In two minds.

Five part series on the history of madness and psychiatry. Part 5: In Two Minds. Dr. Miller concludes his overview of madness and psychiatry by examining contrasting approaches to the psychiatric interpretation and treatment of schizophrenia.

Shot list: Dr. Ruth Seifert, Hackney Hospital, with schizophrenic woman patient; Kate Millett; Brain, sliced; Photo, autopsy, 19th. C.; Brain scans, ID twins, 1 normal, 1 schizoid; Dr. Daniel Weinberger, NIMH, Washington; Petscans of brain (coloured); ID twins'- petscans while carrying out cognitive tasks. Face of one marked for scanner focus; Dr. Tim Crowe, Northwick Park Hospital, London; Moving models: clown/acrobat; dolls, 1 blowing bubbles; black musician; Kate Millett (On increasing use of "disease" label); R.D. Laing, alone and with patients; Women in mental hospital ward; Woodstock; Trieste - as the hospital was, and Dr. Franco Rotelli's community today; Dr. Robert Mezzina; Jenny Miller, patients' Rights representative, with patient (California); Berkeley, California, an advocacy centre; Picture of Hippocrates; David Hill, MIND drop-in centre, Camden, North London; Bleuler's diagnostic criteria for schizophrenia quoted by David Hill, pages shown; Dr. Seifert with schizoid female patient and in discussion with Jonathan Miller; Island of Leros, Greece, 1990. There is a full archive credit list at the end of the programme.

Is madness - in particular schizophrenia - a disease or an intelligible reaction to stress? This programme brings together opposing practices and points of view concerning the history and treatment of schizophrenia. There are scenes from Hackney Hospital, London; Trieste; Berkeley, California and Greece as Dr. Miller scours the world for a workable definition. Brain scan pictures of identical twins (one schizoid, one normal) show that the schizophrenic brain displays shrinkage. A brain is dissected and Dr. Miller sums up the history of theories of madness and gets drawn into the social and philosophical considerations of power, freedom and free will. Power is one of the main issues debated, with Kate Millett, David Hill (author of "The Politics of Schizophrenia") and Professor Rotelli of Trieste insisting on the dubious motives and results of subjecting schizophrenic patients to confinement in an asylum. David Hill also argues that too many different kinds of behaviour are included under the single label of schizophrenia and that class, race, gender - and only then, behavioural symptoms - are the real criteria for its "diagnosis". Dr. Ruth Seifert (Hackney Hospital) agrees, but with the reservation that schizophrenia cannot so easily be dismissed. There is an excerpt from an archive filmed interview with R.D. Laing in which he speaks of the power gap between the mentally ill and normal people and considers that madness is the reaction of normal people to intolerable family pressures. Dr. Seifert, however, considers that family pressures alone do not bring about the degree of disintegration which we call madness. Dr. Miller describes the anti-psychiatric movement of the 1960s, which led to a new, community-based system of treatment in Trieste. Here, the local asylum was replaced by a network of community care, including the opportunity to work, which did much to remove the stigma from madness. The Patients' Rights movement in America is seen at work with a patient discussing his appeal against involuntary committal to an asylum with a Patients' Rights representative. An advocacy "drop-in" centre at Berkeley, run by ex-patients, is shown. None of this, however, answers the question concerning the nature of madness. Medicine, from Hippocrates to the end of the nineteenth century, classified idiocy, dementia, mania and melancholy as diseases. Psychiatrists in the last century extended their territory by treating other kinds of behaviour as evidence of mental illness. Thus there were instances of escaped and recaptured slaves being diagnosed as suffering from a morbid obsession with liberty. Kraepelin and Bleuler identified schizophrenia and manic depression as the two main categories of mental illness, but there are other brain disorders, such as Parkinson's disease and epilepsy, which carry clear indications of physical causes. Is there, then, a neurological basis for schizophrenia? In conclusion, Dr. Miller considers that there are organic causes for much of what we call madness. The clinical picture is hard to clarify because the brain expresses itself through the personality, not just as an organ (as the liver, kidney, etc. do). Dr Miller alludes to past atrocities in the name of medicine whilst showing contemporary footage (1990) of patients in a Greek asylum, wandering around naked and then washed in mass sessions with a hosepipe. His point is that the insane should be treated as individuals, being the most effective treatment for their suffering. Dr. Miller's parting observation is that madness and misery are among the inescapable risks of being human.

UK : BBC-TV, 1991.

1 videocassette (VHS) (60 min.) : sound, color, PAL.
1 DVD (60 min.) : sound, color, PAL.

Brook Production for BBC Television in Association with KCET Los Angeles.

BBC Television.