A month after I graduated from the Washington Psychoanalytic Institute, I enrolled in a screen-writing class at the Writer's Center in Bethesda, Md. “You therapist/analyst types really love movies,” my screenwriting instructor commented the first day of class as a dozen of us from disparate backgrounds introduced ourselves. Then he began his lecture, “Movies are the fulfillment of wishes …” and I felt right at home.
I had anticipated the association between films and dreams because of my involvement in the Forum for the Psychoanalytic Study of Film. Always a movie lover, as a first-year candidate I added a new dimension to my enjoyment of film. A colleague brought to class an early issue of the Forum's publication, Projections, which features articles ranging from film theory to psychoanalytic discussions of specific films, both classic and popular. I joined the Forum just to subscribe to this well written, intellectually stimulating publication. Throughout my psychoanalytic training, I preserved a Sunday-night routine of dinner and a video with extended family and suggested to family members that they read the discussions of the films we watched. Everyone agreed that the discussions heightened their enjoyment of the film. By the time I graduated from psychoanalytic training in 1995, writing a film script seemed the most natural thing to do next.
What I came to realize through my study of screenwriting is that not only do dreams and movies fulfill wishes, but also film scripts and psychoanalytic case reports share common properties. Both tell a story from the main character's perspective, address universal themes, and deal with powerful affects. A psychoanalytic case report is like the negative of the film “picture”; a screenplay is psychology turned into action, whereas a psychoanalytic case report translates the psychology behind the action.
“When writing up a case, you have to show psychoanalytic process,” said a first-year psychoanalytic instructor. “I need to see what's happening between analysand and analyst,” said a second-year instructor. “Write in such a way that the reader can picture what is going on,” I was told in the third year. My screenwriting teacher gave a similar instruction: “Tell the story so the reader can visualize it.” Like conducting psychoanalysis, writing about psychoanalysis is part creativity and part craft, and the ability to tell a story well can be improved by mastering the techniques, or craft elements, of telling a story within a specific writing genre.
A screenplay is a 120-page story in three acts. Act I is the beginning, Act II is the middle, and Act III is the end. The story must have a hero who has a clear external goal. There must be conflict in every scene and obstacles to the attainment of the hero's goal; the hero must make an irreversible change. A psychoanalytic case report is a twenty-page narrative in three parts: the opening phase, the middle phase, and the termination phase. The analysand must have clear goals. In the report, the analyst is expected to show how the analysand's intrapsychic conflicts and resistances came alive in the transference and how the analysand made irreversible changes.
Suppose you want to write up a case report on Ms. M, an accomplished dancer and poet, who enters psychoanalysis with the chief complaint that she is attracted to “wild” men who either abandon her or mistreat her. Her goal is to understand this attraction and to free herself from it so she can meet a “normal” guy who wants to marry and have a family. In preparation to writing up this case, you sift through five years of process and supervisory notes and reflect on the psychoanalysis. Ms. M's traumatic childhood comes to mind. She grew up with an alcoholic father who when drunk lost control over his temper and sexual impulses while her mother turned a blind eye. You recall important dreams and her associations to them; her brutal revenge fantasies, sublimated in her poetry; her presenting identification of victim and how her unconscious identifications with the aggressor, the caretaker, the rescuer were manifested over time in the transference/countertransference; how she became aware of these and worked them through; how her self-esteem increased; how she ceased her destructive relationships with men; and how you understood the forces in the analysis that enabled her to reach her goal. How will you write about all this and execute a coherent narrative in twenty double-spaced pages?
Here are techniques, the craft elements of screen writing that may be useful in writing up a psychoanalytic case report.
One way to begin writing up a case is to start with what the filmmaker calls an “establishment shot.” This is the first frame the viewer sees, and it tells the story in a sentence, even if the audience does not figure out the meaning until the very end. Another way to begin effectively is to open with material from several sessions that tells the story in an abbreviated form — one or two pages that leave the reader with a question: why? who? what? The rest of the report becomes an elaboration of this opening sequence.
Make the analysand active. Even if the analysand enters psychoanalysis feeling like the fault lies not in himself but in the stars, by midpoint in the report show the analysand turn from passive to active and begin taking responsibility for his life.
Use conflict and “rising stakes” to drive the midphase portion forward. “No conflict, no story,” as my screenwriting instructor said. Rising stakes in script writing translates into the transference “heating up” in case report writing. As the heat rises, narrow the focus. Near the end of the midphase, show an “all is lost” moment. For example, “Just as he was about to receive tenure, he again undermined his success by…” Then show how the analysand recognizes “here I go again,” then rallies, pushes forward, moves into the final stages of integration, accomplishes the goals, and makes the transition into the termination phase.
Create a sense of immediacy. Film scripts achieve this by writing in the present tense. To heighten the sense of immediacy in a psychoanalytic case report, show more of the “here and now” of the transference as opposed to “there and then” history.
A word about dialogue. Poignant psychoanalytic dialogue is like film dialogue: short, mysterious, and confrontational.
Like scenes in a film, psychoanalytic sessions can be understood from multiple perspectives. A different narrative might be written from what the filmmaker or the author of the psychoanalytic case report left “on the cutting room floor.” An example of how a screenwriter might tell a story of a woman whose chief complaint, intrapsychic conflicts, transferences, and resistances are similar to those of Ms. M is found in the film Natural Born Killers. If film is the fulfillment of wishes, then one perspective on this film is that it is protagonist Mallory's revenge fantasy. Natural Born Killers reveals the
Tarpley Mann Long, M.S.W., is a board member of the Forum for the Psychoanalytic Study of Film (for information contact Judith Stevenson, 202-625-0625), a member of the APsaA's Public Information Committee, and co-chair for clinical social work on the Fellowship Subcommittee. She has written a feature-length screenplay, Brown-Eyed Handsome Man, and has completed treatments for Til Death We Part, Same Nickel, and Loser Magnet.
terror and horror of Mallory's raw experience that is sublimated in Ms. M's poetry and dance.
The establishment shot, filmed in black and white, is of a desert with a young wolf in the foreground, positioned at the edge where the desert ends and the highway begins. Leonard Cohen sings “Waiting for a Miracle”: “Baby, I've been waiting, waiting here so long … waiting for a miracle to come.” Next, the opening sequence, filmed both in black and white and in color, shifts back and forth from the present “reality” and the present as it is “perceived” by Mallory and her knight-in-shining-armor rescuer, Mickey, based upon their violent and sexually abusive histories. A rattlesnake's forked tongue flicks menacingly. A waitress pours coffee into a cup and changes the TV channel from “Leave it to Beaver” to “77 Sunset Strip” to a news channel showing President Nixon's resignation speech to a science fiction “creature feature,” then turns it off. Mallory and Mickey sit at a counter in a roadside diner. The waitress talks to Mickey about pie selections. Mallory calls the waitress by the wrong name, walks over to the jukebox, and starts dancing in front of a group of men, her arms raised, fingers V'd like Nixon's. Outside, in the middle of the highway, a newborn snake is run over by an eighteen-wheeler. A pickup truck with a deer tied to its roof pulls into the parking lot of the diner. A close-up of the deer's eye shows it to be hovering between life and death.
Based on the establishment shot, here is the story in a sentence. Lonely, adolescent Mallory lives unprotected in an environment inhabited only by deadly creatures and dreams of someone to rescue her from her misery. Identification with the aggressor and the rescuer are seen in this shot. The opening sequence introduces other identifications, such as the nurturing caretaker in the person of the waitress. Next, details of Mallory's childhood appear. The TV-channel sequence shows the theme of betrayal by the father in an image similar to what Dante wrote in Canto XXXIII of the Inferno: “When a soul betrays as I did, it falls from flesh and a demon takes its place, ruling the body till its time is spent.” Betrayal by the mother is captured by several rapid scene shifts from black and white to color which pervert the “feeding caretaker” identification. Mallory then cruelly rejects the caretaker/waitress' offer of food by deliberately calling her by the wrong name and walking away to dance in front of the men. At this point Mallory foreshadows the identification with the victim; her hands mimic President Nixon's, and now it is she who's about to betray.
In these few scenes, the viewer is introduced to Mallory's background, her attraction to “wild” man Mickey, the theme of parental betrayal, early resistances (repeating rather than remembering; turning from passive to active), a presenting affect, “soul murdered,” neither dead or alive, as symbolized by the deer; and her goal — to have a “Leave It to Beaver”–style happy family. The rest of the film is an elaboration of these themes and the obstacles (resistances) that Mallory must overcome in order for her to achieve her goal.
The study of film and screenwriting offers the psychoanalyst an opportunity to learn how to convey psychoanalytic understanding in writing in a more vivid, immediate, moving way, giving a sense of how we experience psychoanalysis from behind the couch.