A tantalising part of a larger picture

Lucy Johnstone watches Channel 4's 'Life on the Psych Ward'.

I have to admit that I avoided watching this Channel 4 programme, set on a forensic unit at the Bethlem Royal Hospital, when it first aired. I have come to dread the clichés of mental health media depictions – focus on heroic doctors at the expense of the work of the whole team, voyeuristic depictions of emotional anguish, implausibly happy endings thanks to miracle drugs or (even less believably) ECT. This documentary was not free of those tropes. But it also showed the dedication of staff who work in one of the least popular specialisms, with people who are marginalised even within the general field of mental health; and it gained from the honesty and courage of the three men, James, John and Tony, who agreed to open up their lives up to the cameras. For these reasons, I do not wish to criticise the work of the unit – indeed, there seems to be much to admire. What was less reassuring was the narrative of the whole programme, and the way it obscured the particular narratives of the men whose lives we were supposedly being encouraged to understand. The producers and their advisors must take the main responsibility for this.

Let’s start with the title – ‘Life on the psych ward’ – which totally and unhelpfully eroded the distinction between a forensic unit, where patients almost by definition have a history of violence, and an ordinary ward, where the vast majority do not. The opening shots of a large, angry man tearing down decorations in a corridor were unlikely to reduce stigmatising messages. 

More concerning was the totally unchallenged discourse of ‘illness’ and ‘disorder’. The narrator started by announcing that the patients were ‘dangerously unwell’ and introduced the main subjects by their diagnoses – ‘James has borderline personality disorder’; ‘John has a personality disorder’; ‘Tony has been diagnosed with personality disorder and paranoid schizophrenia.’ No lay person would have had the slightest hint that such labels have been described by some of the very psychiatrists who invented them as non-valid, unsafe and unscientific - and if the Maudsley doctors were aware of it, they certainly hadn’t adjusted their language accordingly. Thus, these pseudo-medical terms were presented as the undisputed main facts about the men.

As is routine in mental health systems, the unfounded narrative of ‘illness’ and ‘disorder’ then dominated and undermined any other story about the subjects of the documentary. And clearly, there were other stories to be told. There were hints of this – but no more – from the start. James, for example, had filled an entire poster with events from his life which the viewer was not invited to share. His doctor later described it as ‘a terrible history of neglect and abuse in his early life – one of the worst I’ve heard.’ Given the typical backgrounds of male offenders, the implications of this statement are pretty terrible. The issue is not that we should have been told all the details, but that the significance of such a history should have been explored, rather than presented as an incidental additional factor.  John supplied much of his story himself – he was born with a disability, bullied at school, and sexually abused. With great insight (perhaps derived from aspects of the unit’s work that we were not shown) he described how the resulting hypersensitivity to feeling judged and threatened by others led him to lash out in defence when he felt trapped. This, of course, is no excuse, and he did not offer it as one – rather, he was ‘appalled and disgusted’ by his crimes. But it does present a rather different picture from the tautologous ‘It’s because I have a personality disorder’ account.

Tony was more of a puzzle. Things seemed to go suddenly wrong after a party when he was 18. Like his anguished mother, I wondered what had happened that night, and how we might understand the voices which have tormented him ever since – because we do know that there are ways of making sense of such experiences. But the language of ‘schizophrenia’ (‘a chronic condition’ as his doctor put it) quickly headed us off. No one asked. We were left wondering. 

These personal stories, glimpsed in the gaps between the medical narrative, were a tantalising part of a larger picture – as they always are. One of the doctors said, ‘These individuals didn’t emerge from a vacuum – they are a part of society.’ A large body of evidence tells us that society’s most violent men are the product of violent relationships, social exclusion, and a toxic form of masculinity that offers aggression as reparation for shame, humiliation and marginalisation. This is the real story that needs to be told. Channel 4 failed to do so, and viewers are the poorer for it. 

- Reviewed by Lucy Johnstone, Clinical psychologist, author and trainer

-  Watch the programme now and read the South London and Maudsley NHS Foundation Trust's take on the programme, including FAQs. 

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