By Linnéa J. Hussein, PhD (New York University)
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, 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. 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.
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. These episodes were used in the department’s teaching sessions so that medical students could learn how to recognize major psychiatric symptoms. 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. 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.
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. 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.” 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. 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. 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.” 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.”
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.” 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. 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. 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.
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.
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.”
When the doctor asks her if seeing herself on tape influenced her, she replies:
I told Dr. Lee, that for whatever reason you all decide about televising patients or seeing it, I’m sure you have to decide that, but it was a little like a divine revelation to me. (…) And, as I said, it was just not my outward appearance, ‘cause it was horrible, understandably, but it somehow showed me what I had allowed to happen. (…). I thought it was cruel as anything to show it to me.
In her case, the therapeutic approach of actively seeing herself as others saw her helped her jump start a change in behavior towards her addiction (at least for the short time between the recordings we do not know about subsequent relapses or successes).
In the case of Ms. Berry, however, a woman featured in “69.9: Psychosis with Drug Intoxication,” the same approach did not yield the same result. Ms. Berry does not remember her first interview when asked about it in the second interview.
The doctor asks, “Do you remember going next door and seeing yourself on television?” She says yes, but she does not remember him. He then asks her if she remembers how she felt when she was watching herself on television, to which she replies, “I thought that was a terrible old-looking woman sitting up there!” and laughs. From these two episodes, we can see that some patients were invited to watch their recordings. As such, their presence and recording served not only a teaching purpose but also perhaps a therapeutic one, allowing patients to self-reflect, remember, and be invited to be critical of their own appearance and behavior. The recordings provided a record of the previous week that might challenge patients’ assumptions about the reality of the present-day.
From the videotapes, we do not learn more about the specific approaches to video as a self-therapeutic tool at UMMC in 1969. However, a number of studies from the same time period (mid- to late-1960s) indicate that “video self-observation” or “video self-confrontation” was a trendy topic for research, as attested by a number of articles: P. S. Holzman’s “On Hearing and Seeing Oneself” (1969); I. Alger and P. Hogan, “The Use of Videotape Recordings in Conjoint Marital Therapy in Private Practice” (1967); and A. Paredes and F.S. Cornelison’s “Development of an Audiovisual Technique for the Rehabilitation of Alcoholics” (1968). Conclusions about the use of video self-observation in these articles vacillate between optimistic assertions arguing that the stress induced by it can “function as a productive catalyst” and serve as “one method to facilitate personality change and/or the reorganization of a person’s behavioral repertoire,” or, conversely, negative evaluations noting that the technique can lead to unnecessary stress “which is detrimental to the therapeutic rapport.” The woman with the pill addiction and Ms. Berry offer us just two instances of how patients reacted to this approach. Given their different attitudes towards seeing themselves, it is likely that video self-observation—its “successes” or “harms”—is influenced by a number of factors besides individual diagnoses, such as personality type, age, willingness to cooperate, time of day, or, perhaps, relationship to the medium outside of the therapeutic experiment.
Function (3): accountability created through the act of recording itself.
As we learn from one of the doctors in Ms. Berry’s episode, patients occasionally were invited to an adjacent room to watch themselves on television. And the doctors, of course, watched not just the patients on tape but also themselves conducting the interviews. Aware that their own reactions, questions, and body language would be as scrutinized as their patients’ by students during a lecture, the doctors’ performances evince a vulnerability that I speculate has something to do with their awareness of the cameras. They seem awkward at times, concerned with how to sit or stand, as if wondering how not to block the view or ruin the take. Knowing that their performance as doctors would be studied by students as examples of how to—or how not to—interact during the interview process, I suspect, added an extra layer of accountability that we can ascribe to the presence of cameras, the presumed presence of the people in charge of the cameras, and the act of filmmaking itself.
Aware that their own reactions, questions, and body language would be as scrutinized as their patients’ by students during a lecture, the doctors’ performances evince a vulnerability that I speculate has something to do with their awareness of the cameras.
Teaching films tended to be part of a larger context instead of standing on their own. We can only speculate about the contextualization of the Depressive Neurosis episodes. Perhaps some student clinicians personally knew some patients from live therapy observations, medical rounds, or case reports. Perhaps some students had never met a patient exhibiting symptoms of a mental disorder and received a first exposure to a variety of mental disorders through the tapes. Observational in the context of clinical observation, these videotapes and their calm, ordinary, dedramatized nature offer us a sight of people with a mental illness as people we recognize from our everyday lives; people who are momentarily having a difficult time, but not necessarily people whose lives are in the complete disarray that Hollywood portrayals would suggest. Yes, the doctors all wear suits and a tie and most of them have the black-rim glasses familiar from Hollywood films. Contrived and dramatized medical films such as Out of Darkness (1956), a schizophrenia awareness film hosted by Orson Welles (also available at the NLM), presented patients at the height of their mental crisis in dirty and unrefined clothes. In the Depressive Neurosis episodes, however, well-dressed and composed patients implicitly counter the common cinematic stereotype that outward appearances reflect inner turmoil and that the doctor is the only well-dressed person in the room. There are no overarching narratives, and it is a given that the therapeutic process takes time and cannot conclude in five to ten minutes. In the two episodes in which we see patients a week later, we can observe little changes. As for the others, we do not know.
As mentioned earlier, today this type of recording could not be watched by someone like me, outside the clinical context. For those of us outside, however, these videotapes–recorded two years after Frederick Wiseman visited Bridgewater State Hospital and four years after Senator Robert F. Kennedy was publicly appalled by the living conditions of Willowbrook State School in New York–point perhaps towards a rare shimmer of hope that signifies a shift in the treatment of mental health patients at the turn of the decade. Videotapes played at least a small role in these reforms. In the smaller context of the Depressive Neurosis recordings, I will end with two conclusions: (1) The presence of cameras as well as the understanding that the recordings would be watched by students and peers created an extra layer of accountability for the doctors during the interviews that possibly influenced how they treated the patients. The respectful attitude toward patients is markedly different than other nonfiction or fiction films of the same time (e.g., Titicut Follies or Shock Corridor). (2) These recordings become more and more important as the number of clinicians and patients who remember the making of these recordings declines. The University of Mississippi Medical Center’s archive holds minimal information on the establishment of the recording studio or its use. The videotapes themselves are therefore the only record we have of a time and place in which new approaches to psychiatric practice in the late 1960s can be observed from a historical, cultural, and cinematic perspective. While Nichtenhauser may not have been pleased with the series’ lack of dramatic engagement and storytelling, the videographic capture of patient and doctor details nonetheless reflects a professional aesthetic and understanding of camerawork that demonstrates what collaboration between a specialist and a “competent film maker (not a ‘photographer’)” can achieve.
|Linnéa J. Hussein is a Clinical Assistant Professor in Liberal Studies at New York University, where she is affiliated with the Art, Text, Media concentration in Global Liberal Studies. Her current research project, The Cinematic Straitjacket, examines discourses on mental illness, race, and disability in fiction, documentary, and news media, to reframe censorship as acts of restriction that privilege comfort and protection over the right to self-represent. Her articles and reviews have appeared in Film Quarterly, Studies in Documentary Film, Social Text, and Film & History.|
Adjustment reaction of adolescence, Differential diagnosis: hypochondriacal neurosis, conversion type, Differential diagnosis: psychotic depressive reaction, Schizophrenic reaction, acute undifferentiated type: differential diagnosis: homosexuality, Schizophrenic reaction, acute undifferentiated type, Acute undifferentiated schizophrenia (University of Mississippi Medical Center, Department of Psychiatry. Jackson, Miss.: University of Mississippi Medical Center, Dept. of Psychiatry, 1969)
Depressive neurosis: differential diagnosis: schizoid personality (University of Mississippi Medical Center, Dept. of Psychiatry. Jackson, Miss.: The University, 1969)
Depressive neurosis, hermaphrodite, schizophrenia (paranoid type), alcoholic addiction, organic brain syndrome, psychosis with drug intoxication, adjustment reaction of adolescence, (University of Mississippi Medical Center, Dept. of Psychiatry. Jackson, Miss.: The University, 1969)
Out of Darkness (Al Wasserman, 1956)
Schizophrenia, paranoid type: differential diagnosis: hysterical neurosis, conversion type: schizophrenia, schizo-affective type (University of Mississippi Medical Center, Dept. of Psychiatry. Jackson, Miss.: The University, 1969?)
Shock Corridor (Samuel Fuller, 1963)
Symptoms in Schizophrenia (James D. Page, 1930)
Titicut Follies (Frederick Wiseman, 1967)
 William Stewart Agras, email to author, November 21, 2020.
 The National Library of Medicine lists twenty-seven episodes on eleven tapes. For this article, I was able to review a digitization of four tapes with a total of nine episodes. Each episode is about five to ten minutes in length and shows actual patients during an interview.
 Agras, email to author, November 18, 2020.
 In the 1960s schizophrenia was used as a broad term that covered what today are seen as a variety of mental disorders.
 Adolf Nichtenhauser, Marie L. Coleman and David S. Ruhe, Films in Psychiatry, Psychology and Mental Health (New York: Health Education Council, 1953), 44.
 Nichtenhauser, Cole and Ruhe, 45.
 Nichtenhauser, Cole and Ruhe, 51.
 Nichtenhauser, Cole and Ruhe, 51.
 Nichtenhauser, Cole and Ruhe, 33–34.
 Nichtenhauser, Cole and Ruhe, 52.
 The National Library of Medicine: Programs and Services Fiscal Year 1972 (Bethesda, MD: U.S. Department of Health, Education, and Welfare, 1972), 39.
 National Library of Medicine, 40.
 Agras, email to author, November 18, 2020, and November 20, 2020.
 Student of Psychiatry at the University of Massachusetts in 1978, email to author, January 9, 2020.
 The same period also gave rise to more experimental approaches related to television and therapy, such as the 1967 so-called “Hippie Drug Ward” experimental clinic in San Francisco, where moving images were curated in the hopes of restructuring “the consciousness and sensorium of those who had fallen through the cracks of society” (Carmine Grimaldi, “Televising Psyche: Therapy, Play, and the Seduction of Video,” Representations 139, no. 1 : 96).
 Gerald F. Skillings, “A Review on the History and Application of Videotape Self-Confrontation in Therapy and Human Relations Training,” (MA Thesis, Western Michigan University, 1977), 2–3.
 Nichtenhauser, Cole and Ruhe, Films in Psychiatry, Psychology and Mental Health, 30.
 To read more about the outcry Frederick Wiseman’s Titicut Follies elicited about the state of Bridgewater State Hospital for the Criminally Insane at the 1967 New York Film Festival see Vincent Canby, “The Screen: ‘Titicut Follies’ Observes Life in a Modern Bedlam: Documentary Is Cool Calm and Harrowing ‘The Penthouse’ Offers a Twisted View” in New York Times (October 4, 1967). To learn more about Robert Kennedy’s shocked reaction to the conditions in Willowbrook State Hospital see this interview.