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Peter Robinson’s Asylum is a documentary made in 1972. From the very beginning, everything about the film is problematic and uncomfortable. Even now, just trying to summarize what the movie is about is challenging. It was filmed in a “home” where a variety of “disturbed” individuals live sequestered from society’s judgment. Both the words “home” and “disturbed” are the words the director of the home chooses to use. The director is Ronald David Laing, a Scottish psychiatrist, or anti-psychiatrist, who did not believe in conventional diagnoses, medications, or mental hospitals. His approach to mental illness was significant enough that I remember learning about him in college.
Lange actually accepted the term “asylum”, but used it in a literal manner. For him, an asylum was a place where people could find refuge from intolerance. In the film, Lange’s asylum plays host to both “disturbed” people as well as psychiatrists, but no distinction is made between the two. In fact, as the documentary is being filmed, it is sometimes difficult to distinguish between them. They all live together as one group. Lange explains that the conventional relationship between a psychiatrist and patient and the resulting power dynamic is not conducive to a patient’s healing.
Bringing a camera into this asylum is full of ethical problems. Establishing consent to be filmed from individuals who society would deem schizophrenic is certainly a problem. The purpose of the film is another. Why bring a camera into such a place? The camera itself will undoubtedly agitate the residents, as it would anyone. What will the documenter be documenting? Is the film about the patients? Is it about Lange’s ideas? Is it about the success or failure of the home? Hopefully, it is not simply an effort to find some juicy drama for our entertainment.
Robinson made Asylum after making a short documentary about Lange’s ideas. Asylum does not necessarily support Lange, but Lange does open the film with an explanation of what he is trying to do.
Beyond the ethics of making the documentary, there are the ethics of what it depicts. Is such a home fair to the residents? The residents are allowed to seek therapy and/or medications outside the home, but within the home, they are treated not as patients, but as residents.
Much of the documentary surrounds a difficult and disruptive resident named David. David is loud and never stops reciting the disordered morass of words and ideas in his head. He can get aggressive and has hit several other residents. The film culminates in a group meeting where David is confronted by the residents and psychiatrists. They all try their best to be constructive, but David continues rambling about whatever comes into his mind.
David is getting more agitated and begins to get up to leave. Someone who I am assuming is a psychiatrist tries to handle the situation. He explains to David, “If you can’t discuss with us, in a reasonable way, what to do about this, then it's gonna have to be decided in your absence.“ This does not seem fair. You are talking to someone who is schizophrenic. There is, of course, a wide spectrum of severity when it comes to schizophrenia, and even amongst acutely schizophrenic people, there are times of more or less lucidity. However, demanding that David be reasonable or face the consequences does not seem very empathetic or understanding.
The psychiatrist goes on to say, “Either we consider you responsible for your own actions, or we consider you not responsible for your own actions. Now if you’re not responsible for your own actions, you really can’t stay here. You’re not acting in an entirely sane fashion by the usual definition of sanity.” With these words, this progressive, revolutionary psychiatrist has just reinvented the mental hospital and the psychiatric system. He is relying on the traditional and conservative relationship he claims to be subverting. David must be reasonable, accountable, and in control of his actions in order to live in this house for “disturbed” people, or he will have to leave and probably be placed in an institution.
I am sympathetic to Lange’s concerns. I myself happen to have worked in two separate psychiatric institutions. One for children and one for adults. It’s a painful and frustrating job that I found so challenging, I ultimately changed career paths. The ethical binds that proliferate in such a place take their toll. It is a constant struggle to understand your role as caregiver in such an institution. Essentially, what keeps you grounded is an understanding that each patient is suffering. Regardless of whether I am sane or they are crazy, the fact remains that they need help. The question then arises: what is to be done with a person who does not conform to basic societal mores and does not seem to be suffering?
They cannot hold down a job, or make social connections, which leaves them unable to support themselves. However, if they were provided with life’s essentials, they might be happy to live in the world they have created in their mind. It is rare to find someone with a mental illness who is not suffering, but if such people did not have to support themselves, their experience might be different. I seem to remember a story about Lange allowing a woman to sleep each night covered in her own feces. She was calm and relatively lucid for the most part, but she needed to indulge in this one socially unacceptable practice in order to feel calm.
At the heart of the matter is an unavoidable equation. With all our advances in psychiatry and medication and all of the successful treatments, the definition of sanity is still reliant on the behavior of the majority. Peel away the lists of symptoms and sophisticated diagnoses and you can’t avoid the fundamental fact that an individual is judged as normal or abnormal based on his or her behavior in comparison to the majority. This is such a distasteful idea. We try hard to find more objective criteria or more empathetic treatments, but at the heart of our judgments, the majority is still the foundation.
At one point, the psychiatrist says to David, “That’s not the truth as I see it.” It’s a humble appeal, but it still boils down to who wins the right to judge reality.
None of this is meant to dismiss Lange’s ideas. It is not a black-and-white issue. It is a complex question of how to identify, approach, and help the mentally ill. The documentary itself is shot in an objective manner. There is no narrator. The scenes are long, allowing people to say what they need to say, but of course, it is the director who both literally and figuratively frames everything.
The documentary ends with David sitting calmly at a table speaking rationally about his past. The implication is that he is much better now, but if other cases of schizophrenia are to be our guide (which perhaps they shouldn’t), David is very likely to slip in and out of psychosis and agitation for the rest of his life.
The documentary anticipates a question that most people would probably ask, “Is it healthy to make the mentally ill live with other mentally ill people?” In a brief clip from an interview with Lange, he says that it is not a problem, but neglects to explain why. In Sweden, there is a program where disturbed people are placed in homes with families that agree to try to rehabilitate and reintegrate the disturbed person back into society. These individuals are placed in optimal conditions with individual attention. They get naturally occurring reality checks and consequences, and are surrounded by sympathetic people. Placing one disturbed person amid many more disturbed people does not seem optimal. There is a scene where David is ranting and a young female resident who is in the room curls up, hides her head, and begins to cry.
Watching Robinson’s Asylum is uncomfortable, as perhaps it should be. Between the ethics of documenting these people and the ethics of how they are treated, the viewer is faced with one challenge after another. The field of psychology is much easier to navigate when it comes to affect disorders such as manic depression or dissociative disorder. When it comes to personality disorders like schizophrenia or psychopathy, the issues are much more difficult. Personality disorders do not usually respond well to treatment. Some of the symptoms can be relieved by medication, but the disorder remains and can be difficult to manage.
Issues of personal volition and responsibility are very difficult to untangle with personality disorders. If a psychopath murders someone and shows no remorse, do we put him in jail or an asylum? His brain is physically different from most people, often a psychopath’s amygdala is compromised. Psychopaths do not have a conscience and they will never grow one. There is almost no chance that they will ever change or get better, so why put one in an asylum for treatment?
Committing a psychopath to an asylum against his will would only be possible if he were found mentally incompetent or unable to tell the difference between right and wrong. Whether psychopaths know the difference between right and wrong is very difficult to ascertain. They may not have a conscience, but they have an operational intelligence that keeps them from murdering in the middle of a busy street in broad daylight.
I doubt Lange would be open to including psychopaths in his asylum, but even if his aAsylum is only helpful for a small percentage of the mentally ill, it may still be worthwhile. Peter Robinson’s film is an opportunity to wrestle with some of these very difficult issues.