cw: for images of the depiction of medical torture
Mental illness is rarely depicted in a sensitive way in film, and I can think of few examples of films that are both accurate and ethical, especially in terms of gender. As a broad category, it is treated poorly in cinema. A more specific sub-genre or -trope of mental illness in film is the depiction of electroconvulsive therapy (ECT). Supposedly it is so misrepresented in cinema that it necessitates articles such as About To Have ECT? Fine, but Don’t Watch It in the Movies: The Sorry Portrayal of ECT in Film. Though it seems unanimous that the process is represented as a barbaric, violent, and ineffective one, the way this plays out can be categorized differently often by gender. After viewing a large number of films which depict ECT, here are the basic tropes which seem to occur.
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Victim as Oppressed Man
In these films, the victim of ECT is an intelligent, active man, often transgressive or radical in some way. This type would be exemplified by Shock Corridor (Samuel Fuller, 1963), Chattahoochee (Mick Johnson, 1989) or One Flew Over the Cuckoo’s Nest (Miloš Foreman, 1975). In these films we have masculine protagonists who could be characterized by their near-hypermasculinity: displaying ambition, initiative, aggression, strong sexual appetite, rebellion, and so forth, mental illness (if present at all), is associated more with either men other than the protagonist or criminality — in Chattahoochee, for instance, there are numerous comments on how many of the inpatients are overflow from prison. Care is then feminized: either explicitly (such as in the case of Nurse Ratchet) or through generalization: care is something which is a feminine occupation, distributed by women nurses or by ineffective, relatively impotent men (they are often older, wear glasses, rarely seen doing anything but sitting and hiding behind a desk, with little knowledge of the ‘real’ world or the human/masculine pursuits of the victimized protagonist, and contrast strongly with the hypermasculine protagonist’s vitality), or care is attempted to be distributed by other women (such as the girlfriend in Shock Corridor or sister in Chattahoochee) – in all cases, care is given by a woman or someone without the virility of the victimized man, regardless of if this care is positive or negative.
These films can be read as poisonously feminized institutions targeting a victimized masculinity, a masculinity which is threatened and threatening to encroaching femininity and feminine power. When care is seen as positive, such as the love of the girlfriend in Shock Corridor, it is softer than that of the more powerful institution, and weaker as well. Visually, these depictions will often focus on the face during ECT distorted in pain, violence, disdain, and anger, rather than fear. In these films, the protagonist is almost never sick, it is society that is sick instead.
Victim as Girl/Child
In these films, the ECT victim is either a fragile woman, a child, or a man so ‘emasculated’ that he becomes childlike. In The Snake Pit (Anatole Litvak, 1948), the protagonist’s neuroses stem from trauma relating to her childhood, which drives her back to a childlike state wherein she cannot accept adult responsibility (namely, married life). In Return to Oz (Walter Murch, 1986), the protagonist is a literal girl whose continued fantasies are at odds with her coming of age, and return her continuously to a childlike state where fantasy trumps reality and thus must be attacked through a form of ‘electric healing.’ In Shine (Scott Hicks, 1996), the protagonist’s mental illness renders him to be little more than a child in a man’s body, with almost no agency or coherence of his own, save flashes of brilliance which stem from his past, sane life and can only come to fruition under the hand of mother-figures. His problems are attributed in part to issues with his father (so, childhood, and the already feminized ‘daddy-issues’ are present), and as an adult, post-ECT, he turns to the care of women who take of near-maternal roles, even when they are supposed to be romantic interests.
ECT is used as an entirely ineffective treatment for people who have been rendered childlike through their mental illness, which emasculates them if they are men, or emphasizes girlishness if they are women or nearing womanhood. The focus is more on the mental illness or perceived mental illness rendering the fragile protagonist a child, rather than the ECT which will never work and is simply a source of terror that cannot stop rampant illness’ mental regression: ECT is only part of the ineffective process which further fractures the broken person, but not necessarily a major focus of the treatment, like in One Flew Over the Cuckoo’s Nest. Whether the regression of the ill protagonist is seen as positive or negative (the exploration of the inner child’s fun and whimsy such as in Return to Oz or the emasculation of the adult man who cannot live in adult society without a mother-figure’s help as in Shine), ECT is without fail simply a torturous and misguided attempt to delay the regression, which will not work. Usually these films will promote a different treatment as both more humane or more effective, treatments which can range from the more ‘scientific’ (such as nurturing and semi-romantic talk therapy in The Snake Pit), to love full-stop (as in Shine). Depictions often place visual emphasis on the fear in the face or the mechanical apparatus which administers the shock, making the process inhumane in a scientific or mechanical emphasis, rather than focusing on the specifically malicious doctor who administers shocks as near-personal attack. Additionally, in these films the protagonist is most definitely sick (even Dorothy Gale must learn to forget Oz in Return to Oz) but ECT is never a treatment that will help: the need is for something more nurturing.
Victim as Sexy
The patient in these films will usually have an illness which is based around rebellion, but a feminized one: anti-authoritarianism, alcohol or drug abuse, even political challenge, is added to a rampant sexuality, which is fetishized on screen, and often portrayed by sex-symbol actresses. In Frances, Frances Farmer (Jessica Lange) endures her first course of ECT after her numerous sexual affairs, nude scenes, and generally inappropriate desires for love and affection, while the depiction of the treatment itself focuses on her shaved, arched legs rather than the face distorted in pain or fear. The usual distortion of facial features is avoided by the skillful placing of nurses around her body, so that un-beautiful look of pain is hidden, and the fragmented body is the focus.
Another example of this would be Angelina Jolie’s character in Girl, Interrupted: playing the sexy Lisa who is institutionalized for her wildness and lack of restraint, she is given shock treatments off-screen which are the catalyst for her escape with Winona Ryder’s protagonist Susanna: an escape which involves a kiss between the two women as well as a party where each girl has a hook up, thus attaching the mental illness (and punishment by ECT) to both casual sex and queer feminine sexuality. In From Beyond, an incident with a machine which excites human sexuality leaves an incapacitated Dr. Katharine McMichaels (Barbara Crampton) in the hands of a less sexy woman doctor who threatens her with ECT. This happens, of course, after the effect of the machine influences her to don bondage gear and red lipstick, and attempt to initiate sex with her co-worker, so the grotesqueness and horror of her treatment is balanced by the previous eroticization of her character, while the emphasis on leather, gag, and straps in the ECT sequence become mirrors of her bondage gear. In these films additionally, despite an element of rebellion or transgression, the characters are most definitely sick, but again, ECT will not cure them. In the cases Frances and Girl, Interrupted, this is perhaps because nothing will cure those who receive shocks, while even the insanity-characterized-by-nymphomania in From Beyond is a confirmed insanity which simply could not be changed by ECT as it is derived from an outside source (the villain/monster’s machine): which is to say, that again, her illness would not be curable by medicine.
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When looking into ECT in film, the basic message seems to be that the procedure is presented as a torturous one, which is vastly different from reality. Doctors don’t distribute it as personalized punishment, muscle relaxants and anesthesia are administered with care to attempt to create the most comfortable experience possible, the treatments are generally done with patient consent, and there are no leather straps or gags jammed into the victim’s mouth. But a lot of this rhetoric is about saving the image of the doctors and nurses who administer ECT, and the process itself, with little concern to how it involves the patients, especially in terms of gender. In these examples of ECT in film, one can see that ECT is used to characterize the worst way to treat mental illness, and so can tell us more about mental illness in these films than the ECT itself. And it tells us that: only white people are really mentally ill. There might be one or two men of colour present, but they are never the focus, or are much more ‘insane’ than their white counterparts, suggesting a hierarchy where the white man is least deserving of ECT as he is the most sane. White men who are mentally ill are either castrated children in need of a mother, or just not actually ill, because illness is emasculating, it is stupid, it is weak, and men are not these things. And women who are mentally ill are also either children, often in need of daddy to save them, or they are nymphomaniacs, with an insanity that leads to sexual inhibition and visual pleasure. It will not lead to anything truly transgressive, like the non-ill men are capable of, and even sexually it will be strict: interracial relationships never happen, queer relationships are chaste kisses when compared to wilder sex scenes.
The problem with the representation of ECT in film is that it becomes a marker of severity in illness and ‘treatment.’ Rather than focusing on only how this impacts doctors, nurses, and treatments, it is important to look to how these markers are attached to mental illness and that which it attempts to cure, and the gendered ways this manifests itself. In this manner, ECT films become a microcosm of how mental illness is depicted on-screen, and should be given more attention as such, rather than just for deterring patients from seeking ECT in real life, for this is a basis for general stigma which must be abolished.