Abstract
Poor quality of care in the form of indifference and indignity can be seen as the filmmaker Frederick Wiseman shows in his classic documentary, "Titicut Follies," which was banned form public showing for 25 years.
Have you ever seen the movie, "Titicut Follies"? Have you ever heard of it? The director of this 1967 documentary film is Frederick Wiseman, described in 1991 as "the most successful independent documentary filmmaker currently working in the United States."1 One reviewer describes his film, "Titicut Follies," as a "cinema verite masterpiecevery possibly the greatest documentary film of all time."2 Other reviewers merely say it is outstanding. It is about the quality of careor more accurately the lack of itat Bridgewater State Hospital in Massachusetts. Bridgewater is a forensic psychiatric institution.
The film's title comes from the yearly vaudeville show performed by patients and staff. Titicut is the original Native American name for the area. Patients and staff are enmeshed in an organizational context that creates such a folly. They are tragic, humorous, sympathetic, bizarre, and often blinded to the reality we see as viewers. Getting rid of one bad apple in this organization was not going to solve the problems, which were systemic and deeply embedded.
Robert Coles wrote in his review: "What really hurts is to see the sight of human life made cheapthe inmates needlessly stripped bare, insulted and mocked."3 The scene in which a doctor force-feeds a patient through a nose tube while carelessly letting his cigarette ash dangle over the food mix cannot be erased from this viewer's memory 25 years later. Some of the patients/inmates are shown as clearly insane and talking nonsense. Some of the staff members are shown in compassionate circumstances. Wiseman and his cameraman spent 29 days filming at Bridgewater State Hospital, taking 80,000 feet of black and white film, which he then edited down to 84 minutes.1 The online movie guide describes the tones of "Titicut Follies" as "understated, somber, matter of fact, harsh, downbeat, disturbing, bleak, biting, and austere."4
This movie is the first of about 30 documentaries made by Wiseman of American institutions, including high schools, the army, police departments, welfare services, hospitals, and a department store. As a whole, these films provide a portrait of American life at the time. Wiseman is interested in how such organizations shape human behavior and create contradiction and ambiguity. This is not a Hollywood movie about good guys versus bad guys. These movies have no introduction, no narrator, no separately composed background music, no subtitles, no standard Hollywood plot, no sets, no actors, no script, and no explicit editorial opinion. Wiseman takes his cameraman into these organizations and records what he sees and hears. He then edits this material, selecting and sequencing scenes and sounds, weaving in themes and observed participants. Viewers are left to draw their own conclusions.
In 1967, Massachusetts Superior Court Justice Harry Kalus permanently banned "Titicut Follies" from public showing and ordered all copies of the film seized and the out-takes destroyed.5 Massachusetts attempted to have it banned in New York so that it could not be shown at the 1967 New York Film Festival.1 On appeal in 1969, the Massachusetts court approved showings restricted to psychiatrists, social workers, and other professional audiences.
In banning this film, Massachusetts Judge Harry Kalus wrote in 1968: "[It contains] crudities, nudities, and obscenitieseighty minutes of brutal sordidness and human degradationa hodgepodge of sequences, the camera jumping helter-skelter. There is no narrative, each viewer is left to his own devices as to just what is being portrayed."1 The judge argued that this was an invasion of the individual's right to be left alone. This was the first judicial decision in Massachusetts legal history based on such privacy rights.1 It was said to be the only American movie to be banned for reasons other than obscenity or military secrecy. Kalus wrote "no rhetoricof free speech and the right of the public to know can obscurethis [picture] for what it is: trafficking in human misery, degradation and sordidness of the lives of these unfortunate humans."1
The ensuing legal battle drew in some of America's most publicly prominent lawyers, including Alan Dershowitz, James St. Clair, Elliott Richardson, and Edward Brooke. Over the span of 25 years, the issues became complex beyond just those of informed consent and the public's right to know. Eventually the case was resolved in 1992 so that "Titicut Follies" could be shown to general audiences. Today the film is shown and studied mostly in college courses in film technique and history. You might find it hard to watch and be reluctant to view it, but there are lessons in it for quality of care professionals.