TV review: Don’t Call Me Crazy

Don’t Call Me Crazy is a documentary series on BBC3. You can watch all the episodes on the iPlayer until next Monday night – 15th July 2013 – if you’re in the UK. At the time of writing I’ve seen the first two episodes, so my review will be based only on those.

The series focuses on the McGuiness Unit, an in-patient mental health facility for young people in Manchester. The unit treats people with a range of problems, including eating disorders, mood disorders (well, depression, anyway; so far we haven’t seen anyone with bipolar), OCD, and psychotic illness. It houses a mix of voluntary and involuntary patients – which is to say people who have chosen to be there and others who have been sectioned under the Mental Health Act. The documentary follows the “stories” of particular individuals, rather than taking a synoptic look at the work of the unit as a whole. It’s constructed by means of fly-on-the-wall observational filming, as well as informal interviews with patients, relatives and staff. The documentary is clearly aimed at audiences who have little or no prior understanding of mental illness.

I should be clear that, while I suffer from mental illness myself, I have no first-hand experience of in-patient psychiatric care. As a teenager I was hospitalised for a while, but I was treated on a general children’s ward rather than in a psychiatric facility – once it had been established that my illness had no organic cause (i.e., that I wasn’t physically ill), I was discharged to out-patient care. It follows that my observations here will be general rather than specific; a recent edition of This Week in Mentalists has a round-up of posts about the show written by people with first-hand experience.

Speaking from my non-expert, generalist position, I thought the first couple of episodes of this were good – better than OK, but short of outstanding.

For the most part, the documentary-makers steered clear of sentimentalising their subjects, even if there was some emotional manipulation in the choice of music. I felt that the patients were being given an opportunity to speak for themselves, although the response of the audience was heavily steered by the narration. One person in particular, Gill (family names were not given), was almost never seen on screen except when she was accompanied by a doom-laden whisper to the effect that she was highly ‘volatile’. The viewpoint of staff members was definitely, if subtly, privileged over that of patients. To take the case of Gill again, she was shown being restrained on more than one occasion and her only comments were the cries of anguish she made at the time; the staff, in contrast, were interviewed at leisure, albeit in general terms, about events of this nature.

Although the narration spoke of the film-makers’ unprecedented access to the unit, this in fact appeared to be somewhat limited – as it presumably had to be. In particular, the ‘acute corridor’ in which the most unwell (or, as it sometimes seemed, disobedient) patients were confined seemed to be very largely off-limits. A consequence of this was that it seemed more like a place of punishment than healing. Patients in the general population were sent there when they had been the cause of some incident or other – most notably the ever-unfortunate Gill – and were subsequently allowed out again, but there was no sense that anything therapeutic had taken place in the interim. It was like they were prisoners being sent to solitary confinement for breaking the rules, rather than patients being taken to a place where they could be given the intensive support they required. This seems unfortunate in a documentary series aimed at the general public, whose impression of locked mental health facilities is that they are pretty much prisons.

There was, in fact, a general lack of emphasis on the therapeutic nature of what took place on the unit. Several people were shown to have recovered sufficiently to be able to leave, but there was no detailed indication of the means by which this had been achieved. I understand why – with the exception of brief excerpts from group- and art-therapy sessions – intimate details of individuals’ treatment were not included in the programmes. Still, the net result of this was to obscure much of the day-to-day work carried out in the unit, with the effect that it seemed more like a care home or residential centre than a hospital.

Each of the programmes opened with a collage of short film excerpts, and one of these featured a psychologist who works on the unit saying something to the effect that the aim of the unit is not to take in people who are sick and send them out healthy. Unfortunately, as a result of the strictly limited coverage of the work undertaken with patients, this is very much the impression that is given by the documentaries. On more than one occasion patients were referred to in staff meetings as showing worrying signs of suicidality or psychosis, and were next seen bright-eyed and bushy-tailed heading off for a home visit as a precursor to leaving the unit, with no information at all on what had transpired in the interim. (The only real exception to this, at least in the first two episodes, came with a patient called Beth’s progress through a supervised eating programme designed to help her overcome her anorexia, which was followed in some detail.)

With only this information to go on, the viewer cannot help but conclude that patients are being sent home healthy, having been cured of their illness by some mysterious means. As a result of this I would have to say that, on balance, the first two programmes did more to mystify mental health treatment than they did to make it clear – which is, I would guess, the precise opposite of what the programme-makers and the staff on the unit had hoped to achieve. A general viewer who came to this documentary with no understanding of how mental illness is treated would, with the exception of a few scattered references to medication and ‘managing distress’, go away regarding mental health treatment as an entirely “black box” process: one in which particular inputs and outputs are observed, but the means by which the latter is achieved from the former are entirely obscured.

An ever more clueless viewer might find themselves confused as to precisely what was the matter with the young people in the unit. Because it was prominently featured in the opening collage at the start of each episode, the same psychologist’s assertion that the patients were not being treated for illness but instead taught to manage distress would have seemed to such a viewer to be the master quote for understanding the work of the unit. They might then find themselves wondering why – if they are not ill, and are merely subject to the same distressing emotions experienced by everyone – these particular young people are being subjected to complex and expensive interventions. As someone with prior knowledge, I understand that distress is the word psychologists who are wary of the term mental illness use in its place, and that they mean by it something that is different to everyday emotion. But a general viewer (or one who automatically thinks the worst of young people, in typical Daily Mail style) might not know this, and might come way with the idea that, for example, anorexics are just fussy eaters, or that people in the grip of psychosis are simply acting out.

In general, I was greatly heartened by the approach taken by the staff, which seemed to focus more on alleviating suffering than it did on stamping irrevocable diagnostic labels on the foreheads of the young people. I was pleased to see that – even in the case of someone like Crystal, whose parents seemed to be almost pushing for a diagnosis of schizophrenia for their daughter – the people on the unit were not being warned of the potential for lifelong ill-health, but encouraged to look forward to the prospect of permanent recovery. I suspect that the choice to talk about distress and coping strategies, rather than illness and treatment, is part of the means by which the staff on the unit achieve that very worthwhile goal, but for the purposes of the documentary it might have been better if they modified their language a little.

There were other things that could perhaps have been handled differently in the first two episodes. It’s a shame – given that, in general, viewing figures tend to decrease for later episodes of a series – that only female patients were featured in the first couple of episodes, with males not due to appear until the last; that may have inadvertently perpetuated the damaging perception that males aren’t affected by mental illness, or are less seriously affected. I was also concerned by the repeated use of establishing shots which showed young people sitting alone in corridors with their heads in their hands as staff and fellow-patients passed by, apparently unconcerned.

I was uncomfortable that the individuals were shown in such a state on TV, since it seemed very intrusive to me, but I was also concerned that they were there to be filmed in the first place. I assume that the staff make efforts to engage with these people, and that they are not left to stew for hours on end – the alternative would be profoundly unhelpful for their recovery. But, because these efforts were not shown, I found it impossible not to worry that the McGuiness Unit is a place of contrasts: a place where outgoing and demonstrative patients are lavished with attention from staff, and spend their time playing pool and dyeing each other’s hair, but where withdrawn and introspective patients are left alone, and to fend for themselves. As I say, I assume that’s not the case, but the inability to be certain has complicated my response to these documentaries.

As a person with mental health problems of my own, which began when I was roughly the same age as the people featured in the series, these were never going to be easy documentaries for me to watch. In fact, that’s why I’m basing this review on the first two episodes, even though the third aired last night – because I’m not sure when, or if, I will gather together the presence of mind to watch the last one. That seems a little overwrought because, unlike some other people with first-hand experience, I wasn’t directly triggered by anything I saw or heard. But I was cast back to my own teenage years, when it was for a year or two touch-and-go whether I would be admitted to such a facility, and I found myself re-experiencing some of the feelings of confusion and utter powerlessness I had at the time; that awful sense that life-altering decisions were being taken about me, but without my input. I think that’s why the footage of the withdrawn, lonely people in the corridors resonated so strongly with me – because I saw myself in them, an image of what I would have been if I had been admitted.

The first two episodes of this series were well put together. They gave the young people who featured in them an opportunity to speak about their experiences on their own terms – perhaps the single most important thing in any such documentary. They showed that the unit was, taking into account the circumstances in which people find themselves there, a remarkably positive and upbeat place. They showed that it was filled with kind, caring staff, who seemed to see their work as something far more important than just a job. The seemingly endless patience and compassion of various staff members who sat and encouraged Beth as she struggled to eat will stay with me for a long time. But those mute, unhappy figures in the corridors – they’ll stay with me for a long time, too.

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1 Response to TV review: Don’t Call Me Crazy

  1. gun street girl says:

    Although I’m in the States and can’t watch the show, I can hazard a guess as to why they don’t show much of the therapy. If it is anything like inpatient treatment here there is precious little of it. Places that accept voluntary patients tend to be nicer and provide more actual therapy, whether it’s one on one with a doctor or various sorts of groups (substance abuse, occupational therapy, art therapy, drama therapy, family counseling, recreational therapy, CBT, etc). Places that take involuntary patients on the other hand often have such a range of people with different diagnoses, with different levels of distress, and with varying personal and community resources that any actual therapy is incidental. Insurance companies here will pay for about a week of inpatient care before they decide you are well enough to go home. The hospital spends that time stabilizing you on whatever med cocktail it thinks you need. There are daily therapy sessions, true, but since most of the patients are in various stages of stupor or agitation from their medications and many of them are belligerent or lack basic cognitive skills or just want to sleep, the staff spend the time just sort of managing the patients. That is, when the staff bother to show up. You may see your doctor once a day, for about five minutes. You will see your social worker possibly twice, once when you come in and once when he arrives to tell you whatever accommodations have been made for your release. Other staff consists of overworked nurses and “psych techs”, who are not required to have any sort of degree in psychiatry or psychology. None will provide any therapeutic interaction outside of an established group time.

    You are correct about the acute ward being used as punishment. In one of the hospitals I was in they had three adult wards. I was in the mid-level ward, used for involuntary admits who were not generally troublesome. The acute ward was down one hall, behind huge green metal locked doors. We could hear the screaming down there almost constantly. When anyone acted out on my unit they were almost immediately threatened with restraint and “a few days down the hall”. It shut most of us up pretty quickly. People were often admitted directly to the acute ward and then when they stabilized they would come to our unit where they usually sat in a corner by themselves and looked terrified. The third ward was for voluntary patients. It was up a couple of flights of stairs and over on the other side of the building. It took me a while to realize it was far away so that the “nice” patients wouldn’t hear the screaming. We called it “the Promised Land.”

    People do sit around a lot with their heads in their hands. They also pace endlessly and pick their hair and stare at the floor. There is not a lot else to do.

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