New Movie Portrays Cancer Perceptively but Psychology Offensively

[Warning: Although the ending is not revealed, some spoilers from the film 50/50 follow in the article]

Few people go to the movies expecting or even wanting to see reality.  More often than not, people go to the movie theater or reorder their Netflix queue in order to escape and to be entertained.  In fact, the highest grossing genres for years have been science fiction and animation, with documentaries usually coming in dead last.  Even widely renowned and serious films often fail to reflect reality accurately.  A look at the Best Picture Oscar winners for the past 20 years finds movies littered with botched timelines (Braveheart, Gladiator) and inaccurate characterizations of prominent figures (A Beautiful Mind, The King's Speech).  But rarely does a high profile and critically lauded film get something quite as wrong as 50/50 gets the practice of clinical psychology.

The recently released independent film directed by Jonathan Levine and written by Will Reiser has impressed critics (www.rottentomatoes.com reports that 93% of the nation's critics recommend it) and hooked audiences (in its first month of release the film grossed nearly $30 million, or nearly 4 times its production budget).  It's not hard to see why the film has caught on.  Its portrayal of a 27-year-old man (Joseph Gordon-Levitt) who is diagnosed with a rare and serious form of cancer manages to wring tears and laughs in equal measure without ever resorting to mawkish sentimentality or overly juvenile humor.  The central character's relationships with his crass best friend (Seth Rogen), icy girlfriend (Bryce Dallas Howard), and overbearing mother (Anjelica Huston) ring true.  Painfully true in fact.  The film handles the difficult subject matter - what happens when a young man still transitioning into adulthood is given the news that he may die - with wit, insight, and grace.  It is these very strengths that make the film's portrayal of clinical psychology all the more perplexing.

Shortly after receiving his cancer diagnosis, our protagonist is referred to a therapist (played by Anna Kendrick, who I prefer to identify with her inspired and Oscar-nominated turn opposite George Clooney in Up in the Air rather than her involvement in the Twilight franchise).  In her first scene, she performs a series of actions that the writers likely intended to be comic or endearing, but that appeared only unethical and cringe-inducing to anyone with knowledge of the field.  She is woefully unprepared for her client, scarfing down a sandwich oblivious to the fact that she has an appointment.  (But, hey, we've all done that.)  She then quickly lets him know that he is only her third client ever and that she is 24 years old.  (Nothing instills confidence in a therapist like them drawing instant attention to their inexperience.)  Also, she adds, he will be included in her dissertation (disregarding the concept of informed consent).  After that painful introduction, she instructs him to lie down on the couch (is it 2011 or 1961?), guides him through a hokey imagery exercise, and begins caressing his arm (insisting that it is common practice in most hospitals).  When he expresses discomfort, she does what all good therapists are trained to do - act very defensively and argue with the client about what they are really feeling.

Inexplicably, Gordon-Levitt returns to see her for more sessions.  (It is probably because she is so darn pretty.)  Then,  things go from bad to worse.  There are profoundly inappropriate disclosures, massive boundary crossing, a climactic HIPAA violation, and an ending that will likely drive anyone in the field to tears (for all the wrong reasons).   Kendrick does her best with the atrociously written role, finding the good intentions and warm heart in her character and almost making us overlook her myriad ethical violations.  In fact, there are fleeting moments when her characterization beautifully reflects why clinical psychology is sometimes called "the healing profession."  Those moments are few and far between, however.

The misrepresentation of the field in 50/50 is so troubling because it is intended to be a film that deals with cancer in a bold and realistic way.  Although it has a lot of humor, it is not a broad comedy or a satire.  It is marketed as a fresh and perceptive take on an oft-portrayed life experience - and it delivers in many ways.  The filmmakers and marketers have even emphasized throughout the film's promotion that it is in part based on the real life experiences of its screenwriter, who was diagnosed with cancer himself at a young age.   Because of this, audiences walking into the theater are more likely to take what they see at face value.  Those who are unfamiliar with the process of therapy might think this is how it is supposed to work.  We live in a time when the individuals who need psychotherapy the most often do not seek it out or give it a fair shot, when it is a fight to get many psychological services adequately covered by most insurance plans, and when funding for community mental health centers is being slashed.   We need positive and accurate portrayals of what psychologists do in the media.  As portrayed here, the delivery of therapy is scattershot and unscientific and the therapist-client relationship is without structure, boundary, or consequence.   At worst, it discourages people from taking the profession seriously.  At best, it gives people unrealistic expectations about what type of relationship they are entering into and feeds into culture-wide misconceptions of what therapists actually do.

Admittedly, 50/50 is just the latest in the long line of films, television, and literature that have misunderstood and misrepresented clinical psychology.  Even award-winning television series like HBO's In Treatment and The Sopranos and Oscar-winning films like Ordinary People and Good Will Hunting display profoundly questionable methods and ethics at the hands of their well-intentioned practitioners.  What does it say about the status and perception of the field of clinical psychology that even revered works profoundly misunderstand and misrepresent what we do and how we do it?   Perhaps it is a small consolation that increasingly the media accurately portrays why we do it.  Mostly gone are the days when therapists are portrayed as malevolent and deeply dysfunctional themselves.   Without a doubt the field of clinical psychology has a historically rocky relationship with science and ethics and there are many psychologists that are ineffectual and unethical (just as there are in any profession).   But things are changing for the better as we progress through an era when the empirically supported treatments movement continues to grow and ethical oversight is high.  It is time that the creative community caught up with this progress.