Amy Maxmen views a prizewinning film that shines a light into the dark corners of US psychiatric care.
Kings Park: Stories From an American Mental Institution
Lucy Winer checked into Kings Park psychiatric hospital on Long Island, New York, after overdosing on sleeping pills and slitting her wrists. It was 1967; she was 17. Stern nurses dressed her in a hospital gown and escorted her into a room where identically dressed women slept on the floor or leaned lifelessly against walls. The women were literally floored by antipsychotic medications that, as Winer was to find in her six months in the hospital, felt like an iron suit.
“We had been thrown away, stripped, locked up. We were disposable,” says Winer, in the documentary Kings Park. Winer directed and co-produced the film 30 years after her stay at the hospital, now long abandoned. Kings Park tells a tale of mental health care that must be told, she says. The psychiatrists who are now showing it at meetings and workshops around the United States agree: last month, the New York Association of Psychiatric Rehabilitation Services presented Winer with the 2012 Public Education/Media award. Kings Park touches a nerve.
The psychiatrists' goal is to inspire progress by conveying to mental health-care providers how it felt to be on the receiving end of deficiencies in state mental institutions. Although the drugs administered to people with serious mental illness are arguably less dangerous now than they were in the 1960s and therapy is widely accepted, not everyone who needs these advances receives them. In the United States, more than 10% of people with serious mental illness are now homeless, or in prison (L. Davis et al. Curr. Psychiatry Rep. 14, 259–269; 2012).
Winer's intent, too, is to shine a light on the dehumanized patients — and overwhelmed doctors — challenged by inadequate resources for mental-health treatment. She spent 11 years creating the film to explore her terrifying personal experience with mental illness as a teenager. As she turns her gaze outwards in interviews with psychiatrists, attendants and other former patients, Kings Park also becomes a history of US psychiatry told from multiple perspectives. The journey ends in the present, at the assisted-living centres and prisons where many former residents of psychiatric hospitals live. Most large state-run mental hospitals in the United States shut their doors over the course of four decades: between 1955 and 2003, the number of inpatients in them dropped by more than 90%.
Kings Park was comparable to other US state hospitals, but larger and more venerable than many. It opened in 1885 as an asylum for people with mental illness in New York City. In the 1950s, it housed roughly 9,000 patients at any one time. In the same decade, Thorazine (chlorpromazine), an antipsychotic drug prescribed for schizophrenia and other psychiatric disorders, came to Kings Park. It replaced cruder means of quieting patients, such as lobotomy and electric-shock therapy, but caused slurred speech, the writhing and shaking of tardive dyskinesia and other distressing side effects, as doctors experimented with various formulations.
Understaffing occasionally led to patients being harmed when attendants rushed to quiet them. Hannelore Lehnhoff, a psychiatrist at Kings Park from 1960 to 1985, is noticeably distraught as she recalls an extreme example in which a patient seemed to have been suffocated with a pillow by nurses. Winer captures the frustration that psychiatrists felt with too little time to address the needs of so many patients, and a lack of tools to tend to those they saw. The sombre tone lifts momentarily with the news of the Community Mental Health Act signed by President John Kennedy in 1963, which outlined how small, assisted-living situations could provide an alternative to massive state-run institutions. Funding to Kings Park fell soon after the act was passed, and the hospital began to downsize. It shut in 1996.
At the assisted-living facilities visited in Kings Park, former patients cook, give tours to prospective residents and their families, and discuss in peer-support groups how much better it is to be needed than to be abandoned.
But such facilities were and remain rare. Kings Park shows how federal and state budgets were scaled back as state hospitals closed, and many patients ended up on the streets. A trembling former Kings Park resident with schizophrenia, who is now in prison, speaks to camera about how he was arrested for sleeping outside a church. In scenes at Suffolk County Correctional Facility in New York, we hear that one-fifth of the inmates have been diagnosed as mentally ill. Once more, their clothes have been swapped for uniforms.
After a screening at the American Psychiatric Association's annual meeting in May, the discussion lasted for more than an hour. For Evelyn Bromet, a professor of psychiatry at Stony Brook School of Medicine in New York, Kings Park offers a provocative way to teach history to avoid repeating it. “There are mental-health researchers who have no appreciation for what state hospitals were like,” says Bromet. “Winer is telling the story of an enormous group of people who are forgotten.”