Psychologically disturbed and mentally ill characters are a staple of Hollywood dramas. While screenwriters can occasionally be quite perceptive about human psychology and family functioning, much of the time their creations do not correspond very well with the behavior of actual people who come to see therapists and psychiatrists for treatment. Sometimes screenwriters are in fact utterly clueless.

It galls me, for example, that even psychiatrists are praising Silver Linings Playbook. The movie makes people think that it accurately portrays a patient with bipolar disorder, but spreads common, destructive myths about the disorder. A person does not suddenly come out of a manic episode just because his romantic interest says something pertinent!

In A Beautiful Mind, a patient with schizophrenia is seen being hounded by several characters with distinct, complex, and unchanging personalities, and who always look the same. They turn out to be delusional creations. Psychotic delusions in schizophrenia are never even close to being that complex and static.

When it comes to borderline personality disorder (BPD), screenwriters have actually done somewhat better, although they do not usually understand the families that produce offspring with the condition. There have been a few movie portrayals, most of which have not been completely off the mark.

Glenn Close’s character in Fatal Attraction, the behavior of whom was not completely unlike someone with the disorder, was a bit of a caricature, but the movie gave very little insight as to what may have made her the way she was.

Anne Hathaway’s character in Rachel Getting Married is a recovering drug addict but shows some features of BPD. The underlying conflict this character has with her mother could have been a little more developed. Maybe the screenwriter, Jenny Lumet, wasn’t too sure about what it should look like.

In Girl Interrupted, the Winona Ryder character did not act much like a patient with the disorder at all, despite her having been told by the movie doctors that she had it (“...the borderline between what and what?!”). Again there were no clues given about why she was having difficulties.

The Angelina Jolie character in that movie actually was much closer to someone with the disorder, but she also had strong antisocial features as well. Antisocial and borderline traits do in fact occur together, although more often in men than women. Thus, her character was not what most laypeople who are familiar with the disorder think of when they envision a BPD sufferer. And once again, no clues were given as to what made her do the things she did.

I have only seen two movies which not only portray people with the disorder with some accuracy but also portray them with some understanding of the family relationship patterns that I believe are the primary risk factors for developing the disorder.

The first of these was the theatrical version of Frances with Jessica Lange from 1982. It was highly fictionalized but inspired by the true story of a minor movie star named Frances Farmer who ended up in a mental hospital. Two scenes in that movie really stuck out for me. In the first, Frances cunningly makes her psychiatrist break into a cold sweat by zeroing in on his insecurities.

In the second, when Frances decides not to continue as a Hollywood star, her very hostile and controlling mother, who had tried to live vicariously through her daughter’s success, lies to her psychiatrist. Mom tells him that Francis has psychotic, paranoid symptoms, which in fact she does not have. The psychiatrist, of course, believes the mother and not his own patient.

As good as that movie is, there is another movie that was far more astonishing: Thirteen from 2003. It absolutely nailed the family dynamics of people with borderline BPD. It should have been subtitled, How to Turn Your Teenager Into a Borderline Without Even Being Abusive.

Many critics saw it as a movie about the dangers that young teens face from peer pressure, rather than as a portrait of family dysfunction. Part of the reason these critics missed the point of this movie is that, ever since certain therapists came up with unscientific and at times observation-free theories about the role of parenting in the genesis of schizophrenia and autism, it seems everyone is afraid to examine the role of family behavior in the genesis of any other psychological disorder. This is political correctness gone amok.

The protagonist of Thirteen, Tracy, starts out with very nice peers and fellow students before she begins to gravitate to the “corrupting” peer Evie. Even though Evie is attractive to the boys at school and thus her behavior might represent temptation for a teenage girl, her other more dangerous behavior would be a signal to less fragile teens to stay as far away as possible. To which peer group a teen is attracted is no accident of fate. Peer pressure is a red herring in the movie because these peers seek one another out.

The most fascinating thing about this movie was that it was co-written by then 15-year-old Nikki Reed, later of Twilight fame, and it was reportedly semi-autobiographical. According to Wikipedia, Reed’s parents divorced when she was two, and she grew up with her mother. She describes herself as having been "shy and a bookworm" until the age of 12 when she became rebellious and emotionally volatile. The relationship between Reed and her mother became strained. At the age of 14, Reed was emancipated; she then moved out and began living on her own.

Nikki Reed and co-writer/director Catherine Hardwicke reportedly finished the script for Thirteen in just six days. Ms. Reed must have had a rare insight into her family, especially for someone so young, because the film is just packed with true-to-life details about what growing up in a “borderline” family is like. In the movie, she also plays the role of Evie, although in reality, her story was far closer to the story of Tracy.

Tracy’s mother in the movie, Melanie, grew up without a mother in her teenage years, is divorced, and is a recovering alcoholic. She lets her recovering cocaine-addict ex-boyfriend, Brady, back in her life, to which Tracy reacts with utter dismay and a torrent of criticism towards Mel. “Why are you doing this to yourself?!” she scolds her mother in a role reversal. Tracy is also perturbed because Mel allows her friends and customers to take advantage of her financially. Tracy’s sense of helplessness over her mother’s behavior seems to be what triggers her self-injurious behavior, cutting.

At one point after seeing Mel with Brady, she flashes back to Brady becoming sick from drugs. She then goes to the bathroom and starts to cut herself. It appears that she knows exactly where the implements of self-cutting are and exactly what to do. The strong implication is that she has done this before — and most likely well before she ever met Evie.

Tracy’s only leverage with her mother is her ability to induce guilt in a mother who is completely overwhelmed by the responsibilities of parenthood. Mel’s guilt probably stems from issues in Mel’s own family of origin.

This power is frightening for Tracy. When coupled with her mother’s covert admiration for Tracy’s freedom, it induces Tracy to begin to follow in her mother's self-destructive footsteps and to exceed them. For example, the mother knows that Tracy has started to steal, but says nothing and looks somewhat approvingly at her stolen clothes. When Tracy finally confronts her mother’s denial, Mel responds that she just did not think it "went that far."

As Tracy begins to act out more and more and to learn more self-destructive behavior from her new friend Evie, Mel tries to set limits. However, Mel always seems to back down in the face of Tracy’s guilt trips, sarcasm, and feigned outrage. At one point Mel completely loses her cool in the face of Tracy’s spoiling behavior and goes into her own rage, starting to destroy her own kitchen until Brady comes in and stops her. Of course, Brady becomes overwhelmed and moves away from Mel.

Mel tries to call in Tracy’s biological father to help control her. The father has apparently been a frequent no-show on his days to be with Tracy because he is always busy with his job; Tracy is bitterly disappointed when this happens. After Mel calls him, he comes to see if he can solve Tracy’s problem and demands to know what is going on “in a nutshell” while continually being interrupted by cell phone calls from work. Tracy’s brother throws his arms up in frustration when the father begs him to tell him what is going on. Later Mel speaks of letting the father take over Tracy full time — she says “I’m terrible” under her breath — but Tracy concludes that her mother does not really want her.

Evie comes from an abusive borderline environment. It’s hard to know exactly what is true about her and what is not because of her incessant lies, but Evie describes her mother as a "crack whore." Her uncle sexually abused her and pushed her into a fire — she has the burn marks and a newspaper article to prove that. Her care has been taken over by Brooke, a plastic-surgery addicted cousin, who lets her drink beer, tells her she is not allowed to go to certain places but never seems to really care what Evie is doing, and disappears for days at a time.

Evie secretly yearns to be adopted by Tracy's better-by-comparison family. For reasons I will not mention here (so as not to spoil the ending for people who have not yet seen the movie), she induces her denial-filled guardian to make a mistake similar to the one made by a lot of movie critics: the guardian blames Evie's reckless behavior on peer pressure — from Tracy!

There are a lot more details in the movie — and there is not one single scene that rings false. Nikki Reed seems to know more about the environment that spawns borderline personality disorder than do most therapists and psychiatrists.