Meanings from “Malpractice”, ITV

So, it’s been a long time since my last entry.

I have spent a while thinking about what I should write about in this come-back piece and whilst I think that, given time, an update on life in general might be good, I was ultimately prompted to write again after watching a recent series on ITV – Malpractice, Series 2.

For those who haven’t seen it, the storyline follows a final year trainee Psychiatrist who gets called to assess a new mother, who has been referred by her Obstetrician. Various things then unfurl as it becomes apparent she is more unwell than he (or the viewer) thought and he ends up being investigated for his care of her. [Much more happens but I won’t spoil any more in case people want to watch it in the future.]

The reason I wanted to write a blog post about it was because although some parts were wildly inaccurate representations of the mental health system, gilded with dramatic licence for effect, some parts were so true it was quite a harrowing watch.

I don’t know why tv dramas feel it necessary to continually portray psychiatric hospitals as huge, draughty, Victorian buildings with enormously high ceilings and vast corridors for instance. In reality, the Doctors’ office is more likely to be a small, re-purposed cupboard or sluice room than a huge office with a golden name plate on the door and an oak desk. Similarly, although I have been hospitalised many times in various hospitals around the country, never have I ever heard there being Classical music pumped into the communal areas and nor have I been to a community meeting where we all have to introduce ourselves, one by one around the circle, by name and diagnosis as if we are there to repent our actions and thereby work toward removing our labels.

What I really want to talk about though, is Malpractice’s portrayal of the character who was given the ‘BPD’ diagnosis. Throughout the early episodes, this patient is mostly part of the background in the hospital scenes but as time goes on [spoiler alert] she is gradually introduced as the ‘patient who lives in a fantasy world where she and her consultant can have a relationship’ – because obviously there is always one on every ward…hmm. We could quite validly discuss the portrayal of this character as female to begin with. Yes, more females than males are diagnosed as having Borderline Personality Disorder but how much more interesting would it have been if the Malpractice writers had moved against stereotyping and cast a male in this role? As it was, the female casting made it easier for the storyline to develop but they also helped to reinforce that people with personality disorders are mad women who need to be in hospital. (Ok, ok, don’t shoot me down just yet, I acknowledge they also illustrated people with Bipolar and Schizophrenia explicitly!)

Whilst I didn’t particularly like the storyline that developed, I think the actor playing the patient with BPD did an excellent job of portraying the absolute despair and utter grief that comes when she realises she has ‘messed up’ a professional relationship. This was excellently acted and directed and I could feel the pain that I have experienced in the past when I have acted in a way which has put a friendship, family or professional relationship in jeopardy. This scene was one that really rocked the seesaw of my opinion of the series from one of a poorly researched, gratuitous nod to the mental health world, to one of true understanding and implicit compassion for the characters stuck in their own horrific situations.

Another scene which did this [spoiler alert] was one that has haunted me ever since and was, I believe, very brave of the series to show so graphically. The essence of the scene was that after the patient with BPD’s perceived collapse of the relationship that had formed the centre of her world, she made an attempt on her life, ligaturing with some tape. Again, it was superbly acted and directed. The camera focused on the absolute struggle for both the patient and staff to remove the tape, as the patient grew increasingly blue and panic stricken, thinking she might actually die like this – as were the staff.

There is so much to unpack. If you have read back to my early posts on this blog you will know that the whole scene was very close to home for me. I have been that BPD patient on a hospital ward, intent on ending my life and on one occasion I did ligature with tape. It was, quite literally, like watching my own experiences. The panic, the stress, the frantic attempts to escape from the strangle-hold that just twists and gets tighter the more you try and release it.

Why, you might ask did I and the Malpractice character struggle if we did it intentionally in an effort to end our lives? This is something I have been thinking a lot about lately and I think it comes down to two reasons. Firstly, and foremost – it’s a biological response. It’s the same reason that people can’t hold their breath indefinitely no matter how much willpower they have – the body will always scramble to do what it needs to do to survive when it becomes a matter of life and death. The second reason is a little more complex. Yes, when I was in hospital on a Section 3, I was in an awful, desperate space and I was making daily attempts to end my life- hoping they would be successful. However, I do believe that the frequency of my attempts kind of became a habitual response to feeling any kind of emotional discomfort. I have spoken to many people over the last few years, in both my personal and professional lives, who have complex emotional needs (they may or may not be diagnosed with a personality disorder), who say that death is their ultimate ‘go to’ when things are tough e.g. “Oh well, if I burn the family dinner and everyone hates it I can always just kill myself”or “If they turn me down for the job I’ll just kill myself” etc etc. These examples are deliberately somewhat tongue-in-cheek but they do illustrate that death can be seen as the way out of an uncomfortable or upsetting experience. When I was that inpatient who was attempting to facilitate my own death many times a day, the overwhelm was far more than just an inconvenience. However, I do believe that subconsciously and to some extent, I had begun to see carrying out these acts as the way of coping – I wasn’t necessarily calculating every time that I could die from my efforts.

That’s why I struggled against the tape.

Of course, there is also the reality that people can hold two opposing beliefs at the same time. It is not, for instance, incongruous to both want to die and not want to die at the same time.

I am aware that I have written an epic entry to this point and don’t want to go on much longer. Needless to say though, the Malpractice series has had quite an impact on me. The fact that my flashbacks have increased to my experience of death when I did manage to end my life at my own hands (I was resuscitated and defibrillated, I am not a ghost!), illustrates well that triggers for people who have experienced some kind of trauma in their lives are everywhere and largely, they appear without warning. In addition, it adds weight to the discussion that is largely unspoken – those who make attempts to end their own lives find the experiences traumatic and that trauma is often just as harrowing as whatever is causing them to try and end their lives in the first place. Watching Malpractice did make me more aware of the vicarious trauma my attempts will have caused in the staff supporting me too, let alone those who weren’t there at the time but wish they could have done something, anything, differently to have prevented it happening at all.

I could write more. These topics are so important and so relevant to me. However, I have a degree in Philosophy so we could be here for years if I do any more theorising!

Thank you for reading. It’s good to be back.