Garry Gillard & Lois Achimovich 2003, 'The representation of madness in some Australian films', Journal of Critical Psychology Counselling and Psychotherapy, 3, 1, Spring: 9-19.
This article considers representations of characters with mental illness in four Australian films, with a particular focus on suggested aetiology. In these films, environmental influences are potent in the aetiology of the characters' psychiatric presentations. Attention is drawn to a disjunction between psychiatric orthodoxy and the growing body of evidence that trauma can precipitate madness.
There is an ambivalence at the heart of the representation of madness in cinema. We (both filmmakers and audiences) desire to understand and participate imaginatively in the world of the insane. On the other hand we are very happy to see them as different - and not like us. So, while in one sense we want the portrayal of madness to be as accurate as possible, we also want to see crazy people acting in a interestingly irrational, even grotesque, way. Here the issue of stigma is primary (as is the depiction of the mentally ill as violent, see Wilson et al., 1999).
There is another conflict, no less profound, between the orthodox psychiatric view of the nature in mental illness and what is actually shown in films on this subject (Ellard 2000; Nairn 2000; Neumann 1998; Rosen and Walter 2000; Rosen et al. 1997; Wessley 1997) - particularly to do with causation. In films discussed below, psychosis is shown as being contributed to by trauma, whereas the conventional psychiatric view is that madness is something outside of human influence and control, and is specifically a disease of unknown cause (although genes are suspected), variable symptoms and often tragic outcome, where the only hope is to take anti-psychotic medications. In a given film, characters may be shown to hold this view, while the film itself, by virtue of its narrative, represents an alternative view: that the trauma of life experiences can and does cause mental instability.
Insane behaviour as shown in films does not necessarily reveal any kind of truth about madness, but it does imply a view of what madness is like. On the creative side, the themes and characters depicted must be assumed to convey the filmmakers' idea of what madness is, and also what they think audiences want to watch and find acceptable. Audiences' acceptance of these representations must be sufficient to ensure that the film is successful: the expectation of a return on investment is in direct proportion to their presentation of what potential audiences expect and believe. The success of a film must therefore indicate a degree of acceptance of at least the plausibility of what has been shown.
In addition, the arts have been shown to be important in the education of the public about mental illness (Nairn, 2000) and thus serve not only to offer what is expected but also to influence opinions and ideas.
Considerable controversy was caused by Shine, one of the films discussed here. On the one hand, the psychiatric profession expressed displeasure at the depiction of Helfgott's madness as being related to his upbringing and social circumstances. On the other, Scott Hicks defended his right to portray the story from his own artistic point of view (Kalina, 1996). Another combatant was Margaret Helfgott (1998), who denied the factual basis of the film's and Gillian Helfgott's (1996) depiction of the family's life.
It is inevitable that narrative, even a 'true' narrative, will be seen in different ways by those with different agendas. The particular intensity of psychiatric reaction to Shine has led us to a consideration of this and other depictions of the mad, specifically related to aetiology, in some Australian films.
One theme that runs through articles criticising such filmic depictions is that those deemed mad are stigmatised. The 'stigmatising' films are usually those which depict the insane as violent, unpredictable and sadistic. These are condemned by those diagnosed mentally ill and their supporters (www.seecinemania.com/; Philo 1996) - the National Alliance for the Mentally Ill even has a stigma hot line so that they can be notified of breaches and protest accordingly (www.nami.org), while SANE has a StigmaWatch (at www.sane.org).
Other films are approved because they meet certain criteria of authenticity as far as the authors are concerned. Specifically it appears vital that it is shown that serious mental illness is genetic or biochemical in origin and most specifically not the fault of the environmental influences. Yet the films discussed below rely heavily on environmental antecedents to mad behaviour.
We ponder what psychiatrists find objectionable in them. Is it that the depictions of madness and its causation do not concur with current psychiatric practice and/or knowledge? Is it that the films are saying things which the culture believes but psychiatrists do not? Do filmmakers exaggerate environmental rather than bio-medical aetiological factors? Are psychiatrists encouraging unwarranted censorship in requesting film-makers to adopt different narratives? Who is being injured and/or influenced by these films - patients and their families, or psychiatrists, psychiatry and its practices?
The discussion of Shine by Rosen and Walters (2000) leaves us in no doubt of their major objection to the film:
... 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 consumers and carer movements to attempt to dispel this myth, which Shine has effectively resurrected (p.242).
Implicit in this statement is that any reference to environmental contributions to causation is automatically family-blaming, as if all trauma emanates from that source. Also implicit in the statement is the notion that families are going to be relieved to hear that their offspring have an incurable brain disease.
The tension between these two views of aetiology results in a revelatory ambiguity in the representation of insanity. No reference to biopsychosocial models will resolve this difference, a difference which appears to be developing considerable momentum (Read et al. 2001).
We observe in the majority of these films that the characters' madness is portrayed as relating to traumatic events such as parental abuse (Ferrier, 2001). This (the abuse/trauma hypothesis) is not the dominant view of mental illness in the psychiatric literature, where schizophrenia is seen, to a great degree unproblematically, as a disease of the brain, probably of genetic origin.
We also note in passing the relationship between insanity and the socio-economic, political, and cultural conditions in which it occurs. The mad are often poor, unemployed, homeless, have problematic interpersonal relationships, and paternalistic contracts (Doerner, 1981) with their medical carers.
In the light of the above, we consider four Australian films in which major characters are diagnosed as being or seen to be psychotic: Angel Baby (1995, dir. wr. Michael Rymer), Bad Boy Bubby (1994, dir. Rolf de Heer), Lilian's Story (1996, dir. Jerzy Domaradzki), and Shine (1996, dir. Scott Hicks).
After the opening title sequence, Michael Rymer's Angel Baby begins in what is clearly some kind of institution for mental patients. The people are conspicuously odd - especially as seen, later, at a bowling alley. They are recognisable as 'mad' because they look and act differently from other people. Kate (Jacqueline McKenzie) acts funny too - but in an engaging way - and Harry (John Lynch) becomes interested in her.
Kate declares that her father raped her. When Harry asks her what it was like she says it was 'like death'. She also has a phobia about being cut and losing blood, and has scars on her arms which could not have been self-inflicted. The precise cause of the scarification is never revealed, but it is inferred that Kate has had at least two traumatic events in her personal past: one the rape, and the other involving blood-letting. (After she has stopped taking her medication she says at one point, 'If they take my blood they can control me.')
So an aetiology of Kate's schizophrenia is proposed that clearly relates to childhood trauma. On the other hand, other characters in the film are acting on the basis of a hypothesis of a genetic origin for the disease. Two doctors, indicate possible danger in the prognosis now that Kate is pregnant. 'There is a real chance of relapse into psychosis,' they tell her. Not only that, but: 'There is a chance that the child will inherit your illness.'
The film itself thus leaves open the simultaneous possibility of two kinds of aetiology: genetic and traumatic. It suggests the notion that serious mental illness can be related to events such as early and probably repetitive rape, although a genetic origin is also implied and dire consequences predicted.
After Kate has given up the medication for the sake of her unborn child, filmic effects (spiralling crane shot, bright key light directly above, white out, voices on the sound track) convey the effects of her symptoms. And after the collision in the shopping mall, when Kate loses a few drops of her blood onto the floor and a handkerchief, the severity of her symptoms results in her being placed in a locked ward.
While Kate believes in Astral, her guardian angel who sends her messages through The Wheel of Fortune (television show), she also believes in her Stelazine. She is only persuaded by Harry to flush her drugs down the toilet - for the sake of the foetus ('Do you want our baby to be born with Stelazine in her veins?').
By the end of the film however, Harry has entered both of her worlds. He begs his brother Morris for help: 'She needs her medication.' (By this time he is back on his Haloperidol etc.) And finally he shares her particular delusions. Earlier in the film, when Kate joins Harry on the Westgate Bridge, she asks him: 'Shall we do it? Because now I know what peace is I couldn't stay here without you.' (Meaning that they should jump from the bridge to their deaths.) And the film ends with Kate (who has previously died in childbirth) again joining Harry on Westgate Bridge, imitating the flight and sound of the seagulls, before - presumably - he jumps off.
The ambiguity of the film regarding the nature of insanity is not surprising when one knows that the writer (who is also the director, Michael Rymer) did not at first conceive his characters as being mentally ill.
The characters came first [says Rymer], and I found them appealing and intriguing. At some point, these two quirky characters, these extremely strange people ... somehow it occurred to me they might be described as mentally ill. They read signs in things, watched TV game shows for messages from some other world. (Urban, 1995, pp. 10-13)
Rymer was more interested in the quality of life of people diagnosed as mentally ill than in how they came to be so diagnosed, as he told Andrew L. Urban in an interview.
After spending four months attending an informal day care centre for the mentally ill, Rymer had a pretty good (and very compassionate) picture of their daily lives, which he describes as atrocious. He says the film, while accurate, cannot, does not, approximate the full extent of how awful are the lives of schizophrenics. 'It's a cleaned up version ... what they have to go through is messy, ugly and half the challenge [of making the film] is to make it watchable.' (Urban, 1995, pp. 10-13)
While this last statement is undoubtedly true, we have no way of knowing why and in what way the lives of 'schizophrenics' are 'messy' and 'ugly'. This may be due to inadequate treatment models, inadequate funding, the lack of employment for the psychiatrically vulnerable, the side-effects of major tranquillisers - or a result of the 'disease'. The film does not enlighten us on this. It is inferred that not taking one's medication is a bad thing and leads to relapse - but that is a factor which can hardly drive the narrative of a film in a way that will engage an audience. The references to early abuse - the scars on both Harry's and Kate's arms and her report of the rape committed by her father - indicate that some acknowledgment of the possible contribution of these events to the characters' choices would be relevant to the narrative's resolution.
The writer/director's take on mental illness is from contact with a day centre, where he would be exposed to patients who are treated as having organic diseases, but who also relate appalling social histories, often from childhood. Their madness is in their 'otherness', rather than situated in an understanding of the intra-psychic, intrafamilial, pharmaceutical, and socio-economic forces which contribute to the outcast position (Doerner, 1981).
However, the director apparently had an advantage in dealing with this paradox: according to Urban, he believed that schizophrenia is 'a biological disease of the mind'. Urban attaches to his 1995 article about the film a list of seven points to 'go over some of the ground that writer-director Michael Rymer went over in his research [into schizophrenia]', including the one just quoted. There is no mention in the list of any causative factor other than 'biological disease', so it is even more revelatory that Rymer felt it was necessary to refer in the film to other kinds of causes in the backgrounds of his two main characters. And, despite his list, Urban still writes in the body of the article that Angel Baby 'treats mental illness realistically and responsibly, so it may ignite public debate on the issue of mental health - something generally ignored' (1995, pp.10-13). Debate about what? All that is left to discuss is appropriate treatment. The causes of the 'disease' are confined to the genetic, despite the way in which life events obtrude into Rymer's film, in both its past and its present.
In Lilian's Story, on the other hand, we are shown what is to be taken as a primary factor in the development of the insanity of the main character in unremitting detail. After having released from forty years in a mental institution, and after the death of her father, Lilian returns to the paternal home. The film then shows in flashbacks, graphically, her abuse and rape by her father. Her mother having been sent to Pago Pago for a prolonged rest, young Lilian tries on some of her mother's clothing, studies her own body in the mirror, and masturbates. Her father surprises her in the act, and contriving an authoritarian justification, works himself into a choleric and sexual frenzy: 'You entered my study. How dare you. You tight steamy little vixen. You're a disgrace to your sex.' - before first whipping her with his belt, and then forcing her into sexual intercourse. Between the whipping and the rape he pauses and appears to show signs of tenderness, before proceeding to even more violent abuse. His ambivalent, incestuous feelings about his daughter are also indicated by his keeping photos of her in his otherwise empty 'Book of Facts' - the symbol of his intellectual and emotional fraudulence. Lilian appears to be able to resolve and bring closure to her relationship with her father by burying these same photographs at his gravesite.
Rather than evincing a caring attitude in relation to the appalling experiences of his sister, brother Frank apparently does not interfere with her incarceration. Lilian says to him, 'You knew what he was doing to me' - thus indicating that this was not an isolated occurrence.
The locking up of difficult women has a solid history (Matthews, 1984; Milford, 1970, Showalter, 1987, Trombley, 1981, among others). The neglect of the past of women like Lilian Singer in determining her treatment and thus her future is arguably the tragedy of twentieth century psychiatry.
Bad Boy Bubby is another film in which incest is shown graphically. This is however only one aspect of the grotesque situation which contributes to the title character's craziness. Like Kaspar Hauser in Wim Wender's film (1974), Bubby is an adult who has never seen the world outside the place of his captivity with his mother. The world inside is one of cruelty and paranoia. Bubby is told that he cannot ever go outside as the atmosphere is poisonous and he will die. He is told that Jesus is watching him, and that he will be punished if he moves. His mother has sex with him as an everyday event. He tortures the cat and finally kills it with clingwrap - having learnt how suffocation works from his mother's warning. He then applies the same method in killing both her and Pop - his father who returns after thirty-five years, and is the trigger for the next development in the story. Before he does this, he puts on Pop's clothes - Bubby becomes Pop - and he trashes the apartment. When he gets hungry, Bubby ventures into the outside world, where he plays the character of 'Pop', dressed as a priest (a Father), with a band he encounters - and thus survives, as a sort of cult figure. After a number of episodes the story ends quite implausibly with the main character having formed a relationship with a woman called Angel with whom he has created an apparently happy family.
The film works in a similar way to Being There (Ashby, 1979) and The Enigma of Kaspar Hauser (Herzog, 1974): the innocent abroad thrust into a world where he has only a limited number of actions and verbal responses available to him. In Bad Boy Bubby, the latter are generally imitations, inappropriately delivered, and are the source of much of the humour that makes this appalling story tolerable.
The script is so macabre and the production so brilliant that the film takes us along with it. Nothing causes anything after the first few scenes. Extraordinary coincidences occur in this pilgrim's progress and he kills all the right people and evokes care and love from most others. There is no hint that Bubby was 'born like that' - in this sense, the film situates madness in the murky world of raw physical responses, violence, drunkenness, isolation, filth, vile food and cockroaches. Could anybody grow up sane in this place?
The film allows the mad to be 'at a remove' from us. It also allows us to believe that simply getting out of such a situation and into the 'real' world will lead to a happy life. In fact, this man, who has been isolated, abused and neglected, becomes a serial killer who wraps his victims in plastic.
Shine is a film which has generated considerable controversy in the literature, including that of the medical profession (Ellard 2000; Nairn 2000; Neumann 1998; Rosen and Walter 2000; Rosen et al. 1997; Wessley 1997). Rosen & Walter (2000) claim that it 'does a disservice to the public, perhaps mainly by dramatising and perpetuating the simplistic myth that families cause and are to blame for schizophrenia' (p.242). Even non-psychiatrist critics have found that too much stress is laid on the causative role of the father, Peter Helfgott. Evan Williams, writing in The Australian newspaper, had this to say.
Its central argument ... is that David's collapse was brought on by the oppressive, pathologically protective devotion of his father. That this version of events is denied by Helfgott's family may not surprise us; nor need it alter our opinion of Shine as a finished work of art. But by spending too much time indicting David's father, the film allows itself too little time for the more moving story of David's rehabilitation. (Urban, undated)
However, whether Jan Sardi and Scott Hicks, the writer and director, relied to too great an extent on wife Gillian Helfgott's version of events, rather than seeking out sister Margaret Helfgott (Nairn, 2000) - or whether Sardi/Hicks were driven by 'artistic motivation' (Bordwell, 1985) to create a successful film (Ellard, 2000) - they patently felt it was necessary to establish the kind of cause-effect structure typical of the 'Classical Hollywood Film' (Bordwell et al., 1985). They therefore suggest two causal factors in the development of David Helfgott's madness, one familial, and the other to do with a view of the nature of creativity.
The first factor stems almost entirely from the character of the father, the Peter Helfgott character, who is depicted as controlling and protecting his children. This in turn has its origin (in the film) in his experience of escaping the Holocaust. Both Peter Helfgott's mother and father have perished, as have the sisters of his wife. He is, as a result, obsessive about maintaining the integrity of his present family ('If you leave now,' he tells his son, 'you will be punished for the rest of your life.') The result of this protective action may thus be seen as a curse by the young David. We see Peter Helfgott nail up the gap in the corrugated iron fence that surrounds the family home to prevent the daughter again going out to meet a young male friend. Later, the father calls David away from his first meeting with a girl at his bar mitzvah to meet 'someone important'. His desire to protect his family results in what might be seen as mental cruelty on the part of the father - and physical cruelty, in the scene in which he hits David with a towel in the bath.
The young (Noah Taylor) David Helfgott also suffers isolation and loneliness when he goes to study in London at the Royal College of Music. One overbearing father figure is to some extent replaced by another (albeit the benign Cecil Parkes character, John Gielgud) which does not seem to make matters any better: Helfgott, having been depicted as exhibiting only one clearly abnormal action (collecting his mail without his pants on) is shown to break down at the end of his successful rendition of Rachmaninoff's third piano concerto. He sweats, he appears to lose consciousness, he is 'going mad', following the legend of the isolated, suffering artist hero driven mad by the demands of his own creativity - a figure which recurs in numerous films (for example, Cox's Vincent (1987), Duncan's Passion (1999); Minnelli's Lust for Life (1956)). While this may work for audiences, it is hard to believe that playing brilliantly would result in breakdown - playing badly and disappointing himself, his teachers and his family is a much more likely scenario for psychological stress. The scene is dramatic, but artistically and psychologically unconvincing.
The film also suggests that the young David was too young and too socially unsophisticated to deal with the demands of social living in London. In this context, David Helfgott's paradoxical situations - must stay, most go - must obey my father, must become a great pianist - are portrayed convincingly as major contributions to the precipitation of psychotic symptoms.
We are not told what happened to David outside the family, and especially in London. We get little feel for his relationship with his mother. There is good evidence of a very keen mind - his speech as depicted by Geoffrey Rush is full of metaphors which are often ironically relevant, though at least one critic abhorred this depiction of 'the holy fool' (Wessely, 1997).
In view of the acceptance in current psychiatric literature of schizophrenia as a disease of genetic origin 'like diabetes' (Goode, 2002), it is interesting that these films are at the very least ambivalent about this construction of madness. Is this view far wide of the mark, simply a wish to make a dramatic movie? Some researchers in the field have drawn attention to the neglect, by mainstream psychiatry, of the traumatic comorbidity/antecedents of psychotic presentations.
McFarlane (2000), for instance, expressed concern that what is known about the effects of traumatic stress is not informing psychiatry in its engagement with the seriously mentally ill.
In particular, strategies for dealing with the issues of childhood abuse and neglect are not often considered by adult psychiatric services for the chronic and severely mentally, despite these being important predictors of suicidal behaviour, hospitalisation and prolonged disability.
In the study by Mueser et al. (1998), the rate of PTSD in a sample of 275 patients diagnosed with severe mental illness was 43%, but only 3 of 119 patients with PTSD (2%) had this diagnosis in their charts. The presence of symptoms of PTSD was predicted most strongly by the number of different types of trauma, followed by childhood sexual abuse. (35% of 122 men with SMI diagnoses reported CSA and 26% reported sexual assault as adults. 52% of 153 women experienced sexual abuse in childhood and 63.6% experienced sexual assault as adults.) Other traumatic events, eg. witnessing a killing of another person, were also extraordinarily common in this US sample.
The findings, according to the authors, suggest that 'PTSD is a common comorbid disorder in severe mental illness that is frequently overlooked in mental health settings' (Mueser et al., 1998). In a later study, this group postulates a model by which PTSD is hypothesised as mediating the negative effects of trauma on the course of SMI (Mueser et al., 2002).
Greenfield et al. (1994) found that various surveys of SMI patients had incidences of sexual abuse between 34% and 53%. In one study, of 38 adult patients admitted for first-episode psychosis, 20 reported childhood abuse, with equal prevalence in men and women.
Patients with a trauma history are likely to have more severe symptoms, more substance abuse, and tend to need hospitalisation more often (Briere et al., 1997).
John Read, a senior lecturer in psychology at University of Auckland, and his colleagues (Read et al., 2001) take a position which is more radical and challenging to psychiatric orthodoxy. They posit that rather than a theory of stress acting on a genetic vulnerability, the data indicate that neurological and behavioural findings can as easily be explained by trauma in childhood as by inheritable vulnerability. They question the model of stress acting on a predisposed vulnerability and summarise data indicating that early trauma has been studied only in a cursory way, most stress-diathesis studies being confined to the four weeks preceding the first psychotic break. They summarise the neuro-biological data on severe childhood stress and schizophrenic disorder and show that the effects on the HPA axis are almost identical.
In view of the above, why is it that psychiatrists seem to want movies to present 'schizophrenia' as an unambiguously bio-medical condition. How does that help those so diagnosed?
When asked what makes A Beautiful Mind noteworthy in its approach to mental illness, Glen Gabbard stated:
Overall, it's one of the better portrayals, if not the best, of what the disease is like. ... The other thing is that they portrayed the kind of chronic struggle that both the patient and the family goes through around complying with medication. ... Also, it portrays medication as effective and useful. ... In A Beautiful Mind, it's clear that when he does take medication he gets better, and when he's cheeking it and hiding it he doesn't. (Goode, 2002)
As Gabbard himself notes, important aspects of Nash's history are left out of the film, but Gabbard justifies this as follows: 'Of course it romanticizes mental illness. The job of a filmmaker is to fill the seats at the theater. So the entire arc of John Nash's life and marriage is all romanticized.' And:
He gives a stirring speech at the Nobel Prize ceremony that he never really gave. The homosexual relationships he had in real life and his divorce are also excluded from the movie. (Goode, 2002)
As are his work at Princeton in the fifties, his loss of his security clearance and his attempts to defect to other countries.
In other words, what is 'good' about the film is that it portrays those with schizophrenic diagnoses as human and psychiatric medication as vital, and the 'disease' as like diabetes (Goode, 2002; Torrey, 1995) - it can 'strike' anywhere.
Rosen and Walter (2000) are concerned that David Helfgott's father may have been maligned in Shine. However they are equally concerned that years of work have been wasted in teaching families with a psychotic member that they - unlike any other parents in the world - are in no way responsible for or influential on the behaviour of their offspring. They state:
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 (sic) this myth, which Shine has effectively resurrected.
To imply that parents influence their children does not mean that they 'cause' anything. However when any adolescent presents with a psychotic illness, it would seem not only good science but also a humane exercise to consider the stresses and traumas, past and present, which may be changeable or amenable to psychotherapeutic intervention.
Rosen and Walters are most concerned about their version of this aspect of the film, rather than an equally powerful dynamic - the anguish of a young genius forced either not to develop his talent or to leave home prematurely to do so, and who lived in a part of the world which was not an easy place to grow up if you weren't hypermasculine, anti-intellectual, sport-driven and cool.
In three of these films - Bad Boy Bubby, Lilian's Story, and Shine - the filmmakers are in no doubt that traumatic family events can and do contribute to mental breakdown. One film - Angel Baby - explicitly exhibits ambivalence about aetiology - Kate is shown to have been seriously abused, but the medical profession pays no attention to this, except to warn her that her baby may be genetically affected by her illness.
In these Australian films, characters who are mentally ill display the symptoms of their madness in a florid and bizarre ways. Being Other, outsiders, beyond the pale, even grotesque, is still part and parcel of the role of the insane in these movies. Furthermore, they display the environmental origins of some of their symptoms, drawing our attention to a disjunction between psychiatric orthodoxy and the growing body of evidence that trauma can precipitate madness.
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JCPCP (ISSN 1471-7646) is the journal of the Psychology and Psychotherapy Association and is published in the UK by PCCS Books. We thank the editor, Craig Newnes, for publishing the paper, and for allowing us to republish it here on the Web.
Garry Gillard | New: 9 October, 2009 | Now: 17 January, 2018