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OUTSIDE
THE LINES will open with a fast-paced and evocative collection
of faces and voices addressing the major themes of the program.
Their first-person points of view will dominate the program; voice-over
narration will be minimal. Viewers will quickly meet the individuals
and families whose stories will be elaborated in the following segments:
DEPRESSION -- Marian, a white woman in her 60s and the divorced
mother of three, was once a fashion model who now works part-time
in a restaurant. Marian's youngest son Andrew was diagnosed with
bipolar disorder in his mid- twenties. Two years ago he stopped
taking his medication and committed suicide. The combination of
grief and her ongoing depression sent Marian to a very dark place.
"That hopeless feeling is the lowest feeling in the world and I
decided to take my own life," she tells us. "I was going to drive
my car over a bridge." Marian was clearly not responding to medication,
so her doctors suggested that she might be a good candidate for
electro-convulsive therapy (ECT) which has worked well for her.
We also meet Marian's daughter, Lynn, who is a nurse at Bowman Gray
Medical School in Winston Salem. Lynn knows first hand how little
some health care professionals understand about mental illness.
She only had a two-week rotation in mental health as part of her
own training. Having lost her brother and now caring for her mother,
Lynn has some strong opinions about the current state of diagnosis
and treatment of mental illness.
BIPOLAR DISORDER -- Jonathan is a 32-year-old African-American
man who was a brilliant student, musician, and athlete. At 15, he
was selected to attend the prestigious North Carolina School of
Math and Science -- a public boarding school for the gifted. Jonathan's
parents thought it would be a great opportunity for him. Once at
school, however, Jonathan quit going to classes and alternated between
extreme bouts of mania and isolation by locking himself in his dorm
room. The school called his parents saying Jonathan needed help.
In the psychiatrist's office, Jonathan lied about his symptoms and
was misdiagnosed. (Medical thinking at that time suggested that
bipolar disorder only showed up later in life.) Jonathan went untreated,
began drinking heavily, and eventually went to prison for a felony
involving an automobile. Once out of prison, he came home to live
with his parents. Eventually a Raleigh therapist correctly diagnosed
him, but when Jonathan began feeling better with proper medication,
he quit taking it, saying the medicine took away his "manly feelings."
Last Christmas, Jonathan was home for the first time in 15 years
and was back on his medications. His sister says she doesn't trust
that he is there to stay. His mother Anne says, "I've told friends
I would imagine the most difficult thing is to lose a child in death,
but I know in reality the most difficult thing is to lose them over
and over again in life."
SCHIZOPHRENIA -- Darnell is a 45-year-old white woman who
grew up in the southwestern foothills of Virginia. "When I was in
the fourth grade," she says, "my mother took me out of parochial
school because she said the nuns were poisoning the chocolate milk.
She also said our next door neighbor was trying to poison us with
chocolate brownies, but I would sneak over and eat them anyway.
When nothing happened to me, I realized something might be wrong
with my mother." Darnell's mother's paranoia was one of the early
signs of the onset of schizophrenia. Juanita is now living in a
North Carolina nursing home, an institution at the end of a long
line of institutions. Darnell has spent a lifetime caring for her
mother, raising her own children, and coming to terms with the simultaneous
presence and loss of her mother so early to the delusions and violence
of her mental illness. Darnell, her daughter Beth, and Juanita,
on the occasion of her 78th birthday, tell the powerful story of
a system of treatments in earlier decades that were not as effective
as today's options.
"A DANGER TO YOURSELF AND OTHERS" -- This evaluative determination
is often the boundary between freedom and involuntary commitment
for persons with mental illness. In this segment we hear from a
variety of family members and physicians about the difficulties
of proper diagnosis and placement of patients when the care of a
patient exceeds the capacity of his or her family. We meet Beth
and Phyllis, whose brother had a schizophrenic episode in his senior
year in college and then spent 40 years in Raleigh's Dix Hospital.
Now he is in a group home, but the sisters say they wish they had
known more about what treatments were available. Another family
from the coast tells how they recently had to put their 16-year-old
son in a rest home. His roommate was 91.
ASYLUM -- It is a word with dual meanings -- when combined
with the adjective "insane," asylum has decidedly negative connotations,
but asylum can also mean a haven, a place to retreat from the strains
of life. We encounter both meanings of the word in visiting Broughton
Hospital, established in the foothills of North Carolina in 1854
as the State Asylum for the Insane. Once a self-sustaining farm
community where patients retreated from society and received therapy
by working in the fields and dairy, Broughton declined and now has
undergone extensive renovations to serve as a short-term treatment
facility serving western North Carolina. Though efficiently run,
the hospital is jeopardized by state budget cuts. Hospital officials
take us on a tour and explain the evolution of various treatment
theories. Just 50 miles away, we also visit Cooper Riis -- "a healing
farm community" being developed by a couple whose daughter suffers
from mental illness. Having found the transition from hospitalization
to home nearly impossible for themselves and many other families,
Don and Lisabeth Cooper are creating a 21st century haven where
residents will create a self-sustaining organic farm. What was old
is new again.
STIGMA -- Because of the frequency of mental illness among
us (one in every five persons), we never know who is listening if
we throw around words like crazy, batty, nuts. Here we meet parents
and family members active in advocacy groups like the National Alliance
for the Mentally Ill who are working hard to change public perceptions.
We also look at the special challenges of North Carolina's growing
Latino population as an example of how the stigma associated with
mental illness is informed by cultural heritage and how the barriers
to treatment can be further amplified by language and cultural differences.
We hear the story of one Catholic family that sought an exorcism
for a disturbed family member. When the priest arrived, he called
for a psychiatrist.
MEDICATION -- Over and over in the interviews we hear stories
of patients who "cheek their meds," trying not to swallow the pills
that keep their brain chemistry in better balance. Why? Many patients
don't want to take their medications because of the stigma involved
-- taking meds is an acknowledgement of the illness and often the
medications cause individuals to stand out or feel even farther
"outside the lines" of normal. Some medications cause weight gain,
loss of teeth, dull and listless feelings, and loss of sex drive.
Achieving the proper balance among medications is a challenge for
physicians and requires patient compliance. Lithium, the lightest
solid metal on earth, has historically been used to treat certain
forms of mental illness, but it has side effects. It is mined in
abundance in North Carolina. We visit a lithium quarry in Bessemer
City along with a physician who talks about recent pharmacological
developments in the field. We also meet Margie, a practicing psychiatrist
who has finally decided to "come out" with the story of her own
struggle with depression and the stigma of the medications she must
take to maintain her practice and her own precarious balance.
A PLACE TO COME, A PLACE TO RETURN -- As hospitalization
becomes increasingly costly, and state and federal budget cutbacks
continue to force patients out on the streets, the" clubhouse model"
of day treatment for persons with mental illness has spread around
the globe. Based on the notion that every club member has a right
to a place to come and to return for support and friendship, the
clubhouse helps members secure housing, transitional employment,
and guarantees respectful treatment. Members are considered equals
alongside clubhouse staff, and all share responsibility for the
operation. We visit two clubhouses and sit with a number of club
members to hear their histories and how this institution has given
them a welcome regimen, a new productivity, a fresh sense of identity,
and a place to be themselves without as much stress from stigma.
HOPE -- In the closing section, we hear final comments from
our storytellers about their hopes and fears for the future, their
treatment programs, and their suggestions for changes in the public
attitude toward mental illness.
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