Dr. Talia Puzantian’s Publication Evaluates Effectiveness of Films for Educating Pharmacy Students on Mental Illness and Developing Empathy for Patients

Dr. Talia Puzantian, professor of clinical sciences for Keck Graduate Institute (KGI)’s School of Pharmacy and Health Sciences, in collaboration with KGI alumnus Venie Pham, PharmD ’21, and George Washington University Forensic Psychology’s Dr. Payton E. Bock, recently published “Pharmacy students’ perceptions of the effectiveness of a film-based mental health elective course” in Currents in Pharmacy Teaching and Learning.

The study analyzes surveys submitted by 125 KGI students who completed Puzantian’s psychiatric pharmacotherapy elective course, Mental Illness in the Movies: Using Films to Understand Neuropsychiatric Pathology and Pharmacotherapy.

Stigmatizing attitudes of healthcare providers about mental illness can negatively impact patients both in terms of the quality of care received and the likelihood that patients will seek help in the first place. Individuals with mental illness commonly report feeling devalued, dismissed, and dehumanized in healthcare settings.

While direct contact with patients is ideal, this option is not always available for pharmacy students. Some pharmacy educators have explored the use of film, which can facilitate a deeper understanding and improve attitudes toward people with mental illness.

The characters and plots in films can provide a multi-layered perspective of mental illness, allowing viewers to understand better the subjective experience of living with a mental illness and see patients as more holistic and humanistic.

Puzantian’s course provides a deeper dive into medication-related issues in treating patients with mental health disorders such as depression, suicidality, bipolar disorder, schizophrenia, addiction, posttraumatic stress disorder, obsessive-compulsive disorder, and autism spectrum disorder.

For each of the 12 films included in the course, Puzantian presents an overview of the film, focusing on the character’s portrayal of a patient, an illness and its impact, treatment, and the depiction of healthcare workers. This is followed by two or three individual students’ formal pharmacotherapy presentations, which use the character in the film as a model for a patient case study.

“Films as a medium are terrific because they draw you in,” Puzantian said. “You get engrossed and engaged in the person’s story, and you want to know how things work out. So you’re much more connected with the patient than if you were just presented with the patient case on a piece of paper.”

While some studies describe the use of films in healthcare curriculum, few provide specific guidance on film selection and whether some films may be more effective as an educational tool than others. Thus, Puzantian conducted a study to evaluate and compare students’ perceptions of the impact of the films screened on facilitation of learning, attitudes about mental illness, and comfort level in interacting with patients with mental illness.

Seventeen films were featured in the elective course over the four years of the study and had release dates ranging between 1945 (The Lost Weekend) and 2012 (Silver Linings Playbook) and varied in genres, highlighting a wide range of mental illnesses.

After each class session, students would complete an eight-question survey that evaluated:

• How accurately the actors portrayed the mental illness
• How effectively the film facilitated learning about that illness
• How much the students’ conceptual knowledge and awareness were impacted by the film’s portrayal of the mental illness
• How much the movie had changed their level of interest in and comfort with potentially interacting with a patient with the same mental illness as was portrayed in the film

For class discussions, Puzantian encouraged students to analyze the effects of the neuropsychiatric illness on the character’s life and the lives of others, the character’s attitude toward his/her illness, the attitudes of others (healthcare workers, family, friends, co-workers, strangers) toward the character, the treatments depicted (or not depicted), and whether the treatment was shown in a positive, negative, or neutral manner.

Pham has a unique experience as both a participant in the class and a collaborator in the study.

“In the class, it was a significant experience seeing how actors portray the disease state,” Pham said. “It really does help us to empathize with our patients.”

The films with the highest overall positive perceptions and levels of satisfaction with students completing surveys were Temple Grandin (autism), Helen (depression), As Good As It Gets (OCD), Born on the Fourth of July (PTSD), Iris (dementia), A Beautiful Mind (schizophrenia), and Silver Linings Playbook (bipolar). Films with the lowest weighted scores were One Flew Over the Cuckoo’s Nest (general treatment), Prozac Nation (depression), and My Own Private Idaho (narcolepsy).

Student comments praising Temple Grandin cited the movie’s “redefinition of normalcy” and portrayal of a disorder that is defined on a spectrum.

“What really stood out to me was the realistic ending,” Pham said. “There wasn’t a magical cure, but instead, the movie ended with the main character embracing her diagnosis. Also, Temple Grandin is actually a real person who became an advocate for autism disorder and made a huge change in how people perceive and manage it. It was very inspiring to watch.”

Students praised Helen for its realistic depiction of depression.

“The main character eventually goes on medication and gets better, but not in a Hollywood way,” Puzantian said. “One of the key parts is that she’s this beautiful woman who has a very successful career and a lovely husband and daughter. It shows the students that you can still be depressed even if you have a seemingly perfect life.”

While Puzantian mainly chose films for their realism, at the same time, she felt that it was also important to include films that portray the illness or treatment in a non-realistic way to facilitate discussion. One such movie is One Flew Over the Cuckoo’s Nest.

“It’s a good opportunity to really discuss a lot of different topics,” Puzantian said. “One topic is involuntary holds—how do you hold somebody against their will and take their rights away? Also, they force electroconvulsive therapy (ECT) on him as well as a lobotomy.”

Healthcare workers would never force these treatments on a patient, and ECT in practice is far different from how it was shown in the movie, but the film has had a significant impact on how people view ECT.

“That’s why I have this class,” Puzantian said. “Because the media impacts how we perceive mental illness and treatments.”

Although Pham’s current specialty as a pharmacy resident at Kaiser Riverside is in oncology, he feels that working on the study has dramatically enriched his research skills as a healthcare provider.

“In my residency, I’m always looking at new articles on the best treatments for patients,” Pham said. “So it was very transferable to residency, as well as the empathetic side. I talk to many patients every day, and it has been a great experience all around. Talia is an amazing mentor, and I am lucky that I got to work with her.”