Psychiatrists watch TV and movies just like everyone else and, these days, there are plenty of issues for them to analyze within popular media.

For starters, it seems as if every other film or TV show nowadays features at least one character with a mood or personality disorder — like Tony Shalhoub's role on "Monk," as a brilliant police consultant who's afflicted by obsessive-compulsive disorder. Then there's depression-prone mob boss Tony Soprano, a character that has achieved pop-culture immortality.

But light years away from the common mood disorder are the psychotic personalities (which have become media staples) — and the people who are fascinated by them. A few weeks ago, "Mr. Brooks," starring Kevin Costner as a high-functioning serial killer, was released — but I seriously doubt this film will be revered the way "Manhunter" (1986) or "Silence of the Lambs" (1991) now are. Murdering types in film used to be feral and virtually mute, but these days they're portrayed as strangely charismatic and intellectual — like Anthony Hopkins' version of Hannibal Lecter.

But what do any of these characters and genre films have to do with reality? And, for that matter, what about psychiatrists as portrayed in TV and film — are they similar to the real thing?

Dr. Kimberly Vest, president of the Pennsylvania Psychiatric Society in Philadelphia, said yes and no.

"Some aspects of mood disorders and other illnesses as portrayed in the media have changed for the better — there's more realism in many cases," she said. "But there's still a lot of distortion and fearfulness attached to certain conditions, so there could be more improvements here and there."

She praised "A Beautiful Mind," the 1998 film inspired by mathematician and Nobel laureate John Nash and his experiences with schizophrenia.

"It's a complex portrayal of the condition," Vest said. "And we've talked to some patients about the movie because viewing it may be useful.

"It showed that you can have a life around an illness like that; you can have a meaningful career and relationships," she said. "But it didn't gloss over the challenge family members had to go through when dealing with (Nash). So it was realistic."

For many, it also cleared up what schizophrenia is — a psychiatric diagnosis characterized by impairments in the perception or expression of reality, most commonly as auditory or visual hallucinations.

Before, many films, like "Me, Myself & Irene," erroneously referred to people with dissociative identity disorder as schizophrenic.

"A schizophrenic doesn't have multiple personalities," Vest said. "And 'A Beautiful Mind' cleared that up for some people."

In the case of OCD, she said, some patients have made references to "Monk."

"That show has plus and minuses," Vest said. "I mean, you know, OCD isn't that funny in real life, but then again, the character is sympathetic, and has inspired a lot of awareness for the condition."

But that doesn't mean humor and psychiatric issues don't always mix, she said.

"Sometimes humor can be mocking," she said. "But it doesn't have to be. Sometimes laughing about something just means you're being rueful, laughing at the absurdities of life and being human."

In a completely different vein of psychiatric issues and popular media, there's the public's fascination with psychotics or serial killers.

During the '90s, "The Silence of the Lambs" and David Fincher's "Se7en" seemed to give killers A-list box-office status.

Of course, psychotics as cinematic figures go back at least to Alfred Hitchcock's "The Lodger," which was inspired by the director's interest in Jack the Ripper.

But still, the interest in movie serial-killers really didn't gain momentum for decades — and strangely, not until after the '70s, when it seemed like so many real-life examples (Ted Bundy, The Zodiac Killer) were in the news.

Of course, there are cynics who feel the line between fame and notoriety has become so blurred that celebrity is only defined by whatever it takes to get the public's attention (this would explain Paris Hilton, wouldn't it?).

But others, like Vest, said there's a natural human tendency to be fascinated by deviant and criminal behavior.

"It's curiosity inspired by whatever is different," she said. "It's what we know as morbid fascination, which most people have felt one time or another."

And what about the patient/doctor relationships we see in TV and film — like Dr. Melfi and Tony Soprano?

"What's wrong with the (Soprano/Melfi) relationship is complicated," Vest said laughing. "But for starters, he wasn't honest with her, and kept a great part of his life secret.

"Now, many people aren't 100 percent honest in the psychiatrist's office, and usually it's a knee-jerk reaction when people conceal certain things — and people aren't always conscious when they're doing it," she said. "But Tony hides things deliberately, even admits to her that he's doing so because of his criminal activity. There's no trust there, and that means the therapy could never be really effective."

Vest said her all-time pet peeve when watching a film or television show featuring a psychiatrist and patient dynamic is the "eureka" moment.

"You know, the single breakthrough moment in the psychiatrist's office where the patient suddenly understands everything about themselves and they seem cured," she said. "Breakthroughs in therapy almost never happen like that.

"In fact, therapy is like having braces," Vest said. "You can't see your teeth straightening out, it's something that happens over time. And then one day, they're suddenly straight. It's a gradual thing that comes with time and patience."

As a psychiatrist, Vest said she was taken in by the very publicized row between Tom Cruise and Brooke Shields.

We all remember that one, don't we?

It was the spring of 2005, and Shields began to speak to reporters and Oprah Winfrey about her battle with postpartum depression — an experience that included, for Shields, depression, thoughts of suicide and delayed maternal bonding.

Then in May 2005, Tom Cruise (at the beginning of his tweaker phase), a Scientologist whose religion frowns upon psychiatry, condemned Shields for using the antidepressant drug Paxil — among other things.

"That was interesting," Vest said. "It started a serious dialogue about postpartum depression between people in the streets and on the Internet, everywhere."

In August of 2006, Cruise privately apologized to Shields for the incident, and Shields accepted, saying it was "heartfelt."

"Lots of people came to (Shields) defense at that time," Vest said. "And it was gratifying to hear from so many who were well-informed on the subject — which shows how much people have started to take psychiatric issues seriously — without the fear of stigma.

"When you're going through a problem like that, it's always good to have allies," Vest said. "That's what everyone should know."

Culture Shocked! is an award-winning pop culture column written alternately by Carla DiFonzo and Jed Reinert. E-mail is welcome at cdifonzo@lnpnews.com and jreinert@lnpnews.com.