‘The Sopranos’

Dr. Herbert Peyser’s Viewpoints article in the June 1 issue is a stimulating, well-written commentary on the behavior of the psychiatrist in HBO’s “The Sopranos.” He criticizes her for treating Tony Soprano, a fictitious New Jersey mobster who has developed panic attacks in midlife.

Viewers learn early in the series that Tony Soprano is a killer and sociopath, and the psychiatrist knows it. Dr. Peyser criticizes the psychiatrist both on moral grounds for accepting such a bad person as a patient, as well as on technical grounds by remaining silent and “neutral” while the patient haltingly, and with much resistance, tells his story. In his opinion, the psychiatrist is incompetent, and if he were examining her for the boards, he would flunk her. Dr. Peyser pointed out, however, that he had seen only a “bit of the show” (several episodes?).

Being a bit of a devil’s advocate, since I agree Tony is a “high-risk, difficult-to-treat” patient whom practically no one should be “required” to accept, I nonetheless disagree with his opinion.

Now that I am (mostly) retired after 37 years of psychiatric practice (and other years as a Navy doctor), my wife and I have time to browse at Blockbuster Video, where, out of curiosity, we took out the first nine episodes of “The Sopranos.” At first, after several episodes, we would have agreed with Dr. Peyser: The psychiatrist was using poor judgment, seeming to countenance violence, practicing rescue psychiatry or “Red Crossing,” at times being unconsciously seductive—overall, she was playing with fire and had bitten off more than she could chew. She was even risking her life as the sinister Capo “Uncle Junior” became aware that his nephew, Tony, might be blabbing to his psychiatrist. She also was the verbal target of several of the patient’s rage attacks.

In later episodes, however (get on down to Blockbuster, Dr. Peyser, and take out a few more episodes), this psychiatrist’s incredible courage, fearless dedication, and commitment to the patient emerge. By the ninth episode (that’s as far as we’ve gotten since we don’t have HBO), Tony has actually begun to change his behavior: At the last minute, and despite his ambivalence, he has canceled a “hit” on a soccer coach who had seduced a teenaged friend of his daughter and decided (after consultation with the psychiatrist) to leave the coach’s punishment up to the police and courts.

Thus, as we continued to watch, we felt that “The Sopranos” is a fascinating, beautifully written, and brilliantly cast series that portrays a psychiatrist as a complex woman and psychiatric physician who exemplifies the highest values of our calling: courage and commitment to the individual patient, but not without that “certain risk to one’s own personal safety” that Justice Holmes averred was necessary to being truly alive. I’m also reminded of Freud’s comment on being asked what he planned to do now that he had to go into private practice to support his family: “I plan to do my best by whatever patient comes my way. . . .”