1

Chapter I: Introduction

Background of the Study

The way people generally perceive and act towards mentally ill people has a

strong impact on how they experience and view their own illness. An inaccurate perception

about mental illness often leads to an environment that magnifies their incapacity and hinders

their active function and participation in society.

The lack of correct representation about mental disorders leads to individuals who can’t

come to terms with what they’re going through, families who don’t know how to approach an

affected love one, institutions who put little attention to mental health, and a society as a whole

that is capable of making the mentally ill feel vulnerable to the judgment of others and tired from

what seems like an endless daily battle (Mental Health America, n.d.).

The nonspecific concept of madness has been around for thousands of years but

schizophrenia was only classified as a distinct mental disorder by Emile Kreapelin in 1887

(Berrios & Hauser, 1988). Eugene Bleuler first coined the term “schizophrenia” in 1911, derived

from the Greek roots “Schizo” (split) and “Phrene” (mind) to describe the fragmented thinking of

people with the disorder (Andreasen, 199). This term was not meant to mean the idea of split or

multiple personality, a common misunderstanding, but rather the fragmented thinking of people

with the disorder.

Schizophrenia in particular is one of the top mental illnesses with more than 24 million

people affected worldwide (WHO, 2001). Nationwide, it tops the charts among all mental
 2

disorders in the country with 57% in outpatient facilities, 63% in community inpatient facilities,

and 71% in mental hospitals (WHO-AIMS, 2007).

In the Philippines, schizophrenia turns out to be the most prevalent mental illness but

ironically the least understood (Manila Standard, 2018). The World Health Organization finds

this lack of understanding as the main reason why the state of schizophrenia has not improved.

Their studies have found that treatments do exist and are available; in fact over 80 percent of

schizophrenics can be cured and be free from relapses with the right treatment and interventions

as most don’t even need any psychotic medicines. ​However despite these breakthroughs, nearly

two-thirds of the mentally ill never seek professional help because the “stigma, discrimination,

and neglect prevent care and treatment from reaching people.” This lack of understanding leads

to medical institutions with not enough resources, governments with little to no policies on

mental health, and the individual deprived of the right treatment (WHO, 2001).

Schizophrenia is a mental illness where a person experiences changes in their behavior

and perception. They develop a disordered thinking and sense of reality, also referred to as

psychosis (Australian Government Department of Health and Ageing, n.d.). According to

Warner (2000) it is a severe condition that impairs a person’s emotions, thinking, judgment, and

grasp of reality. Schizophrenia is characterized by delusions, hallucinations, disorganized speech

and behavior, and other symptoms that cause social or occupational dysfunction and to be

diagnosed with schizophrenia, symptoms must have been present for six months and include at

least one month of active symptoms and normally follows a traumatic or stressful event in a
 3

person’s life, such as a death, starting college, or moving out on one’s own. (American

Psychological Association. 2013, Iorizzo, 2014).

There is no known cause of schizophrenia, but certain factors seem to increase the risk of

developing or triggering schizophrenia such as genetics, social stress, viruses, and complications

concerning the circumstances of one's birth (Warner, 2000). Contrary to popular belief, drug

abuse does not cause schizophrenia. However it is possible, although there is no certainty, that

drugs can trigger the manifestation of schizophrenia (Frith & Johnstone, 2003).

Schizophrenia affects thinking, feeling, movements, and behavior, these are all

regulated by the brain and when the brain is assaulted by an illness such as schizophrenia, its

usual processing can be disturbed in several ways (Mason & Miller, 2011). Symptoms differ

from person to person, and can change overtime from getting better or getting worse. The 5th

edition of the Diagnostic and Statistical Mental Disorders raised the symptom threshold,

requiring that an individual exhibit at least two symptoms and diagnosis requires that symptoms

must have been present for six months and include at least one month of active symptoms

(American Psychiatric Association, 2013). When diagnosed, the symptoms of schizophrenia are

divided into three categories: positive, negative, and cognitive. Positive symptoms are the

presence of sensations, beliefs, and behaviors that would not normally occur such as wild

changes in normal behavior and can include but are not limited to delusions and hallucinations,

the inability to complete a thought, incomplete sentences when talking, and acting silly at the

same time as being distressed. Negative symptoms on the other hand are the lack of important

abilities like the absence of normal thoughts, loss of drive, poverty of thought, and emotional and

social withdrawal. Cognitive symptoms refer to difficulties with concentration and memory,
 4

these symptoms can the most problematic because they can interfere with daily activities like

remembering and understanding information, and paying attention or focusing (Iorizzo, 2014.

Mason & Miller, 2011). But no matter how schizophrenia develops, it is important to remember

that schizophrenia is an illness of the brain and it is no one’s fault. The brain is like any other

organ in the body, and it can get sick just like any other organ.

The many misconceptions that surround schizophrenia contribute to the stigma, isolation,

and discrimination that can be experienced by schizophrenic people (Australian Government

Department of Health and Ageing, n.d.). According to Mental Health America, a major cause of

these misconceptions is the leading connotation that the acquisition and existence of

schizophrenia, along with other mental illnesses, are rare and so little attention and

understanding is given. As most people have no direct experience of mental disorders, they look

to the media as a source to find more insight.

With a significant amount of knowledge about schizophrenia coming from popular

media, schizophrenics are more often than not portrayed in a negative light. Some prevalent

depictions include people with schizophrenia as violent and dangerous, associated with

split-personality disorder, and that they are mentally disabled or they’re intelligence capacity is

hindered (Ciplamed, 2017).

Debunking these myths, schizophrenics are actually seldom dangerous, most especially

when they’re already receiving treatment. In very rare occasions do they become aggressive due

to extreme episodes of psychosis that make them feel intense fears and delusions. Additionally,

this aggressive behavior is often directed towards themselves more likely harming themselves
 5

than others. A study by Palmer et al. (2005) shows that the lifetime suicide risk in schizophrenia

is around 4.9%, Hor and Taylor (2010) conclude that an accurate estimated suicide rate is 579

out of 100,000 person per year. Risk of suicide in schizophrenia is significantly higher during

youth but risks of suicide persist until the age of 70 (Osborn et al., 2008). They are also

commonly mistaken to have split personalities but that is a separate type of illness, schizophrenia

causes delusions and distorted sense of reality but not multiple personalities. Lastly

schizophrenics are not considered mentally disabled and have shown a normal range of

intelligence. Their psychosis may sometimes affect and hinder them from thinking straight but

there are many schizophrenics who live their lives normally, able to function and contribute to

society like the rest of us (Australian Government Department of Health and Ageing, n.d.).

These are just a few of the many rising misconceptions people have on schizophrenia that’s

proliferated by the media.

The Voices (2014); Alphabet Killer (1970s); The Butcher Boy (1997); Me, Myself and

Irene (2009); and Psychosomatic (2008) are a few titles in the long list of movies that use

schizophrenia as a condition that motivates dangerous actions. Entertainment media such as

films and television series are a completely different ball game because they are rooted in fiction,

and have no excuse for using schizophrenia to explain away violent behavior. Schizophrenia has

become an excuse for inexcusable actions (Hynds, 2016).

One problem in studying schizophrenia is that it is an extraordinarily diverse disorder

(Frith & Johnstone, 2003). One patient may experience auditory hallucinations such as voices

talking to him/her, while another patient may have delusions of believing to be someone else.

This diversity in cases of schizophrenia has caused some people to believe that there is no such
 6

disorder of schizophrenia and refer to the term as a medley of different disorders with no

common cause ​( ). ​Schizophrenia varies from case to case, some only experience a few brief

episodes in their life, while for others it remains recurrently throughout their lifetime. There are

also those who acquire the illness rapidly with acute symptoms developing over weeks while

others acquire it slowly, developing for months or even years ​( ).

Star (1955) conducted a nationwide survey of the American public in 1950 and found that

the general reaction towards the mentally ill is negative and poorly informed. Cumming and

Cumming (1957) did the same in 1951 and uncovered similar attitudes among residents in a rural

town in Canada. Nunnally (1961) concluded that the mentally ill were viewed with “fear,

distrust, and dislike” by the general public (Warner 2000, 87). Although discrimination against

minority has since receded, prejudice against people with mental illness prevails.

Media representations of the mentally ill have shown little improvement since the Second

World War. In the late 1970s until early 1980s, US media were still projecting a sensational

image of people with mental illness (Steadman & Cocozza, 1987). TV dramas usually

represented the mentally ill as violent or homicidal (Gerbner et al., 1981). ​In 1975, the Academy

Award-Winning film ​One Flew over the Cuckoo’s Nest ​was shot at Oregon State Hospital;

producers had the opportunity to employ actual hospital patients as actual actors but patients not

looking strange enough to match the public image of the mentally ill, pushed them to reject the

idea (Wahl, 1995).​ Media does play a role in the stigmatization of schizophrenia in multiple

countries like Spain, Japan, Italy, Brazil, China, and the United States; it was found that the press

associated mental disorders with negative attributes such as unpredictability, danger, criminality,

and isolation (Cua, 2017). A study by Patricia Owen (2012) where english-language movies
 7

featuring at least one main character with schizophrenia which were shown in theaters from 1990

to 2010 were analyzed concluded that misinformation and negative portrayal of schizophrenia in

contemporary movies commonly underscores the importance of determining how viewers

interpret media messages and how there interpretations ​inform attitudes and beliefs both of the

general public and of people with schizophrenia.

Entertainment media, such a popular songs and soap operas, can heighten awareness and

provide information, and are especially useful for socially taboo topics such as mental illness.

For example, a radio soap opera encouraging AIDS awareness and family planning gained a

wide audience in Tanzania, and was effective in changing attitudes and sexual behavior (E.M.

Rogers et al., 1995).

Statement of the Problem and Objectives

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks,

feels, and behaves. People with schizophrenia may seem like they have lost touch with reality.

Schizophrenia is not as common as other mental disorders but still the symptoms can be very

disabling.

Around the world, the stigma and discrimination associated with mental illness are high,

although they are less severe in parts of the developing world, where symptoms of psychosis are

at times regarded in a more positive light. Postwar attempts to reduce stigma in industrial

countries were largely unsuccessful. Media hyperbole, biased reporting, and negative attitudes

among the general public continue to be major problems (Warner, 2000).

 8

This experimental film aims to break the stigma of people with schizophrenia being

unable to function properly as members of the society. Along with this it also aims to show the

daily struggles that people suffering from schizophrenia go through with the goal of educating

people and changing the perception towards the illness. The film also aims to humanize

schizophrenia and debunk the myth that having schizophrenia makes someone violent.

The film may portray events that most people will think is unimaginable to live with.

These scenarios will show what it’s like to live with schizophrenia. As well as to show that

people with schizophrenia can still function as members of the society even if they have

symptoms.

Significance of the Study

Warner (2004) suggests that due to the stigma associated with schizophrenia, people who

accept the diagnosis of mental illness feel internal pressure to conform to the stereotype of

incapacity and worthlessness, becoming more socially withdrawn and adopting a disabled role.

As a result they become dependent on treatment and other people in their lives. Thus insight to

one’s conditions becomes difficult. The stigma then places people with schizophrenia in a

difficult position, having to accept the illness can mean losing the capacity to cope with it

(Warner et al., 1989).

The stigma that comes with having a mental illness not only affects the victim but also

relatives. Mental health professionals as well as the public often hold negative attitudes for the

relatives of people with mental illness (Lefley, 1987; Mehta & Farina, 1988; Burk and Sher,

1990). This causes relatives to hide or distance themselves from other people (Yarrow et al.,
 9

1955; Thompson & Doll, 1982; Phelan et al., 1988). Perceived stigma and misconceptions from

relatives can influence the course of the illness and can help or worsen the situation (Leff &

Vaughn, 1985).​ Understanding how schizophrenia affects people can help in coping with loved

ones who have schizophrenia.

The film will be an documentary-styled experimental film, utilizing the unconventional

avant-garde approach to show the disoriented reality that schizophrenics experience every day. It

is all about being caught between delusions, hallucinations, trouble with thinking and

concentration, and a lack of motivation while trying to make it through the day.

As for the communication aspect, the film will show how schizophrenics interact with

others and how they express themselves, showing the relationship and importance of

intrapersonal and interpersonal communication. The film will explore how auditory

hallucinations affect the daily experiences of people who suffer schizophrenia.

Scope and Delimitations

Knowing that Schizophrenia is a broad topic, the film will focus mainly on the most

common symptoms, primarily delusions and hallucinations rather than the emotional aspects.

The film will portray schizophrenia based on information gathered through interviews with

experts in the field of schizophrenia as well as patients diagnosed with schizophrenia.

The film will last from fifteen (15) to twenty (20) minutes. This will allow the

filmmakers to showcase the experience of schizophrenia and build a connection with the

audience without cramming too much information in a short period of time.

 10

The filmmakers will interview experts such as doctors and psychiatrists who are well

informed in the field of study regarding schizophrenia. The filmmakers will also do the best they

can to get in contact with people who have schizophrenia as well as their relatives. In addition,

the filmmakers will also survey what the general public thinks of people with schizophrenia to

assess what they think of such cases.

The medium the filmmakers will take will be a documentary-style experimental film

from the perspective of a person diagnosed with schizophrenia. This will enable the story to

relate from actual accounts from experts and patients as well as recreate the effect of psychosis

more efficiently to the audience to create a film that will properly portray what it is to have

schizophrenia.

The filmmakers acknowledge that schizophrenia has unique manifestation per individual.

With this in mind the film will focus on the most common symptoms diagnosed in patients. The

film underlines the fact that schizophrenia can affect how reality is perceived and how that can

affect one’s everyday experiences, and it aims to show that experience.

Finally, the filmmakers will conduct a study regarding the perception and reception of the

audience to be able to assess how effective the film is regarding its objective in changing the

existing notions on schizophrenia. This study will help give a general idea to the filmmakers and

future filmmakers on how in improving on the next films that would tackle schizophrenia.
 11

Chapter II. Production Concept

The filmmakers envisions the film as a documentary-styled experimental film. The film

focuses on how psychosis affects the daily life of someone with schizophrenia. It tackles how

having schizophrenia can change how a person behaves and interacts with others. The film will

be portraying what it feels like to have schizophrenia and the stigma that comes with being

diagnosed with it.

Some sequences of the film will be shot from the point of view of a person with

schizophrenia. Information gathered from medical professionals and patients with schizophrenia

will be used to effectively tell the story. Ideally, voice overs from interviews that the filmmakers

will conduct will be used to narrate part of the story accompanied by appropriate visual

representations of different effects of schizophrenia.

The story begins just before the main character develops schizophrenia and will show

how it progresses along with how it affects the main character’s daily routine. This will

emphasize how having schizophrenia can significantly change the life of a person. This will also

help set the premise of the story and help the audience to relate to the main character.
 12

Chapter III: ​Review of Related Literature

(Nocturne: An experimental film)

(Evaluation of Nocturne analysis of audience perception)

Documentary

Reflexive Documentary

The film will borrow some styles from the Reflexive Mode of documentary. This form of

documentary calls attention to the assumptions and conventions that govern documentary

filmmaking. It increases our awareness of the constructedness of the film’s representation of

reality (Nichols, 2001). A reflexive documentary can contain sizable portions of observational or

participatory footage. Roscoe and Hight (2001) states that in this mode, the representation of the

historical world becomes the focus of interest. Many times, personal filmmakers also use an

ironic or reflexive approach to familiar objects or images, forcing a reanalysis of them: collages,

blank images, text that startles or asks questions, and repetition—all of which forces viewers to

reflect upon or reinterpret the meaning of a sound or image (Aufderheide 2007, 100-101).

Nichols (2001) argues that instead of following the filmmaker in his/her engagement with

other social actors, we should attend to the filmmaker’s engagement with the viewer, speaking

not only about the historical world but about the problems and issues of representing it as well.

The reflexive documentary has greatly contributed the documentary form; through its often

innovative use of fictional codes and conventions, and through its question of how the form

represents the social world (Roscoe and Hight, 2001). Instead of seeing through documentaries

to the world beyond them, reflexive documentaries ask us to see documentary for what it is: a

construct or representation (Nichols, 2001).

 13

Reflexive documentaries also address issues of realism; it takes form as physical,

psychological, and emotional realism through techniques of evidentiary or continuity editing,

character development, and narrative structure (Nichols, 2001).

The reflexive mode is the most self-conscious and self-questioning mode of

representation (Nichols, 2001). Realist access to the world, the ability to provide persuasive

evidence, the possibility of indisputable proof, the solemn, indexical bond between an indexical

image and what it represents—all these notions come under suspicion (Nichols 2001, 128) .That

such notions can compel fetishistic belief prompts the reflexive documentary to examine the

nature of such belief rather than attest to the validity of what is believed. At its best, reflexive

documentary prods the viewer to a heightened form of consciousness about her relation to a

documentary and what it represents

Poetic Documentary

Aside from the reflective form of documentary, the film will also use some aspects of

Poetic documentary. Poetic documentary share some common aspects with the modernist

avant-garde, sacrificing the conventions of continuity editing and the sense of a very specific

location and time and place that follows from it to explore associations and patterns that involve

temporal rhythms and spacial juxtapositions (Nichols 2001, 103). The poetic mode is particularly

adept at opening up the possibility of alternative forms of knowledge to the straightforward

transfer of information, the prosecution of a particular argument or point of view, or the

presentation of reasoned propositions about problems in need of solution (Nichols 2001, 103).

The documentary dimension to the poetic mode of representation stems largely from the

degree to which modernist lms rely on the historical world for their source material (Nichols
 14

2001, 103). The poetic mode began in tandem with modernism as a way of representing reality in

terms of a series of fragments, subjective impressions, incoherent acts, and loose associations

(Nichols 2001, 103).

The modernist event no longer seemed to make sense in traditional narrative, realist

terms.Breaking up time and space into multiple perspectives, denying coherence to personalities

vulnerable to eruptions from the unconscious, and refusing to provide solutions to

insurmountable problems had the sense of an honesty about it even as it created works of art that

were puzzling or ambiguous in their effect.Although some lms explored more classical

conceptions of the poetic as a source of order, wholeness, and unity, this stress on fragmentation

and ambiguity remains a prominent feature in many poetic documentaries (Nichols 2001,

103-104).

Experimental Film

Experimental film techniques will also be used in the treatment of the film, experimental

cinema or avant-garde cinema is a mode of filmmaking that rigorously re-evaluates cinematic

conventions and explores non-narrative forms and alternatives to traditional narratives or

methods of working (Pramaggiore & Wallis 2005, 247). Many experimental films, particularly

early ones, relate to arts in other disciplines: painting, dance, literature and poetry (Marcus 2007,

134), or arise from research and development of new technical resources (Youngblood 1970, 88).

For Sheldon Renan (1970, 17), a director and producer known for his role in ​Akira

(1988), underground film is a certain kind of film conceived and made essentially by one person

and is a personal statement by that person. A film that dissents radically in form, technique, or
 15

content, or maybe in all three. It is usually made for very little money, and exhibited outside

commercial film channels.

Experimental films are made for many reasons. The filmmakers may wish to express

personal experiences or viewpoints and also convey a mood or physical quality in ways that

would seem eccentric in a mainstream context (Bordwell & Thompson 2010, 673). The

experimental filmmakers may tell no story, creating poetic reveries or pulsating visual collages;

alternatively, the filmmakers may create a fictional story, but it usually challenges the viewer

(Ibid, 674).

During its history there existed many terms and tendencies that distinguished avant-garde

cinema, making it difficult to define (Dixon & Foster 2007, 1). Differing from the Hollywood

cinema that rejected the modern art methods and conformed cinema in a traditional form of

narration, avantgarde cinema embraced the radical break with the past, creating a cinema without

borders, without story, characters or dialogues (Da Costa Ferreira 2013, 11).

Malcolm Le Grice (1982, 105-121) classifies the avant-garde films into four categories:

firstly, the perceptual film started by Duchamp. These films try to examine or create experiences

with mechanisms working on the perception and nervous system level; example of these films

were made by Peter Kubelka, Paul Sharits, Brigit and Wilhelm Hein. Secondly – loop and image

repetition – started by Leger in ​Ballet Mecanique​ (1924). Thirdly – manipulation experiments –

experimenting with film print processes and re-shooting as seen in the work of Pat O’Neill,

Klauss Schonherr, Hollis Frampton, Ken Jacobs and Michael Snow. The fourth category –
 16

projection and projector – includes Expanded Cinema and the American abstract experiments by

Jordan Belson and Vortex Concerts.

As the filmmaking technologies advanced through the years, more amore filmmakers

started experimenting with various techniques in producing films. One such filmmakers is David

Griffith, he developed a way to use different camera angles and other techniques such as using

filters and close-ups to convey emotions (Lim 1998, 3-4). Dziga Vertov along with his students

in the former Soviet Union also contributed in the development of techniques in experimental

films in the form of rapid montage editing. Out of necessity, having been denied access to raw

stock to shoot new films, they learned how to cut film by re-editing David Griffith’s ​Birth of a

Nation (​ 1915) in short burst of hyper edited frames. This style of editing then became the

hallmark of Soviet silent films (Dixon & Foster 2007, 2).

Mental Health and Film

There is a growing perception that science alone provides overall insufficient foundation

for the holistic understanding of the interaction between health, illness and disease (Hurwitz

2009). The Health Humanities has emerged as a distinct entity in attempts to ameliorate the

limitations in the provision of healthcare services. The health humanities can broadly be

described as the application of literature and arts to medicine. The relationship between

psychiatry and film falls under the wide-ranging remit of the Health Humanities (Oyebode

2009). Portrayals of mental illness are prevalent in the media, and studies show that they

negatively influence public perception while sustaining the stigma (Pirkis, Blood, Francis, &

McCallum, 2006).
 17

Over the last three decades medical educators have used film as an educational tool for

teaching medical students and psychiatry trainees for a number of mental health conditions and

scenarios. It encompases a wide range and includes assessment of mental state, response of

others to the mentally ill and the relationship between the therapist and the patient (Bhugra

2009).

An advantage of films as a method of pedagogy in undergraduate and postgraduate

psychiatric education is that their utility does not involve encroaching on the confidentiality of a

real patient. Moreover, film can transport the viewer to the protagonist’s childhood, to a different

time and place during which the character may have experienced abuse, adversity or any other

form of trauma that might be a contributory factor to the development of, for example, a

personality disorder later on in that character’s life (Akram 2009).

Datta (2009) published a paper entitled, ​‘Madness and the movies: an undergraduate

module for medical students’​, the respondents in this study were very receptive to the use of film

as an educational tool and were able to understand both its strengths and limitations. The

participants found the module enjoyable, and subjectively rated their knowledge of psychiatric

topics and the history of psychiatry as significantly improved.

Film speaks to the unconscious and conscious mind through metaphor and imagery.

Schizophrenia has been regarded as a blurring between subconscious metaphors and reality

(Modell 2009). Ron Howard (director of A Beautiful Mind) and other notable directors such as

Terry Gilliam (director of The Fisher King) have attempted to shed light on the unseen 'valley' of

schizophrenia.

When I'm unwell I feel (in retrospect) that fifty to sixty percent of my thoughts appear to be submerged in
this ‘unseen’ valley. No book, I feel, is enough to convey my distress of mind; only film
can visually depict my symptoms to a viewer. Indeed I feel A Beautiful Mind was
 18

directed in such a way so that the viewer is given access into the unseen ‘valley’ of
Nash’s schizophrenic mind.
​ inematherapy and Film as an Educational Tool in Undergraduate Psychiatry Teaching: A Case Report and Review
(C
​ ankir, Holloway, Zaman & Agius, 2015)
of the Literature.​, H

People with schizophrenia are amongst the most stigmatized of those with mental

illnesses (Evans-Lacko 2014). A group of researchers in Turkey examined whether an

anti-stigma program which consists of an educational component, social contact with someone

who has schizophrenia and a viewing of a film that depicts an individual with schizophrenia can

positively change attitudes towards people with this illness (Altindag 2006).

Hankir, Holloway, Zaman, and Agius (2015) propose that film (particularly those that

have a mental illness theme) possesses a power that people who have experienced

psychopathology report as healing and mental healthcare providers should at the very least be

familiar with this. Moreover, film has merit in the field of psychiatric education and its utility

should be explored further. With this information, the filmmakers intend to create a film that

would educate the audience, raise awareness, and promote sensitivity towards others.

Mental illness in Film

The filmmakers draw great inspiration from the experimental works of both local and

international artists. First among these is Arce et al.’s Nocturne (2015), an unpublished

undergraduate thesis. Nocturne is an experimental film that uses Sergei Eisenstein's montage to

portray the erratic thoughts of someone suffering from night anxiety (Arce 2015, 28). The use of

montage can be used in the experimental film to portray the disarray of thoughts of a person with

schizophrenia.

Other films that tackle psychological subject matter that inspired the film are Black Swan

(2010) and Fight Club (1999).

 19

Black Swan (2010) by Darren Aronofsky ​revolves around a production of ​Swan Lake

ballet by a prestigious New York City ballet company. The story is about a ballerina who will

play the innocent and fragile White Swan, for which the committed dancer Nina (Portman) is a

perfect fit, as well as the dark and sensual Black Swan, which are qualities better embodied by

the new dancer Lily (Kunis). Nina becomes overwhelmed by a feeling of immense pressure

when she finds herself competing for the part, causing her to lose her grip on reality and descend

into a living nightmare. The film can be perceived as a poetic metaphor for the birth of an artist,

a visual representation of Nina’s psychic journey toward achieving artistic perfection and what it

takes to achieve it.

Fight Club (1999) by David Fincher shows how having a fragmented thinking can lead

one to close touch with reality. The main protagonist had become so discontent with himself that

he had manifested what he wanted to be into a new identity. Revealed later on in the movie that

this person he idolizes is his alter ego. The visual storytelling employed in the movie is an

interesting approach in regard to inner conflicts and turmoil, the antagonist being represented as

someone else.

These films showcased different ways to portray different mental illnesses, this inspired

the filmmakers to take on their own approach in portraying schizophrenia specifically through

experimental film. Although these films were remarkable in their portrayal of mental illness, it

showed the filmmakers that they should be cautious in tackling issues regarding mental illness

and to be careful not to make generalizations regarding different kinds of conditions.

 20

Chapter IV. Research Framework

Psychocinematics

Within the realm of avant-garde or experimental cinema, some movies do not conform to

tell a story and instead may offer a commentary on the art form itself. The core interest of

psychocinematics is to be the understanding of the most common movie experience, which is the

viewing of fictional narratives as portrayed by moving images (Shimamura, 2013, 4).

Filmmakers have developed techniques, largely through trial and error, that drive our

sensations, thoughts, and feelings. The trough acting, staging, sound, camera movements, and

editing, movies develop a storyline, or what commonly called a narrative, that fully engages us

(Shimamura 2013, 1). Psychocinematics seeks to understand the psychological underpinnings of

cinema through empirical research. Psychocinematics is grounded on a scientific analysis of our

aesthetic response to movies all the while encouraging a multidisciplinary approach that includes

psychology, cognitive science, neuroscience, philosophy, film studies, filmmaking, art history,

sociology, and other related endeavors (Shimamura 2013, 2-3).

In essence, aesthetics can be viewed as a hedonic response, which is simply a preference

or liking judgment. This can be measured by how the film was received by the audience, from

being very positive to very negative or from being interesting to being dull; it can even be based

on which this aesthetic response was made, such as having a satisfying ending or not being able

to identify with the protagonist (Shimamura 2013, 2).

 21

Our aesthetic response may be based on the visuals, the action, or how a movie makes us

think or feel. The conceptual basis for a research program in psychocinematics was formulated

by Munsterberg. He argued for a psychological analysis of how movies impinge on our

perception, imagination, and emotion based on his belief that movies work because they model

or simulate mental states. For example a close-up shot is akin to focusing our attention; a

flashback mimics remembering; soft focus connotes a feeling (Munsterberg 2001, 173). When

used as psychological stimuli, movies can help us better understand how we perceive, interpret,

and respond to events (Shimamura 2013, 3).

​ odel which stands for the artist’s intention (I) to

Shimamura (2012) proposed ​I-SKE m

create an artwork and the beholder’s share in terms of the way an artwork influences sensations

(S), knowledge (K), and emotions (E). The filmmakers’s intention plays an important role in the

movie’s overall experience. As suggested by the so-called ​auteur ​theory of film criticism (Sarris,

1968), the creative vision of a movie is often attributed to a single ​artist, ​often the director.

Certain styles and techniques are often associated with the specific filmmakerss, and knowledge

of their intention to communicate certain viewpoints, ideas, or feelings which is part of the

viewer’s experience (Shimamura, 2013, 16).

In cognitive terms, a pattern of thought is developed for certain filmmakers, and this

knowledge can influence how viewing is experienced. Acknowledging that a creator had the

intention to instill an aesthetic experience, which may be to offer a sensory experience, a

conceptual viewpoint, or a certain feeling. The ​I-SKE​ model offers a way to characterize these
 22

three psychological components of movie experience, which is the role of sensations,

knowledge, and emotion in driving our aesthetic response to movies (Shimamura, 2013, 16).

Movie experience is driven by the sensory inputs that envelop and guide viewers.

Through sights and sounds, the filmmakers creates a spatial environment that the viewers often

engage as though they are part of it. Our brains interpret the sensory experience as being within

the spatial environment portrayed by a movie (Shimamura, 2013, 16-17).

Editing and flashbacks represent types of editing that alter the normal temporal

sequencing of events, creating non-linear narrative structures. Editing creates the transition

between events (Lowe & Durkin, 1999). Film cuts are instantaneous, perceptual, and sometimes

temporal discontinuities that do not exist in our own realities but viewers accept cuts as a natural

storytelling technique in film. Walter Murch (1995) suggests that this can be attributed to cuts

experienced in everyday life through the act of blinking thus creating a visual break in

continuity. Another possibility that can explain the innate acceptance of film cuts are in the way

in which we perceive dreams (Ibid). Dreams tend to jump from different scenarios and situations

without any sense of continuity. This nature of films allow viewers to innately understand the

editing despite discontinuities.

Motion is important in attracting attention, a study by Mital, Smith, Hill, and Henderson

(2011) recorded eye movements of individuals while they watched movies. There was a strong

coherence in gaze pattern among the viewers as they all tended to fixate on the same moving

objects. ​Change blindness (​ Levin & Simons, 1997; Levin & Varakin, 2004; Simons & Levin,

1997) is a psychological phenomenon in which individuals are not able to notice alterations in
 23

scenes or mislocations of objects. By capitalizing on the viewer’s attentional focus, filmmakers

impart a sort of magician’s sleight of hand, drawing on moments when viewers are fixated on

movement as a way to conceal edits giving of the effect of an illusion (Shimamura 2013, 18).

Movie sounds, both diegetic and nondiegetic, significantly impact on our emotions and

play an important role in the experience of film (Boltz, 2001; Cohen, 2005). Sound can direct

attention to people or objects, foreshadow events, and amplify emotion. In even simple ways, it

can alter visual perception (Sakuler, Sakuler, & Lau, 1997).

While watching movies, it is common to laugh, cry, and become scared. These feelings

are significantly driven by emotional engagement with the characters portrayed on screen.

Empathic responses like these first involve imaging oneself as someone else, as a result the

viewer experiences another’s feelings (Shamay-Tsoory, 2010).

The filmmakers will utilize sensory features that integrate visual and auditory stimuli,

guided by camera placement and movement, dialogue, sound effects, and editing. Aspects of

film such as bottom-up or sensory guided factors that rely mainly on light, motion, and sound

(Park & Smith, 1989) along with editing and cinematic techniques as well as top-down or

conceptually driven factors like past experiences, internal motivations, expectations, and

background knowledge that influence viewers' perception, understanding and appreciation of

film will be used to establish a sequence of events that lead viewers through a similar sequence

of perceptual, emotional and cognitive states that people with schizophrenia experience.
 24

Cinematherapy

A form of therapy or self-help that uses movies, particularly videos, as therapeutic tools. Cinema therapy
can be a catalyst for healing and growth for those who are open to learning how movies
affect people and to watching certain films with conscious awareness. Cinema therapy
allows one to use the effect of imagery, plot, music etc in films on the psyche for insight,
inspiration, emotional release or relief and natural change. Used as part of psychotherapy,
cinema therapy is an innovative method based on traditional therapeutic principles.

(Cinema Therapy. (n.d.) Segen's Medical Dictionary. (2011). Retrieved July 16 2018
from ​http://medical-dictionary.thefreedictionary.com/Cinema+Therapy​)

The term ‘cinematherapy’ has been coined and refers to the use of film as a therapeutic

tool with service users to deal on issues such as relationship disharmony and identity crises.

Recently, films have also been used for character building and as a means to make apparent the

benefits of virtuous character traits (Hankir et at. 2015). Niemiec et al (2008) have used positive

psychology models portrayed in film to illustrate a number of character strengths such as

wisdom, knowledge, courage, humanity and justice. Such an approach also looks at matters such

as love, kindness, citizenship, hope, humor and spirituality, which can also be developed using

models from films. Although the films that use some of these models are fictional they can

nonetheless still be utilized as the morals that the films convey can be explained, understood and

applied in a real world setting.

Romanowski (2007) captures the essence of what this kind of therapy is about:

Movies, television, music, and videos provide a common experience for many people by addressing
widespread concerns, fears, and prejudices and nurturing aspirations. ... and get us to look
at things in new and different ways. They might explore challenging political, moral,
economic, or religious issues by questioning gender relations or pointing a finger at
sexism, racism, elitism, homophobia, and social or economic injustices. ​(p. 15)
 25

Zhe Wu (2008) describes cinema therapy as a creative, therapeutic intervention in which

a therapist uses a film as a metaphorical tool to promote self-exploration, personal healing and

transformation. Strong (2001) indicates that film therapy may be used successfully as a

therapeutic tool in a counselling context.

In research on the use of movies in therapy, Mann (2007) states the following:

An increasing number of therapists prescribe movies to help their patients explore their
psyches. And while few therapists have actually gone so far as to package their practices around
cinema therapy, movies – like art, books, and music – are becoming one more tool to help those
in therapy achieve their goals and overcome their hurdles.

Niemiec and Wedding (2014) states that movies are more than a commentary on

society, and that they actually inform us of the human condition, lies the truth of the immense

value the use of films in therapy can have. A good example of the impact of watching a movie

clip and the effect it can have on a viewer has been illustrated by Beattie, Sale and McGuire

(2011) where selected extracts from the film ​An inconvenient truth​ have been shown. A

significant effect on the mood state as well as on the explicit social attitudes and cognitions of

the people who watched these clips, was reported.

Cinema therapy has emerged as an outgrowth of bibliotherapy using films or movies as

metaphor to create indirect but powerful therapeutic interventions in marriage and family

counselling (Zhe Wu, 2008). With the growth of the internet and the increasing development of

all kinds of media available on different devices, the possibility of using the social and electronic

media in a variety of ways for therapeutic purposes, is ever expanding. Some of these are
 26

Twitter, YouTube, LinkedIn, Tumblr, Reddit, and Vine. Pinterest, Instagram and Facebook

remain the dominant social networking platforms (Duggan & Smith 2013).

Film therapy may be used in all kinds of therapy. This is because of the characteristics of

this kind of media, using a variety of arts to communicate and therefore being ideal for ‘real

help’ and supporting people in using films and other media to reach a catharsis and identifying

themselves with what they see and experience.

The expansion of the digital media broadening the already available possibilities of film

therapy opened even larger horizons in the therapeutic use and help of people (Strong & Lotter,

2015). It is clearly evident that film therapy – which nowadays may also be used intertwined

with other electronic social media – has developed into an independent therapy which can be

used successfully as an exciting and effective tool for a variety of therapeutic and learning

outcomes. Film therapy is a cutting edge tool in this regard. It fits neatly into the cultural context

of a story hungry society, providing both the therapist and the client or learner with pure

enjoyment (Ibid).
 27

Chapter V. Methodology

Pre-Production

Conceptualization

The film concept will be a documentary-styled experimental film. The filmmakers will

derive a story based on interviews of professionals in the field of mental health as well as people

diagnosed with schizophrenia. Through this, the film concept will be credible and as true to life

as possible and as accurate as possible to effectively portray schizophrenia and effectively

convey the filmmakers’ goal to humanize schizophrenia as a disorder of the mind.

Research

The filmmakers will research on how to efficiently portray schizophrenia and psychosis.

The filmmakers will refer to studies that show how to properly and effectively portray mental

illnesses. Ethical guidelines will also be observed by the filmmakers in producing the film to

appropriately convey their message to the audience. Along with these, the filmmakers will ask

assistance from medical professionals in the field of mental health to fully understand the effects

of schizophrenia on different patients.

Scriptwriting

The filmmakers will write the script according to data presented from the research along

with the initial conceptualization of the film. Following the story of a subject with schizophrenia,

the filmmakers will follow guidelines set from the research conducted in the appropriate visual
 28

representation of mental illness, specifically schizophrenia. The filmmakers will take into

consideration the ethics of writing about a sensitive topic in writing the script for the film.

Casting

The filmmakers will conduct an audition for an actor/ actress who will be able to properly

portray the character. The actor/actress should also be willing to immerse himself/herself with

patients with schizophrenia to be able to understand and express the emotions of patients.

Ideally, the filmmakers is looking for someone who has experience in acting and is willing to

take the role into heart.

Budget

The filmmakers will search for financial sponsors. He will send out solicitation letters to

various companies, organizations, and individuals. The filmmakers will need monetary support

for talent fee, transportation, food, accommodation (if needed), production design, and other

unexpected expenses.

Equipment

Along with financial sponsorship, the filmmakers will also send out solicitation letters for

equipment. Currently, the filmmakers only has a GoPro as primary camera.

If financing is not available, the filmmakers will borrow a camera and other equipment

from whomever is willing to lend necessary equipment to finish production.

 29

Location Hunting

Location scouting will be conducted a few weeks prior to principal photography. The

filmmaker’s general idea for shooting is around places that are part of people’s daily lives. The

idea is to show how a person with schizophrenia sees and experiences these places, to emphasize

the differences and similarities of the experiences between a regular person and a person with

schizophrenia.

Prospect locations include popular places like Session road, Burnham Park, Minesview

Park, and common locations such as sidewalks and buildings around Baguio City. Some scenes

will also be shot in extreme locations like mountain tops, deep in the forest, and seashores. These

locations aim to show the feeling of isolation that people with schizophrenia experience due to

the feeling of being different.

Principal Photography

Once the filmmakers finalizes the script, the list of equipment, and the casting of

actors/actresses, they will ask for permission from the adviser to begin shooting.

The filmmakers will begin shooting sequences that are set in nearby locations around

Baguio City while sequences set in locations outside of the town proper will be scheduled to

accommodate when the actor/actress is available for shooting.

Shooting

Shooting will begin as soon as the filmmakers has been given permission to do so.

Logistics will discussed as soon as possible to avoid any delays. Shooting dates will be arranged
 30

accordingly to adjust primarily to when the filmmakers and actor/actress is available, also to

accommodate any volunteers willing to assist with the shoot.

Manpower

The production will need to have several people helping throughout the process. The

filmmakers will ask for support from his family in helping with transportation to and from

shooting locations. The filmmakers will also ask for the help of his friends in assisting during

shooting to execute everything as smoothly as possible.

Post Production

Post-production will begin simultaneously with the production. After every shoot, the

filmmakers will start to arrange the sequences shot on that day. This will make editing and

selecting shots more convenient for the filmmakers.

Editing

The filmmakers will use Adobe Premiere Pro for editing and Adobe After Effects to add

special effects. The filmmakers will ask the assistance of a friend with the selection and editing

of shots to be used in the final cut as well as the application of some special effects.
 31

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