As is usual Theroux practice, he tells the story through a number of character studies. The first we meet is Jonathan, a man who had spent two years in this particular hospital. Having had a history of mental illness that began with depression, he developed the delusion that his dad had abused him at a young age and was therefore responsible for his unhappiness. And so one morning, while his back was turned, Jonathan stabbed his father to death.
In the seven years since, he has come to terms with actions. It took several months for him to realise that he had done something truly awful and now believes he wasn't abused as a child. Later on in the show, Jonathan goes to the assessment board who advance him up to movement level five. These levels correspond to how "well" the psychiatric staff deem a patient. The higher the level, the more responsibilities and freedoms they can have. In Jonathan's case, as he has been making good progress with his treatments and responding to them well, getting awarded the highest level will allow him to leave the hospital unsupervised. And he plans to use this to visit the local library, go to church on Sundays, and have dinner with his Mom. The only problem is, which he recognised, were the triggers that may spark off an outburst or threatening behaviour. In Jonathan's case, he knew that stress was the catalyst - the last time he had encountered it was when someone recognised him but for his part he was able to resolve the issue and was able to prevent his symptoms from exhibiting.
We also meet Cory as he's about to undergo a periodic reassessment. As someone who is also on movement level five, he has concerns about his eventual release and being able to make it on his own, especially as he's not looking forward to living alone. Probed gently about why he's inside, he had also suffered a catalogue of mental health problems. It came to a head when his girlfriend slashed her wrists and thought that this was part of some conspiracy against him. This brought on the delusion that if he was to die, somehow his death would help Obama get elected to the White House. When the police turned up he attacked the lead officer with an iron bar, and despite getting shot three times he was able to seriously injure him. Talking frankly in front of the camera with a psychiatrist, he admits to hearing voices seeing shooting stars. Sometimes he does what the voices tell him, but won't listen if they suggest bad things. Besides, he says he knows they're not real.
Judith's case was something of the stand out. She had been hospitalised for five years for stabbing a woman on the bus. Despite witnesses, she denies this took place. She also recognises that she's been diagnosed schizophrenic since the 70s but denies her mental illness. Judith believes that she is being held against her will because her release would mean some very powerful people will get embarrassed. While clearly exhibiting mental health problems during her screen time, I was reminded of Erving Goffman's famous book Asylums - no patient could progress through the system until they admit they are ill and submit voluntarily to the programme. In Judith's case, because she refuses to countenance her illness she's basically stuck and doomed to remain there indefinitely until she does.
Louis did introduce us to a tentative success. After five years, William had been approved for conditional release. He had been committed for reckless driving, after getting the notion Wright Patterson Airforce Base were watching him from space. He also simultaneously believed himself to be the Muslim messiah and was in psychic contact with Benjamin Netanyahu. At the same time he suffered with bi-polar disorder, and we see him obsessively checking his medicine before bidding the hospital farewell. As far as he was concerned, these were what stood between him and insanity.
We catch up with him later in the month since release, along with his mom Beverley. Here we are treated to a potted case history that seemed to begin when William was 15/16, shortly after he started experimenting with heavy doses of LSD. Beverley is adamant this is where his problems stem from because as she put it, "do you want me to ever admit that I gave birth to a nut?" How very supportive.
Unfortunately, dealing with the final patient, Eric, we're reminded why the rehabilitation procedures and regimen of medicines discharged patients have to abide by are so stringent. In 1989 Eric was out on weekend release and for whatever reason, he did not take his meds. Eric ended up killing two people. Right now, he's stuck on movement level three seemingly unable to progress higher, apparently because of a 'verbal incident' tat has basically set him back 12 months - it won't be until next year before the assessment board meet again to determine his case. Nevertheless, he hasn't given up hope.
As a serious exploration of mental illness, Louis Theroux certainly deserves some congratulation for turning in a piece of film-making that explores it sensitively in much the same way his previous pieces paedophiles and American jails had done. These are not cardboard cut outs. In most cases they are shown to be people trying to come to terms with what they've done and how going through the system is helping rehabilitate them. This seemed especially the case with Jonathan. Though probably an effect of getting used to the presence of cameras, as the show progressed even lay people could see how his behaviour improved. He appeared more thoughtful and reflective, and indeed went out his way to thank Louis for asking non-medical questions that caused him pause for thought. There is still a huge distance to travel before mental illness is accepted, as well as treated with the due seriousness it deserves. But as someone who is fortunate enough to have good mental health, there's a good chance Sunday night's show did its bit to helping the tendency toward acceptance along.
However, there is one gripe with By Reason of Insanity I have an issue with. And that's informed consent. You get the impression there had to be some serious negotiations between the BBC and Ohio's mental health services. After all, this was the first time in 60 years that cameras had been let into any of their facilities. Yet where do the patients themselves stand with this? While all those interviewed appeared capable of making responsible decisions up to a point, were they informed that attracting extra publicity to their cases could have consequences for them on the outside? Even if the documentary is due for broadcast only in Britain, we live with the internet and it wouldn't be too difficult for something intended for audiences over here could circulate over there. Especially when none of the hospitals featured would be particularly difficult for Ohio residents to track down. So what were the patients told and what did their doctors advise? While doing a good job on mental illness overall, it is these troubling questions that are left unanswered.