Psychiatrists on Broadway, 1974-1982

-S^ Psychiatrists on Broadway, 1974-1982 Anne Hudson Jones Two well-known critical metaphors for literature are those of mirror and lamp.1 As a mirror, literature reflects the reality of the world and the society around it; as a lamp, it sheds light and helps create new realities and new societies. The relationship between literature and medicine works similarly. Literature both reflects cultural attitudes toward disease, illness, medicine, and medical practitioners, and it also helps create and change those attitudes. Thus, a traditional approach to literature and medicine has been the study of literary images of physicians. Following that tradition, in this essay I'll consider images of psychiatrists in some of the best recent plays that have been produced on Broadway, using them as examples of the interaction between cultural concerns and the literary images—in this case the dramatic images—that emerge before us. Psychiatry in the United States is currently in trouble because so few medical students are choosing to specialize in it. The May 16, 1984, Chronicle of Higher Education, which is not given to sensational headlines, ran this one: " 'Extinction' of Psychiatry Seen as Possible with Fewer Doctors Choosing to Specialize." Quoting remarks made by psychiatrist Thomas E. Bittker at the annual meeting of the American Psychiatric Association, the article reports that "the number of young doctors who choose to specialize in psychiatry has dropped significantly since the 1960's," when "between 7 and 10 per cent of the graduates of U.S. medical schools went on to specialize in psychiatry .... In the 1980's, only about 4 per cent are entering psychiatry , and that is insufficient to meet the demand."2 The numbers continue to drop each year: 4.15 per cent of U.S. medical-school graduates in 1982, 3.85 per cent in 1983, and only 3.66 per cent in 1984 entered Anne Hudson Jones 129 psychiatry—not enough to fill all the psychiatric residencies available and not enough to fill the anticipated public demand for psychiatrists in the future. Of the four factors cited in the article as contributing to the problem of declining interest in psychiatry on the part of medical students, the most important for my purpose is the "long-standing hostility to psychiatry ... on the grounds that it is not 'scientific' enough."3 I do not mean to imply here that Broadway plays are responsible for the decline in numbers of psychiatry residents in this country, but I do want to suggest that such plays reflect important cultural attitudes toward psychiatrists. And these attitudes, given expression and powerful dramatic presentation to the public, do affect the way all of us— medical students included—view psychiatrists. As long ago as 1963, well before the current decline in numbers of residents in psychiatry, psychiatrists realized and wrote about the importance of their public image to the future of psychiatry. That year the Joint Committee on Mental Illness and Health recommended that American psychiatrists "do something about the public 'image' of the psychiatrist," because, among other things, "the characteristics of the psychiatrist-image may determine the sorts of physicians who choose to specialize in the field, as well as the expectations of and faith in the psychiatrist which potential patients have; [and] it seems logical to assume that the progress of patients in therapy may be related to the dimensions of their image of the psychiatrist.'"1 Yet psychiatrists have never had an easy time of it on Broadway. In 1955, Harry Wilmer, himself both a psychiatrist and a psychoanalyst , summarized the treatment of psychiatrists in Broadway dramas up to that time: It seems to me that too often when a mental specialist walks onstage he is made the "patsy." Is he permitted to function as a diagnostician or therapist? Rarely. In play after play the psychiatrist is cast as a fool, a down, a sadist, a devil or a deity. Sometimes he is a cartoon-like figure, held up to ridicule along with his supposedly occult science. Sometimes he is depicted as deliberately cruel or deceitful to his patients. . . . the misrepresentation of psychiatrists—the glib assignment to them of unattractive roles as playwrights refuse to face up to...