“Side Effects” SPOILER: Shrink Boundaries and Ethics

Previously I posted a preview of Side Effects, a new film directed by Steven Soderbergh. That, of course, was before I’d seen it; now I want to say more. MAJOR MOVIE SPOILER AHEAD: Read this post only if you’ve already seen Side Effects and/or want to know how psychiatry is portrayed in it.

First, The Not-So-Big Revelations

It’s actually no revelation at all that medication “side effects” that may have led to a murder are a significant factor in this film.

On the other hand, it may be a revelation to some viewers just how enmeshed the relationship between psychiatrists and the pharmaceutical industry can be. It’s a common viewpoint and one that’s succinctly put by psychologist Tyger Latham in his post “In Bed with Big Pharma“: “…(T)he psychiatric field has allowed itself to be co-opted by the industry and failed to fully question the scientific merits of those psychoactive drugs which they prescribe.”

A related issue presented in Side Effects is the ease and quickness with which some shrinks make psychiatric diagnoses. Kelly Patricia O’Meara, author of Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills that Kill, points out in her movie-related post that “the psychiatrist merely has to briefly listen to the patient’s life complaints and, voila, the psychiatrist is able to determine the exact alleged mental disorder.”

Bigger Revelations

Read film reviewer Rex Reed‘s strongly negative critique of Side Effects and without warning, he spills one of the biggest plot spoilers: “What started as a cautionary thriller about drug abuse…now turns into a battle between two psychiatrists for the soul of their patient—one who keeps her medicated, the other who turns out to be her lesbian lover.”

Well. As we know that Jude Law’s character, Dr. Banks, isn’t the lesbian lover, hmmm…who could it be? The one well-known star that every critic mentions is another psychiatrist but then barely says a word about? The former shrink of Emily, the homicidal patient of Dr. Banks?

Anil Vora at Bi Magazine describes ensuing circumstances thusly:

The ‘surprise’ plot twist in the final act is that Victoria Siebert (Catherine Zeta-Jones) is bisexual. By this point in the film we have also learned that Siebert is self-serving, a corporate sellout, and a hypocrite. But she has also done something completely unethical. To get her to confess to this crime, Emily Taylor (Rooney Mara) seduces her. We learn that Taylor had previously seduced Siebert when she was Siebert’s client in therapy. Siebert had allowed herself to be seduced and had sex with Taylor.

What many viewers may not realize is that it’s the shrink who is always responsible for setting the boundaries. It doesn’t matter who seduces whom. Crossing this line is considered exploitative and highly unethical.

Siebert also plots to commit murder—an infraction so obvious it doesn’t need to be spelled out in ethics manuals. In the mind of internist Dr. Frank Spinelli, as expressed in his post titled “Harmful Side Effects,” another aspect to this situation that sucks is that “(i)n perpetuating the stereotype of the crazed gay killer, Soderbergh marginalizes gay people.”

Fellow member of the psychiatry specialty Helen M. Farrell writes in a Psychology Today post regarding some other ethics violations in Side Effects. For one, shock treatment is used as a threat against the patient, Emily; another is that, in an entirely vengeful act by Dr. Banks, Emily is eventually committed against her will to a mental institution .

Dr. Sasha Bardey, the specialist in forensic psychiatry who served as the movie consultant, has apparently indicated that the film’s plot is largely based on real cases or incidents. Therefore, Psyched Out author O’Meara asks: “…(O)ne has to wonder who is the real-life patient that has been committed to a mental institution because the psychiatrist wanted revenge?” In other words, does this actually happen? Do all the other things? How often?

And how about other actions of Siebert such as blackmailing another psychiatrist (Banks) and committing securities fraud?

In Conclusion

Don’t get me wrong. When I saw Side Effects, I was interested in the plot and didn’t always mind that psychiatry was being lampooned and criticized. I’m also okay with some Hollywood-type stretching of reality, whatever the topic.

But will the movie makers out there ever give shrinks a break? Present a more balanced picture? Can’t they lay off the tired ethics breaches, particularly that of becoming sexually involved with a client—especially when little is done to point out how wrong this is?

In the finale, after all, what are the actions that get Siebert into trouble? The securities fraud and conspiracy to commit murder, not having sex with a client. Because the latter is only an issue when the patient complains—and this never happens in popular movies.

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