A Review of the Movie “Joker”

Joseph Merlin Bowers

The movie Joker was controversial even before its release. NAMI national made the pre-release statement: “As many of you know the movie Joker is being released tomorrow. As we understand it, the joker is characterized as having a mental illness and later perpetuates acts of violence.

NAMI national has reached out to Warner Bros. about the film to discuss how they are talking about the issue publicly.

For your reference, we typically follow these guidelines:

NAMI does not encourage protests/boycotts which are tactics that can inadvertently publicize the film.

NAMI does not comment on films we have not seen.

When appropriate, we promote those with positive portrayals/messages.

If NAMI national is contacted by the media, we will respond with: NAMI is concerned by any media that perpetuates stereotypes and discrimination against people with mental illnesses.”

Having now seen the movie, I will comment.

I have lived with a serious mental illness nearly 60 years and I loved the movie and strongly endorse it. I hope it has as big an impact in a positive way as One Flew Over the Cuckoo’s Nest had in mostly negative ways.

It does portray the joker as having a mental illness and he does kill people and incite rioting. However, he is portrayed as a sympathetic character one can relate to and understand how he feels and his motivations.

In the climatic scene he states: “What do you get when you cross a mentally ill loner with a society that abandons him and treats him like thrash? You get exactly what you fucking deserve.”

The movie Joker turns out to be a serious indictment of the mental health industry and society in general.

Our society has largely abandoned the seriously mentally ill and we pay an enormous price for that in many, many ways day in and day out. And that is exactly what we fucking deserve.

To be fair some of us had good intentions striving to protect civil liberties. The problem with that is that freedom and liberty come with much personal responsibility. Even as small children are ill equipped to make life altering decisions, so are psychotic adults. In these cases civil liberties are not a gift but a burden too heavy to be borne.

The joker also complains that mental health professionals don’t listen to him and don’t understand him. I have encountered some who never try to get into the head of the individual patient. They have their standard treatment plans for a specific diagnosis that they apply to all so diagnosed and standard, rote questions that they ask each session. But there are, in my experience, many excellent, dedicated professionals who do listen, do attempt to understand each individual and streamline a treatment plan to that understanding of each individual.

For most of my life, I have felt that our societies treatment of our seriously mentally ill has been steadily getting worse in many respects. Currently, I believe that we have turned a corner. There is greater awareness that we have created a serious crises and greater desire to make things better. I have more hope now than even a short time ago for a better future for families dealing with serious mental illness.

Still today each day we see many totally preventable tragedies. Many, many lives are needlessly wasted while experiencing more hardship and suffering than necessary.

When we decided to abandon the seriously mentally ill, what did we expect?

 

 

 

Mental Illnesses are not Casserole Illnesses

Joseph Merlin Bowers

Someone on Facebook posted that schizophrenia is not a casserole illness. I liked that way of putting things so much that I decided to steal it.

What she meant was that when someone is diagnosed with schizophrenia people don’t come by offering food, starting fund raisers or ice water challenges trying to help the family any way they can. So it is with any mental illness that affects behavior. If the family is not shunned altogether, too often the mother is blamed.

This is not true of any other type of illness that I know of. Mental illnesses are major tragedies for families. The serious illnesses are very debilitating. People with such a disease die as much as 25 years younger than those without. A few years back I visited a traveling Vietnam memorial which got me to thinking: was I lucky or unlucky? Despite graduating from high school in 1965 I didn’t go to Vietnam probably because I had been diagnosed with paranoid schizophrenia and spent two and a half months as a patient in a state mental institution during my junior year. Doing some research I found that a significantly higher percentage of people with schizophrenia died within ten years of their diagnosis than soldiers died in Vietnam. Mental illnesses kill people just as dead as cancer, heart disease or anything else.

My family, like many others, felt that my having a mental illness and spending time in mental institutions shamed the entire family. The subject was never spoken of by anybody in my family. One of the big tendencies those of us with such illnesses must guard against is self-stigmatization. After all society has long told us we should be ashamed.

I believe that that is starting to change.  As more of us speak out and, with treatment, live fairly normal and successful lives, prevailing fear and ignorance lessens.  When I make a NAMI In Our Own Voice presentation, when I get to the part where I talk of my hopes for the future; mine is for the day when mental illnesses are casserole illnesses though I have yet to express it that well.

Until that day comes, I struggle to think of our society as civilized and humane.

 

Then and Now: Changes in Mental Health

by Joseph Merlin Bowers

I first started in treatment for a serious mental illness in 1960. I was first hospitalized in a state mental hospital in 1964. Off and on I have been involved in mental health as a patient or advocate every since. In those 59 years I have seen many changes in the mental health system, society, public perception and public awareness.

Available medications and treatment programs and options have come a long way. Paradoxically, the likelihood that a family like mine of limited means dealing with mental illness will be able to access available treatment is much less. Those that do get the help they need do so with great difficulty.

It used to be too easy to get someone committed involuntarily. Now it’s too hard.

There are many fewer psychiatric beds available now than in the past. The number steadily declines. In some states like Colorado where I now live there are almost no long term care beds for civil patients.

Many state hospitals have closed. The remaining ones house many fewer patients than previously and have been largely transformed from civil institutions to forensic institutions. Civil patients unable to access needed care often wind up in the criminal justice system. This creates greater demand for forensic beds. This unfortunate situation is self-perpetuating.

The hospital psych wards that came about to replace vanishing state hospitals have mostly been closed because they were losing money and converted to profitable uses. Although parity laws have been passed they are not widely adhered to. The last time I was seriously psychotic (1986) I checked myself into a psych ward and was kept there until much better. This is a very uncommon occurrence nowadays.

It is easier for someone with a mental illness to get various types of disability and government funded incomes, but the well intended laws are poorly written. As an example: a person on SSI loses it if he accumulates as much as $2000 dollars in savings. As the end of a month draws near, people are frantically spending money on unneeded, unwanted things to avoid losing their benefit. You tell me how this makes sense or helps them better their living situation.

Stigma among mental health professionals is less widespread. When hospitalized in the ’60s no one saw any point in telling me anything such as my diagnosis, prognosis, available treatments or success rates. The psychiatrists I saw then largely asked prying, personal questions, took notes and offered no reply, comment or feedback. Bedside manner is generally much better these days. Good professional, patient communication is more common. While there are still professionals with disdainful opinions of the mentally ill, this is less commonplace.

Much of the responsibility for dealing with mental illness has shifted from the mental health system to the criminal justice system.

There is greater awareness that we are in a mental health crises.

Younger people have less stigma about mental illness. They are much more likely than older people to admit to a diagnosis and talk about it. Many though are disdainful of medications. Because smoking pot makes them temporarily feel better, they think that pot is what they need.

Civil patients are commonly turned out with little support before they are ready to reenter society. This frequently results in a preventable tragedy or a wasted life.

Many, many things that were previously considered personality traits are now included in DSMs (Diagnostic and Statistical Manuals) as diagnosable mental illnesses. I suspect this is because the industry is driven by insurance companies and people want to get paid for all the treating they do or receive. The unfortunate result is that resources are diverted from those with truly debilitating conditions.

I think there is greater awareness that much tragedy could be prevented and money saved if we did a better job of getting people into treatment before their illnesses got to stage four. People are starting to realize that substance abuse should be and is more effectively treated as a disease and not as a crime. There is almost always an underlying mental condition involved in substance abuse.

There is greater reluctance to use terms like mental illness, crazy or the like. Yes words matter but when someone like me with a mental illness objects to terms like these, I am acknowledging that there is something shameful about having a mental illness-self-stigmatization.

More people are speaking out about their illnesses. This results in less fear and ignorance-the basis of all prejudice and discrimination.

The homeless population rather than fluctuate with the economy as was the historical pattern, hit a high level decades ago and has stayed high ever since. Our jails and prisons are shamefully overcrowded. These are to a degree unintended consequences of deinstitutionalization.

This is a pretty good summery. I’m sure I’ve failed to think of a few things.

 

 

 

 

 

Stigma Does Exist and it is a Problem

by Joseph M. Bowers

Many of us are frustrated by the seeming endless availability of grant money for virtually useless anti-stigma pr campaigns when that money should go toward things like supported housing that do help significantly. We would usually prefer using the word discrimination where stigma is often misused. Also those of us with mental illnesses need to guard against self-stigmatization. Cost and availability are far more often the cause people don’t seek treatment, but stigma does exist and it is a problem.

Our community is more than 50% Latino. The local judge over mental health court and problem solving court has told me that his biggest issue in trying to help the sick people who come before him is the refusal of their families to support his efforts. The Latino culture is somewhat macho, ignorant about mental illness and very reluctant to admit that there could be any such thing in their families. I understand that stigma also runs high in the black community.

No one can convince me that our society’s response to mental illness would be as shabby if mental illnesses were thought of the same as any psychical illness or even Alzheimers or dementia.  What is that if not stigma and is that not a problem?

 

 

In Defense of Peer Specialists

by Joseph M. Bowers

There seems to be a fair amount of controversy about the effectiveness of peer specialists. A brief search of the literature fails to reveal overwhelming evidence one way or the other. I think a lot of the trouble is because the peer specialist is a fairly new position and his role has not been clearly enough defined.

I have taken the classroom training for being a peer specialist and volunteer at a facility run day to day by paid peer specialists. At this facility we do not treat people with mental illnesses. We are adamant in stressing that ours is not a treatment facility. What we do there is support people with mental illnesses. We listen to them nonjudgementally. We help them connect with available services, fill out forms, provide internet access and free coffee. We have support groups and regular activities like art group and cooking group. We are pro medication and pro treatment program. We get referrals from all the major professional service providers in town when deemed appropriate because we have demonstrated value under the right circumstances. We are paid by district court to support people in the judicial system in danger of losing their children because of mental illnesses and /or substance abuse. We spend a couple hours each week in outreach to homeless people in our communities warming shelter looking for ways to help those with mental illnesses and substance issues. We rent out a room to an individual recently released from the state hospital.

We are not and don’t claim nor try to be substitutes for professionals. We work with professionals and have professionals on our board of directors. Our current director is a retired forensic psychiatrist from the state hospital in our town.

We have some advantages over professionals. We are equals with our clients. It is not a professional-patient relationship. Our clients more readily accept that we get it having experienced much of what they are experiencing. During my stays in mental hospitals many conversations among us started: “I would never tell my doctor this but…Some things can’t be related to someone in authority without unwanted consequences but need to be talked about.

We provide hope. I recently had a couple of opportunities to talk about our organization with Dianne Primavera when she was campaigning for her current position as Lieutenant Governor of Colorado. She is a cancer survivor and commented that when she got her diagnosis the people she most wanted to talk to were cancer survivors. We can tell suffering people what has worked for us. We do empathize that we are not recovered. We are in recovery. Staying there takes work.

There is a terrible shortage of everything needed by our mentally ill population. To a limited extent we can fill in some of the gap. Our current popularity to some degree stems from the severe shortage of trained professionals.

I think when the studies have been done they will show better outcomes for people who have worked with peers and professionals than those who have worked only with one or the other.

 

 

 

Unlike Most Illnesses Mental Illnesses Engender Fear and Disgust Rather Than Empathy and Compassion

by Joseph M. Bowers

As a society we seem to have chosen to put mentally ill people in jails and prisons rather than hospitals and other treatment options. This is partly because of the failure of our mental health system, but the system has failed partly because we have chosen to let it fail. We have done this because of the nature of mental illnesses and public perceptions.

Mentally ill people act in ways that do not engender sympathy. We scare people and put them off with bizarre, some times violent behavior that is very hard to understand. Few things in life are as terrifying as the thought of losing your mind.

When people see someone who has, they often try to believe that this can’t and will not happen to them. They sometimes fortify this hope by demonizing the mentally ill: “They are weak lacking character and will power. I’m better than that. They had bad parents.” Mother blaming is still way too common. Also people often think that these cases are hopeless and trying to help is pointless.

Widespread public perception of the mentally ill needs to be changed. The way we react to mental illness must change if we are to claim to be a compassionate, civilized people. How do we do that?

D J Jaffe is a powerful and passionate advocate for the mentally ill whom I follow closely and for whom I have much respect. He believes we react so poorly partly because advocacy groups like NAMI downplay violence associated with mental illness. We need to scare society into action emphasizing how dangerous the mentally ill often are. I disagree. This is negative reinforcement which is rarely effective. We need positive reinforcement. Instead of emphasizing how dangerous untreated mentally ill often are, I would emphasize what an asset to society effectively treated mentally ill people can be.

We need stories of recovery-stories of hope. That’s where I come in.

On February 16, 1964 I turned 17 years old. I was very sick at the time. Before the end of February, I stole up the stairs of our house one night carrying a loaded shotgun intending to kill my beloved grandmother whom I believed was possessed by the devil. With her late husband she had raised me from infancy. There was no one in the world I was closer to, but she had to die I believed. I didn’t kill her through good fortune and instead spent the next two and a half months in a state mental hospital in lower New York State.

Four years later I was arrested for being in a stranger’s house in Middletown, New York. I had never seen that house before but believed I lived there.

Ten years after that I was arrested in Tucson, Arizona and charged with arson. I was burning part of my golf bag thinking I was destroying a dangerous and ancient demon.

In all I had more than 20 years of recurring psychotic episodes with lucid periods in between. With a medication change I have been mostly symptom free more than 30 years now.

Counter-intuitively I was very lucky in that I first got sick in the ’60s  rather than later in our history. In the ’60s we still treated people with serous mental illnesses in hospitals. I was also lucky in that I respond pretty well to treatment.

Between the lucid periods and the extended period mostly symptom free, I have lived a fairly normal, successful life. I’ve earned a B.S. degree from a major university and been married more than 43 years. My wife and I have raised three children all of whom are now adult productive members of society. I am retired from nearly 30 years in the power industry working mostly as a lab tech. I am living where I wish to live and doing what I wish to do.

I am not that unique. Sadly today most people need to commit a serious crime to get the treatment they need-much improved over what was available to me in the past. In the past though, it was much easier to get into treatment. I have friends who have committed serious assault even taken innocent lives who are very stable now with belated but effective treatment. They are making valuable contributions to our community.

What I want people to understand is that many people who are very sick, even dangerous properly cared for can be productive contributors to society living fairly normal, successful lives. When they go to the revolving door of homelessness and jail they are not only a danger to society, they are a loss to society of potentially valuable resources.

Not everyone responds well to treatment, but everyone can have the quality of their lives improved properly cared for. At worst someone requiring permanent hospitalization is less costly there than in the revolving door.

Society is a big time loser when we fail families dealing with serious mental illness.

 

 

 

 

My Views on Substance Abuse Have Evolved

Joseph M. Bowers

In December of 2015 I wrote a blog complaining about the federal government lumping together substance abuse and mental illness in the creation of SAMHSA. At the time, although opposed to the war on drugs and favoring treatment over criminalization, I tended to have a condescending attitude toward those with a substance abuse problem. After all, one chooses to use a drug at least initially.  No one chooses a mental illness.

Since that time I have talked with professional addiction councilors and taken more than 60 hours of classroom training for recovery coaching. I learned that most often addiction is accompanied by mental illness issues. Choices to use are often  made by people whose prefrontal lobes responsible for awareness of consequences are not yet fully developed and now we have an epidemic, caused in large part by false advertising and over utilization of opioids for painkilling. This information made me somewhat less judgmental.

Recently I have been visiting a young man whose mother in another state contacted the local NAMI chapter to which I belong. He will soon be released from a substance abuse treatment center. The center allows two hours of visitation one day a week. During the first hour professional councilors would talk with us visitors and play a TED talk on the subject of addiction of which I have now seen two. I learned a great deal from them.

The original idea of punishing people with addictions and rehabbing them by imposing severe consequences was based on a flawed lab study. Rats were placed in a cage containing only two containers containing liquids-one water and the other water with heroin. The rats almost all preferred  the container with heroin and most would continue going to that container enough to overdose. It was concluded that one use would almost always result in addiction. Only forced abstinence could possibly help.

Some years later another scientist wondered if the cage might be as big a problem as the heroin. He put the two containers in a cage that provided wonderful living conditions for rats-plentiful cheese, tunnels-everything a rat could want. In this cage almost no rats became addicted to heroin. They almost all stuck to the container with just water.

Then there was the Vietnam conflict. During our involvement more than 20% of our soldiers were heavily using opium and heroin. It was thought that our society would have a huge addict problem when they returned home, but a strange thing happened. Upon returning home, most of these people quit using right away. From this one might conclude that addiction happens not because of the addictive quality of the substance but when someone’s life sucks. When one’s life sucks, a person takes things that ease the pain at least temporarily. When things are going well, addiction is unlikely and uncommon. This TED Talk concluded: “The opposite of addiction is not sobriety. It is connection.”

At the end of a session one of the staff told a story I liked: Someone in a group of people held up a new, clean, shiny one hundred dollar bill and asked everyone who wanted it to raise their hand. Everyone did. Then he crinkled it up, threw up in the dirt and mud and just made a mess of it. Then he held it up again and asked everyone who wanted it to raise their hand. Again everyone did because they knew that whatever it looked like, it still had value. People with substance abuse and/or mental illness problems may be a mess, but they still have value. They are still worthy of love.