Identity and Difference: Madness on screen
“Crazy isn't being broken, or swallowing a dark secret. It's you, or me, amplified. If you ever told a lie,
and enjoyed it. If you ever wished you could be a child, forever.” – Susanna Kaysen, ‘Girl, Interrupted,’
(Mangold, 1999.)
Mental health and mental illness have never been as prevalent in society as they are
today. A quarter of all adults will suffer from some kind of mental illness in the course of their
lives, (Mental Health Foundation, 2007,) and this knowledge is being made widespread by
various campaigns, (Time To Change, Rethink,) making what was once a taboo and
shameful subject come in to a new light. But why did mental illness hold a taboo originally?
Perhaps mental illness is the last socially acceptable stigma; there has been years of fighting
for homosexual rights, gender equality and racial equality, but what of the mentally ill? Could
it be related to the depiction of ‘the mad’ through the media? More specifically, film?
This essay aims to explore the cinematic portrayal of ‘the mad’ and the impact this
portrayal has on public attitude and recognition, approach the critical debates surrounding
the subject and subsequently critically assess and comment on the film practices and
strategies directors use when approaching representation of this community. I will be using
the colloquialism of ‘madness’ as an umbrella term encompassing experiences and traits of
mental illness.
Evidence of mental illness is present as far back as Ancient Egypt (Nasser, 1987,)
and documented derivation of entertainment from madness has existed since the formation
of societal and cultural norms; for example, carnivals featuring “freak shows” originating in
the 1630s, (LeRoi, 2005,); and still remains today an oft-used justification in terms of a
'quirky' or 'dark' individual’s actions.
There are many facets of ‘madness’ demonstrated on-screen, mostly to the extremes
of the following; sexual perversion, blurring of gender lines, (Buffalo Bill, Silence of the
Lambs,) premature dementia or amnesia, (Fight Club, Memento,) animalistic/bestial
behaviours, (Mad Max, Lethal Weapon,) murderous and delusional hallucinations, (many,
including The Shining, Se7en,) leading to further theories such as explanations of alternate
realities (K-PAX, The Matrix,) and many more non-specific traits; all of which can manifest as
symptoms of larger illnesses, painting the culture of all mental illnesses with a dark, shadowy
brush. Such negative representations of 'the mad' can cause serious harm when separating
the reality of the mentally ill from the fictitious material on-screen. But where does normality
end and madness begin?
Violation of socially normative behaviour and mental non-conformity.
Perhaps the simplest definition is the above, (Tierney et al., 2002.) Feury, (2004,)
proposes this; “Madness is at one level what medicine determines it to be – but it is also
constituted of the vast narratives that lie beyond medicine, some of which will run counter to
it;” Implying, much as Tierney does, that madness is defined within social context.
Foucalt, (1970, cited in Feury, 2004,) theorised that, “part of the discursive formations
of madness … has been in its medicalization … [which] demonstrates just how impossible a
task it is to show madness in itself.” So how does one develop and produce a broad
representation of madness that will be universally understood, when it cannot be universally
understood? Perhaps realism isn’t the aim here but the “shock value” associated with odd or
unacceptable behaviour that can be interpreted as madness then translated in to fear or
humour as the audience see fit.
Feury (2004,) sees madness in the terms of cinema and interpretation, stating that
we do not wish to delve in to the deepest pools of madness to see what lies under the
surface; for we risk getting lost within madness ourselves; but we make light of what we can
see on the skin - this morbid fascination with the "not quite right."
He continues and asserts that cinema, directors and filmmakers hold a big
responsibility in the representation of this marginalised community of the mentally ill, in that it
can perpetuate or shatter stigma by bringing important issues to the social forefront; cinema
has effectively absorbed, conventionalised and established the representations of madness
for itself as a textual practice and for the wider social domain.” So how do filmmakers bring
forth the subject of mental illness to their audiences? Cinema has a strong reputation for the
disruptive misrepresentation of mental illness on-screen, (Byrne, 1998; Hyde et al., 1991.)
Let us return to some of the examples listed above. I have chosen to focus on some
key points from three films in terms of their representations of madness, each from different
years, narrative viewpoints and directors; One Flew Over the Cuckoo’s Nest, (Forman,
1975); Girl, Interrupted, (Mangold, 1999); and, K-PAX, (Softley, 2001.)
Possibly one of the most well-known films regarding the mad and institutionalisation
of such is One Flew Over the Cuckoo’s Nest (originally a novel by Ken Kesey, 1962,
adapted for screen in 1975,); one of the “best manic messaiah” movies, (The Times, 2002,);
which features Jack Nicholson in the role of R.P. McMurphy; a brash rebel rallying his fellow
patients against the oppression of the ward’s nurse, with no diagnosis (IMDB, n.d.)
Initially we see the identities of the mentally ill established within the opening 5
minutes; People being unshackled, nurses showing apathy in 'pushing pills' in a ‘chemical
cosh,’ each patient has something visibly strange about them; being in a wheelchair, holding
on to a broom, taking their tablets in a peculiar fashion. These are not normal people and
they are dangerous. We are introduced to McMurphy, who assists in the stereotyping of the
mad; laughing inappropriately, howling, generally acting "crazy." There is no
misinterpretation regardless of culture that this man is unwell. Further stereotyping ensues,
the psychiatrist staying that McMurphy is "belligerent, talk[s] when unauthorised, [has] been
resentful in attitude to work in general, that [he's] lazy," and continues to list that McMurphy
has had "at least 5 arrests for assault [and] statutory rape." The line between ‘mad’ and ‘bad’
is blurred as the audience learns that McMurphy has been committed to the institute rather
than prison for his crimes.
Later in the film McMurphy reinforces this idea; when told that he will be put back in
prison for escaping the institution with the other patients and stealing a boat, he replies, “no
[I] won’t, [I’m] nuts!” This reinforces the idea that the mad and bad are one and the same;
that because someone who would usually go to prison can avoid sentencing by proclaiming
their mental illness, this could lead the audience to assuming that all ‘bad’ people are mad,
or vice versa. The question that comes to mind is that if the audience weren’t made aware
that McMurphy is apparently mentally ill, would we label his behaviour as such, or just as a
rebel who challenges authority? Is this how we wish to portray those with mental illness?
It is interesting to note that the book utilises the character of Chief to direct the story
in first person narrative, this has the audience question whether the events portrayed are
actually true or a part of Chief’s illness; in the film this is not the case and there appears to
be no question as to the nature of these events.
Girl, Interrupted, (originally written in 1993 as true account of her experience in a
mental institution by Susanna Kaysen, adapted for screen in 1999,); also based in the 60s;
shows a contrasting view. Instead of an all-male ward with our hero as a criminal we see
Winona Ryder as Susanna herself; an 18 year old, well-to-do, but troubled girl growing up in
the 60s with, as we later learn, borderline personality disorder; “voluntarily” admitted to an
all-female ward, told from a first person narrative. By making the choice to keep the first
person narrative intact Mangold achieves something that Forman does not; a higher level of
empathy and understanding. Much is in part due to Kaysen’s original position, as; unlike
Kesey; she had experienced madness from within, her story was one of experience rather
than speculation. One Flew Over the Cuckoo’s Nest faced criticism upon release due to
accused inaccurate representation and negative characterization of the mentally ill, (Hyler,
1988.)
The protagonist of Susanna differs much from McMurphy, especially in that she is
from a different social class. We can assume that the institution in One Flew Over the
Cuckoo’s Nest to be socially/governmentally funded (much like our NHS) whereas
Claymoore appears to be a private hospital. Susanna is admitted following an attempted
suicide by overdose with much guilt and persuasion of her family, insinuating that her illness
is something to be ashamed of and something that needs ‘fixing.’ Her family call her
admission “a genuine rest.” On the surface Susanna looks ‘normal,’ as is pointed out by a
member of the public – the taxi driver taking her to the hospital; “What did you do? You look
normal.” This could echo the audience’s reaction; whereas McMurphy played up the ‘typical’
mad role Susanna appears quiet, most of her madness is below the surface, this also shows
the public’s morbid fascination with mental illness; ‘this person is ill, it’s something I don’t
understand, perhaps their story will be entertaining,’ or at least their curiosity.
Much like Forman, Mangold choses to initially present the patients as their illnesses.
Odd behaviours such as shouting, screaming, dancing, cradling children’s toys; this is what
the audience expect to see, and Mangold happily gives this to them; a freak show, as such.
We see this before even knowing the patients’ names. We are also introduced to the
concept of restraint fairly early in to the film, where the antagonist Lisa (Angelina Jolie)
returns in police custody after escaping from the hospital. Susanna’s new roommate is
terrified as Lisa proceeds to interrogate her and intimidate Susanna; this leads to Lisa being
restrained roughly with no proper technique and lifted in the air by several orderlies. Is this
how we deal with the mentally ill? Similarly, on multiple occasions we see this happening in
One Flew Over the Cuckoo’s Nest (OFOtCCN,) yet it has more impact here, likely due to the
first person narrative and the ‘normality’ of the protagonist.
When introduced to Lisa we see ‘true’ madness; obvious madness defined by a
series of behaviours that contrast social norms, shouting, manipulation, mood swings (deep
kindness contrasted by cruelty,) Lisa is proud to be who she is; a diagnosed sociopath. The
audience learn that Lisa has been ‘in the system’ for 8 years, perhaps showing the
ineffective treatment that we give to the mentally ill in order to try to ‘cure’ them. Lisa
believes her illness is that she is free; she does not have to conform to social norms
because she has already been defined as ‘mad.’
Much like McMurphy from OFOtCCN Lisa breaks the rules and attempts to
undermine all authority both on and off the ward, effectively creating non-conformity to the
non-conformed, earning her a special status amongst the other patients. This status exudes
a certain amount of control and it is evident that both characters feed on this and appear to
somewhat take advantage of the others (McMurphy hustling money, Lisa using the other
girls to her advantage, upsetting them for entertainment.) This further non-conformity shows
that even the ‘broken’ can be broken. McMurphy’s behaviour earns himself electro-
convulsive treatment and ultimately a lobotomy – costing him his whole identity (and
subsequently his life itself.) Lisa is once more returned to the ward in custody of police and
attempts to sabotage Susanna’s progress, when Susanna stands up to her and exposes her
true identity; “you’re dead already, your heart is cold, that’s why you keep coming back here,
you’re not free … [you’re] pathetic,”; Lisa breaks, dropping to her knees and crying
hysterically, she appears downtrodden in defeat and despair, the illusion of Lisa ‘the
untouchable’ sociopath is shattered and the audience sees what is at the heart of ever
mentally ill person; a person. A person in need of help; of love; not judgement.
In K-PAX, (Softley, 2001,) we meet Prot (Kevin Spacey,) a seemingly delusional,
possibly schizophrenic, man who claims to be an alien from the planet K-PAX, tasked with
writing a report of planet Earth. Prot is introduced in an interesting situation; he is witness to
a mugging and initially thought a suspect by the police, however Prot’s name is cleared by a
second witness but Prot’s slightly eccentric but harmless conversation convince the police
officers that he is possibly drugged or unwell, and so the audience learns that he has been
taken to a psychiatric facility. K-PAX places great importance on the judgements and views
in to the stigma that society holds towards the mentally ill, or even just those who are
‘different,’ making the audience reflect on their own attitudes.
K-PAX is based in the 2000s, so we can see a stark contrast between this facility and
the ones of Girl, Interrupted or OFOtCCN; firstly that the patients are of mixed sex.
Secondly, the nursing staff appears much more friendly and approachable (they are not
wearing uniforms, as is now common across many psychiatric facilities in the UK and
worldwide,) restraint and violence is seen to a far lesser degree. Softley has chosen to
ensure that the patients’ symptoms do not seem as exaggerated; yes there are distinctions,
informing the audience that these people are unwell, (shouting, a lady dressed in high class
clothing whilst in a ward environment,); but this is not the focus. Even the camera work
merely ensures that the audience are made aware of this peculiar world, but do not have
time to form (negative) judgements, they are not privy to violence but just eccentricities. This
continues throughout the film, providing a much kinder (though still stereotypical to a
degree,) representation of those with mental illness. It is, in fact, the case that the patients
themselves are the only ones who believe Prot’s claims, and they turn out to be (somewhat)
correct. Intrinsic human faith, hope and kindness is shown – though briefly – in the way that
Prot’s fellow patients treat him.
What K-PAX does focus on, however, is the relationship between Prot and his
psychotherapist, Mark, and the assessment/treatment that follows.
"Psychoanalysis may not provide all the answers to madness, but it does offer the
possibility of dialogue," (Feury, 2004,) it is this possibility of dialogue that is used extensively
throughout films regarding mental illness, as a way to not only progress the story but to
provide context within the madness. The psychotherapists and nurses appear to take on the
role of general society and the audience, morbid curiosity exploring the nature of madness;
something that not even the professionals can truly understand (as demonstrated by the
psychotherapist in K-PAX; and, the team of psychotherapists assessing McMurphy in
OFOTCCN.) The patients themselves know this (Lisa in Girl, Interrupted, consistently refers
to the "psycho-the-rapists’" lack of understanding and oversimplification,) and it appears that
it takes personal madness to truly know the mad.
When one is mentally ill do they assume the identity of the ‘mad?’ Cinema would
have us think that way, judging from the above. In reality the definition of identity is much like
that of madness, in that it is fluid and hard to define. One could say that identity is simply
‘who we are’ or ‘the mask we hide behind.’ Does one assume the mask of madness when
unwell, or is madness simply just another aspect of our identities?
On the fluid nature of the identity Horowitz, (2011,) said, “We give shape to the
impossibly complex strands of our lives and arrive at some understanding of what we call
identity in large measure through the relationships that make up our world.” Identity – much
like mental illness – is defined by society, the world we live in, the relationships we form and
the opportunities that shape us. With mental illness at such a high prevalence in today’s
society should this group not be represented in a fairer light?
Wahl, et al., (2003) found that 24% of children’s films he viewed had at least one
character labelled as being mentally ill and 43% contained references of some kind to
mental illness, finding that characters with mental illness tend to frighten and threaten other
characters. This portrayal is also evident in films for older generations, as above. It’s also
been noted that references to mental illness in films uses derogatory terms or phrases which
demean the experience of the whole community; mad, bonkers, sick, mental, crazy, psycho,
insane, nut, wacko – several of these can be heard throughout One Flew Over the Cuckoo’s
Nest and Girl, Interrupted by other patients, and perhaps more shockingly by professionals
(K-PAX, One Flew Over the Cuckoo’s Nest,) and even in films with no relation to mental
illness - as an insult or throwaway comment. Madness is inherently common in action film
villains, be it explicit or implicit; The Joker (Implied in Batman: The Killing Joke, Moore,
1988,) Jigsaw, (Saw; Wan, 2004,) Scar (The Lion King; Disney, 1994. [Lawson and Fouts,
2004; Wahl, 2003.])
Forman, Mangold and Softley have tried to represent this community in different
ways. Perhaps without realising that even the best intentions leave this community in a bad
light. One Flew Over the Cuckoo’s Nest perpetuates the mad vs bad mindset, perhaps
Forman’s mistake was in adjusting the narrative point of view. Mangold attempted to garner
feelings of empathy and understanding by retaining the first person narrative in Girl,
Interrupted, which worked to an extent, however the fear instilled by the character of Lisa
may have overridden that work. Softley attempted to show psychiatric illness in a more
modern era, leaning towards the more humorous side of mental illness, though appears that
he could not resist the ‘animalistic’ approach, which is seen clearly during a scene wherein
the whole ward and those above it go – for lack of a better term – “mad,” shouting and
banging on windows because they had seen a prophesised bluebird. Softley’s approach
merely turns the public’s views to laughter than fear, not taking mental illness seriously,
which is equally as saddening.
However, we must look at this in context of all other communities, marginalised or
not, it is a simple fact that in film many occupations and situations are portrayed as
hyperbole. Is war as whimsical as that shown in M.A.S.H. (Altman, 1970)? Is love truly as
romantic as that shown in The Notebook (Cassavetes, 2004)? Even depictions of real events
have some corruption of their tale; Rose and Jack were fabricated in The Titanic (1997,) as
Cameron, (1998,) felt we needed to “be there”; and Susanna Kaysen herself admits that
some of the events in the cinematic production of Girl, Interrupted were exaggerated or
glamorised (BBC, 2001.) If today’s audience’s don’t believe that the police are quite as
corrupt as those in The Untouchables, (De Palma, 1987,) or Man On Fire, (Scott, 2004,);
discharging ammo as if there were no tomorrow, then why is it that films based on mental
illness seem to have lasting effects on the attitude of the public? Possibly because it remains
unspoken, not taken seriously (Lacan, 1993); the last taboo.
"Madness is the emergency exit. You can just step outside, and close the door on all
those dreadful things that happened. You can lock them away... forever." – The Joker,
Batman: The Killing Joke, (Moore, 1988.)
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Byrne, P. (1998). Fall and rise of the movie ‘‘psycho-killer.’’ Psychiatric Bulletin, 22,
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