Two minutes to change minds

1 in 4, two minute trailer showing at Warner cinemas,
October to December
Directed by John Selby

A naked man is curled up, holding himself, in the corner of an empty room. The atmosphere is bleak - a stark wooden floor, bare walls, and a melancholy piano score courtesy of Michael Nyman.

Is this a new art house movie? Far from it. In attempting to combat the stigmatisation of people with mental illness, the Royal College of Psychiatrists is launching a two minute trailer to be shown in Warner Village cinemas from the end of October to December. Its title, 1 in 4, reinforces the message that any of us can suffer from mental health problems. The film will appear in English cinemas, at the Warner Brothers cinema in Inverness, and at the 45th Film Festival in Cork.

The college has chosen film as the medium for its message because it wants to target young people. Its recent survey of public attitudes in Britain showed that stigmatising opinions about mental illness are more common among young people than older people. The fast moving film has rapid cuts and powerful language, deliberate ploys borrowed from pop videos to capture the attention of the MTV generation.

In the first minute of the trailer the naked man is a narrator and agitator. "Cheer up, you miserable git!" he screams to a depressed patient perched on the edge of a bed. "You crazy old bitch, mum," he says with a smile as he leans over and kisses a woman with Alzheimer's disease, whose kettle is whistling while she stares into the distance. We see a young woman with anorexia nervosa standing in front of a mirror, staring at her bodily reflection. As she tightens the drawstring of her bodice, the narrator asks her, "Why don't you just eat something?" He shouts "Cokehead!" to a man who is snorting cocaine.

These are all, perhaps, malicious things that we, the audience, have thought or even said about those with psychiatric illnesses. We recognise the narrator's cruelty as our own.

Having set the scene, the film then tries to shatter our belief that mental disorder is something disgraceful suffered by other people - not us - as a result of their own weakness. "1 in 4 could be your brother, your sister," says the narrator, "your wife, your girlfriend . . . 1 in 4 could be your daughter . . . 1 in 4 could be me . . . it could be you." We feel shaken and chastised. The narrator now holds and comforts the patients, almost defiantly, in contrast to his (our) previous hostility. His last words, spoken directly to the audience, are laced with irony: "Enjoy the film."

The government's mental health "tsar," Louis Appleby, thinks that 1 in 4 has "an uncompromising message." Speaking at the film's launch, he reminded us that stigmatising views "exclude people from their rightful place in society." But can a two minute film really challenge such exclusion?

Anthony Clare, psychiatrist and broad. caster, thinks it can. "Cinema," he said, "can help to change and educate." There has always been an interesting feedback, he explained, between "portrayal, iconography, and our understanding of mental illness. The imagery of cinema informs and moulds our understanding of what psychiatric hospitals look like."

But if this is true then 1 in 4 suggests to the audience that such hospitals are bleak and frightening places, full of patients in states of undress, huddled away, or posing bird.like on their beds. Its imagery does not reflect a modern, bright psychiatric unit but the dark and dingy squalor of an ancient asylum. Its mood is flat and bitter, with little allusion to recovery or rehabilitation.

Lewis Wolpert, professor of biology as applied to medicine and author of a recent book about his own experience of depres. sion, was appalled by the film's "disgusting, self-indulgent art." It could, he believes, have the opposite of its desired effect. "If you wanted to make a film that stigmatised people with mental illness, this was it." Peter Byrne, the psychiatrist and lecturer in film studies who worked on 1 in 4, disagrees. He believes that, despite the startling initial images, "the enduring images are the warmth to the demented mother, comfort to a troubled man, a woman with child, and the naked, initially hostile, presenter."

The only way we'll know what effect 1 in 4 actually has on its intended audience is some form of evaluation. The college will repeat its survey of public attitudes in a year's time, to see whether the film, and other interventions in its "Changing Minds" anti-stigma campaign, have affected young people's views. It remains to be seen whether the other images from 1 in 4 - the shaven heads, the screams, the nudity - will provoke people out of their prejudices or merely frighten them.

Jason Roach, Gavin Yamey, BMJ


studentBMJ 2000;08:395-434 November ISSN 0966-6494