Empathizing With the Criminally Insane: Good Practices for Patient-Provider Communication

Empathizing With the Criminally Insane: Good Practices for Patient-Provider Communication

Randy Sabourin, Rukhsana Ahmed
Copyright: © 2020 |Pages: 20
DOI: 10.4018/IJCBPL.2020010105
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Arkham Asylum is home to some of popular culture's most notorious super villains. The neglect and inadequate care these villains receive mirrors a real-world context where mental illness is surrounded by stigma, misunderstanding, and poor rehabilitation rates. This study explores the less glossy niches between the action-packed button-mashing on the surface of a popular Batman video game Batman: Arkham Asylum. By pulling back the curtain over the routine treatment of Arkham Asylum's patients (also known as inmates), it presents a set of good practices for improving their care through more effective communication. Recorded audio interviews from the video game constitutes the foundation for this set of good practices tailored to the needs of the fictional facility. Narrative inquiry is used to pull these recommendations from the data. Based on narrative elements found in the data, this study recommends an empathy-driven and preventative approach to treating Gotham's criminally insane population.
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Arkham Asylum, the home of Gotham city’s abundant criminally insane population, has seen many artistic interpretations over the years. It has been notably featured in Batman Begins (2005), Batman: The Animated Series (1992), and Arkham Asylum: A Serious House on Serious Earth (1990). Although it is known for housing familiar characters in Batman’s extensive rogues gallery, the facility itself has become an established character in the DC comic book universe. In between the exciting action focusing on Batman, there have been numerous depictions of the day-to-day operations at the hospital. Graphic novels like Arkham Asylum: Madness (2010) placed orderlies and nurses into the foreground as the main characters performing their rounds. These snippets of mundane fictional interactions provide more than simple narrative filler. Characters like Two-Face (Multiple Personality Disorder), the Riddler (Narcissistic Personality Disorder), and Harley Quinn (Dependent Personality Disorder) display a wide variety of mental health symptoms and conditions. These villains present a mental and physical challenge for the medical staff to communicate with in their attempts at rehabilitation. Scholars such as Terrill (2000) and Langley (2012) had profiled these characters in the past, but none have taken a critical look at the quality of the health care they receive at Arkham. Against this backdrop, the purpose of this study was to explore patient-provider communication as it is portrayed in in Rocksteady Studios’s popular video game Batman: Arkham Asylum (2009). Specifically, this study sought to present a detailed critical analysis of the audio recordings of interviews between Mental Health Care Providers (MHCPs) and patients at Arkham Asylum in order to uncover a deeper understanding of these extreme villains as they appear in their everyday life in a medical communication setting at the Asylum (as opposed to their usual depictions of sensational bank robbing, hostage taking, and bat fighting).

Mental Health of the Criminally Insane

The efficacy of mental health correctional treatment programs in reducing recidivism is a controversial and often debated topic. Patients “can present treatment dilemmas because they are inherently unpredictable, making them very difficult and frightening to treat” (Charles, 2010, p. 433). Researchers like Jacoby (2002) took a pessimistic stance on the issue, claiming that “we have become accustomed to the incapacity of the police to prevent crime, of courts to mete out justice, and of correctional institutions to rehabilitate” (p. 168). When patients do not improve their condition, they can become trapped in the system that was created to free them from illness.

Arkham Asylum is, not surprisingly, known for having a revolving door effect on the patients it treats, as they tend to be readmitted soon after their release. Pinpointing the source of this problem is not an easy task, but Shaw (2004) posited, “this process with respect to revolving-door patients might be linked to moral judgments about patients as bad or otherwise” (p. 1034). The criminally insane are often not able to distinguish right from wrong, yet they could be denied effective treatment on moral grounds.

According to Crawford and Brown (2009), treatment of mental health has historically favored a “production line” model, in which rudeness and lack of effort are hallmarks of institutional treatment. Crawford and Brown developed the Brief, Ordinary, and Effective (BOE) model for MHCPs, which prioritizes communication skills in treatment. Their model uses small talk and non-verbal communication to create a “tardis effect,” through which MHCPs are able to make the most of their brief time spent with patients. The core features of this model include gestures that foster ordinariness or familiarity for patients along with evidence-based policies. Their approach stresses the importance of the “everyday aspects of communication,” which this study seeks to examine at Arkham Asylum.

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