Abuse of Trust: A Psychiatrist Eroding Professional Boundaries

Film Review by Khalid Ali, Film and Media Correspondent
‘The Shrink Next Door’ (TV miniseries directed by Michael Showalter and Jesse Peretz, USA, 2021, available on Apple TV).

Caution: this review contains plot spoilers

Psychiatrist-patient stories have been a prominent theme in American cinema; ‘Analyze This’ (Harold Ramis, USA, 1999), ‘Side Effects’ (Steven Soderbergh, USA, 2013), and ‘To the Bone’ (Marti Noxon, USA, 2017) showed different perspectives of the intricate relationship between mentally troubled individuals and their treating doctors. My first ever film review ‘Demystifying Doctors’, published in 2003, explored the fragile interdependency that exists between psychiatrists and their patients. In that review, I argued that some psychiatrists are reliant on patients to maintain their professional identity as much as patients depend on psychiatrists for upholding their mental well-being.[1]

 

 

Professor Teresa Hellín states: “The importance of an intimate relationship between patient and physician can never be overstated because in most cases an accurate diagnosis, as well as an effective treatment, relies directly on the quality of this relationship.”[2] In a seminal article ‘The patient will see you now- The evolution of the doctor-patient relationship’, the reader is invited to reflect on the shift in power dynamics between doctors and patients over time from a paternalistic ‘active-passive’ model to a semi-dependent ‘guidance- co-operation’ model to the present shared-decision ‘mutual participation’ model.[3]

‘The Shrink Next Door’ TV miniseries explores evolving trends in patient-doctor relationships through a narrative inspired by real-life events. The series originated in 2019 as a podcast, with the same title, narrated by Joe Nocera, an American journalist and author. The 14-episode podcast was a dramatised version of the life of an American psychiatrist, Dr Isaac Hersckopf, who was convicted by the Department of Health in New York for ‘violating standards of care in psycho-therapeutic relationships.’[4] In the miniseries, several aspects of patient-psychiatrist interactions are probed: paternalistic practice, trust/ mistrust, professional boundaries, and doctor-dependency. The intriguing plot starts with Dr Ike Hersckopf (Paul Rudd) treating Martin Markowitz ‘Marty’ (Will Ferrell) from anxiety attacks; Ike teaches Marty how to establish boundaries with work colleagues, family members and a demanding x-girlfriend. Ike then swiftly extends his authority to become Marty’s business advisor as an ‘industrial psychologist’. Spending weekends on a regular basis in Marty’s country home at Hampton, Ike, his wife and their two daughters, establish themselves as Marty’s family friends. Moreover, Ike manages to distance Marty from his sister, Phyllis (Kathryn Hahn) and his new girlfriend, Hannah (Christina Vidal).

Masterfully crafting a web of lies and deception, Ike assumes total control over Marty’s life. Marty becomes addicted to Ike, a situation aptly labelled by the Hungarian psychoanalyst, Michael Balint in a famous quote: “The drug doctor” (The doctor herself/himself is the most frequently prescribed medication)”. This toxic relationship spans 27 years till the long-delayed realisation by Marty that Ike is abusing his professional status for personal financial and social gains.

While most doctors are driven by genuine care and empathy, few unprofessional ones exploit the trust of their vulnerable patients. There are a multitude of reasons why Marty became such a manipulated victim; his Impressionable personality, loneliness, low self-esteem, sheltered upbringing, and privileged economic status all made him the ideal prey for Dr Ike’s hunter. Phyllis, Marty’s sister, believes that Marty’s naivety contributed to his demise, and ultimately forgives his shortcomings: “You are just a schmuck like the rest of us”. When Marty eventually recognises Ike’s criminal motivations, he admits: “I was hypnotised or brainwashed. It is like he put a spell on me”. After almost three decades of Marty enduring an emotionally and financially abusive relationship, justice might be long overdue, but when it comes it restores some faith in a medico-legal system that protects mistreated patients.

In his reasoning for dominating Marty’s life, Dr Ike challenges the ‘limitations’ of professional boundaries; he claims that his actions were motivated by a selfless committment to help Marty ‘grow as a person’: “Is it wrong to care in a caring profession?!” Till the bitter end, Ike is oblivious to his detrimental influence over Marty’s life stating: “My work with Marty was unique. There is no doubt”

The series can be interpreted as a cautionary tale for our times. However, it can also be seen as another example of ‘doctor bashing propaganda’? Inspired by a true story, the former viewpoint is more likely. Identifying ‘doctor dependency’, supporting patients, and holding unethical doctors into account is a collective responsibility;[5] an important reminder, and a worthy feat that this thought-provoking miniseries excels in.

 

References

[1] Demystifying Doctors: Stormy Weather: After Life. BMJ 2003; 327 (7423): 1114, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC261762/.

[2] Hellín T. The physician-patient relationship: recent developments and changes. Haemophilia 2002; 8 (3): 450–4.

[3] The patient will see you now- The evolution of the doctor-patient relationship. https://www.dice-comms.co.uk/articles/the-patient-will-see-you-now-the-evolution-of-the-doctor-patient-relationship/ accessed 19th August 2022.

[4] https://en.wikipedia.org/wiki/The_Shrink_Next_Door.

[5] Dr Naomi Hartree. Helping Patients Avoid Doctor Dependency. https://patient.info/doctor/helping-patients-avoid-doctor-dependency.htm accessed 19th August 2022.

 

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