Introduction
I provide a monthly didactic at Rutgers Robert Wood Johnson Medical School called “FIDLER” (hence the title of this blog) that is centered around a feature-length film that we flip as a fictional case study of mental illness. The objective is not to render diagnoses per se as doing so would run the risk of stigmatizing individuals with mental illness (films universally provide inaccurate portrayals of mental disorders). Instead, the selected film serves to stimulate discussion over social media to educate learners as well as inform the general public about mental illness. The following blog is a pre-posting of this month's FIDLER discussion of Rosemary's Baby on Twitter. You can review the educational dialogue by searching #FIDLERbaby (Twitter).
Synopsis
Rosemary's Baby is a 1968 psychological horror film written and directed by Roman Polanski based on a novel by Ira Levin of the same name. In 1965, Guy and Rosemary Woodhouse move into an apartment building in New York City despite a friend informing them of the Bramford’s history of cannibalism and murder. On October 4, Rosemary conceives following a waking dream in which she is raped by a “demonic presence.” The film then depicts her complicated pregnancy during which time Rosemary demonstrates psychotic features juxtaposed with inadequate access to healthcare and poor social support. As of this posting, the film holds an 97% Tomatometer rating on Rotten Tomatoes and a score of 8 out of 10 on IMDb.
How it relates to the field of psychiatry
Like many films depicting demonic possession, Rosemary’s Baby challenges viewers to either interpret Rosemary’s experience as a supernatural event or whether everything she believes is a product of a psychotic mind. Accordingly, the film may be interpreted as a sensational, fictional portrayal of psychosis during pregnancy.
Postpartum Psychosis (PP) afflicts 1–2/1000 childbearing women. The psychotic symptoms may manifest during pregnancy but usually occur within the first 2–4 weeks after delivery (1). The onset of PP is often rapid with new mothers often experiencing psychotic features as early as 2–3 days following childbirth.
Data suggest that PP is an overt presentation of Bipolar Affective Disorder (BAD) after delivery (2). A creative, evidence-based prequel to the film then would depict either a) risk factors (family history) for BAD in Rosemary Woodhouse or b) evidence of her having had suffered a manic episode.
While the film prompts discussion of maternal health to overcome the stigma of mental illness, there are additional themes in the movie that can't be ignored. While the length of this blog precludes a detailed analysis of Guy, the role he plays in inducing Rosemary's psychosis is central to understanding the film. [Spoiler alert] While Rosemary's paranoia proves to be true, clinicians would still deem her fixed belief that she spawned the son of satan to be delusional (this is a clinical perspective and consciously not a supernatural one). The 'poison/herbs' Guy and the Castevets gave (and continue to give) Rosemary are likely playing a role in the perpetuation of this delusion. If our aforementioned creative, evidence-based prequel did not demonstrate a or b above, then the delusional belief of having given birth to the antichrist is likely to have been substance-induced.
THE BASICS