Psychologist Bradley Daniels suggests that in Gotham City, the decision to commit a criminal in Arkham rather than sentence to prison apparently goes like this:
Question 1. Did the defendant wear a costume when committing the crime? If yes, move on to Question 2.
Question 2. Were the crimes centered around some compulsion or theme, such as the number two (Two-Face), plants (Poison Ivy), or riddles (The Riddler)? If yes, refer to Arkham.
Question 3. Could you easily imagine this type of criminal living in and committing this type of crime in the real world? If yes, sentence to Blackgate Penitentiary.15
As Daniels notes, neither this process nor Arkham itself resembles how involuntary civil commitment and mental health treatment really operate. That said, though, Gotham’s court system and its forensic mental hospital each struggle to cope with the management of criminal types that do not themselves exist in the real world.
Lunatics in Charge
“If you think Arkham’s scary as a doctor, you should try it as a patient.”
—Harley Quinn, Detective Comics #831 (June, 2007)
The number of Arkham therapists who go mad and get committed to their own asylum may seem ridiculously high and its guards may strike you as unrealistically callous, cruel, or downright dumb, but honestly, who else would work there? Killer Croc bites off guard Aaron Cash’s hand16 and the Joker murders Cash’s infant son by giving him tetanus with a rusty nail.17 The Joker alone has killed more Arkham staffers than the number of victims a typical serial killer takes in an entire career. To survive your employment at Arkham, your best hope may be to become a master villain yourself. The asylum’s founder, Amadeus Arkham, lives out his days as one of its residents; a later Arkham family member who runs the asylum, Jeremiah Arkham, becomes a supervillain; so does psychiatrist Harleen Quinzel after she falls in love with the Joker; delusional administrator Charles Cavendish lets the prisoners take staff hostage; and administrator Alyce Sinner has committed mass murder before she ever goes to work there. While they all violate ethical standards, Amadeus Arkham and Harleen Quinzel, a.k.a. Harley Quinn, illustrate particular problems with conflict of interest.
Dual relationships or multiple relationships in psychotherapy exist when a therapist has more roles in the client’s life outside the therapeutic relationship. If your suicidal cousin up on a ledge refuses to speak to anyone but you or your former student wants your recommendation for the best therapist for that student’s specific problem, refusing to apply your training as a therapist in the situation might be less ethical than creating that dual relationship would be. You’ve been seeing a client for months before you discover during a family reunion that he’s your wife’s cousin, but promptly terminating therapy will not make the dual relationship go away—you have obligations even to former clients.18
Arkham Asylum’s founder, Dr. Amadeus Arkham, converts his newly inherited family home into a facility for the treatment of the mentally ill, inspired by Martin “Mad Dog” Hawkins, a mentally ill killer likely to become “trapped in the penal system with no hope of treatment.” One night, sometime before the home’s conversion into asylum is complete, Hawkins murders the doctor’s wife and daughter. When the asylum opens on schedule, one of its first residents is Hawkins. For months, Amadeus listens to Hawkins recount the atrocity. One year to the day his family died, Amadeus straps his family’s killer to an electroshock couch and electrocutes the man. He subsequently develops auditory hallucinations, disorientation, distorted sense of time, paranoia, delusions. Not until Amadeus tries to kill his stockbroker does he receive treatment, in the form of commitment to his own asylum. “I’m home. Where I belong.”19 For legal, ethical, and logical reasons, no one should ever have placed Hawkins in the care of his victims’ family member.
Jeremiah Arkham turns out worse. Amadeus hurts his family’s killer; Jeremiah hurts many more. He becomes a crime boss, the new Black Mask. Jeremiah is sometimes psychotic. He hallucinates whole conversations with patients who don’t exist.20 Comic book stories featuring him mix and match symptoms of paranoid schizophrenia and dissociative identity disorder in ways that defy real-world analysis. “He’s a genuine schizophrenic,” says his successor Alyce Sinner. “While he’s Jeremiah Arkham, he has no recollection of his other existence as Black Mask.”21 Alyce, a deranged mass murderer herself, is an unreliable diagnostician, although she’s not the only one to muddle the terms when discussing Jeremiah’s state of mind. Schizophrenia is not multiple personality, and fully schizophrenic individuals likely lack the focus to develop distinct and consistent sets of alter personalities. Schizophrenia involves a broad loss of contact with reality, with symptoms like disorganized thinking, delusions, and hallucinations. Jeremiah’s extensive interactions with hallucinatory patients and delusions regarding them do suggest schizophrenia, specifically paranoid schizophrenia, but the behavior Sinner cites, his periods of dissociating into a distinctly different alter personality as the second Black Mask, would not. After Flashpoint alters history, Dr. Jeremiah Arkham, with his questionable methods, winds up running the asylum again.22
Treatment Issues
“You must admit it’s hard to imagine this place being conducive to anyone’s mental health.”
—Batman in Arkham Asylum: A Serious House on Serious Earth (1989)
Some of Arkham’s therapists and administrators are psychologists, professionals with doctorates in psychology. Clinicians with Master’s degrees don’t tend to call themselves “Master’s-level psychologists” anymore, at least in part due to licensure requirements. Psychologists employed by Arkham appear to be clinical psychologists, who must have specialized clinical training and years of supervised experience treating clients. Psychologists come in many kinds. Despite the popular view of what psychologists do, only about half work in therapeutic occupations. Others work in a variety of fields, including academics (like the Scarecrow, Dr. Jonathan Crane), research, industry, business, government, forensic investigation, and more. Also despite popular views, therapists usually are not psychoanalysts (meaning Freudian or neo-Freudian psychologists or psychiatrists). Arkham also employs psychiatrists, mental health professionals who graduated from medical school, not the same thing as psychologists even though the writers often confuse these terms. Psychologists completed many psychology courses and earned doctorates in psychology, usually a Ph.D. Psychiatrists did not have to take any psychology classes but instead took some psychiatry coursework (medical school classes on prevention, assessment, diagnosis, and treatment of mental illness without requiring broader knowledge of other areas of psychology) and later received specialized psychiatric training during medical residency. Unlike psychologists, psychiatrists can prescribe medication as needed for a range of conditions including obsessions, compulsions, depression, and psychosis, along with many more. Many people get their psychiatric medications from their family doctors or general practitioners even though those individuals have not studied psychiatry as intensively and psychiatrists tend to treat mental illness more effectively.23 Psychiatric nurses, social workers, counselors, and a number of other professionals can qualify to administer psychotherapy depending on educational background, test scores, and state licensure requirements.
Most important, when it comes to understanding how treatment at Arkham Asylum in any way resembles the real world, we must ask: Where are their meds? Psychiatric hospitalization generally includes medication, a lot of it—the sooner, the better.24 The most immediate concern for therapists other than Jeremiah Arkham would be to reduce the residents’ dangerousness. “They’d be heavily sedated, heavily medicated. They’d be walking zombies. People like the Joker would get doped up on Thorazine all the time or other old school antipsychotics where they’ll just sit and be passive.”25 Traditional antipsychotic medications like Thorazine block a neurotransmitter called dopamine, reducing positive symptoms (active hallucinations and delusions) in the majority of schizophrenic recipients.26 They also have fast-acting sedating e
ffects. So why is it that almost every time Batman makes the walk into the asylum, all his enemies are alert in their cells, ready as ever for the next breakout or riot? Arkham’s psychiatric pill-pushers may be administering atypical antipsychotic medications, which are less sedating, show lower rates of relapse, and have different side effects (e.g., possible heart problems instead of involuntary tremors or facial contortions).27 Batman’s enemies don’t show the weight gain that might occur with either type of antipsychotic, so maybe incompetent Arkham staffers fail to make certain the residents swallow their pills.
Arkham’s therapists talk a lot. Usually without following any obvious therapeutic model, they encourage the patients to discuss their lives, thoughts, and desires. To be fair, we see limited examples from the hundreds of hours they spend struggling to manage these difficult clients. Dr. Ruth Adams in Arkham Asylum: A Serious House on Serious Earth likes word association, asking the client to respond with the first word that comes to mind when presented with each item from a word list. Clinicians pay attention to response time, nonverbal reactions, and how unusual the responses are. Individuals with psychosis or other cognitive deficits may show loosening of associations, in which responses unrelated to the stimulus words reflect disorganized thinking, which will also manifest in disorganized conversation. Several Arkham therapists like the approaches employed by Freud and Jung—Amadeus Arkham is said to have spent time with Jung—even though numerous professionals question the effectiveness of Freudian and other talk therapy methods for treating psychotic individuals.28
Dr. Edwards (to Batman): Group therapy—that was Dr. Buscaglia’s suggestion—was one big disaster. The Riddler answered everything with another question. Harvey Dent objected to everything anyone said—including himself. All Maxie Zeus talked about was the women he claimed he seduced in the form of a swan. It was chaos. They couldn’t even agree on how much they hated you.29
More clinicians use group therapy with psychotic individuals than you might expect30—which at Arkham could be tremendously dangerous or potentially hilarious. (“Now, Joker, how do you think that makes Mad Hatter feel?”) Treatment of psychotic individuals tends to include a lot of psychoeducation, teaching clients about themselves and their world, often starting with skills training because cognitive impairments have eroded social skills, problem-solving, basic self-care (like hygiene), coping strategies, and stress management. Symptom management becomes important, teaching clients to notice the symptoms that predict relapse. Through cognitive-behaviorial therapy (CBT), therapists address patients’ symptoms and the distress they cause. Insight training normally involves getting them to understand how their actions hurt others, but psychopathic patients are unlikely to care and the sadistic ones would love finding out that they’ve hurt people even worse than they’d known. When dealing with psychopaths, teaching them to recognize how their behavior hurts themselves can be most useful. The Penguin makes a better counselor for the Riddler than any professional at Arkham when he congratulates the king of clues for discovering the value in operating on the right side of the law (advantages like staying out of jail).31 A therapist, unable to hand the psychopath a conscience, may at least teach that client practical, logical reasons for doing right instead of wrong—admittedly, what might be a hopeless task when the psychopath is also psychotic.
In order to break Harvey “Two-Face” Dent from his obsession with duality and tendency to view everything in black and white (a defense mechanism called splitting), Ruth Adams uses a form of shaping to wean Two-Face away from tossing a coin to make decisions. Getting him to use a six-sided die instead makes him view every choice as having six alternatives instead of two.
Adams: He did so well with the die that we’ve been able to move him onto a deck of Tarot cards. That’s seventy-eight options open to him now, Batman. Next, we plan to introduce him to the I Ching. Soon he’ll have a completely functional judgmental facility that doesn’t rely so much on black and white absolutes.
Batman: But right now, he can’t even make a simple decision like going to the bathroom without consulting cards? Seems to me you’ve effectively destroyed the man’s personality, doctor.
Adams: Sometimes we have to pull down in order to rebuild, Batman. Psychiatry’s like that.
Shaping is the process of training by rewarding successive ap-proximations of a target behavior, as mentioned in an earlier chapter’s look at how systematic desensitization, a shaping technique, can treat phobias. In Harvey’s case, the target behavior—the goal, whatever it is that therapy is supposed to help the client progress into doing—is to make decisions for himself. His method of making choices has changed shape and become more like the target, but does not reach that target because Batman returns Harvey’s coin to him in order to end an asylum takeover. “You’re going to undo all my work,” says Adams. The Joker agrees to let Two-Face decide for them all. Harvey says that if the coin’s scarred side comes up, Batman dies. He tosses the coin, catches it, and announces, “He goes free.” The takeover ends. Harvey appears to have regressed completely, and yet the story’s final pages show him alone, looking at the coin, which actually landed scarred side up. Harvey has lied about the outcome. He has made a choice for himself and for the better.
“Still, you can’t say we didn’t show you a good time. Enjoy yourself out there. In the asylum. Just don’t forget—if it ever gets too tough—there’s always a place for you here.”
—Joker as Batman exits Arkham, Arkham Asylum: A Serious House on Serious Earth
CASE FILE 8–1 The Mad Hatter
Real name: Jervis Tetch
First appearance: Batman #49 (October–November, 1948)
Origin: Arguably the maddest of the madmen to earn a spot in Batman’s rogues gallery, Jervis Tetch, the Mad Hatter, is a diminutive man with prominent upper teeth and macrocephaly, an oversized head. In his childhood days, boys and girls shied away from the misshapen Tetch. Having no friends, “none that I didn’t hypnotize,”1 he grows up fervently wishing he could escape into Lewis Carroll’s Wonderland. Growing up with parents and siblings of normal stature2 likely compounded his inferiority complex, although his physical abnormality is insufficient to explain his psychosis. We know almost nothing else about the late Tetches.b Their methods of upbringing may have steered Jervis wrong. Then again, other biological factors beyond their knowing or control may have caused this son’s paranoid schizophrenia, the type of schizophrenia that most prominently features systematic delusions with persecutory or grandiose content.
“You’re mighty in Gotham, Batman, but in Wonderland, the Mad Hatter reigns supreme.”
—Mad Hatter in “Mad as a Hatter,” Batman: The Animated Series ep. 27 (October 12, 1992)
Dr. Blakloch of Arkham Asylum: “Jervis is a paranoid schizophrenic. And he’s obsessive-compulsive, and highly delusional. He’s got an immature self-image, so he identifies more with children than adults. Oh, and he’s a genius too.”3
Blakloch also notes that Tetch sometimes starts rhyming when stressed. Some psychotic individuals will clang, stringing words together meaninglessly for their rhyming sound—for example, “The bed said it’s led red dead.” Tetch makes more sense than that, but if his psychosis progresses to a point where he suffers greater detachment from logical processes, clang associations seem likely given his existing inclination to rhyme. The rhyming may simply reflect his fascination with Lewis Carroll’s best-known works, Alice’s Adventures in Wonderland and its sequel, Through the Looking-Glass, particularly the first book’s “A Mad Tea Party” chapter. Carroll’s Hatter character becomes Tetch’s own identity.
The Mad Hatter’s debut as a thief on a crime spree, robbing high society like he has a vendetta against the upper class, marks his only Golden Age appearance. A different Mad Hatter appears in the comics from 1956 until 1981, when the original comes back. In his later appearances, Tetch designs mind-control devices that he hides in people’s hats. Even though his prowess with neurotechnology should make hi
m one of either the most successful inventors or the most formidable criminal masterminds on earth, he lacks the necessary vision, talent, charisma, and soundness of mind that might elevate him to either the Forbes 500 or the supervillain A-list.
As a form of self-regulation, Tetch keeps a mind-control device in his own hat so he can change its setting to blissful when he wants to lie naked and drooling, surrounded by hats with one planted across his lap.4 That scene might suggest that his sexual preference involves one of the paraphilias, the group of sexual disorders for individuals who either cannot experience the sexual response cycle or cannot enjoy it without engaging in a specific form of behavior that most of us consider bizarre, and specifically would indicate the paraphilia called fetishism, a need to reach sexual gratification through the use of nonliving, normally nonsexualc objects, a need so persistent that it creates problems such as clinically significant distress, sexual dysfunction, occupational or social impairment, or violations of others’ rights.5 Without a hat, Tetch is not interested. He ignores a tall, beautiful woman who walks by naked during breakfast: “Talk to me again when she’s properly clad.”6 Tetch’s psychosis complicates this diagnosis, though, because we do not know how he would act and feel were he to attain a nonpsychotic state. If he could turn sane, would he want to date a woman who wore no hat? Fetishism, if his attachment to hats is sexual at all, is insufficient to account for the breadth of his interest in them.
Batman and Psychology: A Dark and Stormy Knight (Wiley Psychology & Pop Culture) Page 18
