Category Archives: Course Posts

All the Children Are Above Average…Or Are They?

Oak Grove Middle School Band, a remedial band for kids with Attention Deficit Disorder … so all of their tunes were extremely short.

We are a family dominated by our routines. One of those is being dedicated public radio listeners (we are members of WKSU in Kent, Ohio).  Our Saturdays often move along to a soundtrack including Wait Wait…Don’t Tell Me and This American Life. We frequently find ourselves listening to A Prairie Home Companion on Saturday evenings during dinner.  The kids have been known to burst out laughing at times although I admit that their eyes do glaze over when there’s an opera singer on the show. This weekend was different in that we were scattered about the county but I did listen to part of the show while driving.  Guy Noir was on but instead of enjoying the piece as I usually do, I was horrified by it. I was troubled by it as a mental health advocate and researcher. I was also troubled by it as the parent of a child with ADHD.

The bit involves Guy Noir as a chaperone for the “Oak Grove Middle School Band, a remedial band for kids with Attention Deficit Disorder… so all of their tunes were extremely short.” Remedial? What year is this? One of the strongest myths associated with ADHD/ADD is that such people are stupid or lazy or both. These myths can be magnified when school or work performance is impacted negatively or when kids (and adults) behave impulsively. “Children with ADHD have been called troublemakers and spoiled brats, and undiagnosed adults may go through life labeled lazy or dumb” (Common myths, 2010, para. 3). Since ADHD/ADD is so strongly associated with children, particularly males, the stigma can be even more intense for girls and adults (Sherman, 2003).  Hinshaw argues that:

[s]tigmatization can be difficult for anyone who has ADHD, but the burden falls more heavily on girls and young women. People continue to think of ADHD as an exclusively male problem. According to this stereotype, if a girl exhibits common ADHD traits, there must really be something wrong with her. Something similar may be operating with adults. Since ADHD is commonly thought of as a childhood disorder, adults who have it, or claim to have it, come under suspicion. The thinking seems to be, “Either you made it up to compensate for the failures in your life, or there’s something very wrong with you” (Sherman, 2003, para. 9-10).

Guy is with the band because he’s broke and  his niece plays clarinet with them. She is presented as a self-absorbed, snotty, and negative child with a partially shaved head and a tattoo which serves to reinforce the bratty troublemaker stereotype of kids with ADD/ADHD. This goes hand in hand with the myth that all these children really need is better parenting and more discipline not to mention the belief that they just need to try harder (Common myths, 2010).

It wasn’t easy to keep the ADHD band all headed in the same direction.

At this point in the story, the band members appear to scatter without a plan leaving their burned out and unconcerned teacher behind. “His clarinet section was going off in six directions, his percussion section had disappeared. It didn’t bother him.” Another of the many myths is that “[p]eople with ADHD don’t “want” to focus or complete tasks” and “don’t care about consequences” (Tartakovsky, 2011). The image in the minds of listeners is intended to be one of attentionally-impaired teens and tweens running wild and unsupervised because they have so beaten down their teacher that he can’t wait to get away from them.

The myth of contagion is added to the mix with the introduction of the assistant principal who gets stuck like a malfunctioning turntable when trying to say “special needs children”. Guy asks if she has “some kind of tic” to which she replies, “It’s only when I’m around special needs chi—— for special needs chi—–for special needs chi——.”

Guy continues his clever narration with, “[s]o we wandered around, me and the ADHD band, and it occurred to me that most of the people I saw in Washington were special needs people, and the Congress is designed for verbally aggressive listening-impaired people, and that months go by and nothing gets done….” Verbally aggressive and listening-impaired. So that’s what people with ADHD/ADD are like. Right. They are as bad a Congress.

In his final conversation with the assistant principal, Guy tries to strike an enlightened tone saying, “They’re just children. We’re grown-ups. We all have special needs.”

Principal: You don’t understand, Mr. Noir. We have programs for these people.

Noir: Fine. But just call them children.

Principal: But they’re not. They’re special needs chi— —–special needs chi—– special needs chi—— special needs chi—— special needs chi——(FADES)

Noir: I didn’t bonk her on the head. I left her there in the bushes and the ADHD band went off to the Smithsonian and the kids were going in sixteen different directions…

To me, this was the most distressing part of the bit. These people. These other not normal people who need programs. As Carl Sherman (2003) states,

[t]here’s nothing shameful about having attention deficit disorder (ADD ADHD) — or at least there shouldn’t be. But in our society, people who have the disorder are seen as somehow “defective,” despite ample evidence suggesting that ADDers can be just as competent, personable, and skilled as “normal” people (para. 1).

In the same piece, Stephen Hinshaw remarks that

…many people still don’t believe that ADHD is a bona fide medical condition.They see it as an excuse for sloppiness or laziness. The fact that ADHD symptoms appear to come and go,depending on the situation, only feeds the doubters’ contempt. They say, or think, things like, “Why can’t you pull it together? You’re fine with certain friends — how come you can’t sit down and do your homework?” (Sherman, 2003, para. 3).

As Hinshaw notes, one of the most dangerous aspects of this constellation of negative beliefs is that people will internalize them. “…I’ve gotten to know hundreds of children who have ADHD, and I’ve heard many say things like, ‘I just can’t make it,’ or ‘I’m just not cut out for school.’ The stigma has so poisoned their motivation that they’ve given up even trying to be successful” (Sherman, 2003, para. 7). According to Hinshaw, another also damaging response to the cultural stereotypes is denial. “You consider the stereotypes of ADHD and think, ‘That’s not me.’ You want nothing to do with such a shameful identity” (Sherman, 2003, para.8). In addition to self-hatred and denial, one of the real effects is the avoidance of getting appropriate treatment. As Jonathan D. Carroll (2012) suggests, social stigma associated with ADD/ADHD can delay or even prevent appropriate diagnosis and treatment.

If you’ve stuck with me this far through all the quotes, citations, and academic arguments, you may just be ready to smack me around for being a smug liberal (criticizing one of my own no less) who can’t take a joke and is only interested in censoring hardworking radio show hosts. This has nothing to do with my sense of humor (I have one), or my politics (I refuse to apologize for being progressive), or my profession (I won’t apologize for being a psychologist either). Here’s an exercise for you: Try placing some other vulnerable group in place of “ADD” in the name of the band.  Let’s say it’s a remedial band for autistic children who are then depicted as spinning and hand-flapping while simultaneously achieving great feats of memory or mathematics. The backlash would be swift and biting. Then why is it OK to use ADD/ADHD? Because people still don’t believe it’s real and that it causes real suffering for those it touches. I wonder how many of the kids in the real band from Oak Hill Middle School are living with diagnoses?

It’s always disappointing when someone you enjoy being entertained by, someone you’ve long considered to be enlightened and intelligent, does something insensitive and hurtful. It’s even more disappointing when the person you see getting hurt is just 10 years old. As my daughter listened to the piece, I could see the wheels in her head turning. By the time it was half over, she said, “they are making fun of people with ADHD aren’t they?” I said, “Yes they are. Do you want me to write a letter to let them know how you feel?” She said, “Yes, please.”

If only Mr. Keillor had taken Guy’s statement that “They’re just children. We’re grown-ups. We all have special needs” to heart before making kids like mine feel even more isolated than they already do.

If you feel the same, here is the address:

Prairie Home Productions, LLC
611 Frontenac Place
St. Paul, MN 55104

phc@mpr.org

You can also make your opinion known to your local public radio affiliate.

References:

Carroll, J. D. (2012). Stereotyping ADD and ADHD. Retrieved May 28, 2012 from http://adhdefcoach.com/2012/05/02/stereotyping-add-and-adhd/

Common myths, misconceptions, and stigmas surrounding ADHD. (2010). retrieved May 28, 2012 from http://www.health.com/health/article/0,,20434636,00.html

Sherman, C. (2003). Overcoming the ADHD stigma. Retrieved May 28, 2012 from http://www.additudemag.com/adhd/article/2003.html

Tartakovsky, M. (2011). 9 myths, misconceptions, and stereotypes about ADHD. retrieved May 28, 2012 from http://psychcentral.com/blog/archives/2011/06/24/9-myths-misconceptions-and-stereotypes-
about-adhd/

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Shutter Island: Dangerous and Damaged

For the first several years of teaching Movies & Madness, I began the semester with Milos Forman’s classic One Flew over the Cuckoo’s Nest (1975).  This tradition ended when a student who had taken the class sent me an email with a link to the trailer for a film due to be released in the coming months. In her message, she said that she and her friends were out at the movies and, when she saw the trailer for Shutter Island (Scorsese, 2010), she knew I would be interested. After watching the film (my husband and I had a rare date night after which he said, “Next time, can we have a date where you’re not working?”), Cuckoo’s Nest was replaced as the opening film for the class.

My current group of students will be watching Shutter Island this evening.  Shutter Island was directed by Martin Scorsese and stars Leonardo DiCaprio. The film is based on the novel of the same name by Dennis Lehane (Gone Baby Gone, Mystic River). Their instructions will be to watch the film mindfully and intentionally. Their charge will be to answer this question: What does this film communicate to the audience about people with mental illness and mental health care providers?

Chuck: All I know is that it’s a mental hospital.
Teddy: For the criminally insane.
Chuck: Yeah, if it’s just folks runnin’ around hearing voices and chasin’ after butterflies they wouldn’t need us.

The story is set in the 1950’s and begins with U.S. Marshals Teddy Daniels (Leonardo DiCaprio) and Chuck Aule (Mark Ruffalo) arriving at Ashecliffe Hospital on Shutter Island to investigate the disappearance of one the patients.  The woman (Rachel Solando) they are looking for murdered her own children but lives in a delusional world where she believes that they are still alive. The appearance of the island as they approach is menacing and the music dark. As they walk up to the gates, Teddy and Chuck are met by the Deputy Warden (John Carroll Lynch) who takes their firearms before allowing them to enter.  He states that they “only take the most dangerous, damaged patients” making it clear to the audience that they are walking into a very, very dangerous place.

The Patients/Inmates

In many ways, Shutter Island is a typical “asylum” thriller involving a number of common elements including a series of “zoo” scenes which serve to introduce the main characters and the audience to the patients and the facilities. In Shutter Island this first occurs as Teddy and Chuck approach the hospital building after entering the gates. The first patient encountered greets them with a silly, childlike grin and wave. He is manacled and is raking the lawn. The next man is older, also manacled, and he stares blankly as the men walk by. His clothes are faded and old.  Some patients appear to by attended by individual staff who shepherd them around and monitor them as they work. The most memorable patient shown prior to their entry into the building is a woman whose image was heavily used in promotional material for the film. She is manacled, emaciated, much of her hair is missing, her eyes are darkly clouded, and her teeth black and decayed. She initially communicates a warning (“Shhh”) but then switches to coquettish flirting.

The hospital/prison is highly secured with locked gates, electrified fencing, and alarms. Patient rooms are barren and lack personalization. The day room includes patients smoking, playing cards, and otherwise engaging in either bizarre or purposeless activities. Later, two more patients are interviewed. One is a young man dressed a tattered sweater vest with a boyish hair style. He committed a very violent crime but he has an aggressive tantrum when pushed. The second is an older woman who murdered her abusive husband. She is composed and calm at first but becomes frightened and agitated by the end of the interview. Finally, viewers are introduced to the Ward C patients who are male, violent, and frequently very bizarre in appearance. Several are naked. One is tearing at his skin and marking the wall in blood.  The physical space of Ward C is wet, dark and industrial. It is a haunted house of horrors.

In his book Media Madness (1995), Otto Wahl argues that people with mental illness in the mass media tend to be presented with certain, stereotypical attributes: Dangerous/Unpredictable, Childlike/Incompetent, Blameworthy/Malingering, and Contagious/Untreatable.

Throughout the film, the patients are presented as dangerous and unpredictable while simultaneously being childish and incapable of caring for themselves. In addition, their crimes are morally reprehensible. This serves to enhance their blameworthiness and underscore the belief that no treatments will work.

The characteristics outlined by Wahl are especially obvious in the central character of the film. It eventually becomes clear that Teddy Daniels is actually Andrew Laeddis. Andrew is no longer a U.S. Marshal and is a patient at Ashecliffe. He is there as a result of murdering his wife because she killed their three children. He no longer acknowledges his identity as Laeddis instead adopting the complex delusion that he is the hero Teddy Daniels. Even before the audience knows who he really is, he is violent, unpredictable, unstable, and obviously stressed. He is shown experiencing hallucinations, delusions, flashbacks, nightmares, and headaches. He becomes increasingly paranoid as the story unfolds. The audience finds out along the way that Andrew is a decorated war veteran who may have committed atrocities of his own while liberating Dachau. It is more than implied that he has been traumatized by his wartime experiences and may be suffering from PTSD. It is also suggested that he is an alcoholic. In one character, the audience sees a man who has suffered multiple traumas, is an addict, has a wife who has bipolar disorder which he ignored, whose wife drowned their three children while psychotic, and he murdered his wife because of what she did.

As is the case in many films in this genre, the idea that mental illness is contagious (or at least contaminating) is communicated in Shutter Island in terms of the transformation endured by the film’s main character.  As was the case in One Flew over the Cuckoo’s Nest, the protagonist enters the hospital in street clothes with a strong sense of identity.  As the film progresses, the relatively colorful suit and tie are stripped away and replaced by a white orderly uniform.  In the final scene, he is wearing the same greys and blues as the other patients and is submitting himself to an identity erasing procedure.

The Doctors/Staff/Guards

Dr. John Cawley (Ben Kingsley) seems sincere and caring but also deceptive and guarded. He presents a philosophy that is actually quite progressive. He says that he has “…this radical idea that if you treat a patient with respect, listen to him, try and understand, you just might reach him.” He argues against pharmaceuticals, psychosurgery, and harsh treatments.  He argues on behalf of the patients as the storm approaches. And, as the film concludes, he is shown to have gone to extreme lengths professionally and personally to treat individual patients regardless of their crimes. As he states, “My job is to treat my patients not their victims. I’m not here to judge.” At the same time, the elaborate treatment he has designed for Andrew is at best unethical.

Dr. Jeremiah Naehring (Max von Sydow) is presented as a stereotypical, European, psychoanalyst. He asks Teddy questions which are intensely personal and in some ways threatening. Invoking the image of a German doctor is intended associate psychiatry with the acts of the Nazi’s in WWII concentration camps. Naehring is decidedly more harsh and controlling in his approach to treatment.  He is “Dr. Evil” in contrast to Cawley’s “Dr. Wonderful.” When they are introduced, Naehring pushes Teddy/Andrew to see himself as a man of violence tainted by trauma.

Dr. Jeremiah Naehring:  Did you know that the word trauma comes from the Greek for wound? What is the German word for dream? Traüme. Ein ist traüme. Words cannot create monsters. You…you are wounded, Marshal. Wouldn’t you agree, when you see a monster you must stop it?
Teddy Daniels: Yeah. I agree.

The nursing and support staff at times appear professional and engaged while at others disinterested or disdainful. The following is one memorable interchange:

Teddy: Huh. Anything unusual occur?
Nurse: Define unusual.
Teddy: Excuse me?
Nurse: This is a mental institution, Marshal, for the criminally insane. Usual isn’t a big part of our day.

The guards are generally authoritative and apparently competent but menacing music often accompanies their arrival in scenes. The Warden (Ted Levine of The Silence of the Lambs and  Monk) while not appearing in many scenes in the film, has an interchange with Teddy/Andrew during which he makes essentially the same argument as Naehring but in more colorful language.

Teddy: I’m not violent.
Warden: Yes, you are. You’re as violent as they come. I know this, because I’m as violent as they come. If the constraints of society were lifted, and I was all that stood between you and a meal, you would crack my skull with a rock and eat my meaty parts. Wouldn’t you?

Ultimately, the Warden has a great deal of control over Teddy/Andrew’s fate.

Finally, Dr. Sheehan (Chuck Aule) has been playing multiple roles in Andrew’s treatment. As Sheehan, he is his primary doctor directing his treatment. As Chuck, he is Teddy’s new partner. In both roles, he is compassionate and supportive.

Psychic Damage and Unforgivable Sins

The theme that is revisited repeatedly throughout the film is that madness is caused by trauma and violence is an inevitable extension of madness. Wrapped around this causal pathway is the suggestion that people’s choices, their mistakes, their sins, make them deserving of both trauma and madness. For Andrew, he carries guilt from his behavior at Dachau. Even more importantly, however, is the guilt stemming from the death of his children. He knew his wife was ill but he failed to take action and, worse, left his children alone with her. As Sheehan puts it he drank and he stayed away. In essence he is as responsible for their deaths as he is for shooting his wife.

As happens so often in the “asylum” genre, the conclusion to the film reinforces the idea that there is no treatment that will work. The best, the only option is annihilation of the self. Similar to the ending in Cuckoo’s Nest, the lobotomy plays a pivotal role.  In this case, Andrew chooses obliteration to life with the full knowledge of his past.

Teddy: You know, this place makes me wonder.
Sheehan: Yeah. What’s that, boss?
Teddy: Which would be worse, to live as a monster or to die as a good man?
[Teddy gets up and walks towards Cawley and the orderlies]
 Sheehan: Teddy?

What does the naive viewer take away? Primarily, viewers receive a heavy dose of reinforcement for the stereotypes they probably already believe to be true about people with mental illness and those who treat them.  People with mental illness are seen as dangerous, violent, unpredictable, untreatable, and contagious while treatment providers are either brutal and controlling or simply impotent. I’m left wondering how many times the same tired story needs to be told leaving real people with mental illness to be victims of prejudice and discrimination in the real world outside the theater.

The Perils of Stigma Busting: Why I Hate the “NUT HOUSE”

When I started teaching Movies & Madness in 2004, I encouraged students to become vigorous advocates challenging “inaccurate and hurtful representations of mental illness” (NAMI).  I receive NAMI StigmaBuster Alerts by email and have taken action by writing letters and emails and making phone calls on many occasions.

VTB Crazy for You bear

In 2005, NAMI issued a StigmaBuster Alert arguing that the “Crazy for You Bear” offered by the Vermont Teddy Bear Company for Valentine’s Day was offensive and damaging largely because it minimizes, trivializes, and makes fun of the challenges faced by people with mental illness and their families every day. That year, thousands of people, myself included, wrote letters to the Vermont Teddy Bear Company asking that the company stop selling the bear and that the CEO of the company resign from the board of a large hospital.  While VTB pulled advertising for the bear, it continued to sell it throughout the peak Valentine’s season.  The company apologized saying it meant no harm or disrespect but continued to sell the bear. Eventually, the CEO did resign from Fletcher Allen Health Care’s Board amidst the flurry of negative publicity. Win. Right? Not entirely.

The backlash those of us who challenge such products or images face is often as vigorous and harsh as our protests. Read the rest of this entry

Taking Action

If I am worried about a friend, I would rather be aggressive and wrong than passive and right.

Why Have Students Do Stigma Buster Projects?

When I describe my Movies & Madness class to people I am often met with two kinds of concerns: scepticism about the academic rigor of the class and the impossibility of students changing deeply held negative beliefs and attitudes in the space of a semester. The first concern?  Ask the students; I’m a wicked grader.  As for the second concern, I believe that faculty too often underestimate the capacity of students to grow when provided with the opportunity to do so. Sometimes the changes I see are dramatic.  The beauty of it is that there isn’t a single thing that I say during the class that brings about these changes. It’s the students’ own actions that transform them. Read the rest of this entry

“What makes her so special?”

I added a new film to Movies & Madness this fall after a student who had complete the class suggested it. Helen (2009) stars Ashley Judd, Goran Visnjic and Lauren Lee Smith and is a powerfully accurate depiction of major depression and suicidality as it impacts individuals, family and friends. There is intense conflict in the story among Helen (who is suicidal and depressed), David (Helen’s husband), and Mathilda (Helen’s friend who also lives with a mental illness). One of many memorable scenes in the film involves David (Visnjic) frantic with fear and anger, trying to force Helen (Judd) to leave her friend Mathilda’s (Smith) apartment and return home with him. When Helen and David are arguing, she attempts to explain why she doesn’t want to come home with him by saying, “You remind me of who I used to be.” He pleads his case but fails to move her. He becomes enraged when she refuses to go with him and physically assaults Mathilda who has intervened on Helen’s behalf. Read the rest of this entry

The Stigma Process: Part 3

In the second part of this discussion, we explored how the normal and typically adaptive ways in which people think about their social worlds works in the expression of negative attitudes about people with mental illness. Now we need to discuss how people can mindfully reshape this process using controlled rather than automatic processing.

First, what do I mean by automatic processing or automatic thinking? Aronson et al. (2010) define automatic thinking as “thinking that is nonconscious, unintentional, involuntary, and effortless.”  People use categories, stereotypes, and schemas automatically all day long usually with good results.  In contrast, controlled processing or controlled thinking is “thinking that is conscious, intentional, voluntary, and effortful.”  There are pros and cons to both kinds of thinking.  Controlled thinking requires a fair amount of motivation and attention meaning that the person has to choose to use it.  What does it look like when we get people to shift out of auto pilot and into a controlled state of mind? Read the rest of this entry

The Stigma Process: Part 2

In the first part of this discussion, I argued that there are some unfortunate but normal ways in which people think about their social worlds that allow the development and maintenance of negative attitudes about people with mental illness to arise. Now we need to walk through how this plays itself out.

1. I have a category called “crazy” or “mentally ill”.  When my youngest daughter was about to start kindergarten (I believe she was 5), I showed her a cartoon image of a person with the wild eyes and unkempt hair characteristic of the “crazy” stereotype.  I asked her to tell me about the man in the picture. She said he was “cuckoo”.  We form these categories very early and elaborate on them often. Read the rest of this entry

The Stigma Process: Part 1

In Movies & Madness, I present the argument that there are some generally functional and adaptive ways in which people think about their social worlds that allow the development and maintenance of negative attitudes about people with mental illness to arise. I ground the argument in basic social psychological theory and research. This social-cognitive-emotional-behavioral (I’m still working on a better name…) stigma process involves:

1. The tendency to categorize. We humans do it all the time. We can’t help it. It’s actually for the most part adaptive. Think about walking into a party full of people you don’t know.  You scan the room.  Without much conscious attention on your part, you put the people you see into groups and choose which ones to approach and avoid based on where they have been categorized. Read the rest of this entry

What is Stigma?

Stigma is a mark, a sign that somehow discredits the person (Erving Goffman). Being stigmatized refers to being marked for social rejection. Associated emotions include anger, fear, pity, and disgust. Being labeled as “mentally ill” can evoke attitudes and beliefs about people in that category. Wahl (1995) argues that the following tend to be associated with the lable “mentally ill”: unpredictable, dangerous, incompetent, childlike, blameworthy, untreatable, and contagious. Negative attitudes and beliefs (i.e., prejudice) may lead to overt discrimination (e.g., housing, employment, education, and civil liberties).
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