Abstract
When I want your opinion, I'll give it to you—Sam Goldwyn
There is considerable interest in depictions of mental illness in the cinema and other media [1–6], and much attention is being given to the influence of media values and pressures on those depictions [6],[7]. Over recent years, there has been a spate of Australian and New Zealand movies with prominent psychiatric themes [8–10]. Collectively, these films constitute an important chapter in the history of cinema from those two countries but it is likely that, here and especially overseas, many will soon be forgotten. Shine [11] is an exception, leading to an Academy Award for Geoffrey Rush and being the subject of several books [12–15]. The most recent book [15], Out of Tune, by Margaret Helfgott, David's sister, challenges the truthfulness of much of the movie and describes her campaign to clear the family name of accusations of brutality. The following viewpoint draws on a number of sources, including the film, film paraphernalia (e.g. press kit, press cuttings), technical spin-offs (e.g. video, CD, DVD) and the books. Out of Tune provoked the filmmakers to publicly defend potentially damaging stereotypes and images pertaining to mental illness in the movie. This stimulated a further round of debate regarding the film. Now that the Shine phenomenon is not as dazzling, it is time to take stock of its public impact and the issues of contention relevant to our profession. The following comments are not designed primarily to detail the movie's inaccuracies or ‘set the record straight’ indeed, the question of who has the best memory of David's youth and upbringing is not for us to judge. Rather, we wish to suggest that there is scope for several, even dissenting, viewpoints being conveyed in film and we wish to highlight what appear to be the current ‘rules of the game’ according to cinema's treatment of psychiatry and those with mental illness. It will be argued that, despite the constraints faced by filmmakers, some of these rules could be waived to generate more hopeful images of mental illness without losing market share. But first, let us declare our hand.
As practising psychiatrists, we can claim no specific expertise in cinema studies but we regard examining the arts, including film, as a legitimate and important arena of professional concern. We are aware that, historically, films were first shown publicly in 1895, the same year that Freud wrote Project for a Scientific Psychology, and that the fields of psychiatry and filmmaking have had a keen interest in each other from the start [16]. We acknowledge our bias as mental health professionals in examining portrayals of individuals with mental illness, but both of us spend much of our time working in organisations and networks which value collaborative partnerships between mental health service users, carers, the interested community and professional providers. We would readily concede that some of our colleagues, and we ourselves, may sometimes get overly defensive about media portrayals of our profession and patients, rather than pausing to consider how we may be contributing to these portrayals, and how we might improve them [8]. We also concur with Henderson [6] that more balanced images of mental illness do not simply arise from the input of health professionals. Personal experiences recounted by consumer or family advocacy groups can result in more authentic portrayals, for example, of patients and families as articulate, active, caring, irreverent, humorous and resilient, rather than as passive victims to be pitied for their seemingly perpetual distress. One of us (AR) has also had reason to have a particular interest in Shine.
In 1970, as a final year medical student in Perth, the first author's mentor in psychiatry was Bob Csillag, widely regarded as ‘the student's advocate’. Bob Csillag was trained in existential psychotherapy by Victor Frankl, had a reputation as an astute clinician with a particular interest in young people with psychiatric illnesses, and conducted research into psychosexual disorders. As stated in the most recent book on the subject, he was also David Helfgott's psychiatrist during his admission to Sir Charles Gairdner Hospital at the time the first author was a student there [15]. Years later, the first author knew from this experience that at least part of Shine did not ring true. At no point, however, had we ever had reason to doubt David Helfgott's real musical genius or essential generosity of spirit.
Apparent ground rules of ‘psychocinematics’ (movie depictions of psychiatry)
The following ground rules have been gleaned from responses to the film by members of the Helfgott family, the perceptions of fellow mental health service providers, consumers, carers and other members of the community who were interested in this subject or who have been a part of David's life, as well as from our own experiences as audience members. Shine is by no means unique among films in demonstrating these spurious principles, even in an Australasian context [8]. Nor do we know whether their apparent applications to this film were intentional or inadvertent: they are damaging nonetheless.
1. Never spoil a good story with the facts
According to Margaret Helfgott, Shine was littered with untruths. The facts were that her father was not an ogre, was not physically violent towards David and remained in contact with David after David left home. Margaret Helfgott considered her father a gentle, sensitive, exuberantly expressive man who was neither obsessed nor lacked a sense of proportion of what was important in life (not just music, but also good nutrition, exercise, spiritual vision and having fun). Margaret Helfgott contends that even the psychiatric hospital and its staff were not as oppressive as made out: ‘My parents and siblings described in their letters how the nurses hovered around David…his ward was colourfully painted with artworks displayed on the walls and there were always flowers’ [15]. Margaret Helfgott recalls that there were individual and group psychotherapies and occupational therapy, as well as a range of recreational and sport facilities and fixtures.
We readily acknowledge that ‘film storytelling often employs or evokes archetypes and…metaphors. In this respect, it is like myths or dreams’ [Rigg J, personal communication, 1999]. However, in Shine it is implied that the story is real.
Perhaps the filmmakers assumed the real story too dull. However, the ‘interesting’ Shine story features characters that are all or nothing, black or white, good or evil. The irony is that some of the facts may have enriched the film, making the movie's popular acclaim and appeal more enduring. At least there may have been scope for presenting more than one version or viewpoint, as was done to great dramatic effect in the 1999 film Hilary and Jackie, without sacrificing profit [17]. Simon Champ, inaugural Chair of the Australian Mental Health Consumer Network has also pointed out: ‘There is plenty enough drama available if you care to accurately tune in to the subjective experience of an individual or family who has survived mental illness.’ [8].
2. Lend credibility by linking an actual person to a fictional plot
Shine tries to make its story-line believable through direct association with a factual person and its persuasive ‘realism’. The mood of stark realism is created by the use of names (e.g. Roger Woodward) and settings (e.g. Royal College of Music) with which the audience would be familiar, by David's descent to squalid circumstances, and by the vivid representation of psychopathology (e.g. David, at a frantic pace, demonstrates pressure of speech and flight of ideas: ‘I remember Margaret. She called me a pig. All very complicated; complicato in Israel, a battleground. A war zone, a war; what a bore it's a war…war’). While the movie and movie press kit did contain ‘fine print’ disclaimers that the story was based loosely on David Helfgott's life, the film's use of Helfgott's name and the parading of him in association with the movie after its release suggest that the disclaimers were merely gestural. The director's preface to the screenplay states: ‘Shine is David's journey to define his individuality’ [12]. The inevitable conclusion is that the public was supposed to assume the film was about fact.
3. Stereotype at will
Stereotypes can be positive or negative, and by definition, are over-generalised and simplified [18]. Just as labelling portrayals as stereotypes doesn't make them necessarily bad, defining them as storytelling archetypes doesn't make them necessarily good or psychologically sound. Pre-existing attitudi-nal sets (e.g. about mental illness) predispose to stereotyping [19]. Further, once people have been stereotyped in a particular way, it is easy to add more stereotypes that are part of the same constellation of prejudices and which are not based on fact [20].
Possibly the worst stereotypes are reserved for victims of all kinds [21]. People with mental illness are prime candidates for such roles; their parents are also likely targets [22]. Not just one but several stereotypes pertain to the portrayal of David Helfgott in Shine. These include formulaic life scripts such as: ‘If mentally ill, you can only “make it” in society, or are only acceptable, if you are already a genius, or famous, or at least on the path to fame’ [8], and ‘If you are both mentally ill and talented, your audience will only show interest in you if they can gawk voyeuristically at your bizarre antics, however impressed they may be with your talent’. In other words, the talent becomes context for the madness rather than the other way round. We argue that such powerful images may well trump other widely portrayed myths [Rigg J, personal communication, 1999] that performing artists are psychologically fragile and/or that the expression or performance of their arts puts them under intolerable mental strains (e.g. as conveyed in the 1999 film, Passion [23]).
Some music critics, observing David Helfgott's performing tour in concert with the worldwide release of Shine, were uneasy because they felt that they may have been unwitting accessories to his exploitation as a ‘freak’. Arguably, if society treats you like a clever performing seal, you are already being dehumanised or disrespected to some extent. People may be waiting for you to lose your balance and slip off your stand. This could represent a fascination with the exotic, rather than genuine humane, aesthetic and anthropological interest. We do not mean to imply that David Helfgott in reality is a victim who is now just being further exploited. He may well be exercising his own choices in making and enjoying public appearances in association with the film, and in giving performances which capitalise on the interest the film creates.
4. If you are destined for stardom, you will be ‘rushed’
The implication of the movie was that David was being ‘held back’ by his father, while those around him felt there was not a moment to waste, whatever the human cost. What is played out is the real life struggle, in which many prodigies get caught up, between those with the view that talent and fame should be promoted and pursued quickly and whatever the price, versus those with the notion that genius should be nurtured in balance with quality of life. No-one in this unfortunate battle was against David furthering his musical career. The questions between them remain ‘at what cost?’ and ‘for whose benefit?’. A key statement is that of Frank Callaway, Perth's Emeritus Professor of Music ‘…in retrospect…it would have been a good idea to have consulted more fully with Peter Helfgott [David's father] about the suitability of David's going to London’ [15]. This age-old dilemma about how to remain creative without losing your balance is also being played out in the contemporary psychiatric literature (e.g. [24]).
5. Blame the family
Shine contains elements of the ‘naturalism’ film genre in that it seeks to ascribe cause and effect in a pseudopsychoanalytic or ‘scientistic’ manner [25]. There are sinister messages in the portrayal of David's father for all families and ‘young players’ in the health profession. Shine rebreathes life into the myth, popularised by Fromm-Reichman in the 1950s, that families are abusive, toxic and cause schizophrenia [26]. Therefore, the only possible cure is a ‘parentectomy’ or tug-of-love to wrench, and thereby rescue, the victim from the malevolent parent. David Helfgott is portrayed in the film as the victim/ultimate victor. His father is the cruel villain (‘slightly less lovable than Himmler’ as one media account of the film put it [15]). Gillian Helfgott (David's wife) and subsequently Scott Hicks (the director of Shine who became David's friend) have been cast as the joint saviours. One might speculate that these two may have idealised their roles in David Helfgott's comeback to world fame, having been encouraged by media acclaim for themselves, which they fostered in the first place. It is worth noting that mental health professionals both in responding to media portrayals and even in our clinical work can fall into this trap of occupying a role in a triangulated system of relationships: persecutor, victim and rescuer.
Of all the characters in Shine, David's father was the most maligned during and after the film. As Geoffrey Rush said: ‘This film is about how easy you can f—k up your kids’ [15], or as Billy Crystal, guest host for the Oscars, put it to a worldwide audience of over a billion: ‘A mean father who made his son practice at the piano until his fingers bled and then declared “my son is dead”’ [15]. These sorts of comments, apart from having apparently no basis in what actually happened in the Helfgott household according to Margaret Helfgott, also reveal a lack of understanding of what can occur in homes where a child has a mental illness. A parent's attempts to protect and stick by their afflicted offspring for the long haul, while the latter is struggling simultaneously with a life-disrupting illness and the developmental task of becoming independent, may, of course, result in some angry and exasperated exchanges both ways. This can be remembered by the offspring as oppression on the part of the parent, because the offspring may have felt the need to attempt to individuate and separate explosively while at the same time remaining highly dependent on the same parent figure.
In presenting his audience with the reasons for David Helfgott's mental illness, Hicks opted for David's supposed harsh upbringing. What the film ignored was a family history of long-term psychosis, most notably affecting David's aunt, Hannah, who was ultimately institutionalised in Melbourne.
6. Find other targets for blame
In its ‘effort after blame’ and quest for a mantle of naturalism [25], Shine also attributes the cause of David's condition to past trauma affecting his father and to a spuriously introduced racial stereotype. The film suggests that Peter Helfgott was a cruel and heartless concentration camp survivor. As he declares in the movie: ‘No one can hurt me! Because in this world…the weak get crushed like insects.’ An enduring image of Peter Helfgott peering from behind barbed wire is clearly designed to influence the audience's view about his background and character. This convenient depiction of Peter Helfgott as a Holocaust survivor was a fictional device. Margaret Helfgott remembered her father differently. For example, in the late 1930s in Melbourne, he opened a coffee lounge off Bourke Street where he entertained at the piano and which he made ‘the hot spot of Jewish immigrant life [in the city]’ [15]. One reading is that in misrepresenting Peter's past, the filmmakers of Shine are in effect saying that he too must have had a victim mentality, and that his surviving the concentration camps meant permanently abandoning softer human qualities: once barbarised by Nazi persecutors he is destined to imitate them [27]? It would be understandable if this disparaging stereotypic portrayal, resonating as it does with David and/or Gillian Helfgott's preoccupation with ‘rich Jews’ [14], would be offensive to the many Australians of immigrant or refugee backgrounds, some living Holocaust survivors and some members of the Jewish community.
7. Discredit those who cast doubt on the saviours' account
Scott Hicks deliberately and consistently adopted a viewpoint in Shine very close to Gillian Helfgott's account, when other versions were available. Many characters who possibly deserved depiction in the movie were denied this because they may have appeared to be rivals for a place in the limelight, and did not share the filmmakers' and Gillian Helfgott's views. David's mother, father, first wife Claire, his sister Margaret, Chris Reynolds (a GP not portrayed in the film) and Bob Csillag may all fit into this category. In proposing this, we are not meaning to replace demonised father figures with newly idealised ones. Nevertheless, Chris Reynolds, for example, encouraged David over an extended period to reconnect with a public audience through intimate cabaret performances. Bob Csillag's personal commitment to his patients was widely known, as was his capacity for establishing a positive rapport and therapeutic alliance. From an early stage of David's illness, we are told that Bob Csillag expressed caution and fear of David's exploitation [15]. Possibly anybody significant in David's life who tempered encouragement too explicitly with caution was either denigrated (like David's father) or left out.
Psychiatric portrayals as legacies of media values and pressures
It may be too convenient and simplistic to attribute the negative or inaccurate images of mental illness in a movie to badly informed or unsympathetic filmmakers [6]. Undoubtedly, some of these persons are sympathetic to the subject of mental illness. However, there are a number of factors, pressures and constraints that come to bear upon filmmakers [6],[7].
1. ‘Entertainment versus education’ dilemma
While few filmmakers would deny that mental health is a subject requiring both sensitivity and better community understanding, these concerns are often overridden by the commercial pressures to cater to, and maximise, audience appeal. For example, in the contemporary film Cosi [28], psychiatric patients, most of whom would not be admitted to a psychiatric hospital these days, are seen to be cooped up and controlled in hospital wards. This prospect would unnecessarily deter many people with psychiatric problems who saw the film today from seeking treatment. The film was based on Louis Nowra's play of the same name [29] and was derived explicitly from Nowra's own work experiences in a mental hospital in 1971. While Nowra also wrote the screenplay, he agrees that the film's time frame was reset in the present for possibly commercial reasons [Nowra L: personal communication, 1998].
2. ‘Artistic integrity’
Film writers and directors might argue that accurate research can ‘contaminate’ creative freedom and the creative process. In the biographically based film (the ‘biopic’), this argument can be used as a filmmaker's refuge in various ways. First, any demand for historically accurate portrayals may be said to interfere with artistic freedom. Second, it may be claimed that the director's insistence on authentic character portrayals was overridden by the producer or by commercial pressures. Third, it may be almost apologetically offered that the filmmaker wanted the movie to be a fictional variant on reality, but that the commercial marketers insisted on promoting the film, or encouraging it to be mistaken as, a ‘true story’. Together, such arguments tend to cancel each other out. However, filmmakers continue to cloak their disregard for the needs of their audience, and the need to be straight with them in distinguishing fact from fiction, with the defence of ‘artistic integrity’ [Deveson A, personal communication, 1999].
3. Constraints of dramatic characterisation and narrative pace
To appeal to and enthrall audiences, and arguably to ensure commercial success, characters need to be larger than life, recognisable as ‘goodies’ or ‘baddies’ and must move swiftly from distress or conflict to health or resolution. Crichton insists that ‘movies must move’ [7]. Actors readily play up to the demand for erratic, frightening or bizarre portrayals if they are not restrained by the director. The required narrative pace is concentrated to extract maximum drama out of each moment, and ‘is often at odds with the reality of mental health, where people may recover and become ill again.’ [6].
In otherwise ordinary lives, as exemplified by the 1995 film Angel Baby, filmmakers believe rapid breakdown and tragedy contain more drama than gradual recovery and hopeful outcomes [30]. The latter tend to be invisible on the screen. To this end, the need for gripping visuals is a constant concern; Shine has some features of the ‘expressionist’ film style, that is, the type of film that allows the liberal use of technical devices and artistic distortion [25]. Perhaps the best example is David's sudden nervous breakdown which occurs in the course of his prizewinning rendition of the ‘Rach 3’. In a lather of sweat, with a musical score of rapidly changing volume and tempo, David hits the stage floor with a sickening thud and his glasses go flying.
4. Pleasing multiple stakeholders
So many people and interests are involved in bringing a big-screen movie to fruition that the end product is often the result of many compromises, as if it were designed by committee. This militates against one person being prepared to be accountable for any negative effect of the film on sections of the public.
5. The power of the mass media may be vastly overstated
Some filmmakers claim their influence is overstated anyway [7]. They say that even movie blockbusters are seen by at best 15%% of the domestic audience and that those who do go do not necessarily believe or respect what they see and hear. However, movie-goers do not live in isolation. We have a sneaking suspicion that this claim is akin to cigarette manufacturers declaring that their advertising featuring young people's role models are aimed only at switching brands and therefore would not increase smoking per se in that age group. At the same time, we readily accept that viewers are not tabula rasa, and that they generally engage, both imaginatively and intellectually, with screen imagery [Rigg J, personal communication, 1999.] Indeed, even nonmoviegoers are hopefully able to interact imaginatively with the medium, as they are not cocooned from the impact of the strong messages emitted by worldwide blockbusters.
Implications for psychiatry
In his assessment of Shine, Simon Wessley stated: ‘Films that combine genius, the Holocaust, dysfunctional families, romantic music, nail-biting competitions, mental illness and a happy ending are bound to succeed’ [31]. Regrettably, this commercial imperative to succeed, and other factors to do with the medium, sabotaged the potential of Shine to both educate and entertain. Arguably, truth has been a victim. What Margaret Helfgott's book also conveys is that the fallout includes the wrenching apart of a family with the added indignity of public exposure of open wounds. So in Shine we and other commentators have the uneasy feeling that the public has been left with a shallow and damaging product, which should have been a soaring and enduring story of hope and triumph of will over adversity. While this message still comes across in patches, the film does a disservice to the public, perhaps mainly by dramatising and perpetuating the simplistic myth that families cause and are to blame for schizophrenia. It has taken painstaking research by the last two generations of psychiatric professionals and the unrelenting public advocacy of the mental health consumer and carer movements to attempt to dispell this myth, which Shine has effectively resurrected.
There is no single Shine story. The fact is that patients and families will inevitably have different experiences of living with schizophrenia, and may suffer and struggle with different aspects of it. Similarly, just as individuals with schizophrenia and their families will have different experiences and concerns, they will have different priorities and needs from services. They may not agree about these, just as they may not agree about the unfolding story of how this happened. As John Berger, in the preface to his Booker Prize winning novel G, said: ‘Never again should a single story be told as if it is the only one.’ [32].
Mental health professionals are learning to not choose favourites (e.g. by not supporting the patients' view exclusively and effectively excluding the family, and vice versa), but to provide different aspects of service to meet the differing perceptions, expressed needs and priorities of consumers and their families. This is now enshrined in the National Mental Health Standards [33]. Similarly, notwithstanding the constraints of their medium, filmmakers should learn to weave stories together from different points of view which are inspirational for all who live and struggle with psychosis and other disabilities, whether consumer, family or enlightened professional, and which celebrate the individual and collaborative hard-won victories over such adversity.
CONCLUSION
We are not persuaded by filmmakers contentions that negative stereotypic portrayals are merely a harmless cinematic device or inadvertent by-product of the complex processes of the medium. We conclude that while these intervening processes are real considerations, they should not override film-makers' taking responsibility for the integrity of their work.
We can partly understand and empathise with filmmakers and other artists who crave artistic autonomy. This is a familiar argument to clinicians; it is parallel to the demand, in some quarters, for unfettered ‘clinical autonomy’ while blaming therapeutic failures on the health system or on unavoidable ‘collateral damage’. As psychiatrists, we are learning how to stake more modest claims for clinical autonomy and are discovering, sometimes painfully, how to extract a richer lode from our turf as practitioners by not sifting out the valuable inputs of multidisciplinary teams, mental health consumer and carer perspectives, quality assurance systems and evidence-based approaches. We are being increasingly challenged by the demand to be answerable to our community. Both clinicians and filmmakers can continue to be creative and innovative without being immune to the ethos of social responsibility and accountability which should underpin all professional endeavours. It is not too much to expect a film to be entertaining, uplifting and educational at the same time and for the ground rules of ‘psychocinematics’ to be less grubby. We need not only a more level playing field but also one with less mud to kick up and sling around.
Acknowledgements
We thank Julie Rigg, Barbara Hocking, Tom Politis, Michael Shortland, Anne Deveson, Karen Barfoot and Sylvia Hands for their suggestions and encouragement.
Postscript
The Australian rights to Out of Tune [14] are held by Penguin yet that publisher has chosen not to exercise or release them. Was this a commercial decision based on the belief that the market for this story is waning or has that publisher somehow become the defender of the Gillian Helfgott/Scott Hicks account? In any event, the decision is mysterious.