reviews

CLINICAL PSYCHIATRY NEWS
REVIEW BY ROLAND ATKINSON, M.D.
Professor of Psychiatry at Oregon Health & Science University, Portland

out of the shadow is a noteworthy documentary in which the filmmaker
tells the story of her own mother, who suffers from schizophrenia. We meet
a woman who was once strikingly beautiful and full of promise, before her
debilitating journey through dark labyrinths of severe, persistent mental
illness and a dysfunctional public mental health system. We grasp the
hardships endured by the filmmaker when she was a child. We observe
the steadfastness, compassion and burden of responsibility that mark the
relationship between an adult child and her mother today. It is an honest
film, unencumbered by self-pity, mawkishness, or manipulation.

out of the shadow, directed by Susan Smiley, a veteran television
documentarist, recounts the problems her mother Millie's illness has
posed – for herself as well as for Susan, her younger sister Tina, and
others. The film is quite short (67 minutes), yet the important issues
concerning the experience and consequences of schizophrenia are
illuminated with clarity and authenticity in an unhurried manner. Old
family photos and home movies are nicely intercut with recent scenes
and interviews. Direct audio is supplemented by Susan's narrative
voiceovers. This is a skillful, straightforward documentary production,
made with remarkable economy.

MILLIE'S DESCENT

Millie was 25 when she first showed signs of schizophrenia, shortly
after Susan's birth. Her erratic behavior led Susan's father to divorce
Millie, leaving her to care for Susan and Tina, aged 3 years and 1 year.
Millie often beat Susan, who was more defiant, while Tina shielded herself
through ingratiation. After Susan left when she was 12 to live with her
father, Tina bore the brunt of Millie's rages.

The girls wouldn't tell anyone how bad things could get at home. And Millie
had periods of ostensible normality. It was easy for the other adults to deny
the extent of the problem for years, a situation that changed only after Tina
attempted suicide in early adolescence.

What ensued was a wretched 20-year journey for Millie and her daughters,
a course that is familiar to many families with a loved one suffering from
severe chronic schizophrenia: 17 hospitalizations, 40 or more living places,
no employment, frequent brief periods of homelessness, a serious suicide
attempt, a cycle of ever-changing mental health providers and constantly
revised medication regimens.

Meanwhile, the girls grew up. Susan moved to Los Angeles to make films.
Tina married and moved to another state. Their efforts to keep track of their
mother were often frustrated, not only by Millie's erratic movements, but also
by regulations that prohibited caregivers from sharing information about her
whereabouts or condition without Millie's written consent, which she refused.
Millie received care within a system Susan accurately describes as "fractured."

Susan's restraint – her canny ability to avoid ax-grinding harangues, instead
simply showing us over and over again how the system fails to work – is
remarkable. (Though Millie lives in Illinois, the "system" there functions about
like that in any other state.) We don't just see Millie as a patient, a collection
of symptoms and social conundrums. Susan is careful to show us the brighter,
more charming, "normal" side of her mother, who is still capable on her good
days of conveying the soft, endearing aspect of her personality. We do see
how emotionally changeable, how mercurial, she can be.

LIGHT AT THE END OF THE TUNNEL

There is a happy ending, and it is not contrived. In fact it is a product of
long, hard work by Susan and Tina, and also some simple good luck. A
guardianship is arranged, and Millie qualifies for placement in a group home,
what Susan calls the "holy grail" of care in the Illinois system. It is a small place
with skilled supervision and a guarantee against eviction. Millie regains stability
there. After a few months she joins her ex-husband's second family and her
daughters for an enjoyable Christmas gathering. She begins her first job in 30
years, as a dishwasher in a nearby restaurant. Millie may still lack insight that
she suffers from an illness, but she's now doing well and is proud of herself.

This film is a tour de force: a drama with a strong narrative arc, central
characters who are all sympathetic, and a comprehensive, edifying look at
the problems of chronic mental illness in the United States. More importantly,
Ms. Smiley has managed simultaneously to grace her film with a sense of
deep emotional involvement and also a scrupulously dispassionate, and
therefore all the more powerful, gaze at the problems for everyone posed
by her mother's illness and the faulty public care system on which they
all must depend.