‘Patrick’s Day’ and schizophrenia: The troubled terrain of human relations

The film has potential to become an outstanding educational and therapeutic tool for experiential learning about schizophrenia and how it ravages families and communities

The double bind: Moe Dunford in Patrick’s Day

As a psychiatrist, I am not usually blown away by films about mental illness, but this one, Patrick's Day, written and directed by Terry McMahon, hit me like a hurricane. I saw the film at the Palm Springs Film Festival in January not knowing what to expect: maybe a remake of One Flew Over the Cuckoo's Nest, or an Irish version of David and Lisa.

What I got instead was a poignant, terrifying, heartbreaking and soul-crushing story of “shared madness” (schizophrenia) in the relationship between a mother and her “psychotic” son, and how society at large, and psychiatry in particular, manages – or mismanages – the disorder through inappropriate and often unnecessary use of medications, involuntary incarceration and, when all else has failed, electric shock treatments and lifelong sequestration in so-called “mental hospitals,

This troubled terrain of human relations has been explored and exploited in hundreds, maybe thousands, of films and books down through the years. I doubt, however, that many of them could measure up to the truth and authenticity of Terry McMahon's Patrick's Day that carries a message of significant importance to the medical profession and governmental health administrators in particular, and to society as a whole.

Crushing freedom: Catherine Walker, Kerry Fox and Moe Dunford in Patrick’s Day

In my opinion, McMahon, with cinematographer Michael Lavelle, their superb production team, and a brilliant ensemble cast – Moe Dunford, Kerry Fox, Phillip Jackson, Catherine Walker and Aaron Monaghan – have created a film with a real potential to become an outstanding educational and therapeutic tool for experiential learning about schizophrenia and how it continues to ravage families and communities in Ireland – and, indeed, all over the world – in ways that are not yet fully understood.


Schizophrenia, which was first described by the Greeks, is a disorder of thought, emotion, behaviour, faulty perception, inappropriate activity and feelings, withdrawal from society and personal relationships into fantasy and delusion together with a sense of mental and emotional fragmentation.

The aim of therapy for schizophrenia and other serious mental disorders is to integrate thought and action, intellect and emotion, body and soul, without neglecting one for the other.

Malignant Shame is a major vector in the continuing ignorance and silence that exists around all things schizophrenic. There is still a profound shame about the disorder in Ireland. Psychotic family members, children and adults alike, are still sequestered by families in attics or cellars for fear that their very presence and existence would cast a cloud of criticism about the family if the “shameful secret” should become known in the community. In some ways, the plight of “the mad” In Ireland, and everywhere else for that matter, their plight is similar to that of the lepers in the 19th century who were famously stripped of their civil rights before being sequestered and abandoned on Molokai, an island in the Hawaiian archipelago, and left for dead because they were revoltingly ugly and dangerously contagious.

McMahon uses the mother/child double-bind theory of reciprocal communication developed in the 1960s by psychoanalyst Frieda Fromm Reichmann and anthropologist Gregory Bateson as both the framework and subtext for the story of Patrick's Day.

Sadly, this theory, which was always controversial, has been overshadowed by the explosive growth of neurobiological brain research that is beginning to make substantial breakthroughs in the understanding and treatment of major mental diseases such as schizophrenia. This progress is taking place not only through pharmaceutical discoveries and innovations, but through the establishment of spiritually based therapeutic communities designed specifically to help psychotic persons pursue their quest for meaning and connection in the world.

Bateson’s double-bind hypothesis of faulty communication, connection, and attachment between mother and infant can be summarised as follows: for reasons as yet unknown, some infants are born with a brain defect that may interfere with their ability to interpret messages from the environment which for the first six to nine months of its life consists mostly of their mother’s eyes, face and breasts.

A significant number of infants with this defect who are born to emotionally unstable or “needy” mothers may be unable to tolerate the intensity of the maternal gaze but can learn to block or regulate it by pressing their tiny clenched fists into their eye sockets, or by turning their heads and bodies away to avoid the strain. The emotionally vulnerable mother may misinterpret this biologically constructive behaviour as rejection by the infant she loves more than anything else in the whole world, and, feeling guilty and ashamed, begin to pull away from the relationship, thereby creating a void of negative experience for both herself and her infant child. In turn, the infant manages his or her increasing anxiety about abandonment by further withdrawal from the arena of the relationship, and so on it goes. The life-long schizophrenic dance between mother and child has begun, with the infant paralysed by fear of abandonment, and the mother enraged and mystified by the apparent rejection of her love by her new offspring.

The mother’s instinctive response to this situation is to love and protect her precious child even more by controlling every aspect of his or her life. In turn, child responds by making every effort to escape the gravitational pull of her pathological maternal affection by going into orbit with outrageous conduct. However, these experimental efforts to achieve freedom are always thwarted by orders from the earth-based mission control commander of his or her life – a loving mother – on the grounds that he or she needs more “love and training” before being competent to navigate safely in a world full of danger. This enmeshment in a relationship is often known as a “folie-a-deux” or a “shared madness” between two people based on a delusional misinterpretation of reality in the relationship. And that’s how it is between mother and child until death do them part.

Biologically speaking, these collusive behaviours are intended to correct the attachment defect in both the mother and the infant/child. Eventually, however, one or both of the partners can be “driven overtly mad” by the process which begins to solidify in the relationship over time to a point that each partner depends on the other for negative stimulation. This dynamic stand-off perpetuates the negative process while both mother and child are desperately yearning for positive emotions, such as the innocence and intimacy of love and affection, to replace the unconscious rage and hostility which, as time goes on, begins to pervade not only the mother-child relationship, but all the relationships in the family. The technical definition of a double bind is as follows:

“The person who becomes psychotically unwell finds him or herself in a [reciprocating] communicational matrix in which messages contradict each other, the contradiction is not able to be commented on or discussed, and the unwell person is not able to leave the field of interaction, most frequently the family.”

Thus, the infant, the child, the teenager or the young adult is expected to choose between attitudes or actions that are in conflict with each other, so that whichever alternative he or she chooses always turns out to be wrong.

Synopsis and interpretation

In the film, Patrick, the only child of a middle-aged mother is a 26 year old schizophrenic, his mother’s only child, who takes medications, lives permanently in a mental hospital and works as a box boy in a local neighbourhood grocery store. Just before his 26th birthday, when his mother pays her annual visit to him, Patrick meets and falls madly in love with an alcoholic flight attendant who is looking for a final fling before killing herself.

The mother is appalled to discover this totally unexpected development in her totally dependent son’s life, and resolves to do everything in her power to break up the relationship. But Patrick, who initially stands his ground against his mother’s manipulations, is eventually driven to an impulse to violence by being caught in a double-bind situation where he has to choose between his new-found but high-risk first lover, and responding to the siren call of his mother for him to return to the double-bound safety and protection of her eternal love.

The remainder of the film deals with the development and resolution of this conflict-laden situation with several excellent examples of how the double-bind defence mechanism works to eliminate and crush freedom in the double-bound vice of a disturbed mother-child relationship.

Thankfully and brilliantly, McMahon, decent, kind and compassionate man that he is, generously gives us an ambiguous but very moving ending in which we, the audience, and Patrick, the protagonist, are invited to struggle with the question of whether what we have experienced together is based on reality or a paranoid delusion.

Patrick's Day is an invitation for us to enter the life of a schizophrenic man, and, if we have the courage, to try to find parts of him that gibe with our own experience – in other words, to find the "schizophrenic" in ourselves. If we are at all honest and sensitive about monitoring our own experience we would probably admit that we have all behaved like Patrick and his mother for brief snapshots in time. However, because most of us are not schizophrenic, we always have at our disposal an escape route through dishonesty or denial to make it back to our familiar world of survival through self-deception and corruption in ourselves, and our families, and businesses, and even our countries.

Personal reaction

My personal reaction to

Patrick’s Day

was to think to myself “There, but for the grace of God, go I.” I could identify with aspects of Patrick’s behaviour and personality, with his mother’s rage and her mission of providing lifelong protection to her wounded son, and with the plight of Patrick’s first and only adult lover. After 25 years of alcoholic drinking, and 38 years of sober recovery, I was reminded of similar incidents in my own life in which I had been both the perpetrator and the victim of injustice in scenarios similar to those depicted in the film, where my conduct had often been less than meritorious.

The genius of Patrick's Day is to invite the audience members to abandon their role as observers of the film and become participants in the action, allowing themselves to identify with some of the frightening behaviours of the characters in the film, thereby expanding their knowledge of the truth about their inner selves.

All patients, families and mental institutions including nurses, physicians, attendants and orderlies who currently warehouse patients with drugs, ECT and involuntary confinement should see this film and be given an opportunity to discuss it from their own perspectives. It is equally important to arrange private showings for members of the HSE and other Governmental bodies that govern the institutions that detain these patients at their bidding, and to re-examine their principles, policies and procedures to ensure that they are not doing more harm than good in their implementation.

You will get maximum benefit from watching the film if you are brave and courageous enough to search for and see aspects of yourself in each of the characters and identify the parts that remind you of your own experience.

However, it is only human to expect that some audience members will hurl themselves into the process, while others will retreat to their own familiar havens of safety, thereby missing a unique opportunity to better define the boundary between “sanity” and “madness” by experiencing for themselves the feelings and impulses of the protagonists in the piece.

About the writer

Dr Garrett O’Connor’s opinions of

Patrick’s Day

are based on: 54 years of clinical practice of psychiatry; working at three state mental hospitals in Maryland in the US; and consulting to an institution for the criminally insane in Baltimore. He also founded, and directed for seven years, the Psychiatric Emergency Service at the

Johns Hopkins Hospital

in Baltimore, where seriously ill psychotic patients constituted the bulk of the practice.

In 1967, he founded a residential community called Fellowship House in downtown Baltimore that was modelled, in part. on RD Laing’s Kingsley Hall, a therapeutic living environment for seriously disturbed men and women in London. The only requirement for admission to Fellowship House was to have spent at least five years in a mental hospital with a diagnosis of major mental illness.

Prof Ivor Browne

Patrick’s Day

is more than a creative work of cinema. It is not fiction. It is absolutely true to life. In my 50 years as a psychiatrist, and in the practice of psychotherapy, I have had to deal with family situations exactly like this. I feel it is vital that Patrick’s Day should be shown to as wide a public as possible. This film is an extremely valuable piece of work that will have a major impact on people’s understanding of the nature of psychotic breakdown and indeed of psychiatric illness generally.”

Patrick's Day opens on Friday, February 6th, and psychiatrist Prof Ivor Browne will attend the opening-night screening at the Irish Film Institute in Dublin. He will take part in a post-film Q&A session with the film's director, Terry McMahon, and the cast, hosted by journalist Elaine Crowley. See ifi.ie/film/patricks-day-qa/ and wildcarddistribution.com/movie/patricks-day