Multimedia: Doctors taking over the asylum
Authors: Raj Persaud
Journal: BMJ (1999)

Psychos, Channel 4, Thursdays at 10 pm from 6 May to 10 June

  The last time British television made a major drama series about psychiatry was back in 1991, when Shrinks, produced by Thames TV, was broadcast on the ITV network. It attracted widespread criticism from professionals, who claimed that it trivialised patients’ problems and gave the impression that a few magic waves of the analysis wand meant that the seriously mentally ill could throw away their therapeutic crutches and, psychologically, “walk again.”

In view of the professional opprobrium, the Independent Television Commission commissioned a survey to discover the reactions of viewers. It came up with the paradoxical result that, although only 38% of the sample considered real psychiatrists resembled their counterparts in Shrinks, more than half thought that the series had an important role in enhancing the public’s understanding of psychiatric problems. Those who knew someone with a mental illness, however, were significantly more likely to perceive the series as unrealistic.

If a researcher repeated this survey with Channel 4’s new series, he or she would probably discover that just as few people think that it is a realistic portrayal of psychiatrists. Although the writer of the new series claims that painstaking research has gone into it, and three psychiatrists seem to have acted as “consultants” to the programme makers, it still does not hit a realistic note. It is easy to carp and forget that, for television purposes, any job with all the boring bits cut out is going to seem pretty unrealistic. What is more serious is that none of the psychiatrists in the series seems in the least likeable, or even basically competent.

This is not a new problem. Film portrayal of psychiatry swings between the malevolent and the bumbling. It often suggests that doctors who heal do so only because they befriend patients. The most notorious example of this remains the supposedly positive portrayal in the film Ordinary People, when the benign psychiatrist tightly embraces his patient and, in so doing, cures him.

Like many other clinical dramas, Psychos does not portray the practice of medicine or show how treatments actually work. It is odd that in this series—supposedly focusing on psychiatry—the intimate crises of the patients receive much less attention than the private problems of the doctors. Moreover, no patient ever seems to recover from his or her disorder, which is a serious drawback because destigmatising psychiatry centres on emphasising the treatability of psychiatric conditions. Certainly, the number of staff chain-smoking during ward rounds and the respect accorded to the authority of the senior doctors by the hospital led me to wonder where in the NHS the series had been researched.

It is intriguing that no users of mental health services seem to have been consulted for the series, which might explain why it seems to focus on the psychiatrists’ problems rather than those of the patients. Indeed, the hospital inmates struggle to get any attention above the psychiatrists’ relentless screaming at each other, and the only person you see actually take any medication is the main protagonist, a psychiatric specialist registrar, downing his lithium. His own manic depression seems less well controlled than that of the sectioned patients, who ironically behave rather more calmly.

On another occasion, a patient in psychotherapy has to help a depressed senior house officer regain his concentration. In one of the most dramatic scenes in the series, two junior doctors take a discharged but occasionally catatonic patient home in their own car, and one has to be rescued from the patient’s burning flat a few minutes later. 

Perhaps the lesson to learn is that script writers and programme makers cannot be turned out into the community quite so cavalierly in the future without the necessary support structures. Instead, they should be more closely supervised by their psychiatric “consultants.”