{"id":3496,"date":"2022-10-18T10:00:19","date_gmt":"2022-10-18T09:00:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3496"},"modified":"2022-10-05T17:24:55","modified_gmt":"2022-10-05T16:24:55","slug":"abuse-of-trust-a-psychiatrist-eroding-professional-boundaries","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2022\/10\/18\/abuse-of-trust-a-psychiatrist-eroding-professional-boundaries\/","title":{"rendered":"Abuse of Trust: A Psychiatrist Eroding Professional Boundaries"},"content":{"rendered":"<p><strong>Film Review by Khalid Ali, Film and Media Correspondent<br \/>\n<em>\u2018The Shrink Next<\/em>\u00a0<em>Door<\/em>\u2019 (TV miniseries directed by Michael Showalter and Jesse Peretz, USA, 2021, available on Apple TV).<\/strong><\/p>\n<p><strong>Caution: this review contains plot spoilers<\/strong><\/p>\n<p>Psychiatrist-patient stories have been a prominent theme in American cinema;\u00a0<em>\u2018Analyze This\u2019<\/em>\u00a0(Harold Ramis, USA, 1999),\u00a0<em>\u2018Side Effects\u2019\u00a0<\/em>(Steven Soderbergh, USA, 2013), and \u2018<em>To the Bone\u2019<\/em>\u00a0(Marti Noxon, USA, 2017) showed different perspectives of the intricate relationship between mentally troubled individuals and their treating doctors. My first ever film review \u2018Demystifying Doctors\u2019, 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.<a href=\"#_ftn1\" name=\"_ftnref1\"><sup>[1]<\/sup><\/a><\/p>\n<p>&nbsp;<\/p>\n<style type=\"text\/css\">\r\n       .errordiv { padding:10px; margin:10px; border: 1px solid #555555;color: #000000;background-color: #f8f8f8; width:500px; }#advanced_iframe {visibility:visible;opacity:1;}#ai-layer-div-advanced_iframe p {height:100%;margin:0;padding:0}<\/style><script type=\"text\/javascript\">  var ai_iframe_width_advanced_iframe = 0;  var ai_iframe_height_advanced_iframe = 0;var aiIsIe8=false;var aiOnloadScrollTop=\"true\";\r\nif (typeof aiReadyCallbacks === 'undefined') {\r\n    var aiReadyCallbacks = [];  \r\n} else if (!(aiReadyCallbacks instanceof Array)) {\r\n    var aiReadyCallbacks = [];\r\n}    function aiShowIframeId(id_iframe) { jQuery(\"#\"+id_iframe).css(\"visibility\", \"visible\");    }    function aiResizeIframeHeight(height) { aiResizeIframeHeight(height,advanced_iframe); }    function aiResizeIframeHeightId(height,width,id) {aiResizeIframeHeightById(id,height);}<\/script><iframe loading=\"lazy\" id=\"advanced_iframe\"  name=\"advanced_iframe\"  src=\"https:\/\/www.youtube.com\/embed\/HpbC72kXOsc\"  width=\"560\"  height=\"166\"  frameborder=\"0\"  border=\"0\"  allowtransparency=\"true\"  allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\"  style=\";width:560;height:166;\" ><\/iframe><script type=\"text\/javascript\">var ifrm_advanced_iframe = document.getElementById(\"advanced_iframe\");var hiddenTabsDoneadvanced_iframe = false;\r\nfunction resizeCallbackadvanced_iframe() {}function aiChangeUrl(loc) {}<\/script>\n<p>&nbsp;<\/p>\n<p>Professor Teresa Hell\u00edn states: \u201cThe 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.\u201d<a href=\"#_ftn2\" name=\"_ftnref2\"><sup>[2]<\/sup><\/a> In a seminal article \u2018The patient will see you now- The evolution of the doctor-patient relationship\u2019, the reader is invited to reflect on the shift in power dynamics between doctors and patients over time from a paternalistic \u2018active-passive\u2019 model to a semi-dependent \u2018guidance- co-operation\u2019 model to the present shared-decision \u2018mutual participation\u2019 model.<a href=\"#_ftn3\" name=\"_ftnref3\"><sup>[3]<\/sup><\/a><\/p>\n<p><em>\u2018The Shrink Next Door\u2019<\/em> TV miniseries explores evolving trends in patient-doctor relationships through a narrative inspired by real-life events. The series originated\u00a0in 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 \u2018violating standards of care in psycho-therapeutic relationships.\u2019<a href=\"#_ftn4\" name=\"_ftnref4\"><sup>[4]<\/sup><\/a> In the miniseries, several aspects of patient-psychiatrist interactions are probed: paternalistic practice,\u00a0trust\/ mistrust, professional boundaries, and doctor-dependency. The intriguing plot starts with\u00a0Dr Ike Hersckopf (Paul Rudd) treating Martin Markowitz \u2018Marty\u2019 (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\u2019s business advisor as an \u2018industrial psychologist\u2019. Spending weekends on a regular basis in Marty\u2019s country home at Hampton, Ike, his wife and their two daughters, establish themselves as Marty\u2019s\u00a0family friends. Moreover, Ike manages to distance Marty from his sister, Phyllis (Kathryn Hahn) and his new girlfriend, Hannah (Christina Vidal).<\/p>\n<p>Masterfully crafting a web of lies and deception, Ike assumes total control over Marty\u2019s life. Marty becomes addicted to Ike, a situation aptly labelled by the Hungarian psychoanalyst, Michael Balint in a famous quote: \u201cThe drug doctor\u201d (The doctor herself\/himself is the most frequently prescribed medication)\u201d. This toxic relationship\u00a0spans 27 years till the long-delayed realisation by Marty that Ike is abusing his professional status for personal financial and social gains.<\/p>\n<p>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\u00a0Impressionable personality,\u00a0loneliness, low\u00a0self-esteem, sheltered upbringing, and privileged economic status all made him the ideal prey for Dr Ike\u2019s hunter.\u00a0Phyllis, Marty\u2019s sister, believes that Marty\u2019s naivety contributed to his demise, and ultimately forgives his shortcomings: \u201cYou are just a schmuck like the rest of us\u201d. When Marty eventually recognises Ike\u2019s criminal motivations, he admits:\u00a0\u201cI was hypnotised or brainwashed. It is like he put a spell on me\u201d. After almost three decades of Marty enduring an emotionally and financially abusive relationship, justice might be long overdue, but when it\u00a0comes it restores some faith in a medico-legal system that protects mistreated patients.<\/p>\n<p>In his reasoning for dominating Marty\u2019s life, Dr Ike challenges the \u2018limitations\u2019 of professional boundaries; he claims that his actions were motivated by a selfless committment to help Marty \u2018grow as a person\u2019: \u201cIs it wrong to care in a caring profession?!\u201d Till the bitter end, Ike is oblivious to his detrimental influence over Marty\u2019s life stating: \u201cMy work with Marty was unique. There is no doubt\u201d<\/p>\n<p>The series can be interpreted as a cautionary tale for our times. However, it can also be seen as another example of \u2018doctor bashing propaganda\u2019? Inspired by a true story, the former viewpoint is more likely. Identifying \u2018doctor dependency\u2019, supporting patients, and holding unethical doctors into account is a collective responsibility;<a href=\"#_ftn5\" name=\"_ftnref5\"><sup>[5]<\/sup><\/a> an important reminder, and a worthy feat that this thought-provoking miniseries excels in.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References<\/strong><\/p>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> Demystifying Doctors: Stormy Weather: After Life. BMJ 2003; 327 (7423): 1114, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC261762\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC261762\/<\/a>.<\/p>\n<p><a href=\"#_ftnref2\" name=\"_ftn2\">[2]<\/a> Hell\u00edn T. The physician-patient relationship: recent developments and changes. Haemophilia 2002; 8 (3): 450\u20134.<\/p>\n<p><a href=\"#_ftnref3\" name=\"_ftn3\">[3]<\/a> The patient will see you now- The evolution of the doctor-patient relationship. <a href=\"https:\/\/www.dice-comms.co.uk\/articles\/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\/<\/a> accessed 19<sup>th<\/sup> August 2022.<\/p>\n<p><a href=\"#_ftnref4\" name=\"_ftn4\">[4]<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Shrink_Next_Door\">https:\/\/en.wikipedia.org\/wiki\/The_Shrink_Next_Door<\/a>.<\/p>\n<p><a href=\"#_ftnref5\" name=\"_ftn5\">[5]<\/a> Dr Naomi Hartree. Helping Patients Avoid Doctor Dependency. <a href=\"https:\/\/patient.info\/doctor\/helping-patients-avoid-doctor-dependency.htm\">https:\/\/patient.info\/doctor\/helping-patients-avoid-doctor-dependency.htm<\/a> accessed 19th August 2022.<\/p>\n<p><strong>\u00a0<\/strong><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Film Review by Khalid Ali, Film and Media Correspondent \u2018The Shrink Next\u00a0Door\u2019 (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;\u00a0\u2018Analyze This\u2019\u00a0(Harold Ramis, USA, 1999),\u00a0\u2018Side Effects\u2019\u00a0(Steven Soderbergh, USA, 2013), and \u2018To the Bone\u2019\u00a0(Marti [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2022\/10\/18\/abuse-of-trust-a-psychiatrist-eroding-professional-boundaries\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":345,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[206],"tags":[15099],"class_list":["post-3496","post","type-post","status-publish","format-standard","hentry","category-film","tag-film-review"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Abuse of Trust: A Psychiatrist Eroding Professional Boundaries - Medical Humanities<\/title>\n<meta name=\"description\" content=\"Read Khalid Ali&#039;s review of the TV miniseries, The Shrink Next\u00a0Door, in today&#039;s film and media review.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3496\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Abuse of Trust: A Psychiatrist Eroding Professional Boundaries - Medical Humanities\" \/>\n<meta property=\"og:description\" content=\"Read Khalid Ali&#039;s review of the TV miniseries, The Shrink Next\u00a0Door, in today&#039;s film and media review.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3496\" \/>\n<meta property=\"og:site_name\" content=\"Medical Humanities\" \/>\n<meta property=\"article:published_time\" content=\"2022-10-18T09:00:19+00:00\" \/>\n<meta name=\"author\" content=\"Chris Pak\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Chris Pak\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496\"},\"author\":{\"name\":\"Chris Pak\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/#\\\/schema\\\/person\\\/0e11c1a9a0f1f9f2aa898a719652c44c\"},\"headline\":\"Abuse of Trust: A Psychiatrist Eroding Professional Boundaries\",\"datePublished\":\"2022-10-18T09:00:19+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496\"},\"wordCount\":860,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/#organization\"},\"keywords\":[\"film review\"],\"articleSection\":[\"Film and Media\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3496\",\"name\":\"Abuse of Trust: A Psychiatrist Eroding Professional Boundaries - 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