Medicine And The Media

Spot the loony

BMJ 1994; 309 doi: (Published 10 December 1994) Cite this as: BMJ 1994;309:1588
  1. Kwame McKenzie

    Channel 4 Witness: “Valkenberg” 1 December

    The trailer said that Witness would investigate how the changes in South Africa had affected people with mental illness. A production team had alighted at Valkenberg, a 1000 bedded psychiatric hospital in Cape Town, built as an asylum in 1981. The hospital was exclusively white until the crumbling of apartheid brought integration in 1990. Unfortunately, the promised investigation was not forthcoming. Perhaps everyone was living in harmony and there was no story to be found; perhaps there was a story but the team could not find anyone lucid enough (patients or staff) to be interviewed; or perhaps this angle on the programme was the only way that Channel 4's “politically correct” division could justify a voyeuristic documentary about a large psychiatric hospital.

    “Valkenberg” was a fly on the wall buzz around the hospital's wards (Women's, Long Stay, Neuroclinic, Acute Male, Forensic, Locked Female, Locked Male, Forensic, and Maximum Secure). The fly stopped at each and we were treated to vignettes on one or two patients. Given the timescale (one hour) and the amount that the team wished to cover, the documentary was always likely to descend into a Victorian freak show. There was no time to develop characters, and the team rarely even managed to get skin deep.

    There was little that the production team could not have come across in any British city psychiatric hospital with a multiethnic catchment area. Perhaps the only substantial difference was that none of the psychiatrists spoke the local language. The programme made much of this and by doing so missed the most important point about communication: attitude is as important as language. A graphic example was present but not commented on. A white, English speaking patient got angry in the ward round because he felt powerless with regard to decisions about his care. He gave a heart rending plea: “You can do anything; lock me up, drug me—give me drug treatment. Destroy me—bombard me … increase my medication.” The psychologist who was interviewing him made little eye contact with the patient, looked at the rest of the ward round, and then turned to the patient replying, “OK, we'll discuss that,” before dismissing him.

    Many questions about the practice of psychiatry in South Africa were not covered. I wondered how much mental illness was due to the horrors of apartheid, what initiatives there were to produce more black psychiatrists, what the service was like for black people in South Africa before integration, how white doctors were coping with the change in clientele and their change in status, what the real impact was of the mass killings around the elections, and how the white population was coping with the changes in the power structure. All these aspects could have made interesting television.

    When I was at infant school a group of us used to have to travel on the 207 bus past a well known psychiatric hospital, St Bernard's, in Hanwell, west London. We used to have a bit of fun playing “spot the loony”—have documentary makers really come no further than this?

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