By Danny Wedding
Films can be an incredibly powerful way to learn about mental illness and psychopathology – watching films relevant to mental health can help professionals to become more productive as therapists, and help students become more adept at recognizing and understanding symptoms and behaviors. To supplement the recent publication of my fifth edition of Movies and Mental Illness, where I explore more than 1,500 movies and the characters involved, I am pleased to present a series of “Spotlight” articles that will critically examine the psychological content of new movies as they are released.
Some movies will get it exactly right; the characters who have psychological issues are well-developed and show the appropriate symptoms and corresponding behaviors, and the insight we glean into their characters helps us enjoy the movie. Other times, movies embellish symptoms to provide more dramatic moments, and exaggerate the frequency and severity of violent behavior. When that happens, it can perpetuate the myth that most people with mental illness are likely to be dangerous.
Let’s start with an award-winning movie now in theatres that unfortunately, doesn’t handle mental illness all that well: The Holdovers, which I happen to think is a great movie.
Paul Giamatti recently won a Golden Globe award for his performance in this film, and he is also a contender for a Best Actor Oscar (although I’m predicting the award will go to Cillian Murphy for his lead role in Oppenheimer). Giamatti plays a curmudgeonly prep school teacher who is strict and demanding, and not especially popular with his students, almost all of whom are the children of affluent parents. Because he is single and doesn’t have close relatives, he is duped into staying on campus over the Christmas holidays and supervising five students who don’t have anywhere to go. His only adult companions on the deserted campus are a cook (Da’Vine Joy Randolph, who also won a Golden Globe award for her role) and a janitor.
Four of the students get a reprieve and are air lifted to a ski resort by one of the students’ fathers, leaving the three adults supervising a single teenager, Angus, played by Dominic Sessa. Giamatti’s character winds up losing his job after taking Angus to visit his father (Tom) in a psychiatric hospital outside of Boston. When confronted by Angus’s mother and stepfather (who had just returned from a honeymoon in St. Kitts), Giamatti falsely claims the visit was his idea, and he subsequently loses his job.
Hospital Scene and Diagnosis
Unfortunately, both the scene and diagnosis of Tom’s character are unrealistic and less than convincing. He is unshaven, and he displays blunt affect. He is clearly paranoid (“I think they are putting something in my food”). As Angus reports, “He used to be fine, [but] four years ago he started acting strange. He was erratic and started saying weird shit. . . He saw a bunch of doctors, but medication only made it worse. He got angry and physical.”
Tom’s wife divorced her husband after his hospitalization.
“Angus knows he is not supposed to visit his father. Now Tom wants to come home, which is clearly impossible. He suffers from debilitating mental illness, paranoid schizophrenia, and early dementia . . . . He got violent and he tried to brain one of the orderlies with this goddamn thing [a Christmas snow globe]. . . I have to move Tom now.”
Why isn’t this character realistic? One reason is that although schizophrenia can increase the risk of dementia (Cai & Huang, 2018), the two disorders would be very unlikely to co-occur suddenly in a middle-aged man. The first symptoms of schizophrenia usually occur from ages 21-25 in males, and onset is typically insidious rather than sudden (Nan et al., 2023), as Angus relayed in the movie. In contrast, most people with dementing illnesses like Alzheimer’s are age 65 or older. Multiple trials with different medications may be necessary before symptoms are alleviated, but medication typically helps patients with schizophrenia, and Angus reports that medication only exacerbated his father’s symptoms. It is also unlikely that a single episode of violence would trigger a transfer to a different psychiatric setting. Angus worries about inheriting his father’s illness in the movie, but this is unlikely. Having a parent with schizophrenia only increases your risk for developing the disorder by about 10%; if both your parents have the diagnosis, your risk is increased by about 40% (WebMD, n.d.). Likewise, while having a parent with dementia does increase your risk for developing dementia yourself, most people who develop Alzheimer’s and similar diseases do not have a family history of the disorder (National Institute on Aging, 2024).
Be Sure to See this Movie
Despite this flawed portrayal of one of the characters, The Holdovers is a delightful film that I highly recommend, and one I think could become a Christmas classic, much like It’s a Wonderful Life. Giamatti is superb, and he seems to fit the role perfectly (in real life he is an unassuming man who celebrated his Golden Globe award by going out for dinner at an In-N-Out Burger restaurant.) Giamatti’s performance is just as good as it was in Sideways, another excellent film by director Alexander Payne.
Although The Holdovers doesn’t teach the viewer much about mental illness, it does illustrate the importance of companionship during the holidays, of good will, and of sacrifice and generosity. Do be sure to see this movie.
Cai, L., & Huang, J. (2018). Schizophrenia and risk of dementia: A meta-analysis study. Neuropsychiatric Disease and Treatment, 14, 2047–2055. https://doi.org/10.2147/NDT.S172933
National Institute on Aging. (n.d.). Alzheimer’s Disease Genetics Fact Sheet. Retrieved January 21, 2024, from www.nia.nih.gov/health/genetics-and-family-history/alzheimers-disease-genetics-fact-sheet
WebMD. (n.d.). What causes schizophrenia. Retrieved January 21, 2024, from https://www.webmd.com/schizophrenia/what-causes-schizophrenia
Weltens, I., Bak, M., Verhagen, S., Vandenberk, E., Domen, P., van Amelsvoort, T., & Drukker, M. (2021). Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PloS one, 16(10), e0258346. https://doi.org/10.1371/journal.pone.0258346
Zhan, N., Sham, P. C., So, H. C., & Lui, S. S. Y. (2023). The genetic basis of onset age in schizophrenia: evidence and models. Frontiers in genetics, 14, 1163361. https://doi.org/10.3389/fgene.2023.1163361
Danny trained as a clinical psychologist at the University of Hawaii, and then completed a postdoc at the University of Mississippi Medical Center. After retiring from the University of Missouri School of Medicine, he taught at Alliant International University, American University of Antigua, and the American University of the Caribbean. Danny is the author or editor of a dozen books, the former editor of PsycCRITIQUES, and a Past President of the Society of Clinical Psychology.