Psychiatry and Art: The Changeling
By Jeffrey on October 15th, 2009Posted In: Blog,Mental Illness and Art
The Changeling (2008) – Directed by Clint Eastwood. Starring Angelina Jolie and John Malkovich
I had the chance to watch a movie called The Changeling while I was sick at home last week. It is directed by Clint Eastwood with Angelina Jolie playing the main character supported by John Malkovich. It is a period drama set in Los Angeles 1928.
According to the Internet Movie Database (IMDB):
A grief-stricken mother takes on the LAPD to her own detriment when it stubbornly tries to pass off an obvious impostor as her missing child, while also refusing to give up hope that she will find him one day.
While I thoroughly enjoyed the movie for the acting, set design, and story telling; I was more intrigued by the portrayal of the late 1920′s American psychiatric system, nursing staff, psychiatrist. To note, instead of “intrigued”, let’s say I was more jaw droppingly horrified. I realize that The Changeling was a Hollywood production, so perhaps some things were embellished in order to heighten drama and emotion for movie making sake. But on the other hand, perhaps Clint Eastwood was accurate in his portrayal of the psychiatric system. I would not know because I did not live it. And I am well aware of Psychiatry’s spotty history with ethics, abuse, and human rights violations throughout history. However, for this article, I will take what I saw in the movie for face value.
Here is a comparison of how far Psychiatry has come thus far. Of course, there can still be improvements. But watching this movie and comparing it to how we operate here in Edmonton, Alberta, Canada makes me grateful for our current standards. Here is a break down of the differences:
| The Changeling (?Hollywood-ized circumstances…1928 Los Angeles, California)
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What happens at my Hospital in real life Edmonton, Alberta, Canada 2009 according to my knowledge and experience as a Registered Nurse working in Acute Adult Psychiatry
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| A police chief has the power to institutionalize someone at the “psychopathic ward” without proper assessment and external consultation (maybe even skipping proper documentation) | Police can only Form 10 (Psychiatric illness related legal document written up by an officer with specific reasons and rationale) an individual they suspect has mental illness and wrangle them into a hospital for further assessment |
| The police chief and a single doctor can have the power institutionalize someone | Two psychiatrists separately assess a patient to validate a need to certify someone under the Mental Health Act in order to legally hold them at the hospital |
| A psychiatrist can intimidate, manipulate, and verbally coerce someone into signing a legal document for law enforcement | I could be wrong here, but to my knowledge and training, a patient cannot be coerced into signing any legal documents while in hospital. The verbal bullying and intimidation practices used by the psychiatrist in the movie really contrasts the communication styles I have observed psychiatrists/physicians using in our hospital. It is more therapeutic and respectful. |
| Patients are locked in their rooms unless it is meal time | Patients have different observation levels that grant them certain priviledges and freedoms depending on their behavior, cognition, and judgement. While some are regulated to the unit on constant supervision, others may have access to wander the ward or hospital grounds outside in the open. |
| Medications must be taken in the form of tablets. Patient has no right to refuse. Refusal means being held down by orderlies, nose plugged by some one’s fingers, and pill forced into mouth | Unless someone has a treatment order where two psychiatrists deem someone incompetent to make decisions, a patient has the right to refuse their medications |
| Police have the power to institutionalize someone when they speak up against the police or may bring damaging allegations to light | Our police do not have that power here. |
| Electro Convulsive Therapy (ECT) is used for disobedience, questioning, and punishment on the whim without any prior medical work up, anesthetics, and consultation | Perhaps ECT was used to punish before as well. But now ECT is not used to punish ad lib whenever someone acts up towards staff. It is ordered by a psychiatrist who usually consults another psychiatrist prior to get a second opinion for validity. Then an anesthetist is consulted, medical history assessed, and current EKG is attained. There is a process in place now. People are no longer randomly dragged into the ECT suite to be zapped. |
| Nurses did not question authority AT ALL | If anything, nurses now are taught to always critically think, question status quo, and speak up. I work with a lot of women. Even on a human level, I could not think of any of them being comfortable or even agreeable to working in the type of environment portrayed in the film without Feminist fires being stoked. |
| Nurses do not smile EVER, wear permanent scowls, and look like they are ready to murder you | I admit that there are nurses that do not smile. I have worked with my number of really burnt out, unhappy individuals as a student and professional. But honestly, most of us laugh, joke, and socialize just like any other practicing profession. |
In closing, I think any medical professional who comes in contact with the mentally ill should watch The Changeling. I especially urge nurses and psychiatrists to experience the movie. The portrayal of both professions reinforces negative stereotypes that we have yet to overcome. However, it did make me reflect on how important it is to look, listen, think, and speak in order to advocate for better practice.
Peep the trailer below:
