****

55 STEPS

This film which is based on a true story, features two outstanding performances by well-known actresses who are on the screen together, probably more than 90% of the movie. Helena Bonham Carter plays Eleanor Riese, a young woman with a mental illness who is depicted as receiving potentially dangerous psychiatric medications against her will in a mental hospital. Hilary Swank plays Colette Hughes, the diligent attorney, two-year out of law school, who along with Mort Cohen, a law professor, played by Jeffrey Tambor, takes on Reise’s case and changes California State Law so that involuntary injection of medication is not allowed under certain circumstances. In the course of this moving story, the attorney and the patient become friends.

Unfortunately, one of us (MB) could not allow himself to simply enjoy this moving story and ultimate important legal battle. The reason being that I am a psychiatrist who has seen the evolution of the treatment of involuntary hospitalized patients and the role that anti-psychotic drugs have played in their care. I had to consider the context of the history of the treatment of the mentally ill in this country. Prior to the 1960s and 1970s, there were mental hospitals all over the country with more than half a million patients who were hospitalized against their will because of severe psychosis (being out of touch with reality often with hallucinations and delusions). In the 1950s, a drug named Thorazine was developed, which could put psychosis into remission. Although this drug could have significant side effects, this medication made a tremendous difference in hundreds of thousands of peoples’ lives. Between 1955 and 1994, 487,000 patients were discharged, leaving about 70,000 patients in state mental hospitals. In fact, most state mental hospitals were eventually closed. When I first stepped onto a psychiatric unit as a psychiatry resident in 1966, the newest antipsychotic drugs had not yet been developed and the drugs of choice was still Thorazine and similar medications. It would not be for another 20 years that much safer antipsychotic drugs were developed and put into use. However, the treatment with these medications was effective enough that in the 1970s, with the help of President Jimmy Carter outpatient clinics replaced most of the hospitalized psychiatric treatment in this country. With the development of new antipsychotic medications in the 1990s, there also were much safer medication treatment with many fewer side effects.

However, to this day, patients who are considered to be a danger to themselves or others (which will often include being out of touch with reality by responding to imaginary voices or to delusional ideas) can still be hospitalized against their will. We saw in this movie that the Eleanor Riese case brought about a change in the California law as the State Supreme Court ruled unanimously that patients who are involuntarily committed to health facilities for short-term crisis may refuse to take antipsychotic medication. There is an exception that allows for involuntary medication if the patient is deemed “incompetent to make such a decision by the courts.” There was also the exception for emergency medications, meaning medication that is used for patients who are “considered an eminent danger to themselves or others either physically or psychologically and refuse to take the medication freely.” Of course, you can also be hospitalized against your will on the same grounds for people who are suicidal. All this only pertains to the State of California. Other states may have slightly different laws. I apologize for the technical psychiatric details, but I know that many of the readers of this blog are related to the mental health field and would want these things clarified. There should be one more detail concerning the real character portrayed in the movie. The young woman may not have had schizophrenia. It was mentioned that when she was younger, she had a brain infection related to a shunt put in her brain and she subsequently had some intellectual deficiencies. This may have been the cause of her depicted mental abnormalities.

Returning to the film, which was done very well and was quite moving. The viewers developed a feeling of understanding and empathy as well as admiration for both of the main characters. There also is a very interesting back story about the making of the film, which we learned about in a post-film discussion with the author and producer, Mark Bruce Rosin. He originally came up with the script 25 years ago when he heard a radio program about Ms. Riese and her lawyer who was fighting for her rights to refuse medication. The movie was almost made by two different studios, but it was ultimately dropped until it eventually came to be made with the director Billie August and now will be released nationwide in the next few weeks. Despite some of unaddressed complexity of issues raised in the film, it was one that will grab you and cause to think and is well worth seeing. (2018)