When I was five years old, I had a friend called Becky. She was a lively little girl, energetic and keen on imaginative play. But Becky wasn't doing too well at school where, even at that age, she was continually subject to taunts from other children. Sometimes she would lash out and then the teachers would look at her as if to say, is it safe to let this child near others- Becky had Down syndrome. It wasn't a particularly severe case and, with proper support, she might have been able to lead a fairly normal life, but other people's attitudes toward her ensured that could never happen.
That was my first experience of mental disability. Over the years which followed I was to meet many more people with learning disorders or mental health problems which set them firmly outside the bounds of mainstream society. Most of these people managed to live independent lives with help from friends, relatives and the medical establishment, but from time to time some of them simply found it too hard to cope. For these people, the only adequate help came from a period of refuge in a mental hospital - an asylum.
Asylums have a bad reputation with the public, which is not altogether surprising considering their history, and still less so considering the way that history has been portrayed. The image of shrieking, desperate inmates locked away in Bedlam against their will still has a powerful effect on the public consciousness, reinforced by popular films, like From Hell and Sweeney Todd, depicting that period. Of course, no-one would expect an asylum to look like that today, but there's a popular belief that only the décor has really changed and that the patients are quieter simply because they have been drugged. 1975's One Flew Over the Cuckoo's Nest, with its ruthless daily routine and domineering nurse, set the standard for how such places are perceived today.
Patients dissatisfied with their experience of the system assert that such places still exist today, but a lot has changed over the past three decades and the notion of the asylum as a place which really can help people has gradually begun to take its place in the popular imagination. Crucial to this was the massively successful 1988 film Rain Man, in which Charlie, a Los Angeles car dealer played by Tom Cruise, kidnaps his severely autistic brother in order to try and obtain his share of their inheritance. Dustin Hoffman won an Oscar for his studied portrait of the brother, Raymond, but what really makes the story work is the relationship between the two and Charlie's gradual recognition both of Raymond as a person and of the extent of his care needs. The journey they make together reflects that being made by society in its understanding of the mentally disabled, and the film was massively influential, presenting Raymond as a character in his own right rather than somebody who ought to be hidden away. However, in parallel to this emotive storyline we come to understand that Raymond cannot cope with ordinary life and that he really was happier in the institution where he spent most of his life. The asylum is thus presented as a place of refuge where his freedom from the day to day struggle allows him to be himself. Crucially, it is a place which also has room for Charlie - as a visitor - demonstrating that the two worlds these brothers inhabit can intersect. Life in the asylum is not out of sight and out of mind. It is a part of the bigger picture.
Of course, not every mental disability is as socially acceptable as Raymond's, and the reaction of the public to mental illnesses like schizophrenia has always been less sympathetic. From its first major appearance in film in 1976's sensationalist Schizo (with the tagline 'when the left hand doesn't know who the right hand is killing') schizophrenia has largely been used as an excuse for creating monsters, with very little exploration of the character and experience of affected people themselves. 2002's Spider features a man whose schizophrenia has driven him to violence (we may still have to wait some years for major features in which it is seen in a more mundane form), but its presentation of him is both realistic and sympathetic. This is less of a surprise when one considers that it was written by Patrick McGrath (adapted from his own novel), whose father was an asylum supervisor and who grew up amongst people with severe mental disabilities of all sorts.
Spider opens with the eponymous hero, played by Ralph Fiennes, emerging from the asylum, where he has spent the whole of his adult life, to live in a halfway house. Whilst recounting the story of his institutionalisation in flashback, it also deals with his attempts to reintegrate into society, a difficult process in which he receives little support. By far the happiest scenes in the film are those which reflect his time as an asylum inmate, performing simple work and spending time with friends in a place where he felt secure. Unlike Rain Man, this is the story of a man with no outsiders to care for him, a man whose whole emotional focus has been within the system. It presents a world in which a more ordinary life is placed out of reach by society's careful isolation of and avoidance of the institutional environment.
A more positive picture is presented in the German film Elementarteilchen (also known as Atomised and Elementary Particles) released in 2006. This is another tale of two brothers, Michael and Bruno, who find love in unexpected places. Throughout the film, Bruno (Moritz Bleibtreu) is presented as a difficult character, belligerent and sometimes racist, not easy to like, but his life is transformed when he meets the dynamic Christiane (Martina Gedeck) and we share his delight at the new world opened up to him. Unfortunately, this happiness is not to last, as Christiane suffers a devastating accident and subsequently commits suicide. Devastated by the loss of her, Bruno experiences a mental breakdown and is unable to care for himself. The latter part of the film deals with his institutionalisation and his gradual retreat into a form of madness which enables him to find peace again.
The most striking thing about the asylum we see in Elementarteilchen is that it looks like any other hospital. Gone is the rose-tinted view offered by Spider, and likewise the hyper-sanitised, hostile landscapes of One Flew Over the Cuckoo's Nest. This is a building clearly designed for practicality and one from which Michael (Christian Ulmen) and his wife can easily come and go to visit Bruno. There are no prisoners there, just people for whom it is home. We see Michael, initially intimidated, grow increasingly comfortable with it as he learns to integrate the visits into his life, and he is also able to take Bruno out on day trips, so that despite the extra support he needs he is able to participate in the same sorts of activities as anyone else.
In examining the social history of the asylum, Michael's journey is as important as Bruno's. As the outsider, he takes the part of the viewer. He enables the audience to step inside the asylum as presented onscreen and to imagine themselves interacting directly with its inmates.
One film which attempts a different way of enabling this process of identification is Lars Von Trier's highly controversial Idioterne (The Idiots). Released in 1998 to a storm of protest, it concerns a group of young people living in Denmark who regularly go out in public and pretend to be mentally retarded, creating havoc as a result. Their self-reported motive is a desire to restore society's creative impulse, but Von Trier's seems to be twofold: to present a direct challenge to societal mores, and to confront society with the legacy of what it has hidden away. It's a bold assertion of the existence of those aspects of humanity which we routinely try to disown; in Von Trier's world we are given no asylum from the insane. It has been called exploitative and many people find it hard to watch, but it shows us that, whilst mental hospitals may be there to help those who cannot cope otherwise, that's no excuse for us to refuse to acknowledge such people. If we were more willing to accept them within ordinary society, a lot more people would be able to get along without needing that refuge - out of the asylum.