Stereotype and stigma

By Janice Kennedy, The Ottawa CitizenJune 8, 2009

Psychiatric facilities have not fared well onscreen. As far back as 1948, “insane asylums” famously immersed poor Olivia de Havilland into The Snake Pit’s horrors. In 1975, also famously, they subjected the patients of One Flew Over the Cuckoo’s Nest to the sadistic ministrations of Nurse Ratched.

But that was then. We’re much better educated now about mental illness and its treatment. The stigma is gone, the age enlightened. Snake pits and cuckoo’s nests are so yesterday, right?

Well, no, actually. Did you happen to catch the season finale of House, the award-winning TV medical drama?

Sheila Deighton did, and it really ticked her off — which is saying something, since there isn’t a kinder person in Ottawa than Deighton, the Schizophrenia Society of Ontario’s tireless regional co-ordinator. But the show irked her, and not just because of its protagonist, the obnoxious Dr. Gregory House.

“How can you expect the public to have any other perception of mental illness when it’s constantly bombarded with dated images like that?” she fumes.

She’s talking about the episode’s ending, in which House, encouraged by his buddy, enters a psychiatric institution to get help for his drug-induced psychotic break from reality. It was the depiction of the place (“Mayfield Psychiatric Hospital, est. 1876″) that got to Deighton. A dark gothic structure at the end of a long driveway far out in the country, it was gloomy and prison-like. (Even the skies were grey.) Strategically removed from the community, it featured predictable men in white coats waiting for House at the front door. His buddy, meanwhile, avoided contagion by staying safely back at the end of the driveway, watching.

“The thing that got me was the use of the old stereotype,” says Deighton. Thanks to the show’s innovative creators, House himself works medical miracles in a gleaming hospital with the latest ideas and technology. But psychiatry is still shoved out to the cultural back of beyond, to a snake pit that looks as if it still has a staff of Nurse Ratcheds.

For Deighton — who operates out of an office at the shiny new Royal Ottawa Mental Health Centre, works with caring and cutting-edge professionals, sees progress and potential in both the psychiatric field and the people it serves — such outdated images are both counterproductive and frustrating.

“It just reinforces the stigma,” she sighs. “It just stigmatizes the illness further.”

I’d thought the stigma was mostly gone, thanks to the heroic efforts of people like Deighton, institutions like the Royal Ottawa, and effective campaigns like the one starring Daniel Alfredsson. But it’s not, says Deighton, despite evidence of modest progress. (Some media reporting is not as uninformed as it used to be, she notes.) Mental illness still brands its sufferers with that stubborn, if false, dishonour, immersing them in deep wellsprings of others’ fears, irrational prejudices and profound ignorance. If it didn’t, we wouldn’t get the kneejerk negative reactions we usually do to findings of “Not Criminally
Responsible” in the justice system, decisions that seem to grate painfully on our more conservative media commentators. The recent NCR finding for Vincent Li, who did the unspeakable on a bus last summer, killing and beheading a fellow passenger, is a heartbreaking, horrifying case in point.

Profoundly psychotic, suffering from schizophrenia that both Crown and defence attorneys acknowledged, Li was nonetheless found guilty outside the courtroom. The Winnipeg Free Press reported that “Vincent Li is headed to a hospital — not a prison cell — after being found not criminally responsible …”

The victim’s mother — with understandable emotion but still painfully uninformed — angrily insisted that “he should be held responsible for it.” And Alberta-based Mom Magazine, defending her, tried to rally readers against “the completely ridiculous law that takes care of the criminal and forgets about the victim.”

(Deighton, who is also the mother of a son who was killed, says that if the victim’s mother really wanted to get at the root of the problem, she would ask for a coroner’s inquest, which she calls a “stepping stone to change.” Since Li had left an Ontario facility where he had been a certified involuntary patient, she thinks there may have been a systemic failure. An inquest would look into it, possibly preventing similar recurrences.)

But tragic and terrible though it was, the Li incident is extreme and atypical in any case, something else an uneducated public might not recognize as it recoils from the generalized stigma of mental illness.

Deighton and others like her want to change that. Among other initiatives of her Ottawa chapter is “Open the Doors,” a program that introduces area high school students to young people who speak about their own experience with serious mental illness, including the treatment that has changed their lives. It is educational, it is stigma-busting and it is filled with hope all round.

As humans, we share so many vulnerabilities. In our fragile little psyches, a shockingly vast range of things can go bafflingly awry — from sudden unexplained bouts of anxiety or depression, to self-destructive eating disorders, to the life sentences handed out by a callous fate to sons and daughters (usually in their prime, usually filled with promise) hit with schizophrenia.

Adding shame to that is unbelievably cruel. And like the snake pits of an earlier time, filled with humans getting less-than-human consideration, it is also outdated, unenlightened and jarringly wrong.

Janice Kennedy’s column appears here on Sundays.

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