The Oscar-nominated film Silver Linings Playbook depicts the life of a man living with bipolar disorder. Clinical psychiatrist Chris Bojrab, specializes in psychopharmacology, the use of medications as one of the treatments of psychiatric conditions. See what he thinks about the future of medicine, the big Oscar nod and why he still loves Star Trek.
Psychiatry covers a lot of territory. What is your specialty, and what fascinates you about it?
My specialties/areas of interest include psychopharmacology (the use of medications as one of the treatments of psychiatric conditions), sleep disorders, cognition, as well as mood and anxiety disorders. When people ask me why I went into psychiatry I tell them that part of the reason is that I believed that it was likely to be the area of medicine that would see the most growth and change during my professional lifetime. Psychiatry is an absolutely fascinating field; the brain is certainly the most complex part of the body, and arguably the most complex structure in the known universe. Your brain is what makes you you, it is the meat of the mind, the substrate of all that we think, feel, fear, and believe. All the big questions are there. Hopefully the answers are too.
Were there any films or television shows that influenced your decision to seek a career in science? What were your favorites? What do you watch now?
I always was (and still remain) a fan of science fiction. I have always been a big fan of Star Trek. All of the series, even the original series with all of its campiness, made an effort to explain the importance of the science and make it sexy to the masses. It offered a glimpse of what science can offer at its best, not just technological advances, but perhaps more importantly, a future for humanity where that technology can reduce poverty, inequality, prejudice, ignorance, disease, etc. It offers us the opportunity to be our better selves. I also recall watching Carl Sagan’s Cosmos on television when I was a kid. It had a dramatic effect on me. I remember thinking about the scale and age of the universe, thinking about the fact that we were on one planet orbiting one star of a billion stars in a galaxy in a universe of a billion galaxies. For someone like me who is not a person of faith, it was a relatively rare transcendent experience. This experience of learning not only what we knew about the universe, but how and why we knew it was the start of my love of science. Some of my more recent favorite shows include The Walking Dead, The Big Bang Theory, Archer, and Family Guy. In addition to sci-fi, I really enjoy comedy. Comedy is a very interesting form of communication, and the psychology of comedy fascinates me. Comedy, especially satire, can be a way to connect with other people, to point out the foibles of others and of ourselves in a lighter, less threatening way. Good comedy should do what good science does, it should make you question your beliefs and challenge you to think about things in a different way.
What does a typical day on the job look like, for you?
I spend most of my days seeing patients in the office of Indiana Health Group, the largest behavioral health care practice in Indiana, owned by myself and two other partners. My new patient appointments last 90 minutes and provide an opportunity for the patient and I to get to know each other and for me to collect some information about them, their symptoms, their medical history, etc., and to begin to develop an understanding of the nature of their problem and an initial treatment plan. Most of my day is spent seeing patients for follow-up appointments, sometimes appointments lasting 15 to 30 minutes focused primarily on their response to medications that I prescribed, and other patients for appointments lasting 45 to 60 minutes if I am seeing them for psychotherapy as well as or in place of treating them with medications. In addition to my clinical work with patients, I do a lot of work as a consultant for a number of pharmaceutical and medical education companies. In my role as a consultant, I often give presentations on specific medical conditions or specific treatments for a variety of medical conditions to other physicians and health care practitioners around the country. I work as an adviser with a few companies involved in medical communications and marketing. I am also involved in professional organizations such as the American Medical Association and the American Psychiatric Association in leadership positions at a state and national level.
Silver Linings Playbook has received a lot of press this awards season. Have you seen the film? If so, what did the movie get right about depicting mental illness? What did it get wrong?
I saw the film recently and really enjoyed it. I think Bradley Cooper did a great job portraying a patient with bipolar disorder. It is a hard role to portray an illness that has so many facets and for which there exists such a variety of symptoms and levels of severity. I think that he accurately reflected some of the core themes of this illness – the mood swings, the lack of insight that complicates treating someone who does not think there is anything wrong with them, the conflict between the benefits and potential side effects of medications, etc. As a psychiatrist I was a little bothered by the portrayal of a patient with bipolar disorder being violent (actually rates of violence among patients with psychiatric illnesses is roughly equivalent to rates of violence in the general population). Also, I do not think it would be appropriate to attempt to purposefully trigger a violent reaction in a patient by playing a song that you thought would incite them to violence or rage in your waiting room. However, given the fact that these were both key story lines I understand the need to have included them in the movie. Robert De Niro did a great job of portraying someone with obsessive-compulsive symptoms vs. the degree of ritualized/superstitious behaviors of which people are capable when money or the outcome of an important game is on the line. Jennifer Lawrence was wonderful, although the story line did not seem to permit more of an exploration of the origins of her sexual addiction.
The main character is a patient who resists taking the drugs prescribed for him, a major problem for the mental health community. Do you think movies and television shows improve public understanding of mental illness – or make it worse?
This is a mixed bag. Psychiatric patients are typically portrayed in unflattering ways in the media. Often times the patients and their illnesses are lampooned in a way similar to the way in which alcoholism was portrayed in decades past (think Otis, the “loveable town drunk” spending many a night in the unlocked Mayberry Jail on the Andy Griffith Show). Other times, these illnesses are portrayed in their most severe forms, as if every patient suffering from a mental illness was a stone’s throw away from being dangerously psychotic. This is not what most psychiatric patients look like. They mostly look like everyone else, because they mostly are like everyone else. Still, I believe that ongoing attempts to more accurately portray these illnesses, including their prevalence and the potential for successful treatment outcomes, help to reduce the stigma of mental illness and hopefully lead to more people seeking appropriate treatment.
Which movie or television show had the best depiction of someone in your profession? The worst?
Probably the worst depictions of psychiatrists in the media would include Richard Gere in Final Analysis and Anthony Hopkins as Hannibal Lecter in Silence of the Lambs (I am pretty sure that there is some rule about not having sex with or eating your patients, if not a rule then at least a strongly worded guideline). Some of the better or at least more flattering depictions are In Treatment and The Sopranos that both showed the hard work of patients involved in a challenging psychotherapy and the emotional drain that it can put on the doctor as well. Unfortunately, psychiatrists are spending less time doing psychotherapy and more time providing medication management due to financial pressure from insurance companies who force patients to see psychologists or master’s-level clinical social workers for therapy and attempt to utilize psychiatrists in a more circumscribed role of managing the psychiatric medications and leaving the therapy to other mental health professionals whose hourly rates are less expensive in the short run.
How did you first become involved with The Exchange?
I became involved in The Exchange after learning of it from a presentation by Jennifer Ouellette at The Amazing Meeting (an annual conference focused on science, skepticism, and critical thinking). She explained the goals and function of The Exchange and I thought that it sounded like an outstanding idea. I thought that The Exchange could be incredibly helpful to people in the creative arts in producing more accurate and realistic content as well as allowing scientists to help popularize science for the masses.
What have you enjoyed most in your role as a consultant? What have you learned from it?
So far I have only had a couple of requests to provide information through The Exchange, but I would certainly welcome additional opportunities to be an accessible, quick, and easy resource for those authors, writers, directors, producers, actors, developers looking for input/technical expertise in medical practice, in general, or in psychiatry/neuroscience in particular. I have learned that most artists want to get the science right and that most of the time it takes only a little time and effort to do so. I also believe that a better understanding of the science at hand can often provide even greater opportunities to enhance or expand the story line.
Do you have anything that you would like to add? Anything we should have asked you, but did not?
I think one interesting question would be my opinion on the piece of media that could have benefitted the most from contacting The Exchange, but apparently did not. My nominee (by a landslide) would be Prometheus. It was a huge production, visually spectacular, and had a great storyline. Unfortunately, they got the science so spectacularly wrong that I can imagine it becoming a nerdy party game to rent it and watch it with a group trying to point out all of the “science fail” moments in the movie, or a drinking game where you had to do a shot for every “science fail’’ moment of the film. If so, I hope I could borrow the auto-surgeon from the movie to perform the liver transplant that I would need.