Correspondence Address:
Ajish G Mangot
OPD 22, Department of Psychiatry, Krishna Institute of Medical Sciences Deemed University, Karad - 415 539, Maharashtra
India

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Art is a creative form of expressing personal thoughts, opinions, and feelings. It is often a reflection of prevailing ethos and has been around for almost as long as man's existence. It is not only cathartic but also possesses hedonic value.[1] It is interesting to note that art has evolved with man, and today motion pictures (movies) are the most popular forms of artistic expression. Short films, documentaries, and feature films are extremely popular among the masses. They touch on various issues of human interest such as our society, fantasy, sci-fi, and in recent times, emotions. Films also provide the viewers a window into the existing societal attitudes with respect to mental illnesses.[2] The Indian film industry, Bollywood, churns out more number of movies than the iconic Hollywood. Bollywood has a huge influence on shaping social attitudes not only in India but in several Southeast Asian countries, and its popularity is picking up in the West, too.[3] Being such a powerful influence on the society, make films the ideal vehicle for bringing about a change with respect to knowledge and attitudes toward mental health and illnesses.

Hollywood has been depicting psychological maladies for quite some time now–one flew over the cuckoo's nest, the notebook, memento and rain man, to name a popular few. Bollywood too has caught the attention of viewers and mental health professionals alike in recent times. For example, the Hindi feature film Dear Zindagi (DZ) and the Marathi one, ventilator. The former follows the journey of a troubled young professional who chooses to seek help from a mental health professional, while the latter light-heartedly explores the dynamics of interpersonal relationships shared by members of a family. DZ brought out sensitive issues such as the influence of childhood events on shaping one's personality and behavior, homosexuality and introduced a realistic therapist-client relationship to the lay audience. Cultural boundaries between the younger generations from different parts of the world are blurring-creating a new breed of urban, global youth. That's probably why people around the world appreciate and can relate even to foreign films like inside out and a beautiful mind. Particularly, inside out an animation film with a depressed young girl at the center of the plot provided a visual animated depiction of the symptoms and pathology of a depressive disorder in a manner that was fun, unique, and grasped easily by a young audience.

Creative arts also find their way into therapy for various emotional disturbances-music therapy, dance/movement therapy, play therapy, psychodrama, and poetry therapy. These may collectively be known as creative arts therapies, although the terms expressive therapies and integrative therapies have also been used variably. Every artwork induces unique emotional and cognitive experiences within the creator, participant, and observer. These experiences weave all these individuals together. Films, especially Indian films provide many elements of art-poetry, music, dance/movement and creative writing, simultaneously to those involved. Cinema may, therefore, be considered an “integrative expressive therapy.”[4] Engagement in artistic pursuits has been found to have a positive impact on one's psychological and physiological states.[5]

Film-makers remain hidden behind the cameras and offer us a mesmerizing experience. Just like painting is considered “therapeutic” by many, creating motion pictures has also been found to have therapeutic potential. “Therapeutic filmmaking” is a novel take on traditional psychotherapeutic techniques and resembles arts-based therapy, where clients make videos or short films based on their personal experiences.[6] In the group context, “creative video therapy” has been used as a therapeutic tool.[7] Hence, it is not altogether surprising to see an exponential rise in popularity of internet-based platforms like YouTube in the recent years suggesting that people are already using this avenue as a means to help themselves and others.

Art is processed at many sensory, cognitive, and emotional levels by the viewers. This multimodal experience is heightened when involving motion pictures. Movies are a combination of real life human experiences and fantasy. The interpretation of such art is heavily based on individual characteristics, knowledge, past experiences, and current social and personal environment. Participatory arts therapy is a term for the therapeutic benefits conferred by the process of acting/performing on the performer himself/herself. This again offers the performers an eclectic mix of creative therapies-singing, dance and movement along with role playing. Hence, the performers involved in movies have the unique opportunity to experience immense positive emotional and cognitive benefits with a desirable impact on their quality of life.[8] These benefits are additionally attributable to the group nature of filmmaking and the pleasure and motivational effect of productive activity.[8],[9]

An extremely popular concept is that of the impact media has on the society most often being described as unsavory. This phenomenon has been studied by scientists well.[1],[2],[3] This is important considering the early exposure to television and movies in the current generation. The magic of films lies in the fact that the audience tends to identify with characters and scenes depicted and often merge their individual attitudes with the identified traits. People influenced by the older generation of films depicting mental illnesses in an unscientific manner are generally intolerant toward mentally ill people and are averse to community-based treatment of them.[10] Ironically, the most commonly quoted source of mental health-related information for the masses has been films and television - a fact which was hitherto, counter-productive to de-stigmatization of mental illnesses.[10] However, modern-day film-makers are now putting considerable thought and research into their productions, examples of which include DZ and inside out. These movies targeted the youth and through their actors allowed the common man to experience depression and empathize with them. This empathetic identification has the power to soften the hostility that people feel when it comes to depressive disorders and mental illnesses in general, and have a better understanding of these illnesses.[11] A Turkish study reported that viewing films depicting a mentally ill character and a real-life contact with a person suffering from a mental illness can positively change the attitudes of people toward mental illnesses for the better.[12]

Cinematherapy is gaining popularity as a therapeutic tool for people with mental illnesses. It is frequently used as a homework activity allowing patients to watch prescribed movies and induce useful modeling behavior, learn more about their illnesses and develop positive rituals which may be considered similar to bibliotherapy. It can involve different forms such as popcorn cinema therapy, evocative cinema therapy, and cathartic cinema therapy.[13] This has valuable potential in the development of long-term empathy and reflective thinking in the viewers.[14]

Movies extend their usefulness not only for raising public awareness and influencing social attitudes toward mental illnesses and those suffering from them but also as engaging instruments of education for students while pursuing graduate and postgraduate medical/psychiatry and psychology courses. Frtiz and Poe initially described the use of seminars on cinema for psychiatric education.[15] Movies make for great self-study and group study tools.[16] The movie club approach allows for a refreshing method of learning about health and illness. Special study modules for this purpose have also been designed.[17] In India, pioneering work in the field of cinema and mental health education was started in Mumbai.[18]

In conclusion, motion picture arts are an important means available to the mental health professionals today, for public education, de-stigmatization, and novel psychotherapy for patients [Figure 1]. It allows for active learning through fantasy, expressing emotions, exploring one's own feelings and those of others, providing a safe environment for problem-solving strategies, and dealing with unresolved emotions. Of course, the creative exchange that occurs in all those involved in film-making and viewing is an added bonus to stimulate and spawn further talent. Indian mental health professionals must now begin using cinema to its full potential. However, it is indeed heartenting to note that the de-stigmatization revolution has already started with quite a few influential personalities from the film world publicly speaking about their own personal trysts with mental illnesses.{Figure 1}

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