Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we analyze the 2013 psychological thriller "Side Effects." Did ya'll remember that Channing Tatum was in this movie becauwe we didn't and it was a nice surprise! Too bad he died. In this episode, we explore Rooney Mara's portrayal of what we initially believe is major depressive disorder but then discover is actually manipulative behavior more consistent with malingering of a sociopathic level. We also discuss all sorts of medications and their side effects, including antidepressants, mood stabilizers, and antipsychotics. We hope you enjoy!

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[00:10] Dr. Katrina Furey: Hi, I'm Dr. Katrina Fury, a psychiatrist.

[00:12] Portia Pendleton: And I'm Portia Pendleton, a licensed clinical social worker.

[00:16] Dr. Katrina Furey: And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows.

[00:23] Portia Pendleton: Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriends.

[00:28] Dr. Katrina Furey: There is so much misinformation out there, and it drives us nuts.

[00:31] Portia Pendleton: And if someday we pay off our student loans or land a sponsorship, like.

[00:36] Dr. Katrina Furey: With a lay flat airline or a major beauty brand, even better.

[00:39] Portia Pendleton: So sit back, relax, grab some popcorn.

[00:42] Dr. Katrina Furey: And your DSM Five and enjoy.

[00:57] Portia Pendleton: Today we're going to be talking about side effects, which I had never seen before, which I think some people might find, like, shocking. This is like a movie about a lot. Therapy, mental health, medications.

[01:10] Dr. Katrina Furey: Yeah.

[01:11] Portia Pendleton: So we're going to be talking about that today. I'm really excited, and I kind of just wanted to say briefly, wow. Like, Channing Tatum was in it, and I was like, is this why everyone watches the movie? Hello, Andrew Law?

[01:26] Dr. Katrina Furey: Yeah.

[01:27] Portia Pendleton: How long did it take you to figure out who was running the show?

[01:32] Dr. Katrina Furey: So I've seen this movie several times. The first time not till the very end. I remember being really surprised. What about you?

[01:41] Portia Pendleton: Same.

[01:41] Dr. Katrina Furey: Yeah, right. I didn't get it the first time I watched it, I thought I think I thought this was supposed to be a medication side effect. And that was like the whole premise. And then when they got into the insider trading and all this stuff, I was like, oh, whoa. Yeah, I didn't see that coming at all. And then when I rewatched it before recording this episode, I remembered the plot. And so I was really watching Rooney Mars character a lot more closely to see if I could pick up on sort of subtle things that would suggest she was malingering. And they even used that word correctly, which is kind of feigning symptoms for what we call secondary gain, which means, like, to get out of work or to get money in a settlement or to stay out of prison or stuff like that. What did you think about Rooney mara's portrayal of what we think at first is a woman with depression?

[02:41] Portia Pendleton: I thought it was great. I thought it also shows how we can be, like, functional.

[02:47] Dr. Katrina Furey: Yes.

[02:48] Portia Pendleton: So she's working, she is dressed well, but behind the scenes, like someone who's really suffering with kind of it appears, maybe more like major depressive disorders. She's having these episodes versus kind of more persistent depressive disorder, which would just be like persistent depressive depression with periods that you can also have major depressive disorder popping into.

[03:13] Dr. Katrina Furey: Right. And they allude to again, I think we'll talk about her before the twist. So when we think she's just depressed and I'm saying just depressed, not to minimize the depression, but because there's more that comes out later, but I thought her eyes. She just looks subdued. She looks sad. She looks flat. She's not really super joyful. Even when they get him out of prison, she hugs him and stuff, but there's not a lot of animation there. And again, maybe that's just her personality, but she does have this suicide attempt where she rams her car into a wall in a parking garage, and when Channing goes to the hospital, he's like, oh, I thought we moved past this to suggest, like, this has happened before. And that's where she meets Jude Law's character, Dr. Banks, in the Er as the psychiatrist evaluating her.

[04:08] Portia Pendleton: So what did you think of that?

[04:09] Dr. Katrina Furey: Who was he evaluating before her?

[04:12] Portia Pendleton: Oh, the man who was kind of delusional. No, I'm sorry. He was not delusional.

[04:17] Dr. Katrina Furey: He was Haitian. Yes.

[04:18] Portia Pendleton: And so he had seen the ghost of his father driving a cab, and so he kind of attacked the cab.

[04:26] Dr. Katrina Furey: I'm glad I brought that up, because I remembered that's a good portrayal. I think that's something we do learn about in our training is putting the symptoms of various mental health conditions within a cultural context, because sometimes what we might think of in the American culture as delusional, like seeing ghosts of relatives who have recently died in other cultures, is not it's, like, normal in those cultures. So that was an interesting depiction of that. And again, an interesting depiction of a black man in New York City coming in and speaking a language the officer can't understand and wanting to sort of restrain him or punish him or take him to jail. And the doctor, in this case, being able to apparently speak French or Creole I think it was French and get a sense for what's really going on and keep him out of jail. So that's an example of not malingering. That's not malingering. That's like the law psychiatry or mental health interface, like, working appropriately.

[05:32] Portia Pendleton: That was really great, and I thought it was just, like, a good check mark for him, for his character.

[05:40] Dr. Katrina Furey: Yeah. And then now that we're talking about it, like a really interesting juxtaposition to him then moving next door, wherever, and evaluating Emily. Again, a white woman, someone later calls her, like, a fragile bird, attractive and just I guess you're right. I do pick up a lot on the background or the setting. I didn't love that. He didn't close the curtain right away. He starts the interview standing over her. I didn't love that. Just, again, like, a man towering over you and you're feeling really emotional and vulnerable. I don't love sit down so you're level. Don't get too close, though. I like that he didn't get too close. I think eventually he sat. Eventually he closes the curtain. I thought his line of questioning was pretty good in the way that she was saying, like, oh, my head hurts. They said I might have a concussion. And he's like, well, we got to wait for the CT scan. How's your head been lately? That's kind of weird. That's kind of a clunky thing to say. He didn't introduce himself as a psychiatrist right away. I'm not sure why or if that was intentional to see again. Maybe he already suspected she'd withhold things. If he did so, maybe he wanted to see if she'd reveal anything before she knew. That. That, to me now that I'm saying it should have been his first sign that something was off here. He says to her, usually when someone's in a car accident, there's skid marks. You try to avoid hitting the wall, but you went right for the wall. So to us, that suggests a suicide attempt. I can't believe she wasn't hospitalized.

[07:27] Portia Pendleton: Well, that was what I was thinking. I was like, she didn't come in with kind of a thought of suicide and now is presenting, after waiting in the air for many hours as safe and has a caregiver or a partner and is evaluated and is sent home and non hospitalized. That happens a lot. Maybe sometimes it shouldn't, but this was an attempt, and this was a really serious attempt.

[07:52] Dr. Katrina Furey: Like she rammed her car into the wall. I thought, though, that they did a good job portraying what we sometimes look for, which is called future oriented, like having plans for the future. Like, oh, no, I can't be outside. I have to go to work tomorrow. My husband just got home. I can't do that. At the same time, when I was working in Ers with evaluating patients like this, I don't care how future oriented you are, when you ram your car into the wall, you need to be hospitalized. And the fact that she was able to talk him out of it when that was his first instinct to me is, like, in retrospect, red flag number one. Yeah, right. The fact that she's like, you have an office, right? I'll come see you a handful of times.

[08:33] Portia Pendleton: And to me, that was red flag number two, because I don't think that that happens often. I don't know of the ethics behind it, but I just don't think that that's typically available.

[08:46] Dr. Katrina Furey: No. Right.

[08:47] Portia Pendleton: Like, you'd be referring to, like, a PHP partial hospitalization program, tense about patient program through your hospital. You know what I mean? That would be the treatment exit.

[08:55] Dr. Katrina Furey: Not just like, I just ran my car into the walk. I'm going to go see an outpatient psychiatrist. That's not an appropriate level of care for that severe thing that just happened. I think you need at least a couple of days. But again, unfortunately, this should always happen, right? Unfortunately, there's not enough hospital beds. Patients wait and wait and wait in the Er forever. Sometimes insurance won't cover it, even after something like that. I'll never forget my training, working on the inpatient child unit and being told by insurance it was my job to do the peer to peer review because they were denying ongoing a hospitalization for like a twelve year old girl for suicidal thoughts and depression because she hadn't actually attempted anything. So they thought we should discharge her. And it was like, unreal that they told us they're not going to pay for it because she hadn't made an attempt drives me nuts. But anyway, she had made an attempt. She should have been hospitalized. So the fact that she was able to manipulate him into going against his better judgment by appealing to well, I'll see you in your practice. I couldn't tell if he was affiliated with the hospital. It didn't seem like it. It seemed like he was like what we call moonlighting or like picking up.

[10:11] Portia Pendleton: Side shifts, which he does talk about later because he's working all these multiple jobs.

[10:16] Dr. Katrina Furey: Right, exactly. So maybe he's like, oh, a patient, oh, a couple of times a week maybe it seems like he needs the money. And then we sort of start seeing her meeting with him. And again, the boundary crossings just continue our favorite. So, yeah, we see her starting to open up to him. He starts talking about medication, which again is is warranted. Yeah. When someone presents with significant symptoms of depression status post a suicide attempt, I think that's when she brings up Dr. Seabird's name, which is played by Katherine Zeta Jones, and she gives consent for them to talk to each other about her case, all of which is normal. And then somehow he sees Dr. Sebert at, like it looks like a pharma. By pharma I mean pharmaceutical company, like dinner or talk or something. And Dr. Sebert like, very casually mentions, oh, oblixa, I did write down, being a psychiatrist, the medications Dr. Sebert said she had tried Emily on, wellbutrin, Prozac affects her, and she apparently had problems with sleep and nausea. So that's interesting because those can be common side effects. And we have medications in different classes. We have Prozac, which is an SSRI, effects are an SNRI, and then Wellbutrin, which has a different mechanism of action in which we think of as sort of in this category of medications called like, atypical antidepressants, which just means, like other they work in different ways. So looking at that, my thought as a psychiatrist is did she have adequate trials on any of these? Like, could she tolerate them long enough to see did they really work because these medications take several weeks to kick in? Or did she stop them pretty early because of side effects? Problems with sleep and nausea are really common early side effects that usually go away if you can stay on it and you can prescribe things to sort of help with that in the early stages. It's weird to me that she was only on one SSRI. Then we jump and again, I'm assuming we started with Prozac because that's typical practice, but maybe we didn't. But then you jumped to an SNRI then you jumped to this other thing. It's pretty atypical to jump around so quickly. And then it sounds like she was taking, as prescribed by Jude Lav's character Zoloft, 100 milligrams, which is a pretty high dose. So pretty high to get to 100 so quickly. Those are kind of my thoughts.

[12:47] Portia Pendleton: Is that dosage more like along the lines of an OCD patient?

[12:53] Dr. Katrina Furey: Not quite. That's a great question. So usually, like with Zoloft, you start around 50. You could start lower if you've never been on medication before to help ease the side effects as you're starting them, or if it's like, a young person or really thin person, you might start lower. 100 is, like, a pretty good dose for depression. I think the way it was depicted in the movie, I just felt like they got there really quick, which, again, you might want to given the severity of her suicide attempt, but usually you might go a little slower. But maybe again, I'm just assuming this was, like her first dose was 100. OCD definitely responds to higher doses of SSRIs compared to things like anxiety and depression. So for Zoloft, the therapeutic windows anywhere from 50 all the way to, like, 400 milligrams for OCD. Oftentimes people with OCD end up somewhere between two to 400, depending on the situation, but 100 could do it. Okay. Some other early boundary crossings that we see between Emily and Dr. Banks first, not hospitalizing her. The second, I would say, is when she found him. It looks like in it looks like maybe like some common area. So his office must be near the hospital or something. Almost gave me the vibe of, like, a cafeteria or something like that atrium that's right where he was sitting with his wife, who was preparing for a job interview, and he gives her a Pranal, and I thought, oh, gosh, he doesn't have great boundaries. You should never prescribe for your spouse or for someone you know? I mean, do do doctors do that sometimes? I'm sure proprietary is a pretty benign medication, but I think it just speaks to his own poor boundaries and why a patient like Emily might be able to sort of sniff that out and use it to her advantage. So all of a sudden, he gets a call with Emily kind of rambling on the phone, I think after she had tried to maybe jump in front of the subway train. And then the officer saved her at the last minute. But then she shows up as he's.

[15:09] Portia Pendleton: Trying to his wife staring at a poster of oblixa right in the train station for a while, just like looking at it. And then she kind of walks over.

[15:18] Dr. Katrina Furey: To the edge and then toes it. I didn't notice that, but you're probably right, because we'd heard about Oblixa from Dr. Sebert, like, in the scene before, and they kept talking about how you see the ads. You see the ads, and I will say, I hear this all the time from patients. I remember when I started my training, Abilify, there were a lot of ads out there for Abilify, and I had a patient who was like, I want to switch from this medicine. I've been on and been stable on for 20 years to Abilify. So this does come up. I thought that was I wanted to.

[15:49] Portia Pendleton: Ask you, so if a patient comes in and they have seen like, a new medication on TV and it looks and they're excited about it, does that typically make it work better at all? I think Placebo mentioned that in the movie a little bit.

[16:06] Dr. Katrina Furey: Yeah, you're right, she did. She was like, I think with your positive endorsement, it could work better. I mean, so certainly we know that the placebo effect is real. So by the placebo effect, I mean, they've done studies and stuff where if you give patients, like a sugar tablet, but you say it's an antidepressant or something, then sometimes the patients start to feel better, like they believe in what you're giving them. And that is part of the art of prescribing medications, I think, is not necessarily using that to your advantage. But it's really important when you're prescribing a medication, whether it's for psychiatric issues or something else, to get buy in, right? Like, if you're prescribing a medicine to someone because they have high blood pressure and you want them to work on it with lifestyle modifications, like with diet and exercise, you want to get buy in that all three methods of targeting the problem are going to be effective. So I think that's the kind of thing where if you come to me and I'm like, well, we could give you Zola, but it doesn't really work, are you going to be like, sure, I'll take that.

[17:15] Portia Pendleton: That makes sense. I feel like even with therapy, I think some protocols actually, I don't want to say require, but really you're supposed to kind of speak to the results that have been studied. You're supposed to really kind of like, I don't want to say Hype up the program, but Hype is effective. This works for people, really, to get the bind. So it sounds like it's almost along that line. It's not necessarily like placebo effect in our practice, right? That's a lot of in research trials and stuff like that. But you have to get people's kind of excited to what you're trying to have them do.

[17:52] Dr. Katrina Furey: Right? And I think patients will show up having seen ads and commercials and stuff like that for newer medications and wonder about it and some I mean, gosh talk about like buy in. I mean, the the like people like, make these commercials with the goal of, like, kind of manipulating you into wanting to take this specific medication so they can make money from it. And some of these commercials are really intense.

[18:18] Portia Pendleton: So I thought at this point, in the movie, this was where we were going. Right. I thought like big pharma was like trying to kind of push this pill. I almost felt like in a little bit of a way it was going to be like the oxy. We secretly know that it's not effective or there is this really bad side effect. We're brushing it on the rug, don't tell anyone. Prescribers.

[18:39] Dr. Katrina Furey: Push it, push it.

[18:40] Portia Pendleton: But that was not the way this movie ended. But at this point that's what I was thinking.

[18:46] Dr. Katrina Furey: Yeah, that's what I thought too is it was going to be all about Big Pharma. And I think unfortunately, you're right. There are stricter laws now about you see, in the movie pharmaceutical reps taking doctors like out to lunch or dinner. And they talk about how back they could be a quote unquote spokesperson for a pill and be flown out to some conference in an exotic location, give a talk for 15 minutes and have their whole vacation comped. Those sorts of things did used to happen. I didn't get to do any of that because they have these stricter laws which are good. Which are good because they did find like surprise, surprise, doing stuff like that did in fact influence physicians prescribing practices. Which makes sense.

[19:33] Portia Pendleton: Yeah. And I was thinking same along the lines of this used to be a big practice for residential treatment centers, doing kind of the same thing with big pharma as big Pharma. So they would invite you to come tour their facility in Palm Beach and then you're going to refer your patients with substance use disorders there. It really primarily was kind of a big business with substance use all around this kind of same time.

[20:01] Dr. Katrina Furey: Right.

[20:01] Portia Pendleton: I feel like this is really popular to do. They want kind of to push patients. And now we are seeing and have seen the effects of this. So specifically talk a little bit about the state of Florida kind of being famous for having a lot of rehab centers. There was kind of in the news, a lot of unethical drug testing. So they'd be billing at really high rates these really expensive complex blood tests and labs and that's kind of how they're getting paid. And all these people have ended up in Florida and then kind of like homeless and then using drugs. Again, like a halfway highland houses. There's this whole pipeline.

[20:40] Dr. Katrina Furey: It's very interesting that's the thing is, unfortunately, there is a nefarious pipeline. Where? I don't remember all the details, but unfortunately there have been then, like, big business partnerships, I guess, between a rehab center and a halfway house or where the patient would go afterwards, where then the patient does rehab. They pay out the wazoo they charge for these tests, like you're saying. Then they go to this halfway house that's contracted with the rehab center. And then the halfway house, they get reintroduced to the drug, sometimes on purpose. I think that's the most nefarious egregious thing that's come out. I mean, how disgusting is that? And then they go back to the rehab and it's just a cycle, and it's all for money making, and that just makes me want to vomit.

[21:25] Portia Pendleton: Yeah, I mean, it's horrible. And I think that's right. And we've seen that with Big Pharma too, and that's why we don't get this anymore.

[21:33] Dr. Katrina Furey: But I thought this was going to be like a movie, like anti Big Pharma. Anyway, we got derailed, but hey, big Pharma. So Emily somehow finds where he is in the atrium again, like, how unclear? And interrupts his combo with his wife. You can tell his wife's annoyed. She's, like, wanting some emotional support from him. This is a really awkward conversation to have in public. Again. He's like, if this just she sort of makes a provocative comment alluding to, like, sort of happened again. And he's like, well, if that's the case, I need to admit you to the hospital. Yes, that's the right step. And then she's like, no, I just need five minutes. I have to get to work. Can we go talk somewhere? And the answer is no. The answer should be no. But she manipulates him or something.

[22:24] Portia Pendleton: I thought that it was interesting that his wife was I understand why she was upset. Like, she needed support, and her husband was kind of getting called to this work duty. But I feel like I'm assuming that this doesn't happen ever. This is a strange thing, right? Like a patient coming up to him. So I felt like her reaction almost felt, like, a little strange. If I was out in public and out to dinner with my partner, and we're sitting there and a patient comes up to me and starts talking about what seems to be, like, active suicidality, that would be not normal. My partner would be like, what the **** is happening?

[23:06] Dr. Katrina Furey: They wouldn't even get up and leave.

[23:08] Portia Pendleton: Right? Sad or mad at me. They would just be like, this is strange.

[23:14] Dr. Katrina Furey: Weird. Yeah.

[23:15] Portia Pendleton: So I felt like her being mad.

[23:17] Dr. Katrina Furey: Just, like, felt off. I think she was mad that he chose to go, but I feel like.

[23:25] Portia Pendleton: Within the context, you have to handle that. You don't need to meet with him. You know what I mean? But you have to handle the situation. Whether it's like talking to them outside and saying, this is wildly inappropriate.

[23:38] Dr. Katrina Furey: I don't know. Asking her wife, can you go get a security guard?

[23:45] Portia Pendleton: Maybe she was pretty.

[23:46] Dr. Katrina Furey: That's the thing. I was wondering if there was some competition and if that was intentional. I think now we know it probably was to stir up some feelings of jealousy and stuff. And then they have this mini session, like, on some couch somewhere, and there's that Victoria Secret. Yeah. So they're sitting, like, really close together. Their body language was interesting because she's, like, face toward him with her legs up on the couch. You can see her bare legs. She's just sort of talking to him and pulls out, like, a Victoria's Secret bag, saying, like, I'm really trying. And he acknowledges again, I was like, oh, ick, ick, ick, ick, ick. Yeah.

[24:23] Portia Pendleton: And again, the boundary crossing is when he agrees to meet with her also, like, in this public place, so on and so forth, and just meeting with her. But besides that, what he's saying. He's not flirting with her. He's not doing anything, like, inappropriate. Inappropriate in that moment within that context. But I think then we learn later a picture gets taken of them in this moment where she is holding up this Victoria's Secret bag, and they're comfy, quote, unquote, on this couch. But it's like, that is not what was happening.

[24:58] Dr. Katrina Furey: Right, exactly. That's why you always have to be so careful. Totally. And this is why boundaries are so important. And this is why it's important to listen to your own gut feelings when you're evaluating new patients, because I think you could pick up some of these subtle red flags really early on and see how this could unfold. And so again, he doesn't hospitalize her against his better judgment, and then things really unravel. So he's like that's when she, Emily, asks, can you start me on Oblixa? Like, my friend so and so is on it. I hear it works. And he'd heard that from Dr. Sebert, who then we find out is, like, really pushing Oblixa. I loved what Dr. Sebert was like. Oh, you can have an Oblixa pen. Yeah. I was like, we should make analyze script pen.

[25:49] Portia Pendleton: I have a lot of residential treatment pens.

[25:52] Dr. Katrina Furey: I bet you do, right? It's just so classic. So then he puts her on Oblixa instead of Zoloft. And getting back to one of your questions, certainly there are more and more new antidepressants out there. Oblixa. I thought it was so funny the way they picked this fake name because it was like a combo of Abilify. And I thought, like, Trntilix, which are both too. Abilify has been around longer. What about Selexa and Selexa oblixa? They just sort of, like, combined it all.

[26:22] Portia Pendleton: And it sounds real. It totally sounds like a medication sounds.

[26:26] Dr. Katrina Furey: Like a medicine name. So I thought that was funny. And then I think it kind of starts to work, but she starts having these quote, unquote, like, sleepwalking episodes, which seemed convincing right at first, and then that's why he eventually prescribes this new medicine deletrix or something, which, again, sounds like a convincing medicine name. And that's where he's now participating as a consultant with a pharma trial being paid being paid, like, $50,000, which, again, sounds like a lot. I would have cautioned Dr. Banks to say, okay, after taxes, how much are you really getting, and is it worth it?

[27:07] Portia Pendleton: And he does disclose that he did it. Again, it seems some things pretty by the book he's with another patient who he's telling about this trial that he's in and that he is being compensated for it. And he gives her this information that she'll receive the medication at no cost. And it's like, that why people agree.

[27:27] Dr. Katrina Furey: To the trial, right? And that's what I think the pharmaceutical industry uses to its advantage. They still provide free samples, which I.

[27:35] Portia Pendleton: Think can be right on the one hand, a way to assist people who cannot pay for it initially, or there's just problems with that, too, but that still happens. People still do get free samples of lots of things. Birth control antibiotics, or, like, Vivams, like.

[27:56] Dr. Katrina Furey: A new Stimulant, which is really expensive, works great. I prescribe it a lot, but it can be expensive if you don't have good health insurance coverage. So they might give you, like, a quote unquote drug coupon where you can get, like, the first month free, and then you have to pay $600 the rest of the time. Anyway, as we're thinking about this, shout out to Mark Cuban's Pharmacy because they are providing a lot of medications at very affordable rates. Mark Cuban, if you want to sponsor the podcast, please feel free. Anyway, so they add in this new medicine, and then it turns out she murders her husband, basically, right? Like, she again has another one of these quote unquote sleepwalking episodes, ends up stabbing him multiple times, and then goes to sleep and he dies. Before we saw the end of the movie. What did you think about that whole scene?

[28:45] Portia Pendleton: I thought that it was I was shocked, but based on another episode of prior episode of her kind of sleepwalking, I was like, I don't want to say, like, it wasn't surprising, but that didn't shock me. Something was going to happen in the movie. I was like, okay, this is it. And then she's going to be like, how are they going to go after her?

[29:04] Dr. Katrina Furey: Right?

[29:06] Portia Pendleton: Are they going to blame the drug? Are they going to blame her? How will they do this? That's what I was thinking. I was sad to see Channing Tatum go. Martin is his name in the movie, right?

[29:21] Dr. Katrina Furey: He's not a Martin. I'm always sad to see Channing Tatum go. Yeah. I like to watch him walk away. Yeah.

[29:30] Portia Pendleton: But he you know, he did not walk away. He laid on the floor and blooded out.

[29:35] Dr. Katrina Furey: So then she gets shirtless. I know.

[29:37] Portia Pendleton: Like, come on, haven't they seen Magic Mike?

[29:40] Dr. Katrina Furey: What did you think about Rooney Mara's acting in that scene? Did you buy it?

[29:46] Portia Pendleton: I did.

[29:46] Dr. Katrina Furey: Yeah. Too the first time. Totally bought it. And that's where I thought the movie was going. Let's see what happens here. And I thought, actually, their depiction of the whole legal process, the not guilty by reason of insanity, the NGRI, I thought that was actually pretty accurate. And again, I'm not a forensic psychiatrist. We hopefully will be having one on in. The next couple of months. But I thought overall, that was a pretty accurate depiction of how that process works. And thank God for things like not guilty by reason of insanity so that people who do commit crimes or murders or what have you when they are in the throes of a mental health episode instead of just being locked up in jail, which unfortunately has become how sad is this? The largest place where mental health treatment is delivered because we don't have enough mental health hospitals in the country. That's a whole other episode and issue. But anyway, those patients can go to, like, a forensic psychiatric unit and receive treatment. Unfortunately, I think oftentimes what then happens is once their sanity is restored sometimes, then they're tried again. I'm not a forensic psychiatrist. Do you understand that differently?

[31:01] Portia Pendleton: Yeah. And I think it's interesting why it would go either way. Right. Some people are charged with not guilty by reason of insanity go on to serve their time in an inpatient unit and then are let out right into society. And other people are get off temporarily not guilty by reason of insanity, receive the care and then have to and then are tried.

[31:25] Dr. Katrina Furey: Yeah, exactly.

[31:25] Portia Pendleton: I'm curious what the differences are. I'm sure it's clear. I just don't know it.

[31:29] Dr. Katrina Furey: Well, hopefully when we have her case.

[31:31] Portia Pendleton: It sounded like she got the she was going to get R. Right.

[31:35] Dr. Katrina Furey: And that's the part where I'm not sure. Does that actually happen? When we have dr. Tobias wasser on in a couple of months, we will ask him.

[31:43] Portia Pendleton: And it was a really short time. Right. And I think they also had to kind of convince her because at first she was like, no, I don't want to have to go there. I'm not going to be able to leave. And they were like, no, this is the golden egg. You got the best offer. It's 1% that this actually works.

[32:00] Dr. Katrina Furey: I thought it was really weird that the state and the defense both wanted her psychiatrist to be their expert witness and that he would agree either way. Didn't you think that was weird?

[32:14] Portia Pendleton: So I thought at first, before the twist, that the state was involved somehow with big pharma. I thought it was very strange that he was being approached. That lawyer, that guy.

[32:29] Dr. Katrina Furey: I just felt like that would, like.

[32:31] Portia Pendleton: It seemed like he had some other motive.

[32:34] Dr. Katrina Furey: And that's what I was just like.

[32:36] Portia Pendleton: And I was wondering if they were trying to get him, the psychiatrist on board so that he could speak to that it's not the drug. Right. And try to get the drug off. That's what I was thinking.

[32:47] Dr. Katrina Furey: But again, Dr. Banks, like, what a conflict of interest. I feel like that's pretty like Psychiatry 101 where you should not be you.

[32:58] Portia Pendleton: Can'T be the actions treating and her psychiatrist. You have to be one or the other.

[33:05] Dr. Katrina Furey: Not only her past treater. Like when this happened, but you continue to treat her while she's in the forensic unit. Again, that doesn't track for me. That's not really what happened. No, I think any psychiatrist who would unfortunately find themselves in this situation would a, call your malpractice, who will appoint your defense, and B you're not involved anymore.

[33:28] Portia Pendleton: Right.

[33:28] Dr. Katrina Furey: So the fact that he kept getting involved, I think speaks to how she kind of had her hooks in him and he felt compelled, do you think, to clear his own name?

[33:37] Portia Pendleton: I think so.

[33:38] Dr. Katrina Furey: I think it was both.

[33:39] Portia Pendleton: I think he wanted to clear his own name because at this point, he was being harassed by people who were really unhappy with him. His wife seems unhappy with the situation. His practice seems unhappy with the situation. I think he was trying in half to clear his name and then on the other half, I think he felt sorry for her and wanted to help her.

[34:03] Dr. Katrina Furey: And he probably felt like some degree of responsibility, having been the prescriber. And I think prescribing something that he's in getting a kickback for. And even though he's, like, upfront about it, I think maybe he had some guilt there. But in the real world, that's not what happens. Actually, this does happen where attorneys will try to get you to be their expert witness. That actually happens all the time. But you're taught pretty early on and pretty clearly that that's a really bad idea because it's such a conflict of interest. Even if it's like your patients involved in a lawsuit and you're not really related, but your testimony, I guess, could support they're getting more damages or something. That's such a conflict of interest because if you do it or you could just affect the therapeutic alliance and you don't want to mess with that.

[34:54] Portia Pendleton: We only really do it if we are like, subpoenaed. And sometimes subpoenas, I think we really only have to follow through if it's like they're from the state. I think you can kind of fight sometimes a subpoena or push back on it for what they're asking for when it's like a private attorney.

[35:12] Dr. Katrina Furey: And that's why you always just call your malpractice and they tell you what to do. So anyway, I don't think his malpractice.

[35:18] Portia Pendleton: Would have advised him to do this.

[35:20] Dr. Katrina Furey: You see his colleagues telling him, like, you need to stop. Get off the case. And then he asks his colleague for Adderall because he's kind of a mess. And I was like, oh, gosh, no.

[35:38] Portia Pendleton: So then this twist happens, right?

[35:40] Dr. Katrina Furey: So then, you know, we love a twist. Like, one day we'll have a boundaries jingle and then we'll also have, like, a twist. Yeah, that sounds like a tornado.

[35:48] Portia Pendleton: So I feel like for me personally, I got a little confused initially. Like, I maybe I was doing two things at the same time. I wasn't totally engrossed in the movie. I don't know. It took me a couple of minutes to be like, okay, so we're going.

[36:05] Dr. Katrina Furey: In a totally different direction here, right? Yeah. It felt like whiplash. Yeah.

[36:09] Portia Pendleton: So Rudy Mara's character is Malingering.

[36:12] Dr. Katrina Furey: Yeah. Turns out this whole time we see.

[36:14] Portia Pendleton: That she is working with Katherazada Jones's character. Dr. Sebert was her old psychology and love interest. Yes. Which is very inappropriate, obviously. I feel like we don't even need to talk about that. It's obviously inappropriate.

[36:27] Dr. Katrina Furey: And I feel like Hollywood loves to depict psychiatrists and patients boning. They just do. And it just really drives me nut. Yeah.

[36:37] Portia Pendleton: It's really like any other really horrible thing to happen in any other field. Yes, it happens, but it's so rare, so bad. This isn't the norm.

[36:50] Dr. Katrina Furey: So teacher thing. That's like, less, probably less. Right. But I did not see that coming. Like, the first time I saw this movie that turns out like they've been in cahoots the whole time and to get money.

[37:08] Portia Pendleton: So that's their plan is to get this payout from causing which is kind of wild to think about all of these chain reactions to make them rich. That's how it is. So they apparently have been kind of planning to take down Dr. Banks. Right. They send him pictures. They send his wife pictures of him and her, Emily, together, which looks really sexually compromising. They float this past patient of his into his practice. So they want him out. It sounds like there was, like a death of a past patient. She took her life and she named.

[37:46] Dr. Katrina Furey: Him right, in her suicide note. And he said, this is all delusional. This relationship never happened.

[37:52] Portia Pendleton: Which I don't think it did.

[37:54] Dr. Katrina Furey: I think he's telling the truth. And unfortunately, things like that do happen. Yeah. And so, gosh, what a lot of planning.

[38:02] Portia Pendleton: It almost seems like too much, too.

[38:05] Dr. Katrina Furey: Far fetched for it all to fall into place that way.

[38:08] Portia Pendleton: But he starts to get, like he starts to figure it out. And he is appearing to be, like, crazy. Right. He's, like, staying up late.

[38:15] Dr. Katrina Furey: He has this whole wall of all these pictures they always do with, like, a red pen and X's and, like, string taped up. And then he does give the sodium what is it? Ambutol? Truth serum. Basically. He supposedly gives her truth serum to.

[38:31] Portia Pendleton: See if and at this point, we still think that he did.

[38:34] Dr. Katrina Furey: Right.

[38:35] Portia Pendleton: So we find out later that it was just like saline when he is telling the police or the lawyer for the state about it. And first of all, what he did is so unethical. Like unethical. And he can get in a lot.

[38:48] Dr. Katrina Furey: Of trouble for it.

[38:48] Portia Pendleton: So the lawyer is like, I don't.

[38:50] Dr. Katrina Furey: Want to hear this. I don't want to know.

[38:51] Portia Pendleton: You need to delete this. You need to get rid of it.

[38:53] Dr. Katrina Furey: Because he films her. Right.

[38:54] Portia Pendleton: And you can't be tried twice. So the lawyer is like, even if this is true, we have these laws that prohibit double jeopardy, I think it's called. Again, things are moving really fast, and we're starting to see that apparently she has concocted this plan with her old psychiatrist, and they were going to pin.

[39:11] Dr. Katrina Furey: It on whoever evaluated her. It just happened to be him, and he just happened to have this history that sort of helped with their case. And then he's like, oh, no, you're not going to pin it on me. I'm going to pin it on you. And then it turns out that then Dr. Sebert and Emily are sort of pinning it on each other, but he starts lying and deceiving and manipulating almost as bad as Emily was to begin with. Yeah. So it's just really interesting.

[39:37] Portia Pendleton: So it seems like they get her to wear a wire, emily, when she goes and meets with Dr. Sebert and gets her to kind of confess what's going on, and then Dr. Sebert feels because they're going to have sex. So she feels this pack on her back, and then the door opens and the police are there.

[39:57] Dr. Katrina Furey: I know.

[39:57] Portia Pendleton: And then I'm like, oh, Emily gets away.

[40:00] Dr. Katrina Furey: Right?

[40:01] Portia Pendleton: You think that she made this deal, she can't be tried again, and that's not the case.

[40:08] Dr. Katrina Furey: So then you see they're all trying to pin it on Dr. Banks. They want her to be restored to sanity so that she can be discharged from the unit and sort of go live her happy life with Dr. Seabird. But she's supposed to keep seeing him to avoid being hospitalized. And she thought it was just going to be like, okay, let's pretend I'm seeing you, but not really. Like, you know the drill. I was malingering the whole time. I don't really need medications, blah, blah, blah. But then he's like, no, I'm going to prescribe you Thorazine and Depicote, both of which are they work. They're heavy hitters, man. Like, Thorazine is really sedating Depicode again, the side effects they mentioned from these meds were spot on. You can lose your hair with Depicode. You also gain a ton of weight. You're really sluggish cognitively. You can get a lot of acne.

[40:57] Portia Pendleton: So who would be prescribed those? Like, what kind of a patient would be prescribed Thorazine and Depicote? Or either?

[41:05] Dr. Katrina Furey: Yeah. So Depicote is under the class of medications called mood stabilizers, which we use for things like bipolar disorder. You do not use it in women of childbearing age because it has been shown to be associated with a birth defect, specifically neural tube defects, which lead to things like spina bifida. In pregnancy, you always take a high dose Folate, and you can take extra. If you have to be on Depicode, if that's, like, the only mood stabilizer that's ever stabilized your bipolar disorder, then by all means, you need to stay on it. But it's not the first one we use. Also, so many side effects, and there's newer mood stabilizers like lamctal. Lithium has been around forever. But it's like a really good one that's effective. It has low side effects, too. And then Thorazine is an older antipsychotic, which he does acknowledge and is true. It's what we call like a typical antipsychotic like Haldol that is used for psychotic disorders. So things like schizophrenia, we use it a lot in the emergency room and inpatient setting to also help with sedations. Like, if you're so psychotic or manic that you are unable to sleep, you'll often get Thorazine to sort of help promote sleep. So you can imagine how much fatigue goes along with it. Sluggishness. It can be very drying. Like your mouth is really dry. It's not pleasant. So he's basically, like putting her into a pharmacological prison is basically what he's doing and making sure that she has to go get drug tested to show that she's actually taking it or she's going to go back in the hospital. So he gets the final one over.

[42:38] Portia Pendleton: So she is like, no, right, and runs out of there, tries to escape, and that's when she is not then right following. And I think he knows this, that she's going to have this reaction. So she kind of goes to get in the cabin, run away, and the police are waiting for her. He kind of knew all along.

[42:55] Dr. Katrina Furey: I think he tipped him off that this is going to happen. He probably didn't say, like, I'm going to do this and she's going to do that. He probably was like, she's been acting odd. Can you be waiting? And then she goes back, I think to the forensic psych unit, which honestly, that's where she belongs. Yeah, that's where she belongs. Given everything that happened. Gosh, that movie had a lot of twists and turns, lots of ups and downs. I feel like there's probably so much more we could talk about, but this episode has already been really long. I thought it was interesting, Portia, that you didn't seem as into this movie as I was. Do you think it's because I prescribe?

[43:30] Portia Pendleton: I don't know. What's funny, too, is that one of my friends who's not in the field at all, really loved this movie and recommended it. And I don't know, I feel like.

[43:42] Dr. Katrina Furey: I was a little bored, actually. Yeah, you yawned a lot as we were recording this.

[43:48] Portia Pendleton: I don't know what that says.

[43:50] Dr. Katrina Furey: That's why I feel like I also.

[43:51] Portia Pendleton: Missed things throughout it.

[43:54] Dr. Katrina Furey: Do you think it's because we've been talking a lot about psychopaths, like with you, and maybe you're just kind of over it for right now. Maybe Tatum died. Yeah. Maybe this Zach grief is too much for you to bear. Maybe, yeah.

[44:09] Portia Pendleton: I have no idea. I think that's interesting though. I was like bored. I feel like, oh, no, pay attention. Pay attention.

[44:16] Dr. Katrina Furey: I know. And I couldn't wait for us to record this episode and watch it again. And you're like, over here, yawning. And I'm like, and then they got the side effect right, and then they did this right. Then they did this wrong. Maybe someday we'll have a patreon and we can record a bonus episode where we explore that reaction further. Maybe.

[44:34] Portia Pendleton: This felt unbelievable to me.

[44:36] Dr. Katrina Furey: I think it did.

[44:37] Portia Pendleton: It did. And I think that's where I was.

[44:39] Dr. Katrina Furey: Just like, this wouldn't really happen. No, it's totally I mean, again, I think once the twist came into play, then you're like, oh, God, that's what this movie is. That's so unbelievable. You know what? I think it's important that we do analyze scripts that we don't like. Yeah. All right, well, I don't want to hold you up any longer. We'll wrap up this episode. Thanks for listening. I hope that whoever's listening isn't Yawning. We'll see. Please don't forget to rate, review and subscribe follow us on Instagram at Analyze scripts. DM us. Send us an email, analyze [email protected] and let us know what you want us to analyze next. Put you to sleep. Like this movie put portion to sleep.

[45:23] Portia Pendleton: Thanks so much for listening.

[45:25] Dr. Katrina Furey: See you later. Bye.

[45:31] Dr. Katrina Furey: This podcast and its contents are a copyright of Analyzed Scripts.

[45:35] Dr. Katrina Furey: All rights reserved.

[45:37] Dr. Katrina Furey: Any redistribution or reproduction of part or all of the contents in any form is prohibited. Unless you want to share it with.

[45:44] Dr. Katrina Furey: Your friends and rate, review and subscribe, that's fine.

[45:47] Dr. Katrina Furey: All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended.

[45:56] Dr. Katrina Furey: Or should be inferred.

[45:58] Dr. Katrina Furey: This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time.

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