Out of Mind, Out of Sight: A Forensic Psychiatry Close-Up

I first heard of the documentary Out of Mind, Out of Sight when I saw it recommended on the Bipolar, Uninvited blog. It sounded interesting, so I wanted to check it out.

NCRMD

It’s shot at an inpatient unit in a forensic psychiatry facility in Brockville, Canada. All of the patients had committed a criminal offense but the courts found them not criminally responsible due to mental disorder. NCRMD is the Canadian term for not guilty by reason of insanity. To be found NCRMD, essentially the court must be convinced that at the time of the offense the person was affected by their illness to the point that they were unable to distinguish right from wrong.

Family

One of the patients who spoke extensively with the filmmakers was a young man who had killed his mother while extremely psychotic. At the time of filming, his schizophrenia was reasonably well controlled with the antipsychotic clozapine, and he was very well-spoken. He was able to demonstrate insight into his illness, although he’s never really been able to come to grips with what he did. At the beginning of the film, he was reluctant about being released, and he was quite fearful that people around him would know about what he did. By the end of the film, though, he’d had a successful transition to the community and outpatient care.

His family was also interviewed. One of his brothers expressed that there was no need to forgive him because their mother had died because of his disease, not him. While the family was very supportive, they were also realistic. His father expressed the belief that he should never be given an absolute discharge (i.e. a release with no conditions whatsoever) because he can get ill so quickly if he stops his medications. This wasn’t out of a desire for punishment; rather, he recognized the seriousness of his illness and the absolute necessity of ongoing treatment.

Staff

The staff observed that female patients were actually more violent than the males while on the unit. One of the female patients was quite pleasant while interviewed for the film, but she could become violent quickly and had punched multiple large holes in the walls. Staff reported that one of the most difficult patients was a female with borderline personality disorder. She would do very deep cutting, and she had almost managed to kill herself by strangulation while on the unit. At one point, she had set a fire because she was angry with staff.

The staff seemed kind and caring, and skilled in de-escalation. They appeared to view the patients as people rather than criminals, and treated them with respect while maintaining firm limits.

Representation

I thought the film did a lot to humanize people who have committed violent acts while psychotic. They explain how rare it is for psychotic people to become violent, and also state that it’s often family members who become the targets rather than random strangers. Simple things, like showing the romantic relationship between two of the patients, helped to show that these are just regular people who happen to have serious illnesses. Nothing was presented in a sensationalized manner.

The film ended on a hopeful tone, which is not who you’d likely expect to see from a film about people who had committed violent offenses. It didn’t play into stereotypes or make generalizations. It’s a film that’s likely to decrease stigma rather than promote it, and for that, I definitely give the filmmakers props.

You can watch Out of Mind Out of Sight here.