“If you gone up to the eighth floor you never come back, just disappeared like crap up the hose of a hoover.”
For those who are unfamiliar, Poppy Shakespeare is a made for Brit TV film based on the book of the same name by Clare Allan. It aired for the first time in March 2008 and tells a story of failing mental health care and stigma through the eyes of Black British mental health patient Poppy Shakespeare and her guide through treatment, N.
From the beginning we know that Poppy’s story will not end well because N tells us “you can’t blame me for what happened. All I done was try and help Poppy out.” Her comments stand in stark contrast to the vivacious Poppy Shakespeare we meet a few minutes later. She sweeps into the room, and on to camera, well-dressed, articulate, and beautiful, demanding to know why she has been sent to the Dorothy Fish Day Hospital for the Mentally Ill. The other patients, mill around her in various states of disarray further marking her out as different.
The film intentionally trades on ablism related to mental health that marks sanity on the body; if you are fashionable and articulate, you must not be “crazy.” And thus, we believe Poppy when she tells us that she is not insane and that something has gone horribly wrong. Surely, a fashionable mother of a young girl concerned about paying her bills and making her family happy is no more insane than the rest of us. We are also meant to believe that N is insane despite her seeming high function and ongoing narrative about all of the ways she works to appear insane to her doctors so as not to be discharged. (Her attempts include filling out forms with her left hand and marking up the back of her pants with a chocolate bar on evaluation day.) And though N clearly has issues, when she starts to wear makeup and fashionable clothes The Dorothy Fish tries to make N believe she is sane; N herself knows the deal, choosing to dawn these same visual cues when she goes to be an advocate for Poppy after being discharged. More subtly, the film contrasts the various stages of disarray of the Dorothy Fish patients with the increasingly sophisticated clothing and decor of the Dorothy Fish and its employees. As the hospital becomes more dysfunctional, both its staff and interior design become more high end.
These subtleties stand in contrast to the mental health patients in the film, who besides Poppy and N never really become three dimensional. Instead, their various quirks are played out in snippets in the background to establish the futility of the treatment they are receiving from the mental health system and how it would weigh down on anyone mandated to be there. While many will interpret this as an ablist failing on the part of the filmmaker, the physicians and clerks in this film are no more three dimensional than the mental health patients. All of them are treated as tangential to the real action of the film which is these two women trying to navigate a system that is “crazy making.”
Unlike the film adaptation of Girl Interrupted, which failed to transfer the book’s scathing critique of the mental health industry and its policing of women, Poppy Shakespeare puts the British mental health system on trail and finds it severely lacking. The patients in The Dorothy Fish are “lifers”, people who have been in and out of institutionalization for so long that they have become dependent on the system for meaning in their lives because all other meaning has been stripped away. They show up to the day center to sit in an empty rec-room and spin paranoid delusions about what the doctors are up to while they wait for their meds. Like overworked bureaucrats that have long given up on getting the right kind of funding from the government to do their jobs or never really cared to begin with, the doctors of the Dorothy Fish treat patients like hopeless cattle. They talk in sing-song voice, make them do ridiculous exercises, and only evaluate them once a year. They are so checked out that they do not even realize that patients have created a pill swapping market inside The Dorothy Fish to swap out their meds for “better ones”; some trade for cigarettes others trade nutri-bars for appetitite suppressants. Any sign of independence that challenges this system is promptly discouraged or marginalized to the point of ineffectiveness, while quiet compliance is rewarded with continued meds.
Patient advocacy is also put under the microscope in this film. One of the patients in the film, convenes a “patients’ rights board” meeting in the rec room on a regular basis, clearly delusional about why the patients are all left to mill around. While he often outlines some of the core issues of the film, like questions about the warehousing of mental health patients, the privatizing of mental health services that leads to less care, and the permanency of diagnosis based on sometimes arbitrary review, his speeches are also riddled with general paranoia. The other patients oscillate between egging him on and ignoring him, while the doctors take the latter approach. His failed attempts at advocacy point to how ineffectual a patients’ rights board is in an ablist world where patients are never seen as credible enough to assess their own needs.
On the other end of the spectrum are the Mental Health Legal Aid Specialists who are respected lawyers mandated to help people caught up in the system. They are paid directly by the state to help advocate for patients who feel their rights are being violated. Early on, N takes Poppy to see one such lawyer, who tells her she has “a good case.” Unfortunately, even though he believes Poppy has likely been admitted under dubious circumstances and is being made worse not better by mandated treatment, her is unable to help her because she is not receiving social security benefits for mental health issues. The only way the lawyer can do pro-bono service is if he is paid through the social security fund which means she has to be a recipient; the only way for Poppy to be a recipient is to have the state declare her legally insane.
Part of what causes Poppy’s decline is the illogical assertion that the only way to prove she is sane is by first being declared insane. The more she tries to advocate for herself the more the system knocks her down with its rules that seem to make no sense. Besides being declared crazy to fight being declared crazy, she’s been mandated to treatment but receives none; instead, she sits around in a room with other mental health patients becoming increasingly anxious about providing for her daughter and how she will be judged by her peers. This anxiety follows her in the rest of her life, making her less and less able to be involved in her child’s school and with her friends. Although she is already mandated to day treatment, in order to qualify for social security she must fill out a series of forms that if she answers correctly will lead to her being rejected from assistance. In order to survive the system, she must emulate the patients around her who are experiencing various forms of clinical distress but the more she emulates them the less likely the mental health system is to release her. And while she appears to be the most high functioning patient at the Fish, other patients with much larger issues are being released daily while Poppy is forced to keep coming to treatment.
It is no wonder that Poppy Shakespeare falls into a major depression as a result of being mandated to the Fish. Worse, her growing list of symptoms are largely ignored b/c the patients believe she is just trying to fit in and the doctors are too busy discharging other patients to bump up their success rate and keep their funding. Her major depression soon burgeons into Trichotillomania (pulling out ones hair) and self-abusing (burning her arms with boiled water b/c she is cold) and repeated suicide attempts. When she finds herself so desperate that she has to turn to N to prove her sanity and keep her child, it all becomes too much.
There is no happy ending here, neither Poppy nor N get their needs met. The Fish still warehouses patients and the system still reduces them to symptoms. While some have criticized Clare Allan’s prose for being too heavy handed in its critique and transparent in her execution, the film plays out in very moving and recognizably disconcerting ways. Allan herself was institutionalized for 10 years and like Susanna Kaysen seems to be trying to tell us the story of systemic oppression in the mental health system that resists the idea that you must be sane to recognize what is insane or that health care providers must be completely evil in order to participate in a system that may in fact cause horribly unjust things to happen.
* A Note on Race – because of the racial difference of the film’s two leads, it would be easy to read this as a binary story in which N gains sanity on the back of Poppy’s increasing insanity. Certainly the scene where Poppy begs N for help but receives none b/c N is “too caught up in her own issues” could be read as an all too familiar dynamic. However, both women in this film are suffering both from the system that has taken over their lives and permanently labeled them and the internal issues that complicate the way they live their lives. Watching the film through the unspoken rules that N lives her life by makes it easier to understand the relationship the two women have and why N occasionally seems out of step or uncaring. Subtle moments, like when N allows Poppy to touch her (observant viewers will not N keeps her sleeves up over her hands to keep from making physical contact with others) or cries over Poppy setting herself apart remind us of how invested N is in Poppy’s success. Their symbiosis is thus less about racial oppression and more about the ablist ones.
You can watch Poppy Shakespeare on DVD or Hulu. The book upon which it is based is out of print in the U.S. but available in the U.K.