Psychiatry Ethics Film Festival - Do the films really do justice to their aims?

There's a film festival in Edinburgh running from 26 November to the 28 November. It's called the "Psychiatry Ethics Film Festival".

It raises some questions: "Should individuals with certain mental health problems be placed, against their will, in psychiatric institutions? What are the causes of some of these mental disorders? Do some of the disorders run in families? In other words, is it genetic? Is surgery on the brain of a patient possible? Should it take place again their will?"

All interesting questions, and it will "seek to answer some of these questions while leading post-film debates with an ethics expert.
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So, what are the films? (links go to the film festival website [FFW], or the Internet Movie Database [IMDB]):

1. The Eighth Day [IMDB]
2. Girl, Interrupted [IMDB]
3. Mental + Sectioned Double Bill [FFW]
4. Stephen Fry: The Secret Life of the Manic Depressive [FFW]
5. The Madness of King George [IMDB]

What's the problem with these films? Do they help us understand the questions raised above?

Well, The Eighth Day is about someone with Down's Syndrome (Georges) and their friendship with a man who is down on his luck (Harry). No problem with that. It's just that we already know that Down's syndrome is genetic. Although Georges is on the run from an institution, it's not really clear that the story is about this. The story is about the development of the friendship between the two characters.
 
Girl, Interrupted is set in an institution...in America...in the 1960s. Of questionable relevance to British psychiatric hospitals in the 21st Century, perhaps. The main character (played by Winona Ryder) gets a diagnosis of  "borderline personality", and the other key protagonist (played by Angelina Jolie) demonstrates a range of rather dissocial personality traits. It's based on a book by Susanna Kaysen and her experiences in a psychiatric hospital in the late 1960s. At the time, she was given diagnoses of "psychoneurotic depressive reaction" and "personality pattern disturbance, mixed type".

It's difficult to know how relevant or informative this film really is. In a review of the book and film in the journal Psychiatric Services, Dr Jeffrey Geller suggests, "historical accuracy about borderline personality disorder is abandoned. At the time Ms. Kaysen was in the hospital, one could not simply take a book of diagnostic criteria off the shelf, as occurs in the film, and read about "borderline personality". The film needs this distortion to make itself whole." It's undoubtedly a Hollywood creation, and perhaps tells us more about the Hollywood portrayal of mental illness than mental illness itself.

The Madness of King George is a strange choice. Admittedly, King George III displays some unusual behaviour. The problem is that there is a possibility that he suffered from one of a range of physical illnesses. One theory is that he had 'variegate porphyria' [Paper Download], a genetic illness which did seem to exist in his family. Another is that he suffered from arsenic poisoning [Paper Download]. Both are rare conditions that are likely to tell us much about the ethical issues affecting psychiatric services today.

Onto Stephen Fry: The Secret Life of the Manic Depressive. Stephen Fry has become the celebrity voice of Bipolar Disorder. The festival website actually calls it 'Manic Depression', an outdated term. However, I'm not entirely convinced that his experience is representative of many people with Bipolar Disorder. His high level of functioning, whilst not a clear exclusion criteria, is rare for many people with bipolar disorder in community mental health teams. Additionally, he appears to be on no medication yet he is told that he has a severe case. To maintain such prolonged media activity and level of functioning with a severe bipolar disorder, yet be on no medication is difficult to reconcile for most psychiatrists who see patients with affective disorders. Again, one wonders how his case can be matched to some of the aims of the film festival.

The only film which would seem to be of real people with real mental illness in contemporary times is Sectioned, which was shown on terrestrial TV some time ago. The other documentary (Mental: A History of the Madhouse) is about the closure of mental asylums in the UK following the Second World War. Yes, it does address mental institutions but it remains to be seen how relevant the experience of people 50 years ago is when trying to address such ethical issues in a completely different Health Service and with an entirely different system of Mental Health legislation.

I suppose that those behind the festival should be credited with not showing One Flew over the Cuckoo's Nest, but this is probably one of the only films which shows psychiatric neurosurgery (albeit lobotomy which hasn't been used for decades). The other film showing psychosurgery was Frances, starring Jessica Lange. This was apparently based on the life of Frances Farmer and was based on the 1978 book 'Shadowland' by William Arnold. All well and good, except that it turns out he made a lot of it up, and Frances Farmer never had psychosurgery.

So, the festival has some laudable aims, but the films all have substantial problems and few actually relate to the questions that the festival is attempting to answer. By raising important questions, but showing what is arguably a poor choice of films, I'm not convinced that the festival is doing much to expand our knowledge...