April 16, 1999

By Glen O. Gabbard, M.D.

The number one movie at the box office last month was Harold Ramis's hilarious satire "Analyze This." Robert De Niro plays an organized crime boss who is paralyzed by panic attacks and seeks treatment from a psychiatrist played by Billy Crystal. In keeping with Hollywood conventions, the doctor is beset with as many problems as his patient.

Crystal's character lives in the shadow of his hugely successful father (also a psychiatrist); he has an overweight son, who is overly intrusive into his father's private life; and he has a fiance (Lisa Kudrow), who is in a tizzy about the fact that her wedding is repeatedly disrupted by De Niro and his henchmen. The screenplay is brimming with wit, and the audience is generous with its laughter.

Why then did I experience a sense of déjà vu when I sat through this delightful comedy with an overflow crowd in my local cineplex? Perhaps because "Analyze This" is the fifth time this decade that I have chuckled about the incongruous high concept of a mobster visiting a therapist to get in touch with his feelings. Bill Murray spouts psychobabble as a gangster who tells his cronies about his therapy in the 1993 film "Mad Dog and Glory." Four years later John Cusack's hit man poured out his soul to psychiatrist Alan Arkin in "Grosse Point Blank." The therapist's countertransference anxiety that his patient might bump him off provides one of the funniest scenes in recent memory. The same year National Lampoon's "The Don's Analyst" appeared on cable with Robert Loggia as the Don and Kevin Pollack as the analyst. The pinnacle of this trend was reached on HBO earlier this year with "The Sopranos," a weekly series where James Gandolfini, like De Niro in "Analyze This," suffers a panic attack that leads him to therapist Lorraine Bracco. "The Sopranos" is distinguished by some of the finest writing and the most accurate depiction of psychotherapy ever to grace a television screen.

So how do we understand this recent trend in entertainment? We can speculate that audiences, who have flocked to "Analyze This" and who have made "The Sopranos" the number one show on cable, find this juxtaposition of a therapist and a mafioso compelling and enjoyable in a particular way. We all would love to believe that the hard-boiled criminal is really just a sensitive pussycat underneath the surface. When Robert De Niro weeps at a schmaltzy commercial about a father and son, the audience chortles with glee at the generic conceit that mobsters aren't so mean and threatening after all. Down deep, they are just like you and me.

The enormous popularity of Quentin Tarantino films is also emblematic of this bit of cinematic mythology. In "Reservoir Dogs" and "Pulp Fiction," for example, the audience repeatedly witnesses thugs and sleazeballs struggling with moral dilemmas. Is it acceptable to withhold a tip from a waitress when she provides mediocre service, even though women are disadvantaged in the job market? Does giving a foot massage to another man's wife count as adultery?

Audiences love to imagine that these sleazoid personalities are tormented with pangs of conscience, that they are trying to do the right thing, and that they are wracked with guilt when they don't. A much more chilling thought, of course, is that criminals callously kill, cheat, and lie without any remorse whatsoever for the victim.

Placing a mob boss on an analyst's couch is certainly a marvelous setup for a few good laughs. After Crystal explains the Oedipus complex to his patient, De Niro asks, "Have you ever seen my mother?" Moreover, although the therapy depicted in the film is certainly outrageous by conventional standards, the process clearly helps De Niro confront his demons, and he emerges as a new man.

Director Ramis is sold on therapy. In a New York Times interview, he said, "I have a lifelong interest in psychotherapy. I know a great number of therapists. I've relied heavily on psychotherapy during every crisis of my life."

In writing the second edition of Psychiatry and the Cinema, my coauthor and I reviewed more than 400 American films that feature some sort of therapist at work. A relatively small number suggest that therapy may actually be helpful. "Analyze This" is one of them. In an era where psychiatry, and particularly psychotherapy, is beleaguered, we should gratefully accept good publicity, even when it comes from the most unexpected sources.

Dr. Gabbard is the Callaway Distinguished Professor at the Menninger Clinic and coauthor (with Krin Gabbard) of the second edition of Psychiatry and the Cinema , recently published by American Psychiatric Press Inc.