17 Oct 2018

Show on mental illness an edgy experience for psychiatrist

The expert panel on the SBS two part series, "How 'mad' are you?"
 L-R: Prof Tim Carey, Ms Jan Mcintire & Prof Jayashri Kulkarni
Professor Jayashri Kulkarni, Director of Monash Alfred Psychiatry research centre (MAPrc), gives us a behind-the-scenes look at the two-part SBS documentary How ‘Mad’ Are You? in which she appears.

It is a two part series, broadcast 11 & 18 October 2018, and available on SBS On Demand.

by Anne Crawford

When MAPrc Director, psychiatrist Professor Jayashri Kulkarni, was asked to take part in the SBS documentary series How ‘Mad’ Are You? she enthusiastically agreed, thinking she was going to sit on a panel of experts discussing mental illness. Instead she became part of an unusual, intriguing and ultimately uncomfortable social experiment.

The two-part documentary series took 10 Australians, five of whom have a history of mental illness, and asked them to spend a week together. The panel’s task was to assess which five people had previously been diagnosed with mental illness and which five had not. The conditions were schizophrenia, depression, anxiety disorder, bipolar disorder, Obsessive Compulsive Disorder (OCD) and eating disorder.

The aim was to challenge assumptions about mental illness and what it looks like, and air public discussion about stereotypes and stigma.

The series is based on a BBC Horizon/Discovery Channel Co-Production of the same name,
inspired by an experiment in the US in 1972 in which a psychologist and his colleagues assumed symptoms of mental illness to see if they’d be admitted to psychiatric institutions.

“The producers had conducted considerable background work, and spoken with various people in the field, including agencies such as SANE,” Professor Kulkarni said. “I thought it would be great to be involved on a panel to de-stigmatise mental illness.”

The other two experts were senior psychiatric nurse at the Alfred Hospital, Jan Macintire, and Alice Springs clinical psychologist Professor Tim Carey.

The true nature of the series emerged later – that the panel would live in the same complex as the participants, reality-TV style, and watch them undergo a number of specially designed psychological tests and activities.

“There was a lot of mystery about what was involved. The producers wanted to make sure we were kept in the dark so our responses were authentic and unscripted. They went to enormous lengths to make sure the 10 participants were kept separate from us,” Professor Kulkarni said.

The experts were told to pull their blinds down when the 10 people were outside to avoid getting any visual clues about them, and had separate meal times. “There was a lot of lockdown – you lost your bearings because it was all artificial light being in a darkened room.”

The panel were also deprived of their usual tools and ways of operating professionally.

Professor Kulkarni had anticipated that they would assess the participants as they usually do: talking to them, taking a history, doing a mental state examination and perhaps speaking to relevant people in their lives, before arriving at a suggestion on the show about previous diagnoses.

“This was another surprise. We were completely taken out of our comfort zones by not having access to the participants and not having access to any of that information,” Professor Kulkarni said.

The panel was filmed watching edited film clips of the participants undergoing the activities. “I thought ‘oh my goodness, it’s like ‘psychiatric Gogglebox’!”

The neuropsychiatric tests on the whole were not those normally used by health professionals, and when they were, the tests were out of context of the battery of tests in which they normally be given, she said.

In the first part of the series, for example, the participants were asked to perform stand-up comedy to a pub audience as a test for social anxiety and were given gambling chips at a roulette table to test for impulsive behaviour and perhaps bipolar disorder.

There were also unexpected “rules” to the show, which potentially mitigated against the experts arriving at a ‘correct’ diagnosis.

Professor Kulkarni said that while the format used made for interesting TV, she was concerned about the “game show element” of the series, in which viewers made guesses matching participants with mental illnesses.

“The premise of the program was that they wanted to make the point that if someone has a mental illness they’re not going to look any different to someone who doesn’t have a mental illness once they’ve been treated and are functioning well in the community. Therefore, there shouldn’t be a stigma about getting help,” Professor Kulkarni said.

“I totally agree with that premise and it’s important to raise consciousness about it.”

However, the premise meant that the experts – like the TV viewers – had to fail to pick up the diagnoses correctly.

“I don’t think the goal was about getting it right – it’s about the bigger point, which is to destigmatise mental illness. But in the back of my mind there’s a concern that some people watching will say ‘well, if these people can’t pick up mental illness why should I go and seek help from the so-called experts?’,” Professor Kulkarni said. “I hope it doesn’t take away from the profession.”

The trio, while approaching the diagnoses from different disciplines, was remarkably cohesive and collaborative, and have kept in contact with each other in the year since the documentary was filmed, she said.

The filming ended by bringing together participants and experts in scenes where those who had experienced mental illness declared themselves and shared their stories.

“There were a few shocks there,” Professor Kulkarni said. “It worried me because I thought ‘how much of this is going to be stressful and traumatic for people’.”

Professor Kulkarni had found it hard watching some of the participants negotiate their way through the particularly stressful tests. “A lot of times we were stepping into the shoes of these individuals and that was difficult. We’re trained to be empathic and pick up cues and see things from the individual’s perspective so that can be really trying at times. You think ‘how is this person going to deal with this, oh, I can’t watch!’”

The producers provided a counsellor for the participants throughout the filming and the editing was sensitive, she said.

Professor Kulkarni, who has appeared on television speaking about mental illness on a number of occasions, hasn’t yet seen the final episode of the series.

She knows though that the participants give inspiring stories of hope and resilience.

“The good message is that someone does so well from their treatment of mental illness that you can’t distinguish them. Rarely do you get stories about people who have triumphed over schizophrenia or OCD or some of the other conditions, and that’s an important message as well.”

Professor Kulkarni hopes the documentary also includes her call for better, more objective diagnostic tests such as those used in other branches of medicine. “Throughout the program I keep making a plug for neuroscience because it’s one of the things I’m passionately interested in,” she said.

How ‘Mad’ Are You? Part 2 airs Thursday 18 October, at 8.30pm on SBS and will be on SBS On Demand.

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