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Thanks For Coming In Today

Posted by Dr No on 25 March 2015

cubist_03.jpgWearing togs of mailbag grey, but missing the convict’s vertical arrows, Louis Theroux’s cubist aspect stalked the corridors of an American asylum for the criminally insane, searching for nutcases. The nutcases failed to stand out. Scanning a corridor, it was not possible to discern whether that man with a trolley was a janitor on rounds or an axe-murderer who just might rip the steel bars off his trolley and wrap them tightly round your neck. To make matters even more confusing, some of the staffers looked pretty nutty. Only the psychiatrist was easier to spot, dressed in a cream suit from last year’s fashion rail at the local charity shop. She’d come a long way, from Lithuania to be precise, and had three settings: stern, giggly and frightened rabbit, as well she might, given the human powder kegs she sat on. This being a psychiatric instatooshn, ward rounds and meetings were called reviews, many opening and/or closing with that old psychiatric smoothie, ‘Thanks for coming in today’. Despite the smoothness, it tends to sound a bit hollow when addressed to an inmate who has not a hope in hell of not coming in today to the review.

One of the battiest inmates was a lucid bridge-playing little old lady – she could have played Miss Marple as well - who was keen to remind us there had been a mix up in the Bible. There was also, she conceded, the tiresome allegation of stabbing someone on a bus with a pair of scissors, but the important thing was to get the truth out about the Bible mix up. Instead of one Jesus, there had been two, Jesus and Jesus Christ, and she, the little old lady, was the real female Jesus Christ, alive at the time of the other Jesus of the Bible. “You see,” she said, “the hard road [sic] I’ve had to hoe.” One saw immediately what a hard road she’d had to travel, or possibly hard row she’d had to hoe. The psychiatrist looked both pleased, as if her poodle had done its best parlour trick, and concerned, as if her poodle might not be very well. Louis shifted in his chair, and reset his jaw at another cubist angle. Miss Marple might not be the real JC, but when it came to psychosis, she certainly was the real McCoy.

Theroux’s technique was to introduce the person and then the ‘incident’. This was simple, but effective, because it meant that by the time we learnt of the incident, we already knew something of the person. Most of the persons were mild, even subdued, on screen, though quite possibly this was caused by a combination of institutionalisation and medication. The exception was a live wire who had in the past been touched by The Lord. Perhaps there were evangelical after-shocks still coursing round his body, despite what must have been agricultural doses of anti-psychotics, evidenced by the very visible abnormal movements caused by his medication. But, by and large, the ambience was one of calm, with staff who seemed genuinely to care about their patients.

The Golden Triangle of goals in these seriously ill patients is insight, treatment and, if possible, discharge. Insight is at the apex of the triangle, because without insight, the insight that one has done something terribly wrong, even if it is not one’s fault, but that of the illness, there can usually be little else in the way of progress. This is why Miss Marple is such a tough nut to crack: as long as she has no insight, the staff have, and will continue to have, a hard road to hoe.

Through Jonathon, whose ‘incident’ was violent patricide several years in the past, Theroux showed us the negative symptoms of psychotic illness, symptoms not of the abnormal present, but of the human missing: the flat affect, the dulled spark, the zombie nature. He then did something odd, at least by the book: he asked a direct question, “Did you love your father?” The ‘correct’ question would have been more neutral, “How did you feel about your father?” But Theroux’s question worked. It caused Jonathon to reflect, and after he had reflected, he volunteered that in fact he had loved his father, until the illness got in the way. The bonfire of insight was getting going, with every hope that one day the phoenix of a newer, more alive Jonathon will rise from the ashes.

Being Theroux’s America, we were briefly invited through another patient to ponder links between televangelism and insanity. Does practicing televangelism cause lasting cortical injury, or is it madness that drives American evangelists on to TV? Whatever the answer, William, the live wire we met earlier, was now ready for supervised discharge, having made good progress from the height of his illness, when he believed he wasn’t just wired, but had a full-on connection with Israel’s Benjamin Netanyahu, under whose direct control he lay. William’s orders were to drive fast round the city, ignoring red lights. Even at discharge, William’s eyes glowed, like distant tail-lights. Dr No hopes the discharge will be a success, but fears it may not.

Media portrayal of insanity is never easy, be it in fact or fiction. On the one hand, political correctness stifles, on the other, stereotypes suffocate and stigmatise. The taboos are still very alive, the myths still rife. Few who believe they are sane care to look behind the thin veil that separates them from those who have been told they are insane, and a heavy curtain still hangs over the asylum door. Theroux will be both praised and deplored for taking his style and camera inside the asylum door . The precious politically correct will deplore the crass insensitive journo scooping and trivialising stories; with wry gentle humour attracting special disapprobrium as cheap cynical laughs. Those, like Dr No, who believe that sensitive light shone in dark difficult places, not heat, is what we need, will welcome Theroux’s attempt to bring to the screen what goes on in the minds behind the asylum door.

Mindful of the benefits of more light, Dr No scanned the schedules past and present for possible future presenters of similar programmes. He weighed carefully but decided against Can Gerry Robinson Fix the Criminally Insane? - too light-weight, too fluffy. Following a certain ‘incident’, indeed the ‘incident’ that brought Louis to our screens early, he contemplated but rejected Top Nut: By Reason of Jeremy Clarkson, as likely to end in tears. Mike Mosley he ruled out immediately, on the grounds that a man willing to eat black pudding made from his own blood should on no account ever be let loose with a camera inside the asylum. So no dice. Instead we just have Louis, level of head and cubic of jaw, teaching us more in sixty minutes about serious psychotic illness than could a year of lurid headlines and florid text. It wasn’t perfect, but it was good; and so well worth the detour, if you have not already seen it.


I agree it was an interesting program but the USA always does things bigger and better than us and that's certainly the case when it comes to the criminally insane.

Closer to home and certainly closer to the reality of what community mental health nurses, that's CPNs in old money, deal with is "Nurse" on BBC2, Tuesdays at 10pm. It's billed as a comedy but don't let that put anyone off. Written and peformed by Paul Whitehouse and Esther Coles it's a gem of a series.

Louis Theroux does some very interesting pieces. I always like his take on people. I think what he does is fascinating, and also a bit dangerous at times. I think this is a man you can talk to for hours and hours and not notice the time pass by. maria

Thank you for providing the detour Dr No and well worth the visit it was too. Theroux has a particular skill – there is no doubt about it – in tuning in with ordinary folk whether diagnosed with mental illness or not.

Tis true that he taught us more in sixty minutes re serious psychotic illness than any lurid headline or soap portrayal could ever achieve. One little ‘glitch’ however in his proof of empathy/insight/understanding is when he offered amusement (as a laugh) as an inmate
proffered ideas of reference for his crime.

That said, he aint a psychiatrist is he? A further that said: maybe psychiatrists (and RMNs) could learn a lot from his approach, for kind and understanding he was, not patronising, offensive or confrontational.

Those at the Ohio State Psychiatric Hospital appear a kindly understanding lot and one hopes this continues to be the approach when the camera crew aint in… if it does then I think that here in the UK we have much to learn. Somehow I cannot imagine Broadmoor and Southall offering such therapeutic environments…

Stuff that might interest you regarding soaps portrayal of mental illness:

Anna :o]

I always thought that this alternative is pretty dangerous in several respects. First, it is not ok for them, because they are getting in an environment where their violent impulses are emphasized, not minimized. Secondly, although I am not a person that judge others, each one must pay for their mistakes and offenses.

The Golden Triangle of goals in these seriously ill patients is insight, treatment and, if possible, discharge.Seriously ?

Wow, i really loved this story. I love how Dr No is such an intricate character...this is outstanding work, congrats!

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