International Review of Psychiatry, June 2009; 21(3): 218–223

Malayalam cinema and mental health

KORAVANGATTU VALSRAJ MENON1 & GOPINATH RANJITH2

1Department of Psychiatry, East London NHS Foundation Trust, London, and 2Department of Liaison Psychiatry,

St. Thomas’ Hospital, South London and Maudsley Foundation Trust, London, United Kingdom

AbstractThere is a tradition of using films to teach various aspects of psychiatry and we feel that Malayalam cinema can also be usedsuitably to teach effectively. These films can be an invaluable resource in cultural competency training as they depict theeffects of culture on psychopathology and cultural and regional influences on attitudes to mental illness and stigma. We alsonote that the portrayal is often far from reality but this is not a barrier for using the films as an effective alternative totraditional and didactic teaching methods. This method of teaching can stimulate interest and discussion and demystify themyths of novice students and others about mental health.

Kerala and Malayalam cinema

Kerala is the southern-most state of India. The state

has a population of 31.8 million. Malayalam is the

official language of the state of Kerala and the people

are referred to as Keralites or Malayalis. Malayalam

is a Dravidian language and is spoken predominantly

in the state of Kerala but a large population of

Malayalis live outside Kerala in other Indian states as

well as around the globe – particularly large groups of

Malayali diasporas are found in the Middle East,

North America, Western Europe and Australia. They

form their own communities in these places and a

popular form of entertainment is watching films in

Malayalam.

Malayalam cinema refers to films made in the

Indian state of Kerala in Malayalam. Malayalam

cinema forms a small but significant component of

Indian cinema and films have been produced since

the late 1920s. Currently there are between fifty and

hundred films released per year. Cinema is a popular

form of entertainment. Malayalam films have a wide

overseas distribution. These films are also easily

available as video, CD or DVD at south Indian

outlets and can be viewed on the Internet and other

regional subscription TV channels which are also

freely available across the globe.

Mental illness and Malayalam cinema

There has been a tradition of portraying mentally ill

patients and mental health professionals in movies

from the early part of last century (Gabbard &

Gabbard, 1999). This is true of Indian films

including ones in Malayalam. There is also an

impression that the portrayal changes with time and

is dependent on the year of release, suggesting that it

is influenced by the social, cultural, political and

economic context (Bhugra, 2005). Malayalam

cinema is known for tackling social issues and is

more realistic than the formulaic nature of commer-

cial films in Hindi popularly called Bollywood. Even

when some of the Malayalam movies portraying

mental illness are based on successful Hollywood

movies, they have been remade with suitable

adaptations to fit in with the regional cultural

context.

Psychiatric educators have long advocated teach-

ing psychiatry through cinema and we feel that

Malayalam cinema can also be suitably used to teach

effectively. In addition to points generally made

elsewhere and in other articles in this issue there may

be specific instances when Malayalam films may

prove useful:

1. In teaching undergraduate and postgraduate

students in Kerala aspects of psychiatric pre-

sentations, attitudes, etc. Most of the teaching

still relies on textbooks and teaching material

prepared in the west; the use of clips from

Malayalam films would provide a local flavour

and facilitate the educational process.

2. In areas where there are large Malayali dia-

sporas these films may be used to educate local

staff about issues related to mental health

Correspondence: Dr Gopinath Ranjith, Consultant Liaison Psychiatrist, Adamson Centre, St. Thomas’ Hospital, Westminster Bridge Road, London, SE1

7EH, UK. Tel: þ44 (0)20 7188 6008. Fax: þ44 (0)20 7188 6020. E-mail: g.ranjith@iop.kcl.ac.uk

ISSN 0954–0261 print/ISSN 1369–1627 online � 2009 Institute of Psychiatry

DOI: 10.1080/09540260902748043

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presentations, attitudes and beliefs in the

community.

3. These films could be used in public education

campaigns both in Kerala and in Malayali

communities elsewhere.

4. Malayalam films could prove handy in cultural

psychiatry seminars and cultural sensitivity

training.

The films we describe in this article may be used in

a variety of ways to suit the learning needs of the

target audience. Clips may be used to illustrate

points made in an educational lecture, scenes may be

used to facilitate a group discussion and an entire

film may be viewed before-hand and discussed in a

seminar. For teaching, the fact that the depiction of

psychiatric patients and professionals are often not

realistic is not a major problem as in such clips can be

used effectively to stimulate a small group discussion.

Methodology

We identified the films that portray mental illness by

contacting various experts by telephone, e-mail

correspondence and personal interview. We also

went through website links to get complete listings of

films and we then discussed with experts and chose

the films that depict mental illness. We also did a

literature search to identify any articles on

Malayalam cinema and mental illness.

We looked at the portrayal of mental illness,

mental health professionals, mental health institu-

tions, treatment modalities and issues relating to

stigma and discrimination. Our aim in this paper is

not to provide a comprehensive review of all films

that depict these issues. Instead we discuss films that,

in our opinion, best illustrate the issues that we

discuss in greater detail below. Our primary aim has

been to choose films and clips that could most

effectively be used as teaching tools. The films are

listed in the Appendix.

Portrayal of mental illness

Film makers are interested in delving into the depths

of a character, and mental illnesses provide an ideal

vehicle to do so. Malayalam film makers, like their

counterparts elsewhere, have made abundant use of

characters with mental illnesses as well as psychia-

trists. The portrayals do not always fit in with

psychiatrists’ notions of mental illness but may

reflect lay perceptions. In this section we look at

how films understand the development of mental

illness and their manifestation.

Thaniyavarthanam (Exact Repetition, 1987) the

illness is shown as hereditary, but this does not

necessarily imply a medical explanatory model or

treatment. The family and the entire village are

convinced beyond doubt that it is the result of a curse

from the goddess and is treated with religious ritual

and ceremonies. There is tension between the old

and new generation in a joint family with regard to

the customs, traditions, superstitious beliefs and the

belief in a religious cure. This film is a good example

of societal and familial influences on the develop-

ment and course of mental illnesses. Other films that

take a more psychological approach to aetiology seem

to subscribe to the notion of a single traumatic event

as responsible for the mental illness – good examples

are Ulladakkam (Content, 1991), where witnessing

her boyfriend’s brutal murder is the precipitating

event of the illness in the female lead character, and

Thalavattam (Circle of Rhythm, 1986) where the

death of the hero’s fiancee brings on the onset of the

mental illness. Aham (Self, 1992) stands out in this

respect by emphasizing a more rounded formulation

and may be described as an intensive case study –

childhood emotional deprivation and pre-morbid

personality traits are shown as predisposing to

delusional jealousy. The possession state of Ganga

in Manichitrathazhu (The Ornate Lock, 1993) is also

traced to a childhood characterized by parental

neglect.

We have noted that even for the movies released in

the last two decades directors prefer to stick to

stereotypes of portraying mental illness – one of the

commonest stereotypes is the patient who behaves in

hospital as if he were in his previous role. Examples

from Ulladakkam are the railway station master who

continues to wave his flag to stop trains and the

school headmistress who behaves as if others in the

hospital are her pupils. Even when the depiction of

the main character with mental illness is sympathetic

the bizarre behaviour of other patients are shown to

elicit cheap laughs from the audience. This corre-

sponds to the description of psychiatric patients as

zoo specimens (Hyler, Gabbard, & Schneider, 1991).

It is not clear whether such portrayals are a result of

the film makers’ lack of awareness of mental illness or

the need to give primacy to entertainment.

Psychopathology and diagnosis

The depiction of psychiatric symptoms, particularly

those not reflected in outward behaviour, has always

been problematic for film makers. Violence and

aggression are usually the main features of the

mental illness rather than symptoms such as delusions,

depression or anxiety. In films such as Ulladakkam and

Aham the patient, under the influence of a mental

illness, commits homicide. Films depicting a normal

person being labelled as mentally ill have been a staple

of Hollywood and it is Thaniyavarthanam where the

attached label becomes a self-fulfilling prophecy. The

Malayalam cinema and mental health 219

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thin line between sanity and insanity is also the theme

of many films with the psychiatrist in Sesham

repeatedly referring to the patients as suffering from

distress rather than mental illness. Psychiatric symp-

toms shown in Malayalam films include hallucinations

(Aham), obsessions and compulsions (Aham), psycho-

genic amnesia (Innale-Yesterday, 1989), delusional

jealousy (Vadakkunokkiyanthram-Compass, 1989).

Culture has a pathoplastic effect on the expression

of psychiatric symptoms, and films made in non-

western contexts may be a good way of teaching

cultural differences. The fascination of western film

makers with dissociative disorders such as multiple

personality disorders in films such as The Three Faces

of Eve and Sybil has been much commented upon.

Manichitrathazhu depicts a dissociative disorder that

is not uncommon in that part of the world –

possession syndrome (Somasundaram, Thivakaran,

& Bhugra, 2007). There are scenes depicting self-

harm and suicide in films: self-harm by self-lacera-

tion and head banging are shown in Ulladakkam and

Sesham (Thereafter, 2002) respectively and Aham

ends with the main character committing suicide by

hanging. A homicide-suicide is depicted in

Thaniyavarthanam with the mother poisoning the

son who is labelled mentally unwell to relieve his

suffering and later ending her life; in Thalavattam it

is the friendly psychiatrist who performs the act of

mercy killing on the patient who has been made

comatose by psychosurgery.

Diagnoses used in films often do not correspond

with psychiatrists’ ideas or diagnostic manuals

(Hyler, 1988). In Vadakkumnathan (The Lord of

the North, 2006) the diagnosis of the main character

played by Mohanlal is supposed to be bipolar

disorder but apart from irritability and impulsive

aggression no characteristic symptoms of mania or

depression is shown. ‘Sea phobia’ is mentioned as

the diagnosis of the female patient in Ulladakkam,

but the behaviour and symptoms suggest a psychotic

rather than a neurotic disorder. Similarly possession

state is mentioned as a diagnosis in Manichitrathazhu

but conversations between the psychiatrist and the

traditional healer refers to a psychotic disorder. From

a psychiatric point of view the diagnosis of

Sidharthan in Aham might be considered to be

anakastic personality disorder with symptoms of

obsessive-compulsive disorder with the gradual

development of a psychotic disorder characterized

by auditory hallucinations and delusional jealousy. In

Sesham it is unclear if the main character has a

mental illness or lacks daily living skills as a result of

being institutionalized.

There are instances where films perform an

important role in drawing attention to a neglected

disease or disorder (Rao & Krishna, 2008). The

demographic changes associated with Kerala

have resulted in a life expectancy of about 75.

Epidemiological research has shown that dementia is

likely to be a major problem in Kerala but people

often consider it a natural part of the ageing process

(Shaji, Bose, & Verghese, 2005). In this context the

film Thanmatra (Molecule, 2005) which has a

sympathetic portrayal of a middle-class family

coping with early onset dementia in the bread

winner is likely to increase awareness about this

disease and perhaps lead to more resources for

psychosocial care. Scenes from this film are ideal for

public education sessions.

Mental health professionals

In most of the Malayalam movies the key mental health

professional is the consultant psychiatrist. The other

professionals shown are nurses and other auxiliary staff,

but their role seems confined to carrying out the

instructions of the psychiatrist. One good example is

Nurse Rachel in Thalavattam who, though clearly

modelled on Nurse Ratched from One Flew Over the

Cuckoo’s Nest, is a much less scary and authoritarian

character perhaps reflecting the role of nurses in the

traditional hospital hierarchy. Schneider, in the context

of Hollywood films, classified the portrayal of psychia-

trists in films as Dr Dippy, Dr Evil and Dr Wonderful

(Schneider, 1987). In Malayalam cinema we also note

the presence of a Dr Saviour who is desperate to save

the patient, in the process becoming emotionally

entangled. The best example of Dr Wonderful is the

psychiatrist played by Mohanlal in Ulladakkam. The

psychiatrist played by the same actor in

Manichitrathazhu may be described as a combination

of Dr Dippy and Dr Wonderful. Both these films also

perpetuate the notion of the psychiatrist as a detective, a

common trend in Hollywood. In the former film Dr

Wonderful’s image is built up by showing other

psychiatrists as rather ineffectual and looking up to

him – the scene showing him charming an aggressive

patient to give up a sharp weapon is ideal for

demonstrating to medical students and novice psychia-

trists how not to approach a dangerous patient!

Fortunately Dr Evil is not commonly encountered

in Malayalam films, the only exception being the

hospital director in Thalavattam. This film has three

psychiatrists, giving viewers a chance to compare and

contrast them. Dr Unnikrishnan is certainly

Dr Good if not quite Dr Wonderful and the female

psychiatrist is shown as an over-involved Dr Saviour.

It is also pertinent to note that when a female

psychiatrist makes a rare appearance the only inter-

vention she can offer is love. This may say something

about prevailing gender stereotypes.

There are several interesting observations in

general. Psychiatrists are mostly shown as well-

intentioned except in the examples shown above of

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the evil psychiatrist. When not played by one of the

main actors they are generally benevolent but

unspectacular characters. The popular perception

of psychiatrists as oddballs often finds mention

in Ulladakkam. The psychiatrist’s mother says

‘I shouldn’t have let you become a mind doctor’.

The viewers are invited to consider the antics of the

psychiatrist in Manichitrathazhu as an understand-

able part of his profession. In Sesham the film maker

tells the psychiatrist that the local public considers

him as mad as his patients. Such scenes could be

used to stimulate medical students to discuss

attitudes to the profession and to dispel myths.

Ulladakkam also examines the effects of a patient’s

violent behaviour on a psychiatrist. The psychiatrist

has shut himself off from society for seven years after

the murder of his wife on their wedding day by his

patient and is only able to move on once he has

forgiven her.

While most films with a central mentally ill

character depict a psychiatrist, there are some

exceptions. Professor Bharatha Pisharody, the char-

acter played by Mohanlal, in Vadakkumnathan is

shown as having received psychiatric treatment in the

past, but psychiatrists don’t make an appearance in

the film. Instead an Ayurvedic expert on mental

health is consulted for herbal medicines and advice.

It is common in Kerala context for patients to receive

traditional and modern treatments simultaneously.

In Thaniyavarthanam this is played out as a clash of

generations – the patient’s brother initates a consul-

tation with a psychiatrist while his uncle and older

relatives arrange religious rituals.

Boundary violations are as common in Malayalam

films as they are in Hollywood movies (Gharaibeh,

2005). In Ulladakkam the psychiatrist played by

Mohanlal admits his friend’s sister to his hospital and

treats her. He also goes beyond the call of duty and

spends a lot of time with her, though to the director’s

credit this issue is addressed by the senior psychia-

trist in the hospital. But the words used by the senior

psychiatrist, ‘You can be sympathetic but not

empathetic to your patient’, do not make much

sense. Transference is also explicitly mentioned in

the context of a conversation between the psychiatrist

and his fiancee. An even more serious boundary

violation happens in Thalavattam where the female

psychiatrist played by Karthika falls in love with the

patient she manages to cure. It is disturbing that the

senior colleague who supervises the treatment

accepts this state of affairs without censure.

Ethical issues related to consent and confidenti-

ality are also raised by other films such as Sesham in

which a student film-maker is shooting a diploma

film in a psychiatric hospital and in Aham in which a

psychiatrist hands over the tapes of a hypnosis

session to a researcher without the patient’s consent.

In the latter film the patient complains to the

psychiatrist that he had no right to do this.

Mental health institutions

Mental hospitals in films such as Thalavattam and

Sesham are depicted as large asylums with patients

wearing hospital clothes with a number. This may

just be a reflection of reality as large mental hospitals

still exist in the state sector in Kerala. In Thalavattam

the mental hospital is shown as a sinister place with

routine physical abuse of patients. There are other

more positive portrayals as well: in Aham the hospital

is a rehabilitation centre run by the Church and

patients are shown participating in a variety of

activities. The central character Sidhartha Swamy

has his own space with a private library. In

Ulladakkam patients are not generally locked up

and patients do spend time in music, outdoor

activities and go on short day trips. Patients leave

the hospital when they are better, thus conveying a

positive message about prognosis and recovery.

Sesham specifically addresses the issue of deinsti-

tutionalization. The central female character, a

student film maker, is challenged about her social

commitment by her fiance. Realizing that she needs

to do more than just make a film about mentally ill

people, she embarks on a project to rehabilitate one

of the inmates of the psychiatric hospital in the

community. In the end the patient is seen as

returning to the hospital conveying the message

that society is not ready yet to accommodate people

with mental illness. This film may be used in mass

education campaigns.

Many films give erroneous impressions of the

functioning of a psychiatric hospital. In Ulladakkam

the use of Rorschach inkblots (or a cinema version) is

shown as a routine interview technique used by a

psychiatrist in making a diagnosis. Techniques such

as hypnosis and drug-assisted interviewing used

rarely by psychiatrists are shown as routine and

mainstream techniques. The psychiatrist in

Manichitrathazhu comes to a diagnosis on the basis

of ‘psychic vibrations’. Such films could be used to

challenge popular perceptions about the work done

by psychiatrists.

Psychiatric treatments

In most films reviewed in this article psychiatric

disorders are depicted as treatable and various

treatments are shown, though there are some

exceptions. In Aham the nun running the rehabili-

tation centre states that in her centre the only

treatment given was ‘love therapy’. Administration

of psychiatric medications, as well as a common

problem on psychiatric wards, non-compliance with

Malayalam cinema and mental health 221

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medications, is handled with some humour in

Thalavattam. The effect of the medications is usually

to turn the patient into a ‘zombie’ – in

Thaniyavarthanam a mother is shown sobbing

uncontrollably on seeing the physical appearance of

her son who has just returned from a psychiatric

hospital. Herbal medications are prescribed by an

Ayurvedic practitioner in Vadakkumnathan.

Electroconvulsive therapy (ECT) is a favourite of

film makers worldwide, and the situation is the same

in India as well (Bhugra, 2006). Except Thalavattam

where ECT is used as a punitive treatment, in other

films such as Ulladakkam, Thaniyavarthanam and

Vadakkunokkiyanthram it is essentially therapeutic.

The objection, from a psychiatric point of view, is

that the indication for ECT is always aggression and

violence while in actual practice it is indicated in

severe depression and catatonia. In fact one would

walk away with the message that the only treatment

in the armamentarium of psychiatrists for aggression

is ECT. ECT is often shown as being given in an

unmodified form. Though it is given under anaes-

thesia in most hospitals there are still hospitals where

unmodified ECT is given (Andrade, 2003).

Psychosurgery, rarely used in contemporary psychia-

try, is shown as a punitive treatment.

While psychosocial factors are often mentioned as

causative factors sophisticated psychological treat-

ments are conspicuous by their absence in

Malayalam cinema. Cure is often instantaneous and

miraculous and occurs on uncovering the trauma. In

Thalavattam the attention and time lavished by the

female psychiatrist cures the hero, while in

Ulladakkam uncovering the trauma through abreac-

tion does the trick. Treatment of a phobia of water by

exposure to the sea (flooding in a literal sense!) in the

latter film is perhaps closer to reality. The most

dramatic cure is effected in Manichitrathazhu where

the psychiatrist collaborates with a faith healer to

recreate a historic scene where the heroine Ganga is

cured of her dissociative disorder once the alter

Nagavalli is tricked into thinking that she has

murdered her tormentor.

Stigma and discrimination

Many films show how having a mental illness results

in social stigma and discrimination towards the

mentally ill. In Vadakkumnathan the patient’s angry

outburst results in his sister’s arranged marriage

proposal being disrupted. In the end the bride-

groom’s family agrees to the marriage on condition

that the patient does not attend the wedding

ceremony. The effect of having a brother with a

mental illness on his sister’s marriage prospects leads

to the family concealing the existence of the mentally

ill person in Thaniyavarthanam. This may be a new

experience for western audiences who are used to

stigmatizing attitudes at an individual level, and

sensitizes them to considering stigma at the level of

the family (Littlewood, Jadhav, & Ryder, 2007). The

effects of mental illness on marital relationships

may have elements specific to cultures where

arranged marriages are the norm. Two films,

Thaniyavarthanam and Vadakkunokkiyanthram show

the wife being supportive of the husband, but her

family forcing her to leave him. In the former the

wife’s father says, ‘I don’t want my grandchildren to

grow up as the children of a mad man’.

Another film that depicts discriminatory attitudes

towards the mentally ill very well is Sesham.

Lonappan, having left the mental hospital, is put up

in her flat by the film-maker heroine. The members of

the housing association want him removed as he

accidentally caused two children to fall off a see-saw in

the playground. Later, when he gets a job in a school,

the members of the parent-teacher association force

the head teacher to sack him, calling him ‘mad’. That

even doctors are not immune to holding stigmatizing

attitudes is brought home by the scene in Ulladakkam,

where the patient’s brother, a doctor, is reluctant to

admit the patient to a psychiatric hospital.

It is a fact that many psychiatric hospitals have

long-stay patients who do not require hospitalization

but are there only because families refuse to accept

them back. This is forcefully stated by the psychia-

trist in Sesham. It is interesting to note that in

Thalavattam all patients wear numbered clothes and

are referred to by their number rather than their

name. Violence towards patients and unacceptable

methods of restraint are shown in many films. In

Thaniyavarthanam a chronically mentally ill patient

is shown chained in an isolated room of the house.

That such abuses of human rights still endure was

brought home by a tragedy that happened in Erwadi

in the neighbouring state of Tamil Nadu in 2001.

Twenty-seven mentally ill people who were chained

in a mental home run by a religious institution died

in an accidental fire (Sharma, 2003).

The issue of stigmatizing attitudes in movies raises

the question whether movies reflect such attitudes

prevailing in society or contribute to it. The answer is

most likely a combination of the above. Scenes

portraying stigma and discrimination force viewers to

confront and examine their own attitudes to mental

illness. On the other hand, films that equate mental

illness with odd and eccentric behaviour may per-

petuate such attitudes, preventing people from

accessing help in times of distress.

Conclusion

Most discussions of cinema and mental health have

so far concentrated on Hollywood films and

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European cinema and the research being done on

cinema from other parts of the world is encouraging

(Bhugra, 2005). In this article we have concentrated

on Malayalam cinema and examined its usefulness in

teaching in a variety of settings. Some of the findings

are universal in that depictions of psychiatric ill-

nesses, psychiatric professionals and psychiatric

treatments are far from reality. This need not

necessarily be a drawback in using movies as teaching

tools, as such distorted views are prevalent among lay

people as well as students new to psychiatry. Films

may thus be a very effective way of engaging

students, tapping into these attitudes and attempting

to educate them.

Given the globalized nature of today’s psychiatric

practice, it is incumbent on all practitioners to be

culturally competent. Films are a valuable resource

in cultural competence training (Lim, Diamond,

Chang, Primm, & Lu, 2008). We have identified

culture-specific issues in the films under review

including the influence of culture on psychopathol-

ogy, clashes between traditional and modern views

on healing practices and the influence of joint

families and arranged marriages on attitudes to

mental illness and stigma. We hope our review will

spur psychiatric educators to use Malayalam films in

teaching sessions.

Declaration of interest: The authors report no

conflicts of interest. The authors alone are respon-

sible for the content and writing of the paper. Both

authors are from Kerala and now reside in London.

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Appendix: List of films discussed in the

article.

Film Year Director

Thalavattam 1986 Priyadarshan

Thaniyavarthanam 1987 Sibi Malayil

Vadakkunokkiyanthram 1989 Sreenivasan

Innale 1989 P. Padmarajan

Ulladakkam 1991 Kamal

Aham 1992 T. Rajeevnath

Manichitrathazhu 1993 Fazil

Sesham 2002 Rajeev Kumar

Thanmatra 2005 Blessy

Vadakkumnathan 2006 Shajoon Kariyal

Malayalam cinema and mental health 223

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