All That Glitters Isn’t Gold-
Part Three: In The Nuthouse


My final topic in this series is a big one: how mental hospitals are depicted within the media. Speaking from experience of being in a mental hospital, it isn’t ‘One Flew Over the Cuckoos Nest’ or ‘Girl, Interrupted.’ Of course, both of those books were written in the sixties and the system has changed since then; slightly but not enough. 

In TV and movies, institutions are often depicted as hellish places where the staff doesn’t necessarily want a person to get better or even to be rehabilitated. But this sort of inner glimpse of how mental illness is treated started not in books or films but in exposes. In fact it took a woman to make people notice how poorly the mentally ill were treated. In 1887, a journalist named Nellie Bly acted as someone suffering from Mania and was sequestered at Blackwell Island Lunatic Asylum where she witnessed how the mentally ill were treated. Then after her shocking experience, she wrote the groundbreaking expose, “Ten Days in a Madhouse”* which I encourage you to read (she was doing exposes like this when Gloria Steinem didn’t even exist).

Despite this, it took several years for the treatment of people in mental institutions to be taken seriously. She reported everything from harsh experimentation of new medicine or techniques which made the patients’ conditions worse, to the maltreatment of patients in forms of physical,  mental and sexual abuse from the staff. Honestly, I only think this systematic change happened as late as the 1980’s. Even now people should consider that being institutionalized is the first step in a long line of steps towards stability and even then it’s not 100% for sure healing will happen.

The next time the subject of mental institutions came up in a major way was in the groundbreaking movie ‘One Flew Over the Cuckoo’s Nest.’ This was the first piece in popular media that made people really think about institutions and the overall humanity of the places since Nellie Bly.

It got best picture at the Oscars in 1976. Thespian genius Jack Nicholson, a relative unknown newcomer, won numerous awards for his portrayal of McMurphy and sealed his fate as one of the most highly regarded actors in the world. I bet Marlon Brando, James Caan, Gene Hackman and Burt Reynolds regretted their decision to pass on the role. The same situation  happened for the role of Nurse Ratchet. Louise Fletcher won a BAFTA, Golden Globe and Oscar for her machiavellian interpretation. Ellen Burstyn, Anne Bancroft, Angela Lansbury and Lily Tomlin were just a few actresses who were approached for the role and also passed, because of the macabre and malicious character that Nurse Ratchet represents as a whole, the  unsympathetic, selfish and cruel industry of the Mental Institution and Mental Health in general. 

By the way, I know that the stupendous Sarah Paulson recently did an origin story on how Nurse Ratchet became, well… Nurse Ratchet. And it doesn’t matter how much I rate Ryan Murphy, we didn’t need an origin series for that character. Nobody wondered what made the wretched woman into one of the best movie villains and such an iconic role. The best part of Fletcher’s portrayal is how benevolent and machiavellian she is, without explanation. That she’s just as, or if not more mentally psychopathic than all the characters put together. Therefore, the series just didn’t do it for me, sorry Sarah please, don’t cry…

You’re fabulous in everything else, including all of the other seasons of American Horror Story… I still miss Jessica Lange, though. 

Anyway, the really intriguing story is: how did this type of movie get made? It wasn’t easy even when one of the first families of Hollywood, the Douglases, got their hands on the film. Kirk Douglas bought the rights from the author Ken Kesey after producing and starring in the Broadway version of ‘One Flew Over the Cuckoo’s Nest’ in the sixties. Kirk then passed the film rights down to his son, Michael. He produced the film and even featured his best friend, the delightful Danny DeVito, as Martini in his freshman role (the first of many). However, it took until 1975 to get it made for the silver screen. No studio wanted to go near a film about mental institutions or the mentally ill. But eventually this independent film was made for approximately $4 million and the box office return? A whopping $163.3 million dollars. Although Ken Kesey wasn’t satisfied with the project, because it didn’t utilize Chief as the narrator as he functioned in the novel—however this isn’t the first or the last time that the author hated how his project was portrayed in another medium. It doesn’t matter how you look at it, the main character McMurphy is seen as a messianic figure that brings hope to the other patients. This is quashed through the power of the institution and the she-devil Nurse Ratchet. He experiences Electro Shock Therapy and eventually a lobotomy. 

Lobotomies thankfully aren’t performed anymore, to the relief of everyone! Apparently the prefrontal cortex is the area that controls motor functions, emotions and memories, so severing it from the rest of the brain can be detrimental to one's health, who knew? Well, those in 1949 sure didn’t. Antonio Egas Moniz got the Nobel Prize for Physiology or Medicine that year for inventing the macabre procedure. But it wasn’t so much about curing the disease or disorder that mental illness creates as it was about shutting people up.

The other therapy depicted in the film is Electro-Shock Therapy (EST) which, back then, was cruel and painful, with the electrodes inducing a Grand Mal seizure. This treatment is still used now though—thankfully it’s under anesthesia—but the results are a very mixed bag. Some have found solace in the procedure, however a frank majority haven’t. In my opinion when you are messing with the neurons, synapses and functionality of the brain as a whole, you can’t just put electrodes to a person’s temples like you would with a pair of jumper cables to restart a car battery. I feel that a procedure of this nature requires expertise in both neurology and  psychiatry, which is lacking in today’s medical landscape. It’s quite frankly peculiar to me that two fields which are so linked to one organ can be so disconnected.

Let’s move onto another film based on a novel, ’Girl, Interrupted,’ for which Angelina Jolie won best supporting actress. This film depicted another ‘technique’ that no longer goes on in mental institutions: hydrotherapy where someone was kept in a bath of water. This doesn’t sound so bad until you realize three things: the bath was either A) so hot people suffered burns and were effectively boiled alive, B) so cold that you could get hypothermia and die, or C) so long that the person suffered a psychotic break whilst being strapped into the tub and tried to drown themselves—but that was the harsh reality of the mental asylum: you weren’t expected to survive. 

I previously referenced Ken Kesey’s lack of enthusiasm for how his story was projected on the silver screen. The same can be said of the writer of ‘Girl Interrupted,’ Suzanna Kaysen, who actually said "I really hate that movie…(it’s) melodramatic drivel." She didn’t like the way that the focus was solely on the characters and not how the women were actually treated in the facility.

Her adverse reaction actually reminded me of reclusive author J.D.Salinger whose protagonist, Holden Caulfield, is telling his story in hindsight from a sanatorium. Salinger was approached repeatedly in his lifetime to make the book into a movie and he said no. He was afraid that the book’s essence would be lost when it came to the silver screen. Perhaps rightly so. 

Even the name of this site is inspired by Sylvia Plath’s influential book ‘The Bell Jar,’ which was made into a movie in 1979 and wasn’t successful in any way, shape or form. I didn’t even know that it existed as a movie adaptation until now. Plath died in 1963 so she couldn’t complain about the depiction, but I’m sure she would’ve had some choice words. The critics tore it to  pieces. The Chicago Tribune gave it one out of four stars and said it was “downright laughable, a stormy TV soap opera without that genre's sense of humor. 'The Bell Jar' is more than just a bad movie. It's a bad movie based on a book that has meant much to many, and they will be bitterly  disappointed.” One review particularly caught my eye because of the timeless remarks that could have easily been written today. Penelope Gillatt of The New Yorker stipulated, "A lot that is serious and troubled about insanity has been written in world literature, painted, and also dealt with on film. This picture is merely hysterical.”

This quote resonated with me because it made me think of a recent semi-autobiographical book that was ruined for me by the movie adaptation. When I was a teenager I fell in love with the book, ‘It’s Kind of a Funny Story,’ by Ned Vizzini. It’s about a teenage boy experiencing severe depression who is put in an adult mental ward after a suicide attempt. He meets a girl of similar age in the ward and they fall in love. But in reality it wasn’t really a love story. It was about the complexity of the adults, how life could go so wrong and how they ended up in the grips of mental illness that required institutionalization. It was a glimpse into the future of what could  happen to the teenagers in the book. This book was turned into a movie starring Emma Roberts, Zach Galifianakis, and Zoe Kravitz, and I was pumped. Despite somewhat favorable reviews, I was disappointed. The studio turned this book into a hackneyed teen movie with no soul. Furthermore, they added a performance of Queen’s ‘Under Pressure’ which made no sense to the plot at all. I couldn’t put my disappointment into words until now, and someone else did it for me before I was even born; ’This picture was merely hysterical.’ 

But speaking from experience, a mental ward is still awful. That’s because it’s difficult to capture the current day feelings of being trapped and completely ignored in a mental institution. Doctors, residents, nurses and orderlies are still too busy and overworked. The patients are still treated as case studies and not people. The drugs don’t change, they’re still mainly antipsychotics to get people to a meta state so they’re easier to work with. It feels and looks like a prison with pallid walls, hospital food and 20 minutes of yard time twice a day, and it’s divided into wards which do not fraternize with each other. During my time there, I wanted to help everyone there but if I couldn’t be an advocate then I would tell them “they gave you a patient handbook, you have rights.” But the reality is that the more patients complained (and if you had good insurance) the longer you stayed. No-one has captured this recent reality because it’s boring and mundane. It  wouldn’t receive any acclaim or awards.

People have received Pulitzers, Emmys, Tonys, Golden Globes, S.A.G Awards and Oscars for the depiction of mental illness, personality disorders, and murderous insanity, but rarely do people know that some of the characters are based on real people, or that the events are vastly exaggerated, or that the personal stories are hardly taken into consideration. The authors that I  just mentioned—excluding Bly who was writing an expose—had some experience with mental  institutions. Ken Kesey was actually an orderly at a mental institution. After his foray into the dangerous government experiment on mind control, MK ULTRA (again another rant, well, you know the drill by now) he experienced mental illness. Sylvia Plath used the character ‘Esther’ as a pseudonym in ‘The Bell Jar’ to explain her mental illness and institutionalization. Fuck, this very website was inspired by Plath’s willingness to share her experience, despite making up a  transparent pseudonym. Suzannah Kaysen was less obvious with her pseudonym, but was still institutionalized. Even Ned Vizzini was inspired by his experience within a mental institution as a teenager. In fact, a lot of creative people of the past and present have experienced mental illness and institutionalization, but that’s neither here nor there. 

In Part One of this series of think-pieces I thought my friend Sven was wrong, and that mental illnesses and personality disorders should be treated with respect and accuracy in film, TV or other depictions, which they definitely should, and yet they still aren’t. However, he was right about one thing. The crux of the issue is that it doesn’t matter who wins as long as somebody does. And it’s frequently the plain, old apple—the story of having a complex disorder that no one truly understands—that gets the gold. Mental Illnesses and Personality Disorders fascinate people. It doesn’t matter what era you’re in as long as the story is endearing, dramatic or, let’s be honest, completely fucked up.

Unfortunately, most of the time it’s not the zest of a tangy, new orange that gets rewarded;  never mind a concept on a new subject, or a story with an element of diversity. However, let’s face facts: these ‘apples’ are all Granny Smiths with no Red Delicious in sight—not to compare apples to apples—okay maybe I’m writing this whilst hungry but I’ll get to my point. I think the only way a minority actor could ever receive an award for portraying mental illness is if an ‘orange’ masqueraded as an ‘apple’ topic.

The only time I’ve seen this portrayed in the media Is in Steve Lopez’s expose book ‘The Soloist: A Lost Dream, an Unlikely Friendship, and the Redemptive Power of Music.’ The adapted film ‘The Soloist,’ is based on this autobiographical story of a talented strings musician, Nathaniel Ayers (portrayed by Jamie Foxx), an African American child prodigy who attended the infamous liberal arts college, Julliard. He had to drop out because he developed Schizophrenia. After being institutionalized, he became homeless. The only solace he had despite having advanced schizophrenia, was a violin with two strings. Ayers played Beethoven, Tchaikovsky and Brahms in Pershing Square in downtown Los Angeles for years until Steve Lopez, a journalist (played by Robert Downey Jr.) made the fateful decision to help him. He tracks down Ayers’ sister who says that after their mother died he spiraled and disappeared. Old colleagues confirm his extraordinary talent and congeniality. Also, Lopez helps him to achieve some kind of stability despite his advanced Schizophrenia, and to ultimately achieve recognition of his amazing talent. Ayers has since connected with Yo Yo Ma, the infamous cellist who happened to be in the same class at Juilliard as Ayers. He’s performed for the Obamas and other illustrious figures. Ayers also has played with orchestras worthy of his stature. Seventeen years later, Ayers now lives in a mental health facility, where he is looked after and Lopez visits regularly. Lopez still worries and writes about the huge homeless population in Los Angeles and how many truly amazing people--like Ayers-- who are lost to mental illness through a lack of support and therefore experience the grueling treatment of being homeless and destitute.

Another depiction comes from Jharrel Jerome’s Emmy Winning performance in Ava Duvernay’s ‘When They See Us’ which gives a glimpse into the experience that one of the ‘Exonerated  5’ (formerly ‘Central Park 5’) experienced. Most profoundly, it looks at what solitary confinement can do to the human mind. Korey Wise was never the same mentally once he went through that ordeal. Although Wise has been a real mensch: he has used the money he won against the state of New York to improve Harlem, his own neighborhood, especially during  Covid. 

However, there is still overwhelming hypocrisy and racial bias in regards to how mental illness is portrayed in the field of minorities. It’s always regarded as either addiction or PTSD—which are legitimate mental illnesses—but it’s never about Bipolar, Schizophrenia or other conditions that seem to be only portrayed by the Caucasian majority. I think it will take a topic that has always been told by a different race or ethnicity to show how universal this issue really is and what could be done to help it.
©Betsy’s Bell Jar 2022