True magic in the human side

Tom Holliman reviews Louis Theroux's two-part documentary 'By Reason of Insanity'.

I confess to being a tad dubious when sitting down to watch Louis Theroux’s most recent ‘access based documentary’, exploring Ohio’s psychiatric hospitals and the patients who reside in them. The documentary focuses on patients who have been ruled Not Guilty By Reason Of Insanity; many were admitted into psychiatric care following serious crimes, and so the ethical implications of a documentary concerning such sensitive issues were very much on my mind when I began watching ‘By Reason Of Insanity’.

Although not the first time Theroux has focused on mental health, in my mind the filmmaker is associated with his ‘Weird Weekends’ series, taking an often sensational and comical look at American subcultures. However, as patients were interviewed, often with their psychologists or other hospital staff present, many of my apprehensions began to dissipate. Individuals who had committed serious crimes whilst in the thralls of mental illness were allowed to speak as human beings, and presented in a way not often seen in mainstream media; as victims of their illness. Theroux’s trademark interview technique, direct and to the point, works surprisingly well, for the most part, with patients unafraid to speak frankly about their experiences, one patient telling Theroux he enjoyed being asked new and different questions, and that it’s healthy to talk to people from outside of the hospital. At other times, however, interviews felt heavy handed, and on a few occasions I found myself bristling at Theroux’s laughter, or insensitive pushing of an issue on a clearly uncomfortable patient.

Despite these few and fleeting moments, I thoroughly enjoyed 'By Reason Of Insanity'. Theroux's conversations with patients, discussing past events and future hopes, were profoundly moving, and I found myself growing fond of many of the patients involved. This is indeed Theroux's greatest accomplishment; to show that behind the headlines of crimes committed are human beings, suffering with illness but displaying resolve, hope and all the other qualities necessary in those striving for a better life, or hoping for a new beginning. Another positive aspect, similarly unusual in mainstream media, is Theroux’s portrayal of the hospitals and staff; the centres appear to be happy, positive and hopeful places, and the genuine care and compassion of their staff members is obvious.

Although some of my initial concerns remain - the bluntness of some interviews, for example, or confidentiality concerns about the discussion of patient histories - individuals are, in general, treated with respect and sensitivity. Credit must be given to Theroux for presenting mental illness and psychiatric institutions in such a fresh and positive light, but the true magic of ‘By Reason Of Insanity’ comes not from the filmmaker, but from the patients he interviews. Their honesty, stories, hopes and fears show a touching, human side of mental illness, all too often neglected in the media and therefore unseen by the general public. 

- Reviewed by Tom Holliman who is a student at Anglia Ruskin University. Watch the programme now on the BBC iPlayer.

BPS Members can discuss this article

Already a member? Or Create an account

Not a member? Find out about becoming a member or subscriber


A good and comprehensive review. I am pleased to read that you were able to warm to the patients. This nicely reflects your own attitudes towards the people that are placed within these services.

I do, however, not share your concerns about patient confidentiality. It is important to remember that a patients history can be shared at their direction. Discussing it with Louis Theroux and the relevant BBC parties is their prerogative. I fear that your concerns around this matter implicitly suggests that the patients featured in the documentary lack the mental capacity to make this decision due to their diagnosis/diagnoses (although I understand that this may not have been your intention). Should your review be construed in this fashion, it would misrepresent the patients within these services, and subsequently increase mental health stigma.

Similarly to the above, I worry that your concerns of Louis Theroux's direct questioning style implicitly suggests that the featured patients cannot mentally cope with a tough questioning style. If this were to be an issue for any patient, I feel confident that the multidisciplinary team within the hospital would not have permitted the interview.