PSYCHIATRY AND THE MEDIA

Mental health, by Jane Austen
Jean Harris Hendriks

In the year of the College's 150th anniversary, the
President Invited essays with the title 'The Therapeutic

Effects on Psychiatric Patients of a Pleasant and
Congenial Environment'. Writers were asked to
consider "current literature".

Jane Austen knew the pleasant and congenial
environment of Belgravia In 1811 when she
corrected the proofs of Sense and Sensibility at
64 Sloane Street, home of her brother Henry
Austen and his wife Eliza (widow of the Comte
de FeuiUide who had been guillotined In 1794,
two years after the French Revolution). In
1815, awaiting the publication of Emma she
had stayed with them at 33 Hans Crescent.
Each of these novels illustrates that, had she
been in Belgrave Square today, she would have
understood the essay title and could have
written cogently, for her novels are indeed
literature and the Issues which they address
most certainly are current.

She describes her ideal of a substantial
institution in Mansfield Park, where therewere "no signs of contention; no raised
voices, no abrupt bursts, no tread of violence
was ever heard; all proceeded In a regular
course of cheerful orderliness, everybody hadtheir due importance, everybody's feelings
were consulted. If tenderness could ever be
supposed wanting, good sense and goodbreeding supplied its place".

Jane Austen's pleasant environment
encompassed regular meals, comfortable
clothing, unobtrusive availability of servants
and equanimity of mind as to Income (or at
least the prospects of inheriting income). Spaceand privacy are of the essence: "an interval of
meditation, serious and grateful, was the best
corrective of everything dangerous in such high
wrought felicity; and she went to her room, and
grew steadfast and fearless in the thankfulnessof her enjoyment" (Persuasion). The essential is
a room of one's own.

This world does allow vulnerable, difficult
individuals independence, a sense of being
valued and autonomous. In it lives Mr
Woodhouse, father of Emma, hypochondriac,
depressed, chronically anxious, obsessional.

His asylum is his home. His creator says he is"unfit for any acquaintance but such as would
visit him on his own terms". He fusses over his
food, won't let his friends eat. "An egg boiled
soft is not unwholesome... you need not beafraid...". When a young lady of his
acquaintance is frightened by gypsies, MrWoodhouse "trembled as he sat" and "would
scarcely be satisfied without Emma promisingnever to go beyond the shrubbery again".

Jane Austen delineates the small world in
which Mr Woodhouse and his counterpart
Miss Jane Bates, an Impoverishedclergyman's daughter, with pressure of talk
and an ailing mother, are contained, sustained
and respected. Miss Bates and her mother
receive care in the community in the way of
visits, presents of legs of pork and apples,
transport and entertainment with the constant
assurance that this is a sign of their value, not
of their dependence.

But the lives of relatives are constrained in
ways in which they do not recognise. Emma is
held to her home by her father's anxiety, a
leash which prevents her from being away for
more than two hours at a time. Her marriage, a
climax of the novel, takes place only because
Mr Woodhouse regards a husband to his
daughter as a protection against poultrythefts. Jane Fairfax, Miss Bates's niece, pines
throughout the novel. Her aunt says, "She
really eats nothing - makes such a shocking
breakfast, you would be quite frightened if yousaw it". Her pallor is regarded as ladylike - she
is probably anorexic.

From Jane Austen we learn what
researchers on psychiatric care tell us today.
A pleasant and congenial environment, large
or small In scale, requires skill and knowledge,
architecture, gardening, furniture and
constant maintenance. Jane Austen stresses
order and cleanliness. There must be
individual care and concern between human
beings and a mutual respect of the kind which
enables the Bates family to feel loved and
valued within their community. There must be
time, thought and leisure for detailed and
exquisite concern regarding the grief, terror

Psychiatric Bulletin (1995), 19. 101-102 101



BRIEFINGS

and vulnerability of our fellow human beings.
We must recognise that relatives are
vulnerable and that reliable, round the clock
service Is taken for granted and obtained for
low wages.

Jane Austen would not have completed her
novels had she not relatives who were of
substance, who could sustain and support
her, both in London and In her country home.

When considering the current costs of care In
the community, psychiatrists should indeed
review the literature.

Jean Harris Hendriks, Consultant Psychiatrist,
Child and Family Service, South Bedfordshire
Community Health Trust, Dunstable Health
Centre, Dunstable LU6 3SU

Jones the patient

Rosalind Ramsay reviews Hollywood's latest warning to

psychiatrists.

Another film about psychiatrists and
psychiatric patients has been showing in
Britain. At the première of Mr Jones, Richard
Gere, who stars in the leading role spoke about"working hard" to get the role
"symptomaücally and emotionally correct".
Mr Jones has bipolar illness and the film
allows the audience a vivid look at how the
illness affects a person. The history of the
presenting condition begins with Mr Jones,
expansive and grandiose, asking a workmate"Do you ever feel like flying?" Minutes later Mr
Jones has climbed to the top of the roof where
they are working, saying "I'm going to fly..."

Prevented from leaping to his death, Mr
Jones finds himself a patient in an American
state mental hospital. The senior psychiatrist,
overworked and cynical, explains to visiting
medical students that times are difficult, andresources scarce. The doctor's job is simply to
"evaluate, medicate and vacate". The students
Join a round of patients in seclusion. They see
Mr Jones, lying on a bed, his ankles and wrists
in handcuffs. It is time to medicate himforcibly: "He won't bite, we hope".

But this is more than a film describing the life
of a person with bipolar illness, or the
philosophy of care in mental health services.
In best Hollywood style it is also a film about a
relationship between two people, in this case a
man with bipolar illness and the young female
psychiatrist responsible for his care. Mr Jones is
intrusive but engaging, a textbook case of

Infectious gaiety, and breaks through thepsychiatrist's professional defences. We see his
doctor as a person with her own feelings and
needs. In one scene In which staff and patients
are mingling Mr Jones poses as a doctor and
pointing to the three people talking together, he
asks his visitor which one is the patient. The
visitor identifies the psychiatrist.The psychiatrist's thinking, initially driven
by her wish to establish a therapeutic
relationship with the patient and to
understand his symptoms, slips into a less
professional role when she starts to Investigate
his past. Working more as a private detective
than as a psychiatrist she visits his ex-wife.
Roles between doctor and patient reverse when
Mr Jones rescues his psychiatrist from a
violent Incident with another patient on the
ward and asks her If she Is OK. The other
doctors in the hospital are busy and although
they are perhaps aware that something Is
happening between Mr Jones and their
colleague, they are not able to offer guidance
to the young woman. The drama escalates
until the doctors intervene, telling her not to
see Mr Jones and to transfer him to another
hospital.

The film may be looking at mania through
rose-tinted glasses as Mr Jones sweeps his
doctor off her pedestal, but it does illustrate
some of the difficulties psychiatrists face when
developing rapport with patients. Her situation
is made worse because she Is too busy treating
patients to consider her own need for support
from her peers or from the senior psychiatrist.
Although she has a high reputation in the
hospital, she fails in the task of maintaining

102 Ramsay