Chapter One
BADA BEING AND NOTHINGNESS The door to a psychiatrist's office opens into the waiting room. A 40-something female psychiatrist hobbles out on crutches, and the young female patient looks at the cast on her leg with concern. She follows her doctor into the office and sits across from her. After a few seconds of uncomfortable silence, the patient asks her therapist, "Should you really be here?"
The psychiatrist responds, "I feel better when I'm working."
The patient pauses for a moment and asks, "You mean, like Dr. Melfi?"
This real-life account of a therapy session reflects how David Chase's spectacularly successful Home Box Office (HBO) series, The Sopranos, has entered into our collective consciousness. Here the patient is referring to Dr. Jennifer Melfi's rapid return to her consulting room after being raped in a parking garage. In another therapy session, a thousand miles away from the first, a female analyst is upbraided by her patient for walking down an isolated stairwell to a parking garage. Her angry patient shouts at her, "That's where Dr. Melfi was raped!"
The Sopranos has received unprecedented praise from media critics. Writing in the Nation, Ellen Willis referred to it as "the richest and most compelling piece of television-no, of popular culture-that I've encountered in the past twenty years." Television critic Nancy Franklin notes, "There has certainly never been anything like it on TV, and on network TV there never could be anything like it-it goes out on a limb that doesn't even exist at the networks." In its third season the show received the highest ratings in HBO's history for a non-sporting event. Perhaps most telling, in 2001, huge numbers of Academy Awards watchers switched over in the middle of the annual event to get their weekly Sunday evening fix of The Sopranos.
Indeed, in towns and cities all over the United States and Europe, there is a "Sopranos effect" on the evening of a new episode. Retail establishments are suddenly deserted. Restaurant patrons make a hasty exit. Social invitations are declined. Answering machines pick up phone calls so not a single word of dialogue is missed.
The human condition involves psychological conflict, the inevitability of strife in intimate relationships, existential loneliness and crises of meaning. These psychological struggles are writ larger than life each week on The Sopranos, and we are drawn to the show because of them. In this book, I explore human psychology as it unfolds in The Sopranos, not only in the context of psychotherapy but in the characters' relationships, behavior and dreams that occur outside the consulting room. The series' writers, clearly serious students of human behavior, have done what Hamlet recommended to a troupe of traveling players visiting Elsinore. They have held a mirror up to nature-human nature, that is-and 11 million viewers can't take their eyes off the reflection.
Psychotherapists have shown a particular interest in The Sopranos. Many of them hooked up to cable or subscribed to HBO solely to see Jennifer Melfi's latest session with mobster Tony Soprano. And the next day over coffee or in the elevator, they critique Melfi's therapeutic strategies, chortle over Tony's malapropisms (Hannibal "Lecture" is one of my favorites), argue vehemently about whether or not Tony is treatable, express their growing distress about Dr. Melfi's crossing her legs when she wears a short skirt; and they debate Tony's diagnosis and micromanage Melfi's medication choices. These informal discussions were formalized in the third season when three other psychoanalysts and I began discussing each episode on the slate.com TV Club. The Slate discussion became popular beyond the wildest expectations of its editors, with hundreds of thousands of readers regularly following our dialogue.
To be sure, we therapists had been waiting a long, long time for a depiction of psychotherapy in the media that even approximates the complexity of real life we see in our offices. From Dr. Dippy's Sanitarium (1906) to Hannibal (2001), we have endured cinematic depictions of therapists that range from the buffoonish to the malevolent with very rare exceptions that approach what a therapist might actually do in practice. We've watched Peter Sellers attempt to seduce his women patients during group therapy in What's New, Pussycat? (1965). We've munched popcorn in darkened theaters while Woody Allen's other protagonists grow increasingly disillusioned with the therapeutic inaction of psychoanalysis. We've chuckled as Richard Dreyfuss unravels to the point of attempting to kill his patient (Bill Murray) in What About Bob? (1991). We've marveled as one beautiful female therapist after another succumbs to the charms of handsome male patients in movies like Spellbound (1945), Knock on Wood (1954), Sex and the Single Girl (1963), The Man Who Loved Women (1983) and Prince of Tides (1991). And, of course, our culinary preferences have been challenged by watching Hannibal Lecter sauté Ray Liotta's brains while making light conversation in the kitchen (although I think poor Hannibal is regarded with excessive harshness by my colleagues, especially since the American Psychiatric Association ethics code does not strictly forbid eating one's patients).
Television psychotherapists have not fared much better. They appear to be far more disturbed than their patients and seldom helpful to those who seek them out. I am aware that Frasier has been lavished with Emmy Awards and that Sidney Freedman helped Hawkeye work through a devastating trauma on MASH, but for the most part therapists on TV would not lead the average viewer to check the yellow pages for the nearest mental health clinic.
After a disconcerting history of more than four hundred American films featuring outrageous portrayals of mental health professionals at work, we psychotherapists have finally found a therapy process we can take seriously. Not only is the therapy an arguably accurate version of what actually happens in our consulting rooms, but the writers are blessed with an extraordinary psychological sophistication. The themes in Tony's life represented in the therapy are so complicated and compelling that they inspire collegial debate in the hallways of office buildings and at cocktail parties. Lorraine Bracco, who plays Dr. Melfi, and four of the show's five writers have been in psychotherapy themselves, and their experiences give the treatment an "inside" perspective that provides a ring of truth to the sessions between Tony and Dr. Melfi.
Not all mental health professionals are thrilled with the series or with the psychotherapy portrayed. The disagreements have prompted heated exchanges. In Psychiatric News, the official newspaper of the American Psychiatric Association, a reader asserted that he would flunk Dr. Melfi if he were examining her for the board certification exam because she colludes with her patient's antisocial behavior instead of confronting him about it. Another psychiatrist responded with an impassioned defense of Dr. Melfi: "I would dare say that The Sopranos has done more to destigmatize mental illness (through educating the public about such clinical diagnoses as panic disorder and antisocial and borderline personality disorders), reveal to the American public what goes on behind the closed doors of the therapist's office, and help define what a psychiatrist is than any public relations initiative ever promulgated by our own professional guild organization." He goes on to suggest that the American Psychiatric Association should honor the producers and writers. In fact, in December 2001, the American Psychoanalytic Association did present the producers and writers with an award for "the artistic depiction of psychoanalysis and psychoanalytic psychotherapy." Lorraine Bracco received an award at the same event for creating "the most credible psychoanalyst ever to appear in the cinema or on television."
Other colleagues criticize Dr. Melfi for telling Tony that if he reveals an intent to harm others, she will have to report him to the authorities. In their view, she has thus encouraged him to violate the fundamental rule of psychoanalytic therapy, which is to say whatever comes to mind without censoring. Still others have felt that Dr. Melfi is stiff and stilted in her style, heavy-handed, prone to speak in jargon and inclined toward lengthy psychoeducational monologues.
Because psychotherapists rarely see each other work with patients, however, there is no firm consensus about what constitutes a good session with a particular person. Hence, they may have dramatically different opinions on depictions of psychotherapy in a television series. One reason, though, that the psychotherapy in The Sopranos is so fascinating is that the writers make no attempt to idealize Dr. Melfi as an oracular source of truth. They have wisely chosen to show her as a professional and competent practitioner who is nevertheless troubled with conflicts of her own and with specific countertransference reactions to Tony. Countertransference-the therapist's emotional reactions to the patient-is an expectable part of any therapy process and a tool to help understand the therapeutic interaction. Dr. Melfi's mistakes and her own emotional struggles with Tony lend further credibility to the series-and are especially engaging to viewers on both sides of the couch.
The Sopranos also departs from the positive cinematic depiction of psychotherapists. In a brief golden age of psychotherapy and psychoanalysis in the cinema between 1957 and 1963, idealized portrayals of dramatic healing misrepresented psychotherapy as badly as the negative portrayals. Think of Simon Oakland's brilliant psychodynamic formulation of Norman Bates in Psycho (1960) or Lee J. Cobb's magnificent cure of Joanne Woodward in The Three Faces of Eve (1957). In the former, the psychiatrist explains all of Norman's psychopathology and even the location of the missing money after a couple of forensic interviews. In the latter, the therapist integrates the disparate aspects of his patient's multiple personality by hypnotizing her and encouraging her to recall a single traumatic memory from her childhood. With The Sopranos, it is refreshing to see a therapist who is neither devalued as contemptible and incompetent nor raised to a transcendent level of expertise.
Even though The Sopranos is about many other aspects of Tony Soprano's life, the psychotherapeutic relationship between Tony and Dr. Melfi is at its heart. Creator David Chase noted that the therapy session was the germ of his idea for the series. Everything grew from that central image. He has acknowledged in an interview that the sessions with Dr. Melfi reflect his own experience with the woman therapist he saw. He also said he was helped by three or four male therapists before he found her. He insisted on a high degree of realism: "It was very important to me to let the silences play that really happen in a psychiatrist's office."
To say that the therapy represented in The Sopranos is the most accurate and complex ever to appear on television or film is not the same as saying that it is identical to what transpires in the office of the typical female psychiatrist conducting psychoanalytic therapy with a Mafia don. It would be a challenge, of course, to find such a therapeutic pair anywhere in the entire psychoanalytic community. The notion that a powerful mobster would seek out twice-weekly analytic therapy with a gorgeous woman therapist is a conceit that tickles the funny bone of audiences, who find this high concept irresistible. At least producers think they do. The Sopranos series was the sixth time in the 1990s that a mobster visited a therapist to get in touch with his feelings. Bill Murray spouted psychobabble in the 1993 film Mad Dog and Glory. Four years later, John Cusack poured out his soul to psychiatrist Alan Arkin in Grosse Pointe Blank. The same year National Lampoon's The Don's Analyst appeared on cable with Robert Loggia as the don and Kevin Pollak as the analyst. In Faithful (1996), Chazz Palminteri makes phone calls to his therapist (played by the director, Paul Mazursky) while holding Cher hostage. And in Analyze This (1999) Robert DeNiro is a mobster who, like Tony, suffers from panic attacks and Billy Crystal is the therapist. (Coincidentally, their creators made The Sopranos and Analyze This without any knowledge of each other's projects.) There is something inherently reassuring in learning that hard-boiled criminals are really sensitive pussycats beneath the surface. All that mayhem, extortion and cruelty probably just stem from not being loved enough as children.
Media like television and film occupy a region between reality and illusion. This realm is known as a "play space," a concept derived from the work of the British analyst D.W. Winnicott. He refers to a psychological experience that begins between an infant and mother but arises later in other relationships. It is a psychological space between fantasy and reality and between one's inner and external worlds, and it plays a key role in the development of play, creativity and other factors that lend richness to human experience. In the ideal psychoanalytic treatment, the patient and analyst enter this space to explore aspects of the self that are based partly in fantasy and partly in reality. For example, you as a patient may experience your analyst "as if" he or she were your mother or father. This evocation of an old relationship may help you explore feelings toward the therapist that grow out of early experiences, and help you to see how you re-create these feelings in your present relationships.
The unlikely notion that a troubled mobster might visit a therapist for intensive psychoanalytic therapy is an example of entering this fantasy-saturated playground, though in reality such events are unlikely to unfold in just this way. However, if one accepts the premises of the treatment arrangement-if indeed a Mafia don were to actually enter treatment with a beautiful Italian-American psychiatrist, the therapy that unfolds in The Sopranos becomes compelling and believable.
The series' writers rarely miss an opportunity to have fun with the premise of a hard-boiled thug in a psychotherapist's office. When Tony decides to tell his henchmen that he has been seeing a psychiatrist, his colleagues react with stunned silence. Silvio Dante (Steven Van Zandt) finally breaks the silence with words of moral support: "I'm sure you did it with complete discretion."
Continues...
Excerpted from The Psychology of The Sopranos by GLEN O. GABBARD Copyright © 2002 by Glen O. Gabbard
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