menuPaper: The use and abuse of mental illness in fiction
07 November, 2003
author, MD.
Madness has always fascinated people. The neuro-psychiatric diagnosis epilepsia was called ”The Holy Disease” already in ancient Egypt. Since then psychosis in general, with its delusions and hallucinations, has often been looked upon as a medium for messages from hidden, transcendent worlds and the psychotic person as a human beeing with mystic powers and foresight.
In medevial Europe religoius visionaries as Hildegard of Bingen used hallucinations as revelations. During the romantic period i Europe genious and madness was regarded as almost the same. Artists were supposed to be more or less mad. During the late 20th century a political aspect on madness dominated. Michel Foucault and others critizised psychiatric care as an instrument of power used for opression of the individual.
So what is madness? Is there a special meaning to mental illness? Are there some kind of positive aspects? Is mental illness the prize some people have to pay in order to gain a certain understanding of the conditions of Humanity? Or is mental ilness, like physical malfunctions, something that if possible should be cured or relieved without delay?
From a medical point of view there are seven or eight groups of mental malfunctions: congenital cognitive incapacity, psychopathia, injuries of the brain, psychosis, neurosis, abuses and dementia. Nowadays we also talk about autism, border-line personalities and split personalities.
There are some good biographies or case-studies of children with cognitive handicaps and of old people suffering from dementia, e.g. John Bayleys biography ”Iris: A Memoir” and Ulla Isakssons ”The book of E.” – but othervise fiction seldoms deals with dementia.
Hallucinations may occur in any kind of mental ilness – but in fiction schizophrenic hallucinations are the most tempting to use or misuse. Schizephrenia is a desease of young adults. The onset can be slow with withdrawal and bizarr behavior, but sometimes it is very dramatic. The main symtom is a misconception of reality and an incapacity to differ between the outer and the inner world. Voices – the most common hallucinations – heard inside the brain are supposed to come from outside. People are talking and accusing you, there are mystical cars in the street and hidden messages everywere. The voices, often compelling, are telling you to act, sometimes violent to others. Visual hallucinations are not common. The suicidal risk is high. The symptoms can be tranquilzed but there still is no effective treatment.
The prognosis is dubious: several follow-up studies show that one third of the cases will be spontaniously and completely cured, one third will be partially cured and one third will never be cured. Cronic cases evolve symtoms not unlike dementia.
In brief schizophrenia is one of the most devastating cronic diseases causing enormous human suffering not only to the patients but also to their families.
Schizophrenia, is often used, or abused, in fiction writing and in feature films. Most common is pherhaps a tendency to create symtoms or syndroms which do not exist in reality: the filmmaker mixes symtoms from several diseases in order to make the characters more dramatic or entertaining. Another sort if misuse is ”heroization”, to make a schizophrenic person, often with paranoic symtoms, into a revolutinary hero telling the ulitimate truth about a decadent society. A third misuse is to neglect the still unknown but apparent ”inner” causes of the disease and instead present the patient as un oppressed human being who under other circumstanses would never have grown ill.
One example of misuse is the novel ”One flew over the Cuckou´s Nest” by Ken Kesey later made into a film with Jack Nicolson. The men containted in the mental hospital seem all to be prisoners locked in without reason. They are harrased by a sadistic nurse and in the end the protagonist is punished with lobotomia – but is afterwards killed, ”saved”, by his buddy.
There are of caurse reason to critizie mental hospitals and psychiatric care. It is a truth that lobotomia and other drastic treatments have been misused, but hardly in the way shown i ”One flew over the Cocos nest”.
It is, in summary, too easy to use mental illness – often a devastating condition – for all kinds of manipulations, political, romantic or dramatic.
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