Title: Perception “Asylum”
Writers: Kenneth Biller & Mike Sussman
Director: Alan Poul
Network: TNT
Original Airdate: 9 July 2012

Today is World Mental Health Day. Since 1992, this day has been utilised by the World Federation for Mental Health to promote awareness, education and advocacy for mental health conditions and issues. This year’s theme is “Living with Schizophrenia“. Schizophrenia is a condition that affects an estimated 26 million people worldwide, but which is often sorely misunderstood and misrepresented. In addition to the WFMH’s report, the Rethink Mental Illness’s +20 campaign seeks to highlight how people with schizophrenia and other serious mental illnesses have a life expectancy of twenty years below that of average populations, and mainly so due to preventable physical illnesses unrelated to their diagnosis. The New Statesman this week published an affecting article on the same topic.

For my part, I thought it would be timely to revisit another series here on the blog for a second time, and one of which I was quite critical first time around: Perception. Second season instalment “Asylum” felt like a good candidate given that it features schizophrenia even more centrally than usual, and also as it gives some insight into how psychiatric hospitals are represented onscreen. And because—Perception being as it is—it features a guest turn from Judd Hirsch as the imagined presence of Sigmund Freud.

“Asylum” centres around the hook that Dr. Daniel Pierce (Eric McCormack) fakes symptoms of his schizophrenia in order to gain access to a psychiatric hospital. A stabbing has taken place there and patient Erica Beecher (Gia Mantegna), a young woman with obsessive-compulsive disorder, stands accused of homicide. Her lawyer, Dr. Reuben Bauer (David Paymer), petitions Pierce for his help:

It’s clear from the set-up that Erica is innocent, so at least the cliche of the mentally ill as inherently violent is avoided. Setting aside how readily Pierce ensures he is picked up by the police and conveniently dropped off at the right hospital, I found the notion that anyone could fake their way into such a institution highly unlikely. Until, that is, I realised from an exchange in the episode that this has actually happened.

In 1973, psychologist David Rosenhan published a paper called “On being sane in insane places“. The paper is based upon a study now simply known as the Rosenhan Experiment, in which a number of “pseudopatients” successfully gained access to psychiatric hospitals by faking hallucinations, were promptly given diagnoses, and then subsequently refused permission to leave when they came clean about their intentions. In his conclusions, Rosenhan questioned the accuracy of psychiatric diagnoses, and also highlighted the dangers of dehumanisation and labelling in such institutions. Loosely, this is a theme upon which “Asylum” also touches.

Then there is the appearance of Dr. Sigmund Freud. Seventy-five years on from his death and in spite of much of his work now being challenged, it is clear that many of Freud’s ideas and much of his terminology have entered our lexicon—even though some of those ideas have arguably been lost in translation along the way.

Freud first appears to Pierce during a group therapy session, and pops up again throughout the episode as his imagined consultant, as befits one of the somewhat convenient elements of the Perception formula in terms of its representation of schizophrenia. It lends the script a few of its lighter moments—if obviously so—such as when the psychoanalyst offers Daniel Pierce some uninvited observations of his painting during an art therapy session:

Also up for consideration is “Asylum”‘s representation of the psychiatric hospital itself. At the outset, Pierce points us to the fact that this is a hospital with a poor reputation. Nevertheless, it feels somehow muted and sanitised, with patients mostly behaving either humorously or disturbed purely on cue as the script requires it. And then there is the episode’s big reveal—that a rumoured killer in the basement is very real, and that he is one of the staff.

This seems to be turning into a whole new cliche of the genre. Eager to avoid the error of painting sufferers of mental illness as violent criminals, any such audience expectations are undercut and the default is instead to have one of the caregivers be the big bad. I wouldn’t mind so much if this wasn’t becoming so commonplace. The clues are there from early on, but it still sits uneasily with me to paint health professionals in this light. The implication is that, given a position of power over someone so vulnerable, that power will be abused. There may be a grain of truth to this, but it doesn’t help when the reveal is a psychiatric nurse wielding a drill and yelling maniacal threats to lobotomise our hero. There’s no nuance here.

There are, however, some nice touches leading up to and during the instalment’s climax. It is through trusting the half-remembrances of a fellow schizophrenic in the hospital that Daniel is led to the killer. When subsequently kept prisoner in the basement, he realises—with a little gentle prodding from Dr. Freud—that he has been given LSD, and that what he sees as fire-breathing has in fact been brought about by synesthesia confusing and mixing his senses, thus leading him to identify the killer from his choice of chewing gum! And as for our letter opener-swallowing suspect, she is offered hope in the treatment of her OCD through the radical, non-invasive Gamma Knife surgical procedure. This stands in stark—and perhaps deliberate—contrast to the crude lobotomising methodology of the killer-of-the-week.

For all its flaws, then, Perception certainly laces episodes such as “Asylum” with fascinating psychological details, many of them authentic and educational. Another element that the series utilises particularly well is the monologue. Episodes are often bookended with these as Dr. Pierce addresses his students in the classroom on the topic-of-the-week. For some, these scenes may come across as stylistically heavy-handed, but for me—and I speak as someone who used to very much enjoy such voiceovers that were used to great effect in The X-Files (1993-2001) and Millennium (1996-99)—they work well as a framing mechanism. Perhaps the best way to sign off this post, then, is with Pierce’s closing thoughts to his students on dealing with mental illness, which posit a cautiously optimistic future for sufferers: