Sunday, August 03, 2008

Advocating at the "experts"

I joined the Association for Behavioral and Cognitive Therapies (ABCT), and they have an email listserv. Most of the content is just "can anyone recommend a CBT practitioner for a 25yo woman with OCD who is moving to Memphis, Tennessee?" or "Does anyone have a good book to recommend on CBT for a new practitioner?"

But sometimes they have discussions on interesting topics. One of these was the new Batman movie, The Dark Knight. A grad student posted:

I am writing you after having just seen the movie Batman. I am outraged to say that this Blockbuster has done an injustice to the people I deeply care about-- the people all over this nation who suffer from severe and persistent mental illness.

In the movie, Joker's hitch men are portrayed as (quote from the movie) "paranoid schizophrenic" and "my master told me that if I did this, then the voices would stop." These were the people who helped Joker maim and murder the innocent Gothic city citizens (which by the way, I felt was pretty graphic for PG-13, parents beware).

Joker, himself, was portrayed as being crazy, a mental case, hence the reason he enjoyed all the death, destruction, and mental games he planned and participated in. I went tonight to be entertained. I left feeling outraged. Once again, the entertainment industry is perpetuating the message that mentally ill people are dangerous. Mentally ill people are violent. The cause of evilness is mental illness.

This message perpetuates the stigma. The stigma that may stop people from going to get the help that they need for the fear of being labeled. The stigma that plays a role in tax payers and politicians not voting for the mental health funding. The stigma that is part of the reason some of my patients are homeless. Also, part of the reason one of my patients tells me "I am not paranoid schizophrenic... I do not have two personalities, I am not evil!" and then doesn't take his medication, (which leads to more suffering and distress for him as tries to endure living in a world he sees as being out to get him).

The stigma not only affects my patients, but also affects me, as a provider, the places I work, and our community. I am tired of the media sending these messages to the general public... tired of people thinking that this is entertainment.

I am writing this e-mail to send out a voice of awareness. It is your choice whether you go and see this movie. I might even have made you more curious about it and now you want to go see what I am talking about. My hope is that I just open your eyes to what you are really watching on that screen... a stereotype being perpetuated, which in turn leads to unjust prejudice and discrimination.

I agreed with everything she said and planned to say something as soon as I saw the movie. But a PhD-level psychologist from Ireland, of all places, beat me to the punch:

I appreciate your thoughts re mental illness being focus of 'entertainment' (e.g., Batman movie). I think you correctly point out that we as clinicians have a responsibility that we do not necessarily address as frequently as we might.

Apparently Jack Nicholas [sic.], prior to filming of Batman, highlighted to Heath Ledger something along the lines of, 'Beware. Anyone who has ever played the Joker has had nightmares' which, more broadly, might be interpreted as meaning 'Anyone who plays around with mental illness may well have some serious repercussions and/or consequences.'

How CBT clinicians can more directly have impact on (and shape in more positive ways) what appears to be a human being's need to project and split his/her dark side and even possibly laugh at it, is, I think, worth debate.

That's not the point!!!! As you know, I have decided that psychologists are evil and unethical. So I decided to weigh in:

I actually went to this movie with my co-workers as part of a staff appreciation day, and while I found it absolutely spellbinding -- it's a really well-made movie -- I was very upset with one relatively small aspect of it.

Some of the Joker's followers are labeled "paranoid schizophrenics" and say things like, "He promised the voices would stop if I helped him..." However, how many of us have worked with people who have this diagnosis who would EVER have trusted someone like The Joker and joined his team? People with paranoid schizophrenia are more likely to be loners, not joiners, for one thing. So the characterization is patently inaccurate and irrational. It's just a cheap way of amping up the shock value -- and completely unnecessary. If these references were edited out, the movie would only be better.

When interrogated by Batman or police, furthermore, these "paranoid schizophrenics" don't present like people with paranoid schizophrenia. They're not wary and guarded and sullen. Rather, they're spacey and goofy, he stereotypical and inaccurate image of people with mental illness that's constantly promulgated in the popular media. You know, the "crazy" eyes, the wild body language, etc. It's a page out of Otto Wahl's "Media Madness."

Effective media that incorporate inaccurate stereotypes really reinforce those stereotypes. And I find that distressing. I was an antistigma advocate with NAMI long before I got my professional degrees and started working as a clinician. I have to say, I'm a little disappointed in the professional organizations -- American Psychiatric Association, American Psychological Association, etc. -- for their lack of protest at these kinds of media. Who if not psychiatrists and psychologists should tell the creative community that their concept of mental illness is fundamentally inaccurate and harmful?

I don't have much stature as a professional, being a new clinician with two paltry master's degrees, but I know there are people on this listserve who command national attention in the media. Why not make a statement that this movie, entertaining as it is, presents an inaccurate, stigmatizing, and harmful image of people with paranoid schizophrenia that tarnishes its effectiveness as art and slanders people who are suffering?

So the gauntlet is thrown down. Let's see if any prominent clinicians rise to the occasion.
One of the people on that listserv is Bob Leahy, director of the American Institute for Cognitive Therapy and a fairly prominent clinician. I'm wondering if he'll respond. So far, this is the only post of his I've seen on the listserv:

A number of years ago someone told me about a clinic that treated specific phobia by having patients dress up like the phobic object. So, if the patient feared rats, the patient dressed up like a rat for the day. Has anyone ever heard of this unusual exposure treatment? If so, who does this?

Don't tell me this is more important than combating media stigma.
Copyright (c) "Ayelet Survivor"

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