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Actress's Depression Helped Her Craft Role as Psychiatrist

Lorraine Bracco's struggle with depression helps her gain insights on just how her character in the HBO series "The Sopranos" should act when she is treating depression.

For the last five years Lorraine Bracco has played a psychiatrist on television, treating the lead character on her show for depression. Now Bracco, who plays Jennifer Melfi, M.D., on HBO's award-winning program "The Sopranos," is telling the world that she has moved into the real-world role of patient: she has suffered from depression, taken medication, and "talked, talked, and talked."

"The irony hasn't escaped any of us," she said at APA's 2005 annual meeting last month in a session hosted by outgoing APA President Michelle Riba, M.D.

Riba noted that it was important to have Bracco address the annual meeting "to discuss the importance of the doctor-patient relationship in overcoming the misconceptions and stigma that keep people from seeking professional care."

Turning to her, Riba added, "Learning about your story is as important to us as it is to the public."

"Indeed, my own experiences with depression helped me to create my character," Bracco added, noting that her yearlong depressive episode was in full swing when the pilot for the now highly acclaimed television show was shot.

Lorraine Bracco: "For over a year, I felt as though life were happening around me, not with me. I was no longer experiencing any joy, any happiness." David Hathcox

Bracco was initially slated by "Sopranos" creator David Chase to play the part of Tony Soprano's wife, Carmela, a role eventually taken by actress Edie Falco. However, Bracco said, she told Chase she really wanted to play Dr. Melfi and gave him only one ultimatum: "I said, `You cannot make me the psycho sex killer in the end.'"

Some see the character of Dr. Melfi as a realistic portrayal of the difficulties in practicing psychiatry, including the delicacy of the patient-doctor relationship.

"We've been fair and just in what a patient-doctor relationship is really like," she told hundreds of annual meeting attendees. Others may disagree on how fair or how accurate the portrayal is.

In one episode, Dr. Melfi's patient, Tony Soprano, played by actor James Gandolfini, remarks, "This psychiatry shit—apparently what you're feeling is not what you're feeling, and what you're not feeling is your real agenda."

That insight notwithstanding, Bracco's Melfi acknowledges on a separate occasion the frustrations of caring for patients when she reveals to a colleague, "I am drinking in between sessions."

The colleague circumspectly replies, "That's very serious."

Melfi, however, clarifies, "Just on the days when I see [Tony]."

Bracco said she drew on her own life in fleshing out the character of Jennifer Melfi, with loneliness being a key. Both she and Melfi, she noted, have had bad marriages or failed relationships, and both have recently "lost" children to college.

Bracco has also used her own struggle with depression to inform the scenes between her character and that of Tony Soprano.

"We'll be going over a script, and there will be a line for me that really is more appropriate from the patient's perspective—that a psychiatrist wouldn't necessarily say. And we'll change it," she said.

In reality, Bracco said, she finds it easy to separate herself from Melfi.

"I hear from people all the time that they talk to their therapists about Dr. Melfi. I assure you, I don't talk to my psychiatrist about Jennifer Melfi," she told press at a briefing following the annual meeting session.

Bracco recounted what she termed "a really lousy decade" that included many traumas. "For over a year, I felt as though life were happening around me, not with me. I was no longer experiencing any joy, any happiness," she said.

Bracco did not realize she had depression until her life was actually "looking up." At that point, she did not consider getting help—she thought she "could handle it" on her own. She now realizes that stigma played a significant role in her delay in seeking treatment.

"I did not want to see a psychiatrist," she explained, "and I did not want to take medication." She was "afraid that medication would take away her range of emotion and interfere with her ability to act.

When she did gain the courage to see a psychiatrist, however, the doctor "listened to my symptoms and really took the extra steps to help me understand that medications were O.K." He helped her "understand how the medications worked, that they would not be a miracle cure, and that they would take time."

As a result, Bracco continued, her expectations for medication and ensuing talk therapy were realistic. Over several weeks, she began to notice she was feeling better.

After about 15 months of medication and more than two and a half years of talk therapy, Bracco feels well and continues to see her psychiatrist regularly but less frequently. She is no longer on medication, but she would not hesitate to take it again should the need arise, she emphasized.

"Stigma was my greatest enemy," she concluded. "I want to help break stigma down and make mental health a public discussion. It is incredible that I'm getting the opportunity to [tell the story of my depression]. I've been told so many times that Dr. Melfi has inspired people. Now I get to try to do that."

Bracco volunteered her time for the event "A Patient's Perspective" and the press briefing that followed. Her travel expenses were paid by Pfizer Inc. She has been working in partnership with Pfizer in its consumer education campaign titled "Why Live With Depression?," launched in March.

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