I’m a Psychiatrist… Get Me out of Here!
16 Nov, 08 | by Steven Reid
“Take ten volunteers, half have psychiatric disorders, the other half don’t – but who is who? Follow this two-part social experiment to see if you can tell which of the people have a mental health diagnosis”
Reality TV meets mental illness in ‘How Mad are You?’, the first part of which was broadcast last week (in the UK you can still watch it on the BBC iPlayer). The film was made for Horizon, a BBC science programme, but there was little science in evidence here. Ostensibly an exploration of the fuzzy border between mental illness and normality, the producers have rejected the considered investigation that the subject merits and instead invite viewers to indulge in a ‘Spot the Screwball’ contest.
The setup derives from the controversial Rosenhan experiment. This study from the 1970s involved a group of people with no mental health problems attempting to gain admission to a psychiatric hospital by reporting vague psychotic symptoms. The pseudopatients were all admitted, given diagnoses of schizophrenia or manic–depression, and none were identified as imposters by staff. Rosenhan described the experiment in his paper ‘On Being Sane In Insane Places’, a forceful critique of the validity of psychiatric diagnosis, and an insight into the demeaning experiences of psychiatric inpatients. A repeat of Rosenhan’s study, I suspect, is what the Horizon team were looking for but this crass Big Brother escapade falls some way short.
The volunteers have been taken to a picturesque castle in the Kent countryside where they undergo a series of tests that will supposedly reveal symptoms of the six disorders: social anxiety, OCD, anorexia, depression, schizophrenia, and bipolar disorder. In the first episode they all have a turn at stand-up comedy. Someone with social anxiety should be filled with dread at the prospect, although given that they have already agreed to self-exposure on television is telling a few jokes in a pub likely to lead to panic? The next stunt, or challenge, involved cleaning out a cowshed. No prizes for guessing who they were hoping to flush out with that one. I wonder what they have planned for next week – a banquet perhaps?
Competing with the viewers, hidden away in a darkened room watching proceedings, are the three wise men: a psychiatrist, a psychologist and a psychiatric nurse. The psychologist, Richard Bentall, is a vehement critic of psychiatric classification and diagnosis so his willingness to take part comes as a surprise. These experts don’t have much to go on – video clips and a few brief interviews – so they are reduced to making banal and often risible observations, the sort that would make even a daytime TV sofa-shrink squirm. So the ‘thin one’ must have anorexia, the ‘risk-taker’ must have bipolar disorder and every time anyone makes an insightful comment it’s an obvious sign of treatment with cognitive behavioural therapy. At the end of the episode the three select one person who they think has a psychiatric disorder, and one who doesn’t. They correctly spot the man with OCD, catching him out as he says that he is planning to throw his boots away after the mucking-out. The programme’s best moment comes when we see the happiness of one of the volunteers after the experts get it wrong, confidently telling her that it’s clear she has no psychiatric history.
Mental health all too rarely gets a fair deal on our TV screens and I think Horizon gets it wrong here, veering toward exploitation for the sake of entertainment. This programme risks trivializing mental illness. Social anxiety means you don’t fancy being a comic, sticking your hands in dung will be difficult with OCD, and depressed people tend to be rather gloomy. In addition, we’re treated to annoyingly repetitive pan shots of the volunteers standing on a lawn looking perplexed, clumsy expressionist lighting presumably signifying the unknowable interiors of the human psyche, interspersed with some irrelevant neuropsychological tests in an effort to ratchet up the science quotient.
As the first episode drew to a close the narrator intoned, “No one knows what the outcome of this challenge will be…” I can’t say that I particularly care either, but if you do the second episode will be shown on Tuesday 18th November. An 0800 number appeared after the credits, but not for viewers to call in and vote to eject a contestant. It was a support-line for those distressed by what they had witnessed. I was sorely tempted.
It’s fascinating reading the press response to our Horizon documentary – How Mad Are You? (tonight BBC TWO, 9pm and on BBC-Iplayer).
We’ve had praise for it, particularly from mental health charities, but some quarters of the media have levied criticism arguing it is trivialising mental health and is little more than “spot the loon.”
We at Horizon disagree. Mental Illness is a problem that affects as many as 1 in 4 of the UK population. Yet it is often misunderstood, shrouded in stereotype and stigma. The prejudice associated with a diagnosis of a mental disorder can in itself be a major barrier to patients returning to health.
It’s a subject which is traditionally difficult to get television audiences to engage with. Our programme which falls under the umbrella of Horizon (the BBC’s flagship science strand) is designed to engage a wide audience who wouldn’t normally watch a science documentary about mental health.
BBC TWO has access to a broad audience and programmes like these which address important social and health issues need to have a wide appeal. The first programme drew in 1.8million viewers and skewed younger than a traditional science documentary – something we’re proud of. Horizon has an established record of making highly credible science documentaries in an innovative and engaging manner on subjects as varied as cosmology to consumer science.
Whilst making “How Mad Are You?”, we worked with a number of different charities including OCD Action, Shift and Rethink to find volunteers to take part. All of the contributors were keen to raise public awareness about mental health and the wellbeing of the participants was of the utmost importance to the programme makers.
We’ve had a positive response from the volunteers, expert panel and charities, including MIND and SANE who have seen the film.
We hope viewers who watch the programme will have any preconceptions challenged and see how we are aiming to tackle stigma. And, if they want to know more about the programme details about the volunteers, programme and mental health in general can be found on http://www.bbc.co.uk/headroom
Andrew Cohen, Editor, BBC Horizon
Andrew Cohen
November 18th, 2008 at 6:01 pm
[...] depression is badly misleading. My opinions on this have got a little more definite since I read this review of part one, which points out that Richard Bentall is, apparently, known for being a fierce critic [...]
Horizon: how mad are you? Part two « Aethelread the Unread
November 21st, 2008 at 2:44 pm
Re. Athelread’s point about “schizophrenia” - there’s a lovely video clip on the BBC Headroom website of someone called Dolly talking to Ruby Wax (tho I didn’t like the line Ruby had apparently been fed about “schizophrenics” & her assumption that no one with the diagnosis could have been a stand-up before). But yes why wasn’t Dolly on the show or someone with that diagnosis? It was, at least, good anti-stigma that the clinicians mistook someone for having that diagnosis (but undone by First implying it would have been like cancer).
Regarding the scientific remit of Horizon - why were the differences of opinion between the professionals not shown? I’d thought that was why they’d been chosen. Bentall himself says on Radio 4’s All in the Mind programme during the week that he wanted to air the point that psychiatric categories are themselves stereotypes ‘cos most people have “symptoms” that fall into different categories (I know the somewhat different point about blurred boundaries with normality was mentioned). I actually don’t know how Bentall could talk about schizophrenia on national TV when he’s part of a campaign to abolish the term, and used various medical terms when he’s supposedly anti-medicalization. Disappointing, but then the power & influence of establishment psychiatry always tends to drown other things out…
It would have been better if there’d been some “experts by experience” on the panel to further erode the sense of divide (& maybe get better results). One of the many absurdities of anti-stigma campaigns is that mental health professionals often have more negative stereotypes than the public, esp. psychiatrists according to this survey: http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/32/4/709
But I’m glad BBC Horizon tried to bring these issues out in to the open & tried to make it user-friendly & non-stuffy, though I do agree with Steven Reid’s points at the same time.
p.s. coincidentally BBC2 had a great bit featuring Creative Routes some time ago, which did feature a Dolly (the Sheep)… which reminds me of another dodgy assumption the show was based on, that it’s good to be/appear normal…it seems telling that the person alleged to have been diagnosed with schizophrenia seemed to be a sensitive person who apparently didn’t care about normality & tests (or even explaining her choices afterwards!) buy believed in her & others’ uniqueness
Lost Remedy
November 22nd, 2008 at 6:18 pm
Psychologists and particularly nurses are not normally seen as medical diagnosticians - so two out of three of the panel were in dubious positions. Secondly, no medic would attempt a diagnosis on the basis of behaviour alone - so just what was the point of the exercise? How about trying to diagnose the origin of pain by the area grasped by the individual and the grimaces seen? In that sense this programme was demeaning to both participants and the general population of those suffering from ‘mental health problems’ in current jargon. For these reasons this was not a programme which bestowed cretid on the ‘mental health professionals’ involved.
David Bachauer
November 29th, 2008 at 5:58 pm
looking for somewhere to post this as I found the programme deeply unsettling.
I was admitted as an inpatient, aged 15, in the early 70s. I was ill(anorexia), but it seems to me that the professionals and the resulting stigma screwed me up at least as much as the initial diagnosis and treatment. 20 months later I was released on the world as institutionalised, untrusting and terrified of anyone finding out my history, and Ive continued like that for nearly 40 years. I have a good job, a string of professional qualifications, successful children, friends, my own home- and I dont let on about my teenage years to anyone.
I was variously diagnosed as schizoid, manic depressive( as was) and reactive depressive, and given the latest drugs to match. Im not ‘cured’, I manage my own symptoms so no-one else knows because I really feel that the professionals do as much or more harm than good and Im terrified of anyone in the system having that much power over me ever again.
cariad
December 4th, 2008 at 12:42 am