The psychiatrist in American cartoons, 1941- 1990 Walter G. The psychiatrist in American cartoons, 1941-1990. Acta Psychiatr Scand 1992: 85: 167-172.
I
The portrayal of psychiatrists in cartoons from the United States was examined. A total of 404 cartoons from 1941 to 1990 were obtained and arranged chronologically. The appearance, behaviour, treatment methods and efficacy of the cartoon psychiatrist were assessed. It was found that there has been little change in these parameters over the past 50 years. This finding is partly explained by the constraints of the cartoon medium and by the workings of humour and stereotyping. Psychiatric cartoons from other countries and those drawn by psychiatrists themselves do not depart from the American pattern. The differences between the representation of psychiatrists in the cartoon and in other media, such as the film, are highlighted. It is postulated that the cartoon serves to stabilize the more mutable portrayals of psychiatrists in other media. Further studies are suggested.
In the mid-nineteenth century, in The Athenaeum, it was suggested that “the mere work of a cartoonist can neither be interesting nor instructive ... for who would wish to know of the haunts and habits of a spy ... who insults inferiority of mind and exposes defects of body ... who aggravates what is already hideous, and blackens what was before sufficiently dark” (1). The haunts and habits of the cartoonist should be of considerable interest to our profession. For a start, a perusal of contemporary newspapers, magazines and cartoon anthologies would reveal that cartoons featuring psychiatrists and mental illness are common. Secondly, fictional portrayals may provide a marker of unconscious public attitudes and, in turn, influence these attitudes (2). Thirdly, psychiatry has a tradition of interest in humour. Freud’s theories on the function of humour (3,4) were applied to the cartoon by Kris & Gombrich ( 5 , 6 ) who, like Freud, saw cartoon humour as tendentious but emphasized the role played by regression. Cartoons have also been used as a therapeutic tool both in the self-help literature (7, 8) and clinical practice (Twerski A, personal communication). Despite the above considerations, psychiatrists have recently neglected their portrayal in cartoons. By comparison, their depiction in other genres, most notably the film, has attracted a lot of attention (916). Derived from the Latin charta for paper via the French cardon for pasteboard, the word cartoon originally meant a preliminary sketch or design for copy (17). In 1843 a number of such designs were
G.Walter Northside Clinic, Sydney, Australia
Key words: psychiatrist; cartoon; media Dr Garry Walter, 7 Arding Street, Lane Cove, NSW 2066, Australia
1
Accepted for publication September 2 1, 1991
commissioned by Prince Albert for the walls of the British Parliament. The illustrated weekly Purzch disliked the Prince Consort and the designs and produced its own series of drawings, which were satirical. Although the cartoon thus acquired its modern meaning, the first examples of the form can probably be traced to William Hogarth’s graphic crusade against the seamy state of England in the eighteenth century (17, 18). Cartoons about psychiatry did not appear until the early 1920s (19). Such cynically progressive magazines as American Mercury and Smart Set reflected the postwar agglomerate of disillusionment, a loss of respect for authority figures and the need for gaiety. The earliest cartoons about psychiatry seldom showed a psychiatrist, since actual psychiatrists were few and far between, but dealt rather with institutionalized psychotics and the pretentions of asylum superintendents. Cartoons featuring psychiatrists surfaced by the 1930s and, spurred on by the refinement of photoengraving techniques, a New Yorker-inspired streamlined drawing style and the public’s fascination in psychoanalysis, became entrenched by the mid-1940s. Previous studies
The depiction of psychiatrists in cartoons from the United States has been considered by Redlich (20), Davidson (21) and Fuller (22). In 1949 Redlich (20) examined 30 contemporary psychiatric cartoons from The New Yorker, The Saturday Evening Post, Collier’s, The New York Herald Tribune and PM. He 167
Walter observed that the psychiatrist in cartoons “is typically an analyst ... without exception a man ... bearded and balding, with spectacles or pince-nez ... often foreign-looking”. Redlich noted that the enduring symbols for him were Viennese diploma and, even more importantly, the couch. The psychiatrist was portrayed as exaggeratedly hateful, stupid, venal or just plain crazy. Redlich interpreted the cartoon psychiatrist as the aggressive, dominant father or the weak helpless father. To enforce such roles, Redlich concluded, implied some public feeling of guilt, shame and fear. In 1964 Davidson (21)randomly selected 42 contemporary psychiatric cartoons and compared them with cartoons from the anthology Its AZZMental(23), published in 1948. Every doctor in the anthology was a male, had a large hooked nose and in most pictures was bearded. He had a Homburg hat, often had a cigar in his mouth, wore a frock coat, or a jacket with high lapels, only the small tight tie knot being visible. In several, he wore striped trousers. In half the pictures the diploma on the wall was in German or referred to a German or Austrian training institute. This publication thus offered a European concept of the psychiatrist. About a quarter of the book’s cartoons pictured the psychiatrist in an unfavourable light: a buffoon, a fool or wrapped up in trivia. Only one of the anthology’s cartoons touched on the commercial aspects of patient care. Davidson said that the cartoon psychiatrist of the early 1960s “was, like his predecessor, usually an analyst but was now a fairly young man, half the time wearing a thin moustache .,, clearly an American”. Davidson commented that the cartoon psychiatrist had become a sibling rival rather than a father figure. He suggested that a greater proportion of the 1964 sample dealt with monetary aspects of patient care. In 1971 Fuller (22) despaired that, since the inception of the cartoon psychiatrist, the latter’s appearance, character and practice had not changed. Fuller did not examine a sample of contemporary cartoons. His lament was therefore based on impression. He stated that the couch as a psychiatric symbol had featured so often that continued variations of the theme were monotonous. Fuller suggested that the couch promoted regression towards a dependent state and saw portrayals of the cartoon psychiatrist as a function of dependence longings and Oedipal strivings. It is now 20 years since Fuller’s article. Given the burgeoning interest in recent years in our public image and representation in other media forms, it appeared timely to revisit the portrayal of the psychiatrist in cartoons and to compare current depictions with earlier ones. Unfortunately, previous studies had used small sample sizes and had attempted only cross-sectional, or limited longitudinal, analysis. 168
It was hypothesized that, in popular American publications over the past 50 years, there has been little, if any, change in the appearance and behaviour of the psychiatrist and in the nature and result of treatment. Material and methods
A total of 404 cartoons from 1941 to 1990 in which a psychiatrist appeared or was alluded to were obtained; 390 of the cartoons were gag (or regular) cartoons, 7 were editoral cartoons, 5 were comic strip cartoons and 2 were advertising cartoons. The compilation represented the work of 93 artists. The cartoons came from the anthologies Its All Mental (23),M Y S T (Maybe You’re Screwy Too) (24),StrictZy Doctors (25), Shrinks and Other Lunatics (26) and The Far Side Series (27),and from searching through consecutive issues of Collier’s, The New Yorker, Playboy, The Washington Post, The Los Angeles Times, The Saturday Evening Post, The Chicago Tribune and a variety of other popular American magazines and newspapers. The cartoons were grouped according to the decade of their publication. Approximate counting revealed that the different styles of resource literature were represented in similar proportions in each of the 5 decades studied. Each cartoon was scrutinized using a checklist that probed the appearance of the psychiatrist and surroundings, the behaviour of the psychiatrist and the form and outcome of therapy employed. The checklist was derived, in part, from the findings of previous studies. The author also made a more qualitative appraisal of major themes and omissions in the portrayal of psychiatry in cartoons. The sample was restricted to cartoons published in the United States, to offset cross-cultural differences in the expression and appreciation of humour and in attitudes towards our profession. It was not feasible to scour all available American anthologies, newspapers and periodicals for psychiatric cartoons. The source material was limited to mainstream publications. It was acknowledged that this, in turn, implied a certain, albeit diffuse, stratum and orientation of artist, editor and reader. Regional themes and minority views may thus have gone undetected. Finally, the cartoon psychiatrists in the study were inevitably not restricted to medical practitioners. The bona fide and most common cartoon psychiatrist can only be identified by the appearance of such words as psychiatrist, psychiatry, Institute of Psychiatry or M D on the diploma or office door, the presence of a stethoscope, the observed capacity of the therapist to prescribe drugs or an appropriate reference in the caption. Cartoons in which the ther-
The psychiatrist in American cartoons, 1941-1990 apist was definitively identified as a psychologist, social worker or marriage counsellor were not considered. Cartoons in which it was possible, but not certain, that the therapist was a psychiatrist were included. Examples of this last group included cartoons in which the designation on the diploma or door was illegible and cartoons in which the diploma was absent. Results
The results are summarized in Table 1. There has been no appreciable change in the profile of the cartoon psychiatrist’s appearance, behaviour, treatment methods or efficacy over the past 50 years. The psychiatrist was a man in 96% of cases. Women accounted for only 2% of portrayals. The sex of the psychiatrist was uncertain when the psychiatrist wore a costume or large mask, was depicted as an animal or when the (presumably bored) psychiatrist left the patient alone in the consulting room. A balding pate was the most frequent feature of the psychiatrist, being found in 92% of cases. The
beard, spectacles, diploma and couch were also regular accompaniment s. The psychiatrist was negatively portrayed in 56 % of cartoons. The psychiatrist was consistently depicted as mad, licentious, bored, greedy and sadistic, as well as neutrally, but was seldom seen to be actively caring or supportive. Madness was not defined in the narrow sense of psychosis but, according to the lay conception of madness (15), in a broader colloquial sense to include psychosis, folly and eccentricity. It did not appear that most examples of a given behaviour type were accounted for by a single style of resource material. For instance, licentiousness was not just furnished by popular pornographic literature, such as Playboy, but by a broad spectrum of material. It is worth noting that the few female cartoon psychiatrists did not display the above adverse behaviours. Female psychiatrists were depicted as sex objects or housewives. Thus, a leering male patient addressed her: “My sweetest, my sugar” (28) or was advised: “Try not to think of me as a woman” (25)
Table 1. The psychiatrist in American cartoons, 1941-1990 Decade
Total
1941-1950 (n=68) %
195 1-1960 (n= 94) %
1961-1970 (n=73) %
1971-1980 (n= 70) %
198 1-1 990 (n= 99) %
1941-1 990 (n=404) %
94 3 3 86 72 93 81 84
97 1 2 70 75 93 82 79
94 3 4 74 66 89 79 88
99 1 0 80 74 91 96 88
97 1 2 76 77 93 90 92
96 2 2 77 74 92 86 86
34 1
48 1
29 1
26 0
37 1
36 1
21 15 13 7 1 9
11 6 9 14 2 7
14 14 15 13 8 8
14 16 10 23 6 6
16 7 6 13 9 10
15 11 11 14 5 8
Primary treatment method Psychotherapy Pharmacotherapy ECT Difficult to classify
94 0 0 6
93 2 0 5
96 3 0 0
93 3 0 3
95 1 0 4
94 2 0 4
Outcome Improvement or cure No change Deterioration Difficult to classify
2 71 22 6
2 77 13 9
0 73 23 4
2 86 10 1
2 69 14 14
2 75 15 8
Characteristic Appearance of psychiatrist and surroundings Male Female Indeterminate sex Presence of spectacles Presence of beard Balding of pate Presence of diploma Presence of couch Primary behaviour of psychiatrist Neutral Actively caring or supportive Negative: Mad Licentious Bored or disinterested Greedy or money-conscious Sadistic Other or difficult to classify
169
Walter or was scolded: “Before we begin the analysis, Mr. Zeisel, let’s get those shoes off the couch” (29). Davidson’s view (2 1) that the cartoon psychiatrist was becoming younger and more money-conscious was not supported by this study. The age of a cartoon character is often extremely difficult to estimate. However, if baldness is used as a very crude index of age, it would seem that the cartoon psychiatrist has not become any younger. It would also seem that the cartoon psychiatrist has always been concerned with the financial aspects of patient care. Psychotherapy was the most common treatment method. Pharmacotherapy was scarce, despite the introduction and popularization of a number of psychotropic agents within the studied period. Electroconvulsive therapy (ECT) was not witnessed at all. Stable themes of cartoon therapy over the past 50 years included: the emphasis on the patient’s and psychiatrist’s early childhood at the expense of later developmental stages; the influence of the patient’s and psychiatrist’s mother and exclusion of other attachment figures; the mention of Freudian concepts and terminology and neglect of later theorists’ contributions; and the coupling of the “psychiatrist-sleuth” and a single traumatic event. Subspecialists, especially the psychiatrists dealing with drug and alcohol problems and eating disorders, were seldom encountered. Children were usually seen by a child psychologist. Research was also largely the domain of the psychologist. Trends in psychiatry were only occasionally reported. The popularization of psychosomatic concepts and physical treatments could be traced in the sample. The community psychiatry movement, however, escaped notice. Indeed, most developments in 20th-century American psychiatry, elegantly delineated by Sabshin (30), eluded the cartoonist or were avoided. The psychiatrist did not usually change a patient’s condition. Deterioration was more common than improvement or cure which, in turn, were rare sequelae of treatment. Discussion
The psychiatrist in American cartoons is a resilient character whose range of appearances, surroundings, behaviour patterns and treatment methods have withstood the passage of time, innovations in actual psychiatric practice, the creative flair of new generations of comedic artists and the whims of a variety of editors. The constraints of the cartoon medium help one understand some aspects of the cartoon psychiatrist’s consistent appearance. The cartoonist, unlike 170
the novelist and scriptwriter, seldom has a chance to develop a plot. This artist relies on familiar symbols such as the couch and diploma to immediately orient the reader. In reflecting on his cartooning career, Larson (3 1) regretted using such symbols but could not conceive of alternatives. The restrictions of the cartoon also help one understand why the psychiatrist is rarely revered in this medium. A cartoon must, by definition, attempt to be humorous. However, adulation and humorous intent seldom meld comfortably. The cartoon psychiatrist can be empathic or effective but only if simultaneously ridiculed. The rarity of “Dr Wonderful” in cartoon is partly offset by the abundance of neutral portrayals. The psychiatrist who is able to passively and unobtrusively tolerate a patient’s distress would seem to present a desirable image for our profession. Inevitably, however, even the neutral psychiatrist becomes secondarily embroiled in ridicule or, to apply Goffman’s (32) terminology, becomes the recipient of a “courtesy stigma”. The unsavoury behaviours displayed by the cartoon psychiatrist vividly reflect, and endorse, the postulated functions of humour and stereotyping. In addition to the rationales for humour in the individual, such as the discharge of hostile or erotic drives (3,4), the resolution of cognitive dissonance (33), the release of tension (34) and the tapping of rightbrain activity (3 9 , humour has possible social functions (36, 37). Humour is thought to regulate attitudes, establish scapegoats and influence or define the formation of in-groups and out-groups. The explanations for stereotyping (38, 39) are similar. Unfortunately, there has been little research on the effect of cartoons on public perceptions. The scant empirical work has been confined to editorial cartoons. By relying on nameable individuals, these cartoons are possibly more akin to caricature than to the gag cartoon in their effect on the psyche. Brinkman (40) found that editorials and cartoons, presented together, can bring about changed opinions but, as a rule, usually reinforce pre-existing conceptions. Carl (41) found that 70% of their respondents misperceived the intended meaning of cartoons. Anecdotally, cartoons can exert enormous influence (17- 19). Examples include Benjamin Franklin’s legendary “Join or Die” cartoon of 1754, which urged the Colonies to unite against the French and Indians and Thomas Nast’s destruction of the political aspirations of William “BOSS”Tweed and Horace Greeley through his cartoons in Harper’s Weekly in the 1870s. It is in the realm of fantasy that a psychiatric cartoon today could achieve notoriety and swing public opinion concerning our profession from antipathy, or at best ambivalence, to acceptance. This would be the task of Sisyphus. The present century
The psychiatrist in American cartoons, 1941-1990 has also seen other media forms evolve, proliferate and diminish the salience of the cartoon as social critic. The cartoon psychiatrist is, in any case, further relegated to the gag cartoon whose function is to educate, not re-educate, to confirm not challenge, and to suppress. Our profession, in turn, should not dismiss too hastily the aggressive allusions of psychiatric cartoons as being common to psychiatric and nonpsychiatric cartoons alike. Admittedly, other vocational groups are denigrated in cartoons, though arguably less frequently than and differently to psychiatrists. Nevertheless, some psychiatrists may not be kindly healers but unprincipled charlatans. Some may charge too much and deliver too little. Some may sublimate their voyeuristic instincts and attempt to compensate for their neurotic needs by helping others. Some do engage in sexual activities with patients. Psychiatrists have foibles and cannot always assist their patients. The representation of such discomforting realities in cartoons should serve to prick our conscience and galvanize our commitment to further education and to maintaining moral and ethical standards of care. It is worth digressing to consider psychiatric cartoons from countries other than the United States. Of course, parochialism in this idiom has its limitations. The increasing percolation across national and cultural boundaries of trends in pictorial comedy, as well as syndication and the interchange of individual talents, has made the cartoon a cosmopolitan form of humorous expression. However, in 1959, This Week (28) included a number of psychiatric cartoons which had first been published in Spain, the United Kingdom, France and Germany. The hackneyed portrayals of the American cartoon psychiatrist were replicated in these countries. More recently, Punch (42) produced an anthology of British psychiatric cartoons that did not depart from the American pattern. The antipodean scene seems no different. It is also worth considering the cartooning, in America and abroad, of psychiatrists and mental health issues by psychiatrists themselves (43-45), either alone or in conjunction with other artists. Many of these cartoons are published in the medical and specialist literature and tend to deal with the ambiguities of psychiatric terminology. Again, however, the cliched appearance and behaviours of the cartoon psychiatrist are usually retained. The cartoon psychiatrist emerges as a figure who is quite different from the psychiatrist in other media forms. For example, in the early 1960s, Winnick (46) noted that the psychiatrist of the novel shied away from fiscal matters. The movie psychiatrist (10-12) is not uncommonly a woman, regularly invites ridicule or veneration but seldom neutral opinion, and
is not averse to using biological treatments. Improvement or cure are popular outcomes in movie psychiatry. A recent semantic analysis of formal and slang terms for psychiatrists (16) indicates that both positive and negative psychiatrist stereotypes have been regularly expressed through language and that several sobriquets for psychiatrist incorporate reference to physical modes of psychiatric treatment. It was also noted that the linguistic perception of psychiatrists has undergone change. The cartoon presents but one facet of a multifaceted and shifting display of psychiatry to the public. It may not be too adventurous to speculate that a dialogue occurs between the various media forms and that the cartoon serves to keep in check the protean and often more positive portrayals of psychiatrists in other media. Conclusion
There is little to suggest, intuitively or by extrapolation of the data of this study, that the cartoon psychiatrist is about to change. Our colleague is, true to etymological roots, a design for copy. Nevertheless, working on the assumption that a cartoon reflects a number of needs or conventions, several studies are suggested by the current one. It would be valuable, for instance, to compare the depiction of psychiatrists in the popular medical and lay literatures to ascertain how other medical practitioners regard us and are prepared to tolerate us. It would also be instructive to compare our cartoon portrayal with those of other mental health professionals, other doctors and other occupational groups. It would be interesting to consider a sample of psychiatric cartoons rejected by editors, as it has been estimated (18) that, in the 1950s, The Saturday Evening Post printed about 30 cartoons a week from more than 4000 submitted. Certain themes might be developed - the noted dearth and mode of representation of female professionals in this study may not be peculiar to cartoon psychiatry but, as Tuchman (47) would suggest, be consistent with a “symbolic annihilation” of professional women by most fictional media. Most importantly, an investigation might be conducted into cartoon portrayals of the psychiatric patient. This last endeavour would not simply continue the legacy of interest (48) in attitudes towards mental illness but, moreover, introduce a new dimension into an understanding of those attitudes, which often bedevil our patients. Another 20 years should not be allowed to elapse before psychiatry’s interest in the cartoon is rekindled. Acknowledgements The author thanks Herbert Modlin, MD, Menninger Clinic, Kansas, for support, Eric Bondy for statistical advice and the staff of
171
Walter The Northside Clinic and the Department of Psychiatry, University of Sydney, for useful comments on an earlier version of this article.
References 1. HILLIER B. Cartoons and caricatures. London: Studio Vista, 1970. 2. LESSERS. Fiction and the unconscious. Boston: Beacon, 1959. 3. FREUDS. Jokes and their relation to the unconscious. In: Standard edition of the complete psychological works of Sigmund Freud, vol. 8. London: Hogarth Press, 1957. 4. FREUDS. Humour. In: Pelican Freud Library, vol 14. London: Penguin, 1976. 5. KRISE. Ego development and the comic. Int J Psychoanal 1938: 19: 77-90. 6. KRISE, GOMBRICH E. The principle of caricature. Br J Med Psycho1 1938: 17: 319-343. 7. MONTGOMERY B, EVANSL. You and stress. New York: Viking O’Neil, 1984. 8. CORNELIUS H, FAIRES. Everyone can win: how to resolve conflict. Sydney: Simon & Schuster, 1989. 9. EBERM, O’BRIENJM. Psychotherapy in the movies. Psychother Theory Res Practice 1982: 19: 116-120. 10. SAMUELS L. Female psychotherapists as portrayed in film, fiction and non-fiction. J Am Acad Psychoanal 1985: 13: 367-378. 11. SCHNEIDER I. The theory and practice of movie psychiatry. Am J Psychiatry 1987: 144: 996-1002. K, GABBARD GO. Psychiatry and the cinema. 12. GABBARD Chicago: University of Chicago Press, 1987. 13. SHORTLAND M. Screen memories: towards a history of psychiatry and psychoanalysis in the movies. Br J History Sci 1987: 20: 421-452. 14. VAN ALPHENPJM. Psychiatrists and mental health in philately. Acta Psychiatr Scand 1988: 77: 225-227. 15. WALTER G. The stereotype of the mad Psychiatrist. Aust NZ J Psychiatry 1989: 23: 541-554. 16. WALTERG. The naming of our species: appellations for the psychiatrist. Aus NZ J Psychiatry 1991: 25: 123-128. 17. GEIPEL J. The cartoon - a short history of graphic comedy and satire. London: David & Charles, 1972. 18. HALSEYWD, ed. Collier’s encyclopaedia, vol 5. New York: Macmillan, 1986. 19. MURRELL WA. A history of American graphic humour. New York: Praeger, 1933. 20. REDLICH FC. The psychiatrist in caricature: an analysis of unconscious attitudes towards psychiatry. Am J Orthopsychiatry 1950: 20: 560-571. 21. DAVIDSON HA. The image of the psychiatrist. Am J Psychiatry 1964: 121: 329-334. 22. FULLERRE. Headshrinker - the psychiatrist in cartoons. Bull Menninger Clin 1972: 36: 335-345. 23. VERTES M. It’s all mental. New York: Tudor, 1948.
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24. IRWIN T, ed. Maybe you’re screwy too. New York: Farrell Publishing, 1950. 25. RICHTER M. Strictly doctors. New York: Pocket Books, 1963. 26. DANZINGER H. Shrinks and other lunatics. New York: Greeting Books, 1982. 27. LARSONG. The far side series. New York, Andrews & McMeel, 1989. 28. This week, 1959. 29. SMILBYJ. More cartoon classics. Oradell: Medical Book Division, 1970. 30. SABSHIN M. Turning points in twentieth-century American psychiatry. Am J Psychiatry 1990; 147: 1267-1274. 31. LARSONG . The prehistory of the far side - a tenth anniversary exhibit. New York: Andrews & McMeel, 1989. 32. GOFFMAN E. Stigma: notes on the management of spoiled identity. New Jersey: Prentice-Hall, 1963. 33. HAIGR. The anatomy of humour: biopsychosocial and therapeutic perspectives. Springfield, IL: Charles C. Thomas, 1988. 34. SPENCER H. The physiology of laughter. Macmillan’s Magazine 1860: 1: 395-402. 35. GARDNERH, LING PK, FLAMML. Comprehension and appreciation of humorous material following brain damage. Brain 1975: 98: 399-412. 36. BERGSON H. Laughter: an essay on the meaning of the comic. London: Macmillan, 1911. 37. OBRDLIK AJ. Gallows humour - a sociological phenomenon. Am J Sociology 1942: 47: 709-716. 38. MILLERAG, ed. In the eye of the beholder: contemporary issues in stereotyping. New York: Praeger, 1982. 39. GILMANSL. Difference and pathology: stereotypes of sexuality, race and madness. New York: Cornell University Press, 1985. 40. BRINKMAN D. Do editorial cartoons and editorials change opinions? Journalism Q 1968: 45: 724-726. 41. CARLLM. Editorial cartoons fail to reach many readers. Journalism Q 1968: 45: 533-535. 42. BARNESP, ed. Shrink rap - Punch on the analyst’s couch. London: Grafton Books, 1986. 43. COPANSS, SINGER T. Who’s the patient here - portraits of the young psychotherapist. New York: Oxford University Press, 1978. M. Dr Calman’s dictionary of psychoanalysis. Lon44. CALMAN don: W.H. Allen, 1979. 45. LOUDONP, WILKINS B. An illustrated glossary of common jargon. J Fam Ther 1985: 7: 77-80. 46. WINNICKC. The psychiatrist in fiction. J Nerv Ment Dis 1963: 136: 43-57. 47. TUCHMAN G. The symbolic annihilation of women by the mass media, In: TUCHMAN G, DANIELS A, BENETJ, ed. Hearth and home - images of women in the mass media. New York: Oxford University Press, 1978. D. Attitudes towards mental illness: a review of the 48. BHUGRA literature. Acta Psychiatr Scand 1989: 80: 1-12.
I
The portrayal of psychiatrists in cartoons from the United States was examined. A total of 404 cartoons from 1941 to 1990 were obtained and arranged chronologically. The appearance, behaviour, treatment methods and efficacy of the cartoon psychiatrist were assessed. It was found that there has been little change in these parameters over the past 50 years. This finding is partly explained by the constraints of the cartoon medium and by the workings of humour and stereotyping. Psychiatric cartoons from other countries and those drawn by psychiatrists themselves do not depart from the American pattern. The differences between the representation of psychiatrists in the cartoon and in other media, such as the film, are highlighted. It is postulated that the cartoon serves to stabilize the more mutable portrayals of psychiatrists in other media. Further studies are suggested.
In the mid-nineteenth century, in The Athenaeum, it was suggested that “the mere work of a cartoonist can neither be interesting nor instructive ... for who would wish to know of the haunts and habits of a spy ... who insults inferiority of mind and exposes defects of body ... who aggravates what is already hideous, and blackens what was before sufficiently dark” (1). The haunts and habits of the cartoonist should be of considerable interest to our profession. For a start, a perusal of contemporary newspapers, magazines and cartoon anthologies would reveal that cartoons featuring psychiatrists and mental illness are common. Secondly, fictional portrayals may provide a marker of unconscious public attitudes and, in turn, influence these attitudes (2). Thirdly, psychiatry has a tradition of interest in humour. Freud’s theories on the function of humour (3,4) were applied to the cartoon by Kris & Gombrich ( 5 , 6 ) who, like Freud, saw cartoon humour as tendentious but emphasized the role played by regression. Cartoons have also been used as a therapeutic tool both in the self-help literature (7, 8) and clinical practice (Twerski A, personal communication). Despite the above considerations, psychiatrists have recently neglected their portrayal in cartoons. By comparison, their depiction in other genres, most notably the film, has attracted a lot of attention (916). Derived from the Latin charta for paper via the French cardon for pasteboard, the word cartoon originally meant a preliminary sketch or design for copy (17). In 1843 a number of such designs were
G.Walter Northside Clinic, Sydney, Australia
Key words: psychiatrist; cartoon; media Dr Garry Walter, 7 Arding Street, Lane Cove, NSW 2066, Australia
1
Accepted for publication September 2 1, 1991
commissioned by Prince Albert for the walls of the British Parliament. The illustrated weekly Purzch disliked the Prince Consort and the designs and produced its own series of drawings, which were satirical. Although the cartoon thus acquired its modern meaning, the first examples of the form can probably be traced to William Hogarth’s graphic crusade against the seamy state of England in the eighteenth century (17, 18). Cartoons about psychiatry did not appear until the early 1920s (19). Such cynically progressive magazines as American Mercury and Smart Set reflected the postwar agglomerate of disillusionment, a loss of respect for authority figures and the need for gaiety. The earliest cartoons about psychiatry seldom showed a psychiatrist, since actual psychiatrists were few and far between, but dealt rather with institutionalized psychotics and the pretentions of asylum superintendents. Cartoons featuring psychiatrists surfaced by the 1930s and, spurred on by the refinement of photoengraving techniques, a New Yorker-inspired streamlined drawing style and the public’s fascination in psychoanalysis, became entrenched by the mid-1940s. Previous studies
The depiction of psychiatrists in cartoons from the United States has been considered by Redlich (20), Davidson (21) and Fuller (22). In 1949 Redlich (20) examined 30 contemporary psychiatric cartoons from The New Yorker, The Saturday Evening Post, Collier’s, The New York Herald Tribune and PM. He 167
Walter observed that the psychiatrist in cartoons “is typically an analyst ... without exception a man ... bearded and balding, with spectacles or pince-nez ... often foreign-looking”. Redlich noted that the enduring symbols for him were Viennese diploma and, even more importantly, the couch. The psychiatrist was portrayed as exaggeratedly hateful, stupid, venal or just plain crazy. Redlich interpreted the cartoon psychiatrist as the aggressive, dominant father or the weak helpless father. To enforce such roles, Redlich concluded, implied some public feeling of guilt, shame and fear. In 1964 Davidson (21)randomly selected 42 contemporary psychiatric cartoons and compared them with cartoons from the anthology Its AZZMental(23), published in 1948. Every doctor in the anthology was a male, had a large hooked nose and in most pictures was bearded. He had a Homburg hat, often had a cigar in his mouth, wore a frock coat, or a jacket with high lapels, only the small tight tie knot being visible. In several, he wore striped trousers. In half the pictures the diploma on the wall was in German or referred to a German or Austrian training institute. This publication thus offered a European concept of the psychiatrist. About a quarter of the book’s cartoons pictured the psychiatrist in an unfavourable light: a buffoon, a fool or wrapped up in trivia. Only one of the anthology’s cartoons touched on the commercial aspects of patient care. Davidson said that the cartoon psychiatrist of the early 1960s “was, like his predecessor, usually an analyst but was now a fairly young man, half the time wearing a thin moustache .,, clearly an American”. Davidson commented that the cartoon psychiatrist had become a sibling rival rather than a father figure. He suggested that a greater proportion of the 1964 sample dealt with monetary aspects of patient care. In 1971 Fuller (22) despaired that, since the inception of the cartoon psychiatrist, the latter’s appearance, character and practice had not changed. Fuller did not examine a sample of contemporary cartoons. His lament was therefore based on impression. He stated that the couch as a psychiatric symbol had featured so often that continued variations of the theme were monotonous. Fuller suggested that the couch promoted regression towards a dependent state and saw portrayals of the cartoon psychiatrist as a function of dependence longings and Oedipal strivings. It is now 20 years since Fuller’s article. Given the burgeoning interest in recent years in our public image and representation in other media forms, it appeared timely to revisit the portrayal of the psychiatrist in cartoons and to compare current depictions with earlier ones. Unfortunately, previous studies had used small sample sizes and had attempted only cross-sectional, or limited longitudinal, analysis. 168
It was hypothesized that, in popular American publications over the past 50 years, there has been little, if any, change in the appearance and behaviour of the psychiatrist and in the nature and result of treatment. Material and methods
A total of 404 cartoons from 1941 to 1990 in which a psychiatrist appeared or was alluded to were obtained; 390 of the cartoons were gag (or regular) cartoons, 7 were editoral cartoons, 5 were comic strip cartoons and 2 were advertising cartoons. The compilation represented the work of 93 artists. The cartoons came from the anthologies Its All Mental (23),M Y S T (Maybe You’re Screwy Too) (24),StrictZy Doctors (25), Shrinks and Other Lunatics (26) and The Far Side Series (27),and from searching through consecutive issues of Collier’s, The New Yorker, Playboy, The Washington Post, The Los Angeles Times, The Saturday Evening Post, The Chicago Tribune and a variety of other popular American magazines and newspapers. The cartoons were grouped according to the decade of their publication. Approximate counting revealed that the different styles of resource literature were represented in similar proportions in each of the 5 decades studied. Each cartoon was scrutinized using a checklist that probed the appearance of the psychiatrist and surroundings, the behaviour of the psychiatrist and the form and outcome of therapy employed. The checklist was derived, in part, from the findings of previous studies. The author also made a more qualitative appraisal of major themes and omissions in the portrayal of psychiatry in cartoons. The sample was restricted to cartoons published in the United States, to offset cross-cultural differences in the expression and appreciation of humour and in attitudes towards our profession. It was not feasible to scour all available American anthologies, newspapers and periodicals for psychiatric cartoons. The source material was limited to mainstream publications. It was acknowledged that this, in turn, implied a certain, albeit diffuse, stratum and orientation of artist, editor and reader. Regional themes and minority views may thus have gone undetected. Finally, the cartoon psychiatrists in the study were inevitably not restricted to medical practitioners. The bona fide and most common cartoon psychiatrist can only be identified by the appearance of such words as psychiatrist, psychiatry, Institute of Psychiatry or M D on the diploma or office door, the presence of a stethoscope, the observed capacity of the therapist to prescribe drugs or an appropriate reference in the caption. Cartoons in which the ther-
The psychiatrist in American cartoons, 1941-1990 apist was definitively identified as a psychologist, social worker or marriage counsellor were not considered. Cartoons in which it was possible, but not certain, that the therapist was a psychiatrist were included. Examples of this last group included cartoons in which the designation on the diploma or door was illegible and cartoons in which the diploma was absent. Results
The results are summarized in Table 1. There has been no appreciable change in the profile of the cartoon psychiatrist’s appearance, behaviour, treatment methods or efficacy over the past 50 years. The psychiatrist was a man in 96% of cases. Women accounted for only 2% of portrayals. The sex of the psychiatrist was uncertain when the psychiatrist wore a costume or large mask, was depicted as an animal or when the (presumably bored) psychiatrist left the patient alone in the consulting room. A balding pate was the most frequent feature of the psychiatrist, being found in 92% of cases. The
beard, spectacles, diploma and couch were also regular accompaniment s. The psychiatrist was negatively portrayed in 56 % of cartoons. The psychiatrist was consistently depicted as mad, licentious, bored, greedy and sadistic, as well as neutrally, but was seldom seen to be actively caring or supportive. Madness was not defined in the narrow sense of psychosis but, according to the lay conception of madness (15), in a broader colloquial sense to include psychosis, folly and eccentricity. It did not appear that most examples of a given behaviour type were accounted for by a single style of resource material. For instance, licentiousness was not just furnished by popular pornographic literature, such as Playboy, but by a broad spectrum of material. It is worth noting that the few female cartoon psychiatrists did not display the above adverse behaviours. Female psychiatrists were depicted as sex objects or housewives. Thus, a leering male patient addressed her: “My sweetest, my sugar” (28) or was advised: “Try not to think of me as a woman” (25)
Table 1. The psychiatrist in American cartoons, 1941-1990 Decade
Total
1941-1950 (n=68) %
195 1-1960 (n= 94) %
1961-1970 (n=73) %
1971-1980 (n= 70) %
198 1-1 990 (n= 99) %
1941-1 990 (n=404) %
94 3 3 86 72 93 81 84
97 1 2 70 75 93 82 79
94 3 4 74 66 89 79 88
99 1 0 80 74 91 96 88
97 1 2 76 77 93 90 92
96 2 2 77 74 92 86 86
34 1
48 1
29 1
26 0
37 1
36 1
21 15 13 7 1 9
11 6 9 14 2 7
14 14 15 13 8 8
14 16 10 23 6 6
16 7 6 13 9 10
15 11 11 14 5 8
Primary treatment method Psychotherapy Pharmacotherapy ECT Difficult to classify
94 0 0 6
93 2 0 5
96 3 0 0
93 3 0 3
95 1 0 4
94 2 0 4
Outcome Improvement or cure No change Deterioration Difficult to classify
2 71 22 6
2 77 13 9
0 73 23 4
2 86 10 1
2 69 14 14
2 75 15 8
Characteristic Appearance of psychiatrist and surroundings Male Female Indeterminate sex Presence of spectacles Presence of beard Balding of pate Presence of diploma Presence of couch Primary behaviour of psychiatrist Neutral Actively caring or supportive Negative: Mad Licentious Bored or disinterested Greedy or money-conscious Sadistic Other or difficult to classify
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Walter or was scolded: “Before we begin the analysis, Mr. Zeisel, let’s get those shoes off the couch” (29). Davidson’s view (2 1) that the cartoon psychiatrist was becoming younger and more money-conscious was not supported by this study. The age of a cartoon character is often extremely difficult to estimate. However, if baldness is used as a very crude index of age, it would seem that the cartoon psychiatrist has not become any younger. It would also seem that the cartoon psychiatrist has always been concerned with the financial aspects of patient care. Psychotherapy was the most common treatment method. Pharmacotherapy was scarce, despite the introduction and popularization of a number of psychotropic agents within the studied period. Electroconvulsive therapy (ECT) was not witnessed at all. Stable themes of cartoon therapy over the past 50 years included: the emphasis on the patient’s and psychiatrist’s early childhood at the expense of later developmental stages; the influence of the patient’s and psychiatrist’s mother and exclusion of other attachment figures; the mention of Freudian concepts and terminology and neglect of later theorists’ contributions; and the coupling of the “psychiatrist-sleuth” and a single traumatic event. Subspecialists, especially the psychiatrists dealing with drug and alcohol problems and eating disorders, were seldom encountered. Children were usually seen by a child psychologist. Research was also largely the domain of the psychologist. Trends in psychiatry were only occasionally reported. The popularization of psychosomatic concepts and physical treatments could be traced in the sample. The community psychiatry movement, however, escaped notice. Indeed, most developments in 20th-century American psychiatry, elegantly delineated by Sabshin (30), eluded the cartoonist or were avoided. The psychiatrist did not usually change a patient’s condition. Deterioration was more common than improvement or cure which, in turn, were rare sequelae of treatment. Discussion
The psychiatrist in American cartoons is a resilient character whose range of appearances, surroundings, behaviour patterns and treatment methods have withstood the passage of time, innovations in actual psychiatric practice, the creative flair of new generations of comedic artists and the whims of a variety of editors. The constraints of the cartoon medium help one understand some aspects of the cartoon psychiatrist’s consistent appearance. The cartoonist, unlike 170
the novelist and scriptwriter, seldom has a chance to develop a plot. This artist relies on familiar symbols such as the couch and diploma to immediately orient the reader. In reflecting on his cartooning career, Larson (3 1) regretted using such symbols but could not conceive of alternatives. The restrictions of the cartoon also help one understand why the psychiatrist is rarely revered in this medium. A cartoon must, by definition, attempt to be humorous. However, adulation and humorous intent seldom meld comfortably. The cartoon psychiatrist can be empathic or effective but only if simultaneously ridiculed. The rarity of “Dr Wonderful” in cartoon is partly offset by the abundance of neutral portrayals. The psychiatrist who is able to passively and unobtrusively tolerate a patient’s distress would seem to present a desirable image for our profession. Inevitably, however, even the neutral psychiatrist becomes secondarily embroiled in ridicule or, to apply Goffman’s (32) terminology, becomes the recipient of a “courtesy stigma”. The unsavoury behaviours displayed by the cartoon psychiatrist vividly reflect, and endorse, the postulated functions of humour and stereotyping. In addition to the rationales for humour in the individual, such as the discharge of hostile or erotic drives (3,4), the resolution of cognitive dissonance (33), the release of tension (34) and the tapping of rightbrain activity (3 9 , humour has possible social functions (36, 37). Humour is thought to regulate attitudes, establish scapegoats and influence or define the formation of in-groups and out-groups. The explanations for stereotyping (38, 39) are similar. Unfortunately, there has been little research on the effect of cartoons on public perceptions. The scant empirical work has been confined to editorial cartoons. By relying on nameable individuals, these cartoons are possibly more akin to caricature than to the gag cartoon in their effect on the psyche. Brinkman (40) found that editorials and cartoons, presented together, can bring about changed opinions but, as a rule, usually reinforce pre-existing conceptions. Carl (41) found that 70% of their respondents misperceived the intended meaning of cartoons. Anecdotally, cartoons can exert enormous influence (17- 19). Examples include Benjamin Franklin’s legendary “Join or Die” cartoon of 1754, which urged the Colonies to unite against the French and Indians and Thomas Nast’s destruction of the political aspirations of William “BOSS”Tweed and Horace Greeley through his cartoons in Harper’s Weekly in the 1870s. It is in the realm of fantasy that a psychiatric cartoon today could achieve notoriety and swing public opinion concerning our profession from antipathy, or at best ambivalence, to acceptance. This would be the task of Sisyphus. The present century
The psychiatrist in American cartoons, 1941-1990 has also seen other media forms evolve, proliferate and diminish the salience of the cartoon as social critic. The cartoon psychiatrist is, in any case, further relegated to the gag cartoon whose function is to educate, not re-educate, to confirm not challenge, and to suppress. Our profession, in turn, should not dismiss too hastily the aggressive allusions of psychiatric cartoons as being common to psychiatric and nonpsychiatric cartoons alike. Admittedly, other vocational groups are denigrated in cartoons, though arguably less frequently than and differently to psychiatrists. Nevertheless, some psychiatrists may not be kindly healers but unprincipled charlatans. Some may charge too much and deliver too little. Some may sublimate their voyeuristic instincts and attempt to compensate for their neurotic needs by helping others. Some do engage in sexual activities with patients. Psychiatrists have foibles and cannot always assist their patients. The representation of such discomforting realities in cartoons should serve to prick our conscience and galvanize our commitment to further education and to maintaining moral and ethical standards of care. It is worth digressing to consider psychiatric cartoons from countries other than the United States. Of course, parochialism in this idiom has its limitations. The increasing percolation across national and cultural boundaries of trends in pictorial comedy, as well as syndication and the interchange of individual talents, has made the cartoon a cosmopolitan form of humorous expression. However, in 1959, This Week (28) included a number of psychiatric cartoons which had first been published in Spain, the United Kingdom, France and Germany. The hackneyed portrayals of the American cartoon psychiatrist were replicated in these countries. More recently, Punch (42) produced an anthology of British psychiatric cartoons that did not depart from the American pattern. The antipodean scene seems no different. It is also worth considering the cartooning, in America and abroad, of psychiatrists and mental health issues by psychiatrists themselves (43-45), either alone or in conjunction with other artists. Many of these cartoons are published in the medical and specialist literature and tend to deal with the ambiguities of psychiatric terminology. Again, however, the cliched appearance and behaviours of the cartoon psychiatrist are usually retained. The cartoon psychiatrist emerges as a figure who is quite different from the psychiatrist in other media forms. For example, in the early 1960s, Winnick (46) noted that the psychiatrist of the novel shied away from fiscal matters. The movie psychiatrist (10-12) is not uncommonly a woman, regularly invites ridicule or veneration but seldom neutral opinion, and
is not averse to using biological treatments. Improvement or cure are popular outcomes in movie psychiatry. A recent semantic analysis of formal and slang terms for psychiatrists (16) indicates that both positive and negative psychiatrist stereotypes have been regularly expressed through language and that several sobriquets for psychiatrist incorporate reference to physical modes of psychiatric treatment. It was also noted that the linguistic perception of psychiatrists has undergone change. The cartoon presents but one facet of a multifaceted and shifting display of psychiatry to the public. It may not be too adventurous to speculate that a dialogue occurs between the various media forms and that the cartoon serves to keep in check the protean and often more positive portrayals of psychiatrists in other media. Conclusion
There is little to suggest, intuitively or by extrapolation of the data of this study, that the cartoon psychiatrist is about to change. Our colleague is, true to etymological roots, a design for copy. Nevertheless, working on the assumption that a cartoon reflects a number of needs or conventions, several studies are suggested by the current one. It would be valuable, for instance, to compare the depiction of psychiatrists in the popular medical and lay literatures to ascertain how other medical practitioners regard us and are prepared to tolerate us. It would also be instructive to compare our cartoon portrayal with those of other mental health professionals, other doctors and other occupational groups. It would be interesting to consider a sample of psychiatric cartoons rejected by editors, as it has been estimated (18) that, in the 1950s, The Saturday Evening Post printed about 30 cartoons a week from more than 4000 submitted. Certain themes might be developed - the noted dearth and mode of representation of female professionals in this study may not be peculiar to cartoon psychiatry but, as Tuchman (47) would suggest, be consistent with a “symbolic annihilation” of professional women by most fictional media. Most importantly, an investigation might be conducted into cartoon portrayals of the psychiatric patient. This last endeavour would not simply continue the legacy of interest (48) in attitudes towards mental illness but, moreover, introduce a new dimension into an understanding of those attitudes, which often bedevil our patients. Another 20 years should not be allowed to elapse before psychiatry’s interest in the cartoon is rekindled. Acknowledgements The author thanks Herbert Modlin, MD, Menninger Clinic, Kansas, for support, Eric Bondy for statistical advice and the staff of
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Walter The Northside Clinic and the Department of Psychiatry, University of Sydney, for useful comments on an earlier version of this article.
References 1. HILLIER B. Cartoons and caricatures. London: Studio Vista, 1970. 2. LESSERS. Fiction and the unconscious. Boston: Beacon, 1959. 3. FREUDS. Jokes and their relation to the unconscious. In: Standard edition of the complete psychological works of Sigmund Freud, vol. 8. London: Hogarth Press, 1957. 4. FREUDS. Humour. In: Pelican Freud Library, vol 14. London: Penguin, 1976. 5. KRISE. Ego development and the comic. Int J Psychoanal 1938: 19: 77-90. 6. KRISE, GOMBRICH E. The principle of caricature. Br J Med Psycho1 1938: 17: 319-343. 7. MONTGOMERY B, EVANSL. You and stress. New York: Viking O’Neil, 1984. 8. CORNELIUS H, FAIRES. Everyone can win: how to resolve conflict. Sydney: Simon & Schuster, 1989. 9. EBERM, O’BRIENJM. Psychotherapy in the movies. Psychother Theory Res Practice 1982: 19: 116-120. 10. SAMUELS L. Female psychotherapists as portrayed in film, fiction and non-fiction. J Am Acad Psychoanal 1985: 13: 367-378. 11. SCHNEIDER I. The theory and practice of movie psychiatry. Am J Psychiatry 1987: 144: 996-1002. K, GABBARD GO. Psychiatry and the cinema. 12. GABBARD Chicago: University of Chicago Press, 1987. 13. SHORTLAND M. Screen memories: towards a history of psychiatry and psychoanalysis in the movies. Br J History Sci 1987: 20: 421-452. 14. VAN ALPHENPJM. Psychiatrists and mental health in philately. Acta Psychiatr Scand 1988: 77: 225-227. 15. WALTER G. The stereotype of the mad Psychiatrist. Aust NZ J Psychiatry 1989: 23: 541-554. 16. WALTERG. The naming of our species: appellations for the psychiatrist. Aus NZ J Psychiatry 1991: 25: 123-128. 17. GEIPEL J. The cartoon - a short history of graphic comedy and satire. London: David & Charles, 1972. 18. HALSEYWD, ed. Collier’s encyclopaedia, vol 5. New York: Macmillan, 1986. 19. MURRELL WA. A history of American graphic humour. New York: Praeger, 1933. 20. REDLICH FC. The psychiatrist in caricature: an analysis of unconscious attitudes towards psychiatry. Am J Orthopsychiatry 1950: 20: 560-571. 21. DAVIDSON HA. The image of the psychiatrist. Am J Psychiatry 1964: 121: 329-334. 22. FULLERRE. Headshrinker - the psychiatrist in cartoons. Bull Menninger Clin 1972: 36: 335-345. 23. VERTES M. It’s all mental. New York: Tudor, 1948.
172
24. IRWIN T, ed. Maybe you’re screwy too. New York: Farrell Publishing, 1950. 25. RICHTER M. Strictly doctors. New York: Pocket Books, 1963. 26. DANZINGER H. Shrinks and other lunatics. New York: Greeting Books, 1982. 27. LARSONG. The far side series. New York, Andrews & McMeel, 1989. 28. This week, 1959. 29. SMILBYJ. More cartoon classics. Oradell: Medical Book Division, 1970. 30. SABSHIN M. Turning points in twentieth-century American psychiatry. Am J Psychiatry 1990; 147: 1267-1274. 31. LARSONG . The prehistory of the far side - a tenth anniversary exhibit. New York: Andrews & McMeel, 1989. 32. GOFFMAN E. Stigma: notes on the management of spoiled identity. New Jersey: Prentice-Hall, 1963. 33. HAIGR. The anatomy of humour: biopsychosocial and therapeutic perspectives. Springfield, IL: Charles C. Thomas, 1988. 34. SPENCER H. The physiology of laughter. Macmillan’s Magazine 1860: 1: 395-402. 35. GARDNERH, LING PK, FLAMML. Comprehension and appreciation of humorous material following brain damage. Brain 1975: 98: 399-412. 36. BERGSON H. Laughter: an essay on the meaning of the comic. London: Macmillan, 1911. 37. OBRDLIK AJ. Gallows humour - a sociological phenomenon. Am J Sociology 1942: 47: 709-716. 38. MILLERAG, ed. In the eye of the beholder: contemporary issues in stereotyping. New York: Praeger, 1982. 39. GILMANSL. Difference and pathology: stereotypes of sexuality, race and madness. New York: Cornell University Press, 1985. 40. BRINKMAN D. Do editorial cartoons and editorials change opinions? Journalism Q 1968: 45: 724-726. 41. CARLLM. Editorial cartoons fail to reach many readers. Journalism Q 1968: 45: 533-535. 42. BARNESP, ed. Shrink rap - Punch on the analyst’s couch. London: Grafton Books, 1986. 43. COPANSS, SINGER T. Who’s the patient here - portraits of the young psychotherapist. New York: Oxford University Press, 1978. M. Dr Calman’s dictionary of psychoanalysis. Lon44. CALMAN don: W.H. Allen, 1979. 45. LOUDONP, WILKINS B. An illustrated glossary of common jargon. J Fam Ther 1985: 7: 77-80. 46. WINNICKC. The psychiatrist in fiction. J Nerv Ment Dis 1963: 136: 43-57. 47. TUCHMAN G. The symbolic annihilation of women by the mass media, In: TUCHMAN G, DANIELS A, BENETJ, ed. Hearth and home - images of women in the mass media. New York: Oxford University Press, 1978. D. Attitudes towards mental illness: a review of the 48. BHUGRA literature. Acta Psychiatr Scand 1989: 80: 1-12.
