Psychiatric Interview Films in the Age of Reform: Notes on the Depressive Neurosis Series Filmed by the University of Mississippi Medical Center in 1969

When one thinks of audio-visual recordings of psychiatric patients in the United States in the 1960s, the distressing images of Frederick Wiseman’s observational documentary Titicut Follies (1967) likely come to mind. Or, perhaps, the horrors of Sam Fuller’s fiction film Shock Corridor (1963).

The Depressive Neurosis series from 1969, housed in the National Library of Medicine’s audiovisual collection, however, bears no resemblance to these films. Instead, the videotape series offers a rare glimpse into the day-to-day world of late 1960s psychiatric practice, in which people with addiction, mental illness, or mental disabilities seek help and are received with an open mind and treated with dignity by the doctors they speak to and the camera crew that tapes them. These videotapes were not meant to circulate publicly, and yet, as astonishing historic records used and studied responsibly, they exemplify a calm, perhaps a bit dry, but nevertheless respectful treatment of mental health patients that is still not a given in today’s cinematic representations, and as such could, some fifty years after their initial recording, easily serve as important source material for fiction films to come. In today’s context of patients’ rights, HIPAA would prevent any of these recordings from seeing the light of day. Written consent, as well as a timeline for the destruction of tapes, would now be required.^[1] These laws were not yet in place in the 1960s, however, which provides a rare opportunity to examine the Depressive Neurosis series as an example of an historical record that serves as a counter-text to popular cinematic depictions of psychiatry.

The series offers a rare glimpse into the day-to-day world of late 1960s psychiatric practice, in which people with addiction, mental illness, or mental disabilities seek help and are received with an open mind and treated with dignity by the doctors they speak to and the camera crew that records them.

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The series was produced by the University of Mississippi Medical Center’s (UMMC) Department of Psychiatry in 1969. Following typical archival practice, these untitled videotapes are named after the first episode on the tape.^[2] These episodes were used in the department’s teaching sessions so that medical students could learn how to recognize major psychiatric symptoms.^[3] Most episodes are moments from intake interviews, in which the patient is asked to narrate their condition. Usually prompted by the question, “What brought you here?” the patient enters into a dialogue with a psychiatrist or medical student. Professionally shot with a multi-camera set-up, each episode begins with a simple title card stating the number of the recording and the topic. Among the titles are “69.3 Schizophrenia, Paranoid Type,” “69.4 Alcoholic Addiction: Differential Diagnosis, Passive Aggressive Personality,” “69.6 Psychosis with Drug Intoxication,” and “69.2 Hermaphrodite.” The patients’ demographics are as diverse as these diagnoses, featuring White and African-American Southerners, with ages that range from sixteen to sixty years old, and a variety of class backgrounds and sexual orientations.

With the help of an archivist at UMMC, I managed to track down and interview people who worked in UMMC’s Department of Psychiatry in the 1960s.

The Depressive Neurosis episodes are short fragments without a cohesive narrative. Sometimes scenes end abruptly with no explanation, sometimes a diagnosis is part of a title, sometimes the title just refers to the number of interviews we are about to watch. The tapes exist in the archive without any further information about the authors or subjects. There is no narrative to the individual episodes, and different archival listings group different episodes together, so that we also cannot easily read a larger framing or narrative from the compilations themselves. How, then, do we make sense of these partial interviews that do not reveal any information about their makers, their use, or the people they feature other than their location? With the help of an archivist at UMMC, I managed to track down and interview people who worked in UMMC’s Department of Psychiatry in the 1960s. In this article, I weave together their memories of the making of the tapes with the information we can gather through the surviving moving images themselves in an effort to piece together a moment of psychiatric media history currently fragmented in the UMMC archive. My goal is to place the tapes into their historic context as well as to discuss their importance for posterity. In doing so, I concentrate on speculations about three main functions of the tapes: (1) the establishment of a catalog of sample lessons for medical lectures, (2) the creation of self-reflexive approaches to therapy, and (3) the accountability created through the act of recording itself.

Function (1): the establishment of a catalog of sample lessons for medical lectures

Most of the tapes deal with cases of sub-differentiations of what was then called schizophrenia followed by multiple episodes on neuroses and anxiety disorders, both acute and chronic.^[4] Other titles in the series deal with alcoholism, addiction, sexual orientation, what at the time was called “mental retardation,” teenage angst, and passive-aggressive behavior. Given the range of topics, it seems that the goal in 1969 was to establish a catalog of major psychiatric diagnoses for students to consult.

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The use of moving images for psychiatric education is almost as old as the medium itself. The German neurologist Paul Schuster filmed patients exhibiting neurological disorders for the purpose of teaching as early as 1897. Not long thereafter, the Romanian clinician Gheorghe Marinesco was fascinated by the frame-by-frame analysis the new medium offered to his practice.^[5] Silent instructional films such as Symptoms in Schizophrenia (James D. Page, University of Rochester School of Medicine, 1930) relied on intertitle cards to give the audience information beyond the filmed patient’s image. The German doctor Hans Hennes remarked in 1910 that while films should never, if possible, replace clinical demonstrations, they have a crucial advantage in portraying patients with a mental disorder, for “they could be projected at any time, whereas psychotic patients often would not produce their symptoms in the lecture room or could not be taken there at all.”^[6] In other words, unlike physical conditions, psychiatric disorders cannot be queued up for medical rounds, and it is important for the safety of the patient—as well as for the safety of the doctors—to have a more controllable environment, which films and videotapes provide.

Even though the use of film to teach psychiatry began at the turn of the century and continued through World War II, it was not until the postwar period that the mental-health movement joined other disciplines in their enthusiasm for training and information film.^[7] The National Institute of Mental Health of the United States Public Health Service collaborated with the former National Committee for Mental Hygiene to establish the National Mental Health Film Board in 1949. Among other things, the board helped to finance productions for state mental health agencies.^[8] Alfred Nichtenhauser’s co-edited volume Films in Psychiatry, Psychology and Mental Health from 1953 offers a contemporaneous look into the production and consumption of mid-century psychiatric films. Nichtenhauser, as well as his co-authors Marie L. Coleman and David S. Ruhe, thought of their book as a guide through the psychiatric motion-picture world for professionals, community organizers, students, as well as patients and their families. What is remarkable is that besides medical accuracy, Nichtenhauser gives astute attention to the quality of filmmaking itself, writing, “There are books on the techniques and structuring of films […] and useful film production courses are given in a few places. Not every specialist, however, has the time and talent needed for such training. The best he can do is find a competent film maker (not a ‘photographer’) with whom to work.”^[9] In a refreshing (and rare) way, Nichtenhauser accords an equal amount of respect to the filmmaker as well as to the doctor, instead of seeing the filmmaker as the doctor’s subordinate. When writing about the fields of neurology, psychiatry, and psychology in 1953, Nichtenhauser critiques the lack of sufficient production standards by noting, “Despite the proven effectiveness of motion pictures as a means of professional instruction in these areas, an organized market large enough to attract commercial producers does not yet exist.”^[10]

In a refreshing (and rare) way, Nichtenhauser accords an equal amount of respect to the filmmaker as well as to the doctor, instead of seeing the filmmaker as the doctor’s subordinate.

In 1967, fourteen years after Nichtenhauser voiced his critique, the National Medical Audiovisual Center (NMAC) was launched in Atlanta, creating a national program to improve the “quality and application of current instructional methodology, materials, systems, services, and functions in biomedical professional schools and among its practitioners.”^[11] With funding from the Center and Office of Audiovisual Educational Development of the National Institute of Health’s Bureau of Health Manpower Education, a variety of programs, activities and workshops were designed to strengthen the production of not just psychiatric films but all medical teaching films on a national level.

Among the thirteen educational institution sites surveyed that were part of the NMAC’s consultation program was the University of Mississippi Medical Center.^[12] When Dr. William Stewart Agras arrived at UMMC in the Summer of 1969 to become the new Chair of the Department of Psychiatry, the department’s videotaping of patients was already established. He remembers the department having an excellent audiovisual capacity: a well-equipped recording studio with two full-time employees just for the Department of Psychiatry. These employees would record short episodes of patient intake interviews as well as set up equipment to show videotapes in lectures.^[13] By the time Dr. Agras started recording his patient interviews a few months later, the Department had already produced many of the episodes in the Depressive Neurosis series.

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In line with Nichtenhauser’s emphasis on cinematic standards, the videotapes may not necessarily look polished compared to documentary or fiction films of the same period; however, they do have a television studio feel to them that resembles the simple set-up of many 1950s television news shows. Additionally, these videotapes exhibit a three-dimensional understanding of patients as well as doctors that deserves special attention. While simple in set-up, the individual episodes are edited to reveal different camera positions such as establishing shots showing us how the chairs are set up in the office space, medium close-ups that reveal body language between doctor and patient, and close-ups revealing tears, fidgety hands, or nervous scratching behind the ear. These interviews capture early encounters between a new patient and a doctor. Judging from the patients’ testimonies, they have not always worked with or even seen the doctor before. There is a remarkable calm in these videotapes. Each tape is set up in different medical office spaces. There is either a big desk with the doctor on one side and the patient on the other, or two chairs, arranged like a talk-show set, usually with a small table with some sort of plant, telephone, or lamp in the middle. Compared to other teaching techniques of the time, such as teams of student clinicians observing a therapy session live, as  was common for example at the University of Massachusetts, the camera set-up seems less intrusive, and one can infer that most patients seem to forget about the presence of cameras quite quickly, given that no one ever directly looks into a lens.^[14]

There is no rush to these interviews; the patients are asked to say what brought them there, how they are feeling today, and then the doctors usually ask some follow-up questions that occur naturally within their conversations. In the case of “69.3 Schizophrenia Paranoid Type,” for example, the doctor listens to the patient, a white man in his 40s, talking about the importance of books, of reading, of having owned a dictionary once, human existence, the universe, the Army and the Navy, his engineering studies, and how he is now reading more words to become a doctor one day. The doctor actively listens, interjects follow-up questions here and there, and then proceeds to ask the patient whether he has ever heard of the saying, “A rolling stone gathers no moss.” He goes through different sayings to see how the patient reacts to figurative speech, without ever correcting, mocking, or treating the patient with condescension. Throughout the ten-minute episode, the camera cuts to a close-up of the patient indicating that there is more than one camera in the recording studio. The video cuts back and forth between doctor and patient, sometimes lingering on a close-up of a face or hands, sometimes cutting back to an establishing shot. This trend can be observed in all of the episodes: an embodied approach to studying both the patient’s actions and the doctor’s reactions, which represents the therapeutic setting as the interpersonal, dynamic context it should be.

Function (2): the creation of self-reflexive approaches to therapy

In two different episodes, we learn something else about the series: some patients were invited to view their own recordings. In an episode called “Excerpts from Two Interviews,” we see an unnamed female patient in two sessions, videotaped one week apart. In the first interview, the White, seemingly middle-class woman in her 50s tells the doctor about a sleeping pill addiction that she has had since 1946. She says she would like to get off the pills, but every time she tries, she starts seeing colors, and it is too difficult to quit. She gets emotional and starts to cry, saying she was tired and seeing colors again at the moment. The second interview, as an intertitle card reveals, was taped one week later, and it starts with an establishing shot showing her sitting across the room from the doctor and exclaiming, “I just feel wonderful!” She proceeds to say seeing herself on the videorecording was “the greatest shock of my life.”