Schizophrenia in the cinema

Me, Myself and Irene (UK release date: September 22, 2000) is the latest film from the Farrelly brothers, specialists of ‘gross-out’ comedies such as Kingpin (1996) and There's Something About Mary (1998). Its plot is simple: boy meets girl, boy fights himself for girl, boy gets girl. Comedian Jim Carrey plays the lead role for laughs after he develops “advanced delusionary schizophrenia with involuntary narcissistic rage”. Charlie is nice and meek, a state trooper and caring father. After he becomes ill, his boss sends him on a week's holiday, but tells a colleague that he will not be coming back to work. Hank (his alter ego, second multiple, or whatever cinematic diagnosis seems best) is foul-mouthed and aggressive — a turbulent mental state induced episodically when he stops taking his medication. His behaviour is obscene (he defecates on a neighbour's lawn), violent (all his scenes centre on his uncontrolled rage) and sexually disinhibited (at one point he suckles from a stranger's breast). The object of his affection, Irene (Rene Zellwegger), apologises for this behaviour, explaining that he is a “schizo”. Both Charlie/Hank and Irene are chased across the country by corrupt cops, intent on killing her as the sole witness to a property scam. Along the way they meet a man with albinism, ‘Whitey’ (Michael Bowman), who explains that he has killed his entire family but was released early “to make room for psychos”. The bad guys are captured and the film ends with Hank's touching proposal to Irene: “will you marry me, bitch?”

The reaction (so far)

In the USA, the National Alliance for Mental Illness (NAMI) took the lead in criticising the film as irresponsible, noting that it was released on the first anniversary of the first White House Conference on Mental Health. Dissemination of information about the film within the USA and beyond was achieved through NAMI's stigma busters e-mail alert service (http://www.nami.org/campaign/stigmabust.html ). Their objections centred on three aspects of the film: that schizophrenia is not split or multiple personality, the illness is not a violent one and its symptoms and treatments should not be portrayed as a joke. A US Coalition (http://www.nami.org/campaign/20000606.htm ) urged people to write to the film's distributors, Twentieth Century Fox. SANE Australia, along with other bodies including the Royal Australia and New Zealand College of Psychiatrists, condemned both film and promotional materials (http://www.sane.org/stig3.htm ). The Schizophrenia Society of Canada and the Canadian Association of Psychiatrists, among others, led a similar campaign, and reminded the public of the random attack on a homeless man with schizophrenia in Toronto. Adrian Fillmore was attacked as he lay sleeping in a bus shelter last June: he was stabbed and bled to death (Toronto Star, June 4, 2000). This ad hoc Canadian coalition successfully used the internet to alert people to key facts in the debate (http://www.cpa-apc.org/MIAW/Irene.htm ).

For the film's release in the UK, its distributors are reconsidering all four promotional ideas previously used in the USA. These were jellybean pills to cure schizophrenia (principal side-effect: genital elephantiasis), T-shirt tie-ins (“I'm schizophrenic: so am I”) and a poster of Jim Carrey's face split down the centre showing both Charlie (good) and Hank (evil) (http://www.sane.org/ ) and the tag line “from gentle to mental”. The Irish Censor in particular objected to the promotional tag line, and gave the film an over 18 certificate. Changes to the poster and tag line for Crazy People (1990) following protests have been described by Wahl (1995). At time of writing, the company's strategy for Me, Myself and Irene is to describe the film as a “split personality comedy”. In the UK, the National Schizophrenia Fellowship (http://www.nsf.org.uk/ ) met with Mind (http://www.mind.org.uk ) and the Changing Minds anti-stigma Campaign of the College (http://www.rcpsych.ac.uk ) to agree a joint statement and plan a common strategy.

So what? It's only a movie

Many other groups could line up to complain about this scatological comedy. Its humour ‘ranges’ from dildos and toilet humour to dark comedy. At one point, Hank starts to drown a young girl who has insulted him. It takes shots at racial stereotypes, women (an unprintable personal hygiene gag), lesbians (“how's it hanging, fellas?”), people with albinism (“circus geek” or “Q-Tip”) and people with physical disability. In spite of this, or perhaps because of it, after 7 weeks the film grossed $83 million in the USA (The Guardian, July 28, 2000). It is difficult to measure whether protest may have decreased its box office success. It has earned less than the UK comedy Chicken Run (2000) and substantially less than it would have been expected to earn.

From a mental health perspective, this film has many negative aspects. In addition to the three objections raised by NAMI (above), which taken together will add to the stigmatisation of people with mental illness, there are further considerations. Its target audience is the 15-24-year-old age group, which has the peak incidence of schizophrenia. If this is what they perceive as schizophrenia, how likely are they to seek help, stop self-medicating with alcohol or cannabis, take prescribed medication or stay in our services? Wilson et al (2000) have identified negative stereotypes of mental illness in the majority of children's television programmes. Adverse attitudes to mental illness in the UK have also been recorded, with the strongest perceived association between violence and schizophrenia among 16-24-year olds (Crisp et al, 2000). This film, with its subsequent exhibition on video and television, will add to the misinformation, the misperceptions and the negative stereotypes of mental illness in this age group.

So what can you do?

See the film, preferably as a reviewer. Consult your local user groups and react. Make the debate public and choose the means and the medium of your protest with care (Hart & Phillipson, 1999). Other groups' objections and potential protests have been successful in removing some of the promotional gimmicks listed above. This is also a golden opportunity to draw attention to how easy it is to mock or misrepresent mental illness and how pervasive mental illness stigma is in our society. Talk to your colleagues and friends; it is possible to object to a film like this without appearing to be humourless or cranky. This is not about censorship: they have a right to make any film they wish. Abusing people with schizophrenia is a privilege, but a privilege that psychiatrists have a duty to challenge.