In his prison office the African-American psychiatrist, much earlier in his life, meets his patient, a Caucasian inmate "17431." (0:05)
The psychiatrist tells inmate 17431, "Shouldn't be too difficult to get you committed when your sentence expires... Should be easy to get a couple of my colleagues, a couple of Jew psychiatrists, to certify you as insane." (0:07)
Inmate 17431 appears to hallucinate a miniature of himself climbing out of the drain of the sink in his cell. (0:13)
We see the chief medical officer's handwritten note: "Possible malingerer to avoid duty. Possibly looking for hideout in hospital." (0:16)
In his office the African-American psychiatrist tells inmate 17431, "... there's nothing organically wrong with you... occasional blackout spells... you find it difficult to fall asleep..."
The inmate, later: "You must be a real masochist."
Psychiatrist, later: "Why can't a negro be a psychiatrist?" (0:16)
The psychiatrist thinks to himself, "After several slow and extremely difficult months of analysis there finally came a knowledge..." (0:21)
Inmate 17431 as a child physically abused by his father. (0:22)
The psychiatrist tells the chief medical officer, "I've worked with guys who are sadistic killers who are more human than this guy." (0:39)
The psychiatrist thinks to himself, "... for although psychopaths are a small minority... a psychopath is the leader." (0:58)
The psychiatrist makes an interpretation: "I represented your father... I represented authority..." (1:18)
The chief medical officer seeks confirmation from the psychiatrist: "... you want him to continue with analysis." (1:22)
Inmate 17431 appears to have learned some psychotherapy interventions himself when he challenges the psychiatrist, "I'm not just one person to you, am I? I'm a symbol, a symbol of everything you fear will destroy you." (1:24)
We never hear the inmate ask the psychiatrist how he might expect all this talk to help his insomnia, his presenting chief complaint. One can easily imagine the inmate simply preferring the psychiatrist's office, and even his company, over his cell. One can hardly imagine this encounter taking place at all outside a prison. Consistent with psychoanalytic approaches as well as some other psychotherapies, neither party seems to mind that there is no overt treatment contract, or that while the psychiatrist seems intent on making the patient less hateful and bigotted, perhaps, if he gave it any thought, the inmate might want help to become a better or more effective nazi. Also consistent with psychoanalytic approaches as well as some other psychotherapies, the psychiatrist seems to believe that enough "analysis" can correct any human trait he himself deems objectionable, regardless of the patient's agenda.
How well does the psychiatrist handle his feelings (Gabbard, in his Psychiatry and the Cinema, predictably refers to these feelings as "countertransference feelings" even though the treatment hardly conforms to psychoanalytic parameters.) toward this man who openly hates him? How likely is it that psychotherapy, even with a psychotherapist of the same race and gender as this patient, could have altered his sociopathic traits, much less his bigotted attitudes, especially since that does not seem to be the kind of help the patient wants? The inmate's portrayal as a nazi bigot seems inconsistent with his apparent ability to trust the psychiatrist enough to allow some vulnerability. Is it all an act?