Madness | Surgo

Madness at Arkham Asylum

by Dr Colm Hennessy

 

ST6 in Child and Adolescent Psychiatry

and

Former Surgo Editor

Arkham Asylum looms high over Gotham. Or sometimes it sits on an island in the bay. Or is dwarfed by the modern buildings around it. Or maybe it becomes part of the city, a segment where anarchy reigns. While the details vary, one fact always remains: it’s where the bad people are. Where the murderers, anarchists and freaks of the Batman world are sent after being captured by the Dark Knight. There they stay for a while, contained, sometimes experimented on. They are never cured, never successfully helped. Sometimes they are discharged by misguided staff, sometimes the staff even help them escape. Because they always escape, and return to their life of crime, and then return to Arkham a while later. No one gets better at Arkham, no good is ever truly done. The patients do not recover, and society is never safeguarded. Gotham is indeed where the bad people are.

In the wide pantheon of superheroes, no character or title has paid as much lip service to the medical speciality of psychiatry as Batman has. The hero

himself, irrespective of the portrayal, is always fuelled by trauma – the murder of his parents, and a fear of bats. His villains are often described as mad, or schizophrenic (including the great misunderstanding of schizophrenia as “spilt personality”, personified by Harvey “Two-Face” Dent). He has even faced a remarkable number of evil psychiatrists over the years: Harleen “Harley Quinn” Quinzell, Jonathan “Scarecrow” Crane, Dr Hugo Strange, and others. Not only are bad people held in the city’s secure psychiatric hospital, but the madness is seemingly contagious, regularly spreading to the abusive and incompetent staff. Even the origins of Arkham lie in madness: the name itself comes from the Cthulhu mythos of HP Lovecraft, whose arcane tales told of otherworldly insanities forever pushing in on reality. And old Jeremiah Arkham himself, the architect and founder of the hospital, fell to madness, shuffling through the halls of the institution he built.

Batman is not unique in its portrayal of mental illness as being synonymous with evil and danger, but it is perhaps remarkable in its unreconstructed and profligate portrayal. The institution itself entered the Batman comic book in the early 1970s, at a time when psychiatry was recovering from the excesses of institutionalisation and the barbarism of the lobotomy era. Effective medications were by then available, and the age of de-institutionalisation was beginning. But the image of psychiatry, then as now, was still one of custody and madness. Arkham thus became a super-villain take of “One Flew Over the Cuckoos Nest”, where no one ever recovers and people are contained rather than treated.

Nowhere is the “Arkham Effect” greater than in the character of The Joker. Batman’s greatest villain, he serves as an anarchistic riposte to Batman’s fascistic leanings. The Joker is unpredictable, unhinged and extremely dangerous. He has taken the lives of countless Gothamites, including (during the “Death in the Family storyline) Batman’s young ward, Robin. But despite his leanings towards anarchy, he is a methodical criminal mastermind. There is no hint in his portrayal that he is depressed,

or bipolar. Although unhinged, his mind maintains a consistency of thought and action that is not in keeping with psychosis. There have been instances of catatonia (most notable in Frank Miller’s “The Dark Knight Returns”). But, if any diagnosis were to stick with The Joker, it would be psychopathy.

If Scotland has an institution equivalent to Arkham Asylum, it would be The State Hospital at Carstairs. I have worked there myself. Rather than a gothic building of spires and watchtowers, it is a series of modern flat-roofed buildings set on a remote and windy patch of central belt countryside. As opposed to being a chaotic and abusive place, it is a controlled and contained environment. To be sent to Carstairs, one must generally have a significant mental health problem in addition to requiring a high-secure environment. As a rule the focus is on recovery (if possible) enabling the patient to move to a less-secure environment. There are medications, therapy groups, passes to the community. The other fact that sets Carstairs apart from Arkham is that The Joker would never get in. Because psychopathy, by virtue of not being a treatable mental illness, is the domain of the Scottish prison system.

There is one other particularly troubling aspect of The Joker, and that is the fate of his psychiatrist Dr Harleen Quinzel. It is something of a trope in popular culture that psychiatrists fall in love with their patients, but Dr Quinzel’s case is even more troubling: she styles herself after him, becoming a deranged super-villain named Harley Quinn, and begins a life of crime and terrorism specifically to garner the affections of The Joker. It is here that one of the most troubling aspects of stigma is personified: that mental illness is in some way contagious, and that spending time with the “mad” can make oneself insane.

Then I decided to become a psychiatrist, there were a few comments that I grew tired of hearing pretty quickly. Some people, including relatives, worried about my safety; that the “dangerous” patients would turn on me. Others joked I would become “mad” myself. Finally people asked why I did not want to be a “real” doctor, as if I was abandoning medicine for

imprisonment and mysticism. Stigma is not just damaging to our patients, who must contend not just with mental illness but also with the fear and ignorance of society. Stigma is also directed towards psychiatrists themselves, who are frequently regarded as bizarre, unhinged, and perhaps inferior to their medical colleagues.

It is hard to judge the effect of constructs such as Arkham Asylum on stigma towards psychiatry. Of course Arkham is one (albeit central) part of the Batman mythology, and Batman is only one (very well-known) character. What Arkham Asylum is, though, is part of a wider trend of portrayal of psychiatry in the media. And while stigma is a wide issue, it has its beginnings in the public perception of mental illness. Arkham looms large in comic books, videogames and movies. People who grow up on Batman become aware of it, and this terrifying and nasty environment must surely become internalised, one of many impressions to be called upon when they encounter mental illness in the future. And there it will remain: gothic environments, scary patients, evil staff, and no recovery.