A compelling portrayal of the individual experience of schizophrenia, a denunciation of the brutality that systematically accompanies its medical treatment, and perhaps something of an apology for our collective failure to bridge the distance between the cognitively-abled and those living with this illness—Una cierta verdad is all of these things.
Born in Barcelona in 1975, director Abel García Roure studied filmmaking with Joaquim Jordà at the Universitat Pompeu Fabra de Barcelona, and counts among his accomplishments positions as assistant director on the films En construcción[Work in Progress] (2000), directed by José Luis Guerín, and El cielo gira [The Sky Turns] (2004), directed by Mercedes Álvarez. This, his first long-form cinematic product, is a highly nuanced documentary prioritizing the interplay between the film’s two privileged groups: providers and patients. The battle of voices we watch unfold on screen, then, is not constituted by the medicalized self-talk of the person with schizophrenia, 1 but is instead a social dialogue between these two polarized groups of actors.
This dialogue—one that is simultaneously clinical and social—is pushed forward by two sets of goals so deeply divergent that conflict is unavoidable. To put this into terms that are far too stark to match the director’s perspective, but that illustrate the crux of the matter nonetheless: providers focus on the disease, abstracting it from the patient, who becomes a mere residue or afterthought; on the other hand, patients yearn for a quality of life whose elusiveness is frequently compounded by the imprecise doses or debilitating effects of medications they are forced to suffer. The potential resolution of this conflict—in this Disability Studies reading of García Roure’s film—seemingly lies outside of the clinical institutions into which we are drawn along with these necessarily social actors. Ultimately, the film suggests that it is the clinical paradigm’s low tolerance for nuance and lack of precise tools that in fact perpetuates this ongoing battle of voices. The resulting picture emphasizes schizophrenia as a psychiatric disability that must be understood simultaneously as a social relation.
The release of Una cierta verdad in 2008 is best understood as part of a longer history of attempts to draw attention to the needs of people with schizophrenia living within the Spanish state. It is important to acknowledge that contributions from not only the social and medical but also the cultural/artistic spheres have figured in that longer history. The references here to the Spanish state are a stand-in for an historically and contemporarily heterogeneous grouping of distinct language and culture groups (including also Catalan, Galician and Basque, for example). Here I attend to García Roure’s focus on Barcelona and his inclusion of dialogue in both Spanish and Catalan, but readers should be aware that films emanating from a specific linguistic and cultural tradition are likely to be viewed by audiences throughout the Spanish state. With this in mind, the Spanish Transition toward democracy, following the death of dictator Francisco Franco on November 20, 1975, offered new opportunities to address mental health issues through community frameworks, but also created new hurdles:
The development of a system of comprehensive community services and the deinstitutionalization process started in Barcelona at the beginning of the 1980s […] Before deinstitutionalization, patients with severe schizophrenia lived in hospitals and most of their basic needs were met by the institutions. Nowadays in Spain, with admission to long-stay inpatient units very uncommon, patients live in the community. (Ochoa et al. 201, 202)
A highly relevant study from 2001 noted that the patients in the Catalan context continued to have insufficient access to community-based psychiatric services even in the twenty-first century. 2 In addition, it must be considered that people with schizophrenia living in the community have needs that are not always seen in the same way by patients themselves and by outpatient program staff. While psychotic symptoms were the most frequent need identified by patients taking part in the above study (Ochoa et al. 206), only the relatively low rating of “fair agreement” on needs regarding drugs and psychotic symptoms was reported among both patient and staff populations (Ochoa et al. 205). 3 Moreover, another study carried out by a large collective of researchers drawn from locations across the Spanish Sate—including those in Barcelona, Madrid, Asturias, Valencia and Málaga—validated the concerns expressed by some that antipsychotic drugs carry additional health risks that are not fully understood (Bobes et al. 171). 4
Cultural products have worked to bring these interrelated issues concerning treatment for schizophrenia to the forefront of public discourse, and—contrasted with specialized research articles—have the benefit of reaching a much wider audience. For example, the informational documentary 1% esquizofrenia [1% Schizophrenia] (2006), directed by Ione Hernández and produced by Julio Medem, was a high-profile attempt to draw attention to the existence of this psychiatric disability as well as to the social dynamics implicated in its post-Transition treatment. Compared with Hernández and Medem’s film, which was released two years earlier than García Roure’s film, Una cierta verdad is a much more challenging cinematic text. This is, in part, because it raises important questions regarding the role patients have in directing their treatment—the social inequity that compels them, through threat of violence and in fact through brute force, to accept medications with debilitating side effects whose risks are not completely understood. But Una cierta verdad‘s artistic composition and narrative structure also require more of viewers. All documentaries are by their very nature artistic constructions, even though the wider public may take them to be mere reflections of an extra-filmic reality. Though García Roure’s film is a documentary, the specific artistic decisions that have been made—the shots captured, camera positions, editing and pacing, costuming, and prop symbolism—all play a role in emphasizing the limitations of a contemporary clinical paradigm whose current approach to schizophrenia relies more on power than knowledge, on force rather than precision. Instead of grouping analysis of such representational strategies into one of the article’s sections, these are in fact explored in all three.
In the first section titled “Madness, Cognitive Disability, Film,” this article explores three crucial points of reference that contextualize the present analysis of García Roure’s film: the growing interest in the historical separation between madness and reason, the cognitive and the global turns in Disability Studies, and of course the representation of cognitive disability in film specifically. Next, in the section “Una cierta verdad as Cinematic Window: Perspective, Commitment and Dialogue,” it introduces readers to the major characters and enduring patient-provider conflict presented therein. Here the article asserts the director’s social commitment, introduces the documentary’s major protagonists, and continues to assert the imprecision of psychiatric clinical practice as a major theme. Then, in “Beyond the Parc Taulí towards the Community” the visual narrative’s spatial dimensions take center stage. That is, the Parc Taulí hospital in Sabadell (Barcelona) is portrayed as the site of an emanating material and discursive power that impacts patients far beyond the limits of its walls. And finally the brief conclusion returns to the film’s title and closing sequence—which drives home the central insight and social commitment of García Roure’s captivating cinematic essay.
Leer el artículo completo en: Battling Voices: Schizophrenia as Social Relation in Abel García Roure’s Una cierta verdad [A Certain Truth] (2008)