Thursday, April 27, 2017
Marvel and Netflix Keep The Antipsychiatry Fake News Alive
I try to exercise an hour a day. During that time I am either on a treadmill or an exercise bike. If I am exercising in the house, I am watching television at the same time. I watch a lot of television at the same time. Entire series on Amazon, Netflix, or premium channels. Some of this television can be motivating but even with all of that content bandwidth - I still find myself searching for the occasional independent film because there seems like there is nothing else out there. About 80% of what I watch is on Netflix and a lot of that is science fiction. The Marvel series on Netflix is a rich source of superhero type science fiction. I noticed the latest addition The Iron Fist some time ago, but that name and the visuals were not all that inspiring. At least until I stopped a very bad film dead in its tracks about 15 minutes in an switched over to Iron Fist.
In the opening moments we see a disheveled young man walking barefoot through New York City. We find out that his name is Danny Rand. He appears to be fairly naive. At one point he announces that he is from a large family who owns a prominent building and the man he is talking to suggests that he should: "Sell the building an buy some shoes." He tries to get in to the building to talk with Harold Meachum his father's former partner who is currently the head of Rand Enterprises. He has to fight his way past security. He encounters the adult Meachum children Ward and Joy. They tell him that Harold is dead and they doubt his identity. They say the Rands including Danny were all killed in a plane crash in the Himalayas 15 years ago. He leaves but Ward Meachum dispatches his security forces to find Danny and beat him up or kill him. After he dispatches the security guards he breaks into the Meachum home and eventually meets with Joy back at the company headquarters.
This is where several distinctly antipsychiatry themes start to kick in. Joy drugs Danny and he is taken to what appears to be a small forensic psychiatric hospital. He awakens there in five point restraints and is advised that he is on a 72 hour hold. Over the course of that hold he is given many cups of what are supposedly psychiatric medications. In some cases the orderly forces his mouth open with a tongue blade and pours the cup of capsules and tablets into his mouth. On other occasions, the orderly comes in with an absurdly large bottle of medication and draws the medication out of that bottle into a syringe and he is given an injection. He is told that the medication is given to him so that he will "cooperate". Cooperate is loosely defined as not becoming aggressive but also in some cases giving up the idea that he is Danny Rand. In short, he is basically tortured on this inpatient unit.
To make matters even worse, another patient disguised as a physician with a white coat is alone with him at one point when he is being restrained. The viewer does not realize it at the time until this patient suggests that Danny kill himself and when that fails he sticks a fork under his chin and says he will kill him if he gives him the word. The aggressive patient is eventually removed, but later reinstated as Danny's "tour guide" of the unit. During that tour, he advises Danny of the folly of the 72 hour hold like this: "He was living under a bridge and came in here on a 72 hours hold. Now he has paranoid personality disorder and he has been here for 5 years. He was living on the street and came in on a 72 hour hold. Now he has schizoaffective disorder and has been here for 3 years." He simultaneously points out the folly of the 72 hour hold and suggests that people are just plucked off the street, labelled and stuck in a locked psychiatric facility for a long time. In the span of 5 or 10 minutes we have seen a homicidal patient disguised as a doctor, threatening to kill the superhero, and then becoming a tour guide who is an expert commentator on psychiatric injustices!
Dr. Paul Edmonds is the psychiatrist on the floor. He is pleasantly coercive at first. He seems generally clueless about assessing acute care psychiatric patients and interacting with them. He finally catches on that Danny Rand is who he really says that he is and acts professionally for a brief period of time. He almost gets to the point where he will release Danny, but decides against it when he hears about how Danny is a Warrior Monk who is in possession of the power of the Iron Fist. At that point Harold Meachum who has been watching all of the events in the psychiatric unit remotely and who has concluded that Danny is the real Danny Rand - sends in his security to take Danny out of the hospital. In the finale to episode 2, Danny summons the Iron Fist power to dispatch the security guards who were beating him mercilessly and with a single punch - knocks down a large metal door confining him in the hospital.
There are numerous cliches about psychiatric treatment that are obvious in this episode. The first is that psychiatric treatment is about social control. In this case the Meachums have a problem when Danny shows up. He owns 51% of the company stock. They get him out of the picture by drugging him and taking him to a psychiatric hospital. I have never seen that happen. In real life, if a person in the emergency department shows up there drugged and points out that somebody did this to them, the police would be dispatched to pick them up for assault. The associated dimension here is that the psychiatrist and the hospital are working for the Meachums and doing their bidding at least until Dr. Edmonds finally refuses to provide Joy confidential information on Danny. In my 23 years of inpatient work, treatment was focused on the best interests of the patient, and confidential information was not provided without consent. Forced treatment was portrayed in as heavy handed a manner as possible. The patient was drugged to the point that he was "in control" and in one situation ready to cooperate by accepting a false identity. Dr. Edmonds also appears to lack skill at two levels. It takes him too long to find out who Danny really is and them it seems only by a bit of luck. When he finally does that, he is unable to assess the patient's superhero story (trained warrior monk from the Mother of the Crane order in the mythical K'un-Lun that appears from another dimension once in every 14 years), see it for what it is and release him. Any inpatient psychiatrist has seen and discharged their share of superheroes. Delusional or not - treatment depends on local legal convention and the bias is heavily stacked toward no treatment by the courts and business systems. Businesses don't want anybody spending any length of time in a psychiatric hospital whether they are stable enough for discharge or not. But I suppose that is a far less dramatic premise than psychiatrists and psychiatric hospitals detaining people and torturing them.
At no point do we see legal representatives and representatives of the court to protect the civil rights of anyone who is on a legal hold or subject to involuntary treatment. The viewers have to suffer through another skewed treatment of psychiatric care and an unenlightened view of the containment function of psychiatric units.
There is a clear mischaracterization of acute care or inpatient psychiatric units. Anyone experienced with psychiatric disorders and severe addictions realizes that there are some mental disorders where the person's ability to self correct is gone. That results in uncharacteristic behaviors that can include aggression, suicide, self-injury, and a long list of high risk behaviors that endanger health and life. A common example is mania without psychosis. The manic person can carry on a coherent conversation but may have been hospitalized because his or her judgment and decision-making was greatly impaired by the manic state. A consistent treatment environment is required to assist that person in getting back to their stable mood and decision-making. Having an appropriate treatment unit available can prevent life altering events that can be associated with severe mental disorders. When I refer to a containment effect - it means providing a safe environment for these changes to occur and there are multiple pathways to stability.
I know a lot of people will say it's just a television show. It is a television show with considerable viewership in a country with meager resources for psychiatric treatment. It is a television show in a country that is a mill for antipsychiatry fake news. It is also part of an ongoing process that stigmatizes people with mental illnesses and psychiatrists. You only have to look as far as network television and Gotham or American Horror Story to find an equally grim depiction. It seems that the default horrifying and anxiety producing storyline is to go back to the old myth of the psychiatrist as bogeyman.
The treatment situation is so desperate that in current politically correct times - people with mental illnesses, their families, and doctors need to be treated realistically just like it would occur with any other disadvantaged minority.
Get real with portrayals of mental illnesses, psychiatric treatment, and psychiatrists and drop the unnecessary drama and distortion. It deters people from seeking the safety and treatment that they need and keeps politicians and the businessmen in charge of medicine and cutting psychiatric services to the bone.
It's the 21st century and it is time to wake up and realize that there is an enlightened approach to these problems.
George Dawson, MD, DFAPA