Q&A with Alan Gilsenan - Director

How did the idea for this documentary first come about? What was the motivation behind it for you?
I have wanted to make a film about mental illness for many years and first discussed it with RTÉ perhaps five years ago but other commitments intervened. Usually, for me at least, a film begins as a hunch, an instinct, a curiosity about something… The first film I ever made was a short film about a young woman with schizophrenia so clearly the interest was always there in some form. (Like many young students, I had read the writings of RD Laing, one of the first to question the accepted dividing line between madness and sanity and expose it as something of a myth, and this sparked an interest.) But more specifically, it seemed that issues about mental health have remained by closed doors in Ireland and that today there is still a fear and unspoken stigma surrounding the whole area.

How did you go about getting permission from St. Ita's and the HSE? Was this difficult?
Both the management and staff at St Ita's as well as the then Northern Area Health Board (now the HSE) were cautiously open to the project from the beginning. Naturally, there were many meetings and discussions before we went ahead but they have been enormously co-operative, professional and courteous all along.

When did you first start work on this project and how much time did you spend in St. Ita's?
The series has been about a year in the making and the team would have spent substantial time there over the last twelve months.

Were people reluctant to be included? Did you encounter much resistance from staff or patients?
Naturally there was a certain wariness initially, particularly from the nursing staff who feel that St Ita's has been very unfairly treated by the media in recent times. They were also extremely protective of their patients. But, of course, one approaches a subject as sensitive as this very slowly - we weren't rushing in with cameras on day one. There is a very important process of listening and learning, of trying to communicate what one is trying to do and, above all, build up some trust with everyone - both patients and staff.

Did you get permission from family members as well as participants themselves?
The whole area of permission is a complex and delicate area, and one which is difficult to generalise about. But fundamentally we had a threefold approach: Firstly, we felt that one must respect the autonomy of the patients themselves, regardless of their mental state. Their views and feelings were of primary importance, and they were given a long period to decide whether they wished to take part, and also to be allowed to change their mind over the course of the year. Secondly, we consulted extensively with the clinical staff and, of course, were guided by their professional views. Thirdly, we consulted with families and loved ones. There is, of course, a certain dilemma in this. If an adult with a mental illness wants to take part but their family disagrees, who has the final say morally? Should people with mental illness be treated like children or should their views be respected? It is a complex ethical question and one which I felt could only be addressed on a case-by-case basis. Generalisations are unhelpful and we had to painstakingly look in detail at each case individually. All programmes are subject to strict legal guidelines but here the ethical view took precedence.

Do you feel you lost important content because of this?
Yes, many stories, which we filmed, could not be included in the end. This was disappointing in ways but yet absolutely correct. But any documentary in such a sensitive area can only hint at the truth. There are many, many things which one would never want to show, private moments which one would never wish to intrude on. One wants to open the door into a closed world, cast some light in the darkness surrounding mental health but you certainly don't want to become voyeuristic or exploitative. I remember reading a column in the Guardian in Britain. We pinned it up on the wall of the editing room. The journalist was writing about a number of British programmes in a similar area and he referred to them as "emotional pornography" and I think that is a very apt term. Television is becoming increasingly exploitative of people's emotions and we certainly did not want to become part of that.

Did you have a preconceived idea of what St. Ita's was like? Where you shocked by the conditions?
I try not to bring too many preconceived notions when I embark on a new film. Documentary should be a journey of discovery not a diatribe, a questioning not a polemic, but, of course, I had heard all the rumours and stories about Portrane. People seemed to have a very set notion of what the place is like. (Indeed, we look at this mythology in the final episode). But no, I wasn't shocked by the conditions. At first, it feels depressing and somewhat rundown (though this too has been over-stated) but as you get to know the place the décor ceases to be important and the true sense of the place begins to show through. Strangely, I grew fond of it and came to appreciate the spirit of the patients and warmth and care of the staff - be they nurses or caterers or cleaners or whoever..

Given the length of time you spent in St.Ita's did you find it difficult to remain detached or switch off when you finished your working day?
Any documentary involves a kind of involved detachment. You must be empathetic and yet remain an outsider, an on-looker. But of course you had to be affected by what you heard or saw. Yet despite the heart-breaking stories and the obvious mental anguish, I found the people of St Ita's to be inspirational in their openness, their humour, their capacity for hope, and this made the experience an enhancing rather than a depressing one.

Did certain individual's stories touch you?
Of course, and many individuals who don't appear in the final film touched me as well. One man - Larry Sheehan - whom we all grew very fond of died recently. He had no family and had been in Portrane for the last fifty years and you had a sense at least that in some small way he had left a mark in this world by appearing in the film. And while he lives on in the memory of the patients and staff who know him it is nice to feel that there is some permanent record of his life now and that he hasn't joined the many forgotten who line the history of mental healthcare in this country.

Some people believe that to film people with a mental illness is exploitative. What is your belief?
I think it depends on your approach, and I hope that people will judge the films on their actual contents rather than on idle speculation about what they may or may not contain. I am conscious that there will be those who think we should never have made this series. But against that who are we to make that decision for the mentally ill? Does this not add to the stigma and the ignorance. There is a conservatism surrounding all this that is paternalistic in nature and I would prefer to err on the side of giving those with mental illness the option of having voice in the public arena - if, and only if, they want it. But it is a complex question which goes right to the core of our perceptions of mental ill health in our society.

Can you explain the choice of title for the series which has obvious negative connotations?
I understand that the title could be seen as provocative. The word "asylum" has all the ambiguities implicit in our (mis)understanding of mental health institutions - crudely put: is it a madhouse or a sanctuary? Calling the documentary THE ASYLUM both provokes and questions all our notions of mental illness, which is something the series hopes to do. Many in the film talk convincingly about the importance of the old-fashioned idea of asylum as a place of refuge and safety. There is also something archetypal about it which appeals to me (and indeed Portrane has become emblematic of all mental health institutions within the State).

One of the strengths of the series is that it is non-judgemental, allowing the individual, where possible, to tell their own story. Was this deliberate from the outset?
Yes. The truth is always very complex and all we hoped to achieve was to bring our viewers into the world of the asylum for a brief but intimate visit…. Show them around a little and introduce them to a few people who tell their own stories. Let them face their fears and their prejudices and then let them make up their own minds.

Do you think the viewer will be shocked by the content of this series?
Moved, I hope, but not shocked. Except perhaps by our neglect, as a society, of the whole area of mental health. What is interesting is that whenever one talks about the series, people begin to open up and talk about some mental health difficulties closer to home and I hope that the series will, in some small way, afford us all an opportunity to speak about mental health in a more open, informed and compassionate way.