File #10: "Plummer_MA-Thesis_09.21.2020.pdf"

“What About Bob?”
An Analysis of Gendered Mental Illness in a Mainstream Film Comedy
A Thesis
Presented in partial fulfillment of the requirements for the degree of Master of Arts in the
College of Graduate Studies of Northeast Ohio Medical University.
Anna Plummer
M.D.
Medical Ethics and Humanities
2020
Thesis Committee:
Dr. Julie Aultman (Advisor)
Dr. Rachel Bracken
Brian Harrell

Copyright
Anna Plummer
2020

ABSTRACT

Mental illness has been a subject of fictional film since the early 20th century and
continues to be a popular trope in mainstream movies. Portrayals of affected individuals
in movies tend to be inaccurate and largely stigmatizing, negatively influencing public
perception of mental illness. Recent research suggests that gender stereotypes and mental
illness intersect, such that some mental illnesses are perceived as “masculine” and others
as “feminine.” This notion may further stigmatize such disorders in individuals, as well
as falsely inflate observed gender disparities in certain mental illnesses. Since gendered
mental illness is a newly identified concept, little research has been performed exploring
the way stereotypical gendered mental illness is depicted in mainstream film. This paper
analyzes the movie What About Bob? to show that comedic film perpetuates stigma
surrounding feminine mental illness in men and identifies the need for further study of
gendered mental illness in movies to ascertain the effect such depictions have on the
observed gender disparities in prevalence of certain mental disorders, as well as offers a
proposal for coursework for film and medical students.

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ACKNOWLEDGMENTS

This paper would not have been possible without Dr. Aultman, whose teaching
inspired me to pursue further education in Medical Ethics and Humanities, and whose
guidance has been invaluable not only for this project, but also for addressing ethical
issues in the clinic. I would also like to thank Dr. Bracken and Mr. Harrell for their
constructive feedback and challenging me to broaden my mind while studying such
complex topics. All of the advice and support I have received from these individuals
have shaped me into being a physician dedicated to the compassionate and ethical
treatment of patients and will continue to inspire me to promote the importance of the
study of ethics and humanities in medicine.

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VITA

Education
Northeast Ohio Medical University ..................................................................... 2016-2020
Doctorate of Medicine
Cleveland State University .................................................................................. 2014-2016
B.S., Health Sciences
West Virginia University ..................................................................................... 2009-2013
B.S., Biology

Fields of Study
Major: Medicine; Medical Ethics and Humanities

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TABLE OF CONTENTS

ABSTRACT......................................................................................................................... i
ACKNOWLEDGMENTS .................................................................................................. ii
VITA .................................................................................................................................. iii
INTRODUCTION ...............................................................................................................1
CHAPTER 1: GENDER DISPARITIES IN MENTAL ILLNESS .....................................7
CHAPTER 2: AN ILLUSTRATION OF MENTAL ILLNESS IN COMEDIC FILM ....24
Introducing Bob Wiley ..........................................................................................26
Introducing Dr. Leo Marvin ...................................................................................39
The Physician-Patient Encounter ...........................................................................49
An Emerging Parent-Child Relationship ...............................................................52
Role Reversals: Patient Becomes Healer ...............................................................60
CHAPTER 3: THE IMPACT OF GENDERED MENTAL ILLNESS IN FILM ON
AUDIENCES AND EDUCATORS ..................................................................................73
Film Reception .......................................................................................................74
Film’s Impact on Persons with Mental Illness .......................................................77
Research, Education, and the Social Responsibility of Filmmakers and Medical
Professionals ..........................................................................................................81
The Humanities in Medical Education ..................................................................86
So, What About Bob? ............................................................................................89
Gendered Mental Illness in Film: A Course Proposal ...........................................90
CONCLUSION ..................................................................................................................91
REFERENCES ..................................................................................................................93
APPENDIX A: ELEMENTS OF MISE-SCÈNE ............................................................102
APPENDIX B: GENDERED MENTAL ILLNESS IN FILM: FILM SUGGESTIONS
AND DISCUSSION QUESTIONS .................................................................................108

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INTRODUCTION
Mainstream film comedies that feature characters with mental illness, such as
What About Bob? (Ziskin & Oz, 1991), have the potential to stigmatize persons with
mental illness and negatively affect their lived and clinical experiences. Though their
major role in society is to entertain audiences through humor, caricatures of persons with
mental illness may have other effects, including influencing the attitudes and perceptions
of such individuals in viewers. The genre of comedy itself is characterized by ploys and
themes meant to invoke laughter from audiences. However, the representation of
individuals affected by mental illness may invite the audience to ridicule these characters,
which may influence their attitudes toward persons with mental illness in society.
Comedic films, though seemingly benign, may hold significant power in terms of societal
perceptions of such topics of mental illness. Recently, Boysen et al., (2014) have
suggested an intersection between mental illness and gender, such that certain disorders
are perceived as feminine, while others are masculine. Anxiety disorders are perceived
as stereotypically feminine, and What About Bob? (Ziskin & Oz, 1991) centers around a
man with such a disorder. Feminine disorders in men may be stigmatized, and the role of
comedic film in perpetuating such stigma and its impact on those affected individuals and
general society has not been well-studied. Thus, it is necessary to consider the
intersection of gender and mental illness and how comedic film may reinforce the
concept of gendered mental illness in order to understand the potential impact such films
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have on personal and public stigma, as well as its effect on observed gender disparities in
certain disorders.
Films from other genres have acted as catalyst for societal changes over the
course of history, and the potential for comedies to affect society on a large scale should
be considered. For example, the documentary Blackfish (Oteyza & Cowperthwaite,
2013), which depicts the sad reality of orcas bred and kept in captivity, inspired a
movement that ultimately led to a change in how SeaWorld keeps and uses these
creatures in their parks, as well as a 60% decrease in stock price of the movie’s subject’s,
a Killer Whale named Tillikum, home park (Ferdman, 2014, Lange, 2016). Jaws
(Zanuck, Brown, & Spielberg, 1975) spurred a decrease in beach tourism after its release,
despite the reported rarity of shark attacks (Fisher, 2010). Film also highlights important
issues affecting society that may have otherwise gone unnoticed. The Day After
Tomorrow (Emmerich & Gordon, 2004) shows the potential implications of climate
change, while Erin Brockovich (DeVito, Shamberg, Sher, & Soderbergh, 2000) tells the
true story of a legal clerk who brought a case against a company for contaminating
drinking water.
Illness and disease are common subjects in both nonfictional and fictional film.
Documentaries often introduce the public to rare and/or poorly understood diseases and
the effects said afflictions have on sufferers. Life According to Sam (Fine & Fine, 2013)
shows a child living with progeria and his mother’s mission to find him treatment.
Unrest (Brea, Dryden, Gillespie, Nahmias, and Hoffman, 2017) follows the struggle of a
woman suffering from Chronic Fatigue Syndrome. Afflicted (Logreco & Partland, 2018)
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not only chronicles the lives of the individuals with illnesses, it also sheds light on the
psychological and financial effects of caring for a sick loved one. Fictional films often
use dramatic and comedic approaches to artistically represent the struggles individuals
with illness suffer. Cancer is a popular topic, and is explored in film such as Steel
Magnolias (Stark, Stone, White, & Ross, 1989), The Fault in Our Stars (Godfrey,
Bowen, & Boone, 2014), and A Walk to Remember (Di Novi, Lowry, & Shankman,
2002), to name a few. HIV/AIDS is the medical subject in Dallas Buyers Club (Brenner,
Winter, & Vallee, 2013) and is also implied as the cause of death of Jenny in Forrest
Gump (Finerman, Tisch, Starkey, & Zemeckis, 1994). Paralyzed characters are often
incorporated in films, including Me Before You (Rosenfelt, Owen, & Sharrock, 2016) and
The Diving Bell and the Butterfly (Kennedy, Kilik, & Schnabel, 2007), which centers
around the autobiographical experiences of a paralyzed individual.
Like physical illness, film has long used mental illness as inspiration for
characters and themes. However, unlike physical illness, mental illness is often shown
horror genre. Film often depicts mental illness as something to be feared, with many
such movies either implying or explicitly blaming mental illness for the aggressive
behavior displayed by antagonists and antiheroes (Goodwin, 2013). For example,
Psycho (Hitchcock, 1960) suggests that Norman Bates’ murderous acts are due to an
affliction with dissociative identity disorder. Halloween (Hill & Carpenter, 1978) is the
story of a man who escapes from a mental institution 15 years after murdering his sister
and stalks and kills a group of teenagers on Halloween night.

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Besides the many violent characters with mental illness in film,
misrepresentations of other disorders are common. While mental illness affects all
demographics, many movies tend to show the highly gifted geniuses, which has been
criticized as linking mental illness to greatness (Kondo, 2008). Indeed, the average
person with mental illness does not have such qualities that elevate them to a position of
admiration. On the other hand, it is unfair to assume that mental illness will always
hinder a person from doing amazing things. A Beautiful Mind (Grazer & Howard, 2001)
is the story of John Nash, a Nobel Prize-winning mathematical genius, and his struggle
with paranoid schizophrenia. The Soloist (Foster, Krasnoff, & Wright, 2009) depicts
Nathaniel Ayers, a gifted musician, who also suffers from schizophrenia. Good Will
Hunting (Bender & Van Sant, 1997) tells the story of a math genius, Will Hunting, and
his unspecified mental illness that causes him to experience bouts of rage and violent
outbursts. Although these movies show people with mental illness in a more positive
light than horror films, they still are wholly misleading about mental illness in the general
public.
An important detail to keep in mind when viewing these films is genre. The genre
of a film will largely dictate the presentation of a subject, such as mental illness. Horror
films are designed to instill a sense of uneasiness in the audience, presenting the subject
as a threat. Thus, it might feature characters with mental illness as obviously aggressive
individuals that are intent on terrorizing and/or harming other people, insinuating that
persons with mental illnesses should be feared. In contrast, comedies are designed to
provide a source of material for audiences to laugh at. The situations and characters are
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typically presented in a lighthearted, sometimes ludicrous, manner in order to make light
of, and perhaps mock, the subject. Thus, while horror films may paint persons with
mental illness as a threat, comedies may present them as something to laugh at and may
misrepresent and stigmatize mental illness in a different way. Indeed,
If film perpetuates inaccurate and largely negative stereotypes about mental
illness in general, as discussed above, I suggest that it may also perpetuate the gendered
stereotype of mental illness suggested by Boysen et al. (2014) as well. The use of
cinematic framing techniques, combined with the general portrayal of a character with
mental illness, may influence the audience to perceive a disorder as masculine or
feminine. This may cause the audience to associate a particular disorder with either men
or women, respectively.
Thus, the purpose of this thesis is to examine the impact of gender stereotyping of
mental illness in comedic film, using What About Bob? (Ziskin & Oz, 1991), a movie
featuring a man with a feminine disorder, revealing how these layered stereotypes
contribute to a deeper problem of intolerance in our society that is perpetuated by the film
industry. That is, the gendering of mental illnesses by comedy films may be at least
partially responsible for the gender disparities observed in prevalence rates of mental
disorders by increasing stigma of certain feminine disorders in men. Therefore, there is a
need for more complex mental health education and care, as well as a critical look at the
moral and social responsibilities of film makers to reduce mental health stigma and
gender biases through the messages they send to audiences. Before delving into these
considerations, I begin this thesis by laying the groundwork, discussing the prevalence of
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gender stereotypes in mental illness and the gender schema theory. In the second chapter
of this thesis, I analyze What About Bob (Ziskin & Oz, 1991) using film elements of
mise-en-scène, that is, everything that composes a scene, including lighting, design,
composition, and kinesis (see Appendix for descriptions of the film elements) to illustrate
the complexities of mental illness and the lived experiences among sufferers of certain
gendered mental illnesses. Much like mental illness diagnoses have been used to police
gender roles,
Bob, the subject of the film, is an average man living in New York City who
suffers from severe anxiety, a feminine mental illness. As viewers watch his behavior and
the way Dr. Marvin and others respond to him, they may form ideas about how people
with mental illness behave, as well as stigmatizing attitudes toward these individuals.
In this analysis, I explore how audiences receive such films and the stereotypes
within, as well as consider the moral and social responsibilities of film directors and
writers in recognizing, if not acting to reduce or eliminate, gendered mental illness
stereotypes. Finally, in the third chapter, I identify the potential impact visual media has
on persons suffering from mental illness and the need for further mental health
humanities research and education to acquire a deeper understanding of gendered mental
illness and its representation in film and other media forms.

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CHAPTER 1
GENDER DISPARITIES IN MENTAL ILLNESS

The 2017 National Survey on Drug Use and Health conducted by the Substance
Abuse and Mental Health Services Administration (2018) estimated that 46.6 million
adults in the United States, representing 18.9% of the population, live with a mental
illness. The prevalence of mental illness in women is estimated at 22.3%, while in men,
it is 15.1%. Less than half of affected individuals, 42.6%, (19.8 million) received mental
health services in 2017, with more affected women (47.6%) than men (34.8%) receiving
help. An estimated 11.2 million (4.5% of adults) lived with a serious mental illness in
2017, experiencing significant functional impairment that affected one or more major life
activities. The prevalence of serious mental illness in women was estimated at 5.7%,
while in men, it was 3.3%. Of this figure, 66.7% (7.5 million) received mental health
services in 2017, with more women (71.5%) than men (57.7%) receiving treatment
(Substance Abuse and Mental Health Services Administration, 2018).
The above statistics show a disparity in the overall rates of mental illness between
men and women; furthermore, some disorders are disproportionately diagnosed more
frequently in certain genders, as well. For example, women are nearly twice as likely to
be diagnosed with anxiety and/or depression than men, while men exhibit higher
prevalence rates of antisocial personality disorder and substance abuse disorders
(American Psychological Association, 2011; Eaton et al., 2012; Substance Abuse and
Mental Health Services Administration, 2018). Schizophrenia and bipolar disorder are
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estimated to have a roughly equal prevalence in men and women (Abel et al., 2010;
Diflorio & Jones, 2010).
Hypotheses for the gender disparities in mental illness rates cite a range of
potential factors, from biology to environment. Indeed, a review of meta-analyses
performed by Gatt et al. (2013) found that several specific genetic variants have been
implicated in the development of certain mental disorders, including schizophrenia,
anxiety, depression, ADHD, and bipolar disorder, with potential sexual dimorphisms of
said genes. That is, men and women may have the same gene but have variance in
expression. Thus, the question is how and why individuals may have vastly different
presentations of the same gene and thus, variance in the presence and severity of the
symptoms of mental illness.
It is generally thought that both genes and environment contribute to the
development of mental illness, however, there has been little evidence to adequately
explain why women and men appear to be disproportionately affected by different
disorders (Riecher-Rössler, 2017). Indeed, a review of meta-analyses performed by Gatt
et al. (2013) found that several specific genetic variants have been implicated in the
development of certain mental disorders, including schizophrenia, anxiety, depression,
ADHD, and bipolar disorder. However, the expression a gene and subsequent
development of mental illness appears to depend on more than the mere inheritance of
said gene. This same review observed that some genes associated with certain mental
disorders appear to have sexual dimorphism in expression; that is, men and women may
express the same gene differently. The mechanisms underlying the differential
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expression of said genes are not fully understood but are likely to be a result of complex
processes potentially influenced by environmental processes.
Indeed, familial studies have revealed that the mere presence of implicated genes
does not guarantee the development of mental illness. Several studies involving twins
have noted that many mental illnesses generally tend to have a hereditary component that
increase the likelihood of the individuals of developing said illness; however, these same
studies suggested that genetics were only partially accountable, with environmental
influences contributing to symptom development and severity. A study by Agrawal et
al. (2004) suggested that genetics are significantly associated with the presence of
depressive symptoms in twins, with monozygotic twins having the highest correlation,
independent of sex. This same study found a similar correlation in dizygotic twins,
though to a lesser extent, and with no significant difference between same-sex and
opposite-sex twins. The authors suggested that a model attributing genetic and
environmental factors to variability in depressive symptoms was a better fit than one
attributing solely genetic or solely environmental factors.
Furthermore, a meta-analysis of the heritability of alcohol use disorder in twins
and adoptive siblings by Verhulst et al. (2014) suggested that alcohol use disorder does
appear to have a genetic correlation, but environmental factors may account for variances
in symptoms. However, this same study did not suggest the presence of sex-specific
genes, as both same-sex and opposite-sex twins had similar ratios of correlations. That
is, the authors predict that the same genetic factors contribute to the development of
alcohol use disorder in both males and females. Therefore, though the prevalence of
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alcohol use disorder is greater in men, genetics are likely not the sole factor accounting
for this disparity.
Consistent with the aforementioned studies, though a genetic component is
suggested to be present in the development of certain mental illnesses, environmental
influences are important, as well. One such meta-analysis by Van Houtem et al. (2013)
suggested a heritable component to anxiety disorders and phobias. This same analysis
also suggested that the specific type of phobia may also have a genetic basis, as well.
However, no quantitative differences in genetics were observed between sexes,
suggesting that the same genes were responsible for the development of said anxiety
disorders and phobias in both men and women, despite the higher recorded prevalence in
women.
The question then arises why gender disparities, such as the higher rates of
anxiety and depression in women and the higher rates of substance abuse disorder and
antisocial personality disorder in men, are documented. If the two sexes have the
potential to inherit the same gene, what mechanisms lead to the varying expressions of it
between individuals and the sexes as a whole? Despite the strong support for a genetic
basis of mental illness, individual differences in expression of genes and symptomology
of disorders are likely due to factors not included in the genome, i.e. environmental
factors. From a biological standpoint, epigenetics and hormones have been identified as
potential modulators of mental illness. Epigenetics refers to the modification of a gene
through chemical processes, for example, via DNA-methylation, where a methyl group is
attached to a gene. The modified gene’s expression is then either activated or suppressed,
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depending on the epigenetic change, i.e., the addition or removal of a chemical group.
Recently, researchers have speculated that epigenetic changes may be necessary for the
development of mental illness (Higgins, 2008). Indeed, a review article by Guintivano &
Kaminsky (2014) suggests that epigenetics may be an important mediator between genes
and environment, resulting in altered expression of said genes and the emergence of
mental illness. Moreover, this same article suggests that the timing of such epigenetic
changes during an individual’s development (e.g. during fetal development, early
childhood, etc.) may be important, as well, citing studies linking maternal nutrition,
infection, and more on the development of mental illness in their offspring. Adverse
events in an individual’s life may therefore lead to epigenetic changes in genes that are
linked to mental illnesses, contributing to the phenotypic variances that are observed in
affected individuals.
Another consideration currently being explored is the effect of sex hormones on
mental illness symptoms. Though research in this area is still in its infancy, some studies
have emerged supporting the notion that fluctuations in gonadal hormones may
contribute to the rise of mental illness in an individual. A meta-analysis by Walther et al.
(2019) suggested that low testosterone may be associated with depression in men and that
treatments addressing the lack of this hormone may be therapeutically beneficially in
alleviating depressive symptoms. Likewise, estrogen has been implicated as a potential
mediator for the emergence of schizophrenia. According to a review by Gogos et al.
(2019), low estradiol, a potent estrogen, as well as low progesterone, has been observed
in both men and women presenting with schizophrenia and first-time psychosis.
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Furthermore, high levels of dehydroepiandrosterone sulphate (DHEA-s) and
testosterone were also observed in individuals with schizophrenia, according to a metaanalysis by Misiak et al. (2018), and a negative correlation between serum testosterone
and the severity of schizophrenia symptoms has been reported in several studies, such
that lower levels of testosterone may be associated with more severe symptoms (Gogos et
al., 2019). Other studies have suggested a correlation between gonadal hormone
fluctuations and the onset and severity of symptoms in bipolar disorder and PTSD,
further supporting the hypothesis that sex hormones play a significant role in the
development of mental illness and potentially account for some of the gender disparities
recorded in psychiatric disorders (Gogos et al., 2019).
Though the biological environment appears to be important in the development of
mental illness, another dimension must be considered: the social environment. Adverse
childhood experiences (ACEs) describe any trauma or stressful event that occurs during
childhood, such as abuse and neglect, witnessing violence in the home or neighborhood,
and parent/guardian divorce (Centers for Disease Control and Prevention, 2019). ACEs
have been associated with the development of mental illness in children, including
depression, anxiety, and substance abuse disorders (Zarse et al., 2018). Moreover, a
history of ACE(s) has been associated with increased odds of suicide attempt, with 3-4+
ACEs with a younger age at first attempt (Choi et al., 2018). Research has suggested that
boys and girls experience different types of ACEs. For example, a study by Duke et al.
(2010) suggested that girls may be more likely to experience sexual abuse compared to
their male counterparts. This same study suggested that ACEs were associated with a
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greater risk of perpetrating violence in boys compared to girls. Though it is possible that
the type of ACE experienced by an individual may influence the subsequent behavior,
this potential correlation has not been well-studied yet. Therefore, other factors that may
explain such gender disparities must be considered, including socialization of children
with respect to gender. That is, are boys and girls taught to react in different ways
according to societal gender expectations?
Indeed, from the time children are born, the adults are influential in teaching and
demonstrating how to be, both consciously and unconsciously. An example is the
assigning of toys based on gender. Through the use of colors (e.g. pink for girls, blue for
boys), as well as written and verbal labels and marketing narratives, children learn what
society deems to be gender-appropriate material (Dinella & Weisgram, 2018). One
content analysis of LEGO® Group playsets found that LEGO® City, which is marketed
toward boys, emphasized skilled professions, expertise, and heroism, while LEGO®
Friends, which is marketed toward girls, encouraged being domestic, having hobbies, and
aim for beauty (Reich et al., 2017). Evidence has also suggested that parents interact
with their sons and daughters differently, engaging in “rough and tumble” play consisting
of poking, tickling, tumbling and language related to achievement with boys, while
engaging in more singing/whistling and language related to sadness and about the body
with girls (Mascaro et al., 2017). Furthermore, a study by van der Pol et al. (2015) found
that, when discussing depictions of emotions, parents tended to label angry children as
“boy” and sad and happy children as “girl,” suggesting an association of said emotions
with a certain gender, the implications of which may be the unconscious passing on of
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such implicit stereotypes to children. This early gendering of certain behaviors and
emotions in individuals may provide the basis for later processing of stimuli in terms of
gender. According to Sandra Bem’s Gender Schema Theory, sex-typing, whereby
society associates masculinity with men and femininity with females, may begin with an
individual’s readiness to process new information according to previously established
ideas about sex and gender (Bem, 1981).
Indeed, gender prescribing, in which society dictates what behaviors are
appropriate for men and women based on biological sex appears to occur from an early
age and continues into adulthood from a multitude of external forces. The way men and
women are socialized according to their respective sexes and treated throughout
childhood and into adulthood, as well as the expectations society has of the way they
should behave may be especially impactful in the manifestation of mental illness
symptoms. Men and women are expected to act in certain stereotypical ways, according
to sex, and deviation from these behavioral prescriptions may be met with social and
professional repercussions (Bem, 1974; Prentice & Carranza, 2002). Society favors men
who are assertive and self-reliant, who have leadership qualities and strong personalities,
and rejects men who are emotional, moody, and weak (feminine qualities). In contrast,
society desires women who are warm, kind, sensitive, and cooperative, and reject women
who are rebellious, cynical, and arrogant (masculine qualities) (Prentice & Carranza,
2002). Such collective traits that are connected to one’s sex by social constructs will be
referred to as gender for the purposes of this paper.

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Though women and men who deviate from their prescribed gender stereotypes
face negative consequences in society and the workplace, men may, in fact, be punished
more harshly for their nonadherence to their own gender stereotype. Men who express
traits deemed to be feminine (e.g. emotional, agreeable, vulnerable, humble, etc.) are
often perceived as less competent, less hirable, and of lower status, resulting in fewer
opportunities for promotion and less income, compared to their more masculine
counterparts (Mayer, 2018). These men are often viewed as homosexual, which carries
its own stigma and was once considered a mental disorder, and subsequently, are more
prone to harassment and violence from other men (Burton, 2015; Huebner et al., 2004;
McCreary, 1994).
Such stereotypical thinking intersects with mental health. As Boysen et al.,
(2014) observed, society applies gender to mental illness, as well. Disorders
characterized by externalizing symptoms, in which the individual displays disturbances in
conduct, are perceived as masculine illnesses. These include antisocial personality
disorder and substance abuse disorders, as well as paraphilias. In contrast, disorders
characterized by excessive concern about one’s appearance and emotional lability are
perceived as feminine, including histrionic personality disorder and eating disorders.
Conversely, mental illness has historically been applied relative to gender, as well. A
classic example is the historical diagnosis of hysteria as a female disorder, associated
with the uterus and triggered when a woman did not procreate with a man (Tasca et al.,
2012). Women were generally thought to be weak and vulnerable to mental illnesses, and
though Jean Martin Charcot (1825-1893), the French father of neurology, collected data
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showing that hysteria was more common in men, the overarching belief that hysteria
solely affected women persisted until the 20th century, when contemporary psychiatrists
began suggesting that any person, man or woman, could be affected with such a disorder
(Tasca et al., 2012). Even so, the term “male hysteria” was used, and afflicted men were
suggested to be feminine and sexually inadequate by Sigmund Freud (Kavka, 1998).
Thus, the intertwining of gender and mental illness is not a new concept, but rather, has
been a theme throughout history. Certain illnesses have been associated with femininity
for centuries, most notably hysteria, and men who were diagnosed with such disorders
were thought to be effeminate (Kavka, 1998).
The adherence to rigid gender stereotypes has been suggested to affect the
willingness of men to accept and seek-help for both physical and mental health issues.
Research has shown that men are generally less likely to seek professional help for
mental disturbances, especially when they endorse traditional masculine stereotypes
(Juvrud & Rennels, 2017; Pattyn et al., 2015; Seidler et al., 2016). Masculine norms
dictate that men be self-reliant, therefore expressing a need for help is often interpreted as
a violation of their gender role. This reluctance to consult professional health services
may be further mediated by the type of illness the man is suffering from. Michniewicz et
al. (2016) found that men considered gender-atypical illness as a threat to their
masculinity and feared a loss of gender status when faced with a stereotypically feminine
illness. Consistent with this finding, a focus group conducted by Rochlen et al. 2010
found that men viewed depression, a disorder more commonly diagnosed in women
primarily characterized by emotional disturbances, as incongruent with their masculine
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social roles; participants associated the disorder with weakness and vulnerability, the
opposite of the prescribed masculine traits of strength and stoicism. Western society has
taught men that girls cry and boys don’t, a basic principle that influences a man’s ability
to express such “feminine” emotions and acknowledge his suffering and need for help
(Rochlen et al., 2010; Seidler et al., 2016). Similar observations have been made
regarding men’s attitudes toward other stereotypically feminine mental illnesses. Eating
disorders are generally thought to be a woman’s illness; indeed, the excessive concern an
individual has for the appearance of his/her body that is the foundation of these disorders
is associated with stereotypical femininity (Boysen et al., 2014). As such, men have
indicated that being diagnosed with an eating disorder would be shameful, as eating
disorders are a female problem and admitting their struggle would be an affront to their
masculinity (MacLean et al., 2015; Soban, 2006).
Another consideration for the discrepancies in mental illness rates between men
and women may be due to differences in presentation of the disorder. The Diagnostic
and Statistical Manual of Mental Disorders-5 (DSM-5) (American Psychiatric
Association, 2017) outlines each mental disorder and the criteria that must be met to be
diagnosed with a certain illness. If a person does not meet the criteria for a disorder, he
or she is not diagnosed with it. Research has shown that men and women may present
with the same disorder in different ways. For example, the DSM-5 criteria for depression
requires at least 5 of the following symptoms to be present during a 2-week timeframe,
with at least 1 of the symptoms being decreased interest/pleasure or depressed mood:
depressed mood; diminished interest/pleasure in most activities; significant weight
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change or appetite change; increased or decreased sleep; psychomotor agitation or
retardation; fatigue or decreased energy; feeling worthless; decreased concentration or
indecisiveness; and/or recurrent thoughts of death or suicidal ideation. These symptoms
must cause significant distress or impairment and cannot be attributed to a substance or a
medical condition (Uher et al., 2013). While the DSM-5 largely focuses on internalizing
symptoms for diagnosis, research suggests that the current criteria may not be sufficient
to capture depression in males. Magovecivic & Addis (2008) developed the Masculine
Depression Scale (MDS), which included externalizing symptoms such as aggression,
anger, alcohol/drug use, and sexual activity, to explore the presence of such symptoms in
men after a stressful life event. They found that men who endorsed greater adherence to
masculine gender norms reported more externalizing symptoms. Moreover, a study using
the aforementioned MDS found that, although both genders experience internalizing
symptoms in depression, men significantly endorsed a greater number of externalizing
symptoms, though the overall score on the MDS was similar between men and women
(Genuchi & Mitsunaga, 2015). These results suggest that, though men and women may
experience depression similarly, men are more apt to express the disorder outwardly in a
different manner. The increased use drugs and alcohol during depressive episodes may
also be misinterpreted, with the underlying depression unrecognized and psychiatric
treatment deferred. (Oute et al., 2018).
Yet another factor that may contribute to the gender disparities in mental illness
prevalence rates is bias in healthcare professionals. Research has shown that women are
more likely to be diagnosed with a mental illness than men, even when they present with
18

the same symptoms (Garb, 1997; Lewis et al., 2006). Furthermore, studies suggest that
physicians are more likely to have a physiological explanation for a man’s reported
symptoms, while attributing a woman’s symptoms to a psychological etiology (Hamberg,
2008). A study by Bertakis et al. (2001) found that primary care physicians were more
likely to diagnose women with high scores on the Beck Depression Inventory (BDI) with
depression (stereotypically feminine disorder) than men with high scores. This same
study found a greater number of false positive diagnoses in women than in men with low
BDI scores. Mental health professional gender bias has been observed in the diagnosis
of stereotypically masculine disorders, as well. Fuss, Briken, & Verena (2018) found that
psychologists and psychiatrists generally pathologized atypical sexual behavior more in
men than women. Affected men were more stigmatized than affected women in this
study as well, with mental health professionals perceiving men as more dangerous and
expressing a greater desire for social distance.
Under-recognition of a disorder in a person by the affected individual or those
around him/her, including family, friends, and healthcare professions, may be a
contributing factor to gender disparities in prevalence rates, as well. Campaigns
promoting education and awareness of disorders may mislead the public to assume that
said disorder is highly unlikely to affect one gender. As a result, if the person is the
opposite gender, s/he may not suspect or recognize symptoms of that disorder in
her/himself. Indeed, eating disorders are perceived as stereotypically feminine. Attempts
to educate the public and raise awareness of the disorder often include the high
prevalence rates in females (MacLean et al., 2015). As media reinforces the idea of
19

eating disorders as a strictly female disorder, such disorders may not be acknowledged in
men (Räisänen & Hunt, 2014).
In fact, the role of media as a societal factor contributing to the observed gender
disparities in other mental illnesses cannot be ignored. Film is an especially culturally
relevant form of media that serves a variety of purposes. Through a combination of visual
and auditory elements, it creates stories that audiences can interpret in a multitude of
ways. If educational campaigns can influence society’s awareness and perception of
certain topics, as described above, film, through its dramatization of its subjects, may
play a significant role in the way society’s gender stereotyping of mental illnesses. The
messages that audiences receive from comedic films about stereotypical masculine and
stereotypical feminine mental illnesses in men may affect the level of stigma associated
with each.
Male characters with mental illness are often shown as being violent, their
psychopathy being inspiring murderous sprees in horror movies used to invoke fear and
disgust or at the very least, a general unsettling feeling, in the audience. The cult classic,
Psycho (Hitchcock, 1960), for example, features a homicidal male whose violent nature
is driven by his own mental illness, namely dissociative identity disorder. Having this
character’s alternate personality be a dangerous entity perpetuates the stereotype of
masculine mental illness being defined by violence and aggression. Similarly, Sybil
(Capice, Dunne, Babbin, & Petrie, 1976), depicts a female character with dissociative
identity disorder. However, her alternate personalities are not shown to be violent; rather
her emotional turmoil is directed inwardly, and her personal anguish is amplified in her
20

own suffering. This stark contrast in characters of different genders with the same
disorder arguably propagates the stereotype of masculinity and femininity in behaviors
attributed to mental illness, and the depiction of mental illness reaffirms and reifies
gender norms.
When a male character is shown to have a stereotypically feminine disorde, he is
often shown as a more feminine character in general. The Skeleton Twins (Duplass et al.,
2014), a dramatic comedy, centers on the experience of a brother and sister who struggle
with major depression. Milo, the male twin and who attempts suicide early in the film, is
homosexual, which is often associated with femininity and generally stigmatizing. The
implicit association between major depression and femininity mediated through Milo’s
homosexuality may therefore reinforce the notion of the gendering of such a disorder.
Similarly, Welcome to Marwen (Rapke, Starkey, & Zemeckis, 2018), a film about a man,
Mark Hogancamp, suffering post-traumatic stress disorder (PTSD) following an assault,
presents the protagonist as feminine. Although he is heterosexual, he has a fetish for
women’s shoes and is shown wearing them. Similarly, in the horror film Silence of the
Lambs, Buffalo Bill, a psychopathic serial killer, also dresses in women’s clothing, which
arguably links femininity and deviance from gender norms with psychopathy, despite
cross-dressing not being a diagnosable mental illness. Furthermore, in Welcome to
Marwen (Rapke, Starkey, & Zemeckis, 2018) the people who protect and care for Mark
are women, a role reversal that paints him as vulnerable and that alludes to his own lack
of masculinity, as men are expected to be self-sufficient and independent. Though PTSD
is typically associated with men, likely due to the prevalence among returning military
21

men, it is diagnosed more frequently in women and is characterized by fear and anxiety,
symptoms associated with femininity (Vernor, 2019). Indeed, according to the National
Center for PTSD, women are more than twice as likely to develop PTSD, and the type of
trauma they experience may be a factor (National Center for PTSD, n.d.). Women are
more likely to suffer sexual trauma, such as sexual assault, which has been implicated as
a major conditional risk factor for the development of PTSD. In contrast, men are more
likely to experience physical traumas, such as assault and combat injuries (National
Center for PTSD, n.d). PTSD has historically been linked to men who have been in
battle, though it has been referred to by different names (Crocq & Crocq, 2000). Thus, its
association with men in present day is likely from a long tradition of recognition in male
soldiers. Likewise, Mark Hogancamp developed PTSD after being attacked in a bar,
further reinforcing the narrative of men developing the disorder after a physical assault.
As the audience forms their opinions on mental illness in others, those suffering
from such disorders may develop certain perceptions about their own struggle, resulting
in self-stigmatization. The presentation of mental illnesses in film may reinforce gender
norms and thus, stigma, of disorders that are associated with masculinity and femininity.
Men, especially, may be more prone to self-stigmatization when faced with a
stereotypically feminine mental illness, as their masculinity is often a vital part of their
identity and their sense of self-worth, as well as their social status, may be threatened. If
certain disorders are presented as feminine, it is possible that men will be less likely to
recognize or admit being affected by such illnesses and potentially less likely to seek

22

help. Furthermore, they may be more likely to self-treat, which could contribute to the
gender disparity of substance abuse disorders in men (Oute et al., 2018).
This paper analyzes What About Bob? (Ziskin, & Oz, 1991), because it is a
comedy film that depicts a man with a stereotypically feminine mental illness that is
definitively diagnosed by the psychiatrist in the film. Though mental illness in movies
has been examined in a general manner across all genres, and especially in horror movies,
little work has been done to analyze the representation of mental illness in comedies. The
potential for this genre of film to stigmatize mental illness and propagate inaccurate
representations has not yet been explored in depth. Furthermore, since comedies tend to
caricaturize characters and situations, the potential for them to exaggerate the intersection
of mental illness and gender stereotypes is great. What About Bob? (Ziskin, & Oz, 1991),
is a cult classic and was well-received by both critics and consumers, grossing nearly $64
million at the box office (What About Bob? (1991)- Financial Information, 1991). It
continues to air on television networks regularly, frequently offering opportunities for
those who have not previously seen it to indulge. With its widespread availability and
PG rating, it offers entertainment for adults and children, as well as ample opportunity for
propagating stigma surrounding mental illness, particularly a feminine mental illness in a
man. However, despite it being such a provocative film regarding mental illness in
general, as well as gendered mental illness, in American society and popular media, few
scholars have offered any sustained analyses of it. I contend that this movie is a powerful
tool for teaching medical students and film students about the intersection of gender and
mental illness; therefore, in the next chapter, I dissect the film and identify the feminine
23

and masculine traits of the two major characters, Bob Wiley and Dr. Marvin, and analyze
the implications of framing such gender stereotypes in a comedic film about mental
illness.

CHAPTER 2
AN ILLUSTRATION OF GENDERED MENTAL ILLNESS IN COMEDIC FILM

What About Bob? (Ziskin, & Oz, 1991) is a comedy starring Richard Dreyfuss as
Dr. Marvin, an accomplished psychiatrist, and Bill Murray as Bob Wiley, his new patient
plagued by anxiety. Dr. Marvin has just published a book and is planning on going on
vacation to Lake Winnipesaukee with his family for a month. After a brief phone call
with a colleague, Dr. Marvin agrees to accept a new patient referred, who is revealed to
be Bob. However, at their initial appointment, which occurs the same day, Bob forms an
attachment to Dr. Marvin. He travels to Lake Winnipesaukee and finds Dr. Marvin and
his family, much to Dr. Marvin’s dismay. Though the family welcomes Bob, Dr. Marvin
becomes increasingly angry at his antics until he becomes so disturbed that he attempts to
kill him with explosives. However, Bob breaks free and returns to Dr. Marvin’s home,
where he finds the psychiatrist outside with his family. When the house is engulfed in
flames as a result of the explosives Bob left inside, Dr. Marvin goes into a catatonic state
and is placed in an institution. Later, as he witnesses Bob and his sister, Lily, getting
married, he recovers, yelling out in rage at the sight before him. The movie ends with a
24

black screen and white text stating that Bob went back to school to become a
psychologist and that he wrote a best-selling book called “Death Therapy,” for which Dr.
Marvin is suing for rights.
In this film, Bob is diagnosed by Dr. Marvin as having “multi-phobic personality
characterized by acute separation anxiety and extreme need for family connections”
(14:55-15:03). Phobias and anxiety are perceived as stereotypically feminine mental
illnesses, and according to data, disproportionately affect females. Furthermore, research
by Michniewicz et al., (2016) showed that men tended to perceive feminine disorders as a
greater threat to their gender status and expressed greater distress at being diagnosed with
such gender-atypical disorders than gender-typical disorders. Knowing that media is
influential in our beliefs and perceptions, I analyze gender-associated traits in Bob and
Dr. Marvin as identified by the Bem Sex Role Inventory (Bem, 1974) to show Bob, the
patient, is presented as feminine and Dr. Marvin, the psychiatrist, is presented as
masculine. The significance of these depictions is the stigmatizing of feminine mental
illness in men, as Bob is portrayed as lacking power compared to Dr. Marvin and
depends on his psychiatrist in such a way that he appears to lack self-sufficiency. With
men’s masculinity often being an important part of their identity, the film’s
representation of an anxiety disorder in Bob may reinforce the association of femininity
with anxiety disorders, impacting the way society sees mental illness, affected individuals
perceive themselves, and the willingness of affected men to seek help for such disorders.
Furthermore, I apply mise-en-scène analysis to show that film elements reinforce the
gendering of mental illness and the persons suffering from such disorders. Mise-en-scène
25

encompasses all visual elements within a frame in film. Directors intentionally present
scenes in certain ways to convey meaning to the audience, using everything from the
lighting to the camera angle in order to communicate messages. Every aspect is carefully
considered and designed, leaving virtually no detail insignificant. The combination and
interaction of everything within scene gives said scene’s overall meaning. There are four
main components of mise-en-scène analysis: lighting, design, composition, and
movement (Barsam & Monoham, 2019).
Introducing Bob Wiley
The first several minutes of the film serves to introduce the audience to Bob
Wiley, who we come to know as the patient. Through the careful design of the opening
set, we get a glance of who Bob is before we observe him in action. The movie begins
with a close-up of a goldfish swimming across a black screen as opening credits play.
The background changes to show the goldfish in a simple fishbowl, with only a few
stalks of plastic foliage for decoration. We hear a male voice repeating a mantra: “I feel
good. I feel great. I feel wonderful.” The camera then flashes to reveal a man in his
thirties, who we come to know as Bob Wiley, dressed in a white undershirt and shorts,
sitting up in bed and furiously rubbing his temples as he repeats the affirmation, “I feel
good. I feel great. I feel wonderful.” Morning light pours in from a window to the right
of Bob. A humidifier emits steam nearby. We see several bottles of pills on a stand in
front of the bed. The nightstand is cluttered with items. In the closet, we see a row of
clothing hung up, each article covered in clear plastic. The apartment is painted a neutral
tan, and a large poster detailing the steps of CPR hangs on the wall beside the bed. The
26

frame then switches to a close-up of Bob furiously brushing his teeth, especially his
tongue. Again, the frame switches, now showing Bob emerging from the bathroom,
wearing a white and beige striped dress shirt, tie, and dress pants. A fire extinguisher, a
first aid kit, and a small hand vacuum hang on the wall to his right. Against said wall that
separates the bathroom from the rest of his apartment, a big black book stands atop a
desk, its title visible in gold lettering “Medical Dictionary: Family Health.” Bob then
walks around the corner to where his goldfish is swimming in its bowl by the window.
“Good morning, Gill,” he says, as the fish swims against the side toward his face. He
tells the fish he must go to work, then sits at the cluttered desk. He stamps a timecard
and starts rummaging through the material on his desk.
The scene switches to a close-up of a white-faced analog clock propped on a stack
of books, a statue of a German Shepherd beside it. The background comes into focus,
and we see Bob from the waist down, now wearing a tan jacket as he walks past, arms at
his sides and his fingers rubbing together furiously. The next few seconds show Bob’s
face, visibly anxious and shiny with sweat. The camera flashes a door, which we
understand to be the front door of his apartment. We then see Bob dip with his first step
and walk determinedly to the door, where he stops abruptly, turns around, and says “wish
me luck, Gill.” He opens the door and exits.
The camera then switches to a view at the end of a narrow hallway. Bob enters
the hallway from a door on the right of the screen. The walls are a dirty off-white, and
the hall is barely wider than Bob. He turns sideways, tightens up, and walks toward the
camera in the dim light from a single fluorescent bulb in ceiling. A close-up of his face
27

shows his misery. The next frame is a close-up of his hand, covered with a tissue,
reaching for the aged brass knob of a dark, sloppily painted door. The frame changes to
show a view of the doorway from the outside, as visibly uncomfortable Bob steps out
from a dirty, old building. The background music ceases, replaced by a cacophony of
noises: dogs barking, people arguing, sirens blaring, horns honking, engines running.
Bob descends the flight of steps, staring ahead into the presumably busy world before
him. A couple of young men past him, carrying a boom box that is blaring music. As
soon as he steps onto the sidewalk, a large truck rushes past him, obscuring Bob from our
view. A second later, when the truck has past, we see Bob crouched on the ground, a
cloud of dust surrounding him. As he crawls away, his cheeks are puffed out as he holds
his breath.
From these two short, comical scenes, we gain tremendous insight into the
character, Bob Wiley. His morning mantra, the humidifier, the CPR poster, the first aid
kit, the medical book, and the bottles of pills suggest that he has a great deal of anxiety,
especially surrounding his health and has a sustained relationship with mental healthcare
providers. His waking mantra, “I feel good, I feel great, I feel wonderful,” further
reinforces his relationship with mental healthcare workers, as this repetitive phrase
suggests he is involved in cognitive behavioral therapy, a psychological method of using
one’s thoughts to influence how one feels (Martin, 2019). He works from home,
presumably because his anxiety prohibits him from obtaining a job outside of his
apartment. Though he maintains good hygiene, as evidenced by his teeth-brushing and
neat dress, his untamed hair reminds us that he is suffering from a mental affliction.
28

Beyond Bob’s behavior and appearance, the setting and props of these scenes
reveals much more into this character. His small living space and the brick building that
fills the window suggests he lives, and works a low-paying job, in the city. However, if
we further analyze his environment, we can infer that his living space is also a metaphor
for Bob’s psychological state. The lack of open space in his apartment suggests
claustrophobia and the limitations his anxiety has on his ability to interact with the
greater world, while the clutter reflects his own tangled thoughts. The images of
medical-related items in nearly every frame, including the CPR poster, the medical book,
the first aid kit, and the bottles of pills, represent the constant thoughts he has about his
own health. Furthermore, the narrow hallway that Bob must traverse to make it outside
represents the psychological challenge he faces when he must leave the safety of his
home and step into the world. The walls nearly touch his shoulders on either side, and he
stiffens, turning sideways as he walks. The narrowness of the hall is, perhaps, a nod to
the expression “walls closing in” as Bob is visibly uncomfortable as he walks forward.
The close-up of Bob’s hand protected by a tissue as he turns the doorknob shows us his
fear of touching public surfaces, likely due to his health-related fears.
When Bob steps outside, the quietness of the hall is suddenly replaced by an
overwhelming medley of loud noises. Not only does this abrupt change signal that Bob
lives in a busy city, but it gives us a hint into his own anxious state. As we have come to
understand that Bob has anxieties about leaving his apartment, the sounds associated with
stressful conditions (e.g. sirens, arguing, horns) represent his view of the outside world as
a negative, overstimulating place. When a truck drives by, kicking up a cloud of dust
29

around him, he falls to his hands and knees, ducking his head. He then crawls away,
while holding his breath. His actions, which mimic that of a person during an explosion,
suggest his likening of the benign dust cloud to a life-threatening event.
The combination of lighting, music, camera angles, and Bob’s actions in the
beginning sequence give an overall feel of comedy while portraying Bob as a very odd
individual. Though Bob works from home, he dons dress clothes rather than casual wear.
His unkempt hair sticks up, a contrast to his otherwise neat appearance, suggesting that
only his head is affected, a sort of lunacy perhaps. He talks to his fish and must mentally
push himself to leave his apartment. Furthermore, he uses tissues as a barrier between his
hand and public surfaces and reacts dramatically to a cloud of dust that surrounds him.
Although Bob clearly suffers distress from his anxiety, his situation is presented in a
comedic way. His mannerisms are funny, and the viewer is led to laugh at the ridiculous
nature of Bob, rather than to empathize with the way his mental illness negatively affects
his life. Furthermore, he assumes a set of feminine characteristics that impact the way
audiences see Bob and impacts their understanding of mental illness. Bob is warm,
gentle, affectionate, yielding, sympathetic, understanding, loves children, is childlike, and
loyal.
A warm, gentle, and affectionate man
Bob is an affable man, and his warmth and gentleness can be observed in his
interactions with other people and his goldfish. He nurtures his goldfish, Gill, and we
observe him speaking to it as though it were a human family member a few times during
the first scene of the movie. Bob’s warmth is especially extended to Dr. Marvin and his
30

family, to whom he is drawn to from the beginning. From the moment he encounters
each member of the family, Bob greets them warmly, remembering their names and, in
Fay’s (Dr. Marvin’s wife) case, complimenting her. His friendliness is received well by
Anna (Dr. Marvin’s daughter), Siggy (his son), and especially Fay, who takes his flattery
to heart.
As an affectionate character, Bob expresses his fondness for others both verbally
and through his actions. He forms an attachment to Dr. Marvin and his family early in
the film, and they are the major the recipients of his sentiments. His first significant
observable display of affection occurs on the steps in front of the general store, when he
first encounters Dr. Marvin in Lake Winnipesaukee. After Dr. Marvin agrees to talk to
him via phone, he spreads his arms and steps toward the doctor to embrace him, a gesture
that is inappropriate for Bob to enact, but is intended to make us laugh at the absurdity
rather than repulse us. We are led to side with Dr. Marvin, who rejects Bob’s offer, as he
actively tries to remain professional and set appropriate boundaries between his patient
and himself. Already, the “othering” of Bob, the individual with mental illness, is
occurring. His overly friendly approach to Dr. Marvin suggests his immediate attachment
to the psychiatrist, which is not well-received. Bob has heretofore been represented as an
odd individual, an outcast of sorts, and Dr. Marvin’s insistence that the two not embrace
subtly suggests the social distancing attitude that persons without mental illness tend to
harbor toward those affected. Indeed, hugging a patient is typically considered
unprofessional, but there is also an underlying message that persons with mental illness,
like Bob, are not “normal” and interacting with them so closely is off-putting.
31

Though Dr. Marvin rebuffs his advances this time, Bob is not deterred. He
appears at the Marvin residence later that day, and he and Dr. Marvin have a discussion
outside the house. Dr. Marvin, wishing to be rid of Bob’s presence for the remainder of
his vacation, writes his patient a prescription for a “vacation from his problems.” Bob,
overcome with gratitude, expresses his appreciation for the doctor by verbally praising
the psychiatrist and, catching the doctor off-guard, embracing him. Though one could
argue that Bob is being defiant and willfully disobeying Dr. Marvin, it seems that he is so
overcome with joy and appreciation that he cannot help but express it. Like women’s
hysteria throughout history, he is unable to control his emotions as they wash over him.
His inability to remain stoic in this situation makes him seem feminine, rather than
masculine, as masculinity dictates that men remain in control of displays of affection.
Moreover, his overall warmth and gentleness is stereotypically feminine; he is not
aggressive or dominant, as is typically associated with masculinity. Instead, we are
shown an offbeat man who is very expressive of his emotions.
Though horror movies typically portray individuals with mental illness as
dangerous and threatening, this comedic film shows Bob in the opposite manner. Bob is
not threatening, and he is not dangerous; he merely wishes to be part of a family. Dr.
Marvin rejects his affectionate advances out of a desire to maintain professional distance
from Bob out of annoyance and want of social distancing, rather than fear. Thus, this
film is helpful in showing that persons with mental illness are typically not violent,
dangerous individuals. However, it tends to make light of the seriousness of a patient
stalking his doctor to his private residence and mingling with his family. This behavior is
32

inappropriate for a patient and his psychiatrist, and such incidences of a patient
unexpectedly showing up at his doctor’s house should be taken seriously. One of the
potential implications of showing a patient stalking his physician as a comical matter is
the downplaying of such a situation as something to not be concerned about. Although it
is true that individuals with mental illness are usually not dangerous, any case of a patient
following his doctor should be addressed as a serious matter. Furthermore, the humorous
approach of showing Bob’s intentional crossing of professional boundaries by hugging
Dr. Marvin after the doctor resisted him initially is problematic, as well, as it makes fun
of the situation.
Bob’s overall warmth and affectionate nature is intended to make us accept him
as a benign individual. He is shown as harmless, and even Fay laughs at Dr. Marvin’s
assertion that Bob could be dangerous (“Oh come on, Leo. He’s a sweet guy. He’s
perfectly harmless”) (58:06-58:19). However, this depiction also suggests that Bob’s
actions are not to be taken seriously and addressed appropriately. The implications of this
for society in general is the potential for affected individuals who do act in a similarly
inappropriately manner to be perceived as utterly harmless and should not be taken as
seriously as someone without mental illness. This is demeaning to affected individuals, as
it may lead the public to assume that they are incapable of understanding the gravity of
such inappropriate actions. Rather than hold persons with mental illness who have full
capacity accountable when they do engage in boundary crossing, we may be more likely
to excuse their behavior and write it off as harmless. Bob being shown as warm, gentle,

33

and affectionate makes us more apt to laugh at his actions, rather than be concerned with
them.

A yielding, sympathetic and understanding patient
The best example of Bob’s yielding nature in the film occurs during the family
dinner scene. Dr. Marvin, frustrated with Bob, asserts that he address him as “Dr.
Marvin,” rather than “Leo,” as Bob has been up to this point. Though Bob points out that
he had given him permission to use his first name, Dr. Marvin responds that that was in
his office and that in his home, he wants Bob to call him “Dr. Marvin.” Bob accepts his
demand, casting his eyes down and nodding, an image of submission and an
acknowledgment of the power differential. Even when under threat, Bob does not try to
defend himself. As a yielding nature is perceived as a stereotypically feminine trait,
Bob’s own submission helps to reinforce his character as feminine, and consequently,
may cause the viewer to associate such femininity with his mental illness.
Bob has a sympathetic nature to him, which extends to both people, including Dr.
Marvin’s family members, and his pet goldfish, Gill. An especially significant scene
that illustrates Bob’s understanding personality is during a car ride with Dr. Marvin’s
daughter, Anna. As Anna describes the struggles she has, Bob acknowledges and
identifies with them as well, offering support that Anna is not alone in her experiences.
Anna
I have problems the same as anyone else, same as you

34

Bob
You’re afraid your bladder will explode? Which other ones are the same? Like what?
Like what?

Anna
Well, like analyzing everything to death, to see if what I’m feeling is normal.

Bob
Yes, yes I have that, yeah

Anna
Do you freeze up and turn into wood when you’re around a good-looking guy, and you
don’t even know if he likes you or not?

Bob
Well, not a guy, but yes, I freeze. You know what, I treat people as if they were
telephones. If I meet someone who I think doesn’t like me, I say to myself, ‘Bob, this
one is just temporarily out of order. Don’t break the connection, just hang up and try
again.’

The cinematography in this scene helps show the developing camaraderie between the
two, as well. The up-close images of their faces as they engage in conversation helps the
35

exchange feel more intimate, as if it were two friends sharing their concerns, rather than
two strangers. His sympathy for Anna’s emotional experiences shows that he is willing
to admit his own struggles, even the ones that may be embarrassing. However, Bob’s
responses are meant to be funny, to invite the audience to laugh at him and his odd fears.
We are not led to empathize with his anxieties, but rather, ridicule them. This may be
discouraging to men who struggle with anxiety disorders, as their fear of humiliation and
social rejection may prohibit them from admitting their problems and seeking help.
Furthermore, this scene may perpetuate stigmatization of anxiety disorders in men by
society, as we laugh at the ridiculousness of his fears without truly understanding the
debilitating nature such disorders can be. We may be led to downplay the distress men
may be feeling, rather than empathize with and support them.
Moreover, Bob is empathetic to Dr. Marvin’s emotions, as well. A notable
example occurs after Dr. Marvin’s has an outburst and apologizes for his behavior. “I am
truly sorry. Call it a case of show business nerves,” he says. “We can all certainly
understand that,” Bob replies, understanding of what Dr. Marvin may be feeling and how
his behavior may be affected by his emotions. Rather than hold the doctor accountable
for his tantrum, he readily accepts his apology with total forgiveness. This is a recurrent
theme throughout the film. Bob appears to identify with the feelings of others and frames
their behavior accordingly. This allows him to easily connect with the other characters,
which, though it makes him likeable to the others, also makes him stereotypically
feminine.
A Childlike Individual
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Within seconds of meeting Dr. Marvin for the first time, Bob is drawn to a picture
of the doctor’s family. Standing in front of the photographs, he makes a few guesses as to
their names before Dr. Marvin corrects him and leads him to his seat. Dr. Marvin notices
Bob’s interest in his family, even going so far as to comment on it when recording his
diagnosis of Bob after their session (e.g. extreme need of family connections).
Our first glimpse of Bob’s childlike disposition comes during his first meeting
with Dr. Marvin. After Dr. Marvin hands Bob his book, “Baby Steps,” explaining the
concept behind the therapy, Bob, in awe of the idea, begins taking literal baby steps
around, and eventually, out of, the office, a display reminiscent of a child. Furthermore,
in this same scene, the camera often angles down on Bob as he looks up from his seat, as
though we are looking down on a scared child.
The implication of Bob’s childlike personality is that he is not seen as equal,
socially or intellectually, to Dr. Marvin or other adults in the film. We view him as naïve
and incapable of caring for himself, relying on Dr. Marvin and Fay to meet his needs.
His antics are humorous to us, rather than disturbing, as would be the case if he did not
remind us of a young child. Thus, as being childlike is seen as a feminine trait, the
exaggeration of this characteristic in Bob further reinforces his femininity and lack of
power compared to the masculine Dr. Marvin.
A Loyal Patient
Bob is fiercely loyal to Dr. Marvin, even when Dr. Marvin’s behavior toward him
is, frankly, cruel. He often defends Dr. Marvin to anyone who may speak negatively
about him, including his wife and kids. In fact, he often redirects the Marvin family’s
37

adverse thoughts about the doctor and justifies his behavior as wanting the best for his
family and being misunderstood by those who are not as brilliant as himself. Bob’s
loyalty to Dr. Marvin is reflective of his other feminine traits, including his dependence,
yielding, and gentleness. He idolizes the psychiatrist and relies on him heavily for
guidance through his mental illness, which is in stark contrast to the masculine stereotype
of self-reliance, self-sufficiency, leadership, and assertiveness. Bob quietly accepts the
doctor’s ill treatment, rather than fighting back as a more masculine man would be
expected to do.
The significance of Bob’s unwavering loyalty to Dr. Marvin is the overall
femininity it implies about him. A more masculine individual would be expected to
defend himself against such maltreatment. Showing Bob as a rather meek individual may
perpetuate stigma in men with anxiety disorders by the film’s association between this
mental illness, femininity, and weakness. Men who ascribe to the notion that they should
be forceful and dominant may not be willing to admit that they share a mental illness in
common with a character like Bob due to anticipated stigma from society. Unaffected
individuals may also perceive these men as weak and vulnerable, furthering perpetuating
stigma surrounding a diagnosis of such a mental disorder.
What about Bob’s neutral traits?
Bob does show several traits that the Bem Sex Role Inventory (Bem, 1974) deem
to be neutral, i.e., not classified as masculine or feminine. Among these traits, he is
happy, friendly, likeable, sincere, and truthful, reflected in his positive interactions with
Dr. Marvin’s family and others. However, such neutral characteristics do not make Bob
38

any less feminine. In fact, such traits may augment his femininity further. His childlike
personality is reinforced by his happy disposition, friendliness, truthfulness, and sincerity.
His sympathetic nature, gentleness, warmth, and affectionate persona help make him
likeable to Fay, Anna, and Siggy. If Bob were shown as more masculine, these traits
would likely support his masculinity, rather than detract from it. The neutrality of such
characteristics and their effect on the person appear to depend on the overall gender
stereotype of said individual. Arguably, showing Bob as having only neutral traits may
depict him as less feminine. However, it may also make his character less complex and
less interesting to the audience. Perhaps, then, a blend of gender traits, both masculine
and feminine are necessary to make a fictional film character like Bob engaging to the
viewer while decreasing the level of stigma associated with his mental illness.
Introducing Dr. Leo Marvin
The scene begins with a shot of a woman stepping into a room. She is dressed
neatly in a teal suit jacket and skirt, a string of pearls around her neck, a scarf of muted
blue, yellow, and red draped over her shoulders. The walls are gray, the door a rich
wood. A tall hourglass if visible on a stand next to the door. Multiple framed certificates
and degrees are visible on the portion of wall above the stand in the frame. The camera is
presumably behind a desk, from the viewpoint of the person sitting there. She pleasantly
says, “Doctor, it’s your wife on the phone” with a smile, before exiting while the camera
pans to the right, showing a blue couch, a small green plant on a wooden table in the
corner, geometric art prints hanging on the wall, and finally, an older gentleman, Dr.
Marvin, sitting in a cushy leather chair, a smile on his face as he holds a phone to his ear.
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He is wearing a dark suit and red tie, and his short grey hair is neatly combed, his white
beard perfectly groomed. He is proudly telling his wife that his publisher thinks Good
Morning America will be interviewing him next week. He smirks throughout the short
exchange between his wife and him, until the phone buzzes, and his secretary tells him
that another doctor is on the phone. Before disconnecting with his wife, he says “Boy,
they sure do come out of the woodwork…when you’re famous,” and laughs.
At this time, we are given a view of Dr. Marvin’s neat, tidy desk. The sturdy
wood is a rich, reddish hue, and a smaller hourglass, a globe, and gold box decorate the
top. There are no papers on the desk, and a pen sits in its holder. The doctor on the line
is another psychiatrist who begins the conversation by complimenting Dr. Marvin on his
new book. The camera moves to show Dr. Marvin sitting behind his desk, the entire wall
behind him a window looking out at the tall buildings behind him. By the view, it is
apparent that his office is several stories up. To his right is a sizeable bust of Sigmund
Freud. Dr. Marvin leans back in his chair, resting his crossed feet on his desk as he
listens to his colleague. The doctor then informs Dr. Marvin that he is leaving his
practice and has a patient he would like to refer. Dr. Marvin asks if the patient is
psychotic, to which his colleague assures him that he isn’t. “His name is Bob Wiley,” he
says. “He pays early. He comes on time. He just needs someone brilliant.” Dr. Marvin
grins as the doctor continues to compliment him. He then agrees to take Bob as a new
patient. After hanging up with his colleague, he tells his secretary to schedule an
appointment with Bob for after he returns from vacation, to which his secretary informs

40

him that Bob has already called twice and will be his next session. He picks up a thick,
yellow hardback book, the one he has written, and says “that’s persistence.”
This introduction to Dr. Leo Marvin serves to establish the dichotomy between
Bob Wiley and himself. Dr. Marvin is masculine and successful, deserving of our respect
and admiration. From the moment we watch his well-dressed secretary step into his office
to tell him of a phone call, we understand that Dr. Marvin is an important person. The
wall of degrees beside the door indicate that he is an educated man. The large window
behind his desk overlooking the city denotes his social and professional status, as such
offices are reserved for those high on the corporate ladder. The decorations on his desk
appear expensive, suggesting his personal wealth. Although never explicitly stated, we
can deduce that Dr. Marvin is either a psychiatrist or a psychologist from his question to
his colleague about his patient (“Is he psychotic?”), as well as the large bust of Sigmund
Freud atop a podium in his office.
When examining the speech and mannerisms of Dr. Marvin, we understand that
he is quite self-aware of his status and is, perhaps, a narcissist. At the very least, he has a
sizeable ego, which is apparent in his conversations with his wife and colleague. When
talking to his wife, he mentions how unusual it is for Good Morning America to
interview people on vacation, an air of importance in his tone of voice. The way he
laughs after his line, “Boy, they sure do come out of the woodwork…when you’re
famous,” relays his arrogance. Furthermore, while speaking to his colleague, his body
language further suggests his sense of self-importance and power, thriving on
compliments given by others. He seems to believe that he is better than others. When he
41

first begins talking to his colleague, he leans back in his chair, propping his feet up on his
desk, a posture indicating his perceived power. His colleague appears to be aware of Dr.
Marvin’s narcissism, and exploits it to hand off a difficult patient to him. “He just needs
someone brilliant, Leo,” he says, as Dr. Marvin considers the request. “I know you don’t
like flattery, but if there’s anyone I know who could win the Nobel Prize, it’s you.” Dr.
Marvin laughs but does not disagree, and it is apparent that he enjoys the adulation. After
hanging up with his colleague, he picks up the book he has written and looks over the
cover, clearly proud of his achievement.
Dr. Marvin’s character can be described by several masculine traits as defined by
Bem’s Sex Role Inventory. He is analytical, acts as a leader, has leadership abilities,
dominant, assertive, forceful and aggressive, while he only displays one feminine trait: he
is flatterable. These traits are illustrated through his behavior, his relationships, and film
elements that subtly reinforce his masculinity. This depiction of Dr. Marvin is
significant, as it indicates that a man who is allegedly mentally healthy, who has the
education and tools to help others with mental illness, is the ideal picture of masculinity.
The next several sections will identify specific masculine traits Dr. Marvin possesses and
how the film presents such a character, as well as discuss the implications of gender
stereotyping of a mental health professional.
Dr. Marvin is analytical
Dr. Marvin’s career is built around the practice of analysis. From the cover of his
book, we learn that he has a medical degree and a Ph.D., both of which require extensive
education in the practice of analytics. As a psychiatrist, he evaluates people and
42

situations to determine diagnoses and solutions, and from the very first meeting with
Bob, he displays his proficiency in the practice when he makes a quick diagnosis of
Bob’s condition. The decorations in his office also convey the importance of analytics in
his life. The very prominent bust of Sigmund Freud, the father of psychoanalysis, stands
proudly beside his desk, and Dr. Marvin leans on it while seeing Bob for the first time.
This indicates his reliance on his analytical skills in his profession.
As analytical skills are perceived as a masculine trait, and Dr. Marvin’s career is
founded on his analysis of individuals, the message being sent to the viewer is that Dr.
Marvin is assuredly masculine. His ability to rapidly assess and diagnose Bob within their
first meeting is a testament to his level of skill and his maximizing of such a masculine
trait. To the general viewer, as well as those affected by mental illness, this presentation
of Dr. Marvin invokes a level of respect and confidence in his intelligence and his
authority. We trust in his expertise unquestioning, and his quick judgment of Bob is
accepted without protest. A potential negative impact this may have on society’s idea of
psychiatrist is the reinforcement of the great power differential between patient and
doctor. While it should be recognized that psychiatrists have years of training and are
highly qualified in treating mental illnesses, this depiction of Dr. Marvin patients may
feel nervous and hesitant to share certain complaints with them out of fear of quick
judgment and embarrassment. Furthermore, it may perpetuate the notion that a
psychiatrist will be able to identify a patient’s problems more rapidly than what is
realistic. Oftentimes several sessions are necessary to fully understand an individual’s
problems. However, this presentation of Dr. Marvin shows him able to diagnose Bob
43

thoroughly within a single, short session, which may propagate the inaccurate idea that
this is the norm.

Dr. Marvin acts as a leader and has leadership abilities
Dr. Marvin establishes his leadership in both his professional and his family life.
He has established himself as a competent psychiatrist, leading both patients and
colleagues in therapeutic practice. For patients, he guides them through therapies to
alleviate their psychological ailments, and his book, Baby Steps, is a resource for both
layperson and colleague. His designing of a novel therapeutic process paves the way for
those in need of direction in dealing with psychological distress.
The significance of Dr. Marvin’s leadership abilities is the implication that he is
capable and competent. This is in direct contrast to Bob, who relies on Dr. Marvin for
guidance. By showing Dr. Marvin in a leadership role, his masculinity is reinforced and
in stark contrast to Bob’s femininity, further exaggerating the two’s respective gender
roles.
Dr. Marvin is dominant
Dr. Marvin’s dominance is apparent throughout the film, as reflected in his
character’s behavior, as well as the cinematography surrounding him. As an
accomplished psychiatrist who has just released a book, he works in a large, pristine
office with a wall-sized window overlooking the city. He is on his way to becoming very
well-known, as Good Morning America wants to interview him, introducing him to
44

viewers across the country, which implies his position of authority and importance.
Indeed, when we first meet him, he assumes a power stance behind his desk as he speaks
to a colleague on the phone. With shoulders back, hands in his suit pockets, and feet
planted firmly on the ground, he exudes confidence and esteem. His secretary, who sits at
a desk in a small waiting area, is available to answer his calls and organize his schedule.
Moreover, the camera angle helps reinforce his authority. Oftentimes throughout
the film, the camera is pointed at Dr. Marvin from a lower point, looking up at him,
giving the illusion that he is tall and figuratively “above” us. Midway through his first
appointment with Bob, he rises from his chair as Bob remains seated. The camera is then
positioned between the two so that it looks up at Dr. Marvin and down at Bob. This
viewpoint of Dr. Marvin, as he leans against a bust of Freud, helps assert his social
dominance over Bob while suggesting a subtle satirizing of his own perceived
importance. His physically “looking down” at Bob reflects his internal belief that he is
socially above Bob. This suggests that the two men are not equal, and that Dr. Marvin
holds a great amount of power in the relationship, based not only on the psychiatrist’s
position as doctor, but also as the more masculine individual. Bob comes to Dr. Marvin
seeking help for a mental illness seen as a stereotypical feminine disorder, and Dr.
Marvin’s contrasting dominant masculinity may propagate stigma regarding men with
such disorders. Men who place importance on their own masculinity for their identity
and social status may perceive Bob’s femininity compared to Dr. Marvin’s masculinity as
a potential consequence of admitting their own struggles. The loss of masculinity
compared to another man, and the perceived power that accompanies it, may make men
45

struggling from similar feminine mental disorders reluctant to seek help in order to
preserve their social status and power as a man.

Dr. Marvin is assertive, forceful, and aggressive.
Dr. Marvin’s assertiveness is typically directed toward Bob, though other
instances occur with his family. As Bob tries to cross physician-patient boundaries, Dr.
Marvin demands that Bob refrain from violating the professional relationship. Two phone
calls from Bob while Dr. Marvin is on vacation end with Dr. Marvin ordering Bob to stop
trying to contact him and hanging up before Bob can say any more. When Bob shows up
to Lake Winnipesaukee after a long bus ride, Dr. Marvin first demands him return to New
York immediately. After resistance from his needy patient, he agrees to talk to him via
phone later that day, though he refuses Bob’s request to speak in person.
Similarly, Dr. Marvin is assertive with his family, when it comes to Bob’s
presence at their home. After calling an impromptu meeting the second time Bob shows
up unannounced at their house, Dr. Marvin demands that Bob not be let into the house
again, refusing to entertain any opposition from his family. When, shortly after, he spots
Anna and Bob sailing on the lake, he rushes down to the boat launch to speak promptly
with Anna. He condemns her for spending time with Bob, rebutting every retort she has
in favor of himself.
Dr. Marvin’s behavior toward Bob in setting professional boundaries is
appropriate, and we identify with his frustration and efforts to keep his personal life
separate from his work life. Bob’s emotional phone calls to Dr. Marvin depict the patient
46

as a desperately dependent individual who cannot care for himself. His locating Dr.
Marvin at Lake Winnipesaukee is largely inappropriate, and we tend to side with the
psychiatrist’s resistance of his patient violating boundaries. Bob is shown as a great
annoyance, which could be stigmatizing to other men with mental illness. The general
public, especially those who do not have close relationships with persons with mental
illness, may form “othering” perceptions of affected individuals, seeing them foremost as
a pest. Persons with mental illness may also feel a certain shame and embarrassment as
they watch the film and believe that society may view them similarly.
Dr. Marvin is flatterable
The only feminine trait observable in Dr. Marvin is that he is flatterable. We are
shown this side of Dr. Marvin from his first scene, when his colleague, eager to rid
himself of Bob, compliments Dr. Marvin to make him more apt to accept his patient. Dr.
Marvin appears to enjoy the admiration, a smirk present on his face as his colleague
states that “if anyone could win a Nobel Prize, it’s you.” However, his response to this
flattery appears to be less of a feminine display, and more of an egotistical man
appreciating recognition of his work.
What about Dr. Marvin’s neutral traits?
Dr. Marvin displays neutral traits, as well, including conceitedness and jealousy.
As with Bob, his neutral characteristics augment his masculine traits, rather than detract
from them. Dr. Marvin’s conceitedness interacts with his aggressiveness, leadership, and
assertiveness. He sees himself as superior, and thus, justified in his dominant behavior.
Similarly, his jealousy stems from his family’s warm feelings toward Bob. Dr. Marvin
47

feels threatened and that Bob is taking his family’s attention away from him. His
aggression and assertiveness toward Bob partly come from a desire to defend and protect
his family and partly from a need to be the object of adoration. When he feels the
attention shifting away from himself, he becomes enraged and acts to reclaim his position
by barking orders at his family to deny Bob. Similar to Bob, if Dr. Marvin were depicted
purely in terms of neutral traits, he may be less complex and entertaining.
The Physician-Patient Encounter
In the first scene of the film, Bob shakes Dr. Marvin’s hand using a tissue. The
camera angle switches to a low view to show Dr. Marvin looking down at the tissue. We
can interpret this moment as Dr. Marvin perceiving Bob and his neuroses as inferior,
strange, and abnormal. It is the first hint of the power differential between the two
characters that will help define their relationship throughout the film. Bob then becomes
distracted when he sees photos of Dr. Marvin’s family, and though Bob guesses some
unlikely, funny names, such as Bambi, Dr. Marvin remains stone-faced, emotionless.
As the scene progresses, Bob continues to be portrayed as an odd yet humorous
individual while Dr. Marvin retains a very business-like manner. When they are seated at
the desk, Bob reveals his fear of disease and touching public surfaces to the doctor. He
describes feeling “weird” when he leaves his apartment, emphasizing the word, and lists
off a long list of symptoms. Though Bob is clearly distressed at his situation, it is funny
to us. We laugh at his description, which includes “cold sweats. Hot sweats. Fever
blisters…dead hands…fingernail sensitivity. Pelvic discomfort.” The delivery of his
lines and the implied ridiculousness of some of his complaints are meant to be comedic,
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and indeed, they are. His checklist of symptoms reveals that he is familiar with medical
terminology and signs of disease, suggesting to the audience that he may be a bit of a
hypochondriac, rather than experiencing physical manifestations of his mental illness.
When Bob talks about his fear of his heart stopping or his bladder exploding, he looks
down, as though he is ashamed. However, the mere suggestion of such an unlikely event
is funny, and we laugh at him. We laugh at his coping mechanism of acting out his fears,
such as Tourette’s Syndrome and a cardiac arrest, and our perception of him as humorous
is reinforced by the flash to the secretary raising her eyes and then returning to her work.
Meanwhile, Dr. Marvin remains emotionless, almost appearing bored, as he sits back in
his chair, listening to and watching Bob. He is unmoved by his dramatic patient, as
evidenced by him changing the subject and asking very bluntly, “Are you married?”
while Bob lies on the floor pretending to be dead. The unchanging expression and
attitude of Dr. Marvin reinforces the idea that he is in control, while suggesting that he
does not empathize with Bob’s fears. When Bob explains he is divorced because his exwife loves Neil Diamond, the frame switches to a close-up of Dr. Marvin’s face, a look of
bemusement now apparent as he momentarily glances directly at the camera. This subtle
action includes the audience in on the joke, inviting us to judge Bob with the doctor and
creating a subconscious “us vs. him” mentality. Dr. Marvin’s suggestion that Bob’s wife
left him due to his anxious condition, despite a lack of evidence to support such a notion,
further reinforces the idea that people with mental illness are undesirable. He implies
that Bob’s wife left him due to his mental illness, and Bob, who had not considered this
before, is hurt. However, Bob is not offended; rather, he expresses his belief Dr. Marvin
49

can help him, which strokes the doctor’s ego. Dr. Marvin’s response is to rise from his
chair and lean on the bust of Freud, while lecturing to Bob. As the camera switches from
looking down at Bob to looking up at Dr. Marvin, the power differential between the two
is symbolized. The camera looks up at Dr. Marvin to symbolize his dominance and
respectability. The camera looks down at Bob to represent his character as weak and
submissive, looking to Dr. Marvin for guidance.
The doctor-patient relationship is the foundation of Bob’s and Dr. Marvin’s
interactions. The transaction of patient soliciting treatment from a doctor defines the
relationship and help establish the power differential between the characters, as well.
Traditionally, the patient depends on the doctor for advice and care for his conditions,
and the doctor prescribes what he believes is the best treatment for said patient. The
medical knowledge and access gap between the pair shifts the power toward the doctor,
and the patient must decide whether or not to accept the options presented. The patient
cannot gain access to treatments without the doctor’s recommendation and referral, and
thus, he has less power than his treating physician. When viewed through a historical
gendered context, this dynamic tends to femininize Bob, as women have not held
significant power compared to men. In this relationship, Dr. Marvin has the power, and
thus, an inherent masculinity, while Bob lacks power, which suggests femininity.
The doctor-patient relationship is further illustrated in a few key scenes in the
film. Besides the initial meeting, as detailed above, Bob seeks out Dr. Marvin at Lake
Winnipesaukee and the two are reconciled. Dr. Marvin leads Bob around the side of the
store for a private conversation away from his family.
50

Dr. Marvin
I do not see patients on vacation. Ever. How many ways can I make that clear? Now
what I want you to do is get on this bus and go back to New York.

Bob
I can’t, I’m paralyzed, I’m all locked up!

Dr. Marvin
You got yourself here.

Bob
Barely!

This exchange is, in itself, a mini-therapy session. Though Dr. Marvin tries to
delineate the professional expectations of their relationship, i.e. Bob not contacting him
outside of his working hours, Bob persists. He expresses his anxiety to Dr. Marvin, and
Dr. Marvin points out that Bob was able to face his fear to get to Lake Winnipesaukee.
During this exchange, the two are on equal ground, their heights approximately equal.
However, Dr. Marvin tries to end the conversation, saying “getting back will be
51

therapeutic,” as he turns from Bob and begins to climb the steps. The action of turning
his back to Bob and walking away as Bob trails behind signifies that he is in control and
that he has the final say. The back-and-forth between them continues on the steps, with
Dr. Marvin at the top and Bob at the bottom. Though the Bob is actually taller than Dr.
Marvin, their positions on the steps allows Dr. Marvin to look down on Bob both literally
and figuratively. The camera angle supports their power differential as it switches
between frames of Dr. Marvin and Bob. When Dr. Marvin speaks to Bob, the camera is
looking up to him; when Bob is speaking to Dr. Marvin, it is looking down at him. As
before, this suggests that Dr. Marvin is the authoritative individual and that we respect
him, while Bob is someone we look down on and disregard. Bob tries to hug Dr. Marvin
before he leaves, but Dr. Marvin steps back, resisting Bob’s advance. This further
reinforces the doctor-patient relationship and the professional boundaries prescribed.
However, as Bob and Dr. Marvin continue to interact throughout the film, the
dynamics of their relationship change, so that an emerging parent-child relationship
becomes apparent and then, eventually, defines their interactions. Dr. Marvin assumes
the role of the parent, maintaining his authoritative position, while Bob integrates himself
into the family as though he were Dr. Marvin’s child.
An Emerging Parent-Child Relationship
When Bob finds Dr. Marvin at Lake Winnipesaukee in front of the general store,
a parent-child dynamic between the pair are introduced on top of the doctor-patient
relationship. As the two talk, Bob quickly gets emotionally worked up, throwing a sort of
temper tantrum, his facing screwing up, until Dr. Marvin concedes to his wish to talk.
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His outburst of, “Gimme, gimme, gimme! I need! I need!” is reminiscent of an
immature child whining for a parent, on whom he depends, to grant him his desire. As
Bob’s voice rises and he ignores Dr. Marvin’s attempt to reason with him, much like a
child, Dr. Marvin agrees to speak with Bob later, a sort of appeasing so as to settle Bob
and not draw any more attention to them. This exchange is very similar to that of a child
misbehaving in public, the embarrassed parent giving in to avoid others’ stares and
involvement. Bob smiles satisfied that he has gotten his way. Also like a child, Bob tries
to further bargain with Dr. Marvin by asking him if he could move their meeting time up
by half an hour. However, a frustrated Dr. Marvin’s warning, “Bob!” deters Bob from
pushing the issue. The characters’ positions on the steps assists in showing Dr Marvin as
the parent by his being on a higher level and allowing him to appear taller and look down
on the childlike Bob. Meanwhile, Bob must look up to peer into Dr. Marvin’s face. The
camera angle further helps convey the power differential that accompanies a parent-child
relationship, as it looks down at Bob and looks up at Dr. Marvin.
The parent-child relationship between Bob and Dr. Marvin continues to progress
throughout the film, with Bob overstepping professional doctor-patient boundaries in
increasingly invasive ways. Indeed, Bob begins to view Dr. Marvin as a father as he
bonds with the Marvin children and establishes a sibling-like camaraderie with them.
Though the scene outside the store foreshadows the formation of this dynamic, it is not
until Bob shows up unannounced and uninvited at Dr. Marvin’s house that he starts to
integrate himself into the family.

53

When Dr. Marvin sits down to call Bob as he promised, he looks up to see Bob
standing in the window, smiling broadly and waving, excited to be reunited with the
doctor. Dr. Marvin hurries outside to confront Bob on the front porch, and as, he lectures
him on the inappropriateness of his behavior, his daughter, Anna, emerges from the door.
Bob recognizes her from the photo in Dr. Marvin’s office and calls to her, introducing
himself. Fay appears behind Anna and introduces herself, to which Bob showers her with
compliments.
“You are even prettier than your picture,” he says. “And younger.”
Fay laughs as she steps out onto the porch behind Dr. Marvin. Dr. Marvin, whose
face is focused in the center of the screen, Anna and Fay out of focus behind him, has a
strained smile on his face. Dr. Marvin excuses himself and Bob for a talk and steps out
of the frame, but before Bob can follow, Fay rushes forward, offering to take Gil, who is
still suspended in a jar hanging from Bob’s neck. Bob politely agrees.
The significance of this sequence lies in the dialogue, actions, and positions of the
characters. Bob, though on the porch, does not set foot inside the house. This represents
the subtle, gradual method Bob uses to inch closer to Dr. Marvin and the familial
connections Dr. Marvin claims he desires. While talking on the porch, Dr. Marvin
between Bob and Fay and Anna, acting as a guard, a protector of his family. Bob,
however, flatters Fay by complimenting her beauty and youthful appearance, which leads
to Fay feeling comfortable and safe enough to step out onto the porch with him and Dr.
Marvin. When Dr. Marvin steps out of the frame, there is no longer a barrier between
Bob and his family, and it is at this moment that Fay offers to take Gil, who represents
54

Bob, inside. This action is symbolic, as by accepting Gil and welcoming him into her
house, she is also accepting and welcoming Bob.
When Dr. Marvin writes Bob a prescription to take a vacation from his problems,
Bob’s claim that he has been given a “great gift…the gift of life,” can be interpreted as an
allusion to the father-figure role Dr. Marvin is becoming to Bob. Bob’s recognition of
Dr. Marvin’s prescription to him as “the gift of life” represents the role a father has in the
creation of his child. By granting Bob a vacation from his problems, he has given him a
newfound sense of freedom, a type of rebirth, while implicating himself as the giver of
this new life: a father. Bob further goes on to successfully embrace Dr. Marvin, much to
Dr. Marvin’s obvious dismay. The violation of the professional boundary Dr. Marvin has
previously set, the intimate action of a hug, signals a shift in the dynamic between the
two from strictly doctor-patient to a more familial parent-child.
The scene ends with Bob walking away down the gravel road, and the next begins
with Dr. Marvin joining his wife and daughter who are seated in the kitchen of their
house. Fay stands and greets Dr. Marvin as he walks in. She remarks about Bob’s
pleasant demeanor, to which Dr. Marvin agrees that he is “when he’s controlled.” This
bit of dialogue suggests that Fay is accepting of Bob, while Dr. Marvin insinuates that he
requires treatment to be likeable.
As Fay takes her seat, Bob suddenly appears in the door in the background. He presses
himself against the screen, peering in at the Marvins.

55

“I got so excited, I forgot to bring you with me,” he says. Dr. Marvin looks
confused and concerned. A sense of relief and amusement washes over him when Bob
continues, “Gil.”
“Oh, the fish!” Dr. Marvin laughs and turns. The frame briefly fills with an image
of Gil swimming in his jar, and then shows a close-up of Dr. Marvin from the chest up,
the kitchen out of focus behind him. In the background, Bob opens the door and lets
himself in. This is another step toward integrating himself into Dr. Marvin’s family. As
Bob is leaving, both Fay and Anna chuckle as they tell him goodbye, signaling that they
find him amusing, unlike Dr. Marvin, who is hurrying him away. When they reach front
door, Dr. Marvin’s son, Siggy, appears from around the corner. Bob recognizes him, and
Dr. Marvin introduces the two. Bob and Siggy have a brief exchange about Gil, and now
Bob has had a positive interaction with every member of Dr. Marvin’s family. He steps
out the door, and then turns to peer through the screen, calling, “have a great vacation
family!” The frame then fills with the image of the Marvins lined up behind the screen
door. They all yell their goodbyes to Bob before dispersing their separate ways. Fay can
be heard saying, “I think I do look younger than that picture,” signifying that she is still
feeling flattered by Bob’s compliment. This is important, because it implies that Fay
identifies positive feelings with Bob, which will influence how she receives him
throughout the film.
In the next few scenes, Bob ingratiates himself with Dr. Marvin’s children. He
goes sailing with Anna and is present with Siggy when he dives for the first time. The
kids open up to him about their feelings, which they say they are unable to do with their
56

father. After Dr. Marvin acts aggressively toward Bob by pushing him into the lake,
Siggy and Anna suggest they invite him for dinner, to which Fay readily agrees. Though
Dr. Marvin is staunchly against the idea, the next scene shows the family gathered around
the dinner table, Bob seated next to Siggy.
The dinner scene is significant for its depiction of Bob assuming the role of Dr.
Marvin’s “child.” The sequence begins with a close-up of Dr. Marvin’s face, annoyance
coloring his expression. We can hear Bob in the background, vocally expressing his
enjoying of the meal with repeated “Mmmm…mmmm…..mmmm,” as he chews loudly.
His poor table manners and the towel tucked into his shirt like a bib reflect his childlike
nature. The camera pans out to show the Marvins seated around the table, Bob sitting
next to Siggy. Fay sits at the opposite end of the table from Dr. Marvin, and Anna sits
across from Siggy. This arrangement suggests the traditional family dynamic of the
children sitting between the parents, and Bob’s position next to Siggy supports his
transition into the role of child. A close-up of Fay’s face shows her amused, and perhaps
flattered, expression, and a close-up of Anna’s face shows amusement. The camera
flashes to Siggy, who is giggling. The whole family is enjoying Bob’s display, except for
Dr. Marvin, who remains stone-faced and silent, glaring at Bob. When Fay and Anna
both offer Bob another helping of food, Dr. Marvin looks at them disapprovingly. As
Bob continues to moan, Dr. Marvin gets fed up and snaps, “Would you quit that, please?”
Bob jumps, and becomes silent, as the rest of the family looks uncomfortable. Dr.
Marvin has just acted out toward Bob as a frustrated father would act toward a

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misbehaving child. This is his first step into a parental role in his relationship with Bob,
and Bob, quietly obeying, steps into the role of child.
Furthermore, throughout the meal, Bob proves to be a picky eater, requesting
Anna to remove a tomato from his plate, inquiring into a salt substitute, and asking Fay
whether butter or margarine was on the table. Taken together with his noisy eating and
bib, the picture of a child is painted in Bob, one that will continue to develop over the
next few scenes.
Due to a thunderstorm raging, Fay invites Bob to stay the night. Bob takes the
spare bed in Siggy’s room, and the two lay in their respective beds, talking to each other.
Siggy is recounting his fear of dying, while Bob listens intently. He asks, “What else is
there to be afraid of?”
“Well, not diving anymore,” says Bob, to which Siggy grins. “but uh, Tourette’s
Syndrome.”
“What’s Tourette’s Syndrome?” asks Siggy. A close-up of Bob’s face as he lays
in bed shows a mischievous smile spread across his face.
As Dr. Marvin practices his speech for Good Morning America in the mirror in
his own bedroom, Bob and Siggy can suddenly be heard making a raucous commotion
from their room. We then see Siggy and Bob jumping on their beds as they erupt in a
cacophony of foul language. When Dr. Marvin and Fay enter Siggy’s room to check on
the boys, Bob ducks down and sits on Siggy’s bed, holding a pillow front of his face like
a child who has been caught misbehaving.
“I’m sorry, dad. Leo. Dr. Marvin,” says Bob.
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This scene’s significance lies in the full reveal of the parent-child relationship that
has formed between Bob and Dr. Marvin. Bob is acting childish, jumping on beds and
yelling late at night with Siggy. Dr. Marvin comes in to scold them, Fay in tow, as a
father scolds his misbehaving child. Bob’s slip-up, calling Dr. Marvin “dad” represents a
Freudian slip, in which a person accidentally says what he is thinking instead of what he
is meaning to say. Bob is thus viewing Dr. Marvin as his father, rather than his doctor.
The parent-child relationship that is forming parallels the physician-patient relationship.
In this dynamic, the parent in the relationship holds the power, and the child depends on
the parent for care. Likewise, in the physician-patient relationship, the physician holds
more power. Furthermore, in the traditional view of the distribution of power in men and
women, men have historically held more power. Thus, the dynamic between Bob and Dr.
Marvin, as examined through a physician-patient, and now, a parent-child, relationship, is
highly suggestive that Bob is inferior to Dr. Marvin, and, when applied through a gender
stereotype lens, is more feminine. The connection can then be made that Bob, who has
been defined by his mental illness throughout the film, is more feminine and thus, lacks
power when compared to Dr. Marvin. This can be stigmatizing to men with similar
disorders, who may fear losing their power and their masculine identity.
“I don’t want to hear another peep out of here!” says Dr. Marvin angrily. “People
are trying to sleep around here!”
“Honey, it’s just kids being kids,” Fay interjects. In this moment, she breaks
through in her role as a maternal figure to Bob, even referring to him as a kid and
excusing his disruptive, inappropriate behavior. This gesture further solidifies Bob as the
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childlike figure, and Dr. Marvin as her co-parent. As he continues to sternly lecture Bob
and Siggy, the camera is positioned from a height roughly at chest-level, allowing him to
appear tall as his head reaches the top of the frame and thereby suggesting his authority.
Meanwhile Bob hides behind the pillow and looks up guiltily at Dr. Marvin, the camera
positioned at face-level. Siggy is positioned next to Bob, so that the two appear similar in
height. This frame suggests the equality of the two as children, both under the parental
authority of Dr. Marvin. After Dr. Marvin exits, Fay beckons Bob to his bed, lifting the
blanket for him to crawl under. Before she leaves, she touches his face gently, a maternal
gesture further reinforcing her motherly role toward him.
Role Reversals: Patient Becomes Healer
The first suggestion of Bob assuming the role of doctor occurs when Dr. Marvin
begins choking at dinner. The family panics, gathering around him, as his face turns red
and he coughs violently. Bob, however, remains calm.
“Don’t panic, I know what to do,” he says, as he rises from the table to help. He
attempts the Heimlich maneuver on Dr. Marvin, thrusting him into the air, as Fay, Anna,
and Siggy continue to yell. When this doesn’t work, Bob throws Dr. Marvin onto the
sofa and begins jumping on his back, driving his knee into Dr. Marvin until he spits out
what he had been choking on.
“Bob, you saved him!” Siggy exclaims, as he, Anna, and Fay gather round Bob,
leaving Dr. Marvin to cough and collect himself. Bob has indeed just saved Dr. Marvin’s
life, as a doctor would save a patient’s life. This scene echoes the sentiment that Bob
expressed when Dr. Marvin prescribed Bob a “vacation” from his problems, that Dr
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Marvin had given him the “gift of life.” However, in this moment, Bob is the hero
receiving praise for his intervention. A brief close-up of Dr. Marvin, abandoned on the
couch while his family is celebrating, shows him gazing up toward Bob with an
expression suggesting his realization of the shift in power and role reversal that has just
occurred. From this point on, he steadily descends into a type of madness, becoming the
psychiatric patient, while Bob, meanwhile, ascends into the role of doctor.
While Bob, Fay, Anna, and Siggy clean up in the kitchen together, Dr. Marvin
watches from the couch in the living room. A shadow is cast over his face as he glances
over to his singing family. We then see him get up, the camera watching him from
behind, as he walks toward the kitchen. The frame then fills with a close-up of his face.
Part of it is cast in shadow, while the other part is illuminated by a dim golden light. This
lighting suggests a sinister change beginning in Dr. Marvin, foreshadowing his eventual
descent into a violent madness. In a subtly strained tone, he suggests that everyone call it
a night. However, his family and Bob do not hear him over the noise in the kitchen. Dr.
Marvin must then yell over the commotion to be heard. When Fay objects, saying that
Bob can’t walk home in the current storm, Dr. Marvin, a tight smile on his face, says he
will drive him before turning away and walking into the living room. However, when
Anna points out that the car is at the marina, Dr. Marvin turns around, half of his face
obscured by darkness. He responds that when the rain lets up, Bob can walk home then.
He goes to the window, looking out. Siggy asks what Bob will do if the rain doesn’t let
up, and Dr. Marvin responds by snapping angrily, “Then he can borrow my slicker!”

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The kitchen becomes silent, as Fay, Anna, Siggy, and Bob stop to stare at Dr.
Marvin, clearly shocked at his outburst. The frame fills with a close-up of Dr. Marvin’s
face beside the window. Lightning flashes and thunder roars, as Dr. Marvin smiles and
blinks his eyes several times, another allusion to his impending madness. This sequence
of Dr. Marvin’s outburst combined with the lighting of his figure and the storm roaring in
the background suggest that he is about to become like the psychotic characters depicted
in horror movies. The impending mental breakdown, or “snapping” is hinted at, in which
Dr. Marvin will act out violently, through the shadows cast upon his visage and the
lightning flashing behind him as he maintains a strained expression.
That night, before Bob falls asleep in Siggy’s room, he is shown removing a
tissue, which has become symbolic of his mental illness, from the shirt he is wearing and
throws it away. This seemingly small gesture holds significant meaning, as it denotes his
stepping further away from his role as patient. It indicates his transformation,
foreshadowing his casting away of his fears. We also learn later that he was wearing Dr.
Marvin’s pajamas at this time as well, suggesting his transition into a role similar to Dr.
Marvin’s (i.e., a doctor.) Though it is not revealed whether the tissue was Bob’s or had
been Dr. Marvin’s, the removal of the tissue from Dr. Marvin’s shirt can also be
interpreted as a hint to his own transformation into patient. The tissue, which represents
mental illness has come from Dr. Marvin’s pocket, and therefore, we may surmise that
Dr. Marvin currently has a mental illness, though hidden, or will become mentally ill.
The transformation continues during Dr. Marvin’s interview with Good Morning
America. Bob is invited to participate by the staff, much to Dr. Marvin’s dismay, and the
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two sit side-by-side in front of the fireplace. Dr. Marvin is seated in a stately, wing-back
chair, dressed neatly in suit and tie, while Bob perches on a simple wooden chair, likely
from the kitchen. Though heretofore, Dr. Marvin has been portrayed as a confident,
perhaps arrogant, professional, he now sits visibly nervous, as the interview proceeds.
Marie, the reporter, begins with a simple question about how his method and book, Baby
Steps, works on a patient like Bob. At this point, Dr. Marvin’s nerves get the best of him,
and he rambles, almost robotically, a clearly scripted response that does not answer the
question that has been posed. Furthermore, though the reporter’s name is Marie, he
addresses his response to “Joan,” who is the host at the studio tuning in to the interview.
Once he finishes his short speech, his expression changes to disappointment as he looks
down, catching his breath. The frame fills with a shot of Marie, her face confused, who
then directs a question toward Bob. Bob confidently responds, praising Baby Steps and
Dr. Marvin. Marie, encouraged by Bob’s candidness, continues to direct her interview
toward him, rather than Dr. Marvin. Bob tells Marie that he has only been a patient of
Dr. Marvin’s for “three or four days,” to which Dr. Marvin suddenly interjects to assert
that “the book is not really meant to work that quickly,” and, while explaining,
accidentally refers to Bob as “boob,” another Freudian slip. Bob brushes it off, while Dr.
Marvin, hurriedly tries to explain that he did not mean to or want to call Bob that term.
He becomes frustrated, speaking quickly and animatedly, his teeth nearly chattering and
his hands shaking. He tightens up and begins to fidget in his seat as Bob resumes the
interview. His expression gradually turns to one suggestive of anger, a rage perhaps
building inside. Bob brings Dr. Marvin’s family into the picture to introduce them, and
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they all stand in front of the TV camera with Dr. Marvin. However, as Fay, Anna, and
Siggy exit, and Dr. Marvin shuffles around, Bob steals Dr. Marvin’s seat in the wingback chair, forcing Dr. Marvin to take Bob’s wooden chair and literally showing a trade
in position. He finishes the interview, with Dr. Marvin beside him looking, in turn,
confused, defeated, and annoyed.
Following the interview, Bob is shown speaking and saying goodbye to the crew
with Dr. Marvin’s family in front of the house, while Dr. Marvin glares from behind the
screened door in the background. He refuses to come outside for a picture, and Bob takes
his place as he poses with his family and Marie, the first suggestion of Bob replacing him
as father. During the scene, close-ups of Dr. Marvin show a strained, tense smile on his
face as he responds to questions to everyone outside, and it is apparent that he is raging
with anger internally. His fake laughing and his stiff posture and artificial responses
paint the image of a man on the brink of snapping, a foreshadowing of his further descent
into “madness.”
When Bob, Fay, Anna, and Siggy return inside, they are met with a visibly
enraged Dr. Marvin, who yells at Bob to leave as he walks toward him, Bob stepping
backward out the door.
“Get out! You’ve ruined my life! You’ve ruined my career! You’ve ruined my
book! You’ve turned a perfectly peaceful house into an insane asylum! Get out!” He
slams the door in Bob’s face.
The significance of this sequence is the eruption of pent-up emotion within Dr.
Marvin as he accuses Bob of ruining everything, though Bob has not done anything of the
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sort. His accusation that Bob has turned his “peaceful house into an insane asylum” is
ironic and suggests that Dr. Marvin is developing a mental illness. Fay, Anna, and Siggy
have all developed fond feelings for Bob and find joy in their friendship. The only person
that appears to be acting insane is Dr. Marvin, and his assertion suggests that he believes
anyone that acts favorably toward Bob must not be in the right frame of mind.
He continues his outburst, first nearly sobbing that the interview was a disaster,
and then quickly becoming enraged when Siggy asks why he kicked Bob out. His face
red, he roars that Bob didn’t leave, that he is never gone. He opens the door to reveal
Bob standing there to prove his point. “You see!” he shouts. The once-composed Dr.
Marvin, whose career is based on counseling others through emotional turmoil, has
become like his patients. He can no longer express himself in a healthy, coherent way,
and instead, pours out his feelings of wrath and frustration before his family and Bob.
The next scene showing his family and Bob sitting on the porch together, Dr. Marvin
presumed to be in the house, represents the growing social distance between them, not
unlike that observed with Bob and other passengers on the bus.
Dr. Marvin continues to show his transition into the patient with mental illness
when he drops Bob off at the nearby psychiatric ward, into the care of fellow psychiatrist,
Dr Tomsky. He laughs as he signs forms and at the suggestion that staff corroboration
will be needed to hold Bob. As he drives home, he continues to talk and laugh
maniacally at his own plan to rid himself of Bob. When he arrives home, he dances in
front of his house as he hums. However, his joyous celebration is quickly cut short when
a call from the doctor at the psychiatric ward calls Dr. Marvin on the phone and bids him
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back to the hospital. A brief scene of Bob entertaining the hospital staff with jokes plays,
followed by Dr. Marvin arriving at the hospital and finding the psychiatrist who had
admitted Bob. His frustrated outburst continues as the doctor tells him that Bob cannot
be held at the hospital, as he is not ill enough. The conversation between Dr. Tomsky,
and Dr. Marvin parallels the earlier conversation between Bob and Dr. Marvin, but this
time, Dr. Marvin is the patient, rather than the doctor.
“Maybe you should take a vacation,” says Dr. Tomsky, as she watches Dr.
Marvin express his rage. Dr. Marvin angrily responds that he is on vacation. Dr.
Tomsky then suggests that Dr. Marvin check himself into the unit for a few days. This
exchange is packed with meaning, as the Dr. Tomsky dismisses Bob as a patient, while
encouraging Dr. Marvin to seek treatment. Dr. Marvin, who so far has been highly
regarded as a brilliant psychiatrist, has now succumbed to such great emotional distress
that his colleague recommends he assume the role of patient in a psychiatric unit.
Meanwhile, Bob, who was introduced to us as the patient plagued with anxiety and
unable to cope in society, is being released by the same psychiatric unit as he does not
meet criteria for admission.
Another significant step toward the reversal of Bob and Dr. Marvin’s roles occurs
the same evening, when Dr. Marvin arrives home to find that his family has assembled
his closest friends and relatives, including his beloved sister, for a surprise birthday party.
Dr. Marvin is thrilled, until Bob suddenly appears beside his sister, Lily, and wraps his
arm around her shoulders. A close-up of Dr. Marvin’s face shows a rage and wildness
wash over him, and suddenly, the frame fills with the image of him diving through the air
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as he screams, “Don’t touch my sister!” He tackles Bob, and we see the two rolling on
the ground as the crowd screams and tries to separate them.
The scene changes to show Fay and a physician discussing Dr. Marvin. The
physician is older, with gray hair, a neat gray beard, and glasses. He is dressed in a suit
and has a stethoscope. His professional demeanor and stately appearance give the
impression of competency and authority. The physician explains that Dr. Marvin has
been under a lot of stress, which he believes is likely the cause of his suddenly violent
behavior. He tells Fay that the sedative should be kicking in soon, and the two leave the
room as the camera pans over to show Dr. Marvin lying in bed, his angry face against the
pillow and his eyes open and darting. The frame then switches to show Fay and the
physician in the hall with Bob and Lily.

Physician
I’m leaving a prescription for Prozac.

Bob
Excuse me, Phil, but with these particular symptoms, is Prozac really the right choice?

Lily
You think Prozac is a mistake?

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Bob
With this kind of manic episode, I would think Librium might be a more effective
management tool.

Physician
You could be right. I’ll rewrite the prescription
This brief exchange is comical for the ironic role Bob has assumed. He is now
discussing appropriate treatments with a well-trained physician, who takes his input and
changes his recommendation based on Bob’s recommendation. Bob has become like an
equal to the physician, as though he were a professional colleague, while Dr. Marvin lays
in bed, now a patient. In fact, he can be considered Bob’s patient, as Bob has just
discussed his care with the physician and had his suggestion accepted.
Besides his taking on the role of doctor in the relationship, he further volunteers
to assume the role as father as well. Lily, concerned for her brother’s well-being and
trying to understand what could have precipitated his breakdown, asks Bob what he
thinks happened.
“I don’t know, he’s been tense today. But don’t worry, no matter how long it
takes, I’m going to stay on and help out the family. I’ll just be the daddy,” says Bob. His
suggestion implies that he will be taking over the authoritarian role of the family,
providing for and protecting Fay and the kids, as Dr. Marvin is no longer able to fulfill
such duties in his current state. Lily looks up at him admiringly, as though Bob’s

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leadership is a heroic gesture. However, Fay and the kids ask Bob to leave, as they
understand that Bob is triggering Dr. Marvin’s aggressive behavior.
The next few minutes of the film show Dr. Marvin sneaking out of the house, still
dressed in his pajamas, and breaking into a store. He has transitioned into a madman,
who is acting irrationally and dangerously, with the intention of hurting Bob.
Meanwhile, his family has noticed his absence and are searching for him. Siggy
makes a remark that is significant in that it describes the current situation with Dr.
Marvin and foreshadows the upcoming climax:
“I think that’s a mass murderer’s stunt. No one sees you coming and then snap!”
This statement suggests that Dr. Marvin has “snapped,” and that he is now the
man with mental illness. In the beginning of the film, Dr. Marvin had established himself
as a stable, well-respected psychiatrist, trained to help people manage their mental
illnesses. However, the psychiatrist has now become the psychiatric patient, much to his
family’s surprise. He is acting out in ways that none of the other characters would have
predicted, on the verge of committing a homicide to be rid of the man that is aggravating
him. In short, he has snapped and is on track to becoming the murderer that Siggy has
suggested.
Indeed, he comes across Bob walking down the dark road and forces him into the
woods at gunpoint. He proceeds to tie him up and attach the explosives to him, laughing
maniacally as he sets the timer and runs away. However, Bob mistakes Dr. Marvin’s
murder attempt as another therapeutic approach and successfully unties himself. As Dr.
Marvin reunites with his family, Bob comes walking across the yard, holding a cake lit
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with candles and singing “For He’s a Jolly Good Fellow,” to celebrate Dr. Marvin’s
curing him. Dr. Marvin frantically asks Bob where the explosives are, to which he
replies that they are in the house. At that moment, the house explodes in a fiery blaze.
The bust of Sigmund Freud flies through the air and lands, smoking, at the feet of Fay,
Anna, and Siggy, representing Dr. Marvin’s own personal destruction of his role as
doctor. A close-up of Dr. Marvin’s face, illuminated by the fire, shows him blinking in
disbelief, his mouth agape.
The next scene begins in a room, the screen filled with an opaque window as
daylight illuminates the frame from behind. A chain link fence crosses in front of it, a
security measure. The wall adjacent is painted in two tones of gray. The camera slowly
pans down to a close-up of the beginnings of a weaved basket hanging loosely from a
hand. A plaid flannel blanket is draped in the person’s lap. The camera then flashes to
show that the hand and lap belong to Dr. Marvin, who is sitting in the corner dressed in
pajamas, his head down and slightly cocked to one side as he stares blankly. We can see
the edge of a hospital bed in the lower right corner of the screen and thus infer that he is
in an inpatient unit. The gray colors, his position in the corner, and the distance of the
camera away from him making him appear small paint a pitiful picture of the oncepowerful man. In the background, we hear whispering, and suddenly, the frame fills with
Dr. Marvin’s family speaking to Dr. Tomsky, the same psychiatrist he tried to have admit
Bob. They walk over to him, kneel at his feet, and attempt to talk to him. The frame fills
with a close-up of Dr. Marvin’s face, his hair untamed, continuing to stare blankly and

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unable to respond to his family. The transformation into patient is complete as Dr.
Marvin sits in a catatonic state in a psychiatric facility.
Fay
Come back to us! The worst is over!

Siggy
Yeah, Dad. How much worse can it get?

The scene suddenly changes to Bob and Lily at the wedding altar. Dr. Marvin is shown
slumping in a wheelchair in the aisle, Fay holding his hand. He is wearing blue pajamas
and a blue robe, still staring blankly with his head cocked and the flannel blanket in his
lap. He twitches. The minister inquires the crowd if there is anyone who opposes the
marriage. Dr. Marvin looks up. He starts gurgling. The minister pronounces Bob and
Lily as husband and wife. Dr. Marvin suddenly emerges from his stupor, rising from his
chair and shouting, “Nooooo!”
“Dad’s back!” exclaims Siggy. His family and Bob gather round him to
celebrate, and the difference between Bob and him is stark. Bob is now the one wearing
a suit and tie, looking neat, while Dr. Marvin is the disheveled one.
As the crowd claps and the Marvins continue to celebrate, a worded epilogue
flashes across the screen:

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Bob went back to school and become a psychologist. He then wrote a huge
bestseller: “DEATH THERAPY.” Leo is suing him for the rights.

Indeed, Bob has become the successful psychologist, even publishing a book,
much like Dr. Marvin has. The patient has become the doctor. Though we don’t know
what ultimately becomes of Dr. Marvin and his career, his break from his catatonia at the
end gives us hope that he at least recovers from his own mental illness eventually.
The relationship between Bob and Dr. Marvin colors the way we perceive their
gender roles. Bob is plagued by a stereotypically feminine mental illness, and thus, is
represented as having less power than Dr. Marvin. Dr. Marvin, the more stereotypically
masculine character, assumes a position of authority early in the film, consistent with his
prescribed role. Bob, in contrast, is more submissive, reinforcing his stereotypically
feminine character traits that are associated with his mental illness. Besides the
stereotypically masculine and feminine traits as identified by the Bem Sex Role Inventory
possessed by Dr. Marvin and Bob, respectively, the dynamic in their multi-faceted
relationship further supports Bob’s lack of power (Bem, 1974). Their physician-patient
relationship gives Dr. Marvin the power advantage. Likewise, the eventual development
of a parent-child dynamic, which puts Dr. Marvin in the position of parent and Bob as
child, reinforces the idea that Dr. Marvin holds the power in their relationship. The two
characters are also shown as very different in term of stereotypical gender traits, and the
male-female dynamic that exists between the two contributes

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Bob’s character traits, as well as his lack of power compared to Dr. Marvin, may thus
lead the audience to associate his anxiety disorder with femininity, stigmatizing genderatypical mental illness in men. Even at the end, when the roles are reversed, Bob’s
assumption of power is ridiculous and is meant for comedic effect. We aren’t led to
respect him the way we are Dr. Marvin; rather, we laugh at the irony of someone like
Bob becoming a successful authoritative figure. He does not become more masculine or
respectable in our eyes. We are not shown his transformation into successful
psychologist, only a short blurb before the credits roll outlining his eventual career.
Instead, we are left with the image of a man with an anxiety disorder who is presented to
us as a feminine individual that lacks power.

CHAPTER 3
THE IMPACT OF GENDERED MENTAL ILLNESS IN FILM ON AUDIENCES
AND EDUCATORS
As discussed in Chapter 1, media, especially film, has the power to influence our
perceptions on a given topic, and mental illness is no exception. The combination of the
various film elements sends a message to the audience about the subject at hand, shaping
our beliefs about said subject in potentially positive or negative ways. Although the
concept of gendered mental illness is relatively new, film may have been reinforcing such
gender stereotypes for years. The analysis of What About Bob? (Ziskin & Oz, 1991) in
Chapter 2 reveals that Bob, who is affected with a feminine mental illness, assumes many
other feminine character traits as described by the Bem Sex Role Inventory (Bem, 1974).
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As the film is a comedy and Bob is the object of hilarity, one might form an association
between anxiety disorders and femininity, as well as stigmatize men who suffer from
such disorders. However, beyond the effects that the portrayal of gendered mental illness
has on the general public’s perception of affected individuals, such depictions may have
major implications on persons who are suffering from said disorders. In this chapter, I
zoom out from What About Bob? (Ziskin & Oz, 1991) to discuss how films about mental
illness are typically received by critics and general audiences. I then discuss how
mainstream films, like What About Bob? (Ziskin & Oz, 1991) may affect persons with
gendered mental illness, as well as the moral responsibility of filmmakers and medical
professionals to be educated on the topic and work to reduce stigma. Lastly, I propose a
course to be integrated in both film and medical education curricula to analyze gendered
mental illness in film, including a list of suggested movies and guiding discussion
questions.
Film Reception
What About Bob? (Ziskin & Oz, 1991) has been generally well-received by
critics, some of which use demeaning words to discuss Bob and all of which identify the
egomania showed in Dr. Marvin. The Hollywood Reporter’s Duane Byrge (2018) wrote
the following about the film:

Bob’s such a headcase and an around-the-clock challenge that his shrink
pawns him of on a hated colleague (Richard Dreyfuss) a publicitymongering poop who is about to take off on a month's lakeside
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vacation. The good doctor, in addition to his enlarged ego, has some
problems of his own, which make yet for "another vacation that's not a
vacation for his family": a frazzled wife (Julie Hagerty), a pressured boy
(Charlie Korsmo) and a neglected teenage girl (Kathryn Erbe).

Rita Kempley (1991) of The Washington Post had a different perspective of the
film. Though she refers to Bob as “neurotic” several times in her review, she appears to
have more empathy and tolerance for him. In fact, she criticizes Dr. Marvin for his selfimportant attitude:

The doctor is an emotionally barren man whose obsession with his work has
distanced him from his loved ones. As the author of a new self-help
book called

"Baby Steps," he is even more self-absorbed than usual….The

doctor treats his family as if they were patients, but the childlike Bob
can approach the kids as neurotic equals…the screenplay borrows the
pixilated myth from "Harvey" that crazy is nicer than cured. Even though
he is agoraphobic, claustrophobic, hypochondriac, Bob is better off than
his psychiatrist because he is capable of expressing his needs…Murray
has our empathy, our sympathy and the advantage of just plain looking funny,
like a puddle of lumpy oatmeal. Above all else, "What About Bob?"
addresses the way many a patient feels when his psychiatrist has the nerve to

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go away without giving a thought to his problems. Perhaps it is just one
desperate cosmic cry for help. Then again, maybe it's a threat.
Though Kempley acknowledges that Bob may be at an emotional advantage compared to
Dr. Marvin due to his ability to express his emotions, she still pokes fun at him, referring
to his appearance as “just plain looking funny, like a puddle of lumpy oatmeal.”
Furthermore, she seems to make light of the turmoil a patient may experience when he
feels abandoned, and even hints at the violent potential of persons with mental illness.
The New York Times movie critic Janet Maslin identifies the way the film’s
comedy genre reframes the plot of patient stalking doctor into a topic to laugh at, rather
than fear. Her use of language in describing Bob suggests that she views him as a threat
that would unsettle the viewer if presented in a different context. She also recognizes that
Bob is annoying to the audience and that we tend to empathize with Dr. Marvin’s
frustration.

A happy family in a remote setting, stalked by a deranged man with an
unreasonable fixation on the father: this plot would have the makings of a
thriller (think of "Cape Fear") if it were not in this case played for
laughs…Very quickly, the story's emphasis on Bob's lovability becomes as
annoying to the audience as it is to Dr. Marvin, who is driven absolutely wild.

From these brief examples, it appears viewers tend to look down on Bob and
perceive him in terms that could be derogatory to persons with mental illness.
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Descriptions such as “headcase,” “neurotic,” “deranged,” and “a lumpy puddle of
oatmeal,” suggests the stigma that mental illness carries. These reviews suggest that the
film does little to alleviate such stigma; rather, it tends to reinforce it. Though the above
critics also call attention to Dr. Marvin’s narcissistic behavior, they don’t use insulting
language like they do when talking about Bob, especially not about his appearance.
Thus, though critics were generally entertained by the film, they tended to speak about
Bob and his mental illness in more stigmatizing terms, rather than empathize with his
plight.
Drawing from the above reviews, critics and the general public, alike, seem to be
interested in and entertained by stories about mental illness, and the potential to use this
popular platform to educate and address stigma surrounding such disorders should not be
ignored. As it is, these films, which are consumed by millions of people, are influencing
society in such a way that, while being entertained, audiences are subconsciously forming
perceptions based on inaccurate representations of mental illnesses. Thus, the power of
using more realistic depictions to improve society’s knowledge and attitudes about
persons with mental illness, which could potentially improve affected individuals’
experiences with the general public, should be recognized. However, to effectively use
such a platform for these purposes, more research and education is needed to accurately
portray persons with mental illness, which I discuss later in this chapter. In the next
section, I discuss the effects film has on persons with mental illness and their families.
Film’s Impact on Persons with Mental Illness

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Media generally depicts mental illness negatively, and such representations have
been associated with distressing feelings and self-stigmatization in affected individuals
and their families (Stuart, 2006). The potential for persons with mental illness to
internalize the depictions of others like them on screen, as well as the attitudes of
supporting characters toward them, is likely, given the impact media has on shaping
individual perceptions. The “othering” of characters with mental illness may reinforce
the idea that such persons do not belong in general society, and repeated exposure to this
message may influence an affected person’s sense of self and self-esteem. Families of
persons with mental illness may also feel the impact of watching negative portrayals of
these disorders. They may experience frustration at the inaccuracies and stigma
perpetuated by films that mislead the general public about what their loved ones are
capable of. Media often represents persons with mental illness as unable to function the
same as those without mental disorders, requiring extra care and consideration.
However, this sweeping generalization undermines the vast number of individuals living
with mental illness that, with treatment, function as well as those without. Mental illness
does not necessarily prohibit a person from obtaining and keeping a successful career or
becoming adept at a hobby, but films like What About Bob? (Ziskin & Oz, 1991)
perpetuate this belief by showing such characters as incapable of leading normal lives as
a result of their mental disorder, causing society to doubt the potential and abilities of
affected individuals. In the film, Bob is unable to work outside of his house due to his
extreme anxiety and agoraphobia. Even after he is “cured” and goes on to become a
psychologist and write a best-selling therapy book, the audience is led to laugh and
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ridicule the very idea of his success. The entire film focused on his neuroses, and the
mention of his new career as an afterthought downplays his accomplishment. The viewer
is left with the image of Bob amid his mental illness, reinforcing the idea that persons
with mental disorders cannot obtain the same level of success as persons without.
Though film often depicts mental illness in general inaccurately, the extent that it
gender stereotypes mental illness is largely unstudied. However, one can postulate the
potential impact of such representations on persons living with mental illness. One
possible repercussion may be the unrecognition of a certain mental illness in a person.
For example, a search of films about eating disorders did not return any popular movies
with male main characters. The lack of representation of men with such a disorder in
mainstream film may lead to under recognition of this mental illness in this gender.
Rather, the association of eating disorders with female characters may lead men to
believe that such disorders affect women exclusively and unable to identify similar
symptoms in themselves. These men may then neglect to seek help and experience
further suffering from such an untreated disorder. The representation of mental illness
may also be inaccurate, further contributing to under recognition of disorders by affected
individuals. Bob is shown as having a anxiety disorder, though that is not always the
reality. Milder forms of anxiety disorders exist, though viewers who receive their
knowledge about such mental illnesses through mainstream fictional film may not
recognize them in themselves. Their lack of such exaggerated symptoms may mislead
them to believe they do not have a diagnosable condition that may be treated, and instead,
they may suffer in silence, not realizing they can be helped.
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Furthermore, the reinforcement of stereotypically feminine mental illnesses
through other feminine character traits may lead to self-stigmatization and shame in men
suffering from such disorders. De Visser & McDonnell (2012) found that men reported
the desire to engage in stereotypically masculine behavior while avoiding stereotypically
feminine behavior in order to establish a masculine identity. Such masculine behaviors
included exercising for physique, binge drinking, and heterosexuality, while feminine
behaviors included excessive concern for one’s appearance and dieting for slimness,
consulting professionals for physical and mental health, and homosexuality. When film
depicts characters with mental illness that reinforce gender stereotypes, namely, men
presented as feminine, affected men may form the belief that suffering from such an
illness is a threat to their masculine identity and thus feel further shame and stigma.
Indeed, a meta-analysis by Seidler et al. (2016) observed that men were reluctant to
discuss depressive symptoms with professionals and when they did, engaged in limited
disclosure, in order to maintain their sense of masculinity. Pursuing therapy was
generally believed to be an effeminate solution, and men endorsed seeking help only
when their own internal resources were depleted and symptoms severe. This same
analysis found that men were apt to develop harmful coping skills rather than seek
therapy, including substance abuse, risk-taking behavior, social withdrawal, anger-fueled
conflict, and increased work hours; suicide was also identified as a courageous masculine
act of control to overcome feelings of entrapment. It would not be a stretch, then, to
surmise that by portraying certain mental illnesses, such as anxiety and depression, as
feminine in film is ultimately harmful to the men who consume such media. As men
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associate such disorders with femininity, they may be less likely to admit their own
struggles and seek help when necessary, instead engaging in maladaptive behaviors as a
means of preserving their masculine identity. A further implication of such practices is
the observed gender disparities in certain mental illnesses. If men are less likely to seek
help for stereotypically feminine mental disorders, opting to cope with more masculine
strategies, the recorded rates of mental illnesses by gender are likely skewed. This could
be a factor accounting for the higher rates of substance abuse in men and higher rates of
depression in women, for example. In the case of Bob, the exaggerated depiction of his
anxiety disorder combined with his overall feminine character leads the audience to laugh
at his odd behavior and stigmatize such a disorder in men. As men watch how Bob acts
in the film and how Dr. Marvin, a masculine character, rejects him, as well as observe the
general audience’s reaction to his behavior, they may feel shame at admitting that they
suffer from similar symptoms. They may reject their own suffering and choose to relieve
their suffering through other means, such as substance use, rather than face the social
repercussions of acknowledging their feminine mental disorder.
As the potential impacts of films about gendered mental illness on society, as well
as individuals affected by such disorders, are considered, it is imperative that we strive to
understand the repercussions of such media more fully. Only when such a topic is
researched, and professionals educated within every field affected by the subject, can
changes be made to represent mental illness more accurately and reduce stigma. In the
next section, I will discuss the importance of addressing representation of gendered

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mental illness from film studies to medical humanities, and how education about the issue
can be implemented for maximum effect.
Research, Education, and the Social Responsibility of Filmmakers and Medical
Professionals
Gendered mental illness in film: The importance of research
Further mental health humanities research is vital to fully understand the impact
of portraying stereotypically gendered mental illness in mainstream film. I suggest future
studies be conducted to analyze the representation of gendered mental illness in film and
other media on a large scale to ascertain the prevalence of such stereotypes as well as the
qualitative aspects of the topic. Film scholars should study the representation of
gendered mental illness on a widespread scale, examining film elements to determine
how producers and directors approach the depictions of these disorders on the various
levels that compose a scene. By identifying how the manipulation of a certain element
can affect the message sent to the audience, we can determine how film may be
perpetuating stigma on multiple levels.
Research from a mental health professional perspective is also of utmost
importance in understanding gendered mental illness representation in film. These
persons are invaluable in determining the accuracy of depictions of mental disorders, and
their insight would be helpful in ascertaining whether filmmakers are portraying
individuals with gender-typical and gender-atypical mental illness justly. Mental health
professionals can help identify trends in such representations and challenge how
filmmakers design affected characters. This could result in filmmakers choosing to
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present a less stigmatizing depiction of mental illness, which may help reduce the
negative perceptions audiences have on persons with mental disorders, as well as assist in
making affected persons feel more understood by, and belonging to, general society. Of
course, film is meant to entertain, to be a form of self-expression, and censorship is not
the goal. Filmmakers possess creative licenses to present an idea however they choose.
However, it may be beneficial to filmmakers to understand how mental illness manifests
and to be mindful of how their characters are represented, potentially encouraging them
to form new narratives surrounding mental illness, rather than repeating old tropes.
Furthermore, research is needed to determine how the depictions of gendered
mental illness influence the perception of affected individuals in terms of self-stigma and
help-seeking behaviors. There is a paucity of studies examining how fictional film
presentation of gendered mental illness affects persons with such disorders in these areas.
Focus groups and mixed-method studies should be performed to examine how persons
with mental illness perceive the representation of characters with similar disorders in
cinema and how it affects their self-esteem and willingness to admit their conditions and
seek help, especially with gender-atypical disorders. Moreover, discussion on how these
individuals would like such characters to be shown would be beneficial for filmmakers in
writing realistic and interesting characters that accurately show the complex lives and
personalities of persons with mental illness. This would be especially helpful in
validating the experiences of individuals with mental disorders, while correcting
misconceptions held by general society about said afflictions.
Education and the moral obligation of filmmakers and physicians to be informed
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Besides research, education is necessary to address stigma caused by gender
stereotyping of mental illnesses on affected persons and general society. Film producers
and directors, as well as medical professionals, should be especially informed on the
topic. Persons in these professions have a moral obligation, as well as a social
responsibility, to be aware of how media can manipulate perceptions of gendered mental
illnesses and the repercussions such depictions can have on society. Education about the
topic should occur at every level of the film and medical/mental health industries,
beginning with integration in degree programs and continuing throughout the
professional career.
Producers and directors have a significant amount of power in terms of
influencing the public, and that power should be used responsibly when the potential to
impact society is great. Promoting the common good of society has been identified as an
area of concern for corporations, and the film industry should not be excluded (Garriga &
Melé, 2004). Misrepresenting mental illness through gender stereotypes such that
increased stigma and potential harm occurs for an affected individual as a result runs
contrary to the ethical responsibility a production company should assume. Media,
especially the film industry, should recognize the impact of how mental illness is
gendered in their content on society and make more informed decisions on the way they
choose to represent such disorders. Arguably, the material can be as entertaining, if not
more so, if mental illness is presented more accurately and in such a way that certain
disorders are not stigmatized in a gender.

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Thus, filmmakers should be made aware early on in their education the potential
ramifications of inaccurately representing mental illness, especially the gendering of
certain disorders. Perhaps film studies curricula need to include coursework that teaches
students about the intersection of gender stereotypes and mental illness and the
significant impact film has on public perception of both topics. Courses could be
designed so that students can grasp a thorough understanding of the societal
consequences of their film design decisions, while fostering an ability to critically
analyze such media to identify stigma-promoting material. I suggest these courses
integrate panels of persons with mental illness who can provide personal narratives of
their experiences of living with such disorders, and how film representations of said
illnesses has impacted their sense of self and the stigma they have faced from society.
Psychology courses could be implemented in film programs, as well, with mental health
professionals discussing actual manifestations and treatments of mental illnesses so that
students can gain a better understanding of what is often a foreign concept. Gaining
knowledge on such a stigmatized topic could be beneficial for the filmmaker’s own
perspective and potentially affect the way he presents a person with gendered mental
illness. Filmmakers might then be more intentional in their manipulation of film
elements and character behavior, perhaps choosing to portray persons with mental illness
in such a way that stigma decreases, and audiences are accurately educated. As medical
professionals are obligated to undergo continuing medical education throughout their
careers, I suggest filmmakers engage in further training throughout theirs. Yearly
conferences featuring presentations relevant to gender and mental illness on screen has
85

the potential to challenge filmmakers to create works that promote acceptance, rather
than “otherness,” of individuals with mental illness and inspire those affected individuals,
especially those feeling greater shame at having a gender-atypical disorder, to seek
appropriate treatment.
Medical professionals also have an ethical obligation to recognize the way mental
illness is stereotyped in terms of gender and adjust their practice to identify and treat
these disorders. Bob Wiley had a stereotypically feminine mental illness and his
personality was defined by stereotypically feminine character traits. These character
traits contributed to his being the subject of ridicule by the viewer and frustration by Dr.
Marvin, which may stigmatize feminine mental illness in men. The overall femininization
of a male character with a mental illness associated with femininity may affect how men
present with and seek help for similar disorders. To preserve their masculine identity,
men may deny their symptoms or attempt to deal with them through other means, such as
substance abuse, which may result in underlying issues going unrecognized and
unsolved. I suggest practitioners be aware of how such mental illnesses are stigmatized
according to gender to discuss the potential presence of feminine mental disorders in men
in a way that addresses the patient’s need for mental health care while maintaining his
sense of masculinity. Furthermore, the basic bioethical principles of beneficence and
nonmaleficence dictate that medical professionals act in such a way to benefit the patient
and avoid harm, respectively. The physician must be able to recognize the role of
masculinity as a barrier to men’s admission of certain mental illnesses and develop
strategies to encourage open communication about such topics with the patient. To meet
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these obligations, education is necessary and should be implemented at every level of
training, as well as periodically throughout the professional’s career. To adequately train
physicians in this manner, medical humanities courses are needed. In the next section, I
will discuss the significance of medical humanities in medical education and how it may
be used to develop better physicians.

The Humanities in Medical Education
The importance of humanities-based coursework in medical school curricula has
become increasingly recognized for the development of empathic and competent
physicians over the last century (Jones, Wear & Friedman, 2014). Indeed, underlying the
practice of medicine is the understanding that it is an art; a patient’s health is shaped by a
plethora of factors outside of biomedicine, and a physician must carefully consider these
factors, along with evidence-based practice, when caring for a person. The same illness
may present differently in different patients, and it is up to the astute physician to think
outside the confines of strict textbook medicine to correctly identify and treat said illness
appropriately. Research has demonstrated that having medical students engage in
humanities-based activities enhances their observational and analytical skills, promoting
a broader view of patients’ conditions (Khullar, 2016; Macnaughton, 2000; Naghshineh
et al., 2008). As gendered mental illness is emerging as a topic of concern, it is vital that
physicians recognize the issue and become skilled in analyzing media to decipher what
messages are being sent to the general public about it.
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Furthermore, film can intersect with medical education to help students
understand the human condition and mental illness more thoroughly. Using video clips
to complement lecture material would provide a more comprehensive instruction to
students, allowing for visualization of otherwise abstract concepts. Moreover, accurate
film representations may potentially help students better recognize a disorder when they
encounter it in the clinical setting as visual media allows for a different approach to
understanding and encoding information. Integrating film courses that examine the
representation of illness in such media would provide a means for students to enhance
their analyzing skills while developing empathy for suffering patients, as well. Gaining a
better understanding of the challenges patients face in an environment where open
discussion can occur amongst peers would help provide a holistic view of the illness and
an appreciation for the necessity of teamwork among healthcare professionals.
Using film to explore illness in medical schools could also expose students to
another facet of patient experience: stigma. To fully comprehend the human condition
when one is faced with disease, especially mental illness, the social implications of
diagnoses should be examined. As medicine is increasingly recognizing socioeconomic
considerations and applying such principles to individualize patient care, it is important
for students to become trained in acknowledging the role that stigma can play on a
person’s overall well-being and adherence to treatment.
Medical humanities-based courses should not be limited just to medical schools,
however. As physicians are expected to remain up to date on biomedical information, so
should they keep informed on popular media concerning illness. In much the same way
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that I suggest filmmakers stay in-the-know with visual media representations of mental
illness, I propose a similar model for physicians. Annual conferences with workshops in
medical humanities, as well as offering continuing medical education credits for
completing medical humanities-based activities should be available to physicians.
So, What About Bob?
Bob is prone to societal judgment as a male character with stereotypically
feminine personality traits, as well as a mental illness, both of which carry stigma. What
About Bob? (Ziskin & Oz, 1991) is a popular film that remains beloved thirty years later
and is still played on television. However, as society continues to evolve, and thus,
attitudes regarding mental illness and gender, the caricature of mental disorders in this
film, and others, should be studied. Society is becoming more aware and accepting of
loosened gender roles, and, though stigma persists, men who show femininity are being
supported more than they were in the past. Likewise, more awareness is being brought to
mental illness, and society is becoming more open in their discussions about mental
health (American Psychological Association, 2019). Was Bob, with his shameless
discussion of his mental disorder, ahead of his time? Do characters with mental illness
that openly share their struggles, like Bob, help de-stigmatize and “normalize” the act?
Indeed, Bob, with his overall feminine personality, combined with his feminine
mental illness, may have faced a greater amount of stigma during the time the film was
created compared to present times. Film frequently reflects society, and it’s important to
analyze movies, both past and present, to understand how perceptions of mental illness
and gender-atypicality change over time. Moreover, analyzing movies about mental
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illness using film studies as well as gender studies will help scholars and society alike
identify and challenge negative tropes to inspire widespread change in the representation
of gendered mental illness in film. By continuing to question and criticize movies that
tend to “other” individuals with mental illness, such as What About Bob? (Ziskin & Oz,
1991), viewers can acknowledge the stigmatizing content and confront their own biases,
collectively changing societal perceptions of persons with mental disorders and, as a
result, film representation of these individuals.
Gendered Mental Illness in Film: A Course Proposal
To address the overall lack of medical humanities coursework that explores the
intersection of gender and mental illness in media, specifically, in both film and medical
curricula, I propose a discussion-based course in which students view popular movies and
critically analyze content for dominant themes and messages. The practice of
interpreting such media will assist them in becoming more aware of the issue of gender
stereotyped mental illness and how stigma may be perpetuated through the manipulation
of various film elements. Through careful consideration and conversation with peers and
instructors, students may become more adept at identifying stereotypes while
brainstorming ways to decrease stigma and challenge the inaccurate portrayals of persons
with mental illness. Film students will have a better awareness of the effects their work
can have on society regarding this topic and potentially be inspired to create more
realistic films that entertain the audience while remaining accurate. Medical
professionals will develop a better understanding of how film can influence the
perceptions of affected individuals and general society regarding gendered mental illness
90

and use this knowledge to engage in relevant conversations with their patients to promote
their well-being. In Appendix B, I list several films centered around characters with
mental illness and offer guiding discussion questions to inspire conversation following
each film showing.

CONCLUSION
Media plays a major role in perpetuating stigma and reinforcing stereotypes
regarding mental illness and gender, and its power in portraying the intersection of the
two, positively or negatively, cannot be ignored. While we view film passively, the
elements within the scenes combine to send messages that we internalize subconsciously,
affecting our beliefs and perspectives on the topic being shown. With the gender
disparities observed in certain mental illnesses, we must consider all potential
contributions to fully understand why some disorders appear to disproportionately affect
one gender more than the other. One such factor may be the stigmatizing messages sent
by film about an individual having a gender-atypical disorder, especially a man having a
feminine mental illness.
What About Bob? (Ziskin & Oz, 1991) is one such film that depicts a
stereotypically feminine mental disorder, anxiety disorder, in a male character in such a
way that the character is overall femininized. Bob, the afflicted character, is not
masculine; he possesses mostly feminine character traits, as defined by the Bem Sex Role
Inventory and is the subject of audience ridicule throughout the film (Bem, 1974). Rather
than identify and empathize with him, we laugh at his antics, which arguably stigmatizes
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anxiety in men, such that they view having this disorder as demasculinizing. The
potential for male viewers to internalize such content and form the belief that a feminine
disorder, such as anxiety, is threatening to their masculine identity cannot be overlooked.
Subsequently, both the film industry and the medical and mental health professions
should be aware of the impact such media has on attitudes regarding gendered mental
illness. The gaps in research studying how film portrays gendered mental illness and the
perceptions of audiences following the viewing of such content must be filled within the
entertainment industry, and filmmakers must be educated about the implications of their
work regarding gendered mental illness on society through regular continuing education
courses and conferences, beginning in undergraduate degree programs. Likewise, mental
health research should explore how these films affect the self-stigma of an affected
individual, particularly men with stereotypically feminine mental illnesses, to determine
the impact of such depictions on their recognition of and willingness to seek help for such
disorders. Regular educational opportunities should be afforded to these professionals,
beginning in medical schools and continuing throughout their careers, to foster awareness
of current depictions, as well as the analytical skills necessary to dissect popular media
and its depiction of gendered mental illness. The film and medical industries should then
collaborate to present a more accurate and less stigmatizing picture of gendered mental
illness to educate the public better and promote acceptance of affected individuals.

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REFERENCES
Abel, K. M., Drake, R., & Goldstein, J. M. (2010). Sex differences in
schizophrenia. International Review of Psychiatry, 22(5), 417–428. doi:
10.3109/09540261.2010.515205.
Agrawal, A., Jacobson, K. C., Gardner, C. O., Prescott, C. A., & Kendler, K. S.
(2004). A population based twin study of sex differences in depressive
symptoms. Twin Research, 7(2), 176–181. doi: 10.1375/136905204323016159.
American Psychiatric Association. (2017). Diagnostic and statistical manual of
mental disorders: Dsm-5. Arlington, VA.
American Psychological Association. (2011, August 19). Sex differences in
mental illness: Men more likely to develop substance abuse, antisocial problems;
women more likely to develop anxiety, depression. ScienceDaily. Retrieved from
www.sciencedaily.com/releases/2011/08/110818101733.htm>.
American Psychological Association. (2019, May 1). Survey: Americans
becoming more open about mental health. American Psychological Association.
Retrieved from https://www.apa.org/news/press/releases/2019/05/mental-healthsurvey.
Barsam, R. M., & Monahan, D. (2019). Looking at movies: an introduction to
film (6th ed.). New York: W.W. Norton & Company.
Bem, S. L. (1981). Gender schema theory: A cognitive account of sex
typing. Psychological Review, 88(4), 354–364.
Bem, S.L. (1974). The measurement of psychological androgeny. Journal of
Consulting and Clinical Psychology, 42(2), 155-162.
Bender, L. (Producer) & Van Sant, G. (Director). (1997). Good will hunting
[Motion Picture]. USA: Miramax.
Bertakis, K., Helms, L., Callahan, E., Azari, R., Leigh, P., & Robbins, J. (2001).
Patient gender differences in the diagnosis of depression in primary care. Journal of
Women's Health & Gender-Based Medicine, 10(7), 689-98.

93

Boysen, G., Ebersole, A., Casner, R., & Coston, N. (2014). Gendered mental
disorders: Masculine and feminine stereotypes about mental disorders and their
relation to stigma. The Journal of Social Psychology, 154(6), 546-565.
doi:10.1080/00224545.2014.953028.
Brea, J. (Producer & Director), Dryden, L., Gillespie, P.E., Nahmias, A., &
Hoffman, D. (Producers). (2017) Unrest [Documentary]. USA: Shella Films.
Brenner, R., Winter, R. (Producers), & Vallée, J.M. (Director). (2013). Dallas
buyers club [Motion Picture]. USA: Focus Features.
Burton, N. (2015, September 18). When homosexuality stopped being a mental
disorder. Psychology Today. https://www.psychologytoday.com/us/blog/hide-andseek/201509/when-homosexuality-stopped-being-mental-disorder.
Byrge, D. (2018, May 17). ‘What About Bob?’: THR’s 1991 review. The
Hollywood Reporter. Retrieved from
https://www.hollywoodreporter.com/review/what-bob-review-1991-movie-1110695.
Capice, P., Dunne, P. Babbin, J. (Producers), & Petrie, D. (Director.) (1976). Sybil
[Motion Picture]. USA; Warner Bros. Television Distribution.
Choi, N. G., Dinitto, D. M., Marti, C. N., & Segal, S. P. (2017). Adverse
childhood experiences and suicide attempts among those with mental and substance
use disorders. Child Abuse & Neglect, 69, 252–262. doi:
10.1016/j.chiabu.2017.04.024.
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to
posttraumatic stress disorder: a history of psychotraumatology. Dialogues in clinical
neuroscience, 2(1), 47–55.
De Visser, R. O. D., & Mcdonnell, E. J. (2013). “Man points”: Masculine capital
and young men’s health. Health Psychology, 32(1), 5–14. doi: 10.1037/a0029045.
Devito, D., Shamberg, M., Sher, S. (Producers), & Soderbergh, S. (Director).
(2000). Erin Brockovich [Motion Picture]. USA: Universal Pictures.
Di Novi, D., Lowry, H. (Producers), & Shankman, A. (Director). (2002). A walk
to remember [Motion Picture]. USA: Warner Bros. Pictures.
Diflorio, A., & Jones, I. (2010). Is sex important? Gender differences in bipolar
disorder. International Review of Psychiatry, 22(5), 437–452. doi:
10.3109/09540261.2010.514601.
94

Dinella, L. M., & Weisgram, E. S. (2018). Gender-typing of children’s toys:
Causes, consequences, and correlates. Sex Roles, 79(5-6), 253–259. doi:
10.1007/s11199-018-0943-3.
Duke, N. N., Pettingell, S. L., Mcmorris, B. J., & Borowsky, I. W. (2010).
Adolescent violence perpetration: associations with multiple types of adverse
childhood xxperiences. Pediatrics, 125(4). doi: 10.1542/peds.2009-0597.
Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K.
E.… Hasin, D. S. (2012). An invariant dimensional liability model of gender
differences in mental disorder prevalence: Evidence from a national sample. Journal
of Abnormal Psychology, 121(1), 282–288. doi: 10.1037/a0024780.
Emmerich, R. (Producer & Director) & Gordon, M. (Producer). (2004). The day
after tomorrow [Motion Picture]. USA: 20th Century Fox.
Ferdman, R. A. (2014, December 12). Chart: What the documentary ‘Blackfish’
has done to SeaWorld. The Washington Post. Retrieved from
https://www.washingtonpost.com/news/wonk/wp/2014/12/12/chart-what-thedocumentary-blackfish-has-done-to-seaworld/.
Fine, S. & Fine, A.N. (Producers & Directors). (2013). Life according to Sam
[Documentary]. USA: HBO.
Finerman, W., Tisch, S., Starkey, S. (Producers). & Zemeckis, R. (Director). (1994).
Forrest Gump [Motion Picture]. USA: Paramount Pictures.
Fisher, L. (2010, June 18). 'Jaws' launched summer blockbuster 35 years ago. Abc
News. Retrieved from https://abcnews.go.com/Entertainment/jaws-launched-summerblockbuster-35-years-ago/story?id=10855868.
Furst, S., Johnson, M., Pacheco, C., Goldman, S., Tropper, M. (Producers), &
Cassavetes, N. (Director). (2009). My sister’s keeper [Motion Picture]. USA: Warner
Bros. Pictures.
Fuss, J., Briken, P., & Klein, V. (2018). Gender bias in clinicians’ pathologization
of atypical sexuality: A randomized controlled trial with mental health professionals.
Scientific Reports, 8(1). doi:10.1038/s41598-018-22108-z.
Garb, H. N. (1997). Race bias, social class bias, and gender bias in clinical
judgment. Clinical Psychology: Science and Practice, 4(2), 99–120. doi:
10.1111/j.1468-2850.1997.tb00104.x.

95

Garriga, E., Melé, D. (2004). Corporate social responsibility theories: mapping
the territory. Journal of Business Ethics 53, 51–71. doi: 10.1007/978-94-007-41263_4 .
Gatt, J. M., Burton, K. L. O., Williams, L. M., & Schofield, P. R. (2015). Specific
and common genes implicated across major mental disorders: a review of metaanalysis studies. Journal of Psychiatric Research, 60, 1–13.
doi:10.1016/j.jpsychires.2014.09.014
Genuchi, M. C., & Mitsunaga, L. K. (2015). Sex differences in masculine
depression: Externalizing symptoms as a primary feature of depression in men. The
Journal of Men’s Studies, 23(3), 243–251. doi: 10.1177/1060826514561986.
Gigliotta, D., Cohen, B., Gordon, J. (Producers), & Russell, D.O. (Director).
(2012). Silver linings playbook [Motion Picture]. USA; The Weinstein Company.
Godfrey, W., Bowen, M. (Producers), & Boone, J. (Director). (2014). The fault in
our stars [Motion Picture]. USA: 20th Century Fox.
Gogos, A., Ney, L. J., Seymour, N., Rheenen, T. E. V., & Felmingham, K. L.
(2019). Sex differences in schizophrenia, bipolar disorder, and post‐traumatic stress
disorder: Are gonadal hormones the link? British Journal of Pharmacology, 176(21),
4119–4135. doi: 10.1111/bph.14584.
Goodwin, J. (2013). The horror of stigma: Psychosis and mental health care
environments in twenty-first-century horror film (Part II). Perspectives in Psychiatric
Care, 50(4), 224–234. doi: 10.1111/ppc.12044.
Grazer, B. (Producer) & Howard, R. (Producer & Director). (2001). A beautiful
mind [Motion Picture]. USA: Universal Pictures.
Guintivano, J., & Kaminsky, Z. A. (2016). Role of epigenetic factors in the
development of mental illness throughout life. Neuroscience Research, 102, 56–66.
https://doi.org/10.1016/j.neures.2014.08.003.
Hamberg, K. (2008). Gender bias in medicine. Women's Health, 4(3), 237-43.
doi:10.2217/17455057.4.3.237.
Higgins, E. S. (2008). The new genetics of mental illness. Scientific American
Mind, 19(3), 42–47.
Hill, D. (Producer) & Carpenter, J. (Director). (1978). Halloween [Motion
Picture]. USA: Compass International Pictures.

96

Hitchcock, A. (Producer & Director). (1960). Psycho [Motion Picture]. USA:
Paramount Pictures.
Huebner, D. M., Rebchook, G. M., & Kegeles, S. M. (2004). Experiebces of
harassment, discrimination, and physical violence among young gay and Bisexual
men. American Journal of Public Health, 94(7), 1200–1203. doi:
10.2105/ajph.94.7.1200.
Juvrud, J., & Rennels, J. L. (2016). “I don’t need help”: Gender differences in
how gender stereotypes predict help-Seeking. Sex Roles, 76(1-2), 27–39. doi:
10.1007/s11199-016-0653-7.
Kavka, M. (1998). Ill but manly: male hysteria in late nineteenth-century medical
discourse. Nineteenth-Century Prose, 25(1), 166-139.
Kempley, R. (1991, May 17). “What About Bob?” (PG). The Washington Post.
Retrieved from https://www.washingtonpost.com/wpsrv/style/longterm/movies/videos/whataboutbobpgkempley_a0a104.htm.
Kennedy, K., Kilik, J. (Producers), & Schnabel, J. (Director). (2007). The diving
bell and the butterfly [Motion Picture]. France: Pathé Distribution.
Khullar, D. (2016, December 22). What doctors can learn from looking at art. The
New York Times. Retrieved from
https://www.nytimes.com/2016/12/22/well/live/what-doctors-can-learn-from-lookingat-art.html.
Kondo, N. (2008). Mental illness in film. Psychiatric Rehabilitation Journal,
31(3), 250–252. doi: 10.2975/31.3.2008.250.252.
Lange, K. E. (2016, May 1). Big changes at SeaWorld. Retrieved from
https://www.humanesociety.org/news/big-changes-seaworld.
Langhoff, S., Lee, J., Goldman, J.I., Pechenik, J. (Producers), & Johnson, C.
(Director). (2014). The skeleton twins [Motion Picture]. USA; Roadside Attractions.
Lewis, R., Lamdan, R. M., Wald, D., & Curtis, M. (2006). Gender bias in the
diagnosis of a geriatric standardized patient: A potential confounding
variable. Academic Psychiatry, 30(5), 392–396. doi: 10.1176/appi.ap.30.5.392.
Logreco, P. & Partland, D. (Producers). (2018). Afflicted [Documentary]. USA:
Netflix.
Maclean, A., Sweeting, H., Walker, L., Patterson, C., Räisänen, U., & Hunt, K.
(2015). “It’s not healthy and its decidedly not masculine”: a media analysis of UK
97

newspaper representations of eating disorders in males. BMJ Open, 5(5). doi:
10.1136/bmjopen-2014-007468.
Macnaughton, J. (2000). The humanities in medical education: context, outcomes
and structures. Medical Humanities, 26(1), 23–30. doi: 10.1136/mh.26.1.23.
Magovcevic, M., & Addis, M. E. (2008). The Masculine depression scale:
Development and psychometric evaluation. Psychology of Men & Masculinity, 9(3),
117–132. doi: 10.1037/1524-9220.9.3.117.
Martin, B. (2019). In-depth: Cognitive behavioral therapy. Psych Central.
Retrieved on July 23, 2020, from https://psychcentral.com/lib/in-depth-cognitivebehavioral-therapy/
Mascaro, J. S., Rentscher, K. E., Hackett, P. D., Mehl, M. R., & Rilling, J. K.
(2017). Child gender influences paternal behavior, language, and brain function.
Behavioral Neuroscience, 131(3), 262–273. https://doi.org/10.1037/bne0000199.
Mayer, D. M. (2018, October). How men get penalized for straying from
masculine norms. Harvard Business Review. Retrieved from
https://hbr.org/2018/10/how-men-get-penalized-for-straying-from-masculine-norms.
Maslin, J. (1991, May 17). Review/Film; Getting through August when the
shrink’s away. The New York Times. Retrieved from https://www.nytimes.com
https://www.nytimes.com/1991/05/17/movies/review-film-getting-through-augustwhen-the-shrink-s-away.html.
McCreary, D. R. (1994). The male role and avoiding femininity. Sex Roles, 31(910), 517–531. doi: 10.1007/bf01544277.
Medavoy, M., Fischer, B.J., (Producers), & Scorsese, M. (Director). (2010).
Shutter Island [Motion Picture]. USA; Paramount Pictures.
Medavoy, M., Messer, A.W., Oliver, B., Franklin, S. (Producers)., & Aronofsky,
D. (Director). (2010). Black swan [Motion Picture]. USA; Fox Searchlight Pictures.
Michniewicz, K. S., Bosson, J. K., Lenes, J. G., & Chen, J. I. (2015). Genderatypical mental illness as male gender threat. American Journal of Mens Health,
10(4), 306-317. doi:10.1177/1557988314567224.
Misiak, B., Frydecka, D., Loska, O., Moustafa, A. A., Samochowiec, J., Kasznia,
J., & Stańczykiewicz B. (2018). Testosterone, dhea and dhea-s in patients with
schizophrenia: a systematic review and meta-analysis. Psychoneuroendocrinology,
89, 92–102. doi:10.1016/j.psyneuen.2018.01.007.
98

Naghshineh, S., Hafler, J. P., Miller, A. R., Blanco, M. A., Lipsitz, S. R., Dubroff,
R. P., … Katz, J. T. (2008). formal art observation training improves medical
students’ visual diagnostic skills. Journal of General Internal Medicine, 23(7), 991–
997. doi: 10.1007/s11606-008-0667-0.
National Center for PTSD. (n.d.). How common is PTSD in women? U.S.
Department of Veterans Affairs. Retrieved from
https://www.ptsd.va.gov/understand/common/common_women.asp.
Oteyza, M.V. (Producer) & Cowperthwaite, G. (Producer & Director). (2013).
Blackfish [Documentary]. USA: Magnolia Pictures.
Oute, J., Tondora, J., & Glasdam, S. (2018). ‘Men just drink more than women.
Women have friends to talk to’-Gendered understandings of depression among
healthcare professionals and their implications. Nursing Inquiry, 25(3). doi:
10.1111/nin.12241.
Pattyn, E., Verhaeghe, M., & Bracke, P. (2015). The gender gap in mental health
service use. Social Psychiatry and Psychiatric Epidemiology, 50(7), 1089–1095. doi:
10.1007/s00127-015-1038-x.
Prentice, D. A., & Carranza, E. (2002). What women and men should be,
shouldn’t be, are allowed to be, and don’t have to be: The contents of prescriptive
gender stereotypes. Psychology of Women Quarterly, 26(4), 269-281.
doi:10.1111/1471-6402.t01-1-00066.
Pressman, E.R., Hanley, C., Solomon, C.H. (Producers), & Harron, M. (Director).
(2000). American psycho [Motion Picture]. USA: Lion Gate Films.
Räisänen, U., & Hunt, K. (2014). The role of gendered constructions of eating
disorders in delayed help-seeking in men: a qualitative interview study. BMJ Open,
4(4). doi: 10.1136/bmjopen-2013-004342.
Rapke, J., Starkey, S. (Producers), Zemeckis, R. (Producer & Director). (2018).
Welcome to Marwen [Motion Picture]. USA: Universal Pictures.
Reich, S.M., Black, R.W. & Foliaki, T. Constructing difference: Lego® set
narratives promote stereotypic gender roles and play. Sex Roles 79, 285–298 (2018).
https://doi.org/10.1007/s11199-017-0868-2.
Riecher-Rössler, A. (2017). Sex and gender differences in mental disorders. The
Lancet Psychiatry, 4(1), 8–9. doi: 10.1016/s2215-0366(16)30348-0.
Rochlen, A. B., Paterniti, D. A., Epstein, R. M., Duberstein, P., Willeford, L., &
Kravitz, R. L. (2009). Barriers in diagnosing and treating men With depression: A
99

focus group report. American Journal of Mens Health, 4(2), 167–175. doi:
10.1177/1557988309335823.
Rosenfelt, K., Owen, A. (Producers), & Sharrock, T. (Director). (2016). Me
before you [Motion Picture]. USA: Warner Bros. Pictures.
Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016).
The role of masculinity in men’s help-seeking for depression: A systematic review.
Clinical Psychology Review, 49, 106–118. doi: 10.1016/j.cpr.2016.09.002.
Sinnerbrink, R. (2016). Cinematic ethics: exploring ethical experience through
film. London: Routledge.
Soban, C. (2006). What about the boys?: Addressing issues of masculinity within
male anorexia nervosa in a feminist therapeutic environment. International Journal of
Mens Health, 5(3), 251-267. doi:10.3149/jmh.0503.251
Stark, R., Stone, A., White, V. (Producers), & Ross, H. (Director). (1989). Steel
magnolias [Motion Picture]. USA: TriStar Pictures.
Substance Abuse and Mental Health Services Administration. (2018). Key
substance use and mental health indicators in the United States: Results from the
2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068,
NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration. Retrieved
from https://www. samhsa.gov/data/.
Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women and hysteria In
the history of mental health. Clinical Practice & Epidemiology in Mental Health,
8(1), 110-119. doi:10.2174/1745017901208010110.
Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2013). Major depressive
disorder in dsm-5: Implications for clinical practice and research of changes from
dsm-iv. Depression and Anxiety, 31(6), 459–471. doi: 10.1002/da.22217.
Ult, K., Saxon, E., Bozman, R., (Producers) & Demme, J. (Director). (1991).
Silence of the lambs [Motion Picture]. USA: Orion Pictures.
van der Pol, L. D., Groeneveld, M. G., van Berkel, S. R., Endendijk, J. J., HallersHaalboom, E. T., Bakermans-Kranenburg, M. J., & Mesman, J. (2015). Fathers' and
mothers' emotion talk with their girls and boys from toddlerhood to preschool age.
Emotion, 15(6), 854–864.
Van Houtem, C. M. H. H., Laine, M. L., Boomsma, D. I., Ligthart, L., van Wijk,
A. J., & De Jongh, A. (2013). A review and meta-analysis of the heritability of
100

specific phobia subtypes and corresponding fears. Journal of Anxiety Disorders,
27(4), 379–388. doi: 10.1016/j.janxdis.2013.04.007.
Verhulst, B., Neale, M. C., & Kendler, K. S. (2014). The heritability of alcohol
use disorders: a meta-analysis of twin and adoption studies. Psychological
Medicine, 45(5), 1061–1072. doi: 10.1017/s0033291714002165.
Vernor, D. (2019, October 8). PTSD is more common in women than men.
National Alliance of Mental Illness. Retrieved from
https://www.nami.org/Blogs/NAMI-Blog/October-2019/PTSD-is-More-Likely-inWomen-Than-Men.
Walther, A., Breidenstein, J., & Miller, R. (2019). Association of testosterone
treatment with alleviation of depressive symptoms in men. JAMA Psychiatry, 76(1),
31. doi:10.1001/jamapsychiatry.2018.2734.
Wick, D., Konrad, C. (Producers), & Mangold, J. (Director). (1999). Girl
Interrupted [Motion Picture]. USA; Columbia Pictures.
Wolodarsky, W., Kohn, B., Gubelmann, B., Bisbee, S., Niederhoffer, G., Stark,
A. (Producers), & Forbes, M. (Director). (2014). Infinitely polar bear [Motion
Picture]. USA; Sony Pictures Classics.
Zanuck, R.D., Brown, D. (Producers), & Spielberg, S. (Director). (1975). Jaws
[Motion Picture]. USA: Universal Pictures.
Zarse, E. M., Neff, M. R., Yoder, R., Hulvershorn, L., Chambers, J. E., Chambers,
R. A., & Schumacher, U. (2019). The adverse childhood experiences questionnaire:
two decades of research on childhood trauma as a primary cause of adult mental
illness, addiction, and medical diseases. Cogent Medicine, 6(1).
https://doi.org/10.1080/2331205X.2019.1581447.
Ziskin, L. (Producer) & Oz, F. (Director). (1991). What about Bob? [Motion
Picture]. USA: Touchstone Pictures.

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APPENDIX A: ELEMENTS OF MISE-EN-SCÈNE
Lighting
Lighting plays a powerful role in film. It can be manipulated to highlight certain
aspects within a scene and casting others in darkness, thereby affecting how the audience
sees and interprets the setting and characters. It’s used to help set the mood and tone,
while conveying character. Our sense of cinematic space is created by illumination and
shadow, delineating textures and shapes. Through careful manipulation of lighting,
filmmakers create expressive effects (Barsam & Monoham, 2019). There are three major
aspects of lighting important in mise-en-scène: quality, ratios, and direction. Quality
encompasses a spectrum of light ranging from hard to soft. Hard light refers to the direct
illumination of the subject, creating high contrast and sharply defining the borders
between light and shadow. Details are well-defined, and facial textures, such as wrinkles,
are more visible, resulting in an oft-unflattering image. Hard light is typically associated
with more sober or terrifying situations. In contrast, soft light is diffused as the beams
are scattered before they reach the subject. This results in low-contrast images with lessdefined boundaries between illumination and shadow, as well as softer details. Soft light
is more flattering for characters, as facial textures are not as obvious. This type of light is
typically associated with comedies or romantic movies (Barsam & Monoham, 2019).

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Lighting ratios determine the level of illumination compared with the depth of
shadow in an image. There are several ways to exploit ratios to achieve a desired effect,
but the most common technique is the three-point system. This method uses three
sources of light from different directions to illuminate a subject. The key light is the
main source, and it creates deep shadows. The fill light is positioned on the opposite side
of the camera than the key light and functions to modify the depth of the shadows created
by the key light. The backlight creates highlights along the hair and edges of the subject,
allowing the subject to stand out. Low-key lighting occurs when little to no fill light is
used, creating a high ratio between illumination and shadow. A high-contrast image is
produced and is often used to create the gloomy setting typically observed in horror,
mystery, crime, and film noir. High-key lighting occurs when there is little contrast
between illumination and shadow. The closer the intensity of the fill light is to the key
light, the greater high-key lighting effect, until, eventually, no shadows are observed.
High-key lighting is often used in dramas, musicals, comedies, and adventure films.
(Barsam & Monoham, 2019).
The direction that light is thrown onto a subject can also be manipulated for
effect. The angle of the light contributes to the contrast and shadows, conveying mood
and information about the subject being lit. Backlighting is the result of the light source
being behind the subject, who is in front of the camera. This allows the subject to be
silhouetted, hiding facial details in shadow, and presenting a character as either
intimidating or impressive. Halloween lighting results from light shining beneath a
subject, casting shadows opposite of what we would see in normal lighting. This creates
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distortion of facial features, causing a sense of unnaturalness about a character or
situation. Top lighting is the opposite of Halloween lighting, with the light source above
the character. Depending on the angle, the effect ranges from glamorous to threatening.
Frontal lighting occurs when the light is directed toward the subject from the level of the
camera. This angle results in a lack of shadows on the character’s face, flattening its
features, and may be used to indicate the shallow nature of the subject (Barsam &
Monoham, 2019).
Design
Design encompasses everything from setting to costume/makeup to décor. Every
location, prop, and outfit is intentionally chosen for the purpose of conveying a specific
message, and it is the interaction of each of these elements that allow a story to be told.
So important is design in film that entire teams are designated to constructing each
component (Barsam & Monoham, 2019). This section will briefly discuss the roles of a
few of the major elements in design
Setting is where and when the story takes place. The location may be a real or a
fictional place during a past, present, or future time, and many settings may be observed
within a single film. Besides the physical implications, setting also confers the mood of
the film. Many inferences about the film’s subject can be made based on this element
alone, including a character’s socioeconomic status, culture, personality, and
circumstances Barsam & Monoham, 2019.

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Décor and properties (props and set dressing) decorate the scene. Décor
encompasses the color and texture of interior design, including furniture and window
dressings. Anything held by an actor is referred to as a prop. The set dressing is
everything that is used to create a certain look and feel of a scene, including carpet, paint,
objects, furniture, and decorations Barsam & Monoham, 2019.
Costume and makeup are another important way to convey messages to the
audience. Filmmakers are concerned with presenting characters in aesthetically pleasing
ways that reflect the time and culture of the story. Costume and makeup are also used to
convey meaning about the character and the progression of said character over the course
of the film Barsam & Monoham, 2019.
Composition
Composition is the way that visual elements are organized within a scene. It is
the distribution and balance of everything the viewer sees, including props, actors,
lighting, and movement, within a frame to convey messages. Composition serves an
aesthetic purpose, as well as provides viewers with an understanding of what is most
significant within a scene. Perhaps most importantly, it allows the audience to interpret
the state of a character’s mind, as well as the physical, emotional, and psychological
relationships between characters Barsam & Monoham, 2019.
A common framework in composition is the rule of thirds, which divides the
frame into a grid comprised of three horizontal sections and three vertical sections. This
grid aids filmmakers in balancing visual elements within a shot. Typically, when a
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subject is placed in one section, another corresponding subject will be placed in the
opposite section for counterbalance. When the rule of thirds is broken, compositional
stress occurs, which may cause the subject to appear disturbed or convey uneasiness.
Suspense can be created when negative space is used. Negative space is an imbalance
within the frame that viewers expect to be filled. The relative location of subjects on
screen can be manipulated to convey meaning through deep space composition. Placing
subjects in the foreground, middle ground, and background assists in providing
information about relationships and the present situation. Further information is
conveyed through the subjects’ relative sizes and whether the subject is in focus within
the frame Barsam & Monoham, 2019.

Kinesis
Kinesis refers to the movement that occurs within a scene. Characters and objects
may move about (called figure movement), or the camera itself can move; both forms of
kinesis are manipulated to form messages for viewer interpretation. Figure movement is
essential in film, as it tells the story. Camera movement is also important and can be
manipulated in several ways to affect how the audience sees a frame. The camera may
serve as a narrator, guiding the viewer through the scene as it unfolds, or it may follow a
character’s movement instead.
Though mise-en-scène is often applied to specific frames of film, the above
elements can be analyzed throughout the movie to ascertain the overall meaning. In
Chapter 2, I will apply this method of analysis to What About Bob? to interpret the
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messages being conveyed about mental illness deemed masculine and feminine in men
(Barsam & Monoham, 2019).

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APPENDIX B: GENDERED MENTAL ILLNESS IN FILM: FILM
SUGGESTIONS AND DISCUSSION QUESTIONS

Film Examples
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

What About Bob (1991)
Welcome to Marwen (2018)
Psycho (1961)
Donnie Darko (2001)
A Beautiful Mind (2001)
Infinitely Polar Bear (2014)
Shutter Island (2010)
Good Will Hunting (1997)
Matchstick Men (2003)
Silver Linings Playbook (2012)
The Skeleton Twins (2014)
Girl, Interrupted (1999)
Black Swan (2010)
The Virgin Suicides (1999)
American Psycho (2000)

Guided Discussion Questions
1. Does the character have a masculine or feminine mental illness, and how does the film
portray this positively/negatively?
2. What props did you notice that allude to the mental illness of the character? Do they
suggest masculinity or femininity?
3. What camera angles were used, and what effect did they have on the way you viewed
the character?
4. How did the genre of the film affect how the character with mental illness was
represented?
5. How does the language used in the film, especially in the way other characters describe
the one with mental illness, reinforce or reduce stigma?
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6. What inaccuracies did you notice regarding mental illness, and what message do you
think this sends to a general audience?
7. What messages did the clothing/makeup/appearance send about the characters?
8. Do you think the film contributes to the stigmatization of mental illness? Do you think
the stigma would be affected if the gender of the character was different? Do you think it
would be affected if the gender of the mental illness was different?
9. What do you think the message(s) of this film is?
10. Do you think this film could be used to correctly educate the general public about the
mental illness of topic? What changes, if any, do you think should be made?

11. Film is used as a form of entertainment, and exaggeration of certain elements is used
to immerse the viewer, even if such exaggerations lead to inaccurate representations. Do
you think a film about mental illness would be less entertaining if the exaggerations were
not present and, instead, the film tried to stay as accurate and realistic as possible?

109