Silver Linings: Is Sickness a Shield Against Stigma?

John McGowan

Silver lining or more rain?
Photo: By Im Unicke

I’d been avoiding Silver Linings Playbook. Nothing against it particularly, it’s just that Very Serious films about mental health always feel like a busman’s holiday. I got corralled into seeing it by the missus though, more observant than me, who had clocked that a) it was warmly sentimental, and b) it featured a dance contest. These days plucky young hoofers channelling Patrick Swayze are all I ask of a film. And if someone is also (spoiler alert) saved by the love of a good woman, then my cup runneth over.

As well as Jennifer Lawrence’s Oscar, the talk on the internet has been about how realistic SLP is (or isn’t), and what it tells us about social attitudes to mental illness. Opinions are split between those who see it as a ground-breaking and nuanced portrait of people having emotional difficulties, and those who view its happy ending as idealised and simplistic. Lawrence has been lauded for her portrayal of Tiffany, the aforesaid good woman, who is frequently a bad girl as she seeks to drown the pain of widowhood. This makes her, according to your point of view, either an ideal candidate or the worst possible bet to get things together by dancing/falling in love with fellow recoverer Pat (Bradley Cooper).

We open with Pat checking out of a psychiatric hospital: a stay prompted by finding his wife in flagrante with another fella. The GBH he performed on his rival earned him a diagnosis of bipolar disorder. Pat clearly doesn’t take his illness seriously though. As well shirking his medication, he is using hospital, and his friendship with Tiffany, simply to fulfill the implausible fantasy of getting back together with his estranged spouse. Pat and Tiffany practice their dance moves in her garage, and shout painful truths at one another, but in a way that brings them closer. I’ll leave you to guess the ending. There are some interesting wrinkles along the way, such as Pat’s dad (Robert de Niro) who has obsessive rituals, and a psychiatrist (Anupam Kher) who pipes distressing music into his waiting room and bonds with Pat during a fight at a football game. He probably qualifies as one of the less plausible therapists in the pantheon of TV and movie shrinks.

So is the film simplistic or nuanced? Well, a bit of both really. Clearly a ‘love conquers all’ storyline is going to disappoint if you’re in the market for no-holds-barred realism. But telling Hollywood to eschew happy endings is like telling the wind not to blow. What's more there are those of us, myself among them, who go to the cinema for just such neat resolutions. And there is some complexity in SLP too. Lawrence gives Tiffany emotional heft, balancing sadness, promiscuity, and self-loathing with dignity. Cooper isn’t bad either. He manages to make a socially inept, sometimes unpleasant guy, into someone we can root for. Finding out he has bipolar disorder helps keep our sympathy. However, it’s here that SLP lost me.

While the character of Tiffany has some experience with mental health services (at one point she talks about medication), her arc is primarily about sadness and loss. By contrast Pat is more explicitly offered to us as someone who is mentally ill. Rather than angry, or cuckolded, or bereft, or any one of a host of other adjectives appropriate for a guy who has found his wife cheating on him, he is ultimately bipolar. His illness is invoked every time a minor character tries to diss him. Sickness is his shield against stigma, a point also made by the director. Much of the comment around the film stresses this. It’s praised for its openness about mental illness and how this may break down prejudice.

Most of the stuff I’ve read about stigma lately seems to concentrate on how mental illness is portrayed in the media. By this yardstick SLP is way ahead of something like the Kathy Bates character in Misery (also bipolar). That was over 20 years ago and maybe we’ve moved on.  In our current cultural moment people can be mad-sad, as opposed to just mad-bad. However, we are now stuck in a place where the way to respond to behaviour emerging from emotional problems is with a label of illness. And it’s not just film and TV. The people at Time to Change, the campaign against mental health stigma, are absolutely explicit about it: we should not stigmatise  people with mental illness because these are real health problems, just like physical ones. “As real as a broken arm” says their website. There seems no alternative to seeing emotional struggles through the lens of illness and health.

Nailing one’s colours to the mast in such a concrete way is obviously well-intentioned but, as I’ve argued before,* there are many downsides to diagnosis. These apply to both the reality of the categories and their usefulness. Perhaps the most profound problem is a narrowing of how we understand a person and their struggles. Silver Linings Playbook is a product of a climate dominated by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Pat’s experience and feelings are complicated but we are asked to sympathise with and like him because he’s sick. Look, it’s in the book! And it can happen to anyone. Surely though this isn’t the only way to think about emotional pain and still be compassionate? Instead could we understand Pat as someone with a weird and dominating dad and who has a tricky relationship with his brother? Or perhaps as someone existing in a tough and macho working-class culture (something beautifully realised in the film incidentally), who may struggle to express the humiliation of being so directly faced with his wife’s infidelity? Where would such a wider understanding leave us? Certainly with a more rounded picture of how Pat got to his particular position. And maybe with some more psychological routes forward, rather than the proffered solution being medication compliance.

On the flipside SLP, as Richard Brody in the New Yorker has pointed out, shows Pat straightening out his life via love rather than medicine, and via relationships rather than psychiatric orthodoxy. Though perhaps his dodgy therapist helps that decision. Some of the medical critics who seem most worried about the depiction of mental health problems cured by love, are also fretting about showing recovery without drugs. It’s clearly viewed as the wrong message. While I don’t want to deny that diagnosis and medication are helpful  for some people, I found it sort of a relief that his redemption doesn’t come out of a bottle. The film is more subversive perhaps than it initially seems. Though I’m a sucker for a romantic ending I also think that, in the real world, most of us can buy that not everyone gets a silver lining. It does seem though, that in the face of emotional distress, we can all get a psychiatric diagnosis.

* And so have many, many others. For further reading see: Mad in America, Demedicalising Misery, the Critical Psychiatry Network and the following chapter by my colleague Anne Cooke.