Movies and Madness

Right around the time the Academy Awards named "A Beautiful Mind" best picture of the year, I was in the middle of "Madness on the Couch" by Edward Dolnick. This is a disturbing account of how Freudian psychoanalysis was used to treat schizophrenia, autism and obsessive-compulsive disorder prior to the discovery that such mental illnesses were organic in nature and reacted best to medication rather than the "talking cure".

I had also just seen "White Sound", a powerful and extremely realistic German film dealing with a young man's encounter with schizophrenia. Shown at the New Directors/New Film series in NYC, it benefited from the two years of research about the mentally ill done by the young director, Hans Weingartner. It occurred to me at the time that a survey of films about madness and its treatment would be useful, especially since "A Beautiful Mind"--whatever its flaws--had focused public attention on the need to look at mental patients without prejudice.

Such films are in stark contrast to the typical fare of the 1940s that used asylums for their shock value. The 1946 "Bedlam" starring Boris Karloff and "Snake Pit", the 1948 noir, are typical. Mental patients are represented for their shock value, just as the carnival geeks in Todd Browning's "Freaks".

Although tracking down the 1977 "I Never Promised You a Rose Garden" was not easy, this film was critical for my purposes. Although paying homage to the lurid conventions of the past, the film makes an attempt to show how "the talking cure" helped a sympathetic young woman. Starring Kathleen Quinlan as the teenage mental patient Deborah and Ingmar Bergman regular Bibi Andersson as her therapist, the film is based on an autobiographical novel of the same name by Joanne Greenberg.

Frieda Fromm-Reichmann had treated Greenberg in real life and the book about their interaction was hugely popular with college students in the 1960s. This is understandable since mental breakdown often manifests itself in late adolescence, especially during the freshman or sophomore year of college. If anything, college has become even more stressful in recent years according to a NY Times Magazine article focusing on the suicide of a Korean female student at MIT. (http://www.nytimes.com/2002/04/28/magazine/28MIT.html)

In the novel, we are privy to the interior monologues of the patient who is surrounded by strange denizens of a primitive parallel world that speak to her in a language that only she understands. Since cinema does not lend itself to the description of mental states, we instead are presented with a literal representation of her tormenters who appear to be from the Stone Age but almost all with blonde hair and straight teeth. To signal their appearance, the film sound track plays the Ramayana monkey chant (http://www.bridgerecords.com/9019.htm), which to the untutored ear might sound nightmarish, one supposes. When these delusional demons in loincloth aren't assaulting her, the other patients and attendants are.

She is finally rescued from this snake-pit type hell by Bibi Andersson, who helps her separate delusion from reality through motherly therapy sessions based on what appears to be Freudian orthodoxy. In all likelihood, these sessions probably had as much use in healing Joanne Greenberg as sessions with an aroma therapist or even a good friend.

Fromm-Reichmann, who was married at one point to Frankfurt Marxist and psychologist Erich Fromm, fled Germany like many Freudians and Jews (often an overlapping identity) after Hitler's rise to power. She took up residence at Chestnut Lodge in Rockville, Maryland, where she resisted administering the "treatments" typical of the 1940s and '50s including insulin comas, electroshock, and lobotomy.

Fromm-Reichmann gained a saintly reputation in psychiatric circles for accepting patients as they were. According to Dolnick, one colleague said she would "sit in a patient's urine with him to show there was no difference between them." Another recalled: "a patient would give his feces as a gift, and she would take them." (p. 85)

Although Fromm-Reichmann claimed that she was a Freudian, her main influence appeared to be Harry Stack Sullivan, a bizarre character whose theories also influenced a leftist psychotherapy cult-commune in New York City called the Fourth Wall. In 1989, there was a well-publicized custody battle involving defecting cult members and their spouses. The NY Times reported:

Mr. Cohen, 39, a doctoral candidate in developmental psychology at New York University who left the group in 1985 after belonging for 13 years, said the Sullivanians believed that traditional parents' child-rearing was stultifying for the child and parents and that ''traditional maternal love represented violence against a mother and child.''

Prodded by Mrs. Weinstein, Mr. Cohen testified over the repeated objections of Mr. Paganuzzi that the Sullivanians believed that ''monogamy was bad'' and that the ''relations of an adult with his family must be broken to achieve personal growth."

One can certainly see how Harry Stack Sullivan might have had an impact on this outfit. When serving as a psychiatrist in charge of a six-bed ward for young male schizophrenics at Baltimore's Sheppard and Enoch Pratt Hospital in 1929, he sealed them off from the rest of the hospital with the understanding that the patients had fallen ill because of "bad" relationships with others. This could only be overcome by developing "good" relationships. Sullivan claimed that 80 percent of his patients were cured, but as was universal in these "talking cure" cases, there was no follow-up, nor a clinical trial.

Unlike other areas in medical science, psychoanalysis dispensed with such mundane requirements. No doubt they were influenced by Freud's dictum that "I am not actually a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador--an adventurer, if you want it translated--with all the curiosity, daring, and tenacity characteristic of a man of this sort."

Unfortunately, many of the victims of psychoanalysis (I use this word advisedly) must have felt like the victims of earlier conquistadors. One Freudian psychiatrist named John Rosen developed a theory called "direct analysis" that involved browbeating schizophrenics into reality. When one patient "whined endlessly that he was going to be cut up into little pieces and fed to the tigers," Rosen walked into his room with a big knife and announced that he would cut him up himself. (Dolnick, p. 109)

Just like Fromm-Reichmann and Sullivan, Rosen claimed miracles without producing hard numbers or conducting follow-ups. Rosen began to fall from grace in October 1970 after Sally Zinman, a 33-year-old college instructor, was beaten while under his care. She was kept in a virtual dungeon with nothing but a mattress and a bucket. In 1981, another female patient died when two of Rosen's attendants tried to force her to speak. One held her by the legs while the other punched or kneed her. On March 29, 1983 Rosen was forced to give up his medical license.

Although Sullivan's search for "good" relationships seems characteristically upbeat and American, it does anticipate a subsequent trend in Freudian therapy that evolved in Great Britain, namely R.D. Laing's search for alternatives to a sick conventional society. The normal world was based on schizophrenogenic families that included those moms who--despite their best intentions--made their children crazy.

Laing was an important counter-culture figure in the 1960s and 70s. His "Divided Self" ended up on bookshelves next to Paul Goodman's "Growing Up Absurd" or Charles Reich's "The Greening of America". With the Vietnam War raging, many could sympathize with Laing's belief that bourgeois society itself was insane.

Laing's message was effectively conveyed in Milos Forman's 1975 "One Flew Over the Cuckoo's Nest", based on Ken Kesey's novel. After watching the video, I was rather stunned by the level of misogyny in the film. Louise Fletcher's Nurse Mildred Ratched is a grotesque figure who constantly reminds Billy, the stuttering mental patient, that she is friends with his mother and is not above informing her about indiscretions inspired by the free-spirited Randall McMurphy, played unforgettably by Jack Nicholson.

After having sex with a prostitute that McMurphy smuggled into the hospital on Christmas Eve, Billy's stutter disappears. When Nurse Ratched observes the aftermath of the preceding evening's drunken celebration, she tells Billy that his mother will be shocked by his misbehavior. This leads him to cut his own throat and McMurphy to attempt to strangle hers. As his hands tighten around her neck, squeezing out her life, we see mental patient Christopher Lloyd looking on in glee, mouthing the words, "Yes, yes!". I distinctly recall that audiences found this scene to be positively cathartic. Finally, the forces of sexual repression and straightness would get their comeuppance. It is also interesting to note that Ratched's sadistic attendants are exclusively African-American.

Nowadays few people outside the literature departments of some colleges take R.D. Laing seriously. While his parent-hating views might have seeped into the popular culture, few clinics are now set up based on his precepts. As fashionable as his views were in the 1970s, by the end of the 1980s they were passé. Dolnick writes:

"Done in by drugs and drink and the whim of intellectual fashion, Laing was suddenly old news. His fall was fast and painful. In November 1983, for example, he showed up drunk and stoned for a lecture to the Oxford Psycho-Analytic Forum. He came onstage to rapturous applause, walked up and down in silence for several minutes, began to speak, and then interrupted himself to tug at a tooth that was bothering him. After a prolonged and silent struggle, he wiggled the tooth free, declared the lecture over, and left the stage for the nearest pub." (p. 136)

While touted as a heart-felt plea for accepting schizophrenics on their own terms, Harmony Korine's 1999 "julian donkey-boy" strikes me as a throwback to the sensationalism of the1940s. Supposedly based on his uncle Eddie, a patient at Creedmore in Queens, New York, the film invites us to gaze at the main character Julien as if we were at a carnival side-show. Played by Ewen Bremner of "Trainspotting," Julien is lost in his own jumbled thoughts. He is depicted wandering aimlessly in the streets of Queens with word salad pouring out of his mouth. Just to make sure we get his point, Bremner includes a scene with Julien's father (played by Werner Herzog, whose fascination with the "freak" is an obvious influence on Korine) playing cards with an armless man that he holds in his toes. Speaking obviously for Korine, the character explains that the disabled are no different from the rest of us, a message that the film's gullible boosters in the press obviously swallowed hook, line and sinker. If this were Korine's intention, his track record tends to undermine our confidence in him. In his previous film "Gummo", generally regarded as one of the worst films ever made, a group of feral boys entertain themselves by torturing cats or having sex with a woman with Downs Syndrome.

The film focuses on the interaction between Julien, his father, his brother--an aspiring high-school athlete whom his father badgers mercilessly--and his sister, a dental hygienist whose child she is carrying. Conforming to the austere esthetic dictates of Dogme 95 (http://www.tvropa.com/tvropa1.2/film/dogme95/index.htm), the film makes extensive use of hand-held cameras and natural light. In the hands of a master like Soren Kragh-Jacobsen, the results in a film like "Mifune" are luminous. With Korine, however, we are witness to something that looks like a student film. Korine burst on the scene in 1995 as the eighteen year old screen writer of Larry Clark's voyeuristic "Kids", a film about thuggish skate-boarders, including a character who has unprotected sex with as many woman as possible, while knowing that he is HIV-positive. His lack of talent is matched only by his megalomania. When the Guardian asked him if hooking up with Danish Dogme 95 for "julien donkey-boy" was an attraction because it's such an inherently European project, he replied:

"Definitely, because in America I have no peers. I mean, American film-makers come up to me like, 'Harmony, you're so inspiring, oh Harmony blah blah blah,' and it's just this bullshit rap, right? And I don't feel any affinity with any of it, partly because I don't really like people, but also because Americans don't like films about the real America if you show them something unromanticised, they call it exploitation. Which is how the critics destroyed Gummo." (November 5, 1999).

Turning from the ridiculous to the nearly sublime, "A Beautiful Mind" delivered much more than I would have expected from a lightweight director like Ron Howard and screenwriter Akiva Goldsman who had such gems as "Batman Forever" and "Lost in Space" in his resume.

As everybody probably knows, the film is based on Sylvia Nasar's biography of Nobel prize-winning mathematician and schizophrenic John Nash. The liberties taken with Nash's true-life story have become a major controversy, with critics accusing Howard and Goldsman of soft-pedaling the nastier aspects of Nash's personality, both while sane and when in a psychotic state.

It is best to view the film without a prior understanding of the facts, since it succeeds mostly as an inspirational tale of overcoming mental illness--something that is at the heart of Nasar's book despite the film's embellishments. Key to its success is the performance of Russell Crowe who conveys the distracted mental state of John Nash without resorting to cheap acting tricks typical of the performances in "One Flew Over the Cuckoo's Nest". So convincing is Crowe's performance that I was utterly surprised by the turn in the narrative in which his mental illness is finally revealed both to him and to the audience. We finally understand that his eccentricities had been transformed into a full flight from reality.

With the patient and loving support of his wife and his colleagues, Nash finally becomes productive again. In contrast to the psychoanalytic exorcisms of "I Never Promised You a Rose Garden," healing comes in the form of little pink anti-psychotic pills taken regularly. Eventually Nash stops taking his medication because it interferes with his ability to think analytically and to respond sexually to his wife. Such dilemmas confront every mental patient and the film is brutally honest about the stakes. When Nash finally transcends his private demons without the help of such aids, we cheer for him. We do understand, however, from the film and from interviews conducted with John Nash that the demons never really disappeared--he just found a way to ignore them.

Unfortunately, Nash's inspirational example seems utterly at odds with the cruel reality facing schizophrenics in capitalist society today. If one has to rely on a loving and gifted wife (Alicia Nash was one of only 16 women admitted to MIT, where she met John Nash) and a network of forgiving and patient college professors, then one might conclude that Nash's story is something of a miracle that cannot be repeated.

In one powerful scene, his wife discovers that he has relapsed after giving up his medication. On a hunch, she enters a woodshed behind their house only to discover bizarre wall-to-wall graffiti. In Nash's delusional state, he finds hidden codes in newspaper and magazine articles that are outlined in red pencil.

In an ongoing series about problems facing the mentally ill in the NY Times that began last Saturday, we discover that such graffiti is not uncommon.

It reported that Ms. Valante a patient at the Rockland Psychiatric Center, "wrote all over the walls of her hospital room, a paranoic graffiti about death and evil." A psychiatrist quoted her in her treatment records as saying, "I wish I could just die and rest in peace and eternity." The woman had been sick since her 20's and was estranged at times from her parents in Florida. The Times added, "As her illness worsened, she often refused to bathe and insisted on wearing only one set of clothing, a printed housedress over a long black outfit." With the help of anti-psychotic drugs, Valante was discharged from hospital and sent to Anna Erika, a group home. With 427 beds it is one of the largest facilities in the state. It is also a dumping ground, with not a single qualified case manager to supervise residents, according to a 1999 state report.

In the summer of 2000, Valante decided to stop taking her medication, just as John Nash did. The NY Times reports, "Shortly after 8:30 p.m. on Oct. 3, Ms. Valante went to see her social worker, who had an office on the seventh floor, according to interviews and records. As usual after business hours, no one was there. She paced the hallway, then walked into a room, opened the window and jumped." The Valante family heard nothing from state officials immediately after their daughter's suicide, and got only a single phone call from Anna Erika administrators: "We just wanted you to know that your daughter is dead." One doubts that Hollywood will ever make a film about Ms. Valante.

After Alicia Nash discovers her husband's graffiti, she rushes to the upstairs bathroom of their house where she has left him to bathe their infant son. To her horror, she discovers that he has left the baby under water where he is in imminent danger of drowning. If the baby had indeed died in real life, one supposes that a jury might have been lenient with a Princeton mathematician who had been lauded in Fortune Magazine. He also probably would have been protected by the American legal system of the 1950s, which tended to understand that crimes committed during a psychotic break should not be subject to prison sentences or capital punishment as is often the case today.

The image of a baby submerged in the bathtub of course evokes the recent case of Andrea Yates in Texas, who was found guilty of drowning her five children during a psychotic break. She, like John Nash, had stopped taking her medication. Obviously there is no reason for this poor creature to be in prison, but Texas had rewritten its insanity defense laws on a more stringent basis. Why? The law was rewritten, as were insanity statutes in many states, after John Hinckley was found not guilty by reason of insanity for trying to kill President Ronald Reagan in 1981. Twenty-five states have followed Texas's example, while five states have abolished the insanity defense altogether.

So we have something else to blame on Ronald Reagan. In many ways, a society can be judged on the basis of how it treats the weakest and most defenseless. Not only did Reagan find ways to create a more class polarized society, he also inspired a frontal assault on mental patients, who deserve better. When the safety net was destroyed, people like Ms. Valante were given a prescription and sent on their merry way. If they killed themselves, nobody would weep. That would be one less burden on a society that is geared to the bottom line. If they had a psychotic break and threw somebody into the path of an oncoming subway train, society would be better equipped to get them off the streets by more draconian insanity laws.

When we arrive finally at Hans Weingartner's "The White Sound," we can see for the first time a portrayal of schizophrenia without sensationalism and without false hopes.

Lukas (Daniel Bruhl) has moved to Cologne, where he joins his older sister, Kati (Anabelle Lachatte), and her boyfriend, Jochen (Patrick Joswig), in what amounts to a hippie pad. He plans to go to college there.

Kati and Jochen enjoy partying, booze and recreational drugs. After Lukas takes psilocybin with them in a nearby park, he is alarmed to discover voices accusing him of being a shitty person and urging him to kill himself. He dismantles his room in order to find out where loudspeakers might be hidden to no avail. Such inner voices are one of the main characteristics of schizophrenia. Medication serves to quiet them, but at the expense of one's overall energy and receptiveness. Since schizophrenics find communication difficult to begin with, it is understandable why they would shun medication.

Daniel Bruhl does a tremendous job of conveying Lukas's consternation. Why can't others hear the voices? Why do they conspire against him?

After he plunges into a river to end his suffering, some hippies rescue him and then take him on a trek to beachside Spain where he can "mellow out". At first, their nonjudgmental stance seems to make him comfortable but after a while they too are seen as plotting against him. Whether or not, the director/screenwriter had R.D. Laing in mind, we must understand that this is how things work out in real life. When you are suffering from schizophrenia, the immediate social setting has little to do with whether you have delusions or not. It would be tantamount to expecting epileptic attacks to be prevented by listening to New Age music.

Although some leftist psychiatrists have tried unsuccessfully to make a causal link between capitalist society and schizophrenia, we have no difficulty understanding that capitalist society is inimical to the humane treatment of schizophrenics. Under socialism, we would first and foremost expect tolerance of deviant behavior such as the kind exhibited by John Nash and those less celebrated. The only deviant behavior that will not be accepted is the sort of systematic cruelty that typifies the courts, prisons, mental hospitals and adult care centers of present-day society.