Viewing Mental Health Advocacy in ‘The World Between Us’

A YouTube algorithm brought me to the soundtrack of the Taiwanese drama 我們與惡的距離 The World Between Us (2019). The aftermath of a movie theatre shooting is the premise, a scene of terror well-established in the public imagination. This series is not about the shooter—he remains largely unknown with minimal screen-time up until the ending credits—but the people closest to the tragedy and how they interrogate broken systems and their role within it. Its valences resonate strongly with what I am insecure about in my own work in a Canadian psychiatric system.

Mass shootings are a too-common breaking news-story in the past decade, predominately in the U.S., where pundits are quick to use mental health to distract from a system that privileges race and firearms revenue. This TV series does not centre an English-speaking audience, but the premise is recognizably American. (Are mass shootings one of the American languages?)

Ying Szu-tsung (JC Lin) is a young man experiencing symptoms of first episode psychosis. He and his sister are roommates with Li Hsiao-wen (Chen Yuu), who has changed her name to escape the infamy of being a sibling of the movie-theatre shooter. It is heartbreaking to watch Szu-tsung being escorted off the premises of a kindergarten, exhibiting all the signs of an altered mental status and not be brought to a hospital.

Movie theatre, school with young kids, massive media influx: these are not typical settings—public places with large crowds—people experiencing primary psychosis gravitate towards. Far more likely is their own home, where sometimes they don’t leave for weeks or months, at cost to their own health. Meanings of harm can be interpreted when none exist. In a personal essay, one person describes cutting off friends and talking alone for hours inside her apartment.1 When a person’s world disorganizes like this, the tendency is to hide. People with schizophrenia are more vulnerable to crime than they are likely to perpetrate it, and in the small subset of cases that involve violence, those in their close social circle are more likely than strangers to be targets.2

It will take another unprovoked escalation in the apartment before Szu-tsung is admitted to psychiatry. Hsiao-wen has a chance she didn’t have with her brother, for her to choose to walk towards instead of away from the stigma these siblings now live with. 

This TV series takes day-to-day mental health care and makes it visible, crucial. Szu-tsung and his psychiatrist Dr. Lin (Shih Ming-shuai) discuss auditory hallucinations. On screen, Dr. Lin challenges Szu-tsung’s assertion that he has been hearing his colleague in hospital, with what he had said earlier about the ward being a place that not anyone can enter. This is the first time I’ve seen a non-hyperbolic, non-sinister depiction of insight building in a clinical encounter on TV.

An observation: the involuntary movements and thought blocking Szu-tsung exhibits do not emerge after 24 hours in hospital and are more typical of a patient ten, twenty years, or never along the disease trajectory with current standards of care. Involuntary movements involving the mouth and neck are a now uncommon side-effect of anti-psychotic medication because of lower doses and counter-pharmaceuticals. The slow-down and disruption to his speech and thought process are a progression of the illness, and can be delayed and sometimes prevented with timely treatment.

Also, I’m not sure if professionally I would agree with the decision to approach alone without police or security back-up when Szu-tsung wanders the streets into a psychiatrist’s office with a blade of broken mirror. The doctor is able to verbally de-escalate him but watching the scene made me anxious about boundaries and personal safety. It is implied that the patient may do better if police are not contacted.

The use of force by police in acute mental health responses is a confluence of stigma along raced, gendered lines; I have seen patients — disproportionally Black, indigenous, male— with physical injuries from the police intervention that brought them to hospital for psychosis. I don’t meet the ones who die in the police intervention.3

I have no doubt that the patients who are most vulnerable in their interactions with police are subject to those same inequities in other normative systems, mental health care amongst them. When I see a patient in the emergency department, I am a human being with prejudices; my choices and actions have the potential to disrupt accepted narratives, but are nonetheless defined by the health care and sociopolitical structures that employ me and grant me small privileges. I often think about the dimensions in which I can critique these structures, simultaneously from a site of power and no-power, as a physician and early career, as a naturalized citizen and not white, not male.

I was drawn towards the individual advocacy arcs in The World Between Us because the writing doesn’t depend on resolution. The daily news producer Sung Chiao-an (Alyssa Chia) can probably be described as a “jaded dumpster fire” trope, but Chia’s portrayal is a deeply empathetic one. Even as she humiliates Hsiao-wen in the newsroom, I can feel the character’s visceral self-loathing. She aspires for a media that can be kinder. She erupts periodically in rage-grief at the injustice done to her family with her son’s killing. These contradictory sentiments are made ambiguous by her work perpetuating the harm done by and within media mega-systems in their coverage of vulnerable communities.

For criminal defence lawyer Wang She (Chris Wu), the gap between his intention and outcome within the institution of law is brutal. His motivations are not completely selfless in that he convinces his client to appeal and have a mental health assessment in part to challenge the legal precedent. He does this without foreseeing the personal costs that the process would exact on his client and client’s family. Wang She reignites hope of reconnection for the client’s estranged family (who start preparing extra dishes for their visit), only to find that the client’s execution had been moved up to the same day, for political reasons. Wang She rushes to the courthouse to file a temporary injunction only to be told that the firing squad has already carried out its task. The uncertainties of individual advocacy, its tension with complicity, is painfully felt in Wu’s performance. Wang She cycles through abandonment of his ideals, disillusionment at existing structures of justice, and doubt of his ability to affect change from within.

While the show did not shy away from emotional collisions of law and media discourse on mental health, there was no individual advocacy arc about mental health from a patient or doctor in mental health. Is this an incidental reflection of advocacy that people most affected by mental health do not get any space to struggle in a mental health conversation?

The name of the series, 我們與惡的距離, translates as “the distance between us and evil,” which I’d like to think refers to the lure of inaction but also the uncertainty of action within the unjust systems we inhabit. This uncertainty may be key to a critical stance on the present, not as rejection or paralysis, but as investment of one person’s labour and care into a future that can be more livable for more people.

Through this series I was reminded that mental health work like any other kind of advocacy work is not lessened by struggle. The series’ ending lyrics:

Don’t you stay

多看我一眼

look at me more this once

無視我的臉

don’t see on my face

任何疲倦

any fatigue

Emily Lu was born in Nanjing, China. She is a resident physician in psychiatry and a poet. Night Leaves Nothing New (Baseline Press 2019) is her first chapbook. 

References

1 Hussein, L. (2019). https://torontolife.com/city/survived-psychotic-break/

2 Taylor, P. (2008). “Psychosis and violence: stories, fears, and reality.” Canadian Journal of Psychiatry, 53 (10), 647-659. https://journals.sagepub.com/doi/pdf/10.1177/070674370805301004

3 Harper, T. (2018). https://www.vice.com/en_ca/article/a3y3ek/remembering-the-mentally-ill-people-of-colour-killed-by-toronto-police

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s