By Reasons of Insanity; Does this documentary increase or decrease our understanding of mental illness?

Louis Theroux’s new documentary By Reasons of Insanity: Part 1 presents, in my opinion,  problematic depictions of mental illness. These depictions, and others like them, are what create the stereotypes that can be seen throughout television and film industries.

The first and most significant flaw with this documentary is that it discusses ‘mental illness’ without drawing any distinction between mental ill health and criminality. In a separate article Louis does state that “Indeed, in general, people with mental illness are much more likely to be the victims of a crime than the perpetrators” in a separate article (to read click here) but this sentiment is absent from the documentary, and therefore from most people’s experience of watching the documentary. It is very misleading to someone who does not know much about mental health, because it suggests that all mentally ill people are engaging in criminal activity, in particular the violent attack or murders of innocent people. This stereotype is entirely false, but unfortunately not new.

Dr Peter Bryre spoke at a conference examining the relationship between art and mental health titled ‘The Dust of Everyday Life’. He claimed that there are four main depictions of the mentally ill in film and cinema

  • Sad, pathetic and weak people
  • People with funny behaviours to be laughed at
  • People with violent and harmful tendencies
  • People whose illness is easy to ‘fake’

Not only are all of the above statements harmful to society and individuals experiencing mental illness, but they are also untrue. Mentally ill people are neither weak, nor to be laughed at. I strongly believe this includes the people portrayed in this documentary, regardless of their previous crimes or severity of their illness. Bryre explained that it would be far easier to ‘fake’ a physical condition than a mental one, as mental illnesses are often experienced internally, and may not be easily visible, or visible at all, to an onlooker. As for violent tendencies, the amount of people who become violent because of a mental illness is a tiny, tiny percentage of people with mental health problems.

Returning to Theroux, his focus on the violent crimes by people with schizophrenic based diagnosis re-enforces a very common misconception that people with schizophrenia are dangerous. THIS IS NOT TRUE! As Daryl Cunningham, ex-phyciatric nurse and author, writes in his graphic novel Psychiatric Tales, “sufferers of this illness are more likely to be the victims of crime than the perpetrators”. I have had a friend with schizophrenia since my college days, and am happy to report than I remain 100% un-axe-murdered after 6 years of friendship.

There is a focus on the amount of medication prescribed during the documentary, with constant close ups of pills and bottles. I fear this is leaning towards a pill-shaming attitude (read here for more information on pill shaming) from the editors, where anyone who takes large amounts of medication is untrustworthy or should not be taking medication in the first place. I have often been asked ‘Are you sure you need to be taking those pills?’ and ‘When will you try to come off them?’ when I mention I take anti-depressant medication, which I doubt they would have asked my dad when he was taking medication to treat his cancerous stomach tumour.

The only person in this documentary to mention the stigma around mental illness is a woman who also believes herself to be Jesus Christ. It is such a shame that no-one else raises this issue, as the watchers of this film will likely dismiss any comment a patient makes as ‘delusional’ or pathologise it as part of her illness. This touches on as issue raised at ‘The Dust of Life’ conference I mentioned previously. Emma Davie discusses the way in which the label of insanity was used to discredit an individuals choice and opinions, particularly those of women. Although I am not suggesting the woman in this documentary was not mentally ill, I fear that in reaffirming her diagnosis Theroux reduces the validity of her voice. This could be claimed for all the participants of the documentary, whose responses I felt were challenged or, in the case of Cory, laughed at by Theroux.

I have to give credit where credit is due, and mention the parts of this documentary that I thought were progressive in their message. It was great to hear Cory speaking about his childhood, telling us that his childhood had been a happy, un-traumatic one. It is very important to remember that although some people have mental health issues as a consequence of difficult pasts, many mentally ill people have had fantastic childhoods, family and friends. This is so important, because many supporters of mentally ill people are made to feel it is their fault that their child, parent, relation or friend is unwell. This can lead to people not seeking help for fear of being blamed, or people becoming unwell themselves as they torture themselves with guilt.

The fact that many people interviewed had been in the medical system since a very young age felt very important. It highlighted a lacking in medical provision, as people had presented signs of ill health very early on but did not receive effective treatment until they were incarcerated for a crime. Crimes that, in my opinion, may have been prevented had the necessary healthcare been provided early on. This is a healthy critique of the american health care system and it’s approach to mental health, a critique that I would also bring to our own NHS in the UK.

The comments of one patient’s mother were upsetting, but very important in the narrative of mental health and stigma. The woman would not admit her son was mentally ill, asking ‘Do you want me to admit that I gave birth to a nut?’ I refer to my earlier point about the blame surrounding mental ill health. This mother did not want people to suggest that she had done something to produce, in her words, a ‘nut’. Her language is obviously very problematic, but not unusual for people who are prejudiced toward mental illness. At one point she demands ‘Show me his brain. Prove to me it’s different from all of ours’. This reveals another motivator of stigma; mental illness is invisible. Not only that but, as Emma Davie also pointed out in her talk, mental illness cannot be compared directly with physical illness. Not only is it not visible, but far more ‘complex’ and ‘mysterious’ than many physical ailments. Our knowledge of mental illnesses is far behind that of physical illnesses, as phycology is a much younger area of research than physical medicine. The human brain is mostly not understood, and cannot be explained through simple comparison to a broken limb. This can be very confusing and frustrating to people affected by a mental illness, as there are often no scientific explanations of what is going on, or why, or how it should be treated. I have definitely experienced this frustration myself as various doctors, psychiatrists and therapists have suggested pill after pill after pill and various therapies to the point where it felt cures were being suggested on a purely trial-and-error basis.

I could write more about this documentary, but I feel the points mentioned are the most urgent. There are themes of religion, drug use/abuse and sexuality that could also be discussed at length. The BBC says of this documentary that “Louis explores the nature of mental illness.” Mental illness affects so many people, and such a tiny percentage of those people commit crimes, let alone serious crimes, as a result of their illness. I suppose they believe that making a documentary about people like me with mental illness, leading unsensational lives, would be too boring – they are far more likely to get viewers who want to ogle at the crazies, the psychos and the loonies who are being locked away. It reminds me of the time when Bedlam, a victorian lunatic asylum, would charge people entry to watch, laugh at and poke with sticks the patients within. I feel massively let down by Louis Theroux and the BBC.

I am scared that in watching this documentary, people will assume that I am likely to hurt them.

I am scared that in watching this people will be afraid of me.

I am afraid that in watching this people see mental illness as something Other, Detached and Distant from them and their world, when in reality mental health and illness affects every single one of us on some level.

I am afraid this documentary undoes all the hard work people like me, Dr. Peter Byrne, Emma Davie, SAMHMHFthe See Me campaign, and many others are trying to do to make the world a less dangerous and unkind place for people living with mental illness.


Mental Health and Prisons : The Bradley Report

Eric Allison writes in the guardian explaining how the practice of sharing cells is dangerous. Why? Aside from the fact that cells were only ever designed for one person, there have been numerous cases of inmates being harmed by their mentally unwell cell-mate. This paints the image of monstrous mentally ill psychopaths, frothing at the mouth and waving blooded knives around. An image often painted by the media, film and television … and it’s not very helpful. It is inaccurate for a start – very few mentally ill people will experience the blood lust expected of the stereotype. But it cannot be ignored that mentally ill prisoners pose a greater threat of harm to themselves or others. Why is this, and what can we do to prevent it?

The Bradley Report

The Bradley Report was conducted in 2009, exploring the treatment of mentally ill prisoners. It claims that “vulnerable people’s conditions are not being identified or treated, exacerbating mental health problems and frequently leading many to reoffend, self-harm or even commit suicide” It suggests that mentally in and learning disabled prisoners would be “better off serving community sentences”. It makes 82 recommendations overall, including increased awareness training for medical and prison staff, quicker transferals of vulnerable prisoners to specialist hospitals, and the importance to treating mental health early on in children and young offenders. Prisoners with mental health conditioners are not a minority group; “Around 70% of inmates are believed to have two or more mental health conditions. Around one in 10 has a serious mental health problem.”

The Bradley Report Five Years On

A follow up report has been created to see whether recommendations have been followed. There have been changes across the system, even including placing mental health nurses in police stations.  However, the report is tackling an extremely complex situation, as it explains:

“Just addressing the mental health problems or learning disabilities of those exiting the criminal justice system would be challenge enough. However, those leaving the criminal justice system tend to have complex and multiple problems and require a response that can address these. Inevitably this needs to be a multi-agency response.” This report focussing on the English prison system, which is very different to the Scotish context in which I will be working. I would like to explore the similarities and differences between Scottish and English research and provision for mentally ill and learning disabled prisoners.

Who Votes?

Voting is a hot topic at the moment, as we tread the time between the Independence Referendum and the 2015 General Election. The percentage of young voters has been of interest to politicians, with worries that my generation were disconnecting with the political process. Many strategies and projects have been put in place to engage with these voters my parties who are desperate to secure their vote.

Parties are less interested in securing vote from other groups, such as learning disabled and mentally ill adults. I have worked with adults with learning difficulties, and many people are surprised to discover that they are as eligible to vote as I am. Su Sayer writes for the Guardian saying that “many people still believe that people with learning difficulties or mental health needs shouldn’t have the right to vote which is one of the many factors why they vote in lower numbers than the rest of the populations”. Work has been done to make voting more accessible, withEasy Read guides to the polling booth and Easy News newspapers so that people can keep up to date with current affairs and policies that may affect their vote. This means that many people who are often considered ‘unable’ to vote can exercise their voting rights in a supported way. If we look at the Mental Capacity Act 2005 …

Mental Capacity Act 2005

1 (2) A person must be assumed to have capacity unless sit is established that he lacks capacity

1(3) A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success

1(4) A person is not to be treated as unable to make a decision merely because he makes an unwise decision

This clearly undermines any belief that learning disabled adults can’t vote.

But what about incarcerated adults?

Ben Gunn is an ex-prisoner who served a 36 year sentence for a murder he committed aged 14. He blogged during his sentence, critiquing the criminal justice system, and continues to do so on his release. He believes prisoners should have the right to vote because…

“… rights define the relationship between the people and the state … they are the line of demarcation that defines the sphere of the individual from government intrusion … they are absolutes that define the nature of both the individual and the state”

And whose life is more affected by the relationship between state and individual that those in prison? The argument I’ve heard before is that is someone has chosen to break the law, they don’t deserve the right to have a voice about who chooses those rules.

But rights are not to be ‘deserved’ or ‘earned’, all you need to do to have a right is to be human. Gunn claims this is to “prevent governments oppressing unpopular or difficult individuals or groups”. Patients who have been sectioned because of poor mental health are still allowed to vote, because they meet the definitions of capacity outlined in the Mental Capacity Act above. I draw my attention back to the 1(4):

A person is not to be treated as unable to make a decision merely because he makes an unwise decision

Many people in prison are there because they made unwise decisions. Perhaps in the heat of the moment, perhaps due to a longterm lack of support, care, education, advice, emotional or financial stability and a huge amount of other socioeconomic factors. Perhaps because they were forced.

But, unlike any other group in society, incarcerated adults loose their human rights because society believes they lack capacity due to past unwise decisions.