Content warning: This review contains information about experiences that you may find distressing, including violence and abuse in mental health services and seclusion and restraint. If you are triggered by anything in this review, please call our new service, CHECK-IN, immediately on 1800 845 009.
A new thriller series has been released on Netflix, and it is controversial to say the least.
The American psychological thriller Ratched, revolves around the character of the same name from Ken Kesey’s 1962 novel, One Flew Over the Cuckoo’s Nest, Nurse Mildred Ratched. Created by Evan Romanskay and developed by Ryan Murphy, the series stars Sarah Paulson as the protagonist, with each episode exploring the origin of her story to becoming a nurse at Luciana mental institution. Here she partakes in, and leads, torturous acts on her ‘patients’, as well as manipulating many of the other characters.
The symbiotic relationship between mental health and violence is an extremely complex topic within this series. The characters embody the exploration of violence, trauma and mental distress in ways that we often do not agree with. For example, the character of Charlotte Wells (Sophie Okonedo), who was deemed to have dissociative identity disorder, becomes a plot device showcasing how trauma leads to mental distress, and this distress leads to violence.
However, what the series does impeccably is represent the atrocities of mental institutes throughout the 1900s, and possibly how far we haven’t come.
Throughout the series, the nurses at Luciana mental institute bargain with their morals versus their desire to treat, even at the extent of the ‘patients’ wellbeing. The viewer consistently questions whether the staff are purely ignorant and genuinely believe these experimental treatments will help, or whether their characters are more sadistic, wanting to cause harm.
It is not difficult to believe that the staff in Ratched’s institute would perform such torturous and experimental treatments on the most vulnerable and already marginalised in society, considering the helpers have historically been the hurters, with cases of abuse still occurring daily.
Experimental treatments and misdiagnoses
The institutions shown in Ratched aren’t removed from the goings-on at real mental health facilities in the early 20th century. “Straightjackets, forced medication, authoritarian staff—this was the reality, not some fantasy of the media,” says Stephen Hinshaw, a professor of psychology at UC Berkeley. “My father was placed in numerous such facilities from the 1930s through the early 1960s, nearly losing his life from neglect, beatings. State hospitals originated in the 19th century as alternatives to poorhouses or orphanages, based on theories of humanitarian care, but quickly became large, decrepit snake pits.”
The revolting scenes of lobotomies through eyes was actually a practice that was used in mainstream psychiatry, with more than 1000 operations per year in the UK at its peak. It was often used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders.
One-point Ratched successfully evokes is holding a mirror up to the psychological community’s treatment of homosexuality. For years homosexuality was considered a mental health illness, with it only being removed from the Diagnostic and Statistical Manual of Mental Disorders in 1973 – just 47 years ago. Ratched brings this to the forefront by not only showing the brutal ‘treatments’ used, but also highlighting the failings of what fell under the umbrella of mental illness. This umbrella of people included those who did not fit in the narrow 1940/50s acceptable box, giving the medical establishment power to choose treatments at their discretion.
How much has the system actually evolved?
Throughout each episode, we see ‘patients’ both chemically and physically restrained, as well as the severe damage and trauma it causes. One character actually suicides after realising they will be undergoing these practices trapped in the institute, forever.
What is most distressing is that many of these practices and inhumane treatment of people with lived experience of mental and emotional distress, by both fellow consumers and staff in mental health inpatient units, still goes on; and at alarming rates.
It is true that there is now much more oversight, more recovery and more positive experiences in the mental health system, but consumers are still at great risk of violence, abuse and neglect when they access mental health services. Many of the experiences of violence, abuse and neglect fall under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment. The CAT defines torture as ‘any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person’. Cruel, inhuman or degrading treatment is accepted to be a less severe form of ill-treatment compared to torture and does not need to have been intentionally inflicted.
When consumers in Victoria access mental health services, they are still at risk of violence, abuse and neglect. From violence from first responders, compulsory treatments and restrictive practices; to gendered violence, poor conditions and environment; a lack of privacy, risks to physical health, and failure of safeguards. (To understand our current position on Preventing and responding to violence, abuse and neglect, click here.)
Even more frightening still is that under the Mental Health Act 2014 (Vic), someone on a compulsory treatment order can be subjected to these risks and harmful practices against their will. This normally means that the law allows force to be used to ensure that a person takes their medication or is given electro-convulsive treatment or psychosurgery. These practices have changed over the years, but the use of force remains constant.
Treating someone against their will because of a diagnosis of mental illness is concerning because it not only breaches a person’s human rights, but it has questionable evidence and effectiveness, and can be psychologically harmful and traumatic, particularly for people with a past history of trauma. People should be supported to make their own decisions about the treatment they receive, and that treatment should be of consistently high quality. People should never be traumatised by mental health services.
Despite all of this, Victoria has some of the highest rates of compulsory treatment in Australia, as well as the highest rates of seclusion. (To understand more about the rates of seclusion in Victoria, read our Seclusion Report #2 here.)
Ratched points out the failing in how society treats, and has treated, those who are experiencing mental distress, as well as those who are deemed outside of the status quo, in very real time. We understand mental health services have come a long way, but this series highlights the areas where we haven’t progressed. Coercive and tortuous practices, lack of choice and dignity of risk, inhumane treatment of people outside of what society deems ‘normal’; all of which are very much still happening today.