Cinema and Therapy: The Importance of Hope | Psychology Today

As this blog has progressed, we have established two principles to assist in determining whether a particular film has clinical value in therapy:

1. A film should be emotionally accessible. If a person is unable to engage with a film, they won’t benefit from it. In their book Movies and Mental Illness (2014), Danny Wedding and Ryan Niemiec remind us that viewers enter “a trance, a state of absorption, concentration, and attention, engrossed by the story and the plight of the characters." Visual effects are often impressive but may make it difficult for viewers to connect with characters in a film. Jeffrey Zacks (2015), who studies the impact of film on the brain, reminded us, “When people talk about movies, they may slip in a word or two about the special effects or the soundtrack, but mostly they talk about the story – the characters, the actions, the causes and effects." Also, and of no minor importance, the longer a film, the more likely it will dissuade prospective viewers from even considering it. As cautioned by renowned director Alfred Hitchcock, “The length of a film should be directly related to the endurance of the human bladder.” I know many avid filmgoers who decline to watch Tár, a great 2022 psychological character study, due to its two-hour-and-38-minute running time.
2. The films we use should not misinform, miseducate, or stigmatize mental health challenges and/or the process of treatment.

I now want to introduce a third principle, one that builds upon a necessary factor in all therapeutic schools of thought, including cognitive, behavioral, humanistic, psychodynamic, and trauma-specific methodologies. Indeed, it is not an exaggeration to state this principle is the heart and soul of mental health counseling: Therapy offers hope.

In the early days of psychology, Freud (1905/1968) wrote that the benefits of psychoanalysis could be explained by patients' "expectations, colored by hope and faith" in the treatment process. His belief has stood the test of time. For example, decades later, eminent psychiatrist Irvin Yalom (1995) concluded that the instillation of hope is crucial for all therapeutic endeavors.

Therapy offers the possibility for positive change; no matter how distressed a person is, they can change. Thus, the films practitioners suggest in therapy should offer hope. The last thing I want to do is suggest a film offering no hope to a person seeking my services.

Let’s consider the recent film The Whale (2022). It’s a picture set almost entirely in one murky unkempt room with seemingly unceasing torrential rain outside. Brendan Fraser plays a reclusive, severely obese online teacher who will not even allow his students to see him.

Early on, we learn that he will likely be dead in several days due to his refusal to seek medical care for his deteriorating physical condition. Using the aforementioned film therapy principles, the film has the benefit of a manageable length of just a few minutes short of two hours, a novel screen character of an obese gay man, and introduces clinically significant themes of trauma, enabling, co-dependency, stigma, and food addiction.

It also educates us about the challenges individuals living with severe obesity experience, including adjustments to one’s accommodations for sleep, showering, and even rising from a chair. Regardless, many reviewers found this film stigmatizing and offered little compassion for this character and his choices; I agree with their perspective.

One scene, in particular, shows us the character attempting suicide by eating himself to death. However, even more damaging than stigma, this film offers no hope for this character. There is no chance for growth, no chance for a satisfying life, and no chance for a future. If I were to suggest this film to patients grappling with longstanding body issues, I fear it would lead to depression; indeed, the film is contraindicated.

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In contrast, we have Apples, which I consider the second-best psychological film of 2022. I acknowledge I am cheating here because this film has a 2020 release date but didn’t make it to American screens until 2022. The film is set in either a dystopian future where there is minimal technology or in the not-too-distant past prior to the introduction of cell phones, DVDs, and computers.

A global pandemic is occurring. People are suddenly losing their memories, including those of loved ones dearest to them. Psychological testing finds they forget the significance of holidays and the meaning of major life transitions, such as weddings. A little nap and one awakens disoriented, bewildered, and clueless as to who they are.

In the first scene, we are introduced to Aris (Aris Servetalis), a middle-aged man living in his slovenly apartment (far worse than that inhabited by Brendan Frasier in The Whale); he purchases flowers at a kiosk, boards a bus, falls asleep, and awakens without an identity. Apples jointly tracks the plight of Aris as he adjusts to his new life as well as a team of psychologists developing a treatment regimen they hope will help the afflicted recover their memories or at least anchor new identities.

Intriguingly, there are clear indicators that some residual memories exist. Aris recognizes a dog from his former apartment building, and as its owner approaches, he inexplicably flees before they meet. Similarly, while attending a party, he begins to dance to The Twist, a move he would have no memory of due to his amnesia. This latter scene, by the way, is the most joyous scene of all films in 2022; the camera unwaveringly focuses on Aris’ face as he dances, and it is obvious he is experiencing recall of some meaningful and exuberant experience from his past. It slowly becomes clear that this pandemic is not caused by a viral or biochemical vector but instead has a psychological explanation and one to which we can all relate.

I fully admit Apples uses an all-too-familiar explanation about mental illness first identified by Steven Hyler in his 1988 Comprehensive Psychiatry article titled “DSM-III at the Cinema: Madness in the Movies,” which is that a mental health condition is the result of a singular traumatic event. Films depicting this etiology have a long history, including classics such as Spellbound (1945), The Three Faces of Eve (1957), and Suddenly, Last Summer (1959). All of these films also illustrate the importance of ultimately confronting one’s trauma for long-term mental health.

In contrast to Tár and Memoria, two of the best psychological films of the past year, Apples is the only one I would consider for use in therapy. Based on the criteria thus far developed, Apples is a mere 90 minutes long, is emotionally accessible, demonstrates compassion for its characters, and, of critical importance, offers hope that in spite of the worst suffering, people can and do move forward with their lives. While it might mislead uninformed viewers into believing mental health issues are primarily the result of traumatic experiences, it also truthfully suggests these conditions can sometimes be reactions to the inescapable suffering of life, particularly loss.

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