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The Greek mental institution of Leros, housed on the island of the same name, has received significant journalistic attention. In September of 1989, the London Observer printed a front page account of the hospital, describing it as a "concentration camp." Following the British report, a barrage of Greek press about the island and institution was ignited. All accounts have discussed aspects of the hospital and its horrific patient conditions: patient neglect, absence of medical personnel (for some 1150 adults there are only two psychiatrists), patients who are kept naked throughout the year, inadequate diet, etc. The film "Island of Outcasts" represents another British endeavor detailing the hospital's conditions. It shatters common images of Greek islands as romantic tourist hideaways with tranquil beaches, crystalline blue waters and convivial natives. Rather, a grim and haunting portrait of the island and its mental institution is conveyed.
I visited the hospital of Leros while conducing anthropological research on Greek psychiatry during 1988-1989 (Blue 1991). "Island of Outcasts," which does not specify exactly when it was filmed, but refers to the World Psychiatric Association meetings held in Athens in October 1989, provides an informative, sensitive and in-depth report of the mental institution of Leros. Presented very briefly is the companion institution for children, a "PIKPA," as well as the hospital's Block 16, renowned for its male patients who are kept naked. Sensitively portrayed is the plight of patients who have found themselves housed in the institution; many of Leros' patients have been there for decades, as it has served primarily to unburden other public mental hospitals of unwanted chronic patients. One of the film's strengths lies in its acknowledgment of the intertwining social forces which have kept these patients behind the institution's barbed wire fences.
The Greek attitude of fear and ignorance toward mental illness has been one such pivotal force. As the film's narration states, families are afraid to assume patients back into the household; familial refusal to sign the discharge of a patient, even when the patient has been medically declared in condition appropriate for non-hospital life, is a primary cause of patients' lengthy hospital residencies. The family's perspective is vividly illustrated through the film crew's attempts to reunite particular patients with their families. The visit of an Athenian mother and sister to a male patient in the hospital is shown, including the gentle, yet resolute refusal of the mother to sign the release for her son from the hospital. Another, and emotionally touching example concerns a mother on a nearby island bitterly lamenting the loss of her son through his hospitalization in the institution. However, no effort is made by her to sign him out. Other patients are interviewed to learn their stories; one woman admits her preference to remain in the hospital rather than to live alone as an unmarried woman on the island.
The hospital's history and current efforts toward its reform and patient rehabilitation are accurately discussed in the film's commentary. Described is the experience of patients from Block 16 who were selected for a hospital rehabilitation program designed to provide a personalized living environment, including new clothing. The consequent failure of the program, as well as the failure of other hospital improvements, is noted. Interviews with the institution's two psychiatrists and nursing staff, in addition to the patient interviews, enliven the hospital's dramatic story and appropriately sustain the claim by a British psychiatrist that Leros does not "resemble a hospital at all." The film correctly pinpoints Greek psychiatry and society as associates in the creation and perpetuation of the hospital's dismal conditions and the patients "awful daily monotony."
"Island of Outcasts" tells its story with factual accuracy and sensitivity. However, its failure to examine the island of Leros as a community economic base undermines its potential broader utility. The island's livelihood is intimately linked to the institution itself. The Greek press in 1989 described how the suggested closure of the hospital has been impeded by the islanders' economic dependence on the hospital: the hospital is the single largest employer on the island and local native merchants are the primary suppliers of goods. Greek government and European Economic Community proposals to close the institution have generated local level concerns about continued economic prosperity. An exploration, if even brief, of the local economy's relation to institutional care could have provided a basis for airing issues seemingly unrelated to psychiatric institutionalization but which nevertheless impact patient lives.
A second major shortcoming of the film -- shared, it must be acknowledged, by most other journalistic accounts -- is its disregard of other Greek mental hospitals and the entire mental health care system. From my own experience researching Greek mental hospitals and other psychiatric services, Leros' conditions generally mirror those of the nation's other public mental hospitals. A journalist's visit to Dafni or Dromokaition, two mental hospitals located outside of Athens, would have disclosed similar large rooms with rows of patient beds impersonally placed one next to the other, patient apathy and the mixture of psychiatric cases with epileptics and the mentally handicapped. In all Greek mental hospitals, psychiatric treatment is nearly exclusively pharmacological and all have "patients" who have been residents for years, if not decades, because family members refuse to assume responsibility and sign their discharge. Instrumental in the family's ability to refuse patient discharge are the legal mechanisms which bind the patient to third-party responsibility. Reference to this legislation is overlooked in the film's narration.
While Leros has been framed as some ghastly aberration of Greek psychiatry and society by alarmist journalistic accounts, it is in actuality, rather representative of Greece's inpatient care for the mentally ill. The degrading conditions in the institution, and notably those of Block 16, are not to be excused. However, the failure to situate them fully within the wider context of the nation's psychiatric care system moves attention away from the larger reality. "Island of Outcasts" perpetuates the focus on Leros and does not step beyond a gruesome portrayal of the institution to address and critique broader mental health care issues in Greece.
Though the film notes the nation's rehabilitation programs for hospitalized patients are virtually nonexistent and that community psychiatric care is a "rarity," these aspects of Greek psychiatry are currently changing. Elsewhere in the nation, Greek psychiatrists have exerted tremendous efforts for the social and vocational rehabilitation of mentally ill persons and formerly hospitalized patients. The nation's current psychiatric reform is directed specifically toward development of community care resources, such as hostels and mobile units; the psychiatrists whom I interviewed around the nation nearly unanimously voiced the opinion that patients should be treated within their community context, not in an institution. The omission of these professional efforts, many in effect at the time the film was produced, betrays the film's bias against examining Greek psychiatric care in its entirety.
"Island of Outcasts"' concentration on the hospital of Leros likely limits its educational appeal to a wide audience. This is unfortunate, for despite serious flaws, the film overall holds the viewer's interest. While it captures a feature of Greek life rarely revealed to foreigners (if not natives), a link to larger social processes and cultural understandings is in general implicit. Scholars and educators familiar with Greek culture could easily relate the film's content to other facets of modern Greek life. Those familiar with other Mediterranean countries would likely find cultural parallels with respect to attitudes toward the mentally ill. For professionals interested in cross-cultural mental health care issues, the film has great value in its engaging and in-depth depiction of one society's response to its mentally ill. Island of Outcasts reminds us all of the tragedy of chronic mental illness and the chronic inability of society to address it effectively and humanely.
References:
Blue, Amy
1991. Culture, Nevra and Institution: The Making of Greek Professional
Ethnopsychiatry. Unpublished Dissertation. Case Western Reserve University.
Posted:12/24/96
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