JUMP CUT
A REVIEW OF CONTEMPORARY MEDIA

copyright 2010, Jump Cut: A Review of Contemporary Media
Jump Cut
, No. 52, summer 2010

Freaks, geniuses or biological citizens? Discourses of mental distress in British television documentaries

by Stephen Harper

Ever since Michel Foucault published Madness and Civilisation in the 1960s, the public representation of madness has fascinated cultural critics. Today within the broad field of media and communication studies, a growing number of scholarly articles examine the mediation of mental distress, as well as several full-length books, including Otto Wahl’s Media Madness (1995), the Glasgow Media Group’s Media and Mental Distress (Philo et al., 1996) and, more recently, Gary Morris’s Mental Health Issues and the Media (2006) and my own Madness, Power and the Media (2009). Many of these writings catalogue and critique common media stereotypes about mental distress. Among other things, they seek to dispel the commonplace associations of madness with violence, stupidity, incompetence or incurability — stereotypes which, as I shall suggest here, persist in contemporary media representations of mental distress as part of the dominant ideological imagining of madness.

Yet dominant ideologies are as slippery as eels. In fact, the field of mental health and illness provides a pre-eminent example of how hegemonic media discourses are scrambled and rearranged as quickly as they can be identified. As well as generating old stereotypes, contemporary Western media forms now proliferate what might be called “positive” images of mental distress, that is, representations underpinned by an anti-stigma or awareness-raising agenda. From Ron Howard’s A Beautiful Mind (2001) to Stephen Daldry’s The Hours (2002), a plethora of Hollywood films from the last decade, while often reproducing stereotypical ideas about mental distress (mad women are tragic, for example, while madmen are heroic) attests to an increasing public awareness of – and sensitivity towards – issues of mental distress. This affirmatory shift is underwritten by a constellation of interests including those of pharmaceutical companies, health-promotion agencies, the state itself, and the subjective investments of individuals who are increasingly enjoined to monitor their mental well-being as part of their “will to health.”

One manifestation of this upswing in public awareness of mental health is the growth in cultural texts that stress the importance of cultivating happiness. Weighing the importance of happiness as a life goal, Zygmunt Bauman (2002: 138) argues,

“For most of human history, happiness was not the self-evident purpose of life. If anything, the contrary assumption prevailed. Suffering and pain were seen as permanent companions of life.”

Although Bauman may be underestimating the ancient Greek concern with eudaimonics here, the publication of books such as Richard Layard’s Happiness: Lessons from a New Science (2005), which argues that happiness can be taught, certainly do seem to signal a renewed social-scientific and governmental interest in the cultivation of psychological well-being. At the level of popular culture, meanwhile, television dramas and soap operas increasingly feature storylines that not only depict mental distress sympathetically but also implicitly offer guidance on how to avoid it in the first place. Thus a 2004 storyline in the long-running British soap opera, EastEnders, deals with Garry Hobbs’ mental breakdown and concludes with Garry receiving advice from his father-in-law about the importance of communicating one's negative emotions. Indeed, contemporary television’s images of mental distress are not only sympathetic towards sufferers – as attested by a range of dramas from young adult ‘infotainment’ films such as Losing It (Channel 4, 2002) to the institution-set Poppy Shakespeare (Channel 4, 2008) and the long-running EastEnders storylines involving the bipolar character Jean Slater and her daughter Stacey – but also have a pedagogical purpose, highlighting issues of social stigmatisation and medical prevention. Actors involved in such dramas often ‘speak out’ on mental health issues or champion mental health causes. Lacey Turner, who plays Stacey in EastEnders, for example, participated in National Carers Week in 2006.

This more sympathetic and advisory orientation towards questions of mental health is also commonly adopted in factual television. In the 2006 BBC2 documentary The Happiness Formula, for example, a variety of psychologists emphasize the importance of holidays, artistic endeavor, and other unalienated labour in combating “stress” and promoting happiness. The documentary ends with its narrator’s claim that “governments are now realizing people need to be happy as well as wealthy and are now working out how to convince us to change our lives.” In advanced capitalist countries, where most people are becoming poorer rather than wealthier — and where workers increasingly face longer working hours and fewer holidays (Bunting, 2004) — we should regard such economic progressivism and statist utilitarianism with due scepticism. Nonetheless, the documentary’s conclusion correctly identifies managing mental health as a central component of late-capitalist governmentality. In view of this institutional shift, some of the prevailing theoretical assumptions in this area may need reassessment. As the regulation of mental health assumes increasing importance in shaping people’s subjectivities, it seems increasingly less appropriate simply to discuss good and bad, accurate and inaccurate images of mental distress. In addition to a concern with verisimilitude — or perhaps in relation to it — we must also consider how discourses of mental health are articulated with, and animated by, contemporary capitalism’s ideological and bio-political imperatives.

In responding to this challenge we may draw some lessons from the history of cultural studies. In the 1970s, anti-sexist and anti-racist cultural studies began to replace the binary framework of “good/accurate” versus “bad/inaccurate” images of minority groups that had theretofore prevailed (Pollock, 1977) with a more flexible, anti-essentialist emphasis on difference. As the burden of representational correctness has lifted, critiques of minority representation have been loosed from their positivist prison, problematizing any talk of “true” or “accurate” representations of women or visible minority groups. In the same way, I would suggest, studies of media representations of madness can no longer rest upon essentialist psychiatric definitions of mental illness that take no account of class, gender or racial difference. Our task today is not to replace one set of images with another or to force every media representation of mental distress into a preconceived representational paradigm, but to understand how public images of madness are filtered through ideological discourses of race, gender and social class — discourses whose operations and effects much of the existing critical literature in this field fails to analyze.

It is equally important to consider how media images of madness intersect with Western societies’ regnant ontological assumptions about mental distress. One of these is the dominant psychiatric understanding of madness as “illness.” Put simply, the major problem here is that despite the recent growth of interest in the biomedicine of madness, most if not all psychiatric diagnoses are scientifically indefensible. Patients identified as “schizophrenic,” for example, share neither common symptoms nor prognoses (Read, 2004) and the clinical credibility of “schizophrenia” has been comprehensively demolished (Boyle, 2002). As the psychologist Elie Godsi (2004: 47) says of psychiatric diagnoses:

“Countless attempts to define particular illnesses through obsessively detailed descriptions have failed to achieve anything like acceptable levels of consistency. In any other branch of science this level of unreliability would have led by now to the abandonment of the original concept and a search for another.”

The validity of the medical model of madness, then, seems rooted in discourses of power rather than in empirical reality. Since the end of the period of post-war reconstruction and social reformism in the 1970s, the medical model of madness has enjoyed a resurgence, switching the focus of research from social to biological contexts. As a result, the parameters governing public discussions of the causes of mental distress have narrowed. As Bradley Lewis (2006: 47) puts it:

“This is an era that seems naïve and unsophisticated about the multiple dimensions of depression. The vast majority of clinical discourse embraces a biological model that describes depression as a medical disease involving neurological pathology.”

This medical paradigm exerts an increasing influence on psychiatric treatment. As Western nations transition between Foucauldian “disciplinary societies” characterized by physical enclosures (such as psychiatric institutions) to more “fluid,” Deleuzian “societies of control,” pharmaceutical regulation assumes an increasingly central role in the project of social domination, despite unconvincing evidence for the efficacy of most psychiatric medications. More and more, madness is individualized as a brain disorder in need of pharmaceutical intervention rather than seen as the result of social inequalities and stressful living conditions that require political and structural redress (Fisher, 2009).

Indeed, a key premise of my argument here is that the medical model of mental distress is less useful than the social model, according to which social pressures play the most significant role in the onset of psychological disorders. At the microlevel, the term “social” might designate the individual’s relationship with her family. Thus, relationship breakdowns and bereavement are common causes of mental distress. In cases of long-term distress, childhood experiences of neglect or abuse, whether physical, verbal or sexual, also have a causal impact. Godsi (2004: 65) states of those who experience chronic mental distress that “invariably their distress or violence essentially originates from tragic or traumatic childhood experiences.” As Rogers and Pilgrim (2001: 67) summarize,

“Reviews of the literature on the immediate and long-term effects of sexual abuse on child victims come to the conclusion that there is strong evidence that they are significantly more prone to mental distress than non-abused children.”

Such domestic experiences of powerlessness and victimization are, in addition, surely related to the Hobbesian dynamics of capitalist society, which increasingly pits individuals against each other in a battle for employment, resources and status (Godsi, 2004: 198–9).

At a macrolevel, it is easy to demonstrate an overlap between mental distress and social inequality. Studies have long shown links between serious mental distress and social isolation (Faris and Dunham, 1939), unemployment (Brenner, 1973; Clark and Oswald, 1994; Biddle et al., 2008) and poverty or low pay (Brown and Harris, 1978; Campbell et al., 1983; Theodossiou, 1998; Werner et al., 2007). A study conducted by the Greater Glasgow Health Board in 1999 also shows very strong correlations between poor mental well-being, poverty and alcohol and drug abuse (McKeown, 1999: 14). Social class plays a key role here: Brown and Harris (1978), for example, find that working-class women are four times more likely to experience depression than middle-class women. Indeed,

“the finding that higher prevalence rates for a range of mental health problems are to be found amongst those in the lowest social classes is firmly established” (Pilgrim and Rogers, 2003: 18).

Of course, scholars debate the nature and causative direction of this correlation between class and mental illness; they often take sides with social causation theory or “social drift” theory — according to which social deprivation is a consequence rather than a cause of diagnosis, this debate has proved difficult to resolve (Pilgrim and Rogers, 1993: 13–16). But Christopher Hudson’s (2005) large-scale, seven-year study of the correlation between mental distress and unemployment, poverty and the unaffordability of housing in the United States strongly supports the theory of social causation as opposed to drift theory, as well as showing large gaps in mental illness rates between people from rich and poor areas. At the very least, we can say that the research mentioned above, combined with the paucity of evidence for biological causation, warrants the assumption that

“a large proportion of behaviors that are currently regarded as mental illnesses are normal consequences of stressful social arrangements” (Horwitz, 2002: 37).

The objection to the medicalization of madness is not only that it individualizes suffering that is social in its cause and nature, but also that it may even lead to the stigmatization of sufferers. In his assessment of the pros and cons of the “illness model” of mental distress, Len Bowers (2000: 158) suggests that the medical model “facilitates the treatment of ‘mental illness’ in a non-stigmatising, humane manner.” Yet the evidence to support this assertion is far from unambiguous. Kirk and Kutchins (1999) argue that the medicalization of distress increases the stigmatization of sufferers; some research even suggests that

“doctors stigmatize psychiatric patients more than the general public do” (Lawrie, 1999: 129).

Farina et al. (1978) and Fisher and Farina (1979) have shown that those with psychological problems who conceptualize themselves as having a “disease” are more likely than those who do not to feel helpless about their recovery and to abuse drugs or alcohol. Read et al. note that “knowledge” about mental distress is often equated with the espousal of an illness paradigm. Through a meta-analysis of international research, however, they show that most members of the public prefer psychosocial explanations of distress to biogenetic ones and that biogenetic beliefs and diagnostic labelling are positively related to prejudice, fear and a desire for distance from the mentally distressed. They conclude that anti-stigma campaigns should avoid decontextualized biogenetic explanations as well as terms like “disease” and “illness.” Evidence from electric-shock experiments, meanwhile, suggests that while the public is less likely to blame sufferers with disease diagnoses, they tend to treat them more harshly than those who have been given psychosocial explanations for their problems (Mehta and Farina, 1997). More recently, a review article by John Read et al. (2006) challenges the assumption that the “mental illness is an illness like any other” approach is the most effective way to tackle stigmatization.

Drawing all of these arguments together, I argue here that British television documentaries contribute to a growing body of positive cultural representations of mental distress. Nevertheless, they also revive longstanding stereotypes (particularly that of the “mad genius”), express sexist and class-biased assumptions, and typically reinforce the desocialized biomedical framing of mental distress.

Many of today’s most “positive” documentary representations of mental distress feature celebrity sufferers. Frank Bruno: Gloves Off (ITV1, 2005), which was nominated for a Royal Television Society Award for Best Sports Program in 2006, typifies the growing body of sympathetic mental distress documentaries. Underpinned by a mental health awareness agenda, the documentary serves as a counterweight to the infamous “Bonkers Bruno” headline, which appeared in The Sun newspaper on the occasion of the former boxer’s sectioning under the Mental Health Act in 2003. Gloves Off explores the reasons underlying Bruno’s bipolarity and breakdown, including his loss of the World Heavyweight Champion title to Mike Tyson in 1996, his marriage breakdown, the suicide of his long-time friend and trainer George Francis and his recreational drug use, while Bruno himself talks “honestly and openly,” as the pre-broadcast continuity announcer put it, “about his battle with mental illness.”

Gloves Off belongs to the subgenre of the “comeback documentary,” which typically provide an opportunity for maligned or stigmatized celebrities to “set the record straight” about their breakdowns (another example is MTV’s Britney: For the Record, broadcast in the UK by Sky1 on 22 December 2008, in which the singer, at the end of a tumultuous year, expresses her frustration at having been categorized as “ill” and becoming a “victim” in the media). From the documentary’s interviews with Bruno and some of his friends and family, two messages emerge. The first has to do with the importance of medication in Bruno’s recovery: Bruno notes that he had initially neglected his medication and implies that his medical compliance played a part in his recovery. The second message is the importance of communicating one’s problems to others. As Bruno puts it:

“As a man, I thought I could do it by myself […] I was taking it all in and absorbing it by myself, rather than talking it out.”

As in the EastEnders example discussed above, the emphasis here on the importance of emotional communication reflects a typical and growing concern within anti-stigma discourse: the importance of “talking things through.” As Bruno’s comment implies, this strategy may be especially important to promote among men, who are subject to longstanding cultural prohibitions against emotional disclosure.

In fact, the restorative powers of medication and communication are staple themes of celebrity mental distress documentaries. Channel 4’s The Madness of Prince Charming (17 July 2003), for example, sketched the life of Stuart Goddard, also known as the pop star Adam Ant, who has experienced bipolar disorder throughout his life and suffered a breakdown in early 2002. The documentary contains interviews with Goddard’s friends, a former teacher and ex-band members as well as Goddard himself, as he sits in the deserted ward of the hospital in which he was once detained. Some of the shots used in the documentary could be argued to be stigmatizing. A shaky hand-held pan shot of a darkened hospital corridor, for example, owes much to the conventions of horror cinema. And a shot of a newspaper cutting about Goddard’s breakdown, traversed by bars of shadow, suggests a dark and dreadful incarceration in a jail-like environment.

These obviously troubling images are accompanied by other problematic discursive elements. Although Goddard is reported to have “reinvented himself” after his treatment, using his “music as medicine,” The Madness of Prince Charming reinforces the biomedical model of mental distress. On the one hand, the documentary places Goddard’s breakdown in the context of his numerous personal difficulties — including a family break-up leading to behavioral problems at school, a failed marriage at a young age, exam pressures, and later stresses resulting from his diminishing fame and his experience of being stalked (“it drove me bonkers”). Nevertheless, the psychiatrists whose interviews punctuate the program repeatedly stress that bipolar disorder is an “illness,” and the narrator asserts that it is “often genetic” in origin.

One psychiatrist interviewed for the documentary, Trevor Taylor, further suggests that Goddard’s problems were intimately connected to his creative talent, drawing comparisons between Goddard and the artists Van Gogh, Byron and Virginia Woolf. The program thus links Goddard’s mental distress with his creative genius — an association with ancient origins as well as many contemporary cinematic parallels, such as Scott Hicks’ Shine (1996) and Ron Howard’s A Beautiful Mind (2001). Incidentally, it seems that the madness-genius correlation is reserved almost exclusively for men, as several feminist critics have discussed: Christine Battersby (1989), for example, contends that genius has traditionally been defined as a combination of masculine and feminine qualities attainable only by men. This assumption has a remarkable cultural resilience: in a consulting firm’s list of public nominations for the UK’s “top ten geniuses” in 2007, only 15 of the 100 most commonly mentioned figures were female (Williams, 2007: 13).

In a slightly later two-part documentary, Stephen Fry: The Secret Life of the Manic Depressive (BBC2, 2006), the celebrated British actor and comedian reflects in characteristically urbane fashion on his bipolarity and discusses the condition with other sufferers, including some high-profile celebrities such as singer Robbie Williams, television chef Rick Stein and actress Carrie Fisher. Produced and directed by Scott Wilson, the documentary is worthy of particular attention because of its wide range of interviewees (both celebrities and non-celebrities), its cultural prominence (the production won an Emmy award in 2007 for Best Documentary) and the scope of its enquiry into the symptoms and treatments of bipolarity. Like the documentaries mentioned above, The Secret Life represents a politically astute combination of commercial and public service elements, focusing on celebrity while fulfilling the BBC’s remit to explore issues of socio-cultural import — a remit whose continuance was very much in question in the run-up to 2006, when the BBC’s ten-year Royal Charter was finally renewed after much critical discussion following the damning Hutton Report of 2004. In this sense, the celebrity mental distress documentary can be seen as a valuable hybrid form for public service television organizations under pressure to compete with commercial television without sacrificing what the BBC now calls “public value.”

The journalistic reception of The Secret Life was overwhelmingly enthusiastic. “This bold, touching, unsentimental film should help rid mental illness of some of its stigma,” wrote Sam Wollaston (2006: 32) in The Guardian; “Fry does for manic depression what Pete [a Big Brother contestant] did for Tourette’s.” Wollaston has a point. The Secret Life of the Manic Depressive depicts the plight of various groups of sufferers who are all but invisible in more glamorous cinematic representations of madness, such as older people and women suffering from postpartum depression. Its treatment of celebrity mental distress, meanwhile, counteracts the widespread mockery of celebrity madness in the media. While Robbie Williams was being treated for depression in February 2007, for example, the presenter of ITV1’s Brit Awards, Russell Brand, joked that he possessed “the keys to Robbie Williams’s medicine cabinet.” A few days after the Brit Awards, the guest presenter of Channel 4’s late-night entertainment show The Friday Night Project, actress Ashley Jensen, remarked that Williams’s absence from the event was regrettable given that “he’d already picked out his jacket”; Jensen’s comment was accompanied by a visual image of a straightjacket, provoking laughter from the audience. Fry’s documentary constitutes a valuable riposte to this sort of casual abuse. Fry is often shot standing behind (or peering out from behind) windowpanes, fences and bars, symbolizing the psychological barriers he has had to overcome and his own feelings of frustration and entrapment. Many of these images — such as the shot of Fry standing in silhouette on the deserted beach he frequented after his breakdown — have a distinctly Romantic quality.

Fry’s speculations on the causes and development of mental distress sometimes touch on its socio-cultural determinants. He spends some time, for example, addressing the life problems that may have contributed to the distress of the documentary’s subjects and the documentary offers extensive evidence that psychiatric practices — such as the typical ages at which children are diagnosed as bipolar — vary between the UK and the US. This in turn correctly implies that cultural factors play a large role in the construction of mental distress. Moreover, visiting London’s Maudsley hospital, Fry is told that there is no “brain test” that would indicate his bipolarity, and at Cardiff University he discovers the inconclusiveness of research into the “bipolar gene.” The Secret Life also contains perspectives that run counter biopsychiatric orthodoxy. Fry interviews an ex–Bethlem hospital patient — and high-profile ex-neurosurgeon — Liz Miller, who was sectioned three times, but who eventually stopped taking her medication and who has remained well for 15 years. Miller explains that “medication is like the training wheels on a bicycle” — useful at first, but ultimately unnecessary.

Notwithstanding these counter-psychiatric voices, however, the documentary’s dominant perspective is that of biopsychiatry. An early scene in the first episode combines Fry’s voiceover, in which he asserts his intention to “find out” about his and others’ conditions, with images of monitors showing the output of CT scans, a combination which suggests that medical science has the power to unravel the “mysteries” of mental distress and which in turn invokes the progressivism and positivism that have long characterized television science programming (Gardner and Young, 1981). Fry’s voiceovers also repeatedly stress that bipolarity must be understood as a hereditary illness (“it is an illness”; “manic depression is an illness that’s always handed down in families”; “if you have it, the chances are that somebody else in your family had it too”; “I have a disease of the brain that I share with four million others in the UK”). The medical model of distress is further accented by a range of expert interviewees, such as Aberdeen University’s Professor Ian Reid, who advocates pharmaceutical and electroconvulsive therapies. Moreover, by framing Fry’s interviews with sufferers as conversations between friends, The Secret Life of the Manic Depressive depicts a community of sufferers who readily identify their conditions as biological and who make common cause with each other on that basis. The sufferers’ rapport, and, in the case of Williams, close friendship with Fry thus constitutes a mediated version of what Paul Rabinow (1996) calls “biosociality,” or what Nikolas Rose (2007: 134) terms “biological citizenship’: “collectivities formed around a biological conception of a shared identity.”

Like The Madness of Prince Charming, The Secret Life takes up the theme of madness and genius. Fry speculates that his mania has been largely responsible for his creativity and career success. “It’s tormented me all my life with the deepest of depressions,” he notes at the start of the second episode, “while giving me the energy and creativity that’s perhaps made my career.” The Secret Life also links bipolarity to notions of genius and career success through its selection of interviewees, many of whom either are or had once been professional “high fliers.” While there is certainly no harm in emphasizing that people suffering with mental problems can lead full and meaningful lives, it should also be noted that the figure of the “mad genius” is a distinctly class-based one (the term “genius” itself is generally reserved for artists and intellectuals and seldom applied to bus drivers or refuse collectors).

The madness-genius linkage is also implicit in a BBC2 documentary written and presented by the ex-Labour party spin doctor Alastair Campbell. In Cracking Up (2008) Campbell discusses how, in 1986, he paid for his high-flying journalistic career with alcoholism and subsequently psychotic depression. Cracking Up creates a sense of authenticity through its informal and frank mode of address. Campbell’s voiceover is characterized by a breezy intimacy (on talking to his former GP, Campbell notes, “Bloody hell; this is weird’) and the documentary is framed at the beginning and end by an address to camera in which Campbell calls for an end to the stigmatization of mental distress.

On the face of things, there might seem to be little to object to here. Yet Cracking Up, like The Secret Life, repeatedly asserts that bipolarity is an “illness.” Moreover, the documentary raises questions about the suitability of powerful individuals to “represent” people suffering from mental distress. Campbell is hardly an uncontroversial figure, even among members of his own political party. Unsurprisingly, the documentary makes no mention of Campbell’s possible role in the lead-up to the suicide of David Kelly. Kelly was the British government weapons inspector whom many believe was hounded to his death in 2003 after Campbell’s campaign to “out” him as the source of BBC news reports criticizing the adequacy of the government’s military intelligence leading up to the allied invasion of Iraq. Whatever the facts about Campbell’s role in the Kelly affair, one could argue that his support for the allied attack on Iraq make Campbell an improbable anti-stigma campaigner.

Campbell’s intimate style and the editing of the documentary produces a sense of Campbell’s “ordinariness”: Campbell tells us, for example, that “he is like millions of other people with this illness,” as a shot of Campbell sitting in the police cell in which he was detained in 1986 dissolves into a crowd scene. Yet for all his undoubted suffering, Campbell’s status as a member of a capitalist (read: racist, nationalist and imperialist) political party problematizes his claims to ordinariness. (In the same vein, the frequent use of Winston Churchill as a figurehead for mental health awareness campaigns is highly problematic, given the shockingly long list of oppressions and atrocities for which Churchill was responsible, not to mention Churchill’s support for the forced sterilization of mental defectives). Politicians such as Campbell, it must be added, often reap enormous personal benefits from the public discussion of their problems, appearing on talk shows and producing books and documentaries about their experiences. Clearly, for some individuals, the difference represented by madness is “not excluded but cultivated as a useful social and economic resource” (Johnson, 2008: 44). Yet the political divisiveness of figures such as Campbell raises the question of the extent to which ruling-class politicians can or should “speak for” sufferers of mental distress. It certainly should not be uncritically assumed — as is routine among liberal anti-stigma campaigners — that such individuals project a “positive image” of mental distress or constitute appropriate “role models” for working-class sufferers.

In this latter connection, it is instructive to compare Fry’s Secret Life and Campbell’s Cracking Up with the strikingly different portraits of mental distress presented in My Crazy Parents. This explicit and harrowing two-part documentary broadcast on Channel 4 in 2004 has children and teenagers document their experiences of living with a distressed parent using a “video diary” format to document their lives from their own point of view. The first program focuses on the relationship between 15-year-old Lucy and her mother Elaine, who has a 20-year history of mental health problems, including anorexia, alcoholism and self-harm. The same program also follows the life of 17-year-old Martin as he tries, seven years after the death of his mother, to deal with the erratic and abusive behaviour of his self-harming alcoholic father, Graham. The second program follows a Glaswegian self-harmer, Michelle, from the point of view of two of her three children. Michelle suffers from psychotic depression and has a long-standing addiction to numerous prescription drugs. She blames some of her problems on the side effects of these drugs. Desperate to wean herself off her medications, she checks herself into a psychiatric hospital while her two youngest children go into care. The visual content of both episodes of My Crazy Parents is explicit. The second program, for example, graphically presents the effects of Michelle’s cutting her arms with a razor; Michelle's forearms, often running with blood, are shown in close-up at regular intervals throughout the film.

My Crazy Parents divided the critics in a way that illustrates the difficulty of agreeing upon criteria for evaluating media representations of distress. Writing in Community Care magazine, the child protection officer Clea Barry (2004: 49) notes that the documentary’s video diary format and the absence of interviews with professionals or other outsiders locks the audience into the isolated existence of the families concerned, making for a disconcerting but powerful viewing experience. She also points out, quite correctly, that “there is no story of triumph over adversity,” an all-too-common feature of cinematic portrayals of mental distress. Yet one can also sympathize with journalist Nick Johnstone’s (2004) excoriation of the program in The Guardian as “sensationalist,” “voyeuristic” and “exploitative.” While Barry applauds the documentary’s brutal frankness, Johnstone criticizes its sensationalism. As these divergent critical evaluations of My Crazy Parents attest, it is difficult to assess the merits of the documentary by appealing to stereotype research alone since the program exploits some stereotypes while avoiding others. In such cases it is useful to move beyond the question of whether the documentary’s presentation of madness is accurate or inaccurate to consider the program’s wider ideological discriminations, particularly in this case with reference to social class.

The mode of address of My Crazy Parents is quite different to that of The Secret Life of the Manic Depressive or Campbell’s Cracking Up. Here the effects of serious mental distress are shown on camera rather than described retrospectively. The framing of these images is also noteworthy. The start of the second program contains several shots of family life in a poor area of Glasgow: Michelle’s teenage son Tony is seen smoking and resting his arms on an upper story windowsill of the family’s council house as he talks to friends outside. The shaky camera and blurred focus of many of these shots index a raw emotionality and authenticity, recalling Jon Dovey’s (2000: 55) observation that “the low grade video image has become the privileged form of TV “truth telling.” This “immediate” tabloid style contrasts with the more sedate aesthetic of Fry’s documentary. Focusing on dysfunctional unemployed or working-class families rather than the troubled celebrities and professionals of Fry’s documentary, My Crazy Parents’ images of working-class abjection contrast starkly with The Secret Life’s measured reflections on the sufferings of professional people and its lofty speculations about “creative genius.” My Crazy Parents does not redeem its working-class (and, in the case of Michelle, female) subjects and tends to construct them as spectacles or freaks, since the more heroic, approbatory discourse of “mad genius” is reserved exclusively for middle-class or celebrity sufferers.

The documentaries I have discussed here generally adopt a “positive” perspective on their subjects. At the same time, it is possible to discern a number of freshly problematic elements. While they contain no shortage of “positive images” of the mentally distressed, contemporary documentaries tend to valorize mental distress through appeals to the distinctly classed and gendered discourses of “genius” and “noble suffering” and to a highly contestable biopsychiatric orthodoxy. In their implicit individualism, these discourses participate in what can be seen as a retreat from socio-structural understandings of distress. This retreat is by no means confined to the documentary form. In television talk shows, for example, the analysis of emotional problems is limited by restrictions of time, while questions about the social determinants of individual problems are typically translated into questions of self-discipline and personal morality (Shattuc, 1997; Dovey, 2000).

Of course, there are always exceptions to these trends. Channel 4’s The Doctor Who Hears Voices (26 April, 2008) is a docudrama that combines real-life interview and testimony material with dramatization. It tells the real-life story of the psychologist Rufus May, who plays himself in the docudrama, and a voice-hearing doctor, Ruth (played by actress Ruth Wilson). Much of the drama is based on the real-life transcripts of the conversations between May — a controversial psychologist who, we are told, “does not believe” in mental illness — and his patient. As Ruth, unmedicated and with May’s help, eventually finds a way to accommodate the voices she hears into her everyday routines, the docudrama hints at the limitations of the medical model and of pharmaceutical treatments of distress. Indeed, the docudrama contains an interview with a conventional psychiatrist, Trevor Turner, who contributed his medical expertise to Channel 4’s earlier The Madness of Prince Charming. Turner’s contributions provide a counterbalance to May’s unorthodox views. But it is May’s critical perspective on psychiatry that prevails, suggesting that within British documentary, at least, the hegemony of biopsychiatry, like all hegemonies, is not entirely secure.

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