I finally got round to watching this programme on the iPlayer. It went out on TV last Wednesday, and so is only available to watch there for another few hours. As always, I’m reviewing this from memory – I didn’t take notes – and so the details may not all be 100% accurate, although I’ve tried to make sure they are.
ETA: I’ve just noticed that the programme is being shown at 11-20 tonight (26.05.10) on BBC2.
Sectioned, which was co-produced by the BBC and the Open University, formed part of a mini-season on BBC4 about mental health; other parts of the season seem to have included a repeat of Stephen Fry’s Secret Life of a Manic Depressive programmes, and a history of the old-style loony bins. In the programme, three men who had been involuntarily confined to hospital – or sectioned, in the language of the title – were visited by a camera crew at various stages. The programme featured some footage shot during interactions between the patients and various members of staff – psychiatrists, nurses, occupational therapists etc – mixed together with informal interviews with the patients and staff members. The patient interviews took place both in hospital and during fly-on-the-wall sections, which followed the men during periods when they had been allowed off the hospital premises.
Overall, I thought this was a pretty good documentary. I had the sense that the main participants – the patients who had been sectioned – were being more or less allowed to speak for themselves, with no obvious distortions introduced by the editing process. The documentary also struck, I thought, a pretty good balance between not dumbing down the subject matter on one hand, and making relatively arcane matters easily understandable to a general audience on the other. It’s frustrating that this programme – which was genuinely well balanced and informative – went out on BBC4, where it will have had, almost certainly, a tiny audience, while the fairly recent Scary Mad People Are Scary, And They All Have Axes, Too, which was neither balanced nor informative, went out on BBC2, where it will have attracted a much larger audience.
The three major participants in the programme were an interesting selection: a retired consultant pathologist called Andrew (as with all documentaries involving mentals, druggies or dossers, he wasn’t afforded the dignity of a surname), who had been diagnosed with bipolar disorder; a former BT engineer called Anthony who had been diagnosed with schizophrenia; and an alcoholic drug addict called Richard who had also been diagnosed with schizophrenia. One of the things I liked very much about the programme is that the narration was careful to use that form of words – ‘has been diagnosed with’ – rather than stating that the participants were schizophrenic or manic depressive. I would like to think this was done to highlight the fact that psychiatric diagnosis is problematic and uncertain, with various different disorders shading into each other at the margins, although it may have resulted from a witless belief that being labelled bipolar or schizophrenic is ‘stigmatising’, but the stigma magically disappears if you use a fractionally different form of words.
Of the three participants, there seemed little doubt that Richard was the most seriously unwell. At some points it was clear during interviews that he was receiving instructions from internal voices before responding. He was the only one of the three who was still detained on section as filming came to an end, and was described as being a voluntary inpatient (though I suspect he was only a “voluntary” patient in the sense of ‘technically voluntary, but will be immediately sectioned by rugby-tackling nurses if he starts walking towards the exit’) on the ‘where are they now?’ captions included at the end of the film. There was also little doubt that he was being presented as the tear-jerking, sentimentalised, ‘awww, look at the poor ickle loony’ figure.
So, for example, we got to hear about the time his mother’s abusive boyfriend threw a pan of hot chip fat at his mum, missed, and hit 7-year-old him, and we got to look over his shoulder – interspersed with shots of him wiping away the tears – as he looked at pictures of himself as a carefree young man on holiday, and we listened as he talked about being sexually abused by a teacher at 14 years old. (Slight caveat: there was physical evidence of the chip-fat incident, so that seems certain. There’s no particular reason to doubt the account of sexual abuse – in fact, I believe him – but I guess it does need to be mentioned that he used the exact same flat, matter-of-fact delivery to talk about how he had been told by god to kill himself on christmas day so that he would wake up in hell on boxing day and would receive the energy he needed to become king of England.) In the closing minutes of the film we were given our final opportunity for a good cathartic cry when he was shown saying that he sometimes wished god wouldn’t talk to him because it makes life so much more complicated.
I am perhaps making too much of this. As these things go, this programme really wasn’t bad, but it was nonetheless obvious that the filmmakers had thought about how to ‘shape’ their material into a pleasing story, and that part of that process had involved identifying a dramatic ‘role’ for each of the participants. Thus Richard was the tortured but self-destructive no-hoper, Anthony the ‘rebel’ (although he talked a bigger game than he played), and Andrew the person to challenge the audience’s preconceptions by being articulate, middle-class and materially successful (in other words, rather like the sorts of people who tend to watch documentaries on BBC4…). As always, it left me feeling uncomfortable that real-life people were being manipulated in this way.
Anthony’s rebel status was established by the fact that he was an outspoken critic of coercive psychiatry. He made a number of very effective points at different stages of the filming, most notably when he pointed out that he could think of no other area of life in which a person would be locked up, not for something they had done, but for something they might do in the future. (The other scenario where such a thing can happen, of course, is if you’re Asian and once went on holiday to Pakistan…) Anthony’s attitude seemed to me to be pretty reasonable, given his circumstances. We were told that, on this particular occasion, he had been sectioned after his daughter reported to the authorities that he had stopped eating, and was refusing to let her into his flat. His only other troubling behaviour at the time – something that his psychiatrist brought up as evidence of how dangerously ill he was – was that, when he was brought to the ward, he was wearing three pairs of trousers. This is undeniably odd behaviour, but I was surprised to see it being brought forward as suitable grounds for detaining someone against his will. His daughter, Marcia, explained that he had been sectioned on previous occasions – 12, if I remember correctly – for such unspeakable crimes as going out without any shoes on, and choosing not to play with his grandchildren.
I was, in fact, fairly unimpressed with Anthony’s daughter. She made it clear on several occasions that she wanted her father sectioned and medicated for reasons that were clearly for her benefit, rather than his. So, for example, she felt that her children might not be safe if they were left alone with him when he was unwell, neatly overlooking the fact that her father has absolutely no responsibility for ensuring the safety of her children – that would be her job, and if she is unable or unwilling to do it then she should surrender her kids for adoption. Suggesting that he should be involuntarily medicated just so she would have access to free childcare seemed to me to be more than a little selfish. She also articulated the view that she felt like she ‘didn’t have a dad’ when her father was ill. This is certainly very sad, but many adult children have estranged or difficult relationships with their parents, and it is not normally considered reasonable grounds to depot-inject a person into docile sociability.
The reason I am making such a big deal of this is that Anthony was so emphatically clear throughout the whole of the film that he did not want psychiatric treatment. Unlike both Richard and, to a lesser extent, Andrew, he was not showing obvious symptoms of disordered or delusional thinking, and did not change his opinion as the severity of his illness (which was never very serious, even when he was being kept under full lockdown) varied over time. He was absolutely fixed and settled in his belief that he did not want or need psychiatric intervention, and that he was happier without it. He repeated that over and over again – ‘I am/ was happy’.
This is, as you may remember, something of a personal bugbear for me. I fully endorse the idea of short-term involuntary treatment for people who may be temporarily acting or feeling in a way that is out-of-keeping with their ordinary behaviour. I think, in such circumstances, keeping people safe until they are able to express their true feelings is not only a good idea, but a duty. That’s not the case with Anthony. His illness was not masking his true feelings. He did not articulate the view – as both Richard and Andrew did – that the psychiatrists and nurses had been correct, and that he was glad of their intervention. He had an absolutely settled and unambiguous wish to lead his life without psychiatric intervention, and only cooperated with it (insofar as he did) because of the threat of more serious punishment if he didn’t.
It’s absolutely clear to me that he should have been allowed to lead his life in the way he chose. It was fairly clear that this would have resulted, pretty quickly, in his death from self-neglect, but that was what he wanted. Even when he was fully compliant with his medication and was considered by the staff treating him to be completely healthy, his view didn’t change – he wanted to be left alone to live (and hence die) in the way he chose. Certainly his daughter and grandchildren would have been upset, but, as I have argued previously, the potential emotional distress of family members isn’t, on its own, a valid reason for the wholesale abrogation of a patient’s human rights.
It has to be said, though – for all his loudly expressed unhappiness, Anthony seemed curiously willing to accede to the conditions he railed against. For much of the time while he was on section he was cooperating fully with the nurses, practically eager in the way he threw himself face-down on a bed in order to present his arse for the needle, and when he was released from section he was punctilious about coming back to receive voluntary injections that had been agreed with his psychiatrist as part of the negotiations for early release. (Coincidentally, I really didn’t understand why, once this period of a ‘gentleman’s agreement’ had come to an end, none of the staff tried to persuade him to keep taking the medication, instead of shaking him warmly by the hand and promising they would see him again soon – by which they meant when he was next sectioned. It seems they pretty much wanted him to be a revolving door patient.)
In fact, I was struck by an even greater level of – what’s the right word? docility? compliance? – in the other two patients. Andrew seemed extraordinarily suggestible – he readily and automatically agreed with any and everything that was said to him, whether by the staff or by the filmmakers, and within a few weeks of being released from hospital had been persuaded back into an obviously unfulfilling marriage by his wife. Richard was not so suggestible, but he did seem extraordinarily naïve. For example, he only seemed to realise after the event that it might have been better not to talk about hearing voices during his appeal against his section. As someone who habitually lies to MH professionals, this did seem to me to be extraordinarily trusting behaviour. I began to wonder if it was just the case that patients with this mindset had been recruited for the programme because they were more likely to cooperate with the filmmakers, or whether it’s people with this kind of friendly, easy-going personality who end up trapped inside the MH system, while people like me who are not bothered by being thought of as aggressive and difficult, and are prepared to lie through our teeth, tend to make our escape. It still gives me shudders to think how close I came to being stuck on antipsychotics, and only my sheer bloody-minded determination and willingness to withstand my psychiatrist’s strongly-expressed displeasure kept me out of the grasp of the MH inner circle.
In any case, I can only say that, as someone with pretty much the same attitude towards coercive psychiatry as Anthony, if I ever find myself in a similar position I will not be cooperating with my captors. I will not be exchanging cheerful banter with them across a ping-pong table, nor making sure to tell them that I like them as people, even as they perpetrate physical, psychological and emotional abuse against me. I will not give them the opportunity to absolve themselves from the guilt they feel as a result of what they do to me.
Not that all of them will feel any guilt. One of the more infuriating/ scary parts of the programme were the interviews with a Nurse Specialist who worked in the field of risk management. At one point he was given the opportunity to spout unchallenged a load of complacent nonsense about how “we’re in the business of giving people a normal life”. Given that he was, at the time he spoke these words, standing inside a locked office in a ward separated from the outside world by an ‘airlock’ double-door security system this was demonstrably nonsense (unless he has very unusual living arrangements at home…). What he meant was that, if you first concede that locking people up and forcibly drugging them is a necessary thing, then we try to do that in as nice a way as possible.
And, you know, that’s good. I watched the programme about the old asylums, and that included tales of patients being half-drowned as punishment by the nurses (and that’s without mentioning the ‘treatments’ that seemed more like punishments). A system filled with people focussed on the idea of being as kind to their patients as possible is hugely preferable to that. The fact remains that this is a terrifyingly complacent attitude. It’s based on the assumption that everything a MH worker does is so obviously in the best interests of their patients there’s no need to ever stop and think about it. Let me be clear, this wasn’t a cynical attitude expressed by a burnt-out old lag: it’s what people who work in MH are taught to believe.
For almost everyone who works in the MH system it’s an utterly unexamined lacuna at the very heart of their thinking. They deal with the awkward question of whether detention without trial of people whose only crime is to have a strongly-held desire to live in a non-standard way – to wear three pairs of trousers instead of just one, perhaps – is helpful or beneficial to the trouser-wearing freaks themselves by refusing to think about the whole area. The thought pattern is obvious – I’m a doctor/nurse/OT, therefore I am interested in helping people, therefore everything I do must, by definition, be helpful to people. It comes from a kind place – most people who go into MH work do so for entirely kind and lovely reasons – but it’s a no less scary attitude because of that.
This was a good documentary. It will have given some insights into the world of the mentally ill for people who knew nothing about it. It will have helped to dismiss the idea that the mentally ill are dangerous – although Richard had been arrested for threatening his neighbour with a knife, and Andrew was arrested after a high-speed chase with the police. It will have shown that, for the most part, they’re funny, down-to-earth, ordinary people. Speaking personally, I’m glad I watched it, but that’s mainly because I’m going though a bit of a dodgy patch at the moment, and was having my usual half-yearly wobble about whether I can cope on my own, or whether I ought to seek help. This programme did the very useful thing of giving me the opportunity to remind myself – you’re better off out of it, Aethelread; you’re better off avoiding the lot of them.