“It was the pain of dad’s death that has made me so obsessed with learning about mental health issues. The fact is, globally, someone dies every 40 seconds from suicide. A million people each year. Almost twice the population of Seattle.” — from Delaney Ruston’s narration in Hidden Pictures.
Delaney Ruston is unique — a filmmaker who is also a Stanford trained physician who works with underserved populations. In addition to practicing medicine and raising a family, she has made many strong, important films that address issues about mental health, and approaches her work from a very personal point of view.
Her documentary, Unlisted: A Story of Schizophrenia, chronicles her reunion with her father after 10 years of estrangement. Delaney narrates the film, a deeply moving and honest film that explores her relationship with her father, who suffers from schizophrenia. In addition, Unlisted shows how broken and bureaucratic the American health care system is for those trying desperately to find a path to wellness and integration into their community.
While sharing her own family’s journey with mental illness, Delaney learned that 450 million people globally have some type of mental illness. This fact was the inspiration for her latest feature documentary: Hidden Pictures: a personal journey into global mental health, in which Delaney visits India, China, South Africa, France and the United States in order to start a conversation about global mental health. Once again, Delaney narrates this film, which brings us into contact with people around the world who suffer from bipolar illness, depression, schizophrenia and anxiety.
Hidden Pictures is premiering on public television stations around the country beginning this month. Prior to the broadcast, Hidden Pictures screened in film festivals, conferences, at the World Health Organization, the United Nations and many other venues. The film was the cornerstone of a major awareness campaign to spark a worldwide discussion about mental health on World Mental Health Day, October 10th, 2013. Over 140 organizations across the globe joined the campaign to hold screenings of Hidden Pictures.
Visit hiddenpicturesfilm.com to learn more about the film
Here’s a recent conversation I had with Delaney Ruston about the making of Hidden Pictures:
Glenn Holsten: I remember talking with you about this project when we met years ago at the National Council Film Festival. We were both screening documentaries [OC87 and Unlisted: A Story of Schizophrenia] and you were about to head off to India. Can you tell me a bit about the inspiration for this journey?
Delaney Ruston: It was definitely a long journey with an “unmapped out” direction! I saw with my first film how mental illness can tear families apart — not so much the illness, but getting the proper care to individuals and their families. And I wasn’t seeing that story represented in other documentaries. If anything, I was seeing stories of family members who would make a film about a person in their own family. And similarly, in this age of global health, I was really surprised that I didn’t know anything about global mental health. How did people deal with mental illnesses in different parts of the world? And so, through my work or my husband’s work, we had the opportunity to travel to a different country, and that was how it all began. And ultimately [it] was a six-year adventure that finally wrapped up in an hour-long film.
The film is just now airing, starting in May 2014 on PBS stations.
Glenn Holsten: Congratulations.
Delaney Ruston: Thanks. It’s a long journey.
Glenn Holsten: What are the countries that you visited? Can you tell me about the path of the film?
Delaney Ruston: Early on, I was able to go to China and India and was really shocked by how hard it was to find people to come forward with mental illness in those countries. I started out trying to find advocacy groups and it soon became apparent that there’s next to none, and those that exist are very small. And I went to psychiatrists and talked to everyone I could. Fortunately, I was able to find people. But that was really the key for me – how undercover things are in these countries.
In China, it was a sad situation of a gentleman being hospitalized, when clearly he doesn’t need to be. And that’s the powerful story of Tang.
In India, the family was so ashamed of their daughter’s illness of schizophrenia that they would lie to the other family members, and keep her from going to any family functions, saying she was home studying rather than telling them that she had any mental health problems.
And then I went to South Africa, and recognizing how severe mental illness often gets ignored and only treated with herbs was another powerful story.
In France – the reason I went there is it is that France is rated #1 for health care in the world (you might remember from Michael Moore’s SICKO — whether you like that film or not), and I wondered how they did for mental illness. And I found that they definitely have a lot of services, and the highest per capita number of psychiatrists, but still Steven’s story is unfortunately all too common. He had to lie to try to get a job and when they found out about his mental illness, his history with mental illness kept him from working.
The story of all the stories that is the most close to my heart is the one that features the United States. It features a woman, Patricia, who is a rare hero. She saw a man, Jeff, living on the street. Not only did she start helping him, but she rented an apartment close to him so that he would come live with her.
His untreated psychosis was so bad that he didn’t want help until he was finally hospitalized through much effort — actually for a severely infected leg. Once he was hospitalized, he did agree to live with her, and you see their story. And that one was close to my home that this happened, and Patricia is a real hero. She never really wanted or needed recognition for all she was doing for Jeff.
Glenn Holsten: Was it a big challenge to get these people to join you in this film?
Delaney Ruston: The hardest was in India. And while they let me come and film at their house, I know it was very emotional for them to come forward with their story, having hidden it from their family until only recently before I started filming.
But I know for myself that there is so much healing that can happen from no longer living under the veil of silence, and I would talk to the individuals, and wonder if that was their motivation. And when they clearly saw that this would be a relief to no longer hide, then that’s when I knew the work was not only educating others, but healing for the subject and their family.
Glenn Holsten: Tell me about the shaping of the story. How did it come together once it was shot? How did it take its form?
Delaney Ruston: I actually didn’t want to be in the film. I had already finished the personal documentary about my father, Unlisted: A Story of Schizophrenia, and I was hoping for this one that I wouldn’t have to be in it.
Visit unlistedfilm.com to learn more about the film
But I realized that it really was my journey as I was consciously and subconsciously comparing everyone of the stories in the film to what I had experienced in my family with my father and schizophrenia. Once I realized that and accepted that fate, it made it much easier to tie together the stories by having that personal narration to weave each story one to the other.
There’s a big scene of developing photographs in the dark room, which for me was symbolic for me of revealing a topic and stories that are so often ignored with global mental health. So there was that scene of not just showing photographs, but actually the uncovering of photographs.
I wanted to make it cinematic, and thought that the montages with the photographs was another way that visually could tie the stories together.
Glenn Holsten: At the screenings, do you have people come forward with their own stories or views on global mental health care?
Delaney Ruston: There were studies 30 years ago by the World Health Organization and others that people with schizophrenia do better in low-income countries vs. high-income countries. Yet the study just looked at a few countries and the methodology was flawed in key ways. Occasionally people in the audience would say “I’ve heard people do better in poor countries.”
Sadly in low income countries around 70% to 80% of people with severe mental illness do not get treatment and they and their family are in real distress.
Glenn Holsten: This discussion reminds me of a comment we heard at a screening of OC87 in Los Angeles, when a woman stood up at the Q&A and said “This [mental illness] is an American problem, made by American culture.” And that caused a very contentious, but exciting, Q&A!
Delaney Ruston: It’s just amazing to be on the edge of transformation. We’re at the beginning of a significant increase in awareness of mental illness around the world.
When they look globally at disability, not as much the mortality, but just overall disability, several mental illnesses are ranked in the top 10 to 20 causes. So governments realize that this is a major problem that’s not being addressed, and they’re changing now to take this more seriously.
The World Health Organization, for the first time ever, got all of the 194 member countries together to have them pledge a commitment to improve mental health care in their countries. That was really transformational. That just happened two years ago, and it was launched this past October with a comprehensive mental health action plan. So governments are really starting to look at this.
Glenn Holsten: That’s exciting. Were there any stories that didn’t get into your film?
Delaney Ruston: The story that I would have liked to expanded the most — because it shows the extremes that an individual can go to help another person, and reminds us that we all have it in us to push ourselves a little more — was the story about Patricia and Jeff in the United States. She actually rented an apartment to live close to him — even though in his severe mental illness state, he was refusing to come and live in this small apartment with her. When he eventually did, that’s when I started filming. Eventually he started treatment and began to get better. And as trust was building, he moved into her home and she got rid of the apartment. That’s just one example of many in their journey together that I would love to have filled out more.
Glenn Holsten: What’s important for you to share about these stories?
Delaney Ruston: The key thing for me in making any of these films is so much about showing the possibility and the hope. I was able to film mental health advocates around the country, such as Glenn Close and her family, who have a major anti-stigma campaign. I also filmed a teacher who was teaching fabulous mental health issues to 8th graders, and wanted to bring all of that into the film. I want to create a discussion not just about what the problems are, but I want to elevate the discussion about what solutions are possible.
My ultimate favorite scene in the film is when the teacher teaches the 8th graders and seeing how interested they are. And having screened Hidden Pictures to many students — elementary and high school students — seeing how interested they are in these topics, has really changed me to being incredibly motivated in getting mental health education to children everywhere. I think it should be built into our science curriculum, that it should be built into schools as a way of increasing empathy and understanding. That discussion, to me, is one that is really critical, and needs to start on a large scale.
Glenn Holsten: I agree. If kids learn about mental illness in schools, it would go a long way in taking away the shame and the stigma associated with mental illness. Children would simply grow up with it rather than have it be something that isn’t spoken about.
Delaney Ruston: And when we leave it to parents, because families don’t rally understand things, it’s just not going to get talked about in a way that inspires understanding and compassion.
It doesn’t take that much to build it into curriculums in an integrated way and with the science. Kids are interested in relating this to science, and frankly, there are so many children that are on medication and in treatment and could be in counseling and aren’t getting it in the U.S. and other parts of the world. To not talk about it is making them even more stigmatized and making them more feel like an outsider.
Glenn Holsten: How has making this film changed you?
Delaney Ruston: I think I will look back and have been really happy and proud of increasing that discourse. That’s the good side. The hard part is knowing that we don’t have foundations in the United States that are really taking on world mental health. I’ve seen first hand so many people who could be getting help, but aren’t. My hope is that we look back on this time and say “Gosh I can’t believe we weren’t doing more for people around the world. For people and families that are suffering.” I hope it’s part of a turning point. A small speck, but a part of it.
Glenn Holsten: Well audiences are definitely hungry for more information about mental health and wellness. We see that hunger there in our Q&A’s for OC87. Information coupled with good story telling is a powerful way to reach hearts and minds.
Delaney Ruston: I hadn’t planned to become a global mental health advocate. But there is no way after being out in the field that I could avoid it. And I think that’s what I’ve become. And as the years go on that will never be a topic that I don’t try to bring up and share with others.