Sunday, November 02, 2008

Psychiatry, Hollywood Style

Warning: early plot spoilers...I don't discuss the end at all.

I went to the movies last night and saw The Changeling. It was an intense, riveting movie. Based on a true story: the year is 1928, the town is Los Angeles, and 9-year-old boy is missing, his single mother is terribly distraught, and 5 months later the boy is returned to the mother except, oops, wrong child. There is a side plot about the corrupt police department, and they are using the mother-child reunion as an example of how things sometimes go right, so no one is happy when the child who claims to be the missing Walter Collins steps off the train and mom is not over-joyed. Pictures are taken, and the police chief convinces mom that the boy has changed with time. Take him home on a 'trial basis,' really, this shorter kid is yours. The dentist and teacher confirm that it's not the right kid, but the police have their own doctors in hand, and oh no, they all manage to paint mom as being paranoid when she wants the police to re-open the case and find her the right kid. In the meantime, she's got this other kid hanging around who calls her Mommy.

Mrs. Collins gets agitated while talking to the police chief who simply insists, we got you the right kid. He has her taken away to the psychopathic ward. The staff are emotionless, the place is bleak, the rooms are cells with bars and the room doors have windows with hatches. The patients are all unwashed (though Angelino Jolie's makeup never comes off) and they are dressed in hospital johnnies to make certain they look all the crazier. Medication is forced, and if you smack the shrink, you're hauled off for immediate and un-anaesthetised ECT where the button gets pushed by blank-faced nurses who have no thoughts of their own. And if you refuse to sign a paper saying the police were right, they did nothing wrong, and the kiddy they gave you is yours, same thing-- more ECT, especially if you say to the shrink who asks for the signature, "F** you and the horse you rode in on." To help matters, the psychiatric ward is full of women who've questioned the police (--this could be a setting in Communist Russia) where it's so much easier to call whistle-blowers psychotic and lock them away forever. My favorite was the prostitute, played by Amy Ryan, who was locked up for claiming one of her clients had brutalized her, and oops he was a policeman. She tells the protagonist, ""You gotta do everything you can to look normal. If you smile too much, you're delusional; if you don't smile, you're depressed." Oh, there was something brilliant about if you don't do either, but I can't remember or find the whole line. The message was a simple one of you can't win and no matter who you are, the psychiatrist finds a way of contorting into something being horribly wrong with you.

It's a pretty bleak view of psychiatry all done Hollywood style.


Anonymous said...

Did they have ECT in 1928? I was under the impression that it was first developed in Europe in the 1930s.

Anonymous said...

Electroconvulsive shock therapy was discovered by Ugo Cerletti and Lucio Bini in Rome, in 1937.

The History of Shock Therapy in Psychiatry

Apparently insulin-induced coma was all the rage in the late 20s.

And didn't Francis Farmer (and a whole bunch of other people) get an ice-pick lobotomy from a psychiatrist in the 1950s?

Psychiatrists of yore performed some pretty barbaric treatments on their patients.

It seems the movie took some liberties with "the truth," though. No surprise there.

(I wanted to use the moniker "Tom Cruise," but setting up a new account for that purpose was too much of a hassle.)

Dinah said...

Hollywood needs you peeps to consult. Call Clint Eastwood.

Roy said...

Anon is right about 1937 being the first description, though I suppose it could have occurred earlier but probably not 9 years earlier.

Insulin shock treatment was first described in 1934 by Manfred Sakel, according to my 1948 third edition of Samuel Kraines' The Therapy of the Neuroses and Psychoses. Insulin was used to induce a "therapeutic coma," usually daily for 15-30 days and lasting 30-60 minutes. Occasionally, the coma resulted in a convulsion, and it was found that these convulsions resulted in improvement, spawning many different "treatment" pathways to achieve these therapeutic convulsions.

Kraines (p487): "There may be convulsions present during the coma; but contrary to Sakel's fears, these convulsions are usually found to be beneficial to the patient. Indeed, some authors give metrazol or use electric shock for patients who are in insulin coma." (p493): "... [other] agents include ... picrotoxin, coriamytrin, azoman, ammonium chloride, camphor, methylguanidine and others."

Metrazol was first introduced by von Meduna in 1935 for schizophrenia, the same year that Moniz and Lima from Portugal described prefrontal lobotomies.

I haven't seen the movie yet, but I guess they must have wanted it to be in 1928 (because of stock market crash?), so they took artistic license on when ECT began.

Anonymous said...

My reference was just an internet link, but there are quite a few out there that claim Sakel began using insulin therapy in 1927. I suspect the internet sources just copied one another, so no way am I standing by their credibility.

Sakel published his first book in 1935:

Neue Behandlungsmethode der Schizophrenie. 1935.

(Again, according to the internet)

Anonymous said...

That was snarky, Dinah. :)

Neuroskeptic said...

The portrayal of ECT in movies has long been inaccurate. There's even a paper about it:

The Portrayal of ECT In American Movies

Of course, these are works of fiction, so there's no reason they have to be completely realistic. Especially since the reality of ECT is pretty boring, at least since the introduction of muscle relaxants and general anesthetics. It's just a pity that a lot of people see the movies and think that's how it really is.

Anonymous said...


This story on psych central suggests that maybe the portray of psychiatry in that movie isn't as far off as you think it is:

Texas Mental Hospitals: A Haven for Abuse

And I am shocked that everyone is forgetting about Esmin Green and the person in the North Carolina psych hospital who died after being ignored by staff.

Obviously, these stories doesn't mean that it it is this way in all psych hospitals. But I have read too many different accounts of horror stories that suggest this is a big problem.

Unfortunately, it will never be truly studied because you can't believe "mental patients" and everyone who complains is a scientologist who just wants to start trouble.


Anonymous said...

Thanks for the heads up. I will not be seeing this movie. I have enough real memories of inpatient treatment to try & make sense of.

Synchronicity said...

I don't think I want to see this movie. So what is the consensus? Is this an accurate portrayal or not?

DrivingMissMolly said...

It is the early 90's. I spend my 21st birthday in a psych hospital. Depressed. Suicidal. Referred by our marriage counselor.

They won't let me out. I tell my psychiatrist at the time (my first shrink), that I am not getting better and I want out. I am also concerned about the expense. He refuses to discuss fees and charges with me and threatens to call an ambulance to take me to the state hospital the two times I tell him I need to get out.

Everything is deteriorating and I have become hated on the unit. I am bored and perpetually on suicide watch, so I am not allowed to attend any groups outside the unit.

A weekend nurse that I always clashed with said I was 'manipulative.' I really reflected on that. It surprised me. I never thought of myself that way.

I looked around at the patients who got out for reasons other than that their insurance was running out.

One day I decided pretending to be better was the only way to get out.

I started dressing nice, fixing my hair, going and participating in group. I got off suicide watch in no time and continued the charade. I felt beter. Yes. I slept better. Yes.

I got out. I was there 6 weeks.

This was at a hospital raided by the FBI a few years later. Why? Fraudulent insurance billing. Yeah, that'll get the authorities coming. Never mind what happened to us patients......


DrivingMissMolly said...

You can look it up.

Psychiatric Institute of Fort Worth.

They don't exist anymore.

Anonymous said...

I haven't seen the movie yet but my inpatient experience in Alabama was certainly that bad. There were bars on the windows, no patient was allowed outside or allowed any natural light or fresh air whatsoever, lack of cleanliness was the norm. I was issued a small bar of soap and no shampoo and billed 7 dollars a day for shampoo though I luckily had a friend bring me some nice shampoo a few days in. She also brought me maxi pads because the hospital refused to provide any sanitary protection products and I did get one 5 minute session with a pshink every other day though I was billed 200 bucks a day for psychotherapy. The whole party cost me 1000.00 a day. Luckily I sued and didn't have to pay the bill but I'm the exception I think. I was released because my friends hired a lawyer who started calling the hospital on my behalf though I think, like someone else wrote, if you start making your bed and go to all ordered activities it might help you get out quicker or at least be less abused. The comment that if you smile you're psychotic and if you don't you're depressed is right on point. I think I'll see the movie.

Gretch said...

I identify with miss molly. I've spent some involuntary time in psych hospitals and I have learned the types of behavior that get you "out". Eat your food. Sleep normally. Talk to other patients. Participate in groups. Shower. Don't argue with staff. Don't get too much energy. I am sure that not all patients have enough judgment or reasoning ability to fake behavior while they are in an acute episode of illness but there are plenty who are well aware of what they need to do to get out.

A patient who is educated about psych diseases, what it means to be in the hospital and the involuntary commitment laws in their state can easily figure out how to get released. I don't think that shrinks try to keep this a secret, do they? I mean, they tell you to make goals to progress toward being released. But how much credibility does our behavior actually have in terms of being released. How do you decide when we are "faking" it?

Yes, it feels manipulative. It is lying to get what you want. But when you are involuntary you have no control over how or when you are released except to "prove" you are "better".

During my first time in a psych unit, I didn't understand what the laws were and what I was supposed to be doing while I was in the hospital. I just wanted out. I was honest about that with the staff. They'd ask me what I'd do when I got out. I told them I'd march straight to the store to buy more Tylenol and overdose again. Well, apparently that isn't the way to get out of the hospital.

Anonymous said...

Dinah, thanks for the interesting review. Angelina as a psych patient? Definitely one for me then. And that's a great description of the Catch-22 that (locked up) psych patients find themselves in.

Anonymous said...

I've heard it this way, though I've never tried it, but it makes sense due to the real point of psych hospitals, punishment - if you want to get out of a psych hospital beg to stay, if you want to stay, beg to leave.

Monica Cassani said...

oh yeah, psychiatry is that bad for a lot of folks...

most people in the mental health field don't want to face the reality because it's too disturbing to realize how one is hurting the people they are charged to help...

I speak as a (happy) ex-mental health social worker and an (unhappy) soon to be ex-patient. Yup, after four years of drug withdrawal I'm almost off the last bit of the 7 drugs I was grossly over prescribed...

I will never work in the system's very twisted. Though I will work in mental health again...but only as an alternative care practitioner.

Anonymous said...

Sadly, the portrayal of psychiatric abuse in "Changeling" is all too accurate. I don't know whether Christine Collins received ECT or not; the film may have taken liberties. However, ECT was originally administered without benefit of anaesthesia or pain management. As someone who has had ECT with anaesthesia, let me tell you: it's still no picnic. It is crucial that incidences of psychiatric abuse, past and present, be exposed to the public eye. Otherwise, it's all too easy for them to continue. A psych patient in Elgin, IL recently died because, in spite of color-coded warnings on his chart and his food tray - he was given a food that he was severely allergic to. As another commenter said, Esmin Green didn't die in some far- distant medievalesque past; she died in the 21st century. It's clear that people with psych illnesses - or those labeled as having psych illnesses - are still considered to be of less value than anyone else.

Unknown said...

State mental institutions, especially, were havens of abuse until the 1970's, when laws were passed returning rights to patients.
Regarding the use of ECT in The Changeling: obviously false. Pharmaceutically-induced seizures were introduced in the '30s, followed by ECT; it was not practiced in the '20s in US mental hospitals.
On a related note, please visit the following:
an excellent exhibit detailing some of the lives of people involuntarily committed to Willard Asylum in New York. It's an eye-opening display of the horror of forced institutionalization in this country, when, not so very long ago, an employer, neighbor, or disgruntled spouse (a husband,not a wife, of course - the misogyny which is still so rampant in this country was backed by law for most of the 20th century and before). It is only a small example of the shameful conditions that were and sadly, sometimes, still are, found in psychiatric facilities in this country.