The case of J.D-B.

J.D-B.  is a twenty-one year old man, who has been diagnosed in the past with schizophrenia. He is unmarried, has no children, and is currently not working.

Most of the history was taken from J.’s sister, who appears to be the main carer.

Presenting Complaints:

Those highlighted by J.’s sister were:

1.        Auditory hallucinations

2.        Bizarre behaviour

3.        Aggression 

History of Presenting Complaint:

J.’s sister told me that he was diagnosed with schizophrenia about two years ago, and that he has never been in a completely remitted state since first presentation to Psychiatric services at that point.

She described a gradual deterioration in his mental state over the last few weeks.

The initial manifestation of this was when he was responding to apparent auditory hallucinations, as if he believed he was Jesus Christ.

He later began repeating senseless phrases over and over again, until the words were lost. He would often do this whilst walking through town, with a personal stereo turned up very loudly through a headset. 

He had exhibited increasingly bizarre behaviour, for example:

1.   He insisted on wrestling his younger brother, whilst wearing his underpants, and a brassiere.

2.   He placed food he had prepared for his brother in a dog-dish.

More recently, J. had become quite aggressive. He had assaulted a friend with a rock, apparently laughing throughout and after the incident. It seems that this episode had followed a previous assault on a tortoise.

J.’s sister mentioned that a recent miscarriage she had suffered, had upset J., and that his problems had appeared to deteriorate further after this happened. He had apparently taken the baby’s body from the hospital back to his home.

Drug History:

J.s sister did not know precisely, but thinks he might have been on a depot medication.

Medical History:

Nil known

Personal History:

1. Birth & Development:

Unremarkable as far as known. J. was born and raised in a underprivileged area of town, and has lived all of his life there.

2.Family & Childhood  : 

 a) Mother:  Died seventeen years previously giving birth to J.’s brother, when J. was four years old.

b) Father :   Described as something of a dictator, who bullied (and still bullies) J. and his brother.

His sister remembers him dousing J. in ice-cold water to “harden him up”, and paying J. and his brother to dress up in their dead mother’s clothes and dance with him.

He is also described as an “alcoholic”, who would also “take anything else he could get his hands on”.

c) Brother :Four years his junior, is seventeen, and still at school. Father is training him up to be an “Olympic wrestling champion”. J. is often used for wrestling practice.

d) Sister   : Two years his junior, is nineteen. In the absence of J., she told me that the child she had miscarried, was in fact the child of J. She is not sure, but suspects J. was in a state of mind to realise that the baby was his.

She tells me that she often acts in the role of J.’s dead mother, and finds that he appears to take comfort if she talks in this role.

There is no known psychiatric history in the immiediate or distant family, apart from J.’s “alcoholism”.

3.Employment: J. is not currently employed, and has never worked.

4.Relationships: No long-term relationships known.

Social History:

J. currently lives with his family, who consist of the above members, and also his grandmother who suffers with dementia.

He is not currently working, and the majority of his income is from disability benefits.

His social network outside his family, is mainly the local Blind & Disabled support group, which he spends a lot of time with.

He has a "special friend" from this group, an eleven year old blind girl with whom his sister hints, the relationship may be slightly more than platonic.

Mental State Examination

Appearance and behaviour:

J. appeared older than his chronological age. He was unkempt, dressed shabbily, and was wearing what appeared to be a full set of gold teeth. He often did not seem to be making sense, and appeared to be responding to hallucinations more than answering any questions directed at him. H e had poor eye contact, and was emotionally incongruent with the fragments of speech that were comprehensible.

Speech:

Increased rate and pressured.

Thoughts:

Difficult to examine systematically.

Appeared to believe with full conviction, that he was Jesus Christ, and that he was having a discussion with Adolf Hitler.

Perception:

Appeared to be having auditory hallucinations of Hitler speaking to him. It was unclear as to whether he was having visual hallucinations of the same.

Mood:

Objectively, he was angry and agitated whilst talking to “Hitler”. Unable to examine subjective idea of mood.

Insight:

None apparent.

Discussion: 

The history of J.D-B’s case, may at first glance appear somewhat extreme. Unfortunately, second glance does not afford any further depth, as this history is actually based on the main character from a film which I suppose makes it a little easier to stomach. 

J.D-B, or Julien Donkey-Boy, is also the name of this film by Harmony Korine, famous for directing other little-but-better-known films “Kids” and “Gummo”. The film was said to have been “inspired” by Korine’s uncle who suffers with schizophrenia. 

The picture is filmed with a hand held video-camera, and is throughout, a typical “Art”movie, complete with scratchy soundtrack and grainy focus. Because of this, it conforms to “Dogme 95”, film “regulations” drawn up by a group of Scandinavian fim-makers and described as “a vow of chastity to reject anything deemed artificial”. What this means in effect, is a ban on the use of artificial light, costumes and props (apart from “natural”props found on the film set). After the making of the film, the directors must confess to any rule-breaking for example, Korine confessed to using a pillow to make his girlfriend (Julien’s sister) pregnant, rather than impregnating her the traditional way, because “there just wasn’t enough time”. 

A picture of life with schizophrenia

The film paints a picture of Julien Donkey-Boy, who suffers with Schizophrenia.

Unfortunately, although the film is unconventional in its filming, and lack of plot with improvised acting (which may be seen as a method of representing the erratic nature of Schizophrenia), the portrayal is certainly a conventional stereotype. I can just imagine the cast trying to outdo one another in how “Korine’s uncle really might have been”.

Un/fortunately, depending on perspective, I missed the beginning of the film, so what happens then is a little unclear. From internet reviews I have read, there are a number of perceptions as to what happens. These vary from killing a tortoise, to an assault on a boy, to killing and burying the boy. Although I cannot explain this variation, the consistent detail is that he is laughing maniacally, with mucous dripping from his nose, and saliva dribbling from his chin. By starting the film in this way, it seems that the overall message (at least subliminally) apart from this latter, is that violence is an integral part of Schizophrenia. 

Throughout the film, Julien’s family are caricatured, incorporating more stereotypes to stack up the cards for a Full (“Mad”) House.

They live in Queens, a particularly deprived area of New York.

Julien’s father to start with, is a bully, and shamelessly competitive with his children. We see him drinking cough syrup from his slipper to get high, pushing his gas mask up onto his forehead to retire for a cigarette whilst listening to a Country & Western record. He quotes Clint Eastwood from “Dirty Harry” as literature after dismissing Julien’s verbigerative attempts. We then see him attempting to pay his son to dress up in the clothes of his dead mother, and dance with him.

We then see Julien’s brother training to be an Olympic wrestling champ by wrestling bins and his psychotic brother (who is wearing his sisters bra).

Julien’s sister is pregnant by him. She telephones him, pretending to be his dead mother, and while she tells him she loves him and to brush is teeth, he improvises some testicle-scratching. 

We get a glimpse of Julien’s social life.

He has a friend with no arms who plays drums and cards with his feet. In one of the rare amusing scenes of the film, when accused of cheating at cards, he replies “I haven’t got them up my sleeves, have I?”.

Another friend is a black albino confined to a wheelchair who raps “ I’m a black albino from Alabama, from way down South, and I’m a….”Coda.

We see another of the club’s members (possibly just a visiting cabaret artist) who is able to invert several lit cigarettes into his mouth, to then regurgitate and continue smoking them.

There is no hint of Julien integrating successfully into the wider community.

In terms of his love life, there is an eleven-year old blind girl with whom it is strongly suggested that Julien is having a love affair with. 

The film itself gives the impression that it chronicles an extended period, and through the whole of it, Julien talks gibberish, and continues to behave bizarrely. There is no point through the film where Julien is well, and he remains psychotic for the whole period. 

What message does this give?

The picture of a patient suffering with schizophrenia is one of someone who is:

• violent

• mad

• incestuous

• probably paedophilic

ALL of the time 

What of the family? They’re all mad too, and probably bad too. The picture of the parents is one of abuse as illustrated above. The suggestions of the film are on the same level as the Schizophrenogenic Mother model, whereby the blame for aetiology is shifted onto the parents.  

But it’s only a film?

Of course, all this can be dismissed as the ramblings of a politically correct Psychiatrist (which as it happens, I’m not, in fact P.C.ness is one of my pet hates), because at the end of the day:

It’s only a film, and you can take it with a pinch of salt.

WE know that, because we work in mental health. 

BUT: this is a “serious” film, completely on the opposite pole to its Hollywood counterpart.

A film with “a meaning”, with artistic integrity which will represent reality with no regard to aesthetic considerations. The film is also said to be based on it’s Director’s uncle, so it must be true.

All the more reason to take this film as a realistic representation of Schizophrenia.

That’s my opinion, but what of the lay public?

Using the film critics as a sample of the public with no professional knowledge of Mental Illness:

Do the critics take this film seriously?

“The film may be realistic in its portrayal of Schizophrenia, but that does not really educate its audience, nor influence us to empathise” –Christabel Padmore

“This film is a beautiful elegy on being different” –Nicholas Dawson

“A schizo film about an actual Schizophrenic (Korine’s institutionalised uncle)” –Alfredo Garcia

No they don’t

“Masturbating nuns, an armless drummer….Korine’s world is chock full of revolting characters and images, but for no apparent reason other than shock value….best bet is to skip it altogether”

“annoyed with the oft-trite family blaming…..completely clichéd notion that the father is the sole destroyer of his family” –Ted Prigge

“Nothing to say and nowhere to go”

Did they like it?

“A film of piercing beauty and pain” -Kevin Thomas

“It surely does not merit the pejorative of cinematic elevator music….it made me want to throw something at the screen” –Harvey S. Karten

“precociously original talent”

“Giving a star rating…would be like grading a child’s fingerpainting….hard to know if it’s cynical       -and possibly- offensive voyeurism…..or if Korine is liberating the freaks”

“An exercise in disgust” –Ana Marie Cox

“Nothing to say and nowhere to go”

“Merely an acquired taste” –Dean Schmitz 

And Myself?

Personally, I left the film feeling that people suffering with Schizophrenia and their families would be offended by the film, and the fact that the film was so barefaced about these offensive issues, made me quite angry.

As for entertainment, I was not entertained. 

It is not clear what the message is that Korine is trying to convey. On one hand you could argue that his point is that it is Us, Society who have the prejudices, and using this film is reflecting these back to us, on the other hand that his ideas are simply an unprocessed product of these same prejudices. Either way, the film is rather offensive (which was probably the intention), and it would be interesting to know what his uncle’s view is of the film based on himself. 

What about the General Public?

When I decided to present this at our academic meeting, I thought it would be a good idea to show selected scenes from the film to illustrate my points. Unfortunately, I found that no-one had actually heard of the film.

No video rentals within a half-hour drive stocked it, and when I tried to buy it, only the MEGA-Virgin mega-store sold it, and only on DVD version.

I suppose one good thing about Dogme ’95, was that its rules made this particular film so bad that the damage it could potentially have caused was limited.

From both an artistic, and a political point of view, I would hope that the memory of this film fades with the video recording.