Guardian.co.uk

Hollywood's Mental Block...

Cinema has long been bad news for the mentally ill, typically representing them as the likes of Psycho's Norman Bates – crazed, dangerous and in need of harsh restraint. Film-makers have treated them as conveniently dehumanised as useful monsters, inviting cinemagoers to assume they should be feared, shunned and confined.

So what, you may feel: people can tell the difference between fiction and fact. Unfortunately, such research as has been conducted suggests otherwise. It has shown the mass media shapes people's ideas about mental illness, and that entertainment plays a bigger role in this process than factual output. In focus groups, people with hostile attitudes have cited films like Psycho as influences on their outlook.

To be fair, in Hitchcock's day harsh attitudes to mental illness pervaded not just films but society as a whole. Since then, public thinking has been changing, and so has film-makers'. One Flew Over the Cuckoo's Nest marked a turning point. Before it appeared in 1975, few would have believed that a film sympathetic to the mentally ill could win all five of the Academy's top awards. Though it cost only $3m to make, it brought in $108m at the US box-office. Hollywood took note: compassion can pay.

Of course, scary lunatics continued to find a place on the big screen. When Milos Forman's five-Oscar triumph was finally matched in 1991, it was by a film rather less sympathetic than Cuckoo's Nest – The Silence of the Lambs. The tagline of this year's The Crazies, "Fear thy neighbor", is probably as negative a message about mental illness as has ever made it to a cinema poster. Nonetheless, over recent decades, we have also been presented with the often winsome, sometimes gifted, but generally sympathetic flakes of the likes of A Beautiful Mind, Shine, Rain Man, Adam, The Aviator, The Black Balloon, Séraphine, Keane, Away from Her and Girl, Interrupted.

However, those portrayals have not necessarily been psychiatrically accurate or even entirely helpful to those who are mentally ill in real life. Those that sanitise conditions, like Away from Her, can give the impression that sufferers need less help than they actually do. Where a link with genius is implied, as in A Beautiful Mind, sufferers whose conditions will bring them no equivalent benefit can find themselves disappointing both themselves and those around them.

Still, cinema's treatment of mental illness has been growing more sophisticated as well as more sympathetic. The diversity of the conditions involved is now generally recognised. Autism has its own cinematic sub-genre, which even extended its reach into Bollywood with My Name Is Khan. Bipolar disorder has been honourably treated in Mr Jones, Sylvia and Michael Clayton. Depression has had its day in The Hours, Prozac Nation and The Butcher Boy. Schizophrenia has been acknowledged in The Soloist, Spider and Me, Myself & Irene. The Madness of King George may even have done something for porphyria, though that diagnosis remains disputed.

It's against this background that Martin Scorsese's Shutter Island was eagerly awaited by those concerned with mental health. Here was a big-budget, mass-audience film by a legendary director dealing not just with mental illness but with the intricacies of its treatment. Set in the 1950s, when psychiatry was a battleground in which traditionalists wedded to lobotomy, electric shock and incarceration clashed with modernisers eager to move over to psychotherapy, education and medicine, it is based on a best-selling novel by Dennis Lehane published in 2003. Before filming, Scorsese chose to embark on intensive research. He appointed a psychiatric consultant of his own, Professor James Gilligan of New York University, a world authority on violent psychosis. In the 1970s, Gilligan was the director of a Massachusetts prison hospital for the criminally insane like the one featured in Shutter Island. The film's heroic Dr Cawley (played by Ben Kingsley) is largely based on himself in that era.

Scorsese was out to create high drama and to maximise emotional impact. Gilligan was batting for accuracy. He says he also wanted to protect the image of psychosocial treatments, since he feared that enthusiasm for physical remedies might be on the way back. So what was the outcome of these two men's debates? Maintaining historical accuracy, Gilligan assured me, had been no problem. The lengths to which the designers went to get things right amazed him. The psychiatric picture, however, was another story. But don't read on if you don't want to know the film's big twist.

DiCaprio's character, Teddy Daniels, is essentially delusional. He's not a cop, but a patient. According to Gilligan, a sound medical basis for Teddy's condition does indeed exist: he could suffer dissociative identity disorder. "I have known patients who were like that," says Gilligan. It is Dr Cawley's treatment that is nonsense. Cawley attempts to shock Teddy out of his delusion by enabling him to act it out in glorious detail. This, apparently, is the exact opposite of what would actually happen. According to Gilligan, the therapist's task is to encourage the patient to face reality "and help him to mourn his losses".

Unfortunately, the film's plot depends entirely on Cawley's exotic roleplay experiment, so that was that. Gilligan says that the story as told requires "the willing suspension of disbelief". He comforts himself with the thought that it can at least be seen as "a kind of metaphor for psychosocial methods of treatment as opposed to damaging the brain". Not to worry; elsewhere he seems to have won a victory, given that in the film – unlike the novel – Cawley's non-invasive treatment succeeds.

All the same, Shutter Island has left much of the mental health community unimpressed. The film may speak up for humane treatment; DiCaprio is wonderfully appealing and empathetic. But Shutter Island's world is one in which bipolar mothers kill their children, to be killed in turn by their demented husbands. Hospital patients are gruesome scarecrows. Psychiatrists are obsessive crackpots.

In the end, movies are drawn to madness because it's scary, however kindly they try to treat it. Their chilling images are bound to leave more of an impression than their worthy explanations. Gilligan still believes cinema's ability to instil sympathy for the mentally ill has come to outweigh its negative impacts. It has indeed come a long way. But it has still further to go.