, eating causes problems (altho that’s where many people have gone), and with all the yahoos and their video cameras spying on each other, we don’t have much choice but to behave ourselves. So with the behavior bar set high & few ways to cope, seeing a shrink makes a lot of sense.

All IMHO, of course.

fessie-you are correct about the avalanche of mental health degrees since 1970.We have LCSW, MFC, (was MFCC), PSW, psych tech, & more recently PsyD.(For those wanting a doctorate-but focused on people & not research) Also, believe it or not there are UNACCREDITED graduate schools in psychology. Would you have surgery from an unaccredited doc?

It is an amazing statistic, but one half the hospital beds in the US are for psych/behavior patients. What other field of medicine is so big that it has state hospitals? That’s because local governments can’t handle the patient load.

fessie writes:

> I think it has a lot to do with the Me generation & the load of
> self-help books that came out in the 1970s. EST and Wayne
> Dyer, Gail Sheehy, etc. People started looking for more answers
> right about the time of all that social change - the race riots,
> the women’s movement, the anti-war protests.

There’s a couple of problems with your timeline here. The Me Generation and things like Dyer and Sheehy is the 1970’s. Anti-war protests and race riots are the 1960’s. (Well, there were earlier race riots, but I presume you’re referring to the ones in the 1960’s.) The women’s movement began about 1970, although there were earlier precursors. And regular psychiatric visits for rich people without major mental problems goes back to at least the 1950’s. (Woody Allen began seeing a psychiatrist in the mid-1950’s, for instance, and he wasn’t a pioneer in that sort of long-term psychoanalysis.) You’re conflating a whole bunch of things here. The acceptability of short-term psychological counselling for the general population may have begun in the 1970’s, but the habit of certain rich people seeing psychiatrists for years at a time for minor problems began earlier, like in the 1940’s or 1950’s.

I’m sure you’re correct, Wendell - I was thinking particularly about psychological counselling for the general population, not rich people seeing psychiatrists for analysis. And I was thinking about the 1970s being a period when people in the general population were adjusting to fallout from the 1960s.

They are two separate points. I suppose one could argue that the general populace caught up to a trend that rich people started.