Research Article
Cinema Seminar as an Innovative Mean of Psychiatry Education in Nursing
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Introduction: Cinema education is an interactive and interesting teaching technique using movie clips or screening whole movies for educating students. We organised a cine seminar in order to reinforce the learning of nursing students on personality development, therapeutic alliance and its phases, to understand and relate to concept and techniques of therapeutic communication and take students’ feedback on cinema education as an innovative way to teach and learn.
Methods: We screened Hindi motion picture ‘Dear Zindagi’ in Seminar Hall of our college. A total of 41 people, which included nursing faculty members and nursing students attended the screening. The entire session was of three and a half hours where various movie aspects vis-a-vis Freud’s personality development theory, therapeutic alliance and its phases, boundary violation and therapeutic communication were discussed, and analyzed critically from a psychological perspective in a group setting allowing brainstorming, analysis and sharing processes. Feedback on cinema education as a teaching learning tool was also taken from faculty members and students.
Results: The cine seminar incited the participants to comprehend and analyze the contents of the motion picture in relation to therapeutic alliance, boundary violation, dream analysis, suppressed and repressed content of the unconscious mind. Majority of the viewers reported a positive feedback about cine seminar and appreciated this method of education.
Conclusion: Cine seminar is a powerful and innovative method of education in mental health nursing.
Keywords: Cinema education, Cine seminar, Nursing students
INTRODUCTION
Cinema is a powerful medium providing us with entertainment. Across the globe, films have portrayed a multitude of issues about society, science, mythology, and mankind. Over the decades, films have depicted various psychiatric conditions ranging from suicide and substance use disorders to multiple personality disorders and schizophrenia. Although such portrayals may not always be perfect, they may nevertheless be good enough for us to understand and analyze some aspect of the disorder. Times have changed from the films being criticized for the negative portrayal of psychiatrists and psychiatric conditions to the current times when they can be used to teach in classrooms [1].
The Psychiatric Institute of the Università del Piemonte Orientale, in Novara, Italy was one of the first institutes to have worked with/on movies as an educational stimulus. Eugenio Torre initiated an approach to share and teach emotional experiences, coupling education and arts, and amalgamating theoretical and technical aspects with pieces of group dynamics. The method was based on Jung’s and Hillman’s considerations about the connection between images and archetypes, the archetypal experience and learning (both from a cognitive and an emotional standpoint) [2,3]. The group members were enriched by the mutual exchange of each member’s perspective and experience and relate to the situation depicted in the movie from different angles. This experience can turn into knowledge, both from a cognitive and affective point of view. The group members can sort and discuss the salient movie scenes, thus raising a reflection on characters. Role-playing of scenes with role inversion is used so as to put feelings, emotions and thoughts into words, which can be elaborated and finally integrated with the help of the group leader [4].
Since its development this method has been constantly used in the education and training of medical students, psychiatrists, psychotherapists and, broadly speaking, of people involved in helping professions. Subjects like Psychology, Psychiatry and Psychiatric Nursing have many abstract concepts, models and theories which are sometimes found to be too difficult to comprehend by nursing students. The teachers also find it difficult to build and instil some of these abstract yet basic concepts in them through usual classroom teaching and lectures.
The available literature shows that movies are a unique contemporary learning instrument, which when used effectively can tickle the brain cells and navigate the students to propositions which may otherwise remain unaddressed or overshadowed. It is uncommon for cinema to imply a single meaning, and can be considered a complementary way of thinking about the cosmos. Moreover, human emotions are powerful enough to disturb the equilibrium of psyche and thus, screened fiction does the same job.
Several movies have depicted psychiatric disorders, patient-therapist relationship and in few cases issues such as psychotherapy, countertransference or psychosocial formulation [4].
Issues in psychiatry such as stigma have been discussed using films [1]. Thus, movies for cinema education ought to be chosen cautiously and diligently so that they can help student to relate to, and comprehend abstract psychic concepts and incite analytical thinking.
With these thoughts in the backdrop, we thought of piloting cine-seminar as a teaching learning tool to comprehend certain aspects of therapeutic or helping alliance, psychotherapy and personality development theories, with screening of the movie ‘Dear Zindagi’ on 18th march 2019 in Seminar Hall of our college. Students of M.Sc. Nursing 1st and 2nd year, Post Basic B.Sc. Nursing 2nd year and few faculty members of the college participated in this cine seminar. These students already had some previous knowledge on helping relationship, psychotherapy, personality development theories etc. Their feedback about effectiveness of cine seminar as a teaching learning tool was taken after the seminar. The objectives set out were:
To reinforce the learning of students on personality development, therapeutic alliance and its phases.
To understand and relate to concept of therapeutic relationship and communication.
Pilot cine-seminar as a method of education through entertainment.
METHODS
As per the above objectives, we selected the movie ‘Dear Zindagi’ for the cine-seminar. We assumed that some of the students and faculty had already seen the movie. However, this time the movie had to be seen with a new mindset in order to gain clear perspective on the chosen aspects of Psychiatry and Psychiatric Nursing as mentioned in the objectives earlier here. The same was told to all the students and teachers before start of the movie. We watched and reviewed the movie once again before the screening to discuss how we will screen the movie in four parts and at which junctures in the movie we will pause to discuss and analyze as per the set objectives. We discussed and earmarked the movie scenes that we considered as particularly striking and relatable to the objectives of the cine-seminar. The audience was suggested to give a read to Freud’s personality development theory and therapeutic relationship to refresh it as then only will they will be able to think and relate critically with the contents of the movie.
We pre-screened the movie amongst us once for avoiding any audio video snag before final projection. A formal invitation was sent to the Dean, Principal and to the faculty. Poster and invite were prepared and displayed on college notice board for students. Popcorn was the prime choice for refreshment to give the audience a real movie time vibe.
The seminar commenced with moderator giving a thorough explanation of the expected outcomes of the seminar. It was informed that the movie has been particularly divided into three major parts which reflects three different phases of the life of the lead protagonist. The audience were briefed that seminar requires an active participation, discussion and verbalization of the analysis by the audience on all the aspects depicted in each of the three parts of the movie. They were briefed about the requisite of jotting down the significant points in the movie to have an alive and flowing analysis. It was explained that those who had watched the movie already should see it now with a new perspective vis-à-vis therapeutic alliance, personality development and suppressed and repressed unconscious content. The moderator, initiated the dialogue and as the movie unfolded, critical analysis of the significant points in the movie were discussed with the participants and written on a white board. The audience verbalized their comprehension and analysis of the movie in relation to the objectives. The seminar terminated with summing up of all the themes of the movie. A written feedback from the audience was taken to see how effective the cine seminar was as a teaching learning method.
RESULTS
The cine-seminar went as planned on set date and time. The students and faculty seemed interested to watch the movie with a new perspective. The movie had certain striking segments which were discussed and analyses were made. Reflections on the movie in relation to the objectives are presented here:
The female lead protagonist is seen as an ambitious, young and talented woman. She is overtly fond of her job of cinematography and always looked forward to better work. She has been shown in the movie to be living away from her family and not liking being in contact with her family despite the repeated calls from her mother. She is a shopaholic for the sake of distracting herself from the reality. She rebels against the norms of the society and it is symbolized in her turning objects of decoration at home and office upside down. She does not seem to be in a happy place with the current man she was having a relationship with. She cannot commit in relationship due to constant fear of abandonment. Due to that, she has been seen disliking all couples in love in general. Then she breaks up with another colleague/boyfriend and has to go to live with her parents for some work assignment, where she gets to meet (albeit hesitatingly) Dr. Jehangir Khan, the psychologist, the other lead character of the film. During the introductory session, the therapist highlights the fact that even the families of mental health professionals are not readily accepting of their job as mental health professionals and that even the mental health professionals are ridiculed and stigmatized.
The female lead is not upfront when it comes to verbalizing her problems and so, she fabricates the story that it is her friend who requires professional help as she is not able to express to the therapist and accept that she herself is actually the one who requires the help. But after the psychologist builds up the rapport, she confirms the facts. The movie has a dream analysis scene and dream analysis is one of the techniques of Freudian psychoanalysis. The audience felt that her dream revealed her inner notion of not being good enough in society and not abiding by the set of norms for romantic relationships and marriage as laid down by the society. Her impression of being dirty and cheap was highlighted as she thought she was shifting from one romantic relationship to another which is something the society does not accept. The therapist is portrayed as non-judgmental, empathetic and reflective.
Also, the boundaries of a therapeutic relationship were discussed with reflection of views whether outdoor sessions kept by the therapist in the movie on beach are a sort of boundary violation. The psychologist in the movie is seen to be using several techniques of therapeutic communication including restatement, paraphrasing and asking open ended questions and he gives home work to his client as part of psychotherapy. There is also resistance portrayed by the female lead when asked about her favorite childhood memories and she turns the tables towards the therapist in order to dodge the question.
The female lead expresses her pent-up anger and resentment towards her parents who she thinks abandoned her at her grand parents’ house and left for another country. She reveals to them that she has been seeking psychotherapy for her psychological problems and the family members are shocked and embarrassed to hear this which depicts the stigma associated with the psychological problems and psychotherapy.
In another session with the psychologist, the female lead is shown to finally open up about her childhood experiences and how she was abandoned by her parents. She verbalizes her feelings of being left alone in her grandparents’ house. The therapist uses the technique of catharsis and non-judgmental, accepting, unconditional positive regard attitude and let the client fully express her suppressed emotions. The therapist says that in order to be completely happy she has to let go of the fears of the past. In the following part of the movie, the female lead protagonist is seen to break the parameters of the therapeutic relationship by hiding the timer and asking for more time in the session. She is seen as trying to find a companion in the therapist who listens to her and understands her completely. The boundary violation and the therapeutic relationship turning into a social relationship could almost be seen.
However, in the following session the therapist makes her understand that one shouldn’t burden one relationship with fulfilling all our desires and emotions, instead one should be capable of maintaining social relationships which are contending and blissful in different ways. Also, the audience is left to figure out whether the therapist has developed countertransference towards his client.
The movie takes us through the termination phase of the therapeutic relationship between the therapist and the female protagonist. The session commenced with the therapist trying to explain that psychologist can only help the client to understand the issues and find best possible solutions but it is on the part of the client to utilize the best possible solution and make the most of it. The client accepts her feelings towards the therapist and shows transference. The therapist abides by the boundaries of the profession and does not reciprocate the feelings. He appreciates the fact that she verbalized her feelings towards him and did not express them through covert behaviors. The client is reluctant to terminate the therapy. After the final session ends, the therapist bids her a goodbye and sits on the chair which creaked only when the person sitting on it likes somebody but not able to express. This time the chair creaks for the therapist too implying that he too had developed some countertransference or feelings towards his client but he chooses to follow the ethics of the profession and therapeutic relationship, does not reciprocate and eventually terminates the relationship on a reasonable note and point.
The movie concludes with the lead protagonist making a short film in which she defines a strong character relatable to herself who had to fight numerous battles to come to terms with her inner fears and to come out undefeated.
Our experience demonstrates that using movies can be helpful as an interactive teaching technique to teach humanism in nursing education. Cinema education provides the opportunity for nursing students to learn psychosocial subjects related to nursing through observing and reflecting on movie.
Feedback of the audience on effectiveness of cine seminar as a teaching learning method
We took feedback from the viewers about the effectiveness of cine seminar as a method of teaching and learning. Out of 41 subjects, nearly three fourth of audience felt that cinema education made the subject more interesting and gave a better understanding of client’s perspective. Only 9 (21.95%) participants were of the view that cinema education had limitation as a teaching learning process. More than half of audience (53.65%) agreed that cinema education provided a better understanding of psychopathology of diseases whereas the other half agreed to some extent. 32 (78.04%) participants expressed that it helped in generating empathy among students. 36 (87.76%) verbalized that cine seminar helped to make learning easier. 39 (95.11%) felt that it was a good brain storming exercise and helped relieve the apprehension related with abstractness of the subject [5]. They also found it to be enjoyable endeavor and a great way to understand the basic concepts of the subject. They expressed that cine seminar should be used more often as a teaching learning tool as it has far too many benefits over disadvantages. All 41 participants concurred that this method of teaching helped in promoting positive attitude toward Mental Health and Psychiatric Nursing, hence, helping in dispelling the stigma and ignorance associated with the subject.
CONCLUSION
The cine seminar incited the participants to comprehend and analyze the contents of the motion picture in relation to therapeutic alliance, boundary violation, dream analysis, suppressed and repressed content of the unconscious mind. Majority of the viewers reported a positive feedback about cine seminar and appreciated this method of education. Cine seminar is a powerful and innovative method of education in mental health nursing and ought to be used more often in classrooms.
- Kalra G (2011) Psychiatry movie club: A novel way to teach psychiatry. Indian J Psychiatry 53(3): 258-260.
- Torre E (2000) La formazione psicologica degli operatori [Psychological training of professionals]. Paper presented at: The 1st National Congress SIMB, Turin.
- Zeppegno P, Gramaglia C, Feggi A, Lombardi A, Torre E (2015) The effectiveness of a new approach using movies in the training of medical students. Perspect Med Educ 4(5): 261-263.
- Gramaglia C, Jona A, Imperatori F, Torre E, Zeppegno P (2013) Cinema in the training of psychiatry residents: Focus on helping relationships. BMC Med Educ 13: 90.
- Sharma N, Sharma S, Ghai S (2013) Psychiatry Movie club: A innovative way to teach Psychiatry. Delhi Psychiatry J 16: 2.
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